This study examines the sustainability of livestock farming in Jordan’s arid regions, focusing on smallholder Awassi sheep and Baladi goat farming. It assesses breeders, economic factors, herd productivity, and sustainability, evaluating the vitality of these breeds by examining reproductive success through birth and survival rates. In 2021–2022, a total of 53 traditional Awassi sheep and Baladi goat farms in Northern Jordan’s Mafraq Governorate were surveyed using a comprehensive questionnaire to gather data on breeders’ information, farm economics, and herd indicators. Dry seasons in arid lands are tough on sheep and goats, with limited fodder and water availability harming their health and reproductive capacity. While wet seasons bring relief, they can also introduce diseases. Special care for these animals throughout the year is crucial to maintain healthy herds in arid regions. Linear models were employed to analyze sample data, with variance and correlation tests used to explore relationships among variables. Additionally, chi-squared analysis was utilized to assess the impact of male replacement plans on these herds. The main outcomes of this study reveal that breeder indicators pose challenges to the sustainability and growth of Awassi sheep and Baladi goat farming. Conversely, economic indicators suggest a blend of financial stability alongside obstacles related to profitability and resource ownership. Breeder age emerges as a significant factor in livestock herd management, influenced by elements such as experience, resource availability, and adherence to traditional practices. Experience notably influences breeders’ decisions regarding male insemination replacements, likely due to acquired skills. Crop cultivation is shown to reduce fodder costs, thereby enhancing profitability for each young animal sold and consequently increasing the breeders’ returns. Winter conditions elevate animal mortality rates due to cold stress, while other animals within herds contribute to increased kid mortality by facilitating disease transmission. Breeder experience significantly impacts lamb survival, underscoring its importance in ensuring proper care. Increasing ewe proportions within herds enhances lamb production and lowers lamb mortality rates. Effective ram management and yearling lamb sales further contribute to herd health and productivity. A higher proportion of goats within a herd positively correlates with the number of young yearlings sold but inversely affects breeding males and overall kid numbers, indicating a delicate balance that influences herd productivity and mortality rates. Sheep (92.5%) and goat herds (90.6%) demonstrate reproductive success, indicative of superior long-term vitality. While sheep excel in birth rates, survival, and sales, they exhibit lower ewe and lambing percentages. Goat farming demonstrates high birth rates, sales, and overall success but requires particular attention to ensuring kid survival, especially during the winter months. Improving the characteristics of the Awassi sheep and Baladi goat flocks is crucial for ensuring sustainability, achievable through proper care practices in dry lands. In conclusion, despite the challenges, there are promising opportunities to enhance sheep and goat farming in Jordan. Effective management, informed by the breeders’ experience and economics, is crucial. Empowering small-scale herders and implementing targeted interventions, like winter mortality solutions and selective breeding, is vital for sustainable growth. Full article

Disorders/differences of sex development (DSDs) are defined as broad, heterogenous groups of congenital conditions characterized by atypical development of genetic, gonadal, or phenotypic sex accompanied by abnormal development of internal and/or external genitalia. NR5A1 gene mutation is one of the principal genetic alterations implicated in causing DSD. This review outlines the role of NR5A1 gene during the process of gonadal development in humans, provides an overview of the molecular and functional characteristics of NR5A1 gene, and discusses potential clinical phenotypes and additional organ diseases due to NR5A1 mutations. NR5A1 mutations were analyzed in patients with 46,XY DSD and 46,XX DSD both during the neonatal and pubertal periods. Loss of function of the NR5A1 gene causes several different phenotypes, including some associated with disease in additional organs. Clinical phenotypes may vary, even among patients carrying the same NR5A1 variant, indicating that there is no specific genotype–phenotype correlation. Genetic tests are crucial diagnostic tools that should be used early in the diagnostic pathway, as early as the neonatal period, when gonadal dysgenesis is the main manifestation of NR5A1 mutation. NR5A1 gene mutations could be mainly associated with amenorrhea, ovarian failure, hypogonadism, and infertility during puberty. Fertility preservation techniques should be considered as early as possible. Full article

