How do students of different self-efficacy regulate learning in collaborative design activities? An epistemic network analysis approach.

Introduction: Students' self-regulation skills and self-efficacy are linked to performance and are considered essential for lifelong learning. Understanding these skills and their development is crucial for educational success and long-term personal growth. Methods: In this study, 60 students attending a university-level collaborative design course were recruited as participants. They were initially classified into three groups [high, mixed, and low self-efficacy (SE)] based on the initial test results. Students' written reflections were then analyzed using epistemic network analysis (ENA), aiming to explore the characteristics and developmental trajectories of self-regulated learning (SRL). Results: Comparing with the other two groups, the high self-efficacy (HSE) group demonstrated: (1) more behavioral characteristics of SRL in the performance and self-reflection stages, (2) an earlier development of interest 91 in the task and recognition of its value during collaborative design activities, 92 followed by the utilization of more cognitive and metacognitive strategies; and (3) an "anticipation-behavior-reflection" loop in the self-regulation process. Discussion: These findings highlight the importance of fostering high self-efficacy among students to enhance their self-regulated learning capabilities and overall academic performance. Strategies for improving learners' SRL and future research directions were provided accordingly.

How do Chinese and Egyptian science textbooks differ? A cross-country comparative research.

Textbooks have a crucial role in shaping students' knowledge, behaviors, and attitudes in different school subjects. This study compares the structure and content of science textbooks of grade nine in Egypt and China to reveal the common and different features in the textbook design. It opts for a horizontal analysis of four science textbooks in the associated countries. The results revealed that the distribution of science subjects has partial similarities to some extent among the preparatory stage between the Chinese and Egyptian science textbooks besides the overlapping in the associated topics, presenting Biology as a common subject of interest. Moreover, the number of activities distributed within units and subjects have the highest shares in the Chinese textbooks, and most of the activities in the Egyptian textbooks focused on Chemistry and Physics subjects. In addition to the structure analysis, this study also explored the textbooks content in both countries, covering three dimensions: (1) cognitive expectations, (2) learning goals, and (3) efficiency of illustration. The results provide valuable insights for textbook designers and curriculum developers to enhance the quality of science curricula and textbooks. Therefore, the study recommends considering instructional design and lesson plans when distributing the learning activities and developing international standards for designing school science textbooks.

The Prevalence and Related Risk Factors of Urinary Incontinence Among Adult Women in Al Medina Al Munawara, Saudi Arabia.

Introduction Urinary incontinence (UI) is a common clinical problem. It has an impact on an individual's social, professional, psychological, and physical elements of life. The present study aimed to identify the prevalence of UI and associated risk factors among Saudi women in Al Medina Al Munawara, Saudi Arabia. Methods A cross-sectional study was conducted using an online questionnaire among 430 women aged 18-60 in Al Medina Al Munawara. The participants completed the validated Arabic version of the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) to assess the prevalence of UI and its associated factors. Results Among the participants, 64.8% did not experience urine incontinence, while 17.8% reported slight, 14.0% reported moderate, and 3.3% reported severe incontinence. Stress incontinence caused by coughing or sneezing was the most common cause (48.6%), followed by before reaching the toilet (urge incontinence) (34.5%) and after urination (15.5%). Significant associations were found between age, marital status, number of children, diabetes mellitus, urinary tract diseases, previous abdominal or pelvic surgery, obesity, constipation, and menopausal symptoms. However, no significant association was found between pregnancy and urine incontinence. Conclusions This study reveals a moderate prevalence of UI among Saudi women in Al Medina Al Munawara. The findings highlight the importance of early detection, treatment, and education on pelvic floor exercises to address UI. Factors such as age, marital status, number of children, and various medical conditions are associated with this condition, emphasizing the need for comprehensive management strategies.

Predicting Type 2 Diabetes Metabolic Phenotypes Using Continuous Glucose Monitoring and a Machine Learning Framework.

