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This article introduces an innovative application of the Enhanced Gorilla Troops Algorithm (EGTA) in addressing engineering challenges related to the allocation of Thyristor Controlled Series Capacitors (TCSC) in power grids. Drawing inspiration from gorilla group behaviors, EGTA incorporates various methods, such as relocation to new areas, movement towards other gorillas, migration to specific locations, following the silverback, and engaging in competitive interactions for adult females. Enhancements to EGTA involve support for the exploitation and the exploration, respectively, through two additional strategies of periodic Tangent Flight Operator (TFO), and Fitness-based Crossover Strategy (FCS). The paper initially evaluates the effectiveness of EGTA by comparing it to the original GTA using numerical CEC 2017 single-objective benchmarks. Additionally, various recent optimizers are scrutinized. Subsequently, the suitability of the proposed EGTA for the allocation of TCSC apparatuses in transmission power systems is assessed through simulations on two IEEE power grids of 30 and 57 buses, employing various TCSC apparatus quantities. A comprehensive comparison is conducted between EGTA, GTA, and several other prevalent techniques in the literature for all applications. According to the average attained losses, the presented EGTA displays notable reductions in power losses for both the first and second systems when compared to the original GTA. Specifically, for the first system, the proposed EGTA achieves reductions of 1.659 %, 2.545 %, and 4.6 % when optimizing one, two, and three TCSC apparatuses, respectively. Similarly, in the second system, the suggested EGTA achieves reductions of 6.096 %, 7.107 %, and 4.62 %, respectively, when compared to the original GTA's findings considering one, two, and three TCSC apparatuses. The findings underscore the superior effectiveness and efficiency of the proposed EGTA over both the original GTA and several other contemporary systems.
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Within the scope of sustainable development, integrating electric vehicles (EVs) and renewable energy sources (RESs) into power grids offers a number of benefits. These include reducing greenhouse gas emissions, diversifying energy sources, and promoting the use of green energy. Although the literature on hosting capacity (HC) models has grown, there is still a noticeable gap in the discussion of models that successfully handle transmission expansion planning (TEP), demand response (DR), and HC objectives simultaneously. Combining TEP, DR, and HC objectives in one model optimizes resource use, enhances grid stability, supports renewable and EV integration, and aligns with regulatory and market demands, resulting in a more efficient, reliable, and sustainable power system. This research presents an innovative two-layer HC model, including considerations for TEP and DR. The model determines the highest degree of load shifting appropriate for incorporation into power networks in the first layer. Meanwhile, the second layer focuses on augmenting the RES and EVs' hosting capability and modernizing the network infrastructure. System operators can choose the best scenario to increase the penetration level of EVs and RESs with the aid of the proposed model. The proposed model, which is formulated as a multi-objective mixed-integer nonlinear optimization problem, uses a hierarchical optimization technique to identify effective solutions by combining the particle swarm optimization algorithm and the crayfish optimizer. When compared to traditional methods, the results obtained from implementing the proposed hierarchical optimization algorithm on the Garver network and the IEEE 24-bus system indicated how effective it is at solving the presented HC model. The case studies demonstrated that integrating DR into the HC problem reduced peak load by 10.4-23.25%. The findings also highlighted that DR did not impact the total energy consumed by EVs throughout the day, but it did reshape the timing of EV charging, creating more opportunities for integration during periods of high demand. Implementing DR reduced the number of projects needed and, in some cases, led to cost savings of up to 12.3%.