With the increasing dominance of artificial intelligence (AI) techniques, the important prospects for their application have extended to various medical fields, including domains such as in vitro diagnosis, intelligent rehabilitation, medical imaging, and prognosis. Breast cancer is a common malignancy that critically affects women’s physical and mental health. Early breast cancer screening—through mammography, ultrasound, or magnetic resonance imaging (MRI)—can substantially improve the prognosis for breast cancer patients. AI applications have shown excellent performance in various image recognition tasks, and their use in breast cancer screening has been explored in numerous studies. This paper introduces relevant AI techniques and their applications in the field of medical imaging of the breast (mammography and ultrasound), specifically in terms of identifying, segmenting, and classifying lesions; assessing breast cancer risk; and improving image quality. Focusing on medical imaging for breast cancer, this paper also reviews related challenges and prospects for AI. Full article

Background: This investigation assesses the prognostic value of lactate levels and their clearance in septic shock patients, particularly emphasizing the comparative analysis between COVID-19 and non-COVID-19 patients in the emergency department. This study aims to elucidate the unique prognostic implications of lactate dynamics in these distinct patient groups, thereby enhancing the management of septic shock. Methods: An observational prospective study was conducted, enrolling 114 septic shock patients from the Emergency County Hospital Resita, Romania, categorizing them into COVID-19 and non-COVID-19 groups to examine their initial lactate levels, clearance rates, and their correlation with patient outcomes. Results: This study identified significant differences in the initial lactate levels and clearance rates between the two groups, indicating higher initial lactate levels and slower clearance rates in COVID-19 patients. Survivors demonstrated significantly lower initial lactate levels (1.5 ± 0.4 mmol/L) and higher lactate clearance rates (33 ± 15%) compared to non-survivors (2.5 ± 0.5 mmol/L and 24 ± 9%, respectively; lactate levels p = 0.001, clearance rates p = 0.002). Conclusions: Lactate monitoring, particularly clearance rates, is crucial in the prognostic assessment of septic shock patients. These findings highlight the need for targeted interventions in COVID-19 patients to improve outcomes, underscoring lactate dynamics as a vital component of septic shock management in differing patient populations. Full article

It is well known that the brain is quite vulnerable to oxidative stress, initiating neuronal loss after ischemia-reperfusion (IR) injury. A potent protective mechanism is ischemic preconditioning (IPC), where proteins are among the primary targets. This study explores redox-active proteins’ role in preserving energy supply. Adult rats were divided into the control, IR, and IPC groups. Protein profiling was conducted to identify modified proteins and then verified through activity assays, immunoblot, and immunohistochemical analyses. IPC protected cortex mitochondria, as evidenced by a 2.26-fold increase in superoxide dismutase (SOD) activity. Additionally, stable core subunits of respiratory chain complexes ensured sufficient energy production, supported by a 16.6% increase in ATP synthase activity. In hippocampal cells, IPC led to the downregulation of energy-related dehydrogenases, while a significantly higher level of peroxiredoxin 6 (PRX6) was observed. Notably, IPC significantly enhanced glutathione reductase activity to provide sufficient glutathione to maintain PRX6 function. Astrocytes may mobilize PRX6 to protect neurons during initial ischemic events, by decreased PRX6 positivity in astrocytes, accompanied by an increase in neurons following both IR injury and IPC. Maintained redox signaling via astrocyte-neuron communication triggers IPC’s protective state. The partnership among PRX6, SOD, and glutathione reductase appears essential in safeguarding and stabilizing the hippocampus. Full article

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a complication of cardiopulmonary bypass surgery that frequently occurs in children. The increased availability of pediatric cardiac surgery leads to yearly increases in congenital heart disease (CHD) procedures performed worldwide. The number of complications, including pediatric CSA-AKI, has also increased. Children with CSA-AKI have worse postoperative periods and require more complex post-op intensive care. Thus, the timely commencement of interventions to prevent and to treat kidney injury in CHD children are one of a leading goals of pediatric cardiac intensive care. Full article

Inflaming public opinion about narcotics was the collective goal of anti-narcotics organizers who emerged from the battlefields of the war on alcohol. The most famous was Richmond P. Hobson, who used newspapers, radio, pamphlets, speaking tours, and networking with civic organizations to agitate for reform. This article draws on archival and newly accessible electronic sources to draw a picture of Hobson’s anti-narcotics propagandizing and put it in historical context. Full article

