Social Media and the Spiral of Silence: The Case of Kuwaiti Female Students Political Discourse on Twitter

The theory of the Spiral of Silence (Noelle-Neumann, 1984), explained why the view of a minority is not presented when the majority view dominates the public sphere. For years the theory of the spiral of silence was used to describe the isolation of minority opinions when seeking help from traditional media, which play a significant role in increasing the isolation. The fear of isolation makes many people afraid of exchanging their views face-to-face with others. The main fear comes from identifying the people who hold a minority opinion. However, with the proliferation of social networks people have moved online to exchange their views, whether they hold a minority or a majority opinion, as long as their identities are concealed. Although women are the majority population in many Arab societies, their voices are still considered a minority view. In addition to the effects described in the spiral of silence, there are other obstacles to self-expression. Religion, culture, tradition, and education may have a negative effect, preventing women’s voice being made public. Social networks have helped to promote women’s voices while removing offline obstacles. This paper uses the theory of the spiral of silence in relation to women’s online political participation in Twitter, even though they may not be willing to share their opinions offline (face-to-face), to learn whether the theory is still useful as an account of online relationships. The results show that the spiral of silence does not explain the behavior of women, either face-to-face or online

The Effect of CKD Fineness for Karbala Cement Plant on the Engineering Properties of Cement When add it as a Partial Replacement

Cement kiln dust (CKD) is a waste of cement manufacture. The disposal CKD management has becomes an environmental challenge. In order to overcome this problem, researchers are carried out to find out active means to utilize it in various applications .One of these applications is adding it as partial substitution of cement. The aim of this study is investigating the effect of CKDs fineness on the engineering properties of cement, when utilized as a partial replacement. the CKD was grind by jet mill  and classify into 4 groups according fineness (3000 , 6000  , 8000 ,10000 ) cm2/gm  then prepared blends with (5 ,10 , 15 , 20 , 25 , 30 , 35  and 40) %  replacement by CKD for each fineness ,.The results showed  that  increasing of fineness lead to increasing of water demand for consistency,. Setting time(initial and final) retarded with increase fineness of CKD, and the compressive strength of samples contain CKD up to 20% in fineness more than  6000 cm2/gm are enhanced.  These results may came from the increasing specific area activity of CKD compounds which affected on cement hydration and improve in the cement hydrated particles  packing and more denser and compact of cement hardened. Keywords: Cement, CKD, fineness, consistency, setting time, compressive strength, Karbal

ROLE OF THE PHYSICAL ACTIVITY IN THE IMPROVEMENT OF CARDIAC MEASURES AND DECLINING OF COMORBIDITIES.

Background: Regular physical activity (PA) can prevent many non-communicable diseases, such as cardiovascular disease (CVD) and diabetes mellitus (DM). The present study aimed to assess the health benefits of physical activities including blood pressure and comorbid conditions. Methodology: This is a prospective cohort case-control study that recruited 300 Saudi volunteers living in the city ofHail, Northern Saudi Arabia. Results: Out of 300 participants 155(51.7%) were males and 145 (48.3%) were females. There were 111(37%) participants committed to regular physical activity and the remaining 189(63%) without a defined commitment to physical activity (Uncommitted). Among 111 persons who claimed a commitment to regular physical activity (committed), 61(55%) were males and 50(45%) were females. The majority of committed individuals were at the age group 21-25 years followed by age group 26-30 and 31-35 years representing 32, 30, and 20 persons, respectively. The physical activity was highly practiced at the age range 21-30 years and this was found to be statistically significant P < 0.001. Conclusion: There is a low prevalence of physical activity in Hail region, particularly among females, which necessitates the suggestion of appropriate awareness programs. Younger and elder populations are in much need to be targeted with PA awareness programs

Highly efficient GaN Doherty power amplifier for N78 sub-6 GHz band 5G applications

In this paper, a high-efficiency GaN Doherty power amplifier (DPA) for 5G applications in the N78 sub-6 GHz band is introduced. The theoretical analysis of the matching networks for the peak and carrier transistors is presented, with a focus on the impact of unequal power splitting for both transistors and the recommendation of a post-harmonic suppression network. The proposed design features an unequal Wilkinson power divider at the input and a post-harmonic suppression network at the output, both of which are crucial for achieving high efficiency. The Doherty power amplifier comprises two GaN 10 W HEMTs, measured across the 3.3 GHz to 3.8 GHz band (the N78 band), and the results reveal significant improvements in gain, output power, drain efficiency, and power-added efficiency. Specifically, the proposed design achieved a power gain of over 12 dB and 42 dBm saturated output power. It also achieved a drain efficiency of 80% at saturation and a power-added efficiency of 75.2%. Furthermore, the proposed harmonic suppression network effectively attenuated the harmonics at the output of the amplifier from the second to the fourth order to more than −50 dB, thus enhancing the device’s linearity

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Quantifying risks and interventions that have affected the burden of diarrhoea among children younger than 5 years : an analysis of the Global Burden of Disease Study 2017

Background Many countries have shown marked declines in diarrhoea! disease mortality among children younger than 5 years. With this analysis, we provide updated results on diarrhoeal disease mortality among children younger than 5 years from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) and use the study's comparative risk assessment to quantify trends and effects of risk factors, interventions, and broader sociodemographic development on mortality changes in 195 countries and territories from 1990 to 2017. Methods This analysis for GBD 2017 had three main components. Diarrhoea mortality was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive, Bayesian, ensemble modelling tool; and the attribution of risk factors and interventions for diarrhoea were modelled in a counterfactual framework that combines modelled population-level prevalence of the exposure to each risk or intervention with the relative risk of diarrhoea given exposure to that factor. We assessed the relative and absolute change in diarrhoea mortality rate between 1990 and 2017, and used the change in risk factor exposure and sociodemographic status to explain differences in the trends of diarrhoea mortality among children younger than 5 years. Findings Diarrhoea was responsible for an estimated 533 768 deaths (95% uncertainty interval 477 162-593 145) among children younger than 5 years globally in 2017, a rate of 78.4 deaths (70.1-87.1) per 100 000 children. The diarrhoea mortality rate ranged between countries by over 685 deaths per 100 000 children. Diarrhoea mortality per 100 000 globally decreased by 69.6% (63.1-74.6) between 1990 and 2017. Among the risk factors considered in this study, those responsible for the largest declines in the diarrhoea mortality rate were reduction in exposure to unsafe sanitation (13.3% decrease, 11.2-15.5), childhood wasting (9.9% decrease, 9.6-10.2), and low use of oral rehydration solution (6.9% decrease, 4-8-8-4). Interpretation Diarrhoea mortality has declined substantially since 1990, although there are variations by country. Improvements in sociodemographic indicators might explain some of these trends, but changes in exposure to risk factors-particularly unsafe sanitation, childhood growth failure, and low use of oral rehydration solution-appear to be related to the relative and absolute rates of decline in diarrhoea mortality. Although the most effective interventions might vary by country or region, identifying and scaling up the interventions aimed at preventing and protecting against diarrhoea that have already reduced diarrhoea mortality could further avert many thousands of deaths due to this illness. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.Peer reviewe

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised