Buck-Boost DC-AC converter based on coupled inductors.

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

The level of medical students' knowledge regarding the prevention of cervical cancer.

Background: In Palestine, cervical cancer is the third most common gynaecological cancer, exhibiting higher mortality rates compared to regional counterparts. Late-stage diagnosis and limited awareness contribute to this disparity. This study aims to assess the awareness of Palestinian medical students regarding cervical cancer prevention. Methods: A questionnaire-based survey involving 532 medical students from various Palestinian universities was conducted between October 2023 and December 2023. The survey encompassed closed-ended quantitative and demographic questions distributed through social media. Results: The study was carried out on a group of 532 medical students (66.3% women and 33.6% men), (average age 21.7 years). Most students (77.7%) knew that the main risk factor for cervical cancer was human papillomavirus (HPV) infection. Participants doing the internship had the greatest knowledge, whereas students from the first year had the poorest knowledge about the main risk factors for cancer of the cervix. Only about half, 50.2% of all students, knew that in Palestine, there is no screening program. 84.4% of students correctly indicated that the cervical cancer screening test is a pap smear test. 41.4% of respondents knew that microscopic evaluation of the exfoliated cells from the vaginal part of the cervix is the screening test for cervical cancer which is used. Only about half of the students (45.1%) knew that there were no specific early symptoms of cervical cancer. Conclusions: This study highlights the need for enhanced education, particularly regarding screening program awareness, among Palestinian medical students. Addressing these knowledge gaps is crucial for effective preventive strategies.

The Effect of Germination and Fermentation on the Physicochemical, Nutritional, and Functional Quality Attributes of Samh Seeds.

This study investigated the effects of fermentation and germination on the physicochemical, nutritional, functional, and bioactive quality attributes of samh seeds. Regardless of the processing treatment, samh seeds were found to be a rich source of phenolic compounds, namely gallic acid (79.6-96.36 mg/100 g DW), catechol (56.34-77.34 mg/100 g DW), and catechin (49.15-84.93 mg/100 g DW), and they possessed high DPPH antiradical activity (65.27-78.39%). They also contained high protein content (19.29-20.41%), essential amino acids content (39.07-44.16% of total amino acids), and unsaturated fatty acid content (81.95-83.46% of total fatty acids) and a low glycemic index (39.61-41.43). Fermentation and germination increased L*, b*, foaming capacity, oil absorption capacity (OAC), water absorption capacity (WAC), swelling power, microbial counts, antioxidant activity, total flavonoid content (TFC), total phenolic content (TPC), in vitro protein digestibility, protein efficiency ratio, and total essential amino acids and reduced water solubility, emulsion stability, tannin, and phytate contents compared to raw samh seeds (p < 0.05). The highest levels of pH, ash, carbohydrate, fiber, and glycemic index were observed in raw samh seeds, and both germination and fermentation processes reduced these attributes to various degrees (p < 0.05). Germination increased the redness (a*), moisture content, essential and non-essential amino acids, potassium, zinc, phosphorous, stearic acid, and oleic and unsaturated fatty acids and reduced total solids, fat content, iron, zinc, calcium, magnesium, sodium, palmitic acid, and total saturated fatty acids of the samh seeds compared to the raw ones. Fermentation increased the total solid, acidity, fat, protein, calcium, magnesium, sodium, phosphorous, iron, zinc, palmitic acid, and total saturated fatty acids and reduced the a* value, moisture, non-essential amino acids, and total unsaturated fatty acids of the samh seeds compared to the raw ones. In conclusion, samh seeds are a rich source of nutrients that could generally be enhanced by germination and fermentation processes. The reported information facilitates strategies towards the application of these underutilized seeds in foods.

Case of left atrial myxoid sarcoma with lung metastases presented as a cardiogenic shock: a case report and literature review.

Cardiac tumors are a rare condition that typically presents with nonspecific symptoms. Among the histologic patterns, myxoid sarcomas are rarely identified and may have a less favorable prognosis. Reporting a case of this type of cardiac tumor can increase awareness about this condition and aid in early diagnosis, potentially leading to better outcomes. Case presentation: We are presenting a case of a 41-year-old female with left atrial myxoid sarcoma, which was presented with a cardiogenic shock picture. She underwent surgical excision of the mass and was discharged in good condition. After discharge, she deteriorated and was found to have lung metastases. Clinical discussion: Primary cardiac sarcomas, due to their rarity and poor prognosis, are often diagnosed at an advanced stage of the disease and lack sufficient data to establish a standard course of treatment. The cornerstone of therapy is surgical resection. However, novel therapeutic approaches must be developed. Conclusions: Primary cardiac tumors should be suspected in adult patients with progressive dyspnea, and a biopsy should also be done to determine the histopathological pattern of the mass and estimate the overall prognosis and outcomes.