In Thailand, diesel buses are notorious for their poor energy efficiency and contribution to air pollution. To combat these issues, battery electric buses (BEBs) have emerged as a promising alternative. However, their high initial costs have posed challenges for fleet management, especially for agencies such as the Bangkok Mass Transit Authority (BMTA). This study aims to revolutionize BEB fleet management by developing an energy model tailored to the BMTA’s needs. The methodology consists of two crucial steps: analyzing BMTA bus routes and designing fleet management and charging systems. Through this process, the study seeks to determine the maximum number of BEBs that can be operated on each route with the fewest chargers possible. The results reveal exciting possibilities. Within the city bus landscape, two out of five BMTA bus routes show potential for transitioning to BEBs, provided they meet a maximum energy requirement of 200 kWh every two rounds. This analysis identifies routes ripe for BEB adoption while considering the limitations of battery size. In the next step, the study unveils a game-changing strategy: a maximum of 13 BEBs can operate on two routes with just four chargers requiring 150 kW each. This means fewer chargers and more efficient operations. Plus, the charging profile peaks at 600 kW from 4:00 to 8:00 p.m., showing when and where the fleet needs power the most. However, the real eye-opener? Significant energy savings of THB 10.44 million per year compared to diesel buses, with an initial investment cost savings of over 37%. These findings underscore the potential for BEB fleet management to revolutionize public transportation and save money in the long run. However, there is more work to be done. The study highlights the need for real-time passenger considerations, the development of post-service charging strategies, and a deeper dive into total lifetime costs. These areas of improvement promise even greater strides in the future of sustainable urban transportation. Full article

Background and Objectives: Despite the promise of phage therapy (PT), its efficacy in prosthetic joint infection (PJI) management is unknown. Much of the current literature is largely limited to case reports and series. Materials and Methods: In order to help inform power calculations for future clinical trials and comparative analyses, we performed a systematic review and proportional meta-analysis of early PT outcomes to provide a preliminary assessment of early phage therapy treatment outcomes for cases of PJI. Results: In a search of available literature across MEDLINE (Ovid, Wolters Kluwer, Alphen aan den Rijn, The Netherlands), Embase (Elsevier, Amsterdam, The Netherlands), the Web of Science Core Collection (Clarivate, London, UK), and Cochrane Central (Wiley, Hoboken, NJ, USA) up to 23 September 2023, we identified 37 patients with PJIs receiving adjunctive PT. Patients most frequently reported Staphylococcal species infection (95%) and intraarticular phage delivery (73%). Phage cocktail (65%) and antibiotic co-administration (97%) were common. A random-effects proportional meta-analysis suggested infection remission in 78% of patients (95% CI: 39%, 95%) (I² = 55%, p = 0.08) and 83% with a minimum 12-month follow-up (95% CI: 53%, 95%) (I² = 26%, p = 0.26). Conclusions: Our study provides a preliminary estimate of PT’s efficacy in PJIs and informs future comparative studies. Full article

Background and Objectives: Patella baja is a common complication after operative treatment for patellar fracture. This study aimed to investigate (1) the serial changes in patellar height and (2) the potential predictive factors for patellar height changes after tension band wiring (TBW) for patellar fractures. Materials and Methods: Forty-one patients who underwent TBW for patellar fracture between March 2019 and September 2022 were enrolled. To identify serial changes in patellar height, modified Blackburne–Peel index (mBPI) was assessed at just after surgery, at 3 months, at 6 months, at 1 year and at the final follow-up. Multiple regression analysis was conducted to identify factors correlated with mBPI difference between the contralateral side (considered as preoperative status) and injured side. Results: The postoperative mBPI exhibited a decline over time (mean mBPI immediately post operation/3 months/6 months/1 year/final follow-up: 0.69/0.63/0.63/0.62/0.61) Specifically, mBPI showed a significant reduction immediately post operation to 3 months (p < 0.001), although comparisons at other time points did not reveal significant differences. A lower position of the fracture was associated with a decrease in patellar height after surgery. Conclusions: Patellar height was mainly decreased from immediately post operation to 3 months. A fracture in a lower position of associated with decreased patellar height after the TBW of the transverse patellar fracture. Full article

