Doppler findings of persistent reverse end-diastolic flow (PREDF) in a fetal middle cerebral artery (MCA) are a very rare sonographic finding and are a marker of poor fetal condition. This finding often leads to intrauterine fetal death or early neonatal death. The reverse end-diastolic flow in the middle cerebral artery is the terminal hemodynamic event. Fetal cerebral circulation normally has a high impedance; in the event of fetal hypoxemia, impedance decreases, resulting in the central redistribution of blood flow to vital organs, which maintains the oxygen delivery to the brain. Reverse flow in the middle cerebral arteries describes the loss of this autoregulatory process. PREDF is a sequence happening due to increased extracranial or intracranial pressure. Previous case reports mentioned intracranial hemorrhage, intrauterine growth restriction (IUGR), fetal anemia, and fetal hepatic abnormalities as leading problems to PREDF. This condition presumably arises due to cerebral edema associated with severe hypoxemia. We reported Doppler findings of PREDF MCA in a 33-year-old female at 30 weeks gestation who was referred to the hospital with severe preeclampsia accompanied by IUGR and oligohydramnios. A cesarean section was performed due to severe preeclampsia and a low bishop score. Hypotheses on various etiologies and their association with intrauterine/neonatal death as well as the best management still require further investigation.

To evaluate the effect of middle meningeal artery embolization (MMAE) on chronic subdural hematoma (CSDH). We enrolled consecutive patients with CSDH who underwent burr hole craniostomy (BHC) between January 2021 and February 2023. The primary outcome was recurrence rate, defined as an increase of hematoma width on imaging compared with the immediate postoperative imaging at a 3-month follow-up. Secondary outcomes included the rate of complications and adverse prognosis. Cohorts were balanced using 1:2 propensity score matching (PSM). A total of 271 patients were eligible for this study and divided into the MMAE group (n=23) and the BHC group (n=205). Compared with the BHC group, there was more use of anticoagulant or antiplatelet medication (47.8% vs 22.4%, P=0.008), bilateral hematoma (19.5% vs 19.5%, P=0.043) and hematoma with septations (47.8% vs 21.5%, P=0.005) in the MMAE group. After PSM, 64 cases were finally successfully matched. The logistic analysis result showed that MMAE was associated with the decreased recurrence rate of CSDH in the cohort after PSM (OR 0.072, 95%CI 0.322~0.746, P=0.028) but not with the improved clinical prognosis (OR 0.065, 95%CI 0.533~4.786, P=0.562). MAAE has a positive therapeutic effect on reducing the recurrence rate of CSDHs as an adjunct postoperative treatment after burr hole surgery.

Cerebral blood flow (CBF) decreases across the lifespan, and chronic conditions such as dementia and stroke accelerate this decline. Impaired CBF results in reduced delivery of oxygen and nutrients, which can damage the brain over time. Thus, there is a need to identify lifestyle interventions including diet and exercise to maintain CBF with aging and in the presence of chronic disease. In the present study, we used transcranial Doppler ultrasound to record middle cerebral artery velocity (MCAv), a surrogate measure of CBF, during moderate-intensity exercise in sedentary, cognitively-normal older adults (N = 90). A multiple linear regression model (F(4, 85) = 3.21, p = 0.02) showed self-reported omega-3 supplement use significantly moderated the association between age and mean exercising MCAv in these individuals (p = 0.01). Older age was associated with lower exercising MCAv in the group not taking omega-3 supplements, while exercising MCAv showed no decline with increasing age in the group who reported omega-3 supplement use. These findings suggest omega-3 supplementation may have an important role in the preservation of CBF with aging.

In post mortem analyses, SARS-CoV-2 was found in the middle ear of some, but not all patients with COVID-19 disease. It is not clear whether SARS-CoV-2 penetrated the ear passively post mortem, or existed in the middle ear of living patients during, and perhaps also after infection. This study investigates whether SARS-CoV-2 can be found in the middle ear of living patients during ear surgery. Swabs from the nasopharynx, the filter connected to the tracheal tube and secretion from the middle ear were collected during middle ear surgery. All samples were tested for the presence of SARS-CoV-2 with PCR. History of vaccination, COVID-19 and contact with SARS-CoV-2-positive individuals were recorded preoperatively. Postoperative SARS-CoV-2 infection was noted at the follow-up visit. Overall 63 participants (62%) were children and 39 (38%) were adults. SARS-CoV-2 was found in the middle ear and in the nasopharynx of two and four CovEar Study participants, respectively. The filter connected to the tracheal tube was sterile in all cases. Cycle threshold (ct) values of the PCR test were between 25.94 and 37.06. SARS-CoV-2 penetrates into the middle ear of living patients and can be found in asymptomatic patients. The presence of SARS-CoV-2 in the middle ear may have implications for ear surgery and can pose a risk of infection for operating room staff. It may also directly affect the audio-vestibular system.

Purpose: This study aimed to describe the molecular epidemiology and seasonality of human rhinovirus (HRV) in chronic obstructive pulmonary disease (COPD) and its association with COPD exacerbations in Abu Dhabi, the United Arab Emirates (UAE). Methods: Sputum specimens were collected for analysis from all COPD patients who visited a medical center from November 2021 to October 2022. The real-time quantitative polymerase chain reaction (qPCR) test was used to detect HRV. Results: Of the 78 COPD patients included in the study, 58 (74%) pa-tients presented with one or more exacerbation episodes. The incidence of COPD exacerbation peaked over the winter and substantially decreased during the summer. HRV positivity in pa-tients during exacerbation (E1) was 11/58 (19%) and 15/58 (26%) two weeks after the exacerbation episode (E2). There was no significant difference in the HRV load in these patients. No statistically significant difference was observed in the detection of HRV during exacerbation compared to patients with stable COPD. Conclusion: This is the first study to assess the association between HRV detection by qPCR and COPD exacerbations in the UAE. The high sensitivity of the detec-tion technology helped collect reliable epidemiologic data. Few studies have provided similar Middle East data. This study's pattern of COPD exacerbations and HRV detection parallels that of temperate countries. This information can help with future, more extensive surveillance of res-piratory viruses in the UAE and the Middle East and their association with COPD exacerbations.

An ionospheric response at middle latitudes to geomagnetic storms is not yet very well understood. Total electron content (TEC) variations associated with eight strong geomagnetic storms between 2015 and 2022 obtained from GNSS receivers in the western area of the North Atlantic (Portuguese continental and insular territory) are studied in an attempt to fill this gap. It was found that for most of the studied geomagnetic storms TEC variations are synchronous for the longitudinal ranges from 27ºW and 9ºW. In the southern part of the studied region (around 32ºN) the amplitude of TEC variations is, in general, significantly higher than in the northern part (around 39ºN). Some of the studied geomagnetic storms were associated with TEC variations that we interpret as effects of post-sunset equatorial plasma bubbles that travelled well north from their habitual region. Also, while most of the studied storms were accompanied by reports on different kind of malfunction of GNSS systems (GPS; GALILEO and other), there is no clear pattern in their appearance in dependence on the geomagnetic/ionospheric storms’ strength, commencement time, and its characteristics, in general.

Chronic pain is a serious health concern and potentially debilitating condition, leading to anxiety, depression, reduced productivity and functionality, and poor quality of life. This condition can be even more detrimental and incapacitating in the pediatric patient population. In low and middle income countries (LMICs), pain services are inadequate or unavailable, leaving most of the world's pediatric population with chronic pain untreated. Many of these children in LMICs are suffering without treatment, and often die in pain. Awareness and advocacy for this population must be prioritized. We reviewed the available literature on the chronic pediatric pain burden in LMICs, barriers to treatments, and current efforts to treat these patients.

This review provides a comprehensive overview of two major advancements in hearing loss treatment: the middle ear implant (MEI) and bone conduction implants (BCIs). MEI, surgically inserted in the middle ear, directly stimulate the ossicles, and are primarily employed to treat sensorineural, conductive, or mixed hearing losses. BCIs work via bone conduction, bypassing the outer and middle ear to deliver sound vibrations to the inner ear, beneficial especially for conductive or mixed hearing losses and single-sided deafness. The decision to opt for these devices is a multifaceted process, considering audiological criteria, surgical feasibility, and patient expectations. The review also details the portfolio of available devices, their functioning, and audiological usage indications. While both MEI and BCIs prove beneficial for patients, the review emphasizes the need for careful preoperative planning and counselling, considering factors such as potential complications, surgical challenges, and patient suitability. Overall, the two types of implants, despite their individual complexities, provide an effective alternative to traditional hearing aids, offering a path to improved sound clarity and quality for patients with various types of hearing loss.

Research on climacteric syndrome among middle-aged men remains scant than the research among women. Research is also scant on climacteric syndrome among older adults living alone, particularly men, who are more vulnerable than such females. This cross-sectional study investigated whether the prevalence of climacteric syndrome is associated with the type of household middle-aged men live in and identified the determinants of climacteric syndrome based on the household type. Six hundred middle-aged men living in multi-person households and 600 living alone were surveyed about general characteristics, diet-related factors, and climacteric syndrome. Data were analyzed using Pearson’s chi-squared test, Fisher’s exact test, and logistic regression. The risk of climacteric syndrome in single-person households was found to be 1.6 times higher than that among in multi-person households (p = 0.006). In multi-person households, income and breakfast frequency predicted climacteric syndrome (p < 0.05), while age, breakfast frequency, dinner frequency, and weekly eating out frequency predicted climacteric syndrome in single-person households (p < 0.05). Thus, dietary factors are more closely linked to the prevalence of climacteric syndrome in single-person households than in multi-person households. This highlights the need for climacteric syndrome interventions for middle-aged men whose health concerns may persist into older adulthood.

The Süttő 21 site is a fissure fill of the freshwater limestone of the Gazda quarry in Süttő. The material was collected between 2017 and 2019, the results are summarised in this article, with a special focus on the small vertebrate fauna of the site and its stratigraphic and paleoecological significance. The fissure fill can be placed around the early/middle Pleistocene boundary (ca. 1.1 and 0.77 Ma). The paleoecological analysis of the herpeto- and mammal fauna of the sequence indicates the proximity of a permanent water body. The lower part of the sequence is dominated by open habitat indicator taxa indicating a cool, dry climate. Towards the upper part of the sequence, the climate remained cool but became wetter, and the vegetation gradually changed to forest-steppe/open forest. The fauna of the Süttő 21 site can be compared with the material of sites, which are of similar age, thus revealing taxonomic and paleoecological differences between different areas of the country. While a warm, dry climate and open vegetation can be reconstructed in the Villány Hills around the early/middle Pleistocene boundary, the northern Hungarian areas had a cooler, wetter climate, and slightly more closed (grove, forest-steppe) vegetation during this period.

Drowning is a serious public health concern. Low middle income countries are mostly affected, as they carry 90% of the global drowning burden. The purpose of this epidemiological study is to provide a comprehensive overview of fatal drownings in South Africa between 2016 and 2021. The data used for the study was obtained from the South African Police Service. Descriptive statistics were used to summarise data. Statistical analysis included a t-test and chi-square test. The results indicate that the average fatal drownings per annum is 1477 in South Africa, with a drowning rate of 2.54 per 100 000 population from 2016 - 2021. The KwaZulu-Natal province had the highest incidence of drowning. The 0 – 4-year category has a high prevalence of drowning amongst all the age categories. More males drowned in South Africa compared to females. The study highlights key areas of concern these include age, sex, race, province, type of water body and time of day. This information is crucial to inform drowning prevention initiatives in South Africa.

Based on the 2014-2015 China Education Panel Survey (CEPS) and using the propensity score matching method, we studied the causal relationship between physical exercise and prosocial behavior of junior middle school students in China. Ordinary least squares regression and propensity score matching estimation results showed that participation in physical exercise significantly increases students’ prosocial behavior by more than 0.2 standard points. The results of this study were tested and found to be robust.

