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Abstract This article presents a Z source (ZS) based switched capacitor multilevel inverter (SC-MLI) with low capacitors charging inrush currents utilizing a modified modulation strategy. The topology generates nine output voltage levels with quadruple voltage gain utilizing eight power switches, five capacitors, two inductors, four discrete diodes, and a single DC source. The voltage gain can be further increased by applying shoot through (ST) states to the frontend ZS-network. Owing to its high voltage gain, the topology is suitable for low voltage renewable energy sources such as photovoltaics (PV), and fuel cells (FC). A modified modulation strategy is presented based on the conventional level shifted sinusoidal pulse width modulation (LS-SPWM). The proposed modulation strategy improves the dc-link utilization at higher modulation index. A detailed mathematical analysis is provided for the gain calculation based on the modified modulation strategy. A comparative study is implemented to verify the merits of the proposed topology. A simulation model is implemented utilizing MATLAB / Simulink to verify the topology characteristics. The power losses and efficiency calculations are presented using Altair PSIM. Furthermore, an experimental prototype is constructed to verify the simulation findings. The topology is tested with different loading conditions at numerous modulation index values and ST duty ratios. Furthermore, step change conditions are implemented to test the topology response. The effect of the ZS network on the switched capacitors charging inrush currents is validated. The proposed topology shows an overall advantage in terms of the output characteristics as well as the hardware requirements.

Abstract In this paper, a single stage buck–boost DC–AC converter based on coupled inductors is presented for renewable energy and electric vehicle applications. The proposed topology works with only three semiconductor switches, two diodes, and three coupled inductors to transfer input DC voltage to a high gain or low gain output AC voltage. A coupled inductor is used instead of normal inductors, which will reduce core and size requirements. The sinusoidal pulse width modulation strategy is used in this paper for controlling the main switch. There are many merits in the presented topology, like high gain up to five times of input voltage, compact size, less number of components, which results in reducing the overall cost, reducing switching loss, and increasing the converter efficiency. The simulation study is carried out using MATLAB/SIMULINK to simulate the operation of the proposed converter. Also, an experimental setup is built up to examine the actual operation of the proposed converter. There is a good agreement between simulation and experimental results which increases the validation and confidence of the model.

Today, the biggest challenge faced by the refining industries globally is the production of environmentally friendly fuels with a high amount produced annually to meet the needs of markets due to the sharp regulations imposed environmentally with allowable sulfur levels in diesel fuel. This study examines the most recent developments in solid sorbent adsorption and catalytic oxidization techniques for desulfurizing diesel fuel. Reviewing the benefits, limitations, and future potential of each technique for desulfurizing liquid fuels using solid catalysts constructed using waste from agriculture. Activated carbon is one of these carbon materials; however, the traditional methods of producing activated carbon are time-consuming and costly. Activated carbon has impressive characteristics such as low concentration of ash, enormous surface area, permeability, ease of being activated, and high compressive strength, thereby rendering this an ideal substrate for the synthetic production of heterogeneous catalysts. Because they are in charge of igniting the substances that oxidize, their supported catalysts are crucial to the oxidation process. Various types of homogeneous and heterogeneous catalysts such as metal oxides, ionic liquids, polyoxometalates, and organic acids have been used to form oxidative desulfurization (ODS) systems. Therefore, to enhance the efficiency of catalytic ODS process some modifications must be taken into account. These adjustments may involve doping the catalyst’s surfaces with metal oxides or increasing the catalyst’s surface area when combined with sulfur compounds. In addition to reviewing the preparation conditions for carbon waste-based activated carbon catalysts, this work also carried out the desulfurization procedures to remove substances containing sulfur. Overall, the comprehensive review of carbon wastes into activated carbon catalysts with conventional and microwave heating shows promises in addressing two pressing environmental issues: agriculture waste management and reducing the ODS cost through the production of a sustainable fuel-efficient catalyst. This review explores the environmental feasibility of agro-waste as a waste-to-energy (solid carbon) technology. The use of agro-waste as a source to produce activated carbon catalysts mitigates the environmental impact associated with traditional waste disposal avenues, such as incineration and landfilling.

