Features and frequency of use of electronic health records in primary care across 20 countries: a cross-sectional study.

OBJECTIVES: Variation exists in the capabilities of electronic healthcare records (EHRs) systems and the frequency of their use by primary care physicians (PCPs) from different settings. We aimed to examine the factors associated with everyday EHRs use by PCPs, characterise the EHRs features available to PCPs, and to identify the impact of practice settings on feature availability. STUDY DESIGN: Cross-sectional study. METHODS: PCPs from 20 countries completed cross-sectional online survey between June and September 2020. Responses which reported frequency of EHRs use were retained. Associations between everyday EHRs use and PCP and practice factors (country, urbanicity, and digital maturity) were explored using multivariable logistic regression analyses. The effect of practice factors on the variation in availability of ten EHRs features was estimated using Cramer's V. RESULTS: Responses from 1520 out of 1605 PCPs surveyed (94·7%) were retained. Everyday EHRs use was reported by 91·2% of PCPs. Everyday EHRs use was associated with PCPs working >28 h per week, having more years of experience using EHRs, country of employment, and higher digital maturity. EHRs features concerning entering, and retrieving data were available to most PCPs. Few PCPs reported having access to tools for 'interactive patient education' (37·3%) or 'home monitoring and self-testing of chronic conditions' (34·3%). Country of practice was associated with availability of all EHRs features (Cramer's V range: 0·2-0·6), particularly with availability of tools enabling patient EHRs access (Cramer's V: 0·6, P < 0.0001). Greater feature availability of EHRs features was observed with greater digital maturity. CONCLUSIONS: EHRs features intended for patient use were uncommon across countries and levels of digital maturity. Systems-level research is necessary to identify the country-specific barriers impeding the implementation of EHRs features in primary care, particularly of EHRs features enabling patient interaction with EHRs, to develop strategies to improve systems-wide EHRs use.

Efficient simulation of Time-Fractional Korteweg-de Vries equation via conformable-Caputo non-Polynomial spline method.

This research presents a novel conformable-Caputo fractional non-polynomial spline method for solving the time-fractional Korteweg-de Vries (KdV) equation. Emphasizing numerical analysis and algorithm development, the method offers enhanced precision and modeling capabilities. Evaluation via the Von Neumann method demonstrates unconditional stability within defined parameters. Comparative analysis, supported by contour and 2D/3D graphs, validates the method's accuracy and efficiency against existing approaches. Quantitative assessment using L2 and L∞ error norms confirms its superiority. In conclusion, the study proposes a robust solution for the time-fractional KdV equation.

Dyakonov waves generation at uniaxial chiral-plasma interface.

Numerical analysis of Dyakonov waves generation has been carried out at uniaxial chiral-plasma planar interface. The extended electromagnetic wave theory is utilized, and an impedance boundary conditions approach is employed to obtain characteristics equation. Effective mode index and attenuation under the different values of collisional frequency, plasma frequency and chirality in the THz frequency range for three cases for uniaxial chiral media are discussed. These results can be used in the field of photonics and integrated optics to fabricate nanophotonic devices in the THz frequency range.

Short tandem repeat (STR) variation from 6 cities in Iraq based on 15 loci.

BACKGROUND: One thousand sixty-one individuals were sampled from the cities of Anbar, Baghdad, Basra, Diyala, Najaf, and Wasit in Iraq and typed for 15 forensic STRs to explore the genetic structure of Iraq and develop a forensic DNA database. The total number of alleles that were identified was 203. RESULT: Analyses of molecular variance (AMOVA) were then conducted Baghdad provides a good representation of the rest of the country, while Anbar is the most genetically distinct. The average heterozygosities of these loci was 0.779, homozygosities was 0.221, polymorphism information content was 0.77, power of discrimination was 0.927, and power of exclusion was 0.563. At these loci, a matching genotype will occur, on average, in 1 in 8.152 × 1017 individuals. For paternity tests, the average paternity probability for a matching profile is 99.9997%. CONCLUSIONS: These loci are appropriate for use in forensic and paternity testing for this population. Iraq is similar to other countries in the Middle East, particularly Iran and Turkey, and is more similar to Europe than either Asia or Africa.

Miniaturized Broadband Bi-Yagi Antenna Array for Ambient RF Energy Harvesting.

