The Culture Between the Textual Authority and the Recipient - Rhetoric in the Fatimid Era-As a Model

من أساسيات النظام السلطوي التركيز على الفن القريب من الجمهور المُلقى عليهم الخطاب وإمكانية وسرعة فهمه، بوصفه نصاً يحمل المشاريع السلطوية التأسيسية، فكان النوع النثري وسيلة الاتصال المباشرة بين جهتين مختلفتين (آمر ومأمور)؛ لهذا يسعى البحث للكشف عن تلك الانساق المنطلقة من النصّ النثري تحت مسميات اصلاحية نهضوية تغييرية، تُخفي وراءها أطماع السلطة .One of the fundamentals of the authoritarian system is to focus on the art that is close to the audience and the possibility and speed of understanding it, describing it as a text that carries the foundational authoritarian projects, the type of prose was the direct means of communication between two different parties (authority and the charged), so the research seeks to uncover those patterns that originated from the prose text under the names of reformist and revivalist change, hiding behind the ambitions of the authority. &nbsp

Maximum occlusal bite force in pre-school children with different occlusal patterns

This study was carried out to record maximum occlusal bite force (MOBF) in pre-school children with different occlusal patterns. A randomly selected sample of 1085 kindergarten children in primary dentition stage were selected. The age of subjects ranged between 3-6 years (averaged 4.90 ± 0.86 years). The subjects were divided into 3 groups according to molar relationship; flush terminal (n=335; 165 males and 170 females), distal step (n=450; 200 males and 250 females), mesial step (n=300; 150 males and 150 females) molar relationship. Clinical examination involved the record of molar relationship, overjet, overbite and the presence of wearing facets. Occlusal bite force was measured using a hydraulic occlusal force gauge. The means of MOBF for the different occlusal relationship were: - 193.47N (± 60.98), 179.20N (±56.80) and 245.11N (±69.45) for flush terminal, mesial and distal step molar relationships, respectively. Significant differences between studied groups were detected (P<0.01; P<0.001). MOBF were higher in subjects with distal step molar relationship, increased overjet and increased overbite. Gender differences were detected in flush terminal and distal step molar relationships. MOBF was affected by the different occlusal relationships. Children with distal step and mesial step molar relationship had the highest and the lowest MOBF, respectively. MOBF was similar in children with/without wearing facets

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

The Effects of Socotra Cormorant Nesting Activities on Terrestrial Invertebrates Diversity and Abundance

Seabirds breed on off-shore islands or cliffs often in large aggregations during their 2- 6 month breeding seasons. During this period, seabirds perform an important role in the allochthonous transport of marine nutrients into these terrestrial environments. Depending on the size and density of these aggregations, the impact could be alteration of soil chemistry, vegetation or invertebrate diversity and distribution patterns, primarily through the deposition of large quantities of guano. We studied the impact of breeding aggregations of the Socotra Cormorants (Phalacrocorax nigrogularis) on Siniya Island, Umm Al Quwain, United Arab Emirates, typically ranging between 26,000 to 41,000 breeding pairs. We set up artificial substrate traps along grids in eight areas. These areas were chosen based on whether nesting had occurred in 2016 (nesting areas) or not (non-nesting areas). Traps were deployed in the environment and then removed, specimens preserved and invertebrates identified later. Generally, species richness and diversity is affected negatively in areas that were nested, indicating that some species or taxonomic groups were negatively affected. Coleoptera, Hymenoptera and Isopoda decreased in abundance in areas used for nesting, indicating that selected species within these taxa could not tolerate high levels of nutrient input from guano. The number of ticks (Ornithodoros muesebecki, Acari), a species that is known to parasitize seabirds in the Arabian Gulf, increased overall, particularly in areas that were not used for nesting. Deposition of guano is known to strongly influence vegetation and associated invertebrate communities, often having long-term consequences on island biota. This study shows that insect and other invertebrate communities are impacted by Socotra Cormorant presence during the breeding season, thereby helping to shape the terrestrial communities over the long term. Further work is needed to better understand these interactions and determine how long-term changes could occur in such arid ecosystems

Adolescents' perceptions of their parents' and peers' opinions about their body weight

Purpose: The purpose of this study is to evaluate the associations between adolescents' perceptions of their parents' and peers' opinions about body weight and their actual weight status. Design/methodology/approach: A total of 795 Jordanian adolescents, 15-18 years of age, were recruited in this study. Adolescents completed a questionnaire to evaluate their perceptions: about how their parents' and peers' viewed their weight, regarding any criticism of their parents and peers about their weight and if their parents compared their weight against their siblings. Findings: The study found that the majority of non-overweight adolescents thought their parents and peers considered them to have a normal weight (94.9 and 94.6 per cent for boys, 76.6 and 85.5 per cent for girls, respectively). For obese girls, 83.4 per cent thought their parents and 91.7 per cent thought their peers perceived them as overweight. The risk of being obese was significantly related to the amount of parental criticism perceived by adolescent girls with OR = 3.9 (95 per cent CI: 1.6-9.4; P = 0.01), while perception of peer criticism showed an increased trend of risk for obesity in boys. Adolescents' perceptions regarding parental comparisons between their body weights against their siblings' body weight was found to increase the risk for obesity significantly among girls. Originality/value: The current study highlights that most of the obese adolescents perceived that their parents and peers underestimated their actual weight status. While obese boys were more likely to report being criticized about their body shape by their peers, obese girls indicated that they received more criticism about their weight from their parents. 2018, Emerald Publishing Limited.Scopu

