Accelerated versus Standard Corneal Cross-linking for Progressive Keratoconus in Syria

Purpose: To compare the outcomes of accelerated versus standard corneal cross-linking for the treatment of progressive keratoconus. Methods: In this retrospective comparative study, 63 eyes of 40 patients with progressive keratoconus were divided into two groups; 27 eyes in group one were treated with an accelerated protocol (10 mW/cm2, 9 min) and 36 eyes in group two were treated with the standard method (3 mW/cm2, 30 min). Visual acuity, refraction, corneal topography, corneal tomography, and anterior and posterior corneal higher-order aberrations (HOAs) were assessed preoperatively and 18–30 months postoperatively. Results: The LogMAR uncorrected and corrected distance visual acuity values were improved in both groups postoperatively. However, the improvement was significantly higher in group one (P < 0.05, all). The flattening in the anterior keratometry readings, flat K, steep K, and average K were significantly higher in group two (P < 0.001, all). The maximum anterior keratometry (AKf) values significantly decreased in both groups, whereas the maximum posterior keratometry (AKb) values increased. The reduction in the minimum corneal thickness (ThKmin) was significantly greater (36.49um) in group two, compared to 10.85um in group one. There was a significant increase in the posterior average keratometry, and a significant decrease in the posterior astigmatism, along 3 mm meridian in S-CXL (P = 0.03, P = 0.008, respectively), while the corresponding values showed no statistical significance in group one (P > 0.05). The anterior corneal trefoil was significantly reduced in group one (P = 0.002), whereas anterior total HOAs and coma were significantly improved in group two (P < 0.0014, all). The posterior corneal spherical aberration decreased significantly in group one (P = 0.02), while group two revealed significant reduction in the posterior trefoil values (P = 0.011). The change in the anterior maximum keratometry was significantly and positively correlated to the preoperative maximum keratometry in group two (P = 0.53, P = 0.003). Conclusion: An accelerated cross-linking protocol using 10 mW/cm2 for 9 min showed more visual improvement and less pachymetric reduction when compared to the standard protocol, however, anterior corneal flattening, posterior corneal steepening, and the change in the posterior astigmatism were significantly higher in the standard protocol; while corneal HOAs were improved in both protocols

Impression Management and Employee Contextual Performance in Service Organizations (Enterprises)

This study aims to investigate the effect of impression management on employee contextual performance in service organizations using quantitative methods. The social influence theory, which explains the role of superior influence over the subordinate, served as the theoretical underpinning for the study. A cross-sectional survey design was adopted in line with positivism research philosophy. The accessible population of this study consists of one hundred selected service-oriented firms (four-star hotels, fast food restaurants, and travel agencies) operating in the southern part of Nigeria. The sample consists of middle managers, human resource managers, front desk officers, housekeepers, and customer relationship managers. Frequency distribution was used to analyze participants’ profiles, while linear regression was employed to analyze the formulated hypotheses. Statistical Package for the Social Sciences (SPSS) 20.0 served as statistical software. Linear regression results suggest that self-promotion exerted a significant positive effect on co-worker support. Ingratiation demonstrated a significant positive effect on customer satisfaction. It appears that exemplification exerted a significant positive effect on enterprise compliance. The outcome of this study has demonstrated that traditional managerial skills can no longer hold water in contemporary service-oriented organizations because of the workplace's dynamic and changing technological structure. This study concludes that impression management can assist managers in influencing their employees positively to achieve organizational objectives. Doi: 10.28991/ESJ-2023-07-02-05 Full Text: PD

A Demand-Supply Matching-Based Approach for Mapping Renewable Resources towards 100% Renewable Grids in 2050