Background: Our knowledge of prostate cancer (PCa) genomics mainly reflects European (EUR) and Asian (ASN) populations. Our understanding of the influence of Middle Eastern (ME) and African (AFR) ancestry on the mutational profiles of prostate cancer is limited. Design, setting and participants: To characterize genomic differences between ME, EUR, ASN and AFR ancestry, fluorescent in situ hybridization (FISH) studies for NKX3-1 deletions and MYC amplification was carried out on 42 tumors arising in individuals of ME ancestry. These were supplemented by analysis of copy number profiles of 401 tumors of all ancestries. Outcome measurement and statistical analysis: FISH results of NKX3-1 and MYC were assessed in the ME cohort and compared to other ancestries. Gene level copy number aberrations (CNAs) for each sample were statistically compared between ancestry groups. Results and Limitation: NKX3-1 deletions by FISH were observed in 17/42 (17.5%) prostate tumors arising in men of ME ancestry, while MYC amplifications were only observed in 1/42 (0.23%). Using CNAs called from arrays, the incidence of NKX3-1 deletions was significantly lower in ME vs. other ancestries (20% vs. 52%; p = 2.3 x 10-3). No differences in MYC amplifications was noted between the two cohorts using array-based CNAs. Across the genome, tumors arising in men of ME ancestry had fewer CNAs than those of other ancestries (p = 0.014). Additionally, the somatic amplification of 21 specific genes was more frequent in tumors arising in men of ME vs. EUR ancestry (Proportions test; Q < 0.05). Those included amplifications in the glutathione S-transferase family on chromosome 1 (GSTM1, GSTM2, GSTM5) and the IQ Motif Containing family on chromosome 3 (IQCF1, IQCF2, IQCF13, IQCF4, IQCF5, IQCF6). Conclusion: Significant differences in genetic background exists between different ancestries. The lower number of somatic CNAs observed in prostate cancer arising in men of ME ancestry may explain the relatively good prognosis in this population. Larger studies are warranted.

Available water resources in the Middle East, as one of the most water-scarce regions of the world, have undergone extra pressure due to climatic change, population growth, and economic development during the past decades. The objective of this study is to detect the trends and quantify the changes in aridity with respect to precipitation and potential evapotranspiration in 20 countries of the Middle East and the adjacent area. A Pixel-wised trend analysis was conducted on precipitation, potential evapotranspiration, and aridity index for 71 years from 1948 to 2018. A nonparametric Mann-Kendall test was used over 14106 points in the study area to detect the trends at monthly and annual time scales. Results showed statistically significant (|Z| >1.96) upward trends in aridity (a downward trend in aridity index) up to 96 percent from December through September in most parts of the region. Aridity in October and November had a downward tendency in most parts of the study area. At the annual time scale, 62.5 percent of the statistically significant trends in aridity were found to be upward (up to 96 percent increase in aridity) due to the combined effects of the decrease in precipitation and the increase in potential evapotranspiration and 37.5 percent of the detected trends were downward (up to 61 percent decrease in aridity). The highest and the lowest trends in aridity were found in the north of Sudan (96 percent increase in aridity) and Eastern Arabia (61 percent decrease in aridity), respectively.

This article is an anthropology study on how western-style coffee culture influences Indonesian coffee culture and eventually develops a new localized coffee culture. Immense development of such worldwide coffee franchise as Starbucks affects local community's coffee culture, particularly the middle class. This new wave is considered as an alternative lifestyle for those who are consumptive and seeking for leisure, dynamics, and identity. Broader than just the process of domestication or creolization, Indonesian new coffee culture has an element of “soft countering to” western coffee culture even though it still embraces some parts of the western styles. This phenomenon is referred to by the writer as the cultural encapsulation process or the process of substantial cultural resistance by drawing a line between the two coffee cultures with the intention of taking merely compatible elements.

The Middle East spans the transition between temperate Mediterranean climate in the Levant to hyper-arid sub-tropical deserts in the southern part of the Arabian Peninsula, with the complex alpine topography in the northeast feeding the Euphrates and Tigris rivers which support life in the southeastern Fertile Crescent (FC). Climate projections predict severe drying in major parts much of the ME in response to global warming, making it important to understand the controls of hydro-climate perturbations in the region. Here we discuss 23 ME speleothem stable oxygen isotope (δ¹⁸Occ) records from 16 sites from the SISAL_v1 database, which provide a record of past hydro-climatic variability. Sub-millennial changes in ME speleothem δ¹⁸Occ values primarily indicate changes in past precipitation amounts superimposed on variations of the main synoptic pattern in the region, specifically Mediterranean cyclones. The coherency (or lack thereof) between regional records is reviewed from Pleistocene to present, covering the Last Glacial Maximum (LGM), prominent events during deglaciation, and transition into the Holocene. The available speleothem δ¹⁸Occ time-series are investigated by binning and normalizing at 25-year and 200-year time windows over the Holocene. Important Holocene climatic oscillations are discussed, such as the 8.2 ka, 4.2 ka and 0.7 ka (the Little Ice Age) Before Present events. Common trends in the standardized anomalies are tested against different climate archives. Finally, recommendations for future speleothem-based research in the region are given along with comments on the utility and completeness of the SISAL database.

Office workers often experience occupational musculoskeletal disorders. The aim of the current systematic review was to investigate the effectiveness of workplace exercise intervention on the oldest age group of office workers who have been reported in the literature so far, in terms of workability and well-being. Randomized Controlled Trials were used and the methodological guidelines of PRISMA were followed. The keywords used were: office workers, older, exercise intervention, workplace, microbreaks, workability and well-being. The databases searched were: PubMed, PEDro, ResearchGate, CINAHL, PsychINFO and Science Direct. PROSPERO ID: CRD42022329656. Five studies (total number of participants: 1190, mean age: 46,4) met the inclu-sion criteria. Their quality was deemed to be moderate to high, according to PEDro and MPSER scales. Workplace interventions of gradually increased strengthening and moderate stretching exercises, isometric positioning and postural reminders, either with or without supervision, result in decreasing musculoskeletal pain, disability, sick-leave from work and in the improvement of quality of life and physical activity of the middle-aged office workers, without negative impact on their workability. Despite the worldwide aging workforce, there is a knowledge gap due to research absence in the field of microbreak exercise interventions in the group of older office workers.

The increasing cancer burden is a major health concern in Arab countries with variations in cancer profiles. Given the limited oncology research output and scarce data on cancer trial participation in the Arab region, this study explored the therapeutic cancer trial landscape in Arab countries over the past 20 years. A bibliometric analysis of the PubMed database was conducted on primary publications of therapeutic trials with a participating Arab center. Arab countries participated in 320 published cancer-related therapeutic trials (2000‒2021). There was a consistent increase in the number of trials, sample size, multiregional site participation, and number of randomized trials. However, most trials were small, did not receive external funding, and included a single Arab site. Compared with Arab-only trials, trials with joint non-Arab sites were larger (p = .003) and more likely to be externally funded (p < .001). Citation numbers and journal impact factors were higher in trial publications with joint non-Arab authorship than those without (p < .001, for both). Despite improving conduct and publication records of oncology trials with Arab centers, cancer trial participation remains limited in Arab countries. Concerted efforts are required to encourage sponsorship and international collaboration in this region.

The increasing prevalence of obesity and sedentary lifestyles has led to an increased incidence of metabolic syndrome (MetS) worldwide. In Taiwan, middle-aged women are at a greater risk of MetS, type 2 diabetes, and cardiovascular disease than men are because they have more subcutaneous fat and larger waist circumferences compared to men with equal visceral fat levels. This study investigated the effects of calorie restriction supplemented with fish oil (CRF) in middle-aged women with MetS. For 12 weeks, 75 eligible participants were randomly assigned either calorie restriction (CR) or CRF. Both dietary intervention groups were further divided into two age groups: ≤45 and >45 years. The changes in MetS severity, inflammatory status, iron status, and red blood cell fatty acid profile were evaluated. Seventy-one participants completed the trial. Both dietary interventions significantly ameliorated MetS and improved the participants’ inflammatory status. CR significantly increased total iron binding capacity, whereas CRF increased hepcidin levels. Furthermore, CRF significantly increased the n-6/n-3 and arachidonic acid/docosahexaenoic acid ratios. In conclusion, CR and CRF improved the anthropometric and MetS characteristics of early-middle aged women, including body weight, blood glucose levels, triglyceride levels, as well as the scores for the homeostasis model assessment of insulin resistance and quantitative insulin sensitivity cheque index. Dietary intervention was more effective in >45-year-old women than ≤45-year-old women.

Titanium middle ear prostheses are widely used in surgical practice due to their acoustic properties. However, they present a significant drawback shared by all synthetic materials currently in use for middle ear reconstruction: they can be rejected by the organism of the host. In this study, we aim to review the current literature on titanium TORP and PORP extrusion and dislocation. Eighty-one articles were analysed after full article review based on the inclusion and exclusion criteria. The most common indication for reconstruction was chronic otitis media with cholesteatoma. The average extrusion or dislocation rate was 5.1%, ranging from 0 to 35%. The average improvement in air-bone gap was 12.3 dB (1.6 dB to 25.1 dB) and 13.7 (-0,5 dB to 22.7 dB) for PORP ad TORP groups, respectively. The data reported on this topic are highly variable, demonstrating the functional outcomes are difficult to predict in clinical practice. We believe the current limitations could be overcome with technological developments, including bioengineering research focused on promoting the prothesis adaptation to the ME environment.

Worldwide, 200 million children experience disability, with the vast majority living in low and middle-income countries. The United Nations Convention on the Rights of the Child (CRC) places great importance on the rights of all children for the opportunities for survival, growth, health, and development. A subsequent document, the UN Convention on the Rights of Persons with Disabilities (CRPD) identifies children with disabilities as rights bearers, who should be considered in all policies and programming worldwide. Nigeria, in 1991 and 2010 ratified the CRC and the CRPD respectively. Nonetheless, knowledge of the extent to which their disability and child-directed policies are considered by these two key conventions remains limited. This study examined the extent to which Nigeria’s current disability and childhood policies have integrated the two normative frameworks from the UN. Using a structured search of databases and Nigerian federal and state government websites, we conducted a policy review to identify their disability and child-related disability policies. We also included the CRC and CRPD reports submitted by the Nigerian government to the United Nations Office of the High Commissioner for Human Rights (OHCHR) (2008 &amp; 2010 cyclical year). A thematic analysis, based on the CRC and CRPD report, identified the following six themes: participation, support systems, awareness-raising, factors associated with adherence to the CRC, laws &amp; rights, and services. The review showed that the available Nigerian disability policies were federal, with some state policies which aligned with the CRC and CRPD. Also identified was the lack of disability policies specific to children and their families. We concluded that, to ensure proper inclusion of the rights of all children, including those with disabilities, in Nigeria there is a need for a more optimal uptake of recommendations of the CRC and CRPD as laid out by the UN.

Several studies confirmed the importance of career education interventions since childhood. This study aimed at testing a career education intervention designed for middle school students, conducted, after a specific training on Social Cognitive Career Theory, by students’ teachers. The career conceptions were assessed in both experimental and control groups through the Conceptions of Career Choice and Attainment protocol before and after career education intervention. Result showed that. starting from the same level and increased their conceptions after the intervention. Experimental group increase, in a statistically significant way, more than the control group.

Worldwide, depressive disorder is one of the leading determinants of disability-adjusted life years. Although the benefits associated with physical activity (PA), there is a lack of information related to depression, especially in countries like Czechia, where modern approaches to mental health care only recently emerged. The PA levels were associated with aspects of depression such as clinician-diagnosed history; different severities; continuous depression scores; and specific symptoms that characterize the depression. The multivariable-adjusted Poisson regression models were carried out on 2123 participants (45.3% men, median 48 years). Compared to subjects with insufficient PA, the moderate and high PA levels were inversely associated with clinician-diagnosed depression history (respectively, prevalence rate [PR]= 0.84; 95% CI 0.66-0.82 and PR=0.50; 95% CI 0.36-0.67); and with continuous depression scores (PR=0.85; 95% CI 0.75-0.97; and PR=0.79; 95%CI 0.70-0.90).; but only high PA showed association with depression categories (PR=0.75; 95%CI 0.60-0.95). Depressed mood and worthlessness were the symptoms associated with moderate and high PA. Tiredness, change in appetite, and problems with concentration only with high PA. Although only high PA was sufficient for people intending changes among depression categories, the moderate PA may be enough for slight changes in depressive symptoms, and a good strategy when starting.

The different waves of the COVID-19 pandemic caused dramatic issues regarding the organiza-tion of care. In this context innovative solutions have to be developed in a timely manner to adapted the organization of the care. The establishment of middle care (MC) units is a bright example of such an adaptation. A multidisciplinary MC team, including expert and non-expert respiratory nurses, physicians, physiotherapists, psychologists, nutritionists and social workers, was built and trained to work in the COVID-19 MC unit. Important educational resources were set up to ensure rapid and effective training of the MC team, limiting the admission or delaying transfers to ICU and ensuring optimal management of palliative care. We conducted a retrospec-tive analysis of patient data in the MC unit during the second COVID-19 wave. Fifty-two COVID-19 ‘step-up’ patients admitted to the MC unit were included in the study. Thirty-four (65%) patients worsened, of which 12 (23%) were not eligible for ICU access. In total, 42% of the ICU-eligible patients were managed in the MC unit to avoid the ICU. Among the 22 patients transferred to the ICU, 15 were intubated. The establishment of an MC unit during a pandemic, mixing expert and non-expert respiratory team members, is feasible and needed. MC units possi-bly relieve the pressure exerted on ICUs. A highly trained multidisciplinary team is key to ensur-ing the success of an MC unit during a pandemic.