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The application of magnetic resonance imaging (MRI) in the classification of brain tumors is constrained by the complex and time-consuming characteristics of traditional diagnostics procedures, mainly because of the need for a thorough assessment across several regions. Nevertheless, advancements in deep learning (DL) have facilitated the development of an automated system that improves the identification and assessment of medical images, effectively addressing these difficulties. Convolutional neural networks (CNNs) have emerged as steadfast tools for image classification and visual perception. This study introduces an innovative approach that combines CNNs with a hybrid attention mechanism to classify primary brain tumors, including glioma, meningioma, pituitary, and no-tumor cases. The proposed algorithm was rigorously tested with benchmark data from well-documented sources in the literature. It was evaluated alongside established pre-trained models such as Xception, ResNet50V2, Densenet201, ResNet101V2, and DenseNet169. The performance metrics of the proposed method were remarkable, demonstrating classification accuracy of 98.33%, precision and recall of 98.30%, and F1-score of 98.20%. The experimental finding highlights the superior performance of the new approach in identifying the most frequent types of brain tumors. Furthermore, the method shows excellent generalization capabilities, making it an invaluable tool for healthcare in diagnosing brain conditions accurately and efficiently.
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Diet behavior and nutrition are critical for maintaining health and improving quality of life. Cigarette smoking remains the leading cause of preventable death in the United States. Poor dietary choices, such as excessively frequenting restaurants, consuming ready-to-eat foods from grocery stores, and ingesting ultra-processed foods (like frozen meals and pizzas), can adversely impact health. Despite this, research comparing dietary behaviors between smokers and non-smokers is limited. Using data from the National Health and Nutritional Examination Survey 2017-2018, we analyzed diet behavior based on smoking status. Our findings reveal that smokers had a significant increase (90%) in the frequency of consuming frozen meals/pizzas in the past 30 days compared to non-smokers (coefficient: 1.9; 95% CI: 1.4, 2.6; p-value < 0.001). Additionally, over 70% of participants, regardless of their smoking status, were unaware of MyPlate, a nutritional guide created by the United States Department of Agriculture (USDA) to encourage Americans to make healthier food choices. There is an urgent need to increase public awareness of MyPlate and promote a better understanding of healthy dietary behaviors.
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Comportamento Alimentar , não Fumantes , Inquéritos Nutricionais , Fumantes , Humanos , Masculino , Feminino , Adulto , Estados Unidos/epidemiologia , Pessoa de Meia-Idade , Fumantes/estatística & dados numéricos , não Fumantes/estatística & dados numéricos , Adulto Jovem , Dieta/estatística & dados numéricos , Idoso , Fumar/epidemiologia , Adolescente , Dieta Saudável/estatística & dados numéricos , Política Nutricional , Padrões DietéticosRESUMO
The healthcare sector faces several challenges, such as rising costs, rising demand, and the need for sustainability. A new area of healthcare has emerged due to these problems, focusing on long-term improvements in management, social policy, and health economics. This research explores the cutting edge of healthcare, concentrating on long-term advancements in management, social policy, and health economics. To better understand the problems affecting the healthcare sector and to pinpoint the areas where sustainable solutions are most required, a survey of 2000 healthcare professionals and policymakers was performed. The data were analyzed using structural equation modeling (SEM), and a thorough sustainable healthcare model was created. According to the survey's findings, the healthcare sector now faces three significant challenges: growing prices, increased demand, and the need for sustainability. According to the respondents, the three main areas where sustainable innovations are most required are management, social policy, and health economics. These conclusions were supported by the (SEM) analysis, which also showed that sustainable practices in these fields significantly impact the sustainability of the healthcare system. These findings lead this research to conclude that to guarantee the accessibility and affordability of healthcare for everyone, a move towards sustainable practices in health economics, social policy, and management is needed. Cooperation between healthcare providers, policymakers, and other stakeholders is required to create creative solutions that support sustainability in the healthcare sector. This study offers a thorough framework for sustainable healthcare that may act as a guide for further research and the formulation of new regulations.