Type 2 diabetes (T2D) and prediabetes are classically defined by the level of fasting glucose or surrogates such as hemoglobin HbA1c. This classification does not take into account the heterogeneity in the pathophysiology of glucose dysregulation, the identification of which could inform targeted approaches to diabetes treatment and prevention and/or predict clinical outcomes. We performed gold-standard metabolic tests in a cohort of individuals with early glucose dysregulation and quantified four distinct metabolic subphenotypes known to contribute to glucose dysregulation and T2D: muscle insulin resistance, ß-cell dysfunction, impaired incretin action, and hepatic insulin resistance. We revealed substantial inter-individual heterogeneity, with 34% of individuals exhibiting dominance or co-dominance in muscle and/or liver IR, and 40% exhibiting dominance or co-dominance in ß-cell and/or incretin deficiency. Further, with a frequently-sampled oral glucose tolerance test (OGTT), we developed a novel machine learning framework to predict metabolic subphenotypes using features from the dynamic patterns of the glucose time-series ("shape of the glucose curve"). The glucose time-series features identified insulin resistance, ß-cell deficiency, and incretin defect with auROCs of 95%, 89%, and 88%, respectively. These figures are superior to currently-used estimates. The prediction of muscle insulin resistance and ß-cell deficiency were validated using an independent cohort. We then tested the ability of glucose curves generated by a continuous glucose monitor (CGM) worn during at-home OGTTs to predict insulin resistance and ß-cell deficiency, yielding auROC of 88% and 84%, respectively. We thus demonstrate that the prediabetic state is characterized by metabolic heterogeneity, which can be defined by the shape of the glucose curve during standardized OGTT, performed in a clinical research unit or at-home setting using CGM. The use of at-home CGM to identify muscle insulin resistance and ß-cell deficiency constitutes a practical and scalable method by which to risk stratify individuals with early glucose dysregulation and inform targeted treatment to prevent T2D.

Short-term photovoltaic energy generation for solar powered high efficiency irrigation systems using LSTM with Spatio-temporal attention mechanism.

Solar irrigation systems should become more practical and efficient as technology advances. Automation and AI-based technologies can optimize solar energy use for irrigation while reducing environmental impacts and costs. These innovations have the potential to make agriculture more environmentally friendly and sustainable. Solar irrigation system implementation can be hampered by a lack of technical expertise in installation, operation, and maintenance. It must be technically and economically feasible to be practical and continuous. Due to weather and solar irradiation, photovoltaic power generation is difficult for high-efficiency irrigation systems. As a result, more precise photovoltaic output calculations could improve solar power systems. Customers should benefit from increased power plant versatility and high-quality electricity. As a result, an artificial intelligence-powered automated irrigation power-generation system may improve the existing efficiency. To predict high-efficiency irrigation system power outputs, this study proposed a spatial and temporal attention block-based long-short-term memory (LSTM) model. Using MSE, RMSE, and MAE, the results have been compared to pre-existing ML and a simple LSTM network. Moreover, it has been found that our model outperformed cutting-edge methods. MAPE was improved by 6-7% by increasing Look Back (LB) and Look Forward (LF). Future goals include adapting the technology for wind power production and improving the proposed model to harness customer behavior to improve forecasting accuracy.

Reservoir characterization of the Abu Roash D Member through petrography and seismic interpretations in Southern Abu Gharadig Basin, Northern Western Desert, Egypt.

This research combines petrography and seismic analysis to assess the Upper Cretaceous Abu Roash (AR)/D's carbonate member composition in the Southwest Abu-Sennan oil field in the Southern Abu Gharadig Basin within the Northern Western Desert of Egypt. Various datasets were used, including petrographic thin sections, and electrical well logs for four stratigraphic wells (01, -02, -03, and, -04), along with a time domain seismic dataset covering the study area. Petrographic analysis across multiple depths and intervals has provided valuable insights. Well-01 demonstrates mud-wackstone with diverse mineral components at 1671-74 m MD, indicating favorable reservoir quality. Well-02 exhibits diverse compositions at intervals 1740-43 m MD and 1746-49 m MD, also showcasing good reservoir quality. Well-03 reveals a packstone rock type at 1662-65 m MD with favorable reservoir characteristics. Well-04 displays peloids Wack-Packstone and Oolitic Packstone at intervals 1764-67 m MD and 1770-73 m MD, respectively, both indicating good reservoir quality. Integrating the petrography and seismic attributes results concerning the structural level of AR/D concerning the used wells, it's evident that Well-03 stands out due to its relatively high structural level, drilled near a major fault, revealing distinct fracture sets that contribute to a notably high reservoir quality as depicted in the RMS amplitude and Ant track attributes maps. AR/D reservoir levels in wells 02, and, 04, are relatively positioned at structurally lower levels, and face challenges with overburden pressure and mechanical compaction, resulting in diminished facies quality for the reservoir. Seismic attributes like the Ant track and RMS amplitude indicated that the presence of fractures within the AR/D Member's carbonate is linked to the prevalence of interpreted normal faults. The implemented procedure in this research can be applied to enhance comprehension of AR/D carbonate reservoirs in adjacent regions, thereby increasing the hydrocarbon exploration possibilities.