The development of active food packaging is desirable for food safety and to avoid food loss and waste. In this work, we developed antioxidant bilayer films combining extrusion and electrospinning techniques. These films consisted of a first layer of thermoplastic cornstarch (TPS), incorporated with microcrystalline cellulose (MCC). The second layer consisted of gallic acid (GA) encapsulated at different concentrations in 1:1 chitosan/poly(ethylene-co-vinyl alcohol) (CS/EVOH) nanofibers. This layer was directly electrospun onto the TPS/MCC film. The morphological, structural, wettability, permeability to oxygen, and antioxidant properties were investigated for the first layer and the bilayer films. Water contact angle measurements revealed the hydrophobic nature of the first layer (θ₀ = 100.6°). The oxygen permeability (OP) was accessed through the peroxide value (PV) of canola oil, kept in containers covered by the films. PV varied from 66.6 meq/kg for the TPS/MCC layer to 60.5 meq/kg for a bilayer film. Intermolecular hydrogen bonds, mediated by GA, contributed slightly to improving the mechanical strength of the bilayer films. The bilayer film incorporated with GA at 15.0% reached a radical scavenging activity against the DPPH radical of (903.8 ± 62.2) μmol.L⁻¹.Eq. Trolox.g⁻¹. This result proved the effectiveness of the GA nanoencapsulation strategy. Full article

This study explores the innovative use of CO2 laser technology in frenuloplasty, a significant shift from classic methods like scalpel surgery or electrocautery towards a minimally invasive approach. The research involved 15 patients aged 25 to 50, undergoing frenuloplasty with a CO2 laser system equipped with a 7-inch defocused handpiece, set at 20 Hz and 0.3 W. This method diverges from conventional laser techniques, focusing on controlled laser passes combined with manual traction to elongate the fibrous tissue of the frenulum. The results demonstrated that the CO2 laser technique allowed for a precise and progressive modification of the frenulum, significantly reducing the risks of hemorrhage and secondary intention fibrosis. The healing process was notably expedited, with patients reporting satisfactory outcomes within a two-week period. Statistically significant improvements were observed in patient-reported outcomes, as evidenced by the increases in the Short Form Health Survey (SF-12) scores, with the mean Physical Component Summary (PCS) score rising from 32.5 to 47.5 and the mean Mental Component Summary (MCS) score from 39.3 to 52.3 (p < 0.001 for both). The study concludes that CO2 laser frenuloplasty is an effective and safe technique, offering substantial benefits in terms of reduced healing time and enhanced patient satisfaction. The significant improvements in SF-12 scores underscore the positive impact on patient quality of life, advocating for the broader application of this technique in clinical practice. Further research is warranted to explore its potential in a wider clinical context. Full article

Integrating eye gaze data with chest X-ray images in deep learning (DL) has led to contradictory conclusions in the literature. Some authors assert that eye gaze data can enhance prediction accuracy, while others consider eye tracking irrelevant for predictive tasks. We argue that this disagreement lies in how researchers process eye-tracking data as most remain agnostic to the human component and apply the data directly to DL models without proper preprocessing. We present EyeXNet, a multimodal DL architecture that combines images and radiologists’ fixation masks to predict abnormality locations in chest X-rays. We focus on fixation maps during reporting moments as radiologists are more likely to focus on regions with abnormalities and provide more targeted regions to the predictive models. Our analysis compares radiologist fixations in both silent and reporting moments, revealing that more targeted and focused fixations occur during reporting. Our results show that integrating the fixation masks in a multimodal DL architecture outperformed the baseline model in five out of eight experiments regarding average Recall and six out of eight regarding average Precision. Incorporating fixation masks representing radiologists’ classification patterns in a multimodal DL architecture benefits lesion detection in chest X-ray (CXR) images, particularly when there is a strong correlation between fixation masks and generated proposal regions. This highlights the potential of leveraging fixation masks to enhance multimodal DL architectures for CXR image analysis. This work represents a first step towards human-centered DL, moving away from traditional data-driven and human-agnostic approaches. Full article