A Little Neutrophil Predominance May Not Be a Harbinger of Death: Clinical and Laboratory Characteristics of Meningitis in Jordan.

Background This study aims to evaluate the clinical features, laboratory findings, and outcomes of children and adults diagnosed with meningitis in Jordan. Methodology This is a retrospective chart review study that targeted patients diagnosed with meningitis at King Abdullah University Hospital, a tertiary care center in Northern Jordan, from March 21, 2015, to March 31, 2019. Patients were included in this study if they were older than 28 days and had no risk factors for meningitis. Results A total of 169 patients met the inclusion criteria. Males were overrepresented (67%) and were significantly younger than females (6 vs. 17 years, p = 0.01). Positive meningeal signs were not predictive of greater cerebrospinal fluid leukocytosis (p = 0.348), and they did not provide sufficient sensitivity to be used as screening tools. The most common etiology was aseptic (49%), followed by enterovirus (43%), while bacterial meningitis was an uncommon diagnosis (3.5%). Nearly half of the patients took antibiotics prior to their hospital presentation. During in-hospital admission, six patients died, four of whom had bacterial and two had aseptic meningitis. Enteroviral meningitis showed neutrophil predominance in 44% of cases on lumbar puncture and had a higher neutrophil proportion compared to aseptic meningitis (p = 0.026). Streptococcus pneumoniae was the most common bacterial etiology identified. Conclusions Meningitis in Jordan is most commonly of aseptic and enteroviral origin, and these etiologies carry significantly more favorable outcomes compared to bacterial meningitis. Enteroviral meningitis displays a higher percentage of neutrophils in cerebrospinal fluid compared to aseptic meningitis. S. pneumoniae is the leading cause of bacterial meningitis. Slight neutrophil predominance above half is a weak predictor of bacterial meningitis due to the small contribution of bacteria as a cause among enteroviruses and aseptic etiologies.

Regional Variation in the Neurosurgical Workforce in Saudi Arabia.

OBJECTIVES: To highlight the disparity in the regional distribution of neurosurgical workforce in the Kingdom of Saudi Arabia (KSA) and to correlate the provision of neurosurgeons across the regions with several parameters. METHODS:  The 13 administrative emirates of provinces in KSA were grouped into five geographical regions (central, western, eastern, southern, and northern). The density of neurosurgeons was calculated for each region. The distribution of neurosurgeons across the regions was correlated with several parameters using Pearson coefficient test. RESULTS:  This study examined 238 neurosurgeons working in 85 neurosurgical centers in KSA. The regional median (range) density of neurosurgeons was 7.1 (3.1-10.2) per million population and 9.3 (2.3-23.3) per thousand square kilometer area. The regional provision of neurosurgeons correlated significantly with the distribution of KSA-national (p=0.031), KSA-certified (p=0.0004), Government Hospitals (GHs) (p=0.0012), and private hospitals (PHs) (p=0.0359) funded neurosurgeons. The regional allocation of neurosurgeons also correlated positively with the distribution of the total neurosurgical centers (p=0.048), the PHs centers (p=0.0057) but not the GHs centers (p=0.3296). Furthermore, a mismatch was observed between the regional distribution of the neurosurgical workforce and the provision of neurosurgeons according to their GHs' sub-divisions, regional population, and area. CONCLUSIONS:  The regional distribution of neurosurgeons in KSA was uneven. The density of neurosurgeons was the lowest in the southern and northern regions. There was disparity in the number of neurosurgeons employed by the various GHs' sub-divisions and in the allocation of GHs' neurosurgical centers across the regions. Easy access to quality neurosurgical care is imperative. Policy makers should take this into consideration in the future planning of regional neurosurgical services in KSA.

Item Analysis of the Modified Version of the Routine Blood Transfusion Knowledge Questionnaire.

Background and Purpose: Item analysis is important in examining the quality of items. The main aims of this sub-study were to assess and improve the psychometric properties of the modified version of the Routine Blood Transfusion Knowledge Questionnaire (RBTKQ-2) and produce an optimized version (RBTKQ-O) of it. Methods: Statistical item analysis was performed on the RBTKQ-2 after completion by 305 nurses. Results: There were one (3%) easy, 15 (47%) moderately difficult, and 16 (50%) difficult items. Twenty six (81%) items and six (19%) had positive significant and weak point-biserial correlation respectively. The majority of distractors (n = 66, 64%) were functional. Four sources of information, including item analysis data, informed the development of the RBTKQ-O. Conclusions: The RBTKQ-O addressed the limitations that were identified in the versions published earlier. This version can be used by researchers and academics worldwide.