Knowledge, Attitude, and Practice Regarding the Risk of Diabetic Feet Among Diabetic Patients in the Madinah Region, Saudi Arabia.

Introduction A patient suffering from diabetes mellitus (DM) has a high chance of developing a diabetic foot. Awareness and attitude toward the prevention of diabetic foot ulcers are necessary for a better quality of life. Educating patients with diabetes about the methods of foot care plays an important role in preventing diabetic foot complications in individuals with DM. This study aims to determine the level of knowledge, attitude, and practices of diabetic patients about the risk of diabetic feet in Madinah, Saudi Arabia. Methodology This is an observational cross-sectional study conducted using an online questionnaire. Participants were older than 18 years of age. IBM SPSS Statistics for Windows, Version 27 (Released 2020; IBM Corp., Armonk, New York, United States) was used for data analysis. The questionnaire included patient personal data, patients' knowledge regarding diabetic feet, attitude, and practice regarding the risk of diabetic feet among diabetic patients. Results A total of 1155 participants completed the questionnaire. Exactly 79.9% of people had good knowledge regarding diabetic feet and their care. The analysis revealed that age, gender, education level, and family history of DM are all significant predictors of knowledge levels among the participants. The majority of participants strongly agreed that diabetic patients should promptly seek medical assistance in case of any foot infections (90.8%) and take regular checkups (76.5%). Regarding foot care practices, people generally take good care of their feet but do not seek checkups until they experience symptoms (81.8%). Conclusion The study showed that participants had good knowledge about diabetic feet and a careful attitude toward them. Their practices toward diabetic feet were acceptable; however, the issue of late medical consultation after the development of symptomatology needs to be addressed.

The Prevalent Use of Complementary and Alternative Medicine Among Patients With Chronic Disease in the Al-Madinah Population of Saudi Arabia.

BACKGROUND: Global interest in complementary and alternative medicine (CAM) has recently risen, particularly in Saudi Arabia, and the use of CAM is gaining popularity as a healthcare option. OBJECTIVES: This study aims to assess the prevalence of CAM use among patients with chronic diseases and identify the reasons for resorting to CAM in Al-Madinah, Saudi Arabia. METHODS: A cross-sectional study was conducted in Al-Madinah City. Data for analysis were derived from 416 participants with chronic diseases. The data were collected using a valid, structured online questionnaire that was designed to extract socio-demographic data as well as data on the predominant use of herps, hijama (cupping), acupuncture, and other specific CAM applications. The collected data were analyzed using appropriate statistical methods. RESULTS: Of the 416 participants, 164 (39.4%) were men, and 96.9% were Saudi citizens. Approximately one-third of the studied participants had diabetes (34.1%), while 29.3%, 25.2%, 15.1%, and 12.3% had hypertension, obesity, asthma, and gastrointestinal tract disease, respectively. The prevalence of herb and natural supplement use was 89.2%. The most commonly used herbs and natural supplements were ginger (55.5%), honey and its derivatives (53.4%), cinnamon (45.4%), and frankincense (33.4%). Of the studied participants, 36.1% and 6.5% reported undergoing cupping and acupuncture, respectively. No statistically significant differences were found between the use of herbs and acupuncture or any of the studied factors. Further, the use of acupuncture exhibited no significant differences. However, the use of cupping displayed statistically significant differences in age, sex, and income among the participants. CONCLUSION: The prevalence of CAM use among patients with chronic diseases in Al-Madinah is high. It appears to play an essential role in health care, particularly in treating patients with chronic diseases in this population. Therefore, promoting research in the field of CAM is warranted.

