Karakterizacija terenskih izolata virusa zarazne bolesti Fabricijeve burze u Jordanu uporabom molekularnih metoda - kratko priopćenje.

The reverse transcriptase-polymerase chain reaction/restriction fragment length polymorphism (RTPCR/ RFLP) and RT-PCR specific primer to detect very virulent (vv) strains of infectious bursal disease virus (IBDV) were used for identification and characterization of Jordanian field isolates of IBDV that caused severe outbreaks. In this study, 80 bursa of fabricius samples were used from 20 commercial broiler chicken flocks in Jordan with clinical symptoms of IBDV. The RT-PCR/RFLP was conducted on a 743-bp fragment of the VP2 gene with the restriction enzymes BstNI and MboI. The results indicate the existence of IBDV field strains in Jordan. In addition, 60% of IBDV Jordanian isolates had unique RFLP patterns different from those previously published elsewhere. However, 20% of local IBDV strains were positive on using a specific primer for vvIBDV and had a unique RFLP pattern that differed from the Jordanian IBDV isolate and those previously published elsewhere.Lančana reakcija polimerazom uz prethodnu reverznu transkripciju/polimorfizam dužine restrikcijskih fragmenata (RT PCR/RFLP) i RT-PCR specifične početnice za jako virulentne sojeve virusa zarazne bolesti Fabricijeve burze (ZBFB) bile su rabljene za identifikaciju i karakterizaciju jordanskih terenskih izolata toga virusa koji su uzrokovali teški oblik bolesti. Za istraživanje je bilo rabljeno 80 uzoraka tkiva Fabricijeve burze uzetih iz 20 komercijalnih jata tovnih pilića u Jordanu u kojih su ustanovljeni klinički znakovi ZBFB a. RT-PCR/ RFLP proveden je na odsječku gena VP2 od 743-bp s restrikcijskim enzimima BstNI i MboI. Rezultati upućuju na postojanje terenskih sojeva virusa ZBFB-a od kojih je 60% izolata imalo jedinstveni RFLP obrazac različit od onoga već objavljenog drugdje. Ipak, 20% lokalnih sojeva virusa bilo je pozitivno uporabom specifične početnice za jako virulentni virus i imalo je jedinstveni obrazac RFLP različit u jordanskih izolata u odnosu na izolate objavljene drugdje

Foreign Direct Investment in Post-Conflict Countries: The Case of Iraq's Oil and Electricity Sectors

Foreign direct investment is new phenomenon to Iraq, a post conflict country with abundance of natural resources. With dominant state-controlled public sector, attracting foreign investment is an added challenge to an economy devastated by years of wars. A qualitative case study was conducted to assess determinants of foreign direct investment in Iraq’s energy sector. Data was collected from interviews with business and government subject matter experts, and a review of publically available documents. Lack of security, political instability, corruption, and inadequate government policies towards foreign direct investment as symptoms found and typically shared by other post-conflict countries. The persistence of violence was not seen as a deterrent; however, foreign direct investment activity in the energy sector was virtually limited to the semi-autonomous region of Kurdistan. Investments were either wholly-owned or joint-venture enterprises. Implications to other post conflict countries, using Kuwait and Nigeria as illustrative examples, are presented and recommendations made. Keywords: Foreign direct investment; Iraq; post-conflict country; energy JEL Classifications: F21; F23; O53; P28

Development of a Certificate in Healthcare Improvement for Inter-Professional Teams

Introduction To address gaps in care team improvement-science education and connect geographically dispersed learners, we created a healthcare improvement certificate program, now completing the third program year, for inter-professional (IP) healthcare teams, including third year medical students. Methods This hybrid learning program consists of five modules: Learning Healthcare Systems, Improvement Science, Patient Safety and Diagnostic Error, Population Health and Health Equity and Leading Change. The curricular materials are comprised of focused readings, concise videos, faculty-moderated discussion boards, weekly synchronous calls of participants with faculty, and a longitudinal improvement project. The faculty are content experts, and worked with a curricular designer to define learning objectives and develop content. Results We have completed three years of this six-month program, training 61 participants (17 of whom were medical students) at 14 sites. In the third year, several medical students participated without an IP team. Development of the materials has been iterative, with feedback from learners and faculty used to shape the materials. Discussion We demonstrate the development and rollout of a hybrid-learning program for diverse and geographically dispersed IP teams, including medical students. Time restrictions limited the depth of topics, and scheduling overlap caused some participants to miss the interactive calls. We plan to evaluate the utility of the program for participants over time, using qualitative methods. Conclusion This educational model is feasible for IP teams studying improvement science and implementing change projects, and can be adopted to dispersed geographic settings