Turkey is located in the heart of complex transition geography between Eurasia and the Middle East. In the grand scheme, the so-called Eastern Mediterranean Basin is almost amidst the dusty belt and a hot spot of climate change. The downstream location of dust carrying winds from the closer desert sources reveals Turkey as an open plane to particulate matter exposure throughout the year. In order to clarify this phenomenon, it is aimed to find out the desert dust climatology of Turkey via CALIPSO onboard Lidar. This prominent instrument enables us to understand clouds, aerosols and their types and relatedly climatic systems with its valuable products. In this study, 9-year CALIPSO derived pure dust product is formed to explain horizontal and vertical distributions, transport heights and case incidences. Results indicated mass and conditional abundancy are higher with the location shifts from west to east. In the same direction, dominant spring months change to summer and autumn. Mountain range systems surrounding Anatolia are the main obstacles against lofted and buoyant dust particles travelling to northern latitudes. Even if high ridges accumulate mass load on the southern slopes, it also enables elevated particles to reach the ground level of the inner cities.

During puberty and emerging sexuality, adolescents experience important physical, mental, and social transformations. In the process of dealing with these changes, adolescents can become potentially vulnerable to mental health problems.The aim was to identify and synthesize published research evidence on sexuality-related mental health stressors among adolescent girls and boys, identify gaps (if any) in current knowledge, and contribute to knowledge about the experiences of emerging sexuality and health among adolescents, to further inform research, practice, and policy initiatives in sexual health.A scoping literature review of peer-reviewed articles published between 1990 and 2018. MEDLINE, CINAHL, EMBASE, PsycINFO, Global health, ERIC, and Sociological Abstracts databases were searched for research studies that reported experiences of sexuality related mental health issues and symptomatology of adolescents. We targeted studies conducted with adolescent populations between ages 11-24 years living in LMICs.Data from 12 published research papers, including 8 qualitative studies, 3 quantitative studies, and 1 mixed method study, were systematically analyzed. Four major themes and 4 sub themes were identified regarding sexual health and mental health of adolescents: 1) Relationship of sexuality and mental health; 2) Social and cultural influences; 3) Challenges in seeking sexuality information and services among adolescents; and 4) Educational needs among adolescents related to sexuality; and 4) Educational needs among adolescents related to sexuality. Lack of social support, Unmet needs for accessible adolescent friendly sexual health services, counseling, and age-appropriate information may be associated with several mental health stressors and symptoms, such as sadness, depressive and anxiety symptomatology, regret, fear, embarrassment, low self-esteem, guilt, shame, and anger. Therefore, tackling sexuality-related stressors could play an important role in addressing the overall wellbeing of young people. Future studies need to generate a deeper understanding of the concept of sexual health and its relation to mental health in diverse contexts. Health care professionals need to be aware of sexuality-related experiences of adolescent girls and boys by offering effective youth-friendly sexual and reproductive health education to support overall mental health and improve the experiences of emerging sexuality in adolescents.

Vocational interest inventories are widely used by career counselors to help individuals to make career choices. The most common approach to assess vocational interests is based on verbal or textual stimuli. However, some of them are based on pictorials to overcome reading limits and provide additional information about the working environment and the activities related to a particular job. This article aims to present two studies on the development and first validation of the Multilingual Iconographic Professional Interest Inventory (MIPII) on two samples, one composed of 792 high-school students, and one composed of 366 middle school students. The inventory aimed to assesses the vocational interests of people over 19 areas by illustrations representing 95 jobs, five for each one, combined with their title in six different languages (Arabic, German, English, Spanish, French and Italian in this order). Both illustrations and titles are provided separately in the male and female version on the same page.

Cardiorespiratory fitness (CRF) is a strong independent predictor of morbidity and mortality. However, there is no recent information about the impact of CRF on cardiometabolic risk specifically in Central and Eastern Europe, which are characterized by different biological and social determinants of health. Normative CRF values were proposed and the association between CRF and cardiometabolic outcomes was evaluated in an adult Czechian population. In 2054 participants (54.6 % females, median 48 years), the CRF was predicted from a non-exercise equation. Multivariable-adjusted logistic regressions were carried out to determine the associations. Higher CRF quartiles were associated with lower prevalence of hypertension, type 2 diabetes (T2D) and dyslipidaemia. Comparing subjects within the lowest CRF, those within the highest CRF had decreased chances of hypertension (odds ratio [OR] = 0.36; 95% CI: 0.22-0.60); T2D (OR=0.16; 95% CI 0.05-0.47), low HDL-c (OR=0.32; 95% CI 0.17-0.60), high low-density lipoprotein (OR=0.33; 95% CI 0.21-0.53), high triglycerides (OR=0.13; 95 CI 0.07-0.81), and high cholesterol (OR=0.44; 95% CI 0.29-0.69). There was an inverse association between CRF and cardiometabolic outcomes, supporting the adoption of a non-exercise method to estimate CRF of the Czech population. Therefore, more accurate cardiometabolic studies can be performed incorporating the valuable CRF metric.

Various bat species often occupy the same habitats. Cohabitation should induce different preferences in spatial or trophic components of the bat ecological niche, to reduce their competition. This determines the differences in the trematode fauna of Myotis spp. The purpose of our research was to study the biodiversity of trematodes in syntopic populations of five Myotis species in the Samarskaya Luka National Park. In 2005–2007 we studied 867 bat specimens by the methods of complete helminthological dissection. In total, 11 trematode species were found in Myotis bats. Only three trematode species, Plagiorchis koreanus, Prosthodendrium chilostomum and Parabascus duboisi were revealed in all studied Myotis spp. Prosthodendrium cryptolecithum was recorded for the first time in Russia. Digenean species diversity is higher in Myotis daubentonii and M. dasycneme. The trematode fauna of M. brandtii, M. nattereri and M. mystacinus is less diverse. The determining factor in the infection of bats by trematodes is feeding on semi-aquatic insects, possible second intermediate hosts of these parasites. Our results confirm the data that the ecological niches of the five Myotis species partially overlap. An analysis of the trematode fauna in Myotis spp. showed that in the Samarskaya Luka there may be weak competition for food items among bats.

Pharmaceutical poisoning is a significant global public health concern, causing approximately 190,000 deaths yearly. This scoping review aims to comprehensively map the available literature on pharmaceutical poisoning and compare patterns between high-income countries (HICs) and low-middle-income countries (LMICs). A systematic search was performed across the following databases: Embase, PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and CINAHL. Studies included were from 1st January 2011 to 31st December 2020, in English, with full text available. Seventy-nine articles were included in the study; 21 were from LMICs and 58 were from HICs. The toxic exposure was largely intentional (77%) in LMICs and accidental (68%) in HICs. Drugs acting on the nervous system were responsible for 95% of toxicities worldwide with analgesics accounting for the largest subtherapeutic group in both LMICs (40%) and HICs (58%). Notable statistics were that HICs accounted for 99% of opioid overdoses, and LMICs accounted for 19% of anti-epileptic-induced toxicities. Overall, the medical outcomes of poisonings were generally worse in LMICs. The review provides possible interventions to target specific geographic locations, based on the trends identified, to reduce the burden worldwide. Many gaps within the literature were recognised, calling for more robust analytical research.

Towns emerged as dynamic economic and political centers during the Middle Ages, giving rise to the emergence of new social classes. As a result of these functions, a new relationship began to be forged with the rural world, which supplied towns with foodstuffs that satisfied new social demands. Archaeobotanical analysis (carpology) allows us to understand the flow of cash crops by tracing seeds and fruits produced in the countryside that were consumed in and redistributed from the towns. The study of waterlogged contexts from medieval archaeological sites in the Kingdom of Galicia (Santiago de Compostela, Padrón, and Pontevedra) has provided a set of species that played a crucial role in the economy of the urban dwellers and that possibly were related to differential access or food preferences. Evidence for fruits (grapes, chestnuts, figs, apples, and cherries, among others), garden crops (melon), and cereals (foxtail millet, rye, naked wheat, and oat) has been documented. Broomcorn millet is particularly abundant, demonstrating that it was important for subsistence. Some of the species found (medlar and turnip/grelo) are novel in the archaeobotanical literature of the medieval period in the Iberian Peninsula.

Background: The study aimed to assess the prevalence and correlates of suicidal ideation, plans and attempts among middle school students in Sierra Leone. Method: Data from 2,798 adolescents (15 years of median age) that responded to the cross-sectional “2017 Sierra Leone Global School-Based Student Health Survey (GSHS)” were analysed. Results: The prevalence of past 12-month suicidal ideation was 14.2%, suicide plans 16.0%, and suicide attempts 19.1%. In adjusted logistic regression analysis, worry-induced sleep disturbance (Adjusted Odds Ratio-AOR: 1.84, 95% Confidence Interval-CI: 1.32-2.57), bullied (AOR: 2.90, 95% CI: 1.77-4.74), trouble from alcohol use (AOR: 1.90, 95% CI: 1.03-3.50), and leisure-time sedentary behaviour (AOR: 2.42, 95% CI: 1.18-4.98) were associated with suicidal ideation. Bullied (AOR: 2.40, 95% CI: 1.46-3.95) and current cannabis use (AOR: 2.48, 95% CI: 1.51-4.09) were associated with suicide plans in the past 12 months. No close friends (AOR: 2.63, 95% CI: 1.46-4.72) loneliness (AOR: 1.69, 95% CI: 1.08-2.66), bullied (AOR: 2.33, 95% CI: 1.66-3.28), trouble from alcohol use (AOR: 4.01, 95% CI: 2.25-7.13) and current cannabis use (AOR: 2.93, 95% CI: 1.37-6.25) were positively and school attendance (AOR: 0.62, 95% CI: 0.42-0.92) negatively associated with suicide attempts in the past 12 months. Conclusion: Almost one in five students had made suicide attempts in the past 12 months and several associated variables were discovered that can assist in designing interventions.

The purpose of this study was to examine the relationships between smartphone addiction of middle school students and smartphone usage types, depression, attention deficit hyperactivity disorder (ADHD), stress, interpersonal problems, and parenting attitude. This study was also performed with the aim of verifying the relationships among depression, ADHD, perceived stress, interpersonal problems, and parenting attitude, which are predictors of smartphone addiction. The subjects of this study were 487 local middle school students (234 males and 253 females). The measurement instruments used were the smartphone addiction scale, depression scale (PHQ-9), ADHD scale (K-ARS), perceived stress scale (PSS), interpersonal problem scale (KIIP-SC), and the parenting attitude scale. This study identified the relationships between the variables with correlation analysis and examined the predictors of smartphone addiction with hierarchical multiple regression analysis. According to the study results, the factors that influenced smartphone addiction were gender, stress, and interpersonal problems. In addition, when the confounding variables of smartphone addiction were controlled to examine the effects of smartphone usage types on smartphone addiction, social media use and music/videos were found to have a positively significant effect on smartphone addiction while study had a negatively significant effect. The order of the usage types with the highest influence on smartphone addiction was enjoying music/videos, social media use, and study. This suggests that selective intervention depending on the main smartphone usage type can be effective.

The implications of urban revitalization, gentrification, and residential migration have attracted widespread interest and ongoing debate among scholars across a range of disciplines. While a significant body of literature explores race and class interactions within urban gentrifying neighborhoods, few have examined the environments that await those displaced by this process. This study explores the social and political impact of urban gentrification and class stratification within the black community by examining responses of black middle class residents in Prince George’s County, MD to the growing in-migration of low-income and minority residents from Washington, DC. Drawing on data from the U.S. Census Bureau, a multi-neighborhood sample of ninety-five black middle class residents of Prince George’s County, and informal interviews with subject-area experts, this study explores how race and class shape residential decisions and their impact on residential mobility initiatives. Residents responded to a 26-item survey that covered demographic information, political and community engagement, and their attitudes and beliefs about the poor, changes in their community, and racial unity and responsibility. Findings from cross tabulations and binary logistic regression indicate that lower middle class residents are the most likely to resist in-migration by exiting their communities and/or voting against proposals to create affordable housing options. Core and upper middle class residents were the most likely to stay in their neighborhoods despite increases in low-income migration, to vote in support of policies to create affordable housing options and to believe their responsibility to poor blacks could include sharing residential space.