The Magnitude and Effects of Early Integration of Palliative Care Into Oncology Service Among Adult Advanced Cancer Patients at a Tertiary Care Hospital.

Background Palliative care (PC) has a positive effect on symptom burden, quality of life, psychosocial communication, prognostic understanding, mood, and quality of care at the end of life of patients with advanced cancer. Objectives To investigate the timing of the first palliative consultation and referral of advanced cancer patients to the palliative care service and their determinants at King Faisal Specialist Hospital and Research Center (KFSHRC), Jeddah, Saudi Arabia. Subjects and methods A retrospective cohort study was conducted at KFSHRC. It included advanced cancer patients who died between January 1, 2019 and Jun 30, 2020. The dependent variable of primary interest is the timing of PC consultation and the timing of PC referral. The independent variables included age, sex, marital status, nationality, date of death, types of cancer, Eastern Cooperative Oncology Group (ECOG), palliative performance status (PPS), palliative prognostic index (PPI), code status (do not resuscitate [DNR]), the severity of symptoms (assessed by the Edmonton Symptom Assessment System - Revised [ESAS-r]), referral to home health care (HHC), referral to long-term care (LTC), referral to interdisciplinary team (IDT), length of survival after the first PC consultation, length of survival after the referral to the PC service, length of hospital stay, frequency of emergency room (ER) visits and hospital admission in the last year before death, and involvement in bereavement with advanced care planning (ACP) services. Results Of the 210 advanced cancer patients, 109 (51.9%) were male, and their ages ranged between 18 and 90 years. More than half of patients (56.7%) had a history of PC consultation. Among them, PC consultation was described as late in 60.5% of patients. Concerning the timing of palliative care referral among advanced cancer patients, it was too late and much too late among 25.7% and 58.1% of them, respectively. Patients who visited ER more frequently (≥3 times) (p=0.014) and those who referred to HHC (p=0.005) were more likely to consult PC early compared to their counterparts. Length of survival was significantly higher among patients who reported early PC consultation compared to those without PC consultation and those with late PC consultation, p<0.001. Referral to PC for both transfer of care and symptom management was associated with earlier PC consultation, p=0.021. Patients who were admitted to the hospital three times or more were less likely to be much too late referred to PC services, p=0.046. Also, patients who were not referred to long-term care or home health care were more likely to be referred to PC services much too late, p<0.001. Among 28.8% of patients whose PPS ranged between 30% and 50% compared to 14.9% of those whose PPS ranged between 10% and 20% expressed too late referral time to PC, p=0.040. Conclusion In a considerable proportion of terminal cancer patients, palliative care was consulted late, and the timing of palliative care referral was too late/much too late among most of those consulted palliative care. Length of survival was higher among patients who reported early PC consultation and who with ideal referral time to PC services than others. Therefore, future considerations to facilitate early integration of palliative care in cancer patients are highly recommended through mainly improving staff education in communication skills and palliative care approach.

NMR magnets for portable applications using 3D printed materials.

In this paper, we introduce 3D printing as a possibility for realizing lightweight, yet high-precision NMR magnets. Using a commercially available filament containing steel particles allows for the realization of critical components of NMR magnets such as pole pieces and even the flux-conducting yoke. In contrast to shimming structures made of iron, 3D printed structures made of the lightweight filament allow for a robust and inexpensive way of realizing high-performance NMR magnets for future portable NMR applications. We demonstrate the versatility and achievable high performance of the proposed solution with two different H-shaped NMR magnets. In the first magnet, the 3D-printed filament is used to realize the yoke that guides the magnetic flux inside the magnet, providing the potential for a substantial weight reduction compared to a conventional iron yoke. In the second magnet, we use the 3D-printed material to realize arbitrarily shaped passive shim structures. Numerical size and shape optimizations using non-uniform rational basis splines (NURBS) have been applied to obtain the optimal geometry. The two manufactured magnets achieve measured NMR spectral line widths of 54 ppm and 250 ppm, respectively. Our results clearly demonstrate the efficiency and versatility of the proposed design and optimization approach.

How to read a published clinical trial: A practical guide for clinicians.