The Saudi Critical Care Society practice guidelines on the management of COVID-19 in the ICU: Therapy section

BACKGROUND: The rapid increase in coronavirus disease 2019 (COVID-19) cases during the subsequent waves in Saudi Arabia and other countries prompted the Saudi Critical Care Society (SCCS) to put together a panel of experts to issue evidence-based recommendations for the management of COVID-19 in the intensive care unit (ICU). METHODS: The SCCS COVID-19 panel included 51 experts with expertise in critical care, respirology, infectious disease, epidemiology, emergency medicine, clinical pharmacy, nursing, respiratory therapy, methodology, and health policy. All members completed an electronic conflict of interest disclosure form. The panel addressed 9 questions that are related to the therapy of COVID-19 in the ICU. We identified relevant systematic reviews and clinical trials, then used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach as well as the evidence-to-decision framework (EtD) to assess the quality of evidence and generate recommendations. RESULTS: The SCCS COVID-19 panel issued 12 recommendations on pharmacotherapeutic interventions (immunomodulators, antiviral agents, and anticoagulants) for severe and critical COVID-19, of which 3 were strong recommendations and 9 were weak recommendations. CONCLUSION: The SCCS COVID-19 panel used the GRADE approach to formulate recommendations on therapy for COVID-19 in the ICU. The EtD framework allows adaptation of these recommendations in different contexts. The SCCS guideline committee will update recommendations as new evidence becomes available

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

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

Adaptive Neural Backstepping Control Approach for Tracker Design of Wheelchair Upper-Limb Exoskeleton Robot System

In this study, the desired tracking control of the upper-limb exoskeleton robot system under model uncertainty and external disturbance is investigated. For this reason, an adaptive neural network using a backstepping control strategy is designed. The difference between the actual values of the upper-limb exoskeleton robot system and the desired values is considered as the tracking error. Afterward, the auxiliary variable based on the tracking error is defined and the virtual control input is obtained. Then, by using the backstepping control procedure and Lyapunov stability concept, the convergence of the position tracking error is proved. Moreover, for the compensation of the model uncertainty and the external disturbance that exist in the upper-limb exoskeleton robot system, an adaptive neural-network procedure is adopted. Furthermore, for the estimation of the unknown coefficient related to the parameters of the neural network, the adaptive law is designed. Finally, the simulation results are prepared for demonstration of the effectiveness of the suggested method on the upper-limb exoskeleton robot system

Adaptive Neural Backstepping Control Approach for Tracker Design of Wheelchair Upper-Limb Exoskeleton Robot System

In this study, the desired tracking control of the upper-limb exoskeleton robot system under model uncertainty and external disturbance is investigated. For this reason, an adaptive neural network using a backstepping control strategy is designed. The difference between the actual values of the upper-limb exoskeleton robot system and the desired values is considered as the tracking error. Afterward, the auxiliary variable based on the tracking error is defined and the virtual control input is obtained. Then, by using the backstepping control procedure and Lyapunov stability concept, the convergence of the position tracking error is proved. Moreover, for the compensation of the model uncertainty and the external disturbance that exist in the upper-limb exoskeleton robot system, an adaptive neural-network procedure is adopted. Furthermore, for the estimation of the unknown coefficient related to the parameters of the neural network, the adaptive law is designed. Finally, the simulation results are prepared for demonstration of the effectiveness of the suggested method on the upper-limb exoskeleton robot system

Adaptive Neural Network-Based Fixed-Time Tracking Controller for Disabilities Exoskeleton Wheelchair Robotic System

In this paper, an adaptive neural network approach is developed based on the integral nonsingular terminal sliding mode control method, with the aim of fixed-time position tracking control of a wheelchair upper-limb exoskeleton robot system under external disturbance. The dynamical equation of the upper-limb exoskeleton robot system is obtained using a free and typical model of the robotic manipulator. Afterward, the position tracking error between the actual and desired values of the upper-limb exoskeleton robot system is defined. Then, the integral nonsingular terminal sliding surface based on tracking error is proposed for fixed-time convergence of the tracking error. Furthermore, the adaptive neural network procedure is proposed to compensate for the external disturbance which exists in the upper-limb exoskeleton robotic system. Finally, to demonstrate the effectiveness of the proposed method, simulation results using MATLAB/Simulink are provided