BACKGROUND G6PD deficiency is an inherited an X-linked recessive condition leading to insufficient levels of glucose-6-phosphate dehydrogenase, thus causing hemolytic anaemia under certain conditions. METHODS Our study is explorative for cases admitted to Jordan University Hospital. The studied parameters include demographics, clinical manifestations, biochemical markers including Hb level, WBC count, liver enzymes, and blood grouping. RESULTS Most of the patients were admitted to the emergency unit (53.13%). Individuals who were Rh-positive represented 57.81%, while patients of AB blood group accounted for 75%. The mean values were 4.81 years (age), 29.06 hours (time-to-hospital admission), 38.10 degree Celsius (temperature), 6.11 gm/dl (Hb), 13242.19 (WBC count), 343.20 U/L (S. ALP), and 50.98 IU/L (S. ALT). There was no significant difference between males and females or between favism-induced versus drug-induced hemolytic episodes. AB and Rh positive blood groups are of protective effect in relation to liver enzymes. Patients who were admitted to the hospital within 24 hours from having clinical manifestations had a better prognosis. CONCLUSION This study is the first inferential research on G6PD deficiency from the Middle East to explore cases from one of the largest healthcare centres in Jordan. The role of blood grouping should be investigated prospectively.

Hydrological modeling allows us to make a comprehensive assessment of the interaction between dynamics of the hydrological cycle, climate conditions, and land use. These modeling results are relevant in water resources management field. We use TopModel (TOPography based hydrological MODEL for the hydrological modeling of an area of 17 000 km² in the Middle Magdalena Valley (MMV), a tropical basin located in Colombia. This study is located in the intertropical convergence zone (ITCZ) which is characterized by special meteorological conditions and fast water fluxes over the year. This area has been subjected to significant land use changes, as a result of intense economic activities, e.g., agriculture, hydropower energy and oil & gas production (Avellaneda, 2003). The proposed model is based on a record of 12 years of: i.) daily precipitation data from observed gauges, ii.) daily evapotranspiration data from temperature data and iii.) daily streamflow data as observed data. A calibration process was performed using data from 2000 to 2008, and a validation was performed with data from 2009 to 2012. The Nash-Sutcliffe coefficient was used as an objective function to assess the quality of these processes (values of this metric are between 0.74 and 0.73 respectively, for model calibration and validation). The results show us an adequate performance of the model in areas of the tropical region and allow us to analyze the relationship between water storage capacity in the soils of the area with subsurface runoff. This conclusion is consistent with the characteristics of the region. The calibrated model provides an idea about the hydrological functioning of the basin and estimates an approximation of the groundwater recharge in the region. The estimation of the recharge is important to quantify the interaction of surface water and groundwater, especially during the dry season, due to its importance in the analysis of scenarios with climate variability.

Tissue bioengineering has been assuming a pivotal role in implementing alternatives to conven-tional ossicular middle ear replacement prostheses to overcome extrusion while preserving acoustic properties. This in vitro study aims to explore for the first time in current literature the feasibility of a biohybrid middle ear prosthesis composed of titanium surrounded by bone ex-tracellular matrix as bio-coating. We have hereby studied the adhesion and proliferation of human adipose-derived mesenchymal stem cells (hASC) on titanium scaffolds in vitro. Moreover, we identified the osteogenic differentiation of hASC using immunofluorescence assay to analyze osteoblasts gene expression profile (Alp, Runx2, Col1a1, Osx, and Bglap) and we accounted the presence of collagen as a marker of hASC ability to secrete extracellular matrix. We utilized scanning electron microscopy to evaluate the presence of extracellular matrix on the scaffolds. Our preliminary data demonstrated the titanium ability to support human adipose-derived mesenchymal stem cell colonization, proliferation, and osteoblastic differentiation, to obtain a biohybrid device. Our experience seems encouraging, we advocate further in vivo research to corroborate our results towards bone transplantation.

This study investigates the frequency dependence of the correlation or anticorrelation of ozone and temperature in the middle atmosphere. The anticorrelation of ozone and temperature plays a role for the expected recovery or superrecovery of upper stratospheric ozone in presence of manmade cooling of the middle atmosphere due to increasing carbon dioxide emissions. The correlation between lower stratospheric ozone and temperature indicates the dependence of lower stratospheric temperature trends on the ozone evolution in addition to greenhouse gas emissions. Ozone and temperature measurements of the microwave limb sounder (MLS) on the satellite Aura from 2004 to 2021 are utilized for Bern (46.95∘N, 7.44∘E) at middle latitudes and for the equator region. The time series are bandpass filtered for periods from 2 days to 5 years. The correlation coefficient depends on the period of the oscillation in temperature and ozone. The strongest correlation and anticorrelation are found for the annual oscillation. The anticorrelation between ozone and temperature in the upper stratosphere is about −0.7 at a period of 2 days and −0.99 at a period of one year. Thus, the temperature dependence of the ozone reaction rates also leads to an anticorrelation of ozone and temperature at short periods so that ozone can be considered as a tracer of planetary waves. At the equator, a dominant semiannual oscillation and an 11 year solar cycle are found for nighttime ozone in the upper mesosphere. The SAO in ozone and temperature show a strong correlation indicating a dynamical control of the ozone SAO in the upper mesosphere. The SAO in the equatorial nighttime values of ozone and temperature is due to a semiannual modulation of vertical advection by the diurnal tide.

The coombs (in Catalan comes) form an integral part of the landscape. These are small valleys, with the deepest and flattest part cultivated for agriculture. They are predominantly found in the most arid regions of Catalonia, particularly around the cities of Tarragona and Lleida. They are generally dry land areas. We propose that these coombs gained significance in the early centuries of the Middle Ages, a period marked by intense erosion. It is important to identify their locations and establish connections with medieval written documents, the settlements that thrived throughout the Middle Ages, archaeological sites such as necropolises, and the valuable data derived from to-ponymy studies. We think that understanding these coombs can greatly contribute to under-standing how the territory was organized in the Middle Ages, the extent of cultivated lands that were established, and the distribution of many settlements. Ultimately, this knowledge can aid in acquiring better understanding of the current landscape.

Children five years or younger in low- and middle-income countries (LMICs) are severely affected by diarrhoea disease, especially in the sub-Saharan region. Hence, the study aimed at determining the prevalence and determinants of diarrhea disease among children under 5 years in Epworth Township, Zimbabwe. A descriptive cross-sectional study was conducted at a local clinic in Epworth Township, Harare. A convenience sampling strategy was used to recruit study participants for participation and 386 children were enrolled in the study. The majority were male children (n=229; 59.3%), while there were more female caregivers (n=370; 95.9%) than male caregivers (n=16; 4.1%). The prevalence of diarrhea disease in the study was 25.1%. The determinants associated with diarrhea were being partially vaccinated (OR 2.38, CI 95% 2.80–8.22), collecting water more than 1 kilometre from a household (OR 4.55; CI 95% 2.10–9.85) and using untreated water (OR 6.22; CI 95% 2.13–18.20). The age of the caregiver and using a clean water container (OR 0.05; p=0.020) were protective factors. Provision of primary health care, especially prevention of disease through immunization and rendering environmental health services could reduce the prevalence of diarrhea in disadvantaged townships.

Advanced Hepatocellular carcinoma (HCC) is no longer a terminal illness. This change was mainly attributed to the development of new treatments including tyrosine-kinase inhibitors (TKIs), vascular endothelial growth factor (VEGF) inhibitors and immune checkpoint inhibitors (ICPIs) but the financial toxicity of treating advanced HCC is of a major concern specially in low middle-income countries (LMICs) where the patients are still battling for their most basic rights. Most of advanced HCC patients in LMICs have very limited accessibility to the new treatments including ICPIs. Searching for out of the box solutions to improve access to treatments -mainly ICPIs- is an utmost necessity for LMICs advanced HCC patients.

Greenhouse Gases (GHGs) emission has considerable impact on global warming and climate change. Since energy systems and their features noticeably influence on the amount of GHGs emission, it can be modeled based on the specifications of energy sources utilized by the countries. In addition, economic activity is another factor which should be considered in GHG emission modeling. In this work, Artificial Neural Network (ANN) is used for estimating carbon dioxide emission, as one of the most abundant GHGs, on the basis of shares of various energy sources used as primary energy supply and GDP as an indicator for economic activities. Five countries including Iran, Kuwait, Qatar, Saudi Arabia and United Arab Emirates (UAE) are considered as case studies. Comparing between the estimated data by the achieved model and actual quantities showed acceptable precision of the ANN model for prediction of carbon dioxide emission. The average absolute relative error and the R-squared values of the GMDH model are approximately 2.28% and 0.9998, respectively. The obtained values for the mentioned statistical criteria show the precision of the model in forecasting the emission of Co2.

The human coronaviruses (CoV) include HCoV-229E, HCoV-OC43, HCoV-NL63 and HCoV-HKU1, some known for decades. The severe acute respiratory syndrome (SARS) CoV briefly emerged into the human population but was controlled. In 2012 another novel severely human pathogenic CoV – Middle Eastern Respiratory Syndrome (MERS)-CoV was identified in the Kingdom of Saudi Arabia, where 80% of over 2,000 human cases have been recorded across five years. Targeted research remains key to developing control strategies for MERS-CoV, a cause of mild illness in its camel reservoir. A new therapeutic toolbox being developed in response to MERS is also teaching us more about how CoVs cause disease. Travel-related cases continue to challenge the world’s surveillance and response capabilities and more data are needed to understand unexplained primary transmission. Signs of genetic change have been recorded but it remains unclear whether any impact on clinical disease. How camels came to carry the virus remains academic to the control of MERS. To date, human-to-human transmission has been inefficient, but virus surveillance, characterisation and reporting are key to responding to any future change. MERS-CoV is not currently a pandemic threat; it is spread mainly with the aid of human habit and error.

At the entrance of some churches in Tuscany (Italy), the reproduction of an apparently undecipherable inscription can be found. At least from the 18^th century, this epigraphic puzzle has originated a debate on its interpretation. This study proposes a hypothesis based on the Latin alphabet used in texts contemporary to the churches where the inscription is reproduced and a possible interpretation of the message consistent with the official religious doctrine. The proposed deciphering is extended to the full text, including some signs that were previously considered as geometric forms or a specific elaboration of letters not attested in other contemporary documents.

Background: To compare the clinical efficacy of Japas osteotomy of the middle foot and first metatarsal sequence osteotomy in treating children with cavovarus foot deformity. Methods: A retrospective analysis was performed on the clinical effect of cavovarus foot surgery from January 2012 to January 2019. Thirty light and medium cavovarus foot cases underwent osteotomy based on soft tissue release. Among them, 16 cases of 22 feet underwent first metatarsal sequence osteotomy, and 14 cases of 21 feet underwent middle foot Japas osteotomy. Ankle-posterior foot (Wicart) scoring system was used to evaluate the good and good rates of the two surgical methods. X-ray films were taken before and after the last follow-up in a standing weight-bearing position, and Meary Angle, Hibb Angle, and Pitch Angle were measured to compare the clinical efficacy of the two surgical methods in correcting the light and medium-cavovarus foot deformity.Results: (1) All patients were followed up for an average of 30 months. There was no significant difference in Meary, Hibb, and Pitch Angle between first metatarsal osteotomy and middle foot Japas osteotomy before surgery, indicating that the severity of malformation was similar between the two groups. (2) The Meary, Hibb, and Pitch Angle of the last follow-up were compared between the two groups (P>0.05), which showed no statistical significance, indicating that the two surgical methods had similar effects on cavovarus deformity correction. (3) At the most recent follow-up, there was no statistically significant difference between the two groups regarding the percentage of patients who achieved an excellent or good Wicart score; for the first metatarsal osteotomy group, the rate was 87%, and for the Japas osteotomy group was 90%; the Fisher test p>0.05 indicates that the postoperative excellent and good rates of the two treatments are comparable.II (4) Comparison of operation time and intraoperative blood loss between the two groups, P<0.05, showed statistically significant differences, indicating that the first metatarsal osteotomy had obvious advantages over Japas osteotomy operation time and intraoperative blood loss. Conclusions: There is no significant difference in postoperative efficacy between first metatarsal osteotomy and Japas osteotomy for light and medium-cavovarus with the apex of the deformity located at the medial cuneus or navicular cuneiform joint. However, the intraoperative blood loss and operative time of first metatarsal osteotomy are superior to Japas osteotomy of the middle foot, and the trauma to children is less. Therefore, the first metatarsal osteotomy can be considered a surgical procedure.