Recently, many renewable energy (RE) initiatives around the world are based on general frameworks that accommodate the regional assessment taking into account the mismatch of supply and demand with pre-set goals to reduce energy costs and harmful emissions. Hence, relying entirely on individual assessment and RE deployment scenarios may not be effective. Instead, developing a multi-faceted RE assessment framework is vital to achieving these goals. In this study, a regional RE assessment approach is presented taking into account the mismatch of supply and demand with an emphasis on Photovoltaic (PV) and wind turbine systems. The study incorporates mapping of renewable resources optimized capacities for different configurations of PV and wind systems for multiple sites via test case. This approach not only optimizes system size but also provides the appropriate size at which the maximum renewable energy fraction in the regional power generation mix is maximized while reducing energy costs using MATLAB’s ParetoSearch algorithm. The performance of the proposed approach is tested in a realistic test site, and the results demonstrate the potential for maximizing the RE share compared to the achievable previously reported fractions. The results indicate the importance of resource mapping based on energy-demand matching rather than a quantitative assessment of anchorage sites. In the examined case study, the new assessment approach led to the identification of the best location for installing a hybrid PV / wind system with a storage system capable of achieving a nearly 100% autonomous RE system with Levelized cost of electricity of 0.05 USD/kWh

100% Renewable Energy Grid for Rural Electrification of Remote Areas: A Case Study in Jordan

Many developing countries suffer from high energy-import dependency and inadequate electrification of rural areas, which aggravates the poverty problem. In this work, Al-Tafilah in Jordan was considered as a case study, where the technical, economic, and environmental benefits of a decentralized hybrid renewable energy system that can match 100% of the city demand were investigated. A tri-hybrid system of wind, solar, and hydropower was integrated with an energy storage system and optimized to maximize the match between the energy demand and production profiles. The optimization aimed at maximizing the renewable energy system (RES) fraction while keeping the levelized cost of electricity (LCOE) equal to the electricity purchase tariff. The techno-economic analysis showed that the optimal system in Al-Tafilah comprises a 28 MW wind system, 75.4 MW PV, and 1 MW hydropower, with a 259 MWh energy storage system, for which a RES fraction of 99% can be achieved, and 47,160 MtCO2 are avoided. This study can be easily extended to other rural cities in Jordan, as they have higher renewable energy system (RES) potential. The presented findings are essential not only for Jordan’s planning and economy-boosting but also for contributing to the ongoing force against climate change

Pre and Present COVID-19 Situation: A Framework of Educational Transformation in South Asia Region

This study is designed to support the development of strategies to recover from the disrupted impact of COVID-19 on HE institutes of the South Asian Region (SAR), as the nations in this region are severely cursed by poverty and unemployment. During the unusual phase of the COVID-19 pandemic, the face-to-face learning method is no longer appropriate, and the crisis leads to force on distance learning instead of physical learning. Like all other educational institutions, HE institutions are also in big trouble. Changes in educational structure change the pattern of academic work, which may have an inverse impact on acquiring knowledge and improving skills. Not only students but also a greater number of teachers at the HE institutions required to continue their service through online during this closure period. However, well digital infrastructure and digital contents appear to be the prime requirements for this educational transmission, which are extensively accessible in SAR countries. By following a mixed-methods strategy, the study specifically examines the impact of the pandemic on higher education in the South Asian Region, with an emphasis on the impact on learners, educators, and institutions, and to identify the measures that have been taken by these countries to survive and continue the education system with all the obstacles of the crisis. It concludes with some vital suggestions that may be applied to mitigate the crisis moment and assist in moving forward with more technological advancements for a new future. Doi: 10.28991/ESJ-2023-SPER-06 Full Text: PD

Development of (4-Phenylamino)quinazoline Alkylthiourea Derivatives as Novel NF-κB Inhibitors

For many inflammatory diseases, new effective drugs with fewer side effects are needed. While it appears promising to target the activation of the central pro-inflammatory transcription factor NF-κB, many previously discovered agents suffered from cytotoxicity. In this study, new alkylthiourea quinazoline derivatives were developed that selectively inhibit the activation of NF-κB in macrophage-like THP−1 cells while showing low general cytotoxicity. One of the best com pounds, 19, strongly inhibited the production of IL-6 (IC50 = 0.84 µM) and, less potently, of TNFα (IC50 = 4.0 µM); in comparison, the reference compound, caffeic acid phenethyl ester (CAPE), showed IC50s of 1.1 and 11.4 µM, respectively. Interestingly, 19 was found to block the translocation of the NF-κB dimer to the nucleus, although its release from the IκB complex was unaffected. Furthermore, 19 suppressed the phosphorylation of NF-κB-p65 at Ser468 but not at Ser536; however, 19 did not inhibit any kinase involved in NF-κB activation. The only partial suppression of p65 phosphorylation might be associated with fewer side effects. Since several compounds selectively induced cell death in activated macrophage-like THP−1 cells, they might be particularly effective in various inflam matory diseases that are exacerbated by excess activated macrophages, such as arteriosclerosis and autoimmune diseases