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Human body cells are stem cell (SC) derivatives originating from bone marrow. Their special characteristics include their capacity to support the formation and self-repair of the cells. Cancer cells multiply uncontrollably and invade healthy tissues, making stem cell transplants a viable option for cancer patients undergoing high-dose chemotherapy (HDC). When chemotherapy is used at very high doses to eradicate all cancer cells from aggressive tumors, blood-forming cells and leukocytes are either completely or partially destroyed. Autologous stem cell transplantation (ASCT) is necessary for patients in those circumstances. The patients who undergo autologous transplants receive their own stem cells (SCs). The transplanted stem cells first come into contact with the bone marrow and then undergo engraftment, before differentiating into blood cells. ASCT is one of the most significant and innovative strategies for treating diseases. Here we focus on the treatment of Hodgkin's lymphoma, non-Hodgkin's lymphoma, multiple myeloma, and AL amyloidosis, using ASCT. This review provides a comprehensive picture of the effectiveness and the safety of ASCT as a therapeutic approach for these diseases, based on the currently available evidence.
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Transplante de Células-Tronco Hematopoéticas , Amiloidose de Cadeia Leve de Imunoglobulina , Linfoma não Hodgkin , Mieloma Múltiplo , Humanos , Mieloma Múltiplo/terapia , Amiloidose de Cadeia Leve de Imunoglobulina/terapia , Transplante Autólogo , Linfoma não Hodgkin/terapia , Transplante de Células-TroncoRESUMO
Background: There is limited research on whether women choose urology as a future career. Therefore, we aimed in this study to assess the influencing and challenging factors among female physicians in Saudi Arabia. Methods: We approached 552 female physicians, including 29 (5.2%) urologists and 523 (94.7%) non-urologists. A cross-sectional survey was carried out, which included five sections and 46 items to assess and compare the perspectives of (urologists and non-urologists regarding influencing factors to choose urology, challenges toward applying to urology, and challenges during and after urology residency. Statistical analysis was conducted using SPSS software. Responses were presented as frequencies and percentages, while associations were studied using the Chi-squared test/Fisher's exact test. A p-value of ≤ 0.05 was considered significant. Results: Out of 552 female physicians, 466 completed the survey. The survey items compared urologists and non-urologists among female physicians. Among both cohorts, the most influencing factors in choosing urology were the diversity of practice and urological procedures (p =0.002, p<0.001). There were no social barriers or challenges when applying for urology residency (p<0.001). Overall, the majority of female urologists reported a high level of agreement that they have more time to work at the clinic (55.2%), they are satisfied as they are currently being urologists (75.8%), satisfied with their current lifestyle (72.6%). They would choose urology again as a future career (58.6%). Non-urologist female physicians 326 (74.6%) think they are more likely to have experienced gender discrimination than urologists 15 (51.7%) (p<0.001). Female urologists were less likely to face social barriers when applying for urology residency than non-urologists (p<0.001). Conclusion: As urologists, we must understand women's struggles, such as gender discrimination, a lack of academic advancement, and a lack of mentorship. To foster women's careers in urology, we must understand their unique needs, provide adequate mentorship, exterminate gender discrimination bias, and improve mentorship.
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Introduction: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, there have been some reports regarding the impact of COVID-19 on male psychosexual health. Aims and Objectives: To assess the severity of stress during COVID-19 and to determine the association of stress levels with partner relationships and sexual activity. Methodology: A cross-sectional study was conducted in Saudi Arabia through social media platforms via an online questionnaire between 1 December 2020 and 31 January 2021 among 871 participants after a pilot study among 20 participants, of which 497 were included in the study. Stress levels were assessed using the Arabic version of the Depression, Anxiety, and Stress Scale (DASS-21). Statistical analysis was conducted using SPSS version 20.0. Responses were presented as frequencies and percentages, and associations were studied using the Chi-squared test/Fisher's exact test. A value of p ≤ 0.05 was considered significant. Results: A total of 497 participants who had been infected with COVID-19 completed the survey. In total, it was found that 203 (40.8%) had severe stress scores (severe and extremely severe scores merged), while 131 (26.4%) had moderate stress scores. About 84 (16.9%) participants agreed that their sexual desire decreased, 91 (18.1%) confirmed their sexual intercourse frequency decreased, and sexual satisfaction decreased in 76 (15.3%). A significant positive correlation was found in that those who disagreed with having a good sexual relationship tended to have severe stress (p < 0.001). Conclusion: There were increased levels of stress during the lockdown period, which impacted psychosexual health.
