Saudi Arabian real-life experience with biologic therapy in severe asthma

Background: Severe asthma (SA) is a common health problem associated with increased morbidity and mortality and high medical costs. Biological therapies have emerged in recent decades as promising treatment options for patients with high type 2 (T2) SA. This retrospective observational study from Saudi Arabia aimed to investigate the effects of additional biologics therapy on reducing oral corticosteroid (OCS) consumption, frequency of asthma exacerbations, improvement in lung function, and asthma control.Methods: This multicenter observational study enrolled a cohort of 97 patients from Mach 2019 to February 2021. Outcomes of anti-IgE, anti-IL5/IL5R, and anti-IL4R therapies in severe type 2 asthma were recorded and analyzed in terms of number of exacerbations (emergency visits or hospitalizations required), asthma symptoms, and use of oral corticosteroids, blood eosinophil count, asthma control according to GINA classification, and FEV1 before and during biologic therapy.Results: Ninety-seven patients were included in the analysis The mean age was 46.7±14.1 years, and 69.1% of them were female. The average duration of biological treatment was 16.4±6.8 months. At the time of data collection, the four biologic therapies reduced the exacerbation rate per year from 82/97 (84.5%) to 14/97 (14.4%) with a percent improvement of 83% from 2.9 per year in the year before biologic treatment to 1.6 per year (p<0.001). OCS was reduced from 75/97 (77.3%) to 10/97 (10.3%) for a percent improvement of 86.7%, and the average OCS dose decreased from 7.12 mg to 6.8 mg. Mean blood eosinophil count also decreased after biologic therapy from 750.5±498.5 to 188.0±122.4 cells/μl, most significant result achieved with benralizumab, and mean FEV1 improved from 59.0±12.9% to 76.0±10.2%, most significant result achieved with omalizumab. ll patients had uncontrolled asthma before biologics therapy, but asthma control improved by 91.8% after treatment.Conclusions: Biologic as add-on therapy for high T2 SA was found to reduce asthma exacerbations, systemic glucocorticoid doses, and SA symptoms.

Research on the Industrial Upgrade of Vegetable Growers in Shaanxi: A Cross-Regional Comparative Analysis of Experience Reference

The prime goals of this article are to classify farmers’ production structures in different regions through comparative analysis and propose a structural framework that can quantify the transformation and upgrade of the vegetable industry in Shaanxi. The study utilized New Structural Economics (NSE) theory to construct the theoretical model, and the empirical data set has been crafted from 1992 vegetable growers in the Shaanxi, Hebei, and Shandong provinces. We qualitatively evaluated the potentiality of the Shaanxi vegetable industry, facilitating an industrial upgrade by drawing on the development experience of other regions. More specifically, we utilized the tomato growers to construct a five-step analysis method to transform and upgrade the vegetable industries. This article found that the chosen three provinces have structural differences and similarities in their production sides, and, compared with Hebei and Shandong, the vegetable industry in Shaanxi is still in the catching-up stage. Hebei has similar planting characteristics to Shaanxi, but the production characteristics of growers in Shaanxi are quite different from those in Shandong. Therefore, tomato growers in Hebei are the desired learning object for growers in Shaanxi. By learning planting experience from Hebei growers, tomato growers in the Shaanxi Province can improve their yield and product quality. We found that Shaanxi farmers have 15.57 percent improvement potential in improving crop management and rational allocation of production materials. Proper information-sharing platforms should be implemented to grasp consumption trends on the demand side and guide industrial upgrading.

