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Tafamidis treatment for transthyretin amyloid cardiomyopathy: results from an open-label, early-access, long-term study extension in an all-comers population

Abstract Background In the pivotal Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT NCT01994889), tafamidis significantly reduced mortality and cardiovascular hospitalization in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). Given the high clinical unmet need and the favorable benefit-to-risk profile of tafamidis, there was a justification to provide patients with an option for early access to treatment as part of the ATTR-ACT long-term extension study (LTE; NCT02791230). Purpose To assess long-term safety in an all-comers population receiving early access to tafamidis. Methods Following protocol amendment (20 July 2018), patients with ATTR-CM, not previously enrolled in ATTR-ACT, and without commercial access to tafamidis, were enrolled in the LTE early-access study arm in 13 countries. Patients received open-label, once-daily tafamidis free acid 61 mg for up to 60 months, until they gained product access by prescription or study discontinuation by the sponsor. All-cause and cardiovascular (CV)-related mortality, CV-related hospitalization, and treatment-emergent adverse events (TEAEs) were assessed. Results Of 1481 patients enrolled in the early-access cohort, 1476 received at least one dose of tafamidis and were included in the analysis. Mean (SD) age at enrollment was 76.5 (7.8) years old, 37.5% were ≥80 years old, and 88.8% were male. Most patients (85.6%) had wild-type ATTR-CM, and 14.9%, 52.9%, 30.8%, and 1.3% were in New York Heart Association (NYHA) Class I, II, III, and IV, respectively. Over a mean (SD) follow-up period of 17.7 (13.8) months, all-cause and CV-related mortality rates were 23.4% and 13.8%, respectively (Table). Mean frequency of CV-related hospitalization per year was 0.28 (0.60). Serious TEAEs and TEAEs leading to discontinuation of the study were observed in 0.6% of patients (both); no new safety signals were identified. Conclusions Findings from the early-access cohort of the ATTR-ACT LTE highlight the safety of tafamidis treatment in an all-comers ATTR-CM patient population.

Structure-Guided Discovery of Selective USP7 Inhibitors with In Vivo Activity.

Inhibition of ubiquitin-specific protease 7, USP7, has been proposed as a mechanism to affect many disease processes, primarily those implicated in oncology. The bound crystal structure of a published high-throughput screening hit with low-micromolar affinity for USP7 identified three regions of the compound for structure-guided optimization. Replacing one side of the compound with different aromatic moieties gave little improvement in affinity, and the central piperidine could not be improved. However, the binding site for the other side of the compound was poorly defined in the crystal structure, which suggested a wide variety of synthetically accessible options for optimization. These were assessed by screening reaction mixtures that introduced different substituents to this other side. Subsequent optimization led to a compound with low-nanomolar affinity for USP7, which showed target engagement in tumors, was tolerated in mice, and showed efficacy in xenograft models.

Intravitreal Metformin Protects Against Choroidal Neovascularization and Light-Induced Retinal Degeneration

Neovascular age-related macular degeneration (nAMD), a leading cause of blindness in older adults, presents a challenging pathophysiology involving choroidal neovascularization (CNV) and retinal degeneration. Current treatments relying on intravitreal (IVT) administration of anti-angiogenic agents are costly and of moderate effectiveness. Metformin, the common anti-diabetic drug, has been associated with decreased odds of developing AMD. Studies have shown that metformin can mitigate cellular aging, neoangiogenesis, and inflammation across multiple diseases. This preclinical study assessed metformin’s impact on vessel growth using choroidal explants before exploring IVT metformin’s effects on laser-induced CNV and light-induced retinal degeneration in C57BL/6J and BALB/cJ mice, respectively. Metformin reduced new vessel growth in choroidal explants in a dose-dependent relationship. Following laser induction, IVT metformin suppressed CNV and decreased peripheral infiltration of IBA1+ macrophages/microglia. Furthermore, IVT metformin protected against retinal thinning in response to light-induced degeneration. IVT metformin downregulated genes in the choroid and retinal pigment epithelium which are associated with angiogenesis and inflammation, two key processes that drive nAMD progression. These findings underscore metformin’s capacity as an anti-angiogenic and neuroprotective agent, demonstrating this drug’s potential as an accessible option to help manage nAMD.