One of the main sources of crude oil and product losses in refineries is the storage tanks. The lightest hydrocarbons in these tanks evaporate during operation, causing not only a loss of the precious raw hydrocarbon material but also a source of dangerous gas pollution. For calculating these losses, several direct and indirect approaches have been devised. In this study, we used a method based on the comparison of the differences in the characteristics of crude oil or other products. This work aimed to find the specifications of two products, kerosene and gas oil, and calculate the losses that occur for the quantities in the dispatch warehouse in the NRC. Four samples of kerosene were used and named: kero@02-1, kero@05-2, kero@10-3, and kero@11-4, while four samples of gas oil were named: gaso@02-1, gaso@05-2, gaso@10-3, and gaso@11-4. Also, they depend on the date of certificate issue, respectively. The received quantities were calculated in ml and converted to cubic meters using the tank coefficient (kerosene tank coefficient 0.638 and gas oil tank coefficient 0.408). Calculations were made of 1500 ml for kerosene and 2500 ml for gas oil. In addition, this project dealt with a simplified method of work that includes the physical properties to find the actual quantities that are lost for the mentioned petroleum products. Moreover, the highest losses were for kerosene (5 m 3 ) at sp. gr 0.750, and the highest losses were for gas oil (5 m 3 ) at sp. gr 0.820. The results showed that there is a quantity of fluctuating losses that does not exceed 5 m 3 / 1000 m 3 and that these losses are in accordance with the permissible limits. The results recommend directing the laboratory tester's teams in the NRC Baiji to conduct periodic examinations of the petroleum products, as well as not to collusion when receiving a low product with laboratory examination specifications to reduce losses in quantities.

Abstract In this paper, a single-phase direct pulse width modulation (PWM) buck-boost AC–AC converter is proposed. The proposed converter utilizes a minimum number of semiconductor switches and passive components that decreases the converter power losses and offers high efficiency. It can be operated with simple PWM control and doesn’t require soft-commutation strategies. It does not suffer from input source shoot-through and commutation problems. Moreover, it supplies both continuous input and output currents. The common sharing ground of the input and output gives the proposed converter the feature that it can be utilized for voltage sag and swell compensation. A comparison of the proposed converter performance with similar existing converters is presented. Also, detailed circuit analysis, component design guidelines, and simulation results using the MATLAB/Simulink environment are demonstrated. A laboratory prototype has been built and tested to validate the converter performance and confirm the results obtained by computer simulation.

Modeling and simulation at the bench scale are crucial for understanding industrial process behavior, particularly in oxidative desulfurization (ODS). Mathematical models are powerful tools in chemical process engineering, enabling the adjustment of process conditions without physical modifications, thereby optimizing process performance. In this study, a comprehensive mathematical model for the ODS of sour diesel fuel, supplied by the NRC refinery, was developed using O₂ as the oxidant and Fe/AC as the catalyst, based on experimental data from the literature. This model addresses key limitations of existing ODS models, including their limited applicability in industrial settings and challenges in scaling up while maintaining high sulfur conversion efficiency. By simulating an industrial batch reactor, the model advances current knowledge by providing a robust framework for scaling ODS processes. Optimal reaction conditions were determined to achieve ≥99 % sulfur conversion, with kinetic parameters of a reaction order of 1.2, an activation energy of 50 kJ/mol, and a pre-exponential factor of 9050 g(−0.2).h(−1). Scale-up results, based on these parameters, suggested optimal reactor dimensions of 1.3 m in diameter and 2 m in length. The batch reactor scale-up was conducted using the gPROMS software, yielding insights that can be applied directly to industrial reactors. Ultimately, this model contributes to the field by offering a scalable, practical approach to ODS reactor design and optimization, aiding the production of cleaner diesel fuels in compliance with stringent environmental standards.