Primary and middle school teachers are a critical part of China’s foundational education; teacher turnover heavily affects the stable development of foundational education. In this study, interviews with 20 teachers found that relatively low income, high work pressure, unfair distribution, and difficulty in achieving promotion to higher professional titles are the main reasons for teacher turnover intention. This study investigates 485 primary and middle school teachers from Zhejiang and Jiangsu provinces. We found that primary and middle school teachers reported intense feelings of unfairness about their distribution of income. Their salary satisfaction was low, and the ratio of turnover intention was high. The main reasons for teachers’ high turnover intentions were low income, high pressure from work, unfair distribution, and the difficulty of achieving professional title promotion. To lower teachers’ turnover intentions, China should raise teachers’ income appropriately and increase the number of teachers with high professional titles. Schools should improve procedural, distributive, and interactive justice. Teachers should adjust their income references and perceptions of fairness. This situation can be effectively resolved only if all parties work hard to make positive changes.

Objectives: Low and Middle Income Countries (LMICs) are experiencing a fast-paced epidemiological rise in clusters of non-communicable diseases (NCDs) such as diabetes and cardiovascular disease, forming an imminent rise in multimorbidity (MMD). However, preventing MMD has received little attention in LMICs, especially in Sub-Saharan African Countries. Design: Narrative review which scoped the most recent evidence in LMICs about MMD determinants and appropriated them for potential MMD prevention strategies. Methods: MMD in LMICs is affected by several determinants including increased age, female gender, environment, lower socio-economic status, obesity, and lifestyle behavious, especially poor nutrition and physical inactivity. Results: MMD public health interventions in LMICs, especially Sub-Saharan are currently impeded by local and regional economic disparity, underdeveloped healthcare systems, and concurrent prevalence of communicable diseases. However, lifestyle interventions that are targeted towards preventing highly prevalent MMD clusters, especially hypertension, diabetes and cardiovascular disease, can provide an early prevention of MMD, especially within Sub-Saharan African countries with emerging economies and socio-economic disparity. Conclusion: Future public health initiatives should consider targeted lifestyle interventions and appropriate policies and guidelines in preventing MMD in LMICs.

Focal cerebral ischemia can lead to blood-brain barrier (BBB) breakdown, which is implicated in neuroinflammation and elevation of matrix metalloproteinases (MMPs). The role of the anti-inflammatory protein, monocyte chemotactic protein–induced protein 1 (MCPIP1) plays in the injury of BBB in stroke has not yet been reported. This study was conducted to identify and characterize the role MCPIP1 plays in BBB breakdown. Transient middle cerebral artery occlusion (MCAO) is induced in both wild-type and Mcpip1^-/- mice for 2 hours of occlusion periods followed by reperfusion for 24 or 48 hours. BBB permeability was measured by FITC-dextran extravasation, MMP-9/3 expression was analyzed by western blot, and claudin-5 and zonula occludens-1 (ZO-1) were analyzed by immunohistochemistry and western blot. After MCAO in wild type mouse is induced, there is significantly increase in MCPIP1 mRNA and protein levels. Absence of MCPIP1 leaded to significant increase in FITC-dextran leakage in peri-infarct brain, significant upregulation of MMP-9, MMP-3 and reduced levels of tight junction components, claudin-5 and ZO-1 in the brain after MCAO. Our data demonstrate that absence of MCPIP1 exacerbates ischemia-induced blood-brain barrier disruption by enhancing the expression of matrix metalloproteinases and degradation of tight junction proteins. Overall data indicate that MCPIP1 is important protective role against BBB disruption in cerebral ischemia.

This study aimed to assess the prevalence and identify risk factors for schistosomiasis among school-aged children in low- and middle-income communities. A retrospective cross-sectional study was conducted, involving the examination of 24 034 children for Schistosoma haematobium ova. Data were analyzed using IBM Statistical Package for the Social Sciences (SPSS) version 27. Logistic regression was employed to determine the factors associated with schistosomiasis. The overall prevalence of schistosomiasis in the study population was 75%, with higher rates observed in rural-dominated areas, particularly Bushbuckridge (73%) and Nkomazi (51%). Age, a history of bilharzia, and the presence of blood in urine were significantly associated with schistosomiasis, while being a female child was found to be a protective factor. This study underscores the importance of implementing robust screening procedures and the necessity for health education to mitigate the high prevalence of schistosomiasis and prevent its further spread.

In response to new developments of work and employment in high-income countries (HICs), psychosocial aspects of work and health received increased attention. In contrast, middle-income countries (MICs) are mainly concerned with severe challenges of noxious and dangerous material work environments, poor employment conditions, and deficient social policies, leaving psychosocial aspects in a marginal role at best. More recently, differences between these two worlds were even aggravated by the COVID-19 pandemic. Yet, with economic globalisation and growing worldwide interconnectivity, the world of work in MICs is being rapidly transformed, sharing several concerns with modern Western societies. In this process, psychosocial occupational health will become an increasingly pressing issue. This contribution explores to what extent psychosocial aspects of work and health are already addressed in research originating from MICs. A selective focus on recent findings from two regions, Asia Pacific and Latin America, reveals a high degree of awareness of, and inquiry into, work-stress related problems within these countries. Importantly, in addition to incorporating research progress from HICs, these analyses identify new aspects within specific cultural and socio-economic environments, thus enriching the international state of art.

Transitioning to clean cooking fuels is not only part of achieving SDG7, but also makes a significant contribution to mitigating climate change by reducing carbon emissions. The paper contradicts the conventional wisdom that electricity is too expensive to cook with. The paper explores the energy required to cook dishes using different technologies and fuels by analysing data from Cooking Diaries and Controlled Cooking tests conducted under the MECS programme. Electric pressure cookers (EPCs) use least energy when compared with electric hotplates, and a detailed description of how the EPC works explains why this should be. The paper draws out distinctions between African and Asian dishes, notably the impact of energy intensive dishes prepared mostly in Africa. Standard efficiency based approaches to comparing the performance of stoves are not appropriate to modern electric cooking devices so an alternative approach based on specific energy consumptions is proposed e.g. charcoal stoves use 15 times as much energy as EPCs to cook African dishes. Energy ratios provide a basis for estimating carbon emission reductions associated with transitioning to modern cooking fuels. Historical costs show that the cost of cooking with an EPC can be only 20% of the cost of cooking with charcoal, which highlights the potential for modern, energy efficient electric cooking devices to defy the conventional wisdom of the energy ladder.

Background: The cavernous sinus (CS) is a highly vulnerable anatomical space, mainly for the neurovascular structures which it contains, therefore a detailed knowledge of its anatomy is mandatory for the surgical unlocking. To compare the anatomy of this region from different endoscopic and microsurgical operative corridors, also focusing on the corresponding anatomic landmarks met along these routes. Furthermore, we tried to define the safe entry zones to this venous space from these three different operative corridors and provide indications regarding the optimal approach according to the lesion location. Methods: Five embalmed and injected adult cadaveric specimens (10 sides) separately underwent dissection and exposure of the CS via superior eyelid endoscopic transorbital (SETOA), extended endoscopic endonasal transsphenoidal-transethmoidal (EEEA) and microsurgical transcranial fronto-temporo-orbito-zygomatic (FTOZ) approaches. The anatomical landmarks and the content of this venous space have been described and compared from these surgical perspectives. Results: The SETOA allowed the exposure of the entire lateral wall of the CS without entering its neurovascular structures and part of the posterior wall; furthermore, thanks to its anteroposterior trajectory, it allowed to disclose in a minimally invasive fashion, also the posterior ascending segment of the cavernous ICA with the related sympathetic plexus through the Mullan’s triangle. Through the anterolateral triangle, the transorbital corridor allowed to expose the lateral 180 degrees of vidian nerve and artery in the homonymous canal, the anterolateral aspect of the lacerum segment of the ICA, at its the transition zone from the petrous horizontal to the ascending posterior cavernous segment, surrounded by the carotid sympathetic plexus, and the medial Meckel’s cave. Conclusion: Different regions of the cavernous sinus are better exposed by different surgical corridors. The relationship of tumor and cranial nerves in the lateral wall guides the selection of the approach to cavernous sinus lesions. The transorbital endoscopic approach can be considered a safe and minimally invasive complementary surgical corridor to the well-established transcranial and endoscopic endonasal routes in the exposure of the cavernous sinus. Nevertheless, peer knowledge of the anatomy and a surgical learning curve are required.

Methicillin-resistant Staphylococcus aureus (MRSA) constitutes a serious public health concern with a considerable impact on patients' health and substantial healthcare costs. In this study, patients, and healthcare workers (HCWs)from six public hospitals in Benin were screened for MRSA. Strains were identified as MRSA using conventional microbiological methods in Benin and confirmed using Matrix-Assisted Laser Desorption/Ionization Time of Flight (MALDI-TOF) mass spectrometry in Belgium. Whole genome sequencing (WGS) was used on confirmed MRSA isolates to characterize their genomic content and study their relatedness. In total,304 and 61 samples were collected from patients and HCWs, respectively. The mecA gene was detected in all isolates. The isolates were assigned to five sequence types (STs), with ST8 (55.6%, n=15), ST152 (18.52%, n=5), and ST121 (18.52%, n=5) being the most common. All isolates carried multiple virulence genes, including genes encoding the Panton-Valentine leukocidin toxin (48.15%, n=13) and the test gene (29.63%, n=8) associated with toxic shock syndrome. The presence of strains carrying numerous genomic features associated with antibiotic resistance and virulence in HCWs is a major public health concern. This study highlights the need to implement a multimodal strategy for reducing the risk of cross-transmission of MRSA in hospitals.

The multiple regression method is still an important tool for establishing precipitation forecast models with a lead time of one season. This study developed a flexible statistical forecast model for July precipitation over the middle-lower reaches of the Yangtze River (MLYR) based on the prophase winter sea surface temperature (SST). According to the characteristics of observed samples and related theoretical knowledge, some special treatments (i.e., more flexible and better–targeted methods) were introduced in the forecast model. These special treatments include a flexible MLYR domain definition, the extraction of indicative signals from the SST field, artificial samples, and the amplification of abnormal precipitation. Rolling forecast experiments show that the linear correlation between prediction and observation is around 0.5, more than half of the abnormal precipitation years can be successfully predicted, and there is no contradictory prediction of the abnormal years. These results indicate that the flexible statistical forecast model is valuable in real-life applications. Furthermore, sensitivity experiments show that forecast skills without these special treatments are obviously decreased. This suggests that forecast models can benefit from using statistical methods in a more flexible and better-targeted way.

Introduction. Self-sampling has the potential to increase cervical cancer screening (CCS) among women living with HIV (WLWH) in low and middle-income countries (LMICs). However, our understanding of how HPV self-collection studies have been conducted in WLWH is limited. The purpose of this scoping review was to examine the extent to which the HPV self-sampling has been applied among WLWH in LMICs. Method: We conducted multiple searches in several databases for articles published between 2000 and January 2022. With the combination of keywords relating to HPV self-sampling, LMICs, and WLWH, we retrieved over 9,000 articles. We used pre-defined inclusion and exclusion criteria to select relevant studies for this review. Once a study met the inclusion criteria, we created a table to extract each study’s characteristics and classified them under common themes. We used a qualitative descriptive approach to summarize the scoping results. Results: A total of 12 articles were included in the final review. Overall, 3,178 women were enrolled in those studies and 2,105 (66%) of them were WLWH. The self-sampling participation rate was 92.6%. The findings of our study show that 43% of the WLWH in 8 of the studies reviewed tested positive for high-risk HPV (hr-HPV) genotypes, indicating 4 out of 10 WLWH in the studies are at risk of cervical cancer. The prevalence of the hr-HPV in WLWH was 18% higher than that of HIV-negative women. Most women in the study found the self-sampling experience acceptable, easy to use, convenient, and comfortable. Self-sampling performance in detecting hr HPV genotypes is comparable to clinician-performed sampling. However, limited access (i.e., affordability, availability, transportation), limited knowledge about self-screening, doubts about the credibility of self-sampling results, and stigma remain barriers to wide acceptance and implementation of self-sampling. In conclusion, the findings of this review highlight that (a) cervical cancer is a threat to every sexually active woman but for WLWH the threat increases, (b) self-sampling laboratory performance is similar to clinician performed sampling, (c) self-sampling is associated with an increase in cervical cancer screening uptake and (d) WLWH reported a positive experience with self-sampling. However, personal, environmental, and structural barriers challenge the application of self-sampling in LMICs, and these need to be addressed. Keywords: keyword 1; keyword 2; keyword 3 (List three to ten pertinent keywords specific to the article yet reasonably common within the subject discipline.)