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PURPOSE: This study evaluates the satisfaction of urology residents with the Saudi Board of Urology (SBU) Training Program and identifies areas of weakness and strength to improve the educational environment, surgical competency, and overall satisfaction of urology residents with the program. METHODS: We administered an electronic self-made questionnaire that included two sections. One comprised demographic data (age, gender, weight, height, marital status, level of training, city of training, and center of training), while the other concerned SBU evaluation (satisfaction with different aspects of training, such as ways of assessment, mentors' feedback, surgical competency, research, and strengths and weaknesses of SBU). RESULTS: The overall satisfaction of urology residency program was 28.8% while 44.2% of residents had a neutral response. The highest level of satisfaction with clinical and surgical practice was among graduates (56.9%) and Riyadh residents (45.1%). Furthermore, good work/life balance received the lowest level of satisfaction (5.2%) among senior residents, while good clinical experience received the highest level (62.7%) among the graduates. Residents reported a high exposure in endourology and pediatric urology, while transplant, reconstructive, and neurourology had the lowest exposure. Forty-two percent of respondents undertook research during their residency training, but most respondents (54%) did not publish any research papers during their training. Sixty-two percent of graduates felt that their training program did not prepare them adequately to perform well on the board examinations. CONCLUSION: Our results confirmed that satisfaction of residents with the urology program process is variable according to the city of training. Having high satisfaction level in some cities reflects the improvement of urology training program after restructuring. We identified new areas in need of improvement, namely lack of mentorship, clear and formal assessment process, and variation of training process between central and peripheral programs.
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From the moment the World Health Organization (WHO) declared COVID-19 to be a pandemic disease, COVID-19 began to affect the lives of many healthcare providers worldwide. In response to this pandemic, urology departments and training residency programs implemented urgent measures to reduce outpatient clinics, adopted the use of telemedicine, regulated emergency and outpatient urological procedures, promoted the use of operating theatres, and developed the use of sustainable e-learning alternatives to traditional urology educational activities. We reviewed the response of urologists in Saudi Arabia to the COVID-19 pandemic and how they react to the emerging pandemic both for patients and for healthcare of urologist personnel.
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AIMS: To evaluate the long-term outcomes of sacral neuromodulation (SNM), and patient characteristics that may predict long-term success or complications. METHODS: A single-center retrospective cohort study was performed of all patients who underwent SNM testing and implantation. Outcome results, resolution of symptoms, and device removal were reported. Multivariable logistic regression was used to identify predictors of success. Cox proportional hazards model was used to identify predictors for device removal. RESULTS: Four hundred and thrity four patients underwent SNM test phase of which 241 (median age 48.0 years, 91.7% [221/241] female) had device implantation and were followed up for median [range] time of 4.0 (3 months-20.5 years) years. Multivariable logistic regression showed that male gender (odds ratio: 0.314; 95% confidence interval: 0.164-0.601, p = .0005) was independently associated with decreased peripheral nerve evaluation success. At final follow-up for patients who originally had device implantation, median (interquartile range) percent of symptoms resolution of all patients was 60.0% (0%-90%) and 69.3% (167/241) had SNM successful outcomes. Cox proportional hazards model showed no difference for time to SNM device removal with respect to patient age, gender, or diagnosis. 69.3% (167/241) patients had at least 1 surgical re-intervention. The most common reason at first surgical re-intervention was lead change only (26.3%, 44/167). CONCLUSION: SNM is a minimally invasive procedure with good long-term success rates. There is a high revision rate but overall, SNM has a good safety profile and excellent long-term outcomes.