Innovative, low-loss, and compact optical systems are essential to meet the experimental requirements of emerging novel radiation sources. The microchannel plate (MCP), a metamaterial-based optical device, shows promising potential for shaping, condensing, and focusing soft x-ray radiation at synchrotron radiation (SR) facilities. This study highlights the impact of MCP optical devices on SR beam condensing capability and their sensitivity to the degree of coherence by investigating the profile of transmitted beams through single and double MCP optical devices. Transmitted diffraction patterns of soft x-ray SR radiation change with energy and radiation modes. At 92 eV, the double MCP-based device affects the beam divergence and degree of coherence more than the single MCP. Moreover, the double MCP device shows potential as a condensing optics at shorter wavelengths, i.e., 480 eV. Experiments were performed at the available end-station of the Circular Polarization beamline at the Elettra synchrotron facility in Trieste, using a high-vacuum chamber with a hexapod system, providing the precise movement necessary to align these diffractive optics. The findings contribute to the development of innovative optical systems for SR and free-electron laser beamlines, paving the way for advanced experiments in spectroscopy, microscopy, and imaging in a wide energy range. [ABSTRACT FROM AUTHOR]

Machine learning algorithms have gained popularity recently as a method for predicting the efficiency of industrial processes. The fluctuation of desulfurization process operation conditions, especially sulfur content in diesel fuel, has an impact on the efficiency of the process. This study presents the development of an artificial neural network (ANN) model using Python to predict the efficiency of the oxidative desulfurization (ODS) process in highly sour diesel fuel. Experimental data from a trickle bed reactor were used to train and validate the model. The dataset included variables such as ODS temperature, pressure, liquid hourly space velocity (LHSV), and sulfur content in the feed. The ANN model demonstrated a high prediction accuracy with sulfur conversion results matching the experimental data with approximately 98% accuracy and a regression coefficient (R²) of 0.99. The model effectively captured the influence of the operating conditions, showing that higher temperatures and pressures significantly enhanced the desulfurization efficiency. Additionally, the optimization of LHSV contributed to achieving optimal sulfur removal. This work highlights the potential of machine learning techniques in enhancing the predictive capabilities and efficiency of industrial desulfurization processes. [ABSTRACT FROM AUTHOR]

Objectives: Pain management in the potentially austere search and rescue (SAR) and emergency medical services (EMS) environments can be challenging. Intravenous (IV) and intramuscular (IM) routes of administration may be less practical. This study assesses the efficacy and safety of the sublingual sufentanil tablet (SST) in prehospital settings and hypothesizes that its use will reduce pain while maintaining a reasonable safety profile., Methods: This was a retrospective case analysis examining patient records from Teton County Search and Rescue, Grand Teton National Park EMS, and Jackson Hole Fire/EMS from 2021-2023, based on the criteria that they were administered SST in a prehospital setting. Cases in which SST was used were examined to assess patient characteristics, injury classification, patient reported pain scale before and after SST, other medications administered, and vital signs., Results: Seventy patients met the inclusion criteria. Six individuals were excluded due to missing one or more of the key variables, and the analysis was carried out with the remaining ( N  = 64 cases). The mean pain score decreased from 8.0 ± 1.9 before medication administration to 5.5 ± 2.5 after administration, reflecting a statistically significant difference of 2.6 ± 2.1 ( p  < 0.001).  The results also revealed statistically significant reductions in heart rate (HR) and systolic blood pressure (SBP) following SST administration (mean HR dropped by 4.2 ± 9.1 beats/min,  p  = 0.004, and mean SBP dropped by 11.1 ± 21.8 mmHg,  p  = 0.01). Changes in vital signs, although statistically significant, were not clinically significant and did not necessitate additional monitoring or intervention in any patients., Conclusions: Our study demonstrated that SST administration led to a significant reduction in pain scores and exhibited a favorable safety profile regarding vital signs, including SBP, HR, respiratory rate (RR), and O 2  saturation. These findings support the utilization of SST for pain management in the prehospital setting, particularly in austere environments where traditional routes of administration may be impractical.

