23. Epidemiological aspects and clinical outcomes of mitral valve prolapse in Saudi adults over a 10 year period

Mitral valve prolapse (MVP) is a well recognized clinical entity that is associated with significant morbidity. Epidemiology, echocardiographic (echo) characteristics and clinical outcome of MVP in Saudi Arabia have not been studied. To determine the prevalence, echo features and clinical outcome of MVP among the adult Saudi patients who underwent echo evaluation over a 10-year period.Retrospective review of consecutive cases of MVP or any of its components as diagnose by echocardiogram. Study was conducted in King Abdulaziz Cardiac Center, Riyadh and included 121,419 adult echo studies done between January 2003 and December 2012. Study population consisted of 77,176 patients after removing duplicate studies. Echo parameters for all Saudi nationals ⩾14y of age were collected from the Xcelera database. Mitral valve disease due to non-myxomatous prolapse were excluded. Among the study population (n=77,176) 600 patients were labled as having MVP or any of its echo features (0.7%). Mean age was 64 years and 62% were males. Majority of patients (54.4%) had mild MVP, while moderate and severe prolapse were present in 21.1% and 24.5% respectively. Severe mitral regurgitation was present in 16.5% and chordal rupture was noted in 9%. Left ventricular size was moderately dilated in 7.6% and severely dilated in 1.3%.Prevalence of MVP in Saudi nationals at a referral cardiac center is less than the reported international figure of 1-3%. In contrary to published literature MVP in Saudi population seems to be more common in males and seems to be diagnosed at a later age

Raman Spectroscopy of Graphene, Graphite and Graphene Nanoplatelets

The theoretical simplicity of sp2 carbons, owing to their having a single atomic type per unit cell, makes these materials excellent candidates in quantum chemical descriptions of vibrational and electronic energy levels. Theoretical discoveries, associated with sp2 carbons, such as the Kohn anomaly, electron-phonon interactions, and other exciton-related effects, may be transferred to other potential 2D materials. The information derived from the unique Raman bands from a single layer of carbon atoms also helps in understanding the new physics associated with this material, as well as other two-dimensional materials. The following chapter describes our studies of the G, D, and G′ bands of graphene and graphite, and the characteristic information provided by each material. The G-band peak located at ~1586 cm−1, common to all sp2 carbons, has been used extensively by us in the estimation of thermal conductivity and thermal expansion characteristics of the sp2 nanocarbon associated with single walled carbon nanotubes (SWCNT). Scanning electron microscope (SEM) images of functionalized graphene nanoplatelet aggregates doped with argon (A), carboxyl (B), oxygen (C), ammonia (D), fluorocarbon (E), and nitrogen (F), have also been recorded and analyzed using the Gwyddion software

7. Long term results of quadrangular autologous pericardial patch reconstruction of the pulmonary artery during arterial switch operation on post-

The aim of this retrospective study is to evaluate the technique of Quadrangular Fresh Autologous Pericardial Patch for the reconstruction of the pulmonary artery in Arterial Switch Operation (ASO) to prevent the post-operative pulmonary artery stenosis (PAS). A total of 287 consecutive infants with transposition of great arteries were treated with ASO in our center between January 2000 and September 2014. The mean age was (7.76days) and mean weight was (3.67kg). The new pulmonary arterial root was reconstructed with a fresh quadrangular autologous patch. The technique includes extensive mobilization of both pulmonary artery branches and direct suturing of the parch to 2/3 of the annulus of the new pulmonary artery trunk first, and then reconstruction finish by the re-suspension of the posterior commissure of the new pulmonary valve inside the patch. Patients were examined using trans-thoracic echocardiography consecutively at discharge form the hospital, and at 3–6 months and yearly after discharge. The mean follow up time was 78 months. The early mortality was 5.19% (17 patients), and there were no late mortality. The highest mortality was reported during the beginning of the pediatric surgical program. The mortality for the last 100 patients was 1%. The pressure gradient across the pulmonary valve in 249 patients (87%, was less than 20mmHg. Mild pulmonary stenosis (pressure gradient of 20–40mmHg) was present in 32 patients (11.14%) and moderate pulmonary stenosis with gradient 40–60mmHg was manifested in 4 patients (1.39%). Reconstruction of the new Pulmonary artery during the ASO, using the quadrangular autologous fresh pericardial patch, is effective and reproducible in reducing the incidence of post-operative pulmonary stenosis

Blockchain Bridges Critical National Infrastructures: E-Healthcare Data Migration Perspective

Secure management of Critical National Infrastructures (CNI) is a burning challenge to any state. As a CNI, Electronic Healthcare System (EHS) infrastructure records citizens' medical records, raising security and privacy concerns. Traditional EHS functions independently where patients' records are recorded and maintained in centralized systems that produce massive redundant data. Due to the non-coherence of these systems, data atomicity is not maintained; hence research results based on these data create questioning. Moreover, medical records are valuable for research but cannot be public due to security and privacy. Blockchain (BC) is currently considered a potential solution for the challenges. Blockchain can integrate every independent EHS as a bridging platform. The solution can ensure data uniqueness and overcome security issues. The prime difficulties for the integration are data synchronization of the traditional EHS and BC-based EHS. Furthermore, the autonomous interoperability between SQL and NoSQL database used in typical EHS and BC-based EHS, respectively, is a prime challenge. Therefore, this research proposes a Blockchain-based framework that bridges Traditional E-Health Systems(TEHS) and allows uninterruptible data exchanges between two systems, even for archive medical records. Beyond that, the framework shows an elevated way to overcome a single point of failure, data security, access control, etc., issues in a centralized system. Finally, the testbed implementation justifies the proposed architecture