Mean platelet volume (MPV) and red blood cell distribution width coefficient of variation (RDW_CV) as prognostic markers in community-acquired pneumonia in children: a cross-sectional study

BackgroundCommunity-acquired pneumonia (CAP) is a major global health threat for children, causing numerous hospitalizations and deaths. CAP is a leading cause of mortality in children under five and results in millions of hospital admissions each year. Identifying reliable prognostic markers is crucial. Mean platelet volume (MPV) and red blood cell distribution width coefficient of variation (RDW_CV) are accessible and cost-effective options for prognosis assessment. This study investigates MPV and RDW_CV as prognostic markers in children with CAP.MethodsThis cross-sectional study included 150 children aged 1–15 years diagnosed with CAP upon initial examination and admitted to the hospital. CAP diagnosis was based on clinical symptoms, physical examination, and/or radiographic findings, with hospitalization criteria set for CAP in children. CAP severity was assessed using the Clinical Respiratory Score, categorizing patients into mild, moderate, and severe groups. MPV and RDW_CV were compared among these groups.ResultsAmong the patients, 71 (47.3%) were girls, and 79 (52.7%) were boys. The average hospitalization duration was 6.24 ± 3.82 days, with a median of 5 days. Disease severity distribution was 58 (38.7%) mild, 54 (36.0%) moderate, and 38 (25.3%) severe. Both RDW_CV and MPV were higher in severe cases and in children hospitalized for more than 10 days (P < 0.001). A significant positive correlation was observed between RDW_CV and MPV (r = 0.636, P < 0.001). Mean RDW and MPV values were significantly elevated in children needing ICU admission and those with pleural effusion (P < 0.001). The RDW_CV cutoff was 13.75, with 97.4% sensitivity and 80.4% specificity. The MPV cutoff was 8.25, with 78.9% sensitivity and 69.6% specificity.ConclusionElevated RDW_CV and MPV levels are associated with severe CAP in hospitalized children, providing valuable prognostic insights. RDW_CV is a more precise prognostic indicator than MPV, demonstrating superior predictive value in CAP management.

Are Short-Term Study Abroad Experiences Effective in Developing Global Citizenship in University Students Studying Health Degrees?

Short-term study abroad (STSA) experiences are an increasingly popular strategy used by universities to develop global citizenship in students. Global citizenship is particularly important for emerging health professionals with many health challenges of the 21st century being of global importance. Yet, evidence on the effectiveness of STSA is inconclusive, predominantly due to methodological issues limiting research to date. This quasi-experimental study draws on a recognized global citizenship framework encompassing dimensions of social responsibility, global competence, and global civic engagement to examine the changes in global citizenship pre- and post-STSA experience in health students. The sample consisted of health students (n = 75) who participated in an STSA experience (study tour or practicum) from 16 to 22 days in a less industrialized country and a control group (n = 66) who did not partake in any intervention. The data analysis found that students in the intervention group had significant improvements in their overall global citizenship score and its dimensions separately, except for social responsibility, while no significant changes were seen in the control group. The findings provide evidence to support STSA experiences as an accessible option for universities to promote global citizenship development among health students.

Statins for the treatment of COVID-19 patients: an updated meta-analysis of randomized controlled trials

BackgroundStatin is a low-cost and easily accessible therapeutic option for COVID-19 patients. Previous observational studies and meta-analyses suggest using statins for COVID-19 patients.MethodsDatabases including Medline, Scopus, Embase, Cochrane Library, and clinicaltrials.gov were systematically searched.ResultsAfter screening 754 records, 9 trials were included. Overall, the study demonstrated a non-significant reduction in all-cause mortality (p = 0.14, RR 0.90, 95% CI 0.79–1.03), no significant difference in the need for mechanical ventilation (p = 0.62, RR 0.95, 95% CI 0.77–1.17), and a non-significant reduction in length of hospitalization (p = 0.71, MD − 0.17 (95% CI − 1.09, 0.76)). The certainty of evidence varied across outcomes, with most demonstrating reasonable certainty.ConclusionOur study did not support clinical efficacy of statins for the treatment of COVID-19.

Sacrocolpopexy: The Way I Do It.