Edukasi Masyarakat Tentang Covid-19 Di Kelurahan Negeri Jaya Kecamatan Negeri Besar Kabupaten Way Kanan

ABSTRAK Coronavirus Disease 2019 (COVID-19) adalah jenis penyakit baru yang sebelumnya belum teridentifikasi pada manusia. Dan semakin banyaknya lonjaka angka positif virus corona di Indonesia, sepatutnya menaikkan pemahaman penduduk terhadap bahaya pandemi ini. Rencana dari kegiatan yang dilakukan ini adalah agar masyarakat biasa tau apa itu pengertian dari COVID-19 dan meningkatkan kesadaran akan pentingnya sikap masyarakat terhadap orang-orang yang Terinfeksi Virus COVID-19 baik itu dirinya, keluarga ataupun tetangganya, dan tujuan dari kegiatan khusus ini adalah untuk dapat mengatasi sikap masyarakat terhadap orang-orang yang Terinfeksi Virus COVID-19 secara mandiri dengan memberikan edukasi/informasi tentang COVID-19 setelah dilakukan kegiatan penyuluhan. Sebelum dilakukan kegiatan edukasi diketahui pengetahuan masyarakat hanya sekitar 60%. Kemudian dilakukan edukasi singkat menggunakan aplikasi Zoom dan Power Point terdapat peningkatan 80% kemampuan dan pengetahuan tentang COVID-19 dan bagaimana cara menyikapinya jika ada seseorang yang terinfeksi COVID-19 pada masyarakat kelurahan Negeri Jaya kecamatan Negeri Besar kabupaten Way Kanan. Kata Kunci : COVID-19, Edukasi, Meningkatkan Kesadaran, Sikap Masyarakat. ABSTRACT Coronavirus Sickness 2019 (COVID-19) is a novel form of disease that has never been seen in humans before. Furthermore, the rising number of corona virus positives in Indonesia should raise public awareness of the pandemic's hazards. The goal of this activity is for ordinary people to understand what COVID-19 means and to raise awareness of the importance of public attitudes toward people infected with the COVID-19 virus, whether they are themselves, their families, or their neighbors. The goal of this special activity is to be able to overcome public attitudes toward people infected with the COVID-19 virus independent of the COVID-19 virus. Only approximately 60% of the public was aware of the instructional initiatives before they were implemented. Then, using the Zoom and PowerPoint apps, a brief education was performed in the Negeri Jaya sub-district, Negeri Besar sub-district, and Way Kanan district, resulting in an 80 percent improvement in ability and knowledge of COVID-19 and how to respond if someone was infected with COVID-19. Keywords: COVID-19, Education, Public Awareness, and Community Attitudes

Analysis of Life Cycle Environmental Impacts of Using Enogen Corn in Beef Cattle Rations

Agricultural production systems have been identified as significant sources of anthropogenic impacts across several environmental key performance indicators (KPIs). Livestock husbandry is growing in global importance as the demand for high-quality protein continues to increase. It is therefore imperative to have sustainable intensification technologies, and we describe one such technology. The purpose of this study was to evaluate the performance of Enogen® corn grain compared to conventional feed corn when used as an ingredient in backgrounding and feed yard beef rations using life cycle assessment. The project was conducted in compliance with ISO standards, including a third-party panel review. A series of scenarios were analyzed to evaluate the impacts of boundaries and functional units on the outcomes. The use of Enogen corn as a feed component in beef production showed a quantifiable benefit in terms of the sustainability metrics of primary interest in this study. The gate-to-gate improvements at the feed yard and backgrounding based on full field trial datasets from field trials conducted at Kansas State University and at the University of Nebraska, Lincoln showed 3.4 and 5.8 percent reductions in Global Warming Potential, respectively. It is particularly noteworthy that the improvement in feed conversion ratio at the feed yard results in approximately 6 percent improvement in the four key environmental performance metrics of beef production, which demonstrates potential for the sector to meet its sustainability targets.