Healthcare providers’ attitudes, beliefs and barriers to pulmonary rehabilitation for patients with chronic obstructive pulmonary disease in Saudi Arabia: a cross-sectional study

Objectives: To assess the attitude of healthcare providers (HCPs) towards the delivering of pulmonary rehabilitation (PR) to patients with chronic obstructive pulmonary disease (COPD) and identify factors and barriers that might influence referral. Design: A cross-sectional online survey consisting of nine multiple-choice questions. Settings: Saudi Arabia. Participants: 980 HCPs including nurses, respiratory therapists (RT) and physiotherapists. Primary outcome measures: HCPs attitudes towards and expectations of the delivery of PR to COPD patients and the identification of factors and barriers that might influence referral in Saudi Arabia. Results: Overall, 980 HCPs, 53.1% of whom were men, completed the survey. Nurses accounted for 40.1% of the total sample size, and RTs and physiotherapists accounted for 32.1% and 16.5%, respectively. The majority of HCPs strongly agreed that PR would improve exercise capacity 589 (60.1%), health-related quality of life 571 (58.3%), and disease self-management in patients with COPD 589 (60.1%). Moreover, the in-hospital supervised PR programme was the preferred method of delivering PR, according to 374 (38.16%) HCPs. Around 85% of HCPs perceived information about COPD, followed by smoking cessation 787 (80.3%) as essential components of PR besides the exercise component. The most common patient-related factor that strongly influenced referral decisions was ‘mobility affected by breathlessness’ (64%), while the ‘availability of PR centres’ (61%), the ‘lack of trained HCPs’ (52%) and the ‘lack of authority to refer patients’ (44%) were the most common barriers to referral. Conclusion: PR is perceived as an effective management strategy for patients with COPD. A supervised hospital-based programme is the preferred method of delivering PR, with information about COPD and smoking cessation considered essential components of PR besides the exercise component. A lack of PR centres, well-trained staff and the authority to refer patients were major barriers to referring patients with COPD. Further research is needed to confirm HCP perceptions of patient-related barriers

Decentralized community energy management: Enhancing demand response through smart contracts in a blockchain network

The integration of distributed energy resources (DERs) and digital technologies has accelerated the transition to decentralized energy systems. Among these technologies, blockchain stands out for its ability to facilitate peer-to-peer (P2P) energy trading efficiently and securely. This paper explores the concept of P2P energy trading within community microgrid systems, leveraging blockchain-based smart contracts. The proposed system integrates an incentive-driven demand response program directly into the smart contract framework, offering real-time rewards for load-balancing contributions. By incorporating the microgrid’s Energy Management System (EMS) and transparently recording all transactions on the blockchain, the proposed platform provides detailed data and immediate reward distribution. At the core of our system lies the Supply to Demand Ratio (SDR), ensuring fair energy exchange within the community. Dynamic pricing, enabled by blockchain and Tether (USDT) cryptocurrency, adjusts to real-time market conditions, enhancing transparency and responsiveness in energy trading. This adaptive pricing model fosters a more equitable and efficient trading environment compared to static approaches. Moreover, this system is tailored for community microgrids, emphasizing a community-centric approach. Local prosumers serve as validators in the blockchain network, aligning energy management decisions with community needs and dynamics. This localized engagement promotes efficiency and participation, fostering resilient, sustainable, and user-centric energy landscapes. Through rigorous analysis, we demonstrate the system’s effectiveness in optimizing economic efficiency, reducing operational costs, and increasing compliance rates. By combining blockchain technology with community-focused design principles, the proposed platform represents a significant advancement towards self-sufficiency and resilience in local energy systems

Toward a Generative Modeling Analysis of CLAS Exclusive 2 Photoproduction

AI-supported algorithms, particularly generative models, have been successfully used in a variety of different contexts. This work employs a generative modeling approach to unfold detector effects specifically tailored for exclusive reactions that involve multiparticle final states. Our study demonstrates the preservation of correlations between kinematic variables in a multidimensional phase space. We perform a full closure test on two-pion photoproduction pseudodata generated with a realistic model in the kinematics of the Jefferson Lab CLAS g11 experiment. The overlap of different reaction mechanisms leading to the same final state associated with the CLAS detector’s nontrivial effects represents an ideal test case for AI-supported analysis. Uncertainty quantification performed via bootstrap provides an estimate of the systematic uncertainty associated with the procedure. The test demonstrates that GANs can reproduce highly correlated multidifferential cross sections even in the presence of detector-induced distortions in the training datasets, and provides a solid basis for applying the framework to real experimental data