In stealth applications, there is a growing emphasis on the development of radar-absorbing structures that are efficient, flexible, and optically transparent. This study proposes a screen-printed metamaterial absorber (MMA) on polyethylene terephthalate (PET) substrates using indium tin oxide (ITO) as the grounding layer, which achieves both optical transparency and flexibility. These materials and methods enhance the overall flexibility and transparency of MMA. To address the limited transparency caused by the silver nanoparticle ink for the top pattern, a metal mesh was incorporated to reduce the area ratio of the printed patterns, thereby enhancing transparency. By incrementing the fractal order of the structure, we optimized the operating frequency to target the X-band, which is most commonly used in radar detection. The proposed MMA demonstrates remarkable performance, with a measured absorption of 91.99% at 8.85 GHz and an average optical transmittance of 46.70% across the visible light spectrum (450 to 700 nm), indicating its potential for applications in transparent windows or drone stealth. Full article

Awkward hand-arm posture and overhead work increase the risk of musculoskeletal symptoms. These adverse health effects can also be caused by additional workloads such as hand-arm vibration exposure while carrying or holding a power tool. This pilot trial investigated posture and muscle activity of 11 subjects while using an impact wrench for three working directions: upwards, forwards and downwards. Although the vibration exposure did not show notable differences in the magnitude (4.8 m/s² upwards, 4.4 m/s² forwards and 4.7 m/s² downwards), postural behavior and the muscle activity showed significantly higher workloads for working upwards compared to forwards direction. The muscle activity results for working downwards also showed elevated levels of muscle activity due to the awkward wrist posture. The results demonstrate that not only the working direction but also more importantly the arm, wrist and head posture need to be considered while investigating hand-arm vibration exposure. Full article

Corrosion of conventional steel reinforcement is responsible for numerous structurally deficient bridges, which is a multi-billion-dollar challenge that creates a vicious cycle of maintenance, repair, and replacement of infrastructure. Repair of existing structures with fiber-reinforced polymer (FRP) has become widespread due to multiple advantages. Carbon FRP’s superior tensile strength and stiffness make it particularly effective in shear and flexural strengthening of reinforced concrete (RC) beams. This experimental study incorporates carbon fiber polymer composite bars and wraps to study and report on the flexural behavior of RC beams. By employing a combination of CFRP bar and wrap for strengthening RC beams, this study observed an approximate 95% improvement in flexural load capacity relative to control RC beams without strengthening. This substantial enhancement highlights the effectiveness of integrating CFRP in structural applications. Nevertheless, the key observation is the failure mode due to this combination providing significant insights into the changes facilitated by this combination approach. Full article

Neurofibromatosis type 1 (NF1) is an inherited autosomal dominant disorder primarily affecting children and adolescents characterized by multisystemic clinical manifestations. Mutations in neurofibromin, the protein encoded by the Nf1 tumor suppressor gene, result in dysregulation of the RAS/MAPK pathway leading to uncontrolled cell growth and migration. Neurofibromin is highly expressed in several cell lineages including melanocytes, glial cells, neurons, and Schwann cells. Individuals with NF1 possess a genetic predisposition to central nervous system neoplasms, particularly gliomas affecting the visual pathway, known as optic pathway gliomas (OPGs). While OPGs are typically asymptomatic and benign, they can induce visual impairment in some patients. This review provides insight into the spectrum and visual outcomes of NF1, current diagnostic techniques and therapeutic interventions, and explores the influence of NF1-OPGS on visual abnormalities. We focus on recent advancements in preclinical animal models to elucidate the underlying mechanisms of NF1 pathology and therapies targeting NF1-OPGs. Overall, our review highlights the involvement of retinal ganglion cell dysfunction and degeneration in NF1 disease, and the need for further research to transform scientific laboratory discoveries to improved patient outcomes. Full article

Bird monitoring is an important approach to studying the diversity and abundance of birds, especially during migration, as it can provide core data for bird conservation purposes. The previous methods for bird number estimation are largely based on manual counting, which suffers from low throughput and a high error rate. In this study, we aimed to provide an alternative bird-counting method from video datasets by using five available ImageJ methods: Particle Analyzer, Find Maxima, Watershed segmentation, TrackMate, and trainable WEKA segmentation. The numbers of birds and their XY coordinates were extracted from videos to conduct a side-by-side comparison with the manual counting results, and the three important criteria of the sensitivity, precision, and F1 score were calculated for the performance evaluation. From the tests, which we conducted for four different cases with different bird numbers or flying patterns, TrackMate had the best overall performance for counting birds and pinpointing their locations, followed by Particle Analyzer, Find Maxima, WEKA, and lastly, Watershed, which showed low precision in most of the cases. In summary, five ImageJ-based counting methods were compared in this study, and we validated that TrackMate obtains the best performance for bird counting and detection. Full article