I-cell disease (Mucolipidosis Type II) is a rare lysosomal storage disorder caused by GNPTAB gene defects, leading to severe morbidity and mortality. The authors present the case of a neonate born at 38 wk gestational age, with suspected skeletal dysplasia during pregnancy and a complex clinical and laboratory presentation after birth. This is a rare case, and its diagnosis was made through placental pathology, which revealed the condition called mucolipidosis Type II. To the best of authors' knowledge, this is one of the few cases diagnosed in the neonatal period with placental pathology globally and the first in Canada, highlighting the significance of placental pathology for the diagnosis of these rare conditions and future counseling of the parents. In conclusion, mucolipidosis Type II is a rare condition in neonates. Early diagnosis in neonates can be made through placental pathology for parental counseling., Competing Interests: Declarations Conflict of Interest None., (© 2024. Crown.)

A gap in the literature exists about the associations between adaptive eating patterns like mindful eating, body appreciation and psychological distress within the Lebanese population. The current culture of acceptance and increased emphasis on wellbeing elicits interest in studying body acceptance and its correlates. The aim of the current study is to assess the mediating effect of psychological distress in the association between body appreciation and mindful eating behaviors among a sample of Lebanese adults. This cross-sectional study enrolled 465 participants. Men and women over the age of 18 were eligible to participate. Then, initial participants were asked to recruit other participants they know. Individuals who consented took an online questionnaire that contained the following scales: a section collecting sociodemographic information, Mindful Eating Behavior Scale, Depression Stress Anxiety Scale (DASS-8) and Body Appreciation (BAS-2). The results of the mediation analysis showed that psychological distress fully mediated the associations between body appreciation and eating with awareness/eating without distraction. Higher body appreciation was significantly associated with less psychological distress, whereas higher psychological distress was significantly associated with less eating with awareness/eating without distraction. However, body appreciation was not associated with eating with awareness/eating without distraction respectively. These findings could guide further research on different categories of adaptive eating patterns and positive body variables within the Lebanese population.

Background: Previous studies have reported race-based health disparities in North America. It is unknown if emergency medical service (EMS) treatment of out-of-hospital cardiac arrest (OHCA) varies based on race. We sought to compare markers of resuscitation intensity among different racial groups., Methods: Using data of adult EMS-treated OHCAs from the Trial of Continuous or Interrupted Chest Compressions During CPR, we analyzed data from participants for whom on-scene return of spontaneous circulation (ROSC) was not achieved. We fit multivariate regression models using a generalized estimating equation, to estimate the association between patient race (White vs. Black vs. "Other") and the following markers for resuscitation intensity: (1) resuscitation attempt duration; (2) intra-arrest transport; (3) number of epinephrine doses; (4) EMS arrival-to-CPR interval, and (5) 9-1-1 to first shock., Results: From our study cohort of 5370 cases, the median age was 65 years old (IQR: 53-78), 2077 (39 %) were women, 2121 (39 %) were Black, 596 (11 %) were "Other race", 2653 (49 %) were White, and 4715 (88 %) occurred in a private location. With reference to White race, Black race was associated with a longer resuscitation attempt duration and a lower number of epinephrine doses; Black and "Other" race were both associated with a lower odds of intra-arrest transport., Conclusion: We identified race-based differences in EMS resuscitation intensity for OHCA within a North American cohort, although 40% of race data was missing from this dataset. Future research investigating race-based differences in OHCA management may be warranted., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