This paper presents a miniaturized broadband Bi-Yagi antenna array that covers a bandwidth from 1.79 GHz to 2.56 GHz. The proposed antenna achieves a tradeoff between maximizing bandwidth, effective area, and gain while minimizing physical dimensions. The antenna design considers the coupling between the radiator and director elements, resulting in increased bandwidth as the resonating modes shift apart. Additionally, the proposed design optimizes element spacing and dimensions to achieve high gain, wide bandwidth, efficient radiation, and a minimum aperture size. The proposed antenna, with physical dimensions of 138.6 mm × 47.7 mm × 1.57 mm, demonstrates gains ranging from 6.2 dBi to 9.34 dBi across the frequency range, with a total efficiency between 88% and 98%. The proposed design is experimentally validated by measuring the reflection coefficients, input impedance, gain, and normalized radiation pattern. These features make the antenna well suited for capturing and harvesting electromagnetic waves in mobile wireless and Wi-Fi applications.

A High-Performance Circularly Polarized and Harmonic Rejection Rectenna for Electromagnetic Energy Harvesting.

This paper presents a novel circularly polarized rectenna designed for efficient electromagnetic energy harvesting at the 2.45 GHz ISM band. A compact antenna structure is designed to achieve high performance in terms of radiation efficiency, axial ratio, directivity, effective area, and harmonic rejection over the entire bandwidth of the ISM frequency band. The optimized rectifier circuit enhances the RF harvested energy efficiency, with an AC-to-DC conversion efficiency ranging from 36% to 70% for low-level input power ranging from -10 dBm to 0 dBm. The stable output of DC power confirms the suitability of this design for various practical applications, including wireless sensor networks, energy harvesting power supplies, medical implants, and environmental monitoring systems. Experimental validation, which includes both the reflection coefficient and radiation patterns of the designed antenna, confirms the accuracy of the simulation. The study found that the proposed energy harvesting system has a high total efficiency ranging from 53% to 63% and is well-suited for low-power energy harvesting (0 dBm) from ambient electromagnetic radiation. The proposed circularly polarized rectenna is a competitive option for efficient electromagnetic energy harvesting, both as a standalone unit and in an array, due to its high performance, feasibility, and versatility in meeting various energy harvesting requirements. This makes it a promising and cost-effective solution for various wireless communication applications, offering great potential for efficient energy harvesting from ambient electromagnetic radiation.

Exploring views of members of the public and policymakers on the acceptability of population level dietary and active-travel policies: a qualitative study.

BACKGROUND: There is limited evidence on what shapes the acceptability of population level dietary and active-travel policies in England. This information would be useful in the decision-making process about which policies should be implemented and how to increase their effectiveness and sustainability. To fill this gap, we explored public and policymakers' views about factors that influence public acceptability of dietary and active-travel policies and how to increase public acceptability for these policies. METHODS: We conducted online, semi-structured interviews with 20 members of the public and 20 policymakers in England. A purposive sampling frame was used to recruit members of the public via a recruitment agency, based on age, sex, socioeconomic status and ethnicity. Policymakers were recruited from existing contacts within our research collaborations and via snowball sampling. We explored different dietary and active-travel policies that varied in their scope and focus. Interviews were transcribed verbatim and analysed using thematic reflexive analysis with both inductive and deductive coding. RESULTS: We identified four themes that informed public acceptability of dietary and active-travel policies: (1) perceived policy effectiveness, i.e., policies that included believable mechanisms of action, addressed valued co-benefits and barriers to engage in the behaviour; (2) perceived policy fairness, i.e., policies that provided everyone with an opportunity to benefit (mentioned only by the public), equally considered the needs of various population subgroups and rewarded 'healthy' behaviours rather than only penalising 'unhealthy' behaviours; (3) communication of policies, i.e., policies that were visible and had consistent and positive messages from the media (mentioned only by policymakers) and (4) how to improve policy support, with the main suggestion being an integrated strategy addressing multiple aspects of these behaviours, inclusive policies that consider everyone's needs and use of appropriate channels and messages in policy communication. CONCLUSIONS: Our findings highlight that members' of the public and policymakers' support for dietary and active-travel policies can be shaped by the perceived effectiveness, fairness and communication of policies and provide suggestions on how to improve policy support. This information can inform the design of acceptable policies but can also be used to help communicate existing and future policies to maximise their adoption and sustainability.