Over the last 5 years, there have been more than 140 new drug approvals in the field of Oncology alone, all based on newly published clinical trials. These approvals have led to an ongoing change in clinical practice, offering new therapeutic options for patients. Therefore, it is important for healthcare providers to be able to appraise a clinical trial and determine its validity, understand its results, and be able to apply such results to their patients. In this guide, we provide a simplified approach tailored to practicing clinicians and trainees. The same concepts and principles apply to other medical specialties.

Nurses' Attitude, Behavior, and Knowledge Regarding Protective Lung Strategies of Mechanically Ventilated Patients.

The management of critically ill patients is complicated and often involves complex devices including mechanical ventilators (MVs), which may be associated with many complications. Protective lung strategies (PLSs) are used to prevent complications associated with MVs, but nurses may not possess adequate knowledge to optimize the efficacy of PLSs. This article reports findings from what is thought to be the first study in Palestine that explores critical care nurses' knowledge about PLSs. The purpose of this study was to assess the critical care nurses' attitude, behavior, and knowledge regarding PLSs of mechanically ventilated patients. This descriptive, cross-sectional study was conducted at both public and private hospitals in Palestine. The sample included nurses who worked in intensive care units and cardiac care units and utilized a previously developed and validated questionnaire. The result of the study concludes that the majority of the Palestinian critical care nurses agree with the utilization or application of PLSs but have a severe lack of knowledge about the strategies. This highlights the need to provide additional educational programs related to the optimum use of mechanical ventilation.

Burden of serious fungal infections in Bangladesh.

In Bangladesh there are several published papers on superficial mycoses. Deep mycoses are also recognized as an important emerging problem. Here, we estimate the annual incidence and prevalence of serious fungal infections in Bangladesh. Demographic data were obtained from world population reports and the data on TB and HIV extracted from the online publications on tuberculosis in Bangladesh and Asia Pacific research statistical data information resources AIDS Data HUB. All the published papers on fungal infections in Bangladesh were identified through extensive search of literature. We estimated the number of affected people from populations at risk and local epidemiological data. Bangladesh has a population of ∼162.6 million, 31% children and only 6% over the age of 60 years. The pulmonary TB caseload reported in 2014 was 119,520, and we estimate a prevalence of 30,178 people with chronic pulmonary aspergillosis, 80% attributable to TB. An anticipated 90,262 and 119,146 patients have allergic bronchopulmonary aspergillosis or severe asthma with fungal sensitization. Only 8,000 people are estimated to be HIV-infected, of whom 2900 are not on ART with a CD4 count <350 µL, Pneumocystis pneumonia and cryptococcal meningitis being rare. Superficial mycoses are very common with Trichophyton rubrum as the predominant etiological agent (80.6%). Numerous cases of mycotic keratitis have been reported from several parts of Bangladesh. Candida bloodstream infection was estimated based on a 5 per 100,000 rate (8100 cases) and invasive aspergillosis based primarily on leukemia and COPD rates, at 5166 cases. Histoplasmosis was documented in 16 cases mostly with disseminated disease and presumed in 21 with HIV infection. This study constitutes the first attempt to estimate the burden of several types of serious fungal infections in Bangladesh.

Mid-infrared supercontinuum generation in suspended core tellurite microstructured optical fibers.

We report the fabrication of a tellurite optical fiber with a suspended core design, formed on a 220-nm-wide filament of glass. The fiber was pumped at two different wavelengths (1500 and 2400 nm) using femtosecond pulses generated from an optical parametric oscillator (OPO) in order to produce mid-infrared supercontinuum (SC). We observed that SC spectra extending to 3 µm were readily generated. To further optimize the design, detailed numerical study was performed, which revealed how the fiber structural characteristics dramatically influence the spectral broadening because of the changes in the dispersion profile and in turn, the interplay of nonlinear effects that give rise to SC generation. We found that an accurate control of the core shape can be employed to contain the generated SC spectra within well-defined spectral regions or to provide a broad extension of the continuum to beyond 4 µm.

Dorzolamide synergizes the antitumor activity of mitomycin C against Ehrlich's carcinoma grown in mice: role of thioredoxin-interacting protein.