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Terapia por Estimulação Elétrica/métodos , Plexo Lombossacral/fisiopatologia , Doenças Urológicas/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: This study evaluated the study habits of Saudi urology residents throughout their residency training. It examines the study time and quality of study materials used by Saudi urology residents and identifies ways to maximize study benefits. PATIENTS AND METHODS: An online questionnaire was distributed to 152 registered residents in regions throughout Saudi Arabia (response rate: 93.4%). The questionnaire addressed study habits throughout training, motivations for studying, preferred study resources, impressions on teaching quality, study preparation methods, and exam preparedness among junior and senior residents. RESULTS: Among all residents, 37.3% read for 2-5 hours weekly. Juniors read significantly more than seniors (P = 0.034). Marital status affects seniors' study habits (P = 0.029). For most seniors, preparation for the final board exam is the greatest motivation for studying (P = 0.006). The AUA/EAU guidelines were useful information source for seniors (P = 0.001). Fifty-four percent (54.4%) of residents felt that their residency program did not provide protected study time prior to the board exams. Moreover, the majority (64.8%) felt that the training program did not adequately prepare them for the board exams. CONCLUSION: We recommend that local program directors implement more effective teaching methods. Structured reading habits and specific study materials were found to be positive predictors of successful performance. Residents should also be educated in balancing working hours, social life, and study.
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Sacral neuromodulation has gained widespread use for bladder overactivity, frequency, urgency, fecal incontinence, and nonobstructive urinary retention; hence, implantations of this device in patients with comorbid cardiac conduction diseases have increased. Theoretically, there are some concerns regarding the use of sacral neuromodulation implants in patients with Wolf-Parkinson-White syndrome and cardiac conduction diseases because of the risk of interference with electrical impulses. This study aimed to describe the safety of using sacral neuromodulation to treat nonobstructive urinary retention in patients with a cardiac conduction disease. We report a case in which sacral neuromodulation was performed to treat nonobstructive urinary retention in a 25-year-old woman with Wolf-Parkinson-White syndrome who was receiving antiarrhythmic medication. The patient underwent magnetic resonance imaging of the spine and urodynamic studies after presenting with urinary symptoms at a urology clinic. She was then diagnosed with nonobstructive urinary retention. She underwent two-staged InterStim therapy, which involved implanting a permanent tined lead through the S3 foramen in the first stage and an implantable pulse generator in the second stage. The patient responded well to the therapy, and the frequency of clean intermittent catheterization was reduced from 6 times a day to once daily with only 250 mL drained per day. The cardiology team recommended intraoperative cardiac monitoring and postoperative electrocardiogram monitoring. No interference was observed between the implantable pulse generator and the cardiac rhythm on electrocardiography. She experienced no exacerbation of her cardiac symptoms. Sacral neuromodulation in a patient with Wolf-Parkinson-White syndrome appears to have been safe. Further, prospective and randomized studies with larger study samples are required to investigate the safety of these implants in WPW patients.
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Background Anatomical landmarks and surface markings have long been used in out-patient contexts for conducting percutaneous nerve evaluation procedures, but studies testing the reliability of these anatomical landmarks are scant. There have been reports where the procedure has failed. Could it be possible that the anatomical landmarks that are used are not reliable enough? To answer this question, we used this study to understand the reliability of these anatomical landmarks. Methods Twenty cadavers, 10 males and 10 females, were dissected in the sacral region; the landmarks were tested, and the angulation and curve made by the sacral 3 (S3) nerve were also studied. Results Sacral 3 was identified mainly at the four o'clock position on the right and at the eight o'clock position on the left side. The Sacral 3 foramen was found at a mean distance of 9.17 ± 0.23 cm from the tip of the coccyx. The mean distance of the lateral margin of S3 from the median sacral ridge was found to be 2.16 ± 0.07 cm. Conclusion The landmark of 9 cm from the coccyx tip is a valid landmark for sacral neuromodulation (SNM) procedures. The tip of the lead should follow the curve of the nerve as close as possible at the four and eight o'clock positions on the right and left side, respectively. However, the length of the coccyx differs from person to person. The proximity of the adjacent foramina to each other and the variations in the emerging of the nerve are a few factors to be considered while performing SNM procedures. Further study with a larger sample is required in order to investigate the course of the nerve, and its relationship to response to SNM.