The first aim of the study is to clarify the associations between intuitive eating, self-esteem, physical appearance and psychological distress; and second, to assess the mediating effect of psychological distress on the relationship between self-esteem/physical appearance comparison and intuitive eating. A total of 359 Lebanese participants from several Lebanese governorates were enrolled in this cross-sectional study between September and November 2022. The data was collected through an online questionnaire that included the following scales: Intuitive Eating Scale‑2, Depression Anxiety Stress Scale, Rosenberg Self-Esteem Scale, and Physical Appearance Comparison Scale. The results of the mediation analysis showed that depression partially mediated the association between self-esteem / physical appearance comparison and intuitive eating. Higher self-esteem was significantly associated with lower depression; higher depression was significantly associated with more intuitive eating. Also, higher self-esteem was directly and significantly associated with more intuitive eating. On another hand, higher physical appearance comparison was significantly associated with higher depression; higher depression was significantly associated with more intuitive eating. Finally, higher physical appearance comparison was directly and significantly associated with less intuitive eating. The current study shows how significantly intuitive eating, an adaptive eating pattern, and psychological variables are interrelated and possibly affect each other. It helps shed light on intuitive eating, a somewhat unfamiliar eating pattern within the Lebanese population. These findings allow practitioners to promote healthy eating behaviors and psychological health by educating and guiding patients and clients about intuitive eating., (© 2024. The Author(s).)

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One of the main sources of crude oil and product losses in refineries is the storage tanks. The lightest hydrocarbons in these tanks evaporate during operation, causing not only a loss of the precious raw hydrocarbon material but also a source of dangerous gas pollution. For calculating these losses, several direct and indirect approaches have been devised. In this study, we used a method based on the comparison of the differences in the characteristics of crude oil or other products. This work aimed to find the specifications of two products, kerosene and gas oil, and calculate the losses that occur for the quantities in the dispatch warehouse in the NRC. Four samples of kerosene were used and named: kero@02-1, kero@05-2, kero@10-3, and kero@11-4, while four samples of gas oil were named: gaso@02-1, gaso@05-2, gaso@10-3, and gaso@11-4. Also, they depend on the date of certificate issue, respectively. The received quantities were calculated in ml and converted to cubic meters using the tank coefficient (kerosene tank coefficient 0.638 and gas oil tank coefficient 0.408). Calculations were made of 1500 ml for kerosene and 2500 ml for gas oil. In addition, this project dealt with a simplified method of work that includes the physical properties to find the actual quantities that are lost for the mentioned petroleum products. Moreover, the highest losses were for kerosene (5 m3) at sp. gr 0.750, and the highest losses were for gas oil (5 m3) at sp. gr 0.820. The results showed that there is a quantity of fluctuating losses that does not exceed 5 m3 / 1000 m3 and that these losses are in accordance with the permissible limits. The results recommend directing the laboratory tester's teams in the NRC Baiji to conduct periodic examinations of the petroleum products, as well as not to collusion when receiving a low product with laboratory examination specifications to reduce losses in quantities. [ABSTRACT FROM AUTHOR]

Machines powered by artificial intelligence have the potential to replace or collaborate with human decision-makers in moral settings. In these roles, machines would face moral tradeoffs, such as automated vehicles (AVs) distributing inevitable risks among road users. Do people believe that machines should make moral decisions differently from humans? If so, why? To address these questions, we conducted six studies (N = 6805) to examine how people, as observers, believe human drivers and AVs should act in similar moral dilemmas and how they judge their moral decisions. In pedestrian-only dilemmas where the two agents had to sacrifice one pedestrian to save more pedestrians, participants held them to similar utilitarian norms (Study 1). In occupant dilemmas where the agents needed to weigh the in-vehicle occupant against more pedestrians, participants were less accepting of AVs sacrificing their passenger compared to human drivers sacrificing themselves (Studies 1-3) or another passenger (Studies 5-6). The difference was not driven by reduced occupant agency in AVs (Study 4) or by non-voluntary occupant sacrifice in AVs (Study 5), but rather by the perceived social relationship between AVs and their users (Study 6). Thus, even when people adopt an impartial stance as observers, they are more likely to believe that AVs should prioritize serving their users in moral dilemmas. We discuss the theoretical and practical implications for AV morality., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier B.V.)