Sacrocolpopexy (SCP) is an established surgical procedure for apical vaginal vault prolapse. There remains significant variation amongst surgeons in both the surgical steps and concomitant surgeries utilised when undertaking an SCP. This review article is aimed at summarising the evidence and providing a detailed update of SCP in modern practice, reviewing contemporary evidence behind its indications, efficacy, outcomes, surgical steps, and complications. Sacrocolpopexy remains the gold standard for post-hysterectomy apical prolapse based on good long-term outcomes, patient satisfaction and low complication rates. SCP with concomitant total hysterectomy is not recommended owing to high rates of mesh exposure. The laparoscopic approach remains the preferred option in terms of low morbidity, quicker recovery and lower cost than alternative access options. For optimal outcomes an SCP should be performed with monofilament mesh, using absorbable sutures and with a paravaginal repair for cystocele. Although SCP has become increasingly utilised for apical prolapse, its established efficacy regarding anatomical outcomes, patient satisfaction, and complications is in the context of post-hysterectomy prolapse. SCP with concomitant total hysterectomy has higher rates of mesh exposure. The efficacy and safety of SCP with sub-total hysterectomy or hysteropexy have not been clearly established and require further assessment through well-designed, rigorous randomised controlled trials.

The Future Museum: Integrating Augmented Reality (AR) and Virtual-text with AI-enhanced Information Systems

This study examines how AR, virtual text, and AI in future museums affect visitor engagement, knowledge acquisition, emotional response, and social interaction. The study uses econometrics equations, text analysis, thematic qualitative data analysis, and agent-based modelling. The economic models show that virtual text type, depth of knowledge, personalization, accessibility options, and AR museum experiences increase visitor engagement, knowledge, emotional response, and social interaction. Thematic analysis displays visitor viewpoints such as AR curiosity, personalization, and cultural significance, while correlation matrices indicate their relationships. Bayesian econometrics, text analysis, thematic qualitative data analysis, and agent-based modelling are used to explore museum visitors' interactions with augmented reality, virtual text, and AI-enhanced information systems. These devices improve visitor engagement, social connection, emotional response, and information collection. Self-reported data biases, context biases, and rapid technological advancement limit the study. Museums can benefit from user-centric technology, AR, personalization, and cultural knowledge. The main findings reveal that these technologies significantly increase museum visitors, emphasizing that future museum administration and design must carefully adopt new technology. The findings may affect museum staff, designers, and decision-makers. Learning important technology factors improves AR, virtual text, and AI-enhanced information system design and deployment decisions. UX design prioritizes visitor choices, while immersive and integrated displays connect museum experiences. These practical implications force museums to actively and practically integrate technology to stay relevant. The project's findings, practical insights, and visitor experiences will improve future technological and cultural organisation research. The whole process contributes to the discussion on how emerging technologies affect museum experiences and innovation and decision-making in the ever-changing cultural heritage context.

IMPACT ASSESSMENT OF INFORMATION TECHNOLOGY ON INVESTMENT CHOICE DECISIONS OF ACADEMIC PROFESSIONALS

The substantial impact of information technology on investment decision-making is explored in this study, and strong empirical support is provided through a significant regression model. Understanding the extent to which technology influences investment choices is of utmost relevance in a time of fast technological advancement. The research makes use of a varied dataset that includes a variety of economic and market characteristics, employing robust statistical analysis to evaluate the relationship between technology and investment decisions. Our findings show that information technology and investing choices are statistically significantly correlated. The regression model illustrates how technology is increasingly being used into investment strategies and how it influences investors' decisions. This study emphasizes the importance of incorporating technical expertise into investment plans, with a focus on data analytics, artificial intelligence, and long-term tech investments. Furthermore, the ease with which mutual funds can be invested in, with alternatives for both novice and experienced investors, has made them a practical and accessible option as the study points mutual funds as the most preferred option for investment. Their liquidity and transparency also resonate with investors who appreciate the ability to monitor their investments easily and access their funds when needed. The results of the study highlight how crucial it is to comprehend investor preferences for financial goods. The popularity of mutual funds not only demonstrates their benefits but also emphasizes the necessity for financial institutions and advisors to customise their services and products in order to meet investor needs. KEYWORDS: Information Technology, Investment Choice Decisions, Mutual Funds