Femoral Shaft Fracture Occurring as a Result of Physical Manipulation: A Case Report

Treatments including physical manipulation maneuvers have been widely used for the management of various pain complaints. These maneuvers, although generally considered safe, can be associated with serious complications. We report the case of a 37-years-old previously healthy male patient, who presented to our emergency department (ED) for severe right thigh pain and inability to bear weight that developed during a chiropractic session. Imaging done at the ED showed a displaced distal femoral shaft fracture. The majority of the complications of manipulation maneuvers can be as simple as sprains, however, can be drastic or life-threatening in certain cases causing cerebrovascular accidents or major orthopedic fractures. Such complications are rare and definitely underreported. A femoral shaft fracture occurring as a result of physical manipulation has not been previously reported in the literature. We report a distal femoral shaft fracture that was induced by forceful chiropractic manipulation. It is the first to be reported in the literature. This complication should be noted, reported, and the necessary precautions are taken to avoid such major adverse events

Biopiracy <i>versus </i>one-world medicine – from colonial relicts to global collaborative concepts

Background: Practices of biopiracy to use genetic resources and indigenous knowledge by Western companies without benefit-sharing of those, who generated the traditional knowledge, can be understood as form of neocolonialism.Hypothesis: : The One-World Medicine concept attempts to merge the best of traditional medicine from developing countries and conventional Western medicine for the sake of patients around the globe.Study design: Based on literature searches in several databases, a concept paper has been written. Legislative initiatives of the United Nations culminated in the Nagoya protocol aim to protect traditional knowledge and regulate benefit-sharing with indigenous communities. The European community adopted the Nagoya protocol, and the corresponding regulations will be implemented into national legislation among the member states. Despite pleasing progress, infrastructural problems of the health care systems in developing countries still remain. Current approaches to secure primary health care offer only fragmentary solutions at best. Conventional medicine from industrialized countries cannot be afforded by the impoverished population in the Third World. Confronted with exploding costs, even health systems in Western countries are endangered to burst. Complementary and alternative medicine (CAM) is popular among the general public in industrialized countries, although the efficacy is not sufficiently proven according to the standards of evidence-based medicine. CAM is often available without prescription as over-the-counter products with non-calculated risks concerning erroneous self-medication and safety/toxicity issues. The concept of integrative medicine attempts to combine holistic CAM approaches with evidence-based principles of conventional medicine.Conclusion: To realize the concept of One-World Medicine, a number of standards have to be set to assure safety, efficacy and applicability of traditional medicine, e.g. sustainable production and quality control of herbal products, performance of placebo-controlled, double-blind, randomized clinical trials, phytovigilance, as well as education of health professionals and patients

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

Strategic intent, high-performance HRM, and the role of the HR director: an investigation into attitudes and practices in the country of Jordan

There is an implicit undercurrent in the HRM literature that the role of present day HR director has become ‘strategic’ as opposed to ‘routine’, as in the past. In this paper, we empirically test these assertions in the context of the country of Jordan—a context within which little past research into HRM has been undertaken. The design includes a detailed survey instrument sent to all financial firms within the country. We find that the reliance on routine functions has indeed fallen for HR directors surveyed; however, there is only weak evidence to support that the perceived importance of strategic functions has increased substantially. Results show that male HR directors and those longer serving, with higher qualifications, and those working for companies with lower employee turnover, are more likely to rate as ‘high’ the importance of the most strategic HR functions. Neither company size nor years of establishment moderated this relationship. The empirical evidence from this study—as one of a few conducted in non-Western environment—adds to the literature with some interesting implications and avenues for future work. Importantly, implications from our findings for strategic HRM and the role of the HR director are considered in conclusion