A Wideband GRIN Dielectric Lens Antenna for 5G Applications.

This paper proposes a graded effective refractive indexes (GRIN) dielectric lens for 5G applications. The inhomogeneous holes in the dielectric plate are perforated to provide GRIN in the proposed lens. The constructed lens employs a collection of slabs that correspond to the specified graded effective refractive index. The thickness and the whole lens dimensions are optimized based on designing a compact lens with optimum lens antenna performance (impedance matching bandwidth, gain, 3 dB beamwidth, and sidelobe level). A wideband (WB) microstrip patch antenna is designed to be operated over the entire band of interest from 26 GHz to 30.5 GHz. For the 5G mm-wave band of operation, the behavior of the proposed lens along with a microstrip patch antenna is analyzed at 28 GHz for various performance parameters, including impedance matching bandwidth, 3 dB beamwidth, maximum gain, and sidelobe level. It has been observed that the antenna exhibits good performance over the entire band of interest in terms of gain, 3 dB beamwidth, and sidelobe level. The numerical simulation results are validated using two different simulation solvers. The proposed unique and innovative configuration is well-suited for 5G high gain antenna solutions with a low-cost and lightweight antenna structure.

Corrigendum to 'Single domain antibodies derived from ancient animals as broadly neutralizing agents for SARS-CoV-2 and other coronaviruses': Biomedical Engineering Advances 4 (2022) 100054.

[This corrects the article DOI: 10.1016/j.bea.2022.100054.].

A systematic review of ethnic disparities in the uptake of colorectal cancer screening.

AIMS: Colorectal cancer (CRC) screening reduces mortality, but variation exists in uptake. Ethnicity is suggested to play a role; however, there is no high-level evidence to support this. We aim to clarify the impact of Ethnicity on CRC screening uptake and our barriers to its understanding. METHODS: A systematic review to identify studies reporting on the participation of ethnic minorities in CRC screening worldwide was performed. MEDLINE, Embase, Scopus and Google Scholar databases up until 31 May 2019 were searched. Compliance with screening according to ethnic groups and screening modality was evaluated compared to the 'White' control group. RESULTS: Twenty-two studies were included in the review reporting on 2,084,213 patients. Substantial variation in categorisation of ethnicities (40 sub-categories), screening modality studied and confounding factors accounted for was observed. 8/15 studies for 'Blacks', 10/13 for 'Hispanics', 2/2 for 'Asians' and 1/1 for 'South East Asians' suggest a less likely or significantly decreased compliance with screening for all screening modalities (p < .05) compared to 'Whites'. Interestingly 'Japanese', 'Vietnamese' and 'Filipino' groups consistently show no difference in the uptake of CRC screening compared to the 'White' majority. CONCLUSION: This is the only systematic review on this topic. It highlights the inconsistency in screening uptake behaviour in different ethnic minority groups and identifies barriers like variation in ethnicity categorisation, screening modality and study design utilised to understanding the intricacies of this relationship. Further collaboration and action needs to be undertaken internationally to clarify and improve inequity in the uptake of screening.

Screening tool to improve patient referral to acute surgical care from accident and emergency.

INTRODUCTION: This study aimed, first, to audit the appropriateness of surgical referrals to an acute surgical unit for urgent assessment and, second, to devise a screening tool for use in the emergency department to categorise patients into those who need an urgent surgical review and those who can be seen in an ambulatory setting within the next few days. METHODS: The first phase of the study was an audit of surgical referrals between 1 and 18 February 2020 to check the appropriateness of the surgical referral. In the second phase, a tool was designed to screen patients who did not require urgent surgical review and could be seen in the ambulatory clinic. A prospective questionnaire study was conducted from 1 February to 24 March 2020 with patients who were admitted to an acute surgical ward. Based on responses to the screening tool, patients were given the outcome of whether they can be discharged and seen in an ambulatory clinic. The accuracy of the screening tool outcome was assessed and compared with actual patient discharge outcomes by the surgical team evaluating patients' electronic medical records. RESULTS: In the first audit of referrals to the acute surgical ward, 206 patients were referred to the acute surgical unit and seen by the senior surgeon. Of these, 142 (68.9%) were discharged on the same day with or without follow-up in the ambulatory surgical clinic. In the prospective questionnaire phase of the study, 98 patients completed the questionnaire. The most common presentation was abdominal pain (n=60) followed by urological symptoms (n=11), symptoms of hernia complication (n=10), abscess (n=7), testicular pain (n=2) and trauma (n=2). Of the patients discharged on the same day, 50% were given ambulatory care appointments and 50% were discharged with no further follow-up. The sensitivity and specificity of the screening tool were 100% and 60.7%, respectively; the overall accuracy was 88.4%. CONCLUSION: A large proportion of patients who are referred to the acute surgical unit can be deferred and seen in the ambulatory clinic. The screening tool used for acute surgical referral had reasonable sensitivity and high specificity to screen patients who can be seen in ambulatory clinics. At the same time, it identified patients who were unwell and required urgent surgical admission.