Limitations and characteristics of converted industrial acrylic sheet into an in vitro platform using CO2 laser

The recent US FDA Modernization Act 2.0 has intensified interest in microfluidic-based in vitro systems for preclinical research. However, the high costs of conventional microfabrication methods and commercial devices present significant barriers, particularly in developing countries. This study addresses these challenges by exploring the use of industrial-grade acrylic sheets and a conventional CO2 laser for cost-effective microfabrication. The research investigates the effects of laser parameters—specifically nozzle speed and power—on the dimensions and quality of microchannels, surface roughness, and bonding strength. Results indicate that increased nozzle speed reduces kerf width and enhances microchannel quality, whereas high laser power (∼52 watts) induces bubbling at the edges. A simple acetone and ethanol mixture was found to provide optimal bonding strength without altering the acrylic’s molecular structure. UV spectrophotometry revealed minimal changes (∼6 %) in visible light transmittance due to bonding conditions, while FTIR analysis showed no residuals that could potentially cause cytotoxicity. Despite variations in surface roughness resulting from the etching process, cell viability remained unaffected. The surfaces supported effective cell culture for lung (A549), neuron (SH-SY5Y), and liver (HepG2) cell lines. This approach presents a practical and cost-effective solution for developing in vitro platforms, making it an accessible option for research and academic applications.

Three-dimensional Morphometric Analysis of the Effectiveness of Kinesio Taping on Postoperative Discomfort Following Mandibular Third Molar Surgery: A Prospective Randomized Split-mouth Study

This study investigates the efficacy of Kinesio taping (KT) in reducing postoperative discomfort, including edema, trismus, and pain, following mandibular third molar extraction. A prospective randomized split-mouth design was employed, involving 7 patients with impacted mandibular third molars. KT was applied immediately postsurgery, and outcomes were assessed on the third and seventh postoperative days using a Visual Analog Scale (VAS) for pain, 3D morphometric analysis for swelling, and caliper measurements for trismus. Results showed significant reductions in pain, swelling, and trismus on the KT-treated side compared with the control side. The most notable differences were observed on day 7, where KT demonstrated superior effectiveness in alleviating symptoms. The control group showed improvement over time, but the KT-treated group experienced faster and more pronounced recovery. In conclusion, KT proved to be a safe and effective method for improving postoperative recovery following mandibular third molar surgery, offering a low-cost, accessible option to enhance patient comfort and quality of life.

Study on Misoprostol in Case of Missed Abortion

Background: Misoprostol and manual vacuum aspiration (MVA) are both effective treatments for incomplete abortion. Misoprostol, a medication that induces uterine contractions, is often preferred for its non-invasive nature and ease of administration. MVA, a surgical method, involves removing retained products of conception using suction. Studies suggest that while MVA has a higher success rate and faster recovery, misoprostol is a cost-effective, accessible option with fewer complications, though it may require follow-up treatment in some cases. Objective: In this our main goal is to assess the efficiency of misoprostol versus manual vacuum aspiration for the treatment of incomplete abortion. Method: This hospital based randomized controlled trial study was conducted in in-patient patient Department of Obstetrics and Gynaecology, Chittagong Medical College and Hospital from October 2007 to September 2008. A total of 128 women between the age of 15 to 40 years with diagnosis of first trimester uncomplicated spontaneous incomplete abortion was included in this study. Among them 64 patients were randomized in group ‘A’ as case who were treated with Misoprostol and 64 patients were in group ‘B’ as control who were treated with Manual Vacuum Aspiration. Results: During the study, where the mean gestational size of uterus was 9.52 weeks at the time of initial examination. The mean size of uterus in misoprostol group was 9.07(SD ±1.93) and that of MVA group was 9.87 (SD± 1.35). More women in case group had no child of viable age on the other hand increased number of women in control group had at least one viable birth. 36 (60%) out of 60 women in misoprostol group 26 (41.93%) out of 62 reported pain and 36 (58.07%) out of 62 women in MVA and 24 (40%) patients in misoprostol arm said bleeding as the worst feature. Thirty six percent women in misoprostol group and 16% women in MVA group reported that the adverse effects were easily tolerable. Thirty percent women ...