During the long nineteenth century, Western publics experienced the invention and proliferation of commercial games for children. Card games, board games, and other parlor games were no longer for adults only; these new offerings formalized some aspects of what it meant for a child to engage in play. Many games centered travel, becoming sites for children to simulate adult agency in movement through space. This paper examines the stories told by narrative card games and board games about travel, especially travel within and between urban centers. The games present the city as microcosm of the world. Child players are invited to construct multiple national and ethnic identities as they pretend to be city travelers. The games attempt to teach children, and their caregivers, how to travel. I argue that the structures and aims of the games evolve over time, keeping pace with new mores surrounding work and leisure travel. I also argue for connections between games and the “set moves” of narrative fiction and theatre. Full article

The management and improvement of yam productivity are associated with a good supply of essential nutrients for the growth and development of the crop that has economic viability. This research aimed to evaluate the economic feasibility of foliar fertilization with Zintrac^® in two yam agricultural seasons (2022/2023 and 2023/2024). Therefore, two experiments were conducted at the Rafael Fernandes Experimental Farm, Mossoró, RN, Brazil. The experimental design was in a Latin square design with five treatments of doses of Zintrac^® (0, 1, 2, 3, and 4 L ha⁻¹) and five replications. Among the production costs of yams, labor and seed acquisition were the most significant. The highest profitability index was achieved with the dose of 1L Zintrac^® ha⁻¹ in the first season and second season, which corresponded to 78.97 and 57.86%. For the first season, increments were observed in all treatments that received zinc doses with increases of 48.70, 31.22, 14.30, and 15.93% for 1, 2, 3, and 4 L of Zintrac^® ha⁻¹ compared to the dose of 0 L ha⁻¹. On the other hand, in the second season, there was an increase only in the dose of 1 L ha⁻¹ of Zintrac^®, which corresponded to 51.3% in the net yield (ha⁻¹) of the dose of 0 L ha⁻¹. Therefore, foliar zinc oxide fertilization was economically viable for the yam crop, obtaining higher economic indices at the dose of 1 L ha⁻¹. The highest cost for growing yams is using a dose of 4 L ha⁻¹ of Zintrac^®, totaling USD 6977.59 (first season) and USD 6868.33 (second season) Full article

Collaborative multicenter research has significantly increased our understanding of fetal Ebstein anomaly, delineating risk factors for adverse outcomes as well as predictors of postnatal management. These data are incorporated into prenatal care and therapeutic strategies and inform family counseling and delivery planning to optimize care. This report details the translation of findings from multicenter studies into multidisciplinary prenatal care for a fetus with Ebstein anomaly, supraventricular tachycardia, and a circular shunt, including transplacental therapy to control arrhythmias and achieve ductal constriction, informed and coordinated delivery room management, and planned univentricular surgical palliation. Full article

Legal representatives take a major role in healthcare decisions with and for people with dementia, but only a minority has a qualification in this field. The aim was to evaluate the efficacy of the PRODECIDE education program for legal representatives. In a prospective randomized controlled trial, legal representatives (volunteers and professionals, representing at least one person with dementia) were allocated (1:1 computer-generated block randomization) to the intervention (PRODECIDE education program) and control (standard care) groups. The primary outcome measure was knowledge, operationalized as the understanding of decision-making processes and in setting realistic expectations. Only data entry and analyses were blinded. A process evaluation in a mixed methods design was performed. We enrolled 218 legal representatives, and 216 were included in the primary analysis (intervention n = 109, control n = 107). The percentage of correct answers in the knowledge test post intervention was 69.0% in the intervention and 43.4% in the control group (difference 25.6%; CI 95%, 21.3 to 29.8; p < 0.001). In the comparison of professional and voluntary representatives, professionals had 13.6% (CI 95%, 8.0 to 19.2; p < 0.001) more correct answers. The PRODECIDE education program can improve the knowledge of legal representatives, an important prerequisite for evidence-based, informed decision-making. Full article