High tibial osteotomy in medial compartment osteoarthritis of knee: functional outcome of medial open wedge and lateral closing wedge osteotomies-How does the outliers fare in the medium term?

BACKGROUND AND AIM OF THE STUDY: Our study aimed to compare the functional outcome of HTO performed via lateral closing wedge osteotomy and medial open wedge osteotomy followed up for a mean period of 6 years using Lysholm knee score. Secondary objective was to find out whether an achievement of 2°-6° of mechanical axis had a significant impact in the outcome and how the outliers of 2°-6° (177°-182° (straight knees) and greater than 186° (overcorrection) performed in the medium term and how patients who lost correction to more than - 3° (persistent varus) performed in the medium term. STUDY DESIGN: This is a prospective observational study. MATERIALS AND METHODS: Sixty-two consecutive patients who had undergone HTO by a single surgeon from 2012 to 2015 were followed up. The final follow-up visit was from August 2019 to December 2019. Nine were lost to follow-up, and 53 presented for the follow-up visit. Case records were noted for the preoperative LKS scores, preoperative mechanical axis, ROM, and preoperative tibiofemoral angle. Post-operative mechanical axis in full-length weight bearing at 4 months was also noted. During the latest visit, patients underwent LKS scoring, full-length weight-bearing X-rays to assess mechanical axis, and assessment of tibiofemoral angle. The results were grouped into excellent, good, fair, and poor outcomes based on LKS scale. The mechanical axes attained at surgery and at the follow-up were grouped into less than 177° as varus, 177°-182° as straight 182°-186° as required correction, and more than 186° as overcorrection. Lysholm knee score was dichotomised using LKS 84 as the cut-off (LKS ≥ 84 high LKS; LKS 84 low LKS). RESULTS: A total of 53 patients with a median age of 56 years (SD 4.23) were included in this study. There were 8 (15.1%) males and 45 (84.9%) females. The mean ± SD of BMI of patients was 28.10 ± 2.66 kg/m2. Medial opening wedge osteotomy was performed in 27 (50.9%) cases, and lateral closing wedge osteotomy was performed in 26 (49.1%). Median duration between the time of surgery and the follow-up was 72 months (IQR 32.5). Preoperatively, the mean LKS score of the patients was 50.25 ± 12.43 (88.68% had poor score and 11.32% had fair score), and the mean mechanical axis of the knee was 172.54 ± 3.78 (all had varus deformity). The mean (SD) preoperative LKS score of the 53 participants before the surgery was 50.25 (12.43). Poor score was reported by 47 (88.68%) and fair score by 6 (11.32%) patients, respectively. At the time of final follow-up, the mean (SD) LKS score of 53 patients was 77.81(17.11). At the time of final follow-up (when compared with the score before surgery), 41(77.36%) patients had improvement in the LKS score, 10 (18.87%) patients had no improvement in the score, and 2 (3.77%) patients worsened from fair to poor. The difference between the LKS score before surgery and at the final follow-up was significantly greater for patients who underwent medial opening wedge osteotomy [median (IQR)35 (26-38)] than for the patients who underwent lateral closing wedge osteotomy [median (IQR) 30 (23-34)], U226.5, p 0.026. Knees with desired valgus angle within 2°-6° and knees which remained straight at the final follow-up showed a good or excellent outcome at the final follow-up (23 out of 53 knees). Those knees with had varus HKA axis had a poor or fair outcome at the final follow-up (23 out of 53 knees). Those knees that were overcorrected also had poor outcomes. CONCLUSION: Our study shows that both medial open wedge osteotomy and lateral closing wedge osteotomy are capable of improving knee function in medial compartment osteoarthritis of knee. Medial open wedge with locking plates is a biomechanically more stable construct compared with lateral closing wedge osteotomy. Irrespective of the two techniques chosen, the aim of the osteotomy should be to achieve an overcorrection of 2°-6° of valgus or at least to keep the knee straight (normal mechanical axis). This will give a satisfactory medium-term result. However, varus alignment  and valgus alignment of more than 6° can result in a deterioration of function of knee. The results of the osteotomy are found to deteriorate with obesity, severe varus in  preop mechanical axis and longer duration of follow-up.