Bridging the gap: voices of teachers on inclusive literature

ABSTRACT This study explored teachers’ perspectives on utilising existing children’s books for students with intellectual and additional disabilities. 58 teachers from Israeli special education schools and kindergartens revealed widespread dissatisfaction with available materials. Strikingly, 70.7% were unsatisfied with existing children’s books, and 94.7% believed there were not enough accessible options. Qualitative analysis identified five major barriers: excessive text, inappropriate content for older age groups, challenges with the physical structure of books, mismatches between text and visuals, and specific challenges for teachers of children with multiple disabilities. These findings underscore the substantial need for more accessible literature tailored to the needs of children with disabilities. Despite legislation mandating societal inclusion of people with disabilities, teachers’ dissatisfaction highlights gaps in addressing their students’ literary requirements. The results shed light on these teachers’ vital roles in adapting books and indicate the need for greater collaboration between teachers, publishers, and policymakers. By highlighting the voices of frontline professionals, this study provides a crucial call to action to develop high-quality, customised educational resources for children and young people with disabilities.

Home, but Homebound After Traumatic Brain Injury: Risk Factors and Associations With Nursing Home Entry and Death

ObjectiveTo examine risk factors associated with homeboundness 1-year after traumatic brain injury (TBI) and to explore associations between homebound status and risk of future mortality and nursing home entry. DesignSecondary analysis of a longitudinal prospective cohort study. SettingTBI Model Systems centers. ParticipantsCommunity-dwelling TBI Model Systems participants (n=6595) who sustained moderate-to-severe TBI between 2006 and 2016, and resided in a private residence 1-year postinjury. InterventionsNot applicable. Main Outcome MeasuresHomebound status (leaving home ≤1-2d per week), 5-year mortality, and 2- or 5-year nursing home entry. ResultsIn our sample, 14.2% of individuals were homebound 1-year postinjury, including 2% who never left home. Older age, having less than a bachelor's degree, Medicaid insurance, living in the Northeast or Midwest, dependence on others or special services for transportation, unemployment or retirement, and needing assistance for locomotion, bladder management, and social interactions at 1-year postinjury were associated with being homebound. After adjustment for potential confounders and an inverse probability weight for nonrandom attrition bias, being homebound was associated with a 1.69-times (95% confidence interval, 1.35-2.11) greater risk of 5-year mortality, and a nonsignificant but trending association with nursing home entry by 5 years postinjury (RR=1.90; 95% confidence interval, 0.94-3.87). Associations between homeboundness and mortality were consistent by age subgroup (±65y). ConclusionsThe negative long-term health outcomes among persons with TBI who rarely leave home warrants the need to re-evaluate home discharge as unequivocally positive. The identified risk factors for homebound status, and its associated negative long-term outcomes, should be considered when preparing patients and their families for discharge from acute and postacute rehabilitation care settings. Addressing modifiable risk factors for homeboundness, such as accessible public transportation options and home care to address mobility, could be targets for individual referrals and policy intervention.

EVALUATION OF REMOTE CHECK IN CHILDREN WITH COCHLEAR IMPLANTS

ObjectiveThis study evaluates the feasibility of reducing in-person appointments by utilizing Remote Check (RC) in pediatric cochlear implant (CI) recipients and investigates the most suitable age range for implementing RC. MethodsFifty-eight pediatric CI recipients, aged 1 to 17 years, were evaluated using a web-based RC application by audiologists. Most (84.5%) used verbal communication. Inclusion criteria required stable map status, caregiver tech proficiency, and a compatible phone. ResultsRemote assessments were beneficial, with 89.7% of participants successfully completing RC. Aided threshold tests (ATT) were completed in 73.2% of participants, while speech-in-noise tests (Digit Triplet Test, DTT) were completed in 47.3%. Children as young as 4 successfully completed ATT, while a minimum age of 7 was required for DTT. A significant relationship between age and test success was demonstrated. Verbally communicative children had higher completion success rates. Parental education was significantly correlated with DTT success, with higher success rates in children whose parents had undergraduate degrees. With RC use, 69% of children did not need clinic visits, emphasizing the need for personalized and remote support for optimal cochlear implant performance. In-person appointments were primarily required due to concerns about the duration of device usage. ConclusionThe study confirms the effectiveness and feasibility of using RC in pediatric CI users, even as young as one year old with stable aided hearing. The findings advocate for the integration of RC into routine follow-up protocols, offering a more accessible option for enhanced patient care.

