bluuebunny/crossref_metadata_2025 huggingface dataset:
Three-dimensional Computer-aided Design System used in Orthodontics and Orthognathic Surgery for Diagnosis and Treatment Planning- A Narrative Review
Authors: Bhuskute Kushal Prakash , Jadhav Vikrant , Sharma Mansi , Reche Amit
Published: November 2023

Three dimensional advancements in technology have made a profound impact on various fields, and dentistry, particularly the branch of orthodontics and orthognathic surgeries, which has not been exempt from this transformative influence. Among the cuttingedge technologies that have gained significant traction is Three-Dimensional (3D) printing, which has found its initial applications in orthodontics for producing dental casts. By integrating intraoral scanners, dentists now possess the remarkable ability to obtain dental impressions without subjecting patients to the discomfort associated with traditional methods. Furthermore, 3D planning techniques have emerged as a pivotal element in orthodontics, especially when striving for optimal aesthetic and occlusal outcomes. Precise treatment planning plays a vital role in ensuring successful orthognathic surgeries and other orthodontic interventions. The utilisation of 3D planning techniques facilitates the gathering of comprehensive data, thereby achieving two main objectives: an accurate diagnosis of the dentoskeletal deformity and the formulation of a treatment plan that can be faithfully replicated during the clinical procedure. Even 3D imaging technology, such as Computed Tomography (CT) and Cone Beam Computed Tomography (CBCT), has become an indispensable tool in dentistry. These imaging techniques provide volumetric images of a patient's facial anatomy, enabling the transformation of intricate details into precise 3D representations of the craniofacial skeleton and soft tissue layers. Consequently, this progress has led to the development of computerised resources dedicated to preoperative planning and the fabrication of surgical splints. The integration of advanced technologies, including 3D printing, 3D planning techniques, and 3D imaging technology, has revolutionised orthodontics, providing dentists with precise tools for accurate diagnosis, treatment planning, and ultimately, enhanced patient care. As this field continues to progress, the potential for further advancements and innovative applications utilising artificial intelligence becomes an exciting prospect in the ever-evolving landscape of modern dentistry.
Association of BMI with Semen Parameters in the Male Partners of Infertile Couples: A Cross-sectional Study
Authors: Waghmare Onkar Bharat , Choudhari Sudhir Prabhakar , Fatima Syeda Afroz
Published: November 2023

Introduction: In today’s scenario, obesity is increasing in children and young adolescents, and they are more likely to continue as obese adults. Temporal trends indicate that obesity is increasing while fertility is decreasing. Studies worldwide have reported a negative association between obesity and male fertility, but studies from India are scarce. Hence, there is a need to study the extent of the association between obesity and infertility. Aim: To evaluate the association between Body Mass Index (BMI) and semen parameters in the male partners of infertile couples. Materials and Methods: A cross-sectional study was conducted in the Department of Physiology, Government Medical College Aurangabad, Maharashtra, India, from August 2021 to August 2022. On total of 66 participants divided into two groups: Group A consisted of overweight and obese participants (BMI ≥23.0 kg/m2 ), and Group B consisted of participants with normal BMI (BMI <23 kg/m2 ). The semen parameters studied were semen volume, sperm concentration, total sperm count, total