Single domain antibodies derived from ancient animals as broadly neutralizing agents for SARS-CoV-2 and other coronaviruses.

With severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as an emergent human virus since December 2019, the world population is susceptible to coronavirus disease 2019 (COVID-19). SARS-CoV-2 has higher transmissibility than the previous coronaviruses, associated by the ribonucleic acid (RNA) virus nature with high mutation rate, caused SARS-CoV-2 variants to arise while circulating worldwide. Neutralizing antibodies are identified as immediate and direct-acting therapeutic against COVID-19. Single-domain antibodies (sdAbs), as small biomolecules with non-complex structure and intrinsic stability, can acquire antigen-binding capabilities comparable to conventional antibodies, which serve as an attractive neutralizing solution. SARS-CoV-2 spike protein attaches to human angiotensin-converting enzyme 2 (ACE2) receptor on lung epithelial cells to initiate viral infection, serves as potential therapeutic target. sdAbs have shown broad neutralization towards SARS-CoV-2 with various mutations, effectively stop and prevent infection while efficiently block mutational escape. In addition, sdAbs can be developed into multivalent antibodies or inhaled biotherapeutics against COVID-19.

Epidemiology and outcomes of primary sclerosing cholangitis: an Australian multicentre retrospective cohort study.

BACKGROUND AND AIMS: Little is known regarding the epidemiology and outcomes of patients with primary sclerosing cholangitis (PSC) in Australia. We, therefore, evaluated the epidemiology and clinical outcomes of PSC in a large cohort of Australian patients and compared these to the general population. METHODS: We conducted a multicentre, retrospective cohort study of PSC patients at nine tertiary liver centers across three Australian states, including two liver transplant centers. RESULTS: A total of 413 PSC patients with 3,285 person-years of follow-up were included. Three hundred and seventy-one (90%) patients had large duct PSC and 294 (71%) had associated inflammatory bowel disease. A total of 168 (41%) patients developed cirrhosis (including 34 at the time of PSC diagnosis) after a median of 15.8 (95% CI 12.4, NA) years. The composite endpoint of death or liver transplantation occurred in 49 (12%) and 78 (19%) patients, respectively, with a median transplant-free survival of 13.4 (95% CI 12.2-15) years. Compared to the general population, PSC accounted for a 240-fold increased risk of development of cholangiocarcinoma (CCA) and CCA-related death. CCA risk was increased with older age of PSC diagnosis, presence of dominant stricture and colectomy. Compared to same-aged counterparts in the general population, PSC patients who were diagnosed at an older age or with longer disease duration had reduced relative survival. CONCLUSION: In this large retrospective cohort study of PSC patients in Australia, increased age and time from diagnosis was associated with increased mortality and morbidity particularly from CCA and development of cirrhosis, necessitating need for liver transplant.

Simultaneous malignant hyperthermia reactions in two siblings during living donor liver transplantation.

We report a case of simultaneous malignant hyperthermia reactions occurring in two siblings during living donor liver transplantation. This report highlights the conflicting goals in the clinical management of liver transplantation and malignant hyperthermia, including the use of total intravenous anaesthesia and dantrolene in the face of the potential for drug-induced hepatotoxicity in the remnant liver or transplanted liver graft, as well as cautious fluid management needed for liver transplantation balanced against the liberal fluid therapy required to prevent acute kidney injury associated with malignant hyperthermia. The logistical challenges of managing this emergency in two closely related patients are discussed, including rapid preparation of two vapour-free anaesthesia machines, the need for availability of additional dantrolene and the requirement for additional personnel. Prompt recognition, immediate removal of the triggering agents and conversion to total intravenous anaesthesia helped to curtail the malignant hyperthermic reactions in our patients, both of whom made a full recovery.