Formation evaluation of Abu Madi reservoir in Baltim gas field, Nile Delta, using well logs, core analysis and pressure data.

Baltim Eastern and Northern gas fields in the offshore Nile Delta have very high gas condensate accumulations. Therefore, the present research evaluates Abu Madi and Qawasim Formations and defines the petrophysical parameters for them using various data from five wells composed of wireline logs (gamma-ray, density, neutron, sonic, resistivity), core data, pressure data, and cross-plots. In the current study, the formations of the main reservoirs were evaluated qualitatively and quantitatively based on the petrophysical analysis to assess the production potential. Based on the lithological identification, the two main reservoirs (Abu Madi and Qawasim Formations) are composed of sandstone, calcareous shale, and siltstone. The main petrophysical parameters (Shale volume, effective porosity, net thickness, and fluid saturations) were mapped to track the areal petrophysical variations in the field. The results of the petrophysical analysis reveal that the main reservoirs are promising for the hydrocarbon potential with effective porosity of 18%, low shale content with an average value of about 21%, higher gas saturation of average value of nearly 58%, net reservoir thickness ranges from 25.5 to 131.5 m, net pay thickness (effective thickness) ranges from 6 to 61 m. Also, the conventional core analysis affirms that the main reservoirs are of good effective porosity with high horizontal and vertical permeability values. There is a good match between the well-log results and the pressure data with the production data (DST "perforation tests"). Baltim East (BE3) well has the most desired petrophysical characteristics in the Baltim East gas field, while, the Baltim North-1 (BN1) well showed the most favorable petrophysical parameters in the Baltim North gas field. Different fluid contacts (gas water contact GWC) were detected by integrating all reservoir pressures. The integration of different data in our present work (well logs, core measurements, and pressure data) could reduce the drilling risks and help to determine the best locations for future exploration and development, which is considered a big challenge in the petroleum industry.

3D structural modeling using seismic data and well logs for Khatatba reservoir in Matruh-Shushan Basin, North Western Desert, Egypt.

Middle Jurassic reservoirs present challenges in the northern segment of the Western Desert due to geometric uncertainties arising from structural configurations, lateral facies variations, diverse lithologies, and heterogeneous reservoir quality. Consequently, this study employed an intricate approach, constructing detailed 3D geostatic models by amalgamating diverse datasets, including 2D seismic sections and digital well-logs. The focus of these 3D models was on the Khatatba Formation (Upper-Safa Member, Kabrit Member, and Lower-Safa Member) in Matruh-Shushan Basin in the North Western Desert. The objectives encompassed assessing hydrocarbon potential, precisely estimating reserves, formulating development and exploration strategies, and identifying prospective drilling locations. The resultant structural model revealed a compartmentalized region marked by major and minor NE-SW trending normal faults, establishing structurally advantageous locations for hydrocarbon trapping within the study area. Petrophysical analyses highlighted the promising potential of the Upper-Safa Member as a reservoir, featuring porosity values ranging from 10 to 18%, peaking in the northeast sector, volume of shale (Vsh) between 15 and 24%, water saturation (Sw) spanning from 18 to 53%, and increased sand thickness towards the eastern section. Similarly, the Lower-Safa Member demonstrated favorable reservoir attributes, including porosity values ranging from 10 to 16%, with higher values in the southeastern part, Vsh between 17 and 28%, and Sw varying from 15 to 47%. The study findings underscored the hydrocarbon potential in the northeast block of the study area for the Middle Jurassic Khatatba Formation. These insights contribute valuable information for decision-making in exploration and production endeavors within the basin.

Water quality, human health risk, and pesticides accumulation in African catfish and Nile tilapia from the Kitchener Drain-Egypt.