Downstream Emergency Department and Hospital Utilization Comparably Low Following In-Person Versus Telemedicine Primary Care for High-Risk Conditions.

Telemedicine use expanded greatly during the COVID-19 pandemic. More data is needed to understand how this shift may impact other venues of acute care delivery. We evaluate the association of visit modality (telephone, video, or office) and downstream emergency department (ED) and hospital visits among primary care visits for acute, time-sensitive conditions. Observational study of patient-scheduled primary care telemedicine and office visits for acute conditions (cardiac, gastrointestinal, neurologic, musculoskeletal, and head and neck) in a large, integrated healthcare delivery system. Adults with a new self-booked primary care appointment for an eligible acute condition from January 1, 2022, to December 31, 2022 (with no primary care, ED, or hospital visits in prior 30 days). Visit modality, including office, video, or telephone. Seven-day ED and hospital utilization, adjusted for patient and visit characteristics. Among 258,958 primary care visits by 239,240 adult patients, 57.7% were telemedicine visits; of these, 72.4% were telephone and 27.6% were video. Telephone visits were the timeliest, with over 70% of visits scheduled within 1 day of booking. Rates of 7-day ED utilization were low, and varied by condition group, with cardiac visits having the highest rates (4.8%) and musculoskeletal visits having the lowest (0.8%). There was less than a 1% absolute difference in ED use by visit modality for all condition types; however, telephone visits were associated with slightly higher rates than video visits. The 7-day hospitalization rate was less than 1% and observed between visit type differences varied by clinical condition. Among office, telephone, and video visits in primary care for potentially high-risk, time-sensitive conditions, downstream ED and hospital use were uncommon. ED utilization was lower for video visits than telephone visits, although telephone visits were timelier and may offer a safe and accessible option for acute care.

The Future Museum: Integrating Augmented Reality (AR) and Virtual-text with AI-enhanced Information Systems

This study examines how AR, virtual text, and AI in future museums affect visitor engagement, knowledge acquisition, emotional response, and social interaction. The study uses econometrics equations, text analysis, thematic qualitative data analysis, and agent-based modelling. The economic models show that virtual text type, depth of knowledge, personalization, accessibility options, and AR museum experiences increase visitor engagement, knowledge, emotional response, and social interaction. Thematic analysis displays visitor viewpoints such as AR curiosity, personalization, and cultural significance, while correlation matrices indicate their relationships. Bayesian econometrics, text analysis, thematic qualitative data analysis, and agent-based modelling are used to explore museum visitors' interactions with augmented reality, virtual text, and AI-enhanced information systems. These devices improve visitor engagement, social connection, emotional response, and information collection. Self-reported data biases, context biases, and rapid technological advancement limit the study. Museums can benefit from user-centric technology, AR, personalization, and cultural knowledge. The main findings reveal that these technologies significantly increase museum visitors, emphasizing that future museum administration and design must carefully adopt new technology. The findings may affect museum staff, designers, and decision-makers. Learning important technology factors improves AR, virtual text, and AI-enhanced information system design and deployment decisions. UX design prioritizes visitor choices, while immersive and integrated displays connect museum experiences. These practical implications force museums to actively and practically integrate technology to stay relevant. The project's findings, practical insights, and visitor experiences will improve future technological and cultural organisation research. The whole process contributes to the discussion on how emerging technologies affect museum experiences and innovation and decision-making in the ever-changing cultural heritage context.

Effectiveness of Counseling and Sound Therapies, Including Mobile Applications and Quran Therapy, in Managing Subjective Tinnitus: randomized controlled trial study