Duodenal gastrointestinal stromal tumors (D-GISTs) are a rare subtype of GISTs, accounting for only 4% to 5% of all GIST cases. This case report details the presentation, diagnosis, and management of a 48-year-old female who presented with melena and anemia and was eventually diagnosed with a D-GIST. The tumor was identified through imaging studies, and histopathology performed after surgical resection revealed a submucosal neoplasm composed of spindle cells with extensive hemorrhage and necrosis. Given the tumor's rarity and its challenging presentation, which can mimic other conditions such as pancreatic masses, the case underscores the importance of considering D-GIST in differential diagnoses of duodenal or pancreatic lesions. Surgical resection remains the cornerstone of treatment, with adjuvant therapy considered in high-risk cases to prevent recurrence., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Amin et al.)

Background: Research on incidence and characteristics of Out-of-Hospital Cardiac Arrest (OHCA) in the Middle East is limited. We assessed the incidence, prehospital characteristics, and outcomes of OHCA in Qatar, a Middle Eastern country. Subsequently, we performed gender-specific analysis., Methods: This was a retrospective examination of data obtained from the OHCA registry at Hamad Medical Corporation (HMC) in Qatar from 2017 to 2022. We included adults, non-traumatic, EMS-treatment OHCA. We calculated the incidence of adult OHCA and conducted descriptive analyses for prehospital characteristics, and prehospital outcomes presented by return of spontaneous circulation (ROSC). We evaluated gender differences in prehospital characteristics and ROSC using Student's t-test and the Chi-Square test as appropriate. Furthermore, we conducted a multivariable logistic regression analysis to investigate the correlation between gender and achieving ROSC., Results: We included 4,306 adult OHCA patients, with 869 (20.2%) being females. The mean annual incidence of adult OHCA was 27.4 per 100,000 population-year. Males had a higher annual incidence of OHCA than females. Among all cases, 36.3% occurred in a public location, 25.8% had an initial shockable rhythm, and 28.8% achieved ROSC. Males had a higher proportion of bystander CPR, arrests in public locations, and initial shockable rhythms. While unadjusted analysis showed no significant gender differences in achieving ROSC, adjusted analysis revealed that male gender was associated with higher odds of achieving ROSC (adjusted OR male vs. female 1.38, 95% CI 1.15-1.66, p < 0.001)., Conclusions: Approximately 720 adults undergo non-traumatic OHCA in Qatar every year, with a higher incidence observed in males. Male gender was associated with higher odds of achieving ROSC. Further gender-specific research in OHCA intervention and outcome in the Middle East is required., (© 2024. The Author(s).)

Objective: Optimal timing for subsequent defibrillation attempts for Out-of-hospital cardiac arrest (OHCA) patients with recurrent VF/pVT is uncertain. We investigated the relationship between VF/pVT duration and return of spontaneous circulation (ROSC) in OHCA patients with recurrent shockable rhythms., Methods: We analyzed data from the Salt Lake City Fire Department (SLCFD) spanning from 2012 to 2023. The implementation of rhythm-filtering technology since 2011 enabled real-time rhythm interpretation during CPR, with local protocols allowing early defibrillation for recurrent/refractory VF/pVT cases. We included patients experiencing four or five episodes of VF and pVT rhythms and employed generalized estimating equation (GEE) regression analysis to examine the association between VF/pVT durations preceding recurrent defibrillation and return of spontaneous circulation (ROSC)., Results: Analysis of 622 appropriate shocks showed that patients achieving ROSC had significantly shorter median VF/pVT duration than those who did not achieve ROSC (0.83 minutes vs. 1.2 minutes, p = 0.004). Adjusted analysis of those with 4 VF/pVT episodes (N = 142) revealed that longer VF/pVT durations were associated with lower odds of achieving ROSC (odds ratio: 0.81, 95% CI: 0.72-0.93, p = 0.005). Every one-minute delay in intra-arrest defibrillation is predicted to decrease the likelihood of achieving ROSC by 19%., Conclusion: Every one-minute increase in intra-arrest VF/pVT duration was associated with a statistically significant 19% decrease in the chance of achieving ROSC. This highlights the importance of reducing time to shock in managing recurrent VF/pVT. The findings suggest reevaluating the current recommendations of two minutes intervals for rhythm check and shock delivery., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier B.V.)