This paper compares the Medieval (ca. 400–1500 CE) dynamics of forests from low-mountain (Montcortès; ca. 1000 m a.s.l.) and high-mountain (Sant Maurici; 1900 m a.s.l.) areas of the Iberian Pyrenees, both of which experienced similar climatic forcing but different anthropogenic pressures. The main aim is to identify forest changes over time and associate them with the corresponding climatic and anthropogenic drivers (or synergies among them) to test how different forests at different elevations respond to external forcings. This could be useful to evaluate the hypothesis of general Pyrenean deforestation during the Middle Ages leading to present-day landscapes and to improve the background for forest conservation. The study uses palynological analysis of lake sediments, historical documents and paleoecological reconstructions based on pollen-independent proxies. The two sites studied showed different forest trajectories. The Montcortès area was subjected to intense human pressure during regional deforestation up to a maximum of ca. 1000 CE. Further forest recovery took place until the end of the Middle Ages due to a change in forest management, including the abandonment of slash-and-burn practices. Climatic shifts indirectly influenced forest trends by regulating human migrations and the resulting shifts in the type and intensity of forest exploitation. The highland Sant Maurici forests exhibited a remarkably long-standing constancy and an exceptional resilience to climatic shifts, which were unable to affect forest extension and composition, and to local human pressure, from which they rapidly recovered. The Montcortès and Sant Maurici records did not follow the rule of an irreversible forest clearing during the Middle Ages leading to present-day landscapes. The present Montcortès landscape was shaped after a Medieval forest recovery, a new Modern-Age deforestation and a further forest recovery during the last centuries. The Sant Maurici forests remained apparently untouched since the Bronze Age and were never cleared during the Middle Ages. The relevance of these findings for forest conservation is briefly addressed, and the need for the development of more high-resolution studies on Pyrenean forest dynamics is highlighted.

Background: To date, FM using middle ear packing has rarely reported. In this study, we hypothesized that middle ear packing with dexamethasone soaked gelfoam and fibrin glue over the fat graft could promote the success rate of TMP closure regardless of perforation size. Methods: Between January 2005 and July 2020, a total of 209 patients who underwent fat myringoplasty due to chronic TMP at tertiary referral center were encountered and analyzed. The success rate and audiologic outcome was analyzed. Results: The mean successful TM closure rate was 88.0 %. The success rate by different age generation was not significant difference. The size of the perforation grade showed no significant difference. The perforation site by anterior or posterior was not significant. The preoperative mean threshold of AC, BC and ABG were 55.71, 12.98 and 42.73 dB respectively. The postoperative mean threshold of AC, BC and ABG were 23.67, 12.98 and 10.69 dB. The change of preoperative and postoperative hearing showed statistically significant. Conclusion: From our results, the simple trimming of the perforation edge and middle ear packing with external ear canal packing using fibrin glue induced the stable adhesion between the remnant TM and the fat graft.

Target 9.c of the 2015 United Nations (UN) sustainable development goals (SDGs) specifically addresses increasing access to information and communication technology (ICT) resources, and striving for universal access to the internet by 2020. The present study seeks to evaluate the effectiveness of the youth related national strategies implemented in this regard by a select number of countries in the Middle East region. The study does so, by relying on a spatial bivariate copula regression analysis of data on youth respondents from five countries, extracted from the 2018 Program for international students’ assessment (PISA). Focusing specifically on evaluating the availability of ICT resources to the youth population, and also identifying the impact of ICT resources on youth subjective well-being in the region, we find that except for the UAE and Qatar that have above OECD average youth performance on the ICT resource index, youth from the remaining countries reported below OECD level average access to ICT resources. The within region cross-country comparative analysis of ICT resources availability to the youth population at home, also highlighted significant heterogeneity across the five countries, post 2015 SDG adoption by UN country members. Furthermore, looking at the impact of ICT resources on youth well-being, controlling for not only cross-country spatial correlations, and factors such as home educational resources, cultural possessions at home, parental occupation status, youth expected occupation status, economic and socio-cultural status, age, gender, and grade level in school; we found that every standard deviation increase in ICT resources to the youth population in the region raises their self-expressed sense of belonging in school by 1.88% standard deviations. Given the empowering nature of ICT resources to youth, and the potential of both to support national as well as regional economic development initiatives, a concerted effort to ease ICT resources diffusion by member countries in the middle east region could assist not only each country in its own development path, but also the region as a whole to live up to its growth potential by the 2030.

In this paper, we draw on recent experiences from the Young Lives study to discuss some of the ethical and practical challenges facing longitudinal cohort studies in low- and middle-income countries in the time of coronavirus. We argue that COVID-19 has instigated an ‘ethics of disruption’ for social researchers across the world, and for longitudinal cohort studies like Young Lives, this requires navigating three core considerations: first, managing research relationships and reciprocity within an observational study design; second, maintaining methodological continuity and consistency across time; and third, balancing an immediate short-term response to COVID-19 against the longer-term perspective. We refer to the study’s plan to implement a new COVID-19 phone survey to illustrate how the team are navigating this altered ethical terrain.

Oiola archeological site, located in the mining complex of La Arboleda (Biscay, North Spain) was an important iron smelting center from the Roman Period to the Early Middle Ages and even in more current times (19th-20th centuries). Tap-slags and some plano-convex slags were identified as smelting slags. Samples were analyzed by optical microscopy, X-ray powder diffraction, scanning electron microscopy coupled with electron-dispersive spectroscopy and Raman microspectroscopy to perform a mineralogical and textural characterization. Additionally, thermogravimetric and thermodiffraction analyses were carried out to determine furnace operating temperatures. The mineral assemblage reflects furnace cooling rates and temperatures and the addition of quartz as the main flux to decrease the melting temperature of the iron ore. The comparison of slags from the Roman Period and the Early Middle Age allows to observe changes in the pyrometallurgical process through time.

We replace the current industry-standard empirical forecasts of oil production from hydrofractured horizontal wells in shales with a statistically and physically robust, accurate and precise approach, using the Bakken shale as an illustration. The proposed oil production forecasting method extends our previous work on predicting fieldwide gas production in the Barnett shale and merges it with our new scaling of oil production in shales. We first divide the existing 14,678 horizontal oil wells in the Bakken into 12 static samples in which depositional settings and completion technologies are similar. For each sample, we construct a purely data-driven P50 well prototype by merging the GEV distribution fits of oil production from appropriate well cohorts. We fit the parameters of our physics-based scaling curve to the statistical well prototypes, and obtain their smooth extrapolations to 30 years on production. By calculating the number of potential wells of each Bakken region, and scheduling future drilling programs, we stack up the extended well prototypes to achieve the most plausible forecast. We predict that Bakken will ultimately produce 5 billion barrels of oil from the existing wells, with the possible increments of 2 and 6 billion barrels from core and noncore areas.

Natural ecosystem of Islands and coastal region are vulnerable to climate change phenomena such as increasing temperature, fluctuating rainfalls, ocean acidification and tsunami. Andaman and Nicobar group of islands lies in Bay of Bangal facing such extreme climate phenomena. A spatial-temporal analysis of forest cover of middle Andaman region of the Andaman and Nicobar group of islands was done from 1990 to 2019 with an interval of 5-10 years. Support vector machine classifier, spectral indices such as Normalized Difference Vegetation Index, Normalized Difference Water Index, and Normalized Difference Built-up Index were used for the analysis of greenery, water resources, and urban land. Land surface temperature was estimated using split window algorithm for Landsat 8 and mono window algorithm for Landsat 5. The data showed relative contribution of forest region toward rising temperature in the island region. The research also showed that subsurface hydrology linked to interconnected lineaments provides a stable zone for forest cover. The open forest showed maximum fluctuation while minimum change was observed in Evergreen Forest. The spectral characteristics analysis using indices showed significant change except in 2005 due to Tsunami occurred in 2005. The land surface temperature showed fluctuation near to 30° C from 1990 to 2019.

Middle East region experiences a high prevalence of hypovitaminosis D, yet most genetic studies on Vitamin D have focused on European populations. Furthermore, there is a lack of research on the genomic risk factors affecting the elderly population, who are more susceptible to health burden. We investigated the genetic determinants of 25-hydroxyvitamin D levels in elderly Lebanese individuals (n=199) through a whole exome-based genome-wide association study. We identified new loci with suggestive evidence of an association with Vitamin D levels, including rs141064014 in the MGAM gene (P-value of 4.40 × 10−06) and rs7036592 in PHF2 (P-value of 8.43 × 10−06). A meta-analysis of the Lebanese data and the largest European genome-wide association study confirmed consistence replication of numerous variants, including rs2725405 in SLC38A10 (P-value of 3.73 x 10-08). Despite the lower performance of European-derived polygenic risk scores compared to the European estimations, it still effectively predicted Vitamin D deficiency among elderly Lebanese individuals. Our findings provide novel insights into the genetic mechanisms of Vitamin D deficiency in Middle Eastern elderly populations, facilitating the development of personalized approaches for more effective management of hypovitaminosis D. Additionally, we demonstrated that whole exome-based genome-wide association study is an effective method for identifying genetic components associated with phenotypes.

Delayed diagnosis and a lack of adequate care for people with autism spectrum disorder (ASD) are related to worse outcomes and quality of life. This study aimed to identify the profile of service use, barriers to access care, and factors related to those barriers in Brazilian families with children with ASD. A total of 927 families with ASD children (3-17 years) from five Brazilian regions completed an online version of the Caregivers Needs Survey. Results showed that the most used services were behavioral interventions and pharmacotherapy, while the most used professionals were neurologists, nutritionists, speech therapists, psychiatrists, psychologists, and pediatricians. The main barriers included waiting lists, costs, and the absence of services or treatment. Service use varied according to age, the region of residence, the type of health care system used, and the parents/caregivers' education. Access to behavioral interventions was more frequent among users of the private system/health insurance and families whose caregivers had higher education. The absence of specialized services/treatments was less frequent among residents of state capitals and families whose caregivers had higher levels of education. This study highlights how families with children/adolescents with ASD in Brazil face significant barriers to access care related to sociodemographic factors.

The spatiotemporal variability of vegetation in the Middle East was investigated for the period 2001–2019 using the Moderate Resolution Imaging Spectroradiometer (MODIS) 16-day/500 m composites of the Normalized Difference Vegetation Index (NDVI; MOD13A1). The results reveal a strong increase in the NDVI coverage in the Middle East during the study period (R = 0.75, p-value = 0.05). In Egypt, the annual coverage exhibits the strongest positive trend (R = 0.99, p-value = 0.05). In Turkey, both the vegetation coverage and density increased from 2001 to 2019, which can be attributed to the construction of some of the biggest dams in the Middle East, such as the Atatürk and Ilisu dams. Significant increases in the annual coverage and maximum and average NDVI in Saudi Arabia are due to farming in the northern part of the country for which groundwater and desalinated seawater are used. The results of this study suggest that the main factors affecting the vegetation coverage in the Middle East are governmental policies. These policies can have a positive effect on the vegetation coverage in some countries such as Egypt, Saudi Arabia, Qatar, Kuwait, Iran, and Turkey.

Coronavirus (COVID-19) gained and will continue to gain a lot of global attention over the coming months (and maybe the coming few years). Since its outbreak in Wuhan (China), it has turned into one of the major challenges affecting the whole world. In a comparatively short time, the virus outbreak turned into a pandemic that led to massive negative impacts not only on people health and well-being, but also on the global economy, travel industry, pharmaceutical industry, tourism industry, and many other industries. This research paper aims to investigate the different effects of coronavirus on the global Halal tourism and Halal hospitality industry and whether the coronavirus pandemic is the end of Halal tourism and hospitality as we know it or not. The paper offers an in-depth theoretical examination of the different aspect of the pandemic on Halal tourism and hospitality industry and provides guidance on how to address these different aspects. The current paper is one of very few research papers addressing coronavirus on the tourism and hospitality industry.