Pesticides are toxic and could negatively impact humans and the ecosystem. The Kitchener Drain is among the longest drains in Egypt and carries a wide range of wastewater from the agriculture sector, which contains pesticides and may pollute the ecosystem. Thus, water quality, human health risk, and pesticide accumulation in African catfish and Nile tilapia from the Kitchener Drain-Egypt. The water and fish samples were collected from Kitchener Drain in Kafr Elsheikh Governorate, Egypt, during the four seasons. The results indicated that heptachlor and diazinon were undetected during the four seasons. However, endosulfan, chlorpyrifos, and dicofol were detected in winter and autumn. Only p,p'-DDT was detected during spring. Endosulfan, heptachlor, and aldrin were detected in Nile tilapia during winter. Only heptachlor and aldrin were detected during spring. Endosulfan, heptachlor, dicofol, p,p'-DDT, chlorpyrifos, and diazinon were detected in the autumn season. In summer, dicofol and p,p'-DDT were detected, while endosulfan, heptachlor p,p'-DDT, aldrin, chlorpyrifos, and diazinon were not detected. In African catfish, endosulfan, heptachlor, dicofol, and p,p'-DDT were detected during winter, while chlorpyrifos, aldrin, and chlorpyrifos, aldrin, and diazinon were not detected. In the spring season, endosulfan, heptachlor, and aldrin were detected. Endosulfan, heptachlor, dicofol, p,p'-DDT, aldrin, chlorpyrifos, and diazinon were detected in the autumn season. Similarly, in the summer season, endosulfan, heptachlor, dicofol, p,p'-DDT, aldrin, chlorpyrifos, and diazinon were detected. The sequence of estimated daily intake (EDI) in Nile tilapia during the four seasons is heptachlor > endosulfan > dicofol > p,p'-DDT > aldrin > diazinon > chlorpyrifos. The sequence of EDI in African catfish during the four seasons is endosulfan > p,p'-DDT > heptachlor > aldrin > dicofol > diazinon > chlorpyrifos. In conclusion, the results confirmed the absence of a hazard index for consuming Nile tilapia and African catfish collected from the Kitchener drain.

Prevalence of Insomnia and Its Associated Factors in the General Population of Saudi Arabia: A Cross-Sectional Study.

INTRODUCTION: Insomnia is a common sleep disorder that can have negative impacts on daily functioning and health. However, little is known about the prevalence of insomnia and its associated factors in the general population of Saudi Arabia. This cross-sectional study aimed to investigate the prevalence of insomnia and its associated factors among adults in Saudi Arabia. METHODS: A self-administered electronic questionnaire was distributed to 4818 participants from all 13 regions of Saudi Arabia. The eight-item Sleep Condition Indicator (SCI) based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria was used to assess the prevalence of insomnia. RESULTS: The results showed that 37.6% of participants met all the DSM-5 clinical criteria for insomnia in the past month. The prevalence was higher among females, divorced or widowed individuals, students, unemployed individuals, those living with friends or family, those reporting severe work stress, and those using mobile devices before sleeping. On the other hand, the prevalence was lower among males, married individuals, morning and evening employees, those who practice physical exercise, and those with good health status. CONCLUSION: This study found the prevalence of insomnia to be 37.6% in the general population of Saudi Arabia, which is considerably high. The risk factors associated with insomnia in the Saudi population were found to be age, sex, work stress, and using mobile devices before sleeping, while protective factors included being employed, practicing physical exercise, and having good health status. Further research is needed to explore the impact of insomnia on the quality of life and productivity of individuals in Saudi Arabia.

Dynamic lipidome alterations associated with human health, disease and ageing.

Lipids can be of endogenous or exogenous origin and affect diverse biological functions, including cell membrane maintenance, energy management and cellular signalling. Here, we report >800 lipid species, many of which are associated with health-to-disease transitions in diabetes, ageing and inflammation, as well as cytokine-lipidome networks. We performed comprehensive longitudinal lipidomic profiling and analysed >1,500 plasma samples from 112 participants followed for up to 9 years (average 3.2 years) to define the distinct physiological roles of complex lipid subclasses, including large and small triacylglycerols, ester- and ether-linked phosphatidylethanolamines, lysophosphatidylcholines, lysophosphatidylethanolamines, cholesterol esters and ceramides. Our findings reveal dynamic changes in the plasma lipidome during respiratory viral infection, insulin resistance and ageing, suggesting that lipids may have roles in immune homoeostasis and inflammation regulation. Individuals with insulin resistance exhibit disturbed immune homoeostasis, altered associations between lipids and clinical markers, and accelerated changes in specific lipid subclasses during ageing. Our dataset based on longitudinal deep lipidome profiling offers insights into personalized ageing, metabolic health and inflammation, potentially guiding future monitoring and intervention strategies.