Genes encoding KIRs vary in frequency among different populations and ethnic groups. This study investigated the KIR gene frequency distribution in 148 healthy unrelated Saudi subjects and compared the results with other published findings. All inhibitory and activating KIR genes were present at variable frequencies, with A haplotype-associated genes (KIR2DL1, -2DL3, -3DL1, and KIR2DS4) being observed at higher frequencies (88.9-99.5%) than B haplotype-associated genes (KIR2DS1, -2DS2, -2DS3, -2DS5, -2DL5 and -2DL2) (31.1-70.1%). Thirty-one different KIR genotypes were observed, and AA genotypes displayed the highest frequency (18.2%). This Saudi population possesses similar KIR gene distributional characteristics to those reported in other neighboring populations (e.g., Lebanese) and shows disparities in certain genes and gene contents from other populations (e.g., Australian Aborigines). These findings can be used as a reference control in future studies evaluating the functional significance of the KIR genes and their associations with specific diseases.

Aims: Previous research has reported racial disparities in out-of-hospital cardiac arrest (OHCA) interventions, including bystander CPR and AED use. However, studies on other prehospital interventions are limited. The primary objective of this study was to investigate race/ethnic disparities in out-of-hospital cardiac arrest (OHCA) interventions: EMS response times, medication administration, and decisions for intra-arrest transport. The secondary objective was to evaluate differences in the provision of Bystander CPR (CPR) and application of AED., Methods: We retrospectively analyzed data from the Salt Lake City Fire Department (2010-2023). We included adults 18 years or older with EMS-treated OHCA. Race/ethnicity was categorized as White people, Asian people, Black people, Hispanic people, and others. We employed multivariable regression analysis to evaluate the association between race/ethnicity and the outcomes of interest., Results: Unadjusted analyses revealed no significant differences across ethnic groups in EMS response, medication administration, bystander CPR, or intra-arrest transport decisions. However, significant ethnic disparities were observed in Automated External Defibrillator (AED) utilization, Black people having the lowest rate (6.5%) and Asian people the highest (21.8%). The adjusted analysis found no significant association between race/ethnicity and all OHCA intervention measures, nor between race/ethnicity and survival outcomes., Conclusions: Our multivariable analysis found no statistically significant association between race/ethnicity and EMS response time, epinephrine administration, antiarrhythmic medication use, bystander CPR, AED intervention, or intra-arrest transport. These results imply regional variations in ethnic disparities in OHCA may not be consistent across all areas, warranting further research into disparities in other regions and additional influential factors like neighborhood conditions and socioeconomic status., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