We performed a global analysis with data from 149 countries to test whether temperature can explain the spatial variability of the spread rate and mortality of COVID-19 at the global scale. We performed partial correlation analysis and linear mixed effect modelling to evaluate the association of the spread rate and motility of COVID-19 with maximum, minimum, average temperatures and temperature extreme (difference between maximum and minimum temperature) and other environmental and socioeconomic parameters. After controlling the effect of the duration after the first positive case, partial correlation analysis revealed that temperature was not related with the spatial variability of the spread rate of COVID-19. Mortality was negatively related with temperature in the countries with high-income economies. In contrast, temperature extreme was significantly and positively correlated with mortality in the low-and middle-income countries. Taking the country heterogeneity into account, mixed effect modelling revealed that inclusion of temperature as a fixed effect in the model significantly improved model skill predicting mortality in the low-and middle-income countries. Our analysis suggest that warm climate may reduce the mortality rate in high-income economies but in low and middle-income countries temperature extreme may increase the mortality risk.

The rising prevalence of autism internationally has been accompanied with an increased appreciation of the poorer mental health experienced by people with this condition and also of their family care-givers. In particular higher incidences of anxiety and depression are reported in high income nations and these conditions are likely to be under-recognised and under-reported in lower resourced regions or countries. Mainstream mental health services seem to be ill-equipped to respond adequately to the needs of autistic persons and their care-givers. This scoping review of 30 recently published literature reviews covering over 1,000 journal articles, summarises the insights and strategies that have been shown to promote the mental health and emotional wellbeing of autistic persons. In particular, a focus on family-centred, community-based supports is needed that aim to enhance social communication, extend social connections and promote an individual’s self-esteem, self-determination and social motivation. These low-cost interventions are especially pertinent in low resourced settings but they can be used internationally to prevent mental illness and assist in the treatment of anxiety and depression in autistic persons and their family carers. The priority is to focus on primary care responses with cross-sectoral working rather than investing in high-cost psychiatric provision.

In recent times, the process control network (PCN) of oil and gas installation has been subjected to amorphous cyber-attacks which include Denial-of-Service (DoS), Distributed-Denial-of-Service (DDoS), Man-in-the-Middle (MitM) attacks, and this may have been caused majorly by the integration of open network to Operation Technology (OT) as a result of low-cost network expansion. The connection of the OT to the internet for firmware updates, third-party support, or vendor interventions, has exposed the industry to attacks. The inability to detect these unpredictable cyber-attacks exposes the PCN and a successful attack can lead to devastating effects. This paper reviews the different forms of cyber-attacks in PCN of oil and gas installations and proposes the use of machine learning algorithms to monitor data exchanges between the sensors, controllers, processes, and the final control elements on the network so as to detect anomalies in such data exchanges. Python 3.0 Libraries, Deep-Learning Toolkit, MATLAB, and Allen Bradley RSLogic 5000 PLC Emulator software were used in the simulation of process control. The outcome of the experiments shows the reliability and functionality of the different machine-learning algorithms in detecting these anomalies with significant precise attack detections identified using a coarse tree algorithm.

Background. Oral anticoagulants (OACs) reduce stroke and systemic embolism (SE) in patients with atrial fibrillation (AF) but increase the risk of major bleeding (MB). No study has addressed the incidence and outcomes of bleeding in AF patients in the Middle East (ME). The Jordan AF study evaluated clinical profiles and one-year outcomes of AF patients who sustained bleeding events. Methods. Patients in 29 hospitals and clinics (May 2019 - December 2020) were enrolled and followed up for one year. Demographics and one-year events were compared in patients with or without bleeding. Results. Of 2018 patients enrolled; 166 patients sustained MB or clinically relevant non-major (CRNM) bleeding (8.2 events per 100 patient-years), including 47 patients who had MB (2.3 events per 100 patient-years). Compared with 1852 (91.8%) patients who did not have bleeding, patients with MB were older and had a higher prevalence of hypertension, diabetes mellitus (DM), heart failure, and malignancy, More patients with MB than those with no bleeding were using OACs (93.6% vs. 78.9%, p=0.02). Patients with MB had significantly higher one-year rates of stroke/SE (23.4% vs. 3.6%, p<0.0001) and all-cause mortality (31.9% vs 11.6%, p=0.001). Independent predictors of MB were stroke/SE (OR 10.8, 95% CI 5.3-21.9, p<0.0001), malignancy (3.4, 1.3-8.5, p=0.01), use of OACs (4.4, 1.3-14.7, p=0.02) and DM (1.9, 1.0-3.5, p=0.04). Conclusions. MB and CRNM bleeding occurred in (≈8%) of patients with AF at one year. Patients with MB (≈2%) had worse baseline clinical profiles and one-year prognosis compared with those who did not have bleeding. Keywords: Atrial fibrillation; Major bleeding events; Clinically-relevant non-major bleeding; Oral anticoagulants; Middle Eastern population; Prognosis. Clinical studies registration: the study is registered on clinicaltrials.gov (unique identifier number NCT03917992).

Hearing loss in infancy leads to preventable speech, language, and cognitive developmental delay [1, 2]. Sensorineural hearing loss (SNHL) is caused by damages, problems, or issues related to the inner ear such as the cochlea with or without the auditory nerve; cranial nerve VIII, involvement. There are three anatomic areas which include the outer ear: composed of the auricle and external auditory canal and the middle ear: which includes the tympanic membrane, ossicles, and the middle ear space, the inner ear: composed of the cochlea, semi-circular canals, and internal auditory canals. The unique anatomical shape of the auricle catches the incoming sound waves to send them down the external auditory canal. Hearing risk assessment should be part of all health visits while regular hearing screening checks are done for all children from 4 to 21 years [1, 2]. Assessment of hearing loss includes history, physical examination and specific hearing assessment tests.

This study aimed to assess the differences in the importance and performance of health awareness in Korean middle school students according to the types of online physical education classes they attended during the coronavirus disease-2019 pandemic. Overall, 583 participants were selected using a convenience sampling method; the data were obtained through an online survey using Google forms. Frequency analysis, reliability analysis, independent sample t-test, and importance-performance analysis were performed. First, the differences between importance and performance were found to be the most for sleep and physical activity management, and the least for disease and hygiene management. In addition, both the groups demonstrated higher importance and performance for hygiene and disease management. There were significant differences in the importance and performance of all the sub-factors. Second, hygiene, disease management, and mental health management were found in quadrant I in both the groups, while physical activity, sleep, and dietary habit management were in quadrant III. No factors were in quadrant II and IV.

Background: The ongoing COVID-19 pandemic and subsequent lockdown have adversely affected global health care services to varying extent. Emergency Services were also affected along with elective surgeries, which were deferred to accommodate the added burden of COVID 19 affected patients, on the healthcare systems. We aimed to assess the change in delivery of essential and emergency surgeries due to the pandemic. Methodology: A research consortium led by WHO Collaboration Centre (WHOCC) for Research in Surgical Care Delivery in Low- and Middle-Income countries (LMIC), India, conducted this retrospective cross-sectional study with 12 recruited centers. All surgeries performed during the months of April 2020 were compared with those performed in April 2019. These surgeries were stratified into emergency and elective, and further categorized based on NHS surgery prioritization documents. Results: A total of 4396 surgeries were performed at these centers in April 2019 and 1216 surgeries were performed in same month during 2020, yielding a fall of 72.3% (1216 /4396).We found a 54% reduction in emergency surgeries and a 91% reduction in the elective surgeries. Number of cesarean sections reduced by 29.7% and fracture surgeries declined by 85.3% Laparotomies and surgeries for local soft tissue infections with necrotic tissue reduced by 71.7% and 69.5% respectively. Conclusion: Our study quantifies the effects of COVID 19 pandemic on surgical care delivery in India and documents that the overall surgical volume reduced by three fourths in the pandemic period. Emergency surgeries reduced to half when compared with pre-pandemic period. Cesarean section surgeries were affected the least by pandemic, whereas the fracture surgeries and laparotomies were affected the most.

A short review of the important studies was conducted to evaluate the potential of aerosol transmission of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The minimum size of droplets potentially carrying the SARS-CoV-2 was newly estimated and discussed in this review.

In Low and Lower-Middle-Income countries, the prevalence of anemia in infancy remains high. In early childhood anemia cause irreversible cognitive deficits and represents a higher risk of child mortality. The consequences of anemia in infancy are a major barrier to overcome poverty traps. The aim of this study was to analyze based on a multi-level approach, different factors associated with anemia in children 6–23 m old based on recent available Standard Demographic Health Surveys (S-DHS). We identified 52 S-DHS that had complete information in all covariates of interest in our analysis between 2005 and 2015. We performed traditional logistic regressions and multilevel logistic regression analyses to study the association between hemoglobin concentrations and household, child, maternal, socio-demographic variables. In our sample, 70 % of the 6–23 m old children were anemic. Child anemia was strongly associated with maternal anemia, household wealth, maternal education and low birth weight. Children fed with fortified foods, potatoes and other tubers had significantly lower rates of anemia. Improving overall household living conditions, increasing maternal education, delaying childbearing and introducing iron rich foods at six months of age may reduce the likelihood of anemia at in toddlerhood.

We have studied the relative positions of the frontier levels determine the main electronic properties and reaction ability, there is important necessity to compare the MO of the purine and рyrimidine bases: adenine (A), guanine (G), cytosine (C), thymine (T) and uracil (U). The donor and acceptor properties are the fundamental characteristic of the conjugated molecules and can be quantitatively estimated by relative positions of the frontier molecular orbitals. The MO’s energies can be estimated experimentally or quantum-chemically. Analysis of the relative position of the frontier levels (calibrated by the energy gap) enables the investigation of the donor/acceptor properties of the RNA/DNA bases more detailed. The index φ0 is proposed for the quantitative quantum-chemical estimation of the donor ability of the conjugated molecules: it points on the shifting of the energy gap relative to the reference electron balanced system. The RNA/DNA bases divided strictly by two groups: predominantly donors (φ0 > 0.5) and predominantly acceptors (φ0 > 0.5). Each representative base of the first group forms the stable base pair the representative base of the second group the difference of indices Δφ0 should be optimal to enables the DNA replication.

The craft guilds have been at the core of important historiographical debates on the economic, social and political history of medieval cities for twenty years. The aim of this article is to examine the seamen’s guilds in the town ports of Northern Peninsula in the late Middle Ages. This study analyzes fundamental aspects of the social assistance, labour organization and social identity of the town ports, located on the maritime border of the Kingdom of Castile. In contrast to the more classical view of the craft guilds as protectionist institutions, which only served the interests of a privileged group of masters, this analysis highlights the contribution of the seamen craft guilds to the organization of labor at sea, the training of sea workers, the ability to negotiate with merchants and avoid labor exploitation, the provision of social assistance to the most vulnerable population, and the ability to lead the social protest for the guilders’ representation in the urban government. In summary, it is concluded that the seafarers’ guilds were constituted as networks of mutual help between individuals in the labor, welfare and political spheres of the population of the town ports of Northern Iberia in the late Middle Ages.

The composition and pattern of ecosystems are important factors determining the overall status and spatial differences of ecosystem service functions. However, under the background of differential land policies and ecological protection policies, research on the trend of ecological system pattern changes in the Fenhe River Basin is insufficient. Taking the upper and middle reaches of the Fenhe River Basin as the study area, based on long-term NDVI index and multi-period LUCC remote sensing images, this study used spatial statistics and time trend analysis methods to analyze the spatio-temporal dynamic changes of vegetation, land use, landscape pattern, and explored the impact of major driving factors on ecosystem changes. The results show that: (1) From 2010 to 2020, the vegetation cover in the upper and middle reaches of the Fenhe River Basin increased, with an annual NDVI increment of 0.003 (P<0.001). NDVI showed an increasing trend spatially, with significant statistics (P<0.001) and significant changes (P<0.05) in vegetation in high-altitude mountain areas, and the vegetation cover was mostly forests or grasslands. There was no significant change in vegetation cover in the low-lying urban agglomeration area. (2) From 2010 to 2020, the area of water bodies or wetlands in the study area significantly decreased, with 51.3% converted to arable land and 33.9% transferred to construction land, while only 2.2% remained as water bodies or wetlands. From 2015 to 2020, the trend of water body changes slowed down, with the proportions of conversion to arable land and construction land being 44.0% and 18.4% respectively, while the area of wetlands or water bodies remained at 16.3%. During the period of 2015-2020, the area of water bodies or wetlands converted to other land types increased by more than 14% compared to 2010-2015. This proportion reached more than 30% compared to the 13th Five-year Plan Period. (3) From 2010 to 2020, the spatial changes of landscape diversity (SHDI) and evenness (SHEI) of LUCC showed heterogeneous characteristics. In the high-altitude areas near the river basin boundary, the values of SHDI and SHEI were below 1.0. While in the low-altitude plain areas and urban areas with relatively frequent human activities, the values of SHDI and SHEI were above 1.0, and the values in urban areas could reach above 1.5. The evolution of ecosystem patterns in the upper and middle reaches of the Fenhe River Basin in the past decade has been clarified, providing a scientific basis for the construction and management of ecological environment governance and restoration projects in the Fenhe River Basin, and providing practical references for ecological protection and high-quality development practice in the Yellow River Basin.