Dynamics of heat shock proteins and heat shock factor expression during heat stress in daughter workers in pre-heat-treated (rapid heat hardening) Apis mellifera mother queens.

Honeybees have a limited capacity to control their body temperature when exposed to thermal changes in the atmosphere. Environmental changes, such as thermal climate change, have an adverse effect on honeybee survival. Insects can be pre-heat-treated (rapid heat hardening) with a mild heat stressor to induce Hsp gene expression and protect them from future stresses. Sixty accepted mother queen (MQ) larvae at the age of 7 days were selected and divided into two incubation treatment groups (n = 30). The control group (non-heat-treated mother queens, nH-T MQ) was maintained at 34.5 °C for 15 min and 70% relative humidity (RH), and the pre-heat-treated (pre-heat-treated mother queens, pH-T MQ) group was subjected to 41 °C for 15 min and 70% RH. To evaluate the effect of larval pre-heat-treatment on thermotolerance acquisition of daughter workers, about 500 workers were collected from brood combs of each treatment group. The worker bees in their cages were incubated in digital-controlled thermo-incubators for 1 h under each of the following temperatures: 35, 40, 45, 50, 55, and 60 °C. The expression of Hsp40, Hsp60, Hsp70, HSC70-3, HSC70-4, HSC70-5, Hsp83, and Hsp90 genes in both head and thorax were evaluated by relative quantitative real-time qPCR (RT-qPCR). In general, the pH-T MQ workers exhibited a higher ability to tolerate temperature than nH-T MQ workers under extreme conditions. Furthermore, we reported for the first time that pre-heat treatment of the mother queen's larvae alters the basal and dynamic expression of heat shock proteins (Hsp40, Hsp60, Hsp70, and Hsp90) and heat shock factor (HSF) during thermoneutral conditions and during heat stress of daughter workers, probably indicating a substantial improvement of honeybees' thermotolerance acquisition in arid and semi-arid regions, and improvement of honeybee longevity and management strategies.

Associations of Cardiovascular and Non-Cardiovascular Comorbidities with Dementia Risk in Patients with Diabetes: Results from a Large UK Cohort Study.

BACKGROUND: Type 2 diabetes (T2D) is an established risk factor for dementia. However, it remains unclear whether the presence of comorbidities could further increase dementia risk in diabetes patients. OBJECTIVES: To examine the associations between cardiovascular and non-cardiovascular comorbidities and dementia risk in T2D patients. DESIGN: Population-based cohort study. SETTING: The UK Clinical Practice Research Datalink (CPRD). PARTICIPANTS: 489,205 T2D patients aged over 50 years in the UK CPRD. MEASUREMENTS: Major cardiovascular and non-cardiovascular comorbidities were extracted as time-varying exposure variables. The outcome event was dementia incidence based on dementia diagnosis or dementia-specific drug prescription. RESULTS: During a median of six years follow-up, 33,773 (6.9%) incident dementia cases were observed. Time-varying Cox regressions showed T2D patients with stroke, peripheral vascular disease, atrial fibrillation, heart failure or hypertension were at higher risk of dementia compared to those without such comorbidities (HR [95% CI] = 1.64 [1.59-1.68], 1.37 [1.34-1.41], 1.26 [1.22-1.30], 1.15 [1.11-1.20] or 1.10 [1.03-1.18], respectively). Presence of chronic obstructive pulmonary disease or chronic kidney disease was also associated with increased dementia risk (HR [95% CI] = 1.05 [1.01-1.10] or 1.11 [1.07-1.14]). CONCLUSIONS: A range of cardiovascular and non-cardiovascular comorbidities were associated with further increases of dementia risk in T2D patients. Prevention and effective management of these comorbidities may play a significant role in maintaining cognitive health in T2D patients.