Rhinovirus infection presenting with symptomatic hyponatremia—Atypical presentation of a common infection

Key Clinical Message Rhinovirus infection has the potential to exhibit unconventional symptoms like symptomatic hyponatremia. Health care professionals should remain vigilant about this potential complication, especially in cases with uncommon presentations. Timely identification and effective management of hyponatremia can mitigate potential complications and enhance patient prognosis. Abstract The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a prominent contributor to low sodium levels. Various factors can contribute to hyponatremia, affecting the diagnosis and treatment of the condition. Of note, some infections have been identified as potential causes of SIADH. Although rhinovirus infection has been linked to SIADH, it is usually associated with severe respiratory infections. Herein, we present a distinctive case where rhinovirus caused significant hyponatremia symptoms, even in the absence of typical respiratory symptoms or fever

Stakeholders' Perception of the Palestinian Health Workforce Accreditation and Regulation System: A Focus on Conceptualization, Influencing Factors and Barriers, and the Way Forward.

The Health Workforce Accreditation and Regulation (HWAR) is a key function of the health system and is the subject of increasing global attention. This study provides an assessment of the factors affecting the Palestinian HWAR system, identifies existing gaps and offers actionable improvement solutions. Data were collected during October and November 2019 in twenty-two semi-structured in-depth interviews conducted with experts, academics, leaders, and policymakers purposely selected from government, academia, and non-governmental organizations. The overall perceptions towards HWAR were inconsistent. The absence of a consolidated HWAR system has led to a lack of communication between actors. Environmental factors also affect HWAR in Palestine. The study highlighted the consensus on addressing further development of HWAR and the subsequent advantages of this enhancement. The current HWAR practices were found to be based on personal initiatives rather than on a systematic evidence-based approach. The need to strengthen law enforcement was raised by numerous participants. Additional challenges were identified, including the lack of knowledge exchange and salary adjustments. HWAR in Palestine needs to be strengthened on the national, institutional, and individual levels through clear and standardized operating processes. All relevant stakeholders should work together through an integrated national accreditation and regulation system

Microbiota composition effect on immunotherapy outcomes in colorectal cancer patients: A systematic review.

BackgroundImmune checkpoint inhibitors (ICIs) have emerged as an effective treatment for colorectal cancer (CRC). Studies indicate that the composition of gut microbiota could potentially serve as a biomarker for predicting the clinical effectiveness of immune checkpoint inhibitors.MethodsFollowing PRISMA guidelines, the review was conducted after registering the protocol with PROSPERO. A comprehensive literature search was carried out across five databases: PubMed, Scopus, Web of Science, Embase, and Cochrane Library. Assessment tools from the National Institutes of Health (NIH) were used to gauge the quality of the studies.ResultsA total of 5,132 papers were identified, and three studies and one conference abstract published between 2017-2022 met the inclusion criteria and were summarized in a descriptive synthesis table. These four studies were in accord with the following findings, four main phyla, Firmicutes, Bacteroidata, Actinobacteria, and Verrucomicrobiota were associated with CRC patients' clinical response toward ICIs treatment. Ruminococcaceae was predominantly related to CRC patients responding to therapy, while the Micrococcaceae family was more common among the non-responders. Bacterial taxa such as Faecalibacterium and Prevotellaceae were associated with better responses to ICIs and could be predictive biomarkers. The signature of fecal microbiota with Akkermansia muciniphila and Eubacterium rectale enrichment, and Rothia mucilaginosa depletion could independently predict better response to ICIs in patients with CRC.ConclusionThe findings have brought attention to the notable differences in terms of richness and composition of microbiota between patients who responded positively to the treatment and those who did not. Bacterial species and families, such as Faecalibacterium, Bifidobacterium, Lachnospiraceae, Akkermansia sp., Ruminococcaceae, and Prevotellaceae, have consistently surfaced as potential indicators of immunotherapeutic responses. Furthermore, this review also emphasizes the need for additional comprehensive, multi-center studies with larger sample sizes to validate reported microbiota and expand our understanding of the role of gut microbiota in CRC ICIs therapy. PROSPERO ID: CRD42021277691

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

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

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: 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<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<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. Funding: National Institute for Health and Care Research