Detection and quantification of perioperative heparin-like effects by rotational thromboelastometry in living-donor liver transplant recipients: A prospective observational study.

Background and Aims: Heparin-like effects (HLEs) can affect hemostasis during liver transplantation. The aim of this study was to assess the perioperative incidence and severity of HLE with rotational thromboelastometry (ROTEM) and activated partial thromboplastin time (aPTT). Material and Methods: ROTEM and aPTT were measured intraoperatively and on postoperative days (POD) 1, 3, and 7. HLE was identified if ROTEM INTEM/HEPTEM CT-ratio was >1.25 and severe forms of HLE when ratio was ≥2. Based on aPTT, HLE was defined when aPTT ratio was >1.25 (patient aPTT/control aPTT). Results: Thirty-eight recipients were included. Variable degrees of HLE were detected by aPTT-ratio and INTEM/HEPTEM CT ratio. No significant correlation existed between both ratios. Based on INTEM/HEPTEM CT ratio, HLE was detected in 7/38 during anhepatic phase, 19/38 post-reperfusion, 10/38 on POD1, 4/38 on POD3, and 0/38 on POD7. Four cases of severe HLE were identified by INTEM/HEPTEM CT ratio only in the anhepatic phase. Postoperative infusion of unfractionated heparin led to mild-moderate HLE on POD1 and 3 as evident by both tests. Red blood cell and plasma transfusion were higher with severe HLE (1350 ± 191 ml and 3558 ± 1407 ml). Composite adverse outcome of any complication or death within 3 months for patients without HLE, mild-moderate HLE, and severe HLE as detected by ROTEM was 27.8%, 42.9%, and 66.7%, respectively. Conclusion: INTEM/HEPTEM CT ratio was able to detect and quantify HLE as aPTT ratio. The ability of the INTEM/HEPTEM CT ratio to identify severe HLE earlier in the anhepatic phase needs to be studied in a larger population. HLE is self-limiting, but when identified in a severe form, it is associated with worse outcome.

The effect of music intervention in decreasing pain and anxiety during outpatient hysteroscopy procedure: a systematic review and meta-analysis of randomized control trials.

BACKGROUND: Hysteroscopy is a common outpatient procedure but procedural pain limits its use. Music could be used as a pain-relieving intervention. We performed a systematic review and meta-analysis to investigate the effect of music on pain and anxiety during outpatient hysteroscopy. METHODS: Four electronic databases were searched: PubMed, Scopus, Web of Science, and Cochrane Library, from inception to September 2022. We included only the Randomized Controlled Trials (RCTs) that investigated the effect of music on women who underwent outpatient hysteroscopy in reducing pain and anxiety levels compared to no music. We assessed the quality of included RCTs using the risk of bias tool 1 reported in the Cochrane Handbook of Systematic Reviews of Interventions. Data were pooled as the Mean Differences (MDs) with a 95% Confidence Interval (CI) in a random-effects model, using Review Manager 5.3 software. Also, we assessed the evidence of the results using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: Three RCTs (540 women) were included. Music significantly reduced visual analogue scale (VAS) pain scores as well as State-Trait Anxiety Inventory (STAI) scores compared to controls (MD = -1.28; 95% CI [-2.19, -0.36]; P = 0.007) and (MD = -3.91; 95% CI [-6.98, -0.85]; P = 0.01) respectively. Also, the decrease in VAS score for pain was significantly greater in the music group (MD = 1.44; 95% CI [0.44, 2.45]; P = 0.005). However, the change in STAI showed no significant difference between the two groups. The GRADE ratings for all outcomes were very low. CONCLUSION: Music is a potentially promising method for controlling pain for patients undergoing outpatient hysteroscopy; however, its effect in controlling anxiety is controversial.

Effect of high-flow nasal cannula versus non-invasive ventilation in preventing re-intubation in high-risk chronic obstructive pulmonary disease patients: A randomised controlled trial.