Effect of Culture Medium on in vitro Fertilization in Local Iraqi Ewes.

in vitro fertilization (IVF) is considered to be the most important reproductive biotechnological method having great potential to accelerate genetic improvement in ruminants as well as for research on embryonic development. The present study aimed to investigate the effect of culture medium and the addition of natural and synthetic antioxidants on in vitro maturation (IVM), fertilization (IVF), and culture (IVC) in local Iraqi ewes. A total of 304 reproductive systems of local ewes were collected from a slaughterhouse in Fallujah, Anbar Province, Iraq from 3, January to 1, July 2021. The study was conducted in the Reproductive Biotechnology Laboratory, Department of Surgery and Theriogenology, College of Veterinary Medicine, University of Fallujah, Iraq. A total of 1368 oocytes were recovered from 608 ovaries surrounded by cumulus cells. The method of collection was aspiration and oocytes were divided into eight treatments. The first (T1), the second (T2), the third (T3), the fourth (T4), the fifth (T5), the sixth (T6), the seventh (T7), and the eighth (T8) treatments were MEM + Capparis spinosa extract 50µmol, MEM + Silymarin extract 100µmol, MEM + Coenzyme Q10 5 µmol, MEM only serves as a control, DMEM + Capparis spinosa extract 50 µmol, DMEM + Silymarin extract 100µmol, DMEM + Coenzyme Q10 5µmol and DMEM only serves as a control, respectively. The results indicated a significant difference (P≤0.05) between T5 (DMEM + Capparis spinosa extract) and other controls or treatments. Cultural medium DMEM with Capparis spinosa extract (as an antioxidant) presents the best results in the morula and blastocyst stage.

Levels of trace elements and rare earth elements in honey from Jordan.

Honey is a common sweetener in the Jordanian diet with an annual consumption of approximately one thousand tons, two-thirds of which are imported. It is believed that the elemental profile of honey is an indicator of safety and botanical and geographic origin. In the literature, there are a lack of studies concerning the levels of major and trace elements in honey in Jordan. A total of 46 elements, including 15 rare earth elements (REEs), were analyzed by inductively coupled plasma-mass spectrometry (ICP-MS) in 18 monofloral and multifloral imported honey samples and 12 multifloral local samples. Regarding monofloral samples, Black Forest samples had the highest total metal content, while acacia samples had the lowest total metal content. Local multifloral honey had the largest Sr and total REE levels, while it had the lowest Mn levels. Very low levels of toxic elements were found in all samples, indicating the safety of honey in Jordan for human consumption. The results of this study showed that a large number of samples (> 100) and the application of advanced statistical models are required to discriminate between multifloral imported and local honey.

Tailored strategy to match anatomy and physiology with intervention can improve outcomes of symptomatic neonates with Ebstein anomaly.

Objective: Neonatal presentation of Ebstein anomaly (EA) represents the most severe form of this condition. Despite significant advances, operative mortality remains high and management decisions represent a formidable challenge. We used a strategy aimed to match anatomy and physiology with type and time of intervention to increase survival. Methods: We performed a review of all patients with fetal or neonatal diagnosis of EA managed at a single center between 2007 and 2020. Results: Among 18 patients with EA, 8 underwent neonatal intervention. The most common indication included cyanosis and heart failure (8/8), end organ dysfunction (6/8), and maldistribution of cardiac output (6/8). Only 2/8 had antegrade pulmonary blood flow. Associated conditions included pulmonary regurgitation in 4/8, atrial tachyarrhythmia in 4, and a ventricular septal defect in 3. Three patients underwent initial stabilization with main pulmonary artery occlusion including bilateral pulmonary artery banding in 2. Five patients underwent biventricular repair with conversion to right ventricle exclusion in 2 cases. Three others underwent the Starnes procedure as initially planned. The median age at surgery was 10 days (range, 1-30) and median weight 2.6 kg (range, 1.9-4.0). The median duration of mechanical ventilation and intensive care unit stay were 9 days (range, 5-34) and 30 days (range, 15-100), respectively. Operative mortality was 1/8. At a median follow-up of 130 months (range, 5-146), there were no late deaths, and all survivors remain in functional class I and free of valvular reintervention. Conclusions: Symptomatic neonates with EA can be effectively managed with good outcomes. Preoperative stabilization and choice of management pathway on the basis of anatomy and physiology can help reduce morbidity and mortality.