Introduction: Subjective tinnitus, the perception of sound without an external source, affects approximately 15% of the global population. Despite its non-life-threatening nature, tinnitus significantly impacts the quality of life, causing distress, sleep disturbances, anxiety, and depression. Objectives: This study assesses the effectiveness of counseling therapy combined with two sound therapy modalities; mobile applications and Quran therapy in managing tinnitus symptoms. Methods: This randomized controlled trial study involved 270 participants with subjective tinnitus, recruited from a medical center and a private audiology clinic in Sulaymaniyah, Iraq. Participants were divided into two groups: one receiving counseling therapy and sound therapy via mobile applications (ReSound Tinnitus Relief and Beltone Tinnitus Calmer), and the other receiving counseling therapy combined with Quran therapy (Quranic recitation in Maqam Al-Bayati style). Tinnitus severity and its impact on quality of life were measured using the Tinnitus Primary Function Questionnaire (TPFQ-CK) and the Tinnitus Handicap Questionnaire (THQ-CK) before and six months after the intervention. Results: Both therapy groups showed significant improvements in tinnitus severity and quality of life. The TPFQ-CK total scores decreased from 38.18 to 14.99 in the Quran therapy group and from 38.34 to 17.82 in the mobile application group. The THQ-CK total scores decreased from 43.46 to 22.99 in the Quran therapy group and from 43.74 to 25.25 in the mobile application group. Significant reductions were also observed in tinnitus annoyance and loudness levels. Conclusions: Counseling therapy combined with sound therapy, whether through mobile applications or Quranic recitation, effectively reduces tinnitus severity and improves the quality of life for individuals with subjective tinnitus. Quran therapy, leveraging spiritual and cultural practices, showed a slight edge in effectiveness over mobile applications, suggesting that culturally relevant and accessible sound therapy options can enhance tinnitus management.

A Novel Approach for Temperature Forecasting in Climate Change Using Ensemble Decomposition of Time Series

AbstractThis paper presents FORSEER (Forecasting by Selective Ensemble Estimation and Reconstruction), a novel methodology designed to address temperature forecasting under the challenges inherent to climate change. FORSEER integrates decomposition, forecasting, and ensemble methods within a modular framework. This methodology decomposes the time series into trend, seasonal, and residual components. Subsequently, multiple optimized forecast models are applied to each component. These component models are then carefully weighted and combined through an ensemble process to generate a final robust forecast. Experimental results demonstrate that FORSEER is an efficient computational forecasting methodology for complex climate time series. Furthermore, we show that FORSEER has an equivalent forecasting performance to the M4 competition champion SMYL method for temperature series. Besides, the proposed methodology has less computational complexity than SMYL, making it a more accessible and scalable option. FORSEER's modular architecture also allows flexibility when substituting techniques depending on the context of the problem, facilitating the parallel execution of independent tasks and resulting in a strategy adaptable to multiple contexts.

Primary Patency Success of Arteriovenous Shunts in Hemodialysis Patients: A 28-Month Prospective Study.

Background Arteriovenous (AV) shunts are vital for providing long-term vascular access in hemodialysis patients. While brachiocephalic and radiocephalic shunts are commonly employed, data on their primary patency rates and associated complications in resource-limited settings such as Yemen remain scarce. This study aimed to evaluate the primary patency success of AV shunts and identify factors influencing their outcomes in hemodialysis patients at Al-Thawra Modern General Hospital. Methods This prospective observational study was conducted over 28 months, from April 2021 to August 2023, at Al-Thawra Modern General Hospital in Sana'a, Yemen. A total of 163 patients with chronic renal failure requiring AV shunt creation for hemodialysis were included. Data on patient demographics, comorbidities, shunt characteristics, and postoperative outcomes were collected. Primary patency was assessed at the 8-month follow-up interval. Statistical analysis was performed to identify factors associated with shunt patency. Results Among the enrolled 163 patients, the median age was 43.12 years, with 61.3% undergoing brachiocephalic shunt creation. The overall primary patency rate at 8 months was 87.7%, with brachiocephalic shunts exhibiting a significantly greater patency rate (93.0%) than radiocephalic shunts (67.3%) (p = 0.02). Complications occurred in 25% of patients, with pseudoaneurysm formation being the most common complication (6.1%). Factors such as shunt type, patient age, and comorbidities (e.g., diabetes) significantly influence patencyoutcomes. Conclusion Compared with radiocephalic shunts, brachiocephalic shunts demonstrated superior primary patency rates, suggesting that they may be a preferable option for long-term hemodialysis access in the studied population. These findings emphasize the need for individualized patient management and careful postoperative monitoring, particularly in resource-limited settings such as Yemen, to optimize AV shunt outcomes.