Injectable amniotic membrane/umbilical cord particulate for facet joint syndrome: A retrospective, single-center study

BACKGROUND: Facet joint syndrome (FJS) pain is a significant contributor to back pain and has a high rate of opioid prescription. Unfortunately, there are a limited number of therapeutic options for these patients. OBJECTIVE: To evaluate the safety and effectiveness of amniotic membrane/umbilical cord particulate (AM/UC) in managing FJS pain. METHODS: A single-center, investigator-initiated, retrospective study was performed on consecutive patients with FJS pain who received intra- or peri-articular injection of AM/UC between July 1, 2018 and July 26, 2019. Primary outcome was change in Patient Global Impression of Change (PGIC) at 6 weeks, 3 months, 6 months, and 12 months to assess the self-reported percent improvement relative to baseline. Safety was assessed by AM/UC- and procedure-related complications. Paired t-tests were used to determine whether there is a statistically significant improvement of pain post-injection compared to baseline. RESULTS: There were a total of 54 patients (69.7 ± 13.4 years; 31 female) presenting baseline pain score of 9.2 ± 1.0 despite prior treatments of activity modification (66.7%), NSAIDs (61.1%), opioids (37.0%), and physical therapy (35.2%). Mean GPIC improvement was 65.3%, 67.5%, 56.9%, and 56.7% among responders30, respectively. There were no complications. CONCLUSION: This study supports the safety and effectiveness of AM/UC particulate injection in managing FJS pain.

EAD-Net: A Novel Lesion Segmentation Method in Diabetic Retinopathy Using Neural Networks

Diabetic retinopathy (DR) is a common chronic fundus disease, which has four different kinds of microvessel structure and microvascular lesions: microaneurysms (MAs), hemorrhages (HEs), hard exudates, and soft exudates. Accurate detection and counting of them are a basic but important work. The manual annotation of these lesions is a labor-intensive task in clinical analysis. To solve the problem, we proposed a novel segmentation method for different lesions in DR. Our method is based on a convolutional neural network and can be divided into encoder module, attention module, and decoder module, so we refer it as EAD-Net. After normalization and augmentation, the fundus images were sent to the EAD-Net for automated feature extraction and pixel-wise label prediction. Given the evaluation metrics based on the matching degree between detected candidates and ground truth lesions, our method achieved sensitivity of 92.77%, specificity of 99.98%, and accuracy of 99.97% on the e_ophtha_EX dataset and comparable AUPR (Area under Precision-Recall curve) scores on IDRiD dataset. Moreover, the results on the local dataset also show that our EAD-Net has better performance than original U-net in most metrics, especially in the sensitivity and F1-score, with nearly ten percent improvement. The proposed EAD-Net is a novel method based on clinical DR diagnosis. It has satisfactory results on the segmentation of four different kinds of lesions. These effective segmentations have important clinical significance in the monitoring and diagnosis of DR.

Tofacitinib in the treatment of skin and musculoskeletal involvement in patients with systemic sclerosis, evaluated by ultrasound

Systemic sclerosis (SSc) is a rare autoimmune connective tissue disease characterized by fibrosis of the skin and internal organs, autoimmunity-driven damage and vasculopathy. The current approved disease-modifying treatments have limited efficacy, and treatment is guided toward alleviating organ complications. Thus, there is an unmet need for discovering new effective treatment options. There is recent evidence that the JAK/STAT signaling pathway is markedly activated in SSc patients. To assess the efficacy and safety of tofacitinib (TOF) on skin and musculoskeletal involvement as compared to methotrexate (MTX) in systemic sclerosis (SSc). In this 52-week pilot study, 66 patients with SSc were enrolled: 33 patients received 5 mg of oral TOF twice a day; 33 received 10 mg of MTX weekly. The proportion of dcSSc and lcSSc patients was similar (dcSSc: 42% TOF group and 36% MTX group; lcSSc: 58% TOF group and 64% MTX group). The primary outcome was the change in the modified Rodnan skin score (mRSS). Secondary outcomes included ultrasound (US) skin thickness and musculoskeletal involvement (US10SSc score). Digital ulcers (DUs) and adverse events (AEs) were documented through the treatment. Both groups had similar characteristics and medians on the outcome measures at baseline. At week 52, the TOF median mRSS was significantly lower than the MTX (p < 0.001) with a mean reduction of 13 points versus MTX 2.57. The mean percent improvement in the TOF group was 44% higher than in the MTX group. TOF median US skin thickness was significantly lower than MTX (p < 0.001), with a mean reduction of 0.31 mm versus 0.075 mm in the MTX group. The US10SSc median score was significantly lower in the TOF group (p = 0.002); mean reduction of 10.21 versus 5.27 in the MTX group. Healing of DUs with no new occurrences was observed in the TOF group. There was no significant difference between the groups in the number of AEs from baseline to week 52. TOF showed greater efficacy than MTX in reducing mRSS, skin thickness and musculoskeletal involvement in SSc and a satisfactory safety profile.