Background: Currently, a high-flow nasal cannula (HFNC) has been shown to improve extubation outcomes. However, there is a lack of evidence on the utilisation of HFNC in high-risk chronic obstructive pulmonary disease (COPD) patients. This study aimed to compare the effectiveness of HFNC versus non-invasive ventilation (NIV) in preventing re-intubation following planned extubation in high-risk COPD patients. Patients and Methods: In this prospective, randomised, controlled trial, 230 mechanically ventilated COPD patients at high risk for re-intubation who fulfilled the criteria for planned extubation were enrolled. Post-extubation blood gases and vital signs at 1, 24, and 48 hours were recorded. The primary outcome was the re-intubation rate within 72 hours. Secondary outcomes included post-extubation respiratory failure, respiratory infection, intensive care unit and hospital length of stay, and mortality rate at 60 days. Results: 230 patients after planned extubation were randomly allocated to receive either HFNC (n = 120) or NIV (n = 110). Re-intubation within 72 hours was significantly lower in the high-flow group: 8 patients (6.6%) versus 23 patients (20.9%) in the NIV group {absolute difference, 14.3% [95% confidence interval (CI), 10.9-16.3]; P = 0.001}. The frequency of post-extubation respiratory failure was less in patients assigned to HFNC than in those allocated NIV (25% vs. 35.4%) [absolute difference, 10.4% (95% CI, 2.4-14.3); P = 0.001]. There was no significant difference between the two groups regarding reasons for respiratory failure after extubation. It was observed that the 60-day mortality rate was lower in patients who received HFNC than in those assigned to NIV (5% vs. 13.6%) [absolute difference, 8.6 (95% CI, 4.3 to 9.10); P = 0.001]. Conclusion: The use of HFNC after extubation appears to be superior to NIV in reducing the risk of re-intubation within 72 hours and 60-day mortality in high-risk COPD patients.

Rare penetrant mutations confer severe risk of common diseases.

We examined 454,712 exomes for genes associated with a wide spectrum of complex traits and common diseases and observed that rare, penetrant mutations in genes implicated by genome-wide association studies confer ~10-fold larger effects than common variants in the same genes. Consequently, an individual at the phenotypic extreme and at the greatest risk for severe, early-onset disease is better identified by a few rare penetrant variants than by the collective action of many common variants with weak effects. By combining rare variants across phenotype-associated genes into a unified genetic risk model, we demonstrate superior portability across diverse global populations compared with common-variant polygenic risk scores, greatly improving the clinical utility of genetic-based risk prediction.

Rare penetrant mutations confer severe risk of common diseases.

We examined 454,712 exomes for genes associated with a wide spectrum of complex traits and common diseases and observed that rare, penetrant mutations in genes implicated by genome-wide association studies confer ∼10-fold larger effects than common variants in the same genes. Consequently, an individual at the phenotypic extreme and at the greatest risk for severe, early-onset disease is better identified by a few rare penetrant variants than by the collective action of many common variants with weak effects. By combining rare variants across phenotype-associated genes into a unified genetic risk model, we demonstrate superior portability across diverse global populations compared to common variant polygenic risk scores, greatly improving the clinical utility of genetic-based risk prediction. One sentence summary: Rare variant polygenic risk scores identify individuals with outlier phenotypes in common human diseases and complex traits.

Performance assessment and multiobjective optimization of a biomass waste-fired gasification combined cycle for emission reduction.

The use of renewable fuels leads to reduction in the use of fossil fuels and environmental pollutants. In this study, the design and analysis of a CCPP based on the use of syngas produced from biomass is discussed. The studied system includes a gasifier system to produce syngas, an external combustion gas turbine and a steam cycle to recover waste heat from combustion gases. Design variables include syngas temperature, syngas moisture content, CPR, TIT, HRSG operating pressure, and PPTD. The effect of design variables on performance components such as power generation, exergy efficiency and total cost rate of the system is investigated. Also, through multi-objective optimization, the optimal design of the system is done. Finally, it is observed that at the final decisioned optimal point, the produced power is 13.4 MW, the exergy efficiency is 17.2%, and the TCR is 118.8 $/h.