Quantum computing arrives. Preceded by Mādhava of Sangamagrāma and other Hindu mathematicians, around 1,500 CE, and our previous work, we show at least 4 quantum properties that are indeed universal in some number systems; here we use them to enable quantum computing. Using the sets B={0,1}, B^n, N, Z, Q, and Q*, one has +4 quantum properties that one can trust, as archetypes of easy communication to friends and foes, to ignoranti or cognoscenti, and for quantum consciousness. Therefore, this work applies to computer calculations, apps in cell phones, algebra, atoms, mathematics, physics, and the human mind.

We present a new vision on the double-slit experiment (DSE), that does not use any waves or the so-called wave-particle duality. It is based on particles, viewed as localized vibrations. Rather than being illogical, or mysterious, the approach reproduces logically the interference patterns observed externally, using the well-known ``amplification of stimulated emission'' (ASE). The conservation of particle number is not observed. Different particles can present ASE with in-phase or counter-phase behavior, making the patterns observed for electrons, other particles, even atoms. The Law of the Excluded Middle (LEM) is not broken illogically in two-states macroscopically, but broken naturally in three or more states, microscopically, using ASE. Any particle supporting ASE, in-phase or counter-phase, can enter a DSE, and provide an external interference pattern. Frequency plays a role, while amplitude is not considered. This work is important in quantum computing, possibly saving cost, time, and welcoming more participants.

Although numerous articles have been published to address drivers or barriers of corporate social responsibility (CSR), some parts of the world have received less attention. In this study, I reviewed the literature, from 2010 to 2021, to identify drivers and barriers of CSR in the the Middle East and North Africa (MENA) region and compare them with the findings in western countries. (2) Methods: For this study, I used a structured literature review method. By setting the inclusion and exclusion criteria, only 28 articles remained from selected database; (3) Results: The findings revealed some CSR drivers, such as leadership styles, profitability, reputation, moral commitment, and environmental conservation are common in both regions. There are also some differences between CSR drivers, for example religious beliefs, low concentration of ownership, and company characteristics are some of the drivers in the MENA region. Maintaining social license to operate, avoiding the risks of community opposition, pressure from the government, and consumer demand tend to be more important in western countries. Common barriers in both regions are lack of financial resources, cost, lack of CSR knowledge and awareness, and ownership concentration. This review also highlighted that lack of law enforcement, lack of stakeholder communication, lack of management commitment, lack of interests, corruption, and financial debts are some of the addressed barriers of CSR in the MENA region, while cost/benefit ratio, lack of customer interest, and lack of scientific frameworks are the special barriers in western countries. (4) Conclusions: While researchers in western countries have more focus on energy sector, there is a lack of research about drivers and barriers of CSR in the MENA region in several industries, including oil and gas.

We find at least 4 quantum properties that are indeed universal in some number systems; and we can use them for quantum consciousness. Using the sets B={0,1}, N, Z, or Q has the +4 quantum properties that one can trust, as archetypes of easy communication to friends and foes, to ignoranti or cognoscenti, and for quantum computing. This paper proposes the use of Bayesian geometry to reduce the space of possible results, reducing or increasing initial beliefs by successive experimentation. This is exemplified in biology and mathematics, and can be applied to physics and other sciences. The conclusion is that an experimental fact can be absolutely verified. Any mathematical choice (as verified by computers) militating against R=Q, is under an absolutely low chance to succeed. Infinitesimals are denied based on 3^16 independent factors. This is not a probabilistic result, but based on reduction of the Bayes geometry for updating beliefs. This work applies to non-probabilistic and unknown phenomena, such as those found in oscillations (neutrino, health), evolution, and quantum computing, denies Gödel's uncertainty, and solves the liar's paradox by reflection. This connects different scientific fields with one another, in an internet, i.e., in a network of connections of multiple open networks, using the set Q, resembling a hologram, and includes entanglement.

Human-Computer Interaction, including technology-aided instruction, is beginning to focus on virtual reality (VR) technology due to its ability to support immersive learning, teaching through simulation, and gamification of learning. These systems can deliver high-level multisensory learning experiences that are important in the teaching of many subjects, especially those involving abstract concepts or requiring spatial skills, such as organic chemistry. Haptic experiences with VR, however, remain a challenge. In addition, development have focused on general entertainment/gaming; VR systems in chemistry implement simulations of the chemistry laboratory and other advanced systems whereas those that support safe, game-like, immersive and multisensory learning of organic chemistry with haptics at pre-university education levels are scarce. We developed the VR Multisensory Classroom (VRMC) as an immersive learning environment within a VR head-mounted display, where learners employ hand movements to build hydrocarbon molecules and experience haptic feedback through gloves with built-in sensors and hand-tracking with the Leap Motion system. We report here the evaluation of the first prototype by learners from diverse backgrounds who reported on the ability of the VRMC to support high engagement, motivation, interest and organic chemistry learning as well as diverse learning styles. The VRMC is a novel VR classroom that supports immersive learning in molecular organic chemistry with haptics for multisensory learning.

There is a systematic exclusion of gender-based violence, safe abortion, reproductive cancers, infertility services, comprehensive sexuality education, sexuality services, and STI’s other than HIV in essential health packages in LMICs. To accelerate progress on sexual reproductive health (SRH), the Guttmacher–Lancet Commission proposed the adoption of these interventions into an essential health package of SRH services that should be universally available. In this commentary, we use a healthcare priority-setting processes lens to review the importance of these services for universal health coverage. We isolate inherent challenges in social value judgments for terminal, process and content evidence for their healthcare priority-setting. We then advance promising emerging practical examples from low to middle-income countries on evidence-informed decision-making processes. We recommend capacity development through regional support, generating equity and efficiency evidence and strengthening political and publicly acceptable processes to institutionalise and operationalise evidence-informed decision-making.

In this study, we introduce a novel framework for the estimation of residual renal function (RRF), based on the population compartmental kinetic behavior of Beta 2 Microglobulin (B2M) and its dialytic removal. Using this model, we simulated a large cohort of patients with various levels of RRF receiving either conventional high-flux hemodialysis or on-line hemodiafiltration. These simulations were used to estimate a novel population kinetic (PK) equation for RRF (PK-RRF) that was validated in an external public dataset of real patients. We assessed the performance of the resulting equation(s) against their ability to estimate urea clearance using cross-validation. Our equations derived entirely from computer simulations and advanced statistical modeling, and had extremely high discrimination (AUC 0.808 – 0.909) when applied to a human dataset of measurements of RRF. A clearance-based equation that utilized pre and post dialysis B2M measurements, patient weight, treatment duration and ultrafiltration had higher discrimination than an equation previously derived in humans. Furthermore, the derived equations appeared to have higher clinical usefulness as assessed by Decision Curve Analysis, potentially supporting decisions that for individualizing dialysis frequency in patients with preserved RRF.

Computation of Common Middle Point seismic sections and their subsequent time migration and diffraction imaging provides very important knowledge about the internal structure of 3D heterogeneous geological media and are key elements for successive geological interpretation. Full-scale numerical simulation, that computes all single shot seismograms, provides a full understanding of how the features of the image reflect the properties of the subsurface prototype. Unfortunately, this kind of simulations of 3D seismic surveys for realistic geological media needs huge computer resources, especially for simulation of seismic waves’ propagation through multiscale media like cavernous fractured reservoirs. In order to significantly reduce the query of computer resources we propose to model these 3D seismic cubes directly rather than the shot-by-shot simulation with subsequent CMP stacking. To do that we modify the well known "exploding reflectors principle" for 3D heterogeneous multiscale media by use of the finite-difference technique on the base of grids locally refined in time and space. To be able to simulate realistic models and acquisition we develop scalable parallel software, which needs reasonable computational costs. Numerical results for simulation of Common Middle Points sections and their time migration are presented and discussed.

Vitamin C is an essential nutrient that must be obtained through the diet in adequate amounts to prevent hypovitaminosis C and the potentially fatal deficiency disease scurvy. Global vitamin C status and prevalence of deficiency has not previously been reported, despite vitamin C’s pleiotropic roles in both non-communicable and communicable disease. This review highlights the global literature on vitamin C status and the prevalence of hypovitaminosis C and deficiency. Related dietary intake is reported if assessed in the studies. We also explore if global vitamin C status has changed over time. Overall, the review illustrates the shortage of high quality epidemiological studies of vitamin C status in many countries, particularly low- and middle-income countries. The available evidence indicates that vitamin C deficiency is common in low- and middle-income countries and not uncommon in high income settings. Further high quality studies are required to confirm these findings, including in the countries not yet represented, and to fully understand associations with a range of disease processes. Our findings suggest a need for interventions to prevent deficiency in a range of at risk groups and regions of the world.

Earth Observation (EO) techniques have significantly evolved over time, covering a wide range of applications in different domains. The scope of this study is to review the research conducted on EO in the Eastern Mediterranean, Middle East, and North Africa (EMMENA) region and to identify the main knowledge gaps. We searched through the Web of Science database for papers published between 2018 and 2022 for EO studies in the EMMENA. We categorized the papers in the following thematic areas: Atmosphere, Water, Agriculture, Land, Disaster Risk Reduction (DRR), Cultural Heritage, Energy, Marine Safety and Security (MSS) and Big Earth Data (BED); 6647 papers were found with the highest number of publications in the thematic areas of BED (27%) and Land (22%). Most of the EMMENA countries are surrounded by sea, yet there was a very small number of studies on MSS (0.9% of total number of papers). This study detected a gap in fundamental research in the BED thematic area. Other future needs identified by this study are the limited availability of very high resolution and near real time remote sensing data, the lack of harmonized methodologies and the need for further development of models, algorithms, early warning systems and services.

Diagnostics is believed to drive about 70% of medical interventions, but this may not be true for all demographics. With more than 30% of the African population living in extreme poverty ($1.9 per day - 2022); and healthcare costs competing unfavorably against unbridled access to antibiotics and herbal concoctions, especially in Sub-Saharan Africa, how do you convince such a people to choose diagnostics first? More importantly, how do you design a medical device targeted at meeting the diagnostic needs of this demographic? In developing diagnostic devices for such a market, what is worth sacrificing? How dire is the need for advanced technologies in devices developed for such a demographic? These are questions that remain unaddressed by the technological breakthroughs and current research in medical device development, especially for infectious disease diagnostics. The objective of this paper is to underscore critical concerns which must be considered in the bid to successfully design medical diagnostic devices for Africa and perhaps, other limited-resource settings. It is also written as a suggestive guidance document for researchers whose interest is in the development of infectious disease diagnostic platforms for rural Africa and similar limited-resource environments.

This paper intends to discuss SSLs, how they work, their advantages and drawbacks. It will end with the author’s thoughts on the efficacy of the system and whether it is a viable solution for the majority of network security problems or if those drawbacks prevent that.

A retrospective cohort study was performed to determine the likelihood of malignant stroke after mechanical thrombectomy via ASPECTS-PASS score(A-P score), a novel scoring system using ASPECT score and number of arterial-passes. This prediction score is designed to help clinicians take early measures. Malignant stroke is defined as a large MCA infarct with mass effect that develops during the first 5 days following presentation and is associated with approximately 80% mortality. Previous studies have shown an association of low ASPECTS and high number of passes with poor outcome.We performed a retrospective cohort analysis on 78 patients with anterior circulation stroke who underwent mechanical thrombectomy at our hospital. We analyzed the likelihood of developing malignant stroke post thrombectomy in the first 5 days following successful recanalization (TICI ≽ 2b). Malignant stroke is defined as severe symptoms secondary to edema as evidenced by midline shift, cistern engorgement, and hemorrhagic conversion with edema. Patients with ASPECTS of 0-5 were excluded. We used two variables to predict the outcome: ASPECT score and number-of-passes. We used the equation ASPECT score minus number-of-passes (A-P) to arrive at a single number to predict the risk of malignant stroke. A-P scoring scale ranged from 0-9. Our study showed a statistically significant inverse relationship of A-P score and risk of malignant stroke. Approximately 90% of patients with A-P score < 5 developed malignant stroke in our study. A-P score can help predict malignant stroke post thrombectomy even after successful recanalization. Thus, A-P score of ≤ 5 suggests very high risk. (A-P) Score can assist clinicians to take early measures, and thereby prevent worse outcomes.