The current study aims to examine the relationship between Social Media Use Disorder (SMUD) and Orthorexia Nervosa (ON), and evaluate the indirect effect of loneliness in this association. This cross-sectional study was carried out between July and September 2021. A total of 363 university students were recruited through convenience sampling through several universities in Lebanon's governorates. Data about information about the social media applications mostly used (Instagram, Facebook, Twitter, etc.), the number of times of entry to social media applications, the time spent on these applications, ON, loneliness and SMUD, were also collected. The Mplus v.7.2 software was used to estimate categorical confirmatory factor analyses (CFA) of the SMD and loneliness scales. The one-factorial model of the SMD scale fitted well according to χ2/df (69.71/27 = 2.58), TLI (.967), CFI (.956), and RMSEA values (.066; CI [.047-.085]; pclose = .079). The one-factorial model of the loneliness scale fitted well according to χ2/df (10.30/5 = 2.06) TLI (=0.97), CFI (=0.98), and RMSEA values (=0.054; CI [0.000-0.101]; pclose = 0.379). When entering the social media applications and time spent on these applications as independent variables in a first regression model, using Instagram (Beta = 2.73), using Tumblr (Beta = 3.22), spending 30-60 minutes per day on social media apps compared to less than 30 minutes (Beta = 2.33), higher physical activity index (Beta = 0.04) and loneliness (Beta = 0.67) were significantly associated with more ON. When entering the SMUD score as an independent variable in a second regression model, the results showed that higher SMUD (Beta = 0.50) was significantly associated with more ON. Also, loneliness played a partial indirect role in the association between SMUD and ON (by 16%). The current results can help mental health professionals better detect these potential psychological disorders and might help improve future treatment of issues related to ON and SMUD., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Prior research indicates sex disparities in the incidence and outcomes of out-of-hospital cardiac arrest (OHCA). This study investigates the presence of such differences in Salt Lake City, Utah., Methods: We analyzed data from the Salt Lake City Fire Department (2008‒2023). We included adults with non-traumatic OHCA. We calculated the annual incidence of OHCA and examined sex-specific survival outcomes using multivariable logistic regression, adjusting for OHCA characteristics known to be associated with survival., Results: The annual incidence of OHCA was 76 per 100,000 person-years. Among the 894 OHCA cases included in the analysis, 67.5% were males, 37.3% achieved return of spontaneous circulation (ROSC), and 13.6% survived hospital discharge. Unadjusted analysis revealed that males had significantly higher OHCA in public locations (43.9% vs. 28.6%), witnessed arrests (54.5% vs. 47.8%), and shockable rhythms (33.3% vs. 22.9%). Males also showed higher rates of ROSC (37.5% vs. 36.9%), hospital discharge survival (14.5% vs. 11.7%), and neurologically intact survival. After adjusting for the OHCA characteristics, there was no significant differences between males and females in ROSC, survival to hospital discharge, and favorable neurological function with adjusted odds ratios (male vs. female) of 0.92 (95% confidence interval [CI] 0.73‒1.16), 0.85 (95% CI 0.59‒1.22), and 0.92 (95% CI 0.62‒1.40), respectively., Conclusion: Approximately, 128 adults suffer OHCA in Salt Lake City annually. Males initially showed higher crude survival rates, but after adjusting for OHCA characteristics, no significant sex differences in survival outcomes were found. Enhancing OHCA characteristics could benefit both sexes. Investigations into the relationship between sex- and region-specific factors influencing OHCA outcomes are needed., Competing Interests: The authors declare they have no conflicts of interest., (© 2024 The Author(s). Journal of the American College of Emergency Physicians Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.)

Objectives: Splenectomy during liver transplant can affect platelet function. In this study, our primary aim was to assess the perioperative platelet function by rotational thromboelastometry and the effects of splenectomy on platelet function., Materials and Methods: We studied 40 consecutive liver transplant recipients with end-stage liver disease (50% as a result of hepatitis C). Patients with splenectomy were compared with patients without splenectomy (n = 20/group). Three platelet function parameters by rotational thromboelastometry were studied: platelet activation with arachidonic acid, platelet activation with adenosine diphosphate, and platelet activation with thrombin receptor-activating peptide 6. Patients were monitored perioperatively and until postoperative day 21. Heparin was infused for 2 days postoperatively (60-180 U/kg/day), followed by administration of subcutaneous low-molecular-weight heparin (40 mg/24 h) on postoperative days 2 and 3 and oral acetylsalicylic acid when platelet count was >50 × 103/μL., Results: Liver disease contributed to low perioperative platelet count and function. Patients showed significant improvement by postoperative day 14 and day 21, particularly after splenectomy. Platelet count was significantly correlated with the 3 platelet function parameters by rotational thromboelastometry (P < .001). Acetyl salicylic acid was required earlier (postoperative day 3) for patients with splenectomy (8/20) but only affected the platelet function represented by platelet activation with arachidonic acid, whereas other platelet activation pathways were less affected. Patients received no transfusions of platelet units., Conclusions: End-stage liver disease significantly contributed to low platelet function and counts before transplant. Two weeks were required for recovery of patients posttransplant, with further enhancement by splenectomy. Some recipients showed recovery that exceeded the normal reference range, which warranted monitoring. Acetyl salicylic acid only affected 1 platelet activation receptor.

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