PENINGKATAN HASIL BELAJAR MELALUI PEMBELAJARAN PBL PADA SISWA SMPN 1 TEMPEH

The aim of this study is to use a problem-based learning model to improve student learning outcomes in science subjects. SMPN 1 Tempeh is the site of study. Class VII-E was the test sample. The action research approach was used in this study. The data collection method was put to the test. Regular test questions were included in the study's instrument. Excel is used to validate data. Types of essay exams (objective description). According to the calculations, the mean value of cycle I was 81.05 and the mean value of cycle II was 94.74, meaning that cycle II's learning outcomes were higher than cycle I's, with a 14.45 percent improvement in learning outcomes. Finally, the student-centered PBL learning model, in which students find problems and solve them, will help students develop their science learning outcomes in energy content.

A Multi-Rheology Design Method of Sheeting Polymer Extrusion Dies Based on Flow Network and the Winter–Fritz Design Equation

In the polymer sheet processing industry, the primary objective when designing a coat-hanger die is to achieve a uniform velocity distribution at the exit of the extrusion die outlet. This velocity distribution depends on the internal flow channels of the die, rheological parameters and extrusion process conditions. As a result, coat-hanger dies are often designed for each polymer based on its individual rheological data and other conditions. A multi-rheology method based on a flow network model and the Winter–Fritz equation is proposed and implemented for the calculation, design and optimization of flat sheeting polymer extrusion dies. This method provides a fast and accurate algorithm to obtain die design geometries with constant wall-shear rates and optimal outlet velocity distributions. The geometric design when complemented and validated with fluid flow simulations could be applied for multi-rheological fluid models such as the power-law, Carreau–Yasuda and Cross. This method is applied to sheet dies with both circular- and rectangular-shaped manifolds for several rheological fluids. The designed geometrical parameters are obtained, and the associated fluid simulations are performed to demonstrate its favorable applicability without being limited to only the power-law rheology. The two such designed dies exhibit 32.9 and 21.5 percent improvement in flow uniformity compared to the previous methods for dies with circular and rectangular manifolds, respectively.

Hybrid Bit Technology Deployment Yields Breakthrough Drilling Performance & Cost Savings for Operator

Optimized drilling performance and minimized cost per well are key objectives for operators in the current challenging oil and gas industry. The process of collecting lessons learned and designing new drill bit technologies based on these learnings is critical for optimizing drilling performance and reducing non-productive time (NPT). Southeast Kuwait onshore wells are drilled with conventional drill bit technology such as tungsten carbide insert (TCI) and polycrystalline diamond compact (PDC) bits on rotary or directional-motor bottom hole assemblies (BHA). This paper discusses the analysis that enabled breakthrough-drilling performance of 16-in. hybrid drill bit technology, delivering outstanding results and cost savings for an operator. The non-homogeneous carbonate formation in these onshore wells cause impact damage, limit the drilling efficiency of PDC and TCI bits, and result in a low rate of penetration (ROP) and poor dull conditions. A collaborative technical analysis identified key performance objectives to ensure a step change in section drilling performance. The analysis involved reviewing: Post-run dull conditions Operating parameters Formation compressive strengths Bit design Previous deployments results On Multiple wells, advanced hybrid bit technology and optimized drilling methods achieved outstanding 73-percent improvement in ROP over conventional technologies, saving operator's 3.8 drilling days and more than 27% of drilling costs. The hybrid design completed two consecutive best in class (BIC) wells in southeast Kuwait compared with the typical TCI performance of a single well per bit.