The antitumor activity of carbonic anhydrase (CA) inhibitors is attributed to their ability to induce a state of intracellular acidification. In fact, acidic intracellular pH was demonstrated to upregulate several tumor suppressor proteins and increase the activity of many chemotherapies. The present study aimed to investigate the antitumor activity of the CA inhibitor, dorzolamide, in combination with mitomycin C and to study the effect of these drugs on tumoral thioredoxin-interacting protein (TXNIP) as well as tumor cell proliferation and apoptosis. Solid tumors were induced by subcutaneous inoculation of Ehrlich's ascites carcinoma (EAC) cells in female mice. Mice were treated with dorzolamide (3, 10, or 30 mg/kg/day, i.p.) and/or mitomycin C (1 mg/kg, i.p.) weekly for 3 weeks. Treatment with mitomycin C increased TXNIP level in EAC solid tumors in mice. Likewise, treatment with dorzolamide upregulated TXNIP and p53 while downregulated bcl-2. Both drug therapies increased tumoral caspase 9, caspase 3, and PARP-1 cleavage in addition to decreasing the proliferative Ki-67-stained nuclear fraction. Indeed, a synergistic effect was detected between mitomycin C and dorzolamide. The current data demonstrated that the antitumor activity of mitomycin C and dorzolamide was, at least in part, mediated through stimulating tumoral expression of TXNIP and enhancing tumor apoptosis.

First demonstration of a 2µm few-mode TDFA for mode division multiplexing.

We report the first demonstration of an inline few-mode thulium doped fiber amplifier (TDFA) operating at 2µm for mode division multiplexed transmission. Similar gain and noise figure performance for both the LP(01) and LP(11) modes are obtained in a cladding pumped 2-mode group TDFA. A maximum gain of 18.3dB was measured at 1970nm with a 3dB gain bandwidth of 75nm while the average noise figure was measured to be between 7 and 8dB for wavelengths longer than 1970nm.

Bladder exstrophy combined with uterovaginal prolapse and its surgical management: case report and literature review.

We describe a case of a postmenopausal woman with a corrected bladder exstrophy (BE) who presented with a uterovaginal prolapse complicated by calcified fibroids and discuss its surgical management. A 51-year-old woman presented with a uterovaginal prolapse. She had previously had one full term delivery by caesarean section 20 years ago. She had an ileal conduit performed for her BE at birth. A computed tomography scan revealed significant pelvic anomaly and the uterus contained multiple calcified fibroids. Due to the complexity of her condition the surgical management was planned in two stages: initial examination under anaesthetic in conjunction with a consultant urologist and then the definitive planned reconstructive surgery. This case describes the need for careful evaluation and planning of complex surgery and the successful surgical management option for correction of uterovaginal prolapse in patients with BE. A vaginal approach seemed to be a most sensible route to correct the prolapse in view of her previous multiple abdominal surgeries.

Enhanced prostate cancer gene transfer and therapy using a novel serotype chimera cancer terminator virus (Ad.5/3-CTV).

Few options are available for treating patients with advanced prostate cancer (PC). As PC is a slow growing disease and accessible by ultrasound, gene therapy could provide a viable option for this neoplasm. Conditionally replication-competent adenoviruses (CRCAs) represent potentially useful reagents for treating PC. We previously constructed a CRCA, cancer terminator virus (CTV), which showed efficacy both in vitro and in vivo for PC. The CTV was generated on a serotype 5-background (Ad.5-CTV) with infectivity depending on Coxsackie-Adenovirus Receptors (CARs). CARs are frequently reduced in many tumor types, including PCs thereby limiting effective Ad-mediated therapy. Using serotype chimerism, a novel CTV (Ad.5/3-CTV) was created by replacing the Ad.5 fiber knob with the Ad.3 fiber knob thereby facilitating infection in a CAR-independent manner. We evaluated Ad.5/3-CTV in comparison with Ad.5-CTV in low CAR human PC cells, demonstrating higher efficiency in inhibiting cell viability in vitro. Moreover, Ad.5/3-CTV potently suppressed in vivo tumor growth in a nude mouse xenograft model and in a spontaneously induced PC that develops in Hi-myc transgenic mice. Considering the significant responses in a Phase I clinical trial of a non-replicating Ad.5-mda-7 in advanced cancers, Ad.5/3-CTV may exert improved therapeutic benefit in a clinical setting.

Erbium-doped multi-element fiber amplifiers for space-division multiplexing operations.

Erbium-doped multi-element fiber (MEF) amplifiers have been fabricated to simultaneously amplify multiple transmission channels. MEF devices comprise of multiple single-core fibers (elements) combined in a common coating, with each element working as a single fiber in isolation. MEFs containing 3-elements and 7-elements have been fabricated and characterized. Each element of the fabricated MEFs provides nearly 32 dB of gain with a noise figure of <5 dB for an input signal level of -23 dBm at 1530 nm. Different permutations of element pairs within the MEFs were checked for crosstalk and none was detected, confirming the simultaneous multi-channel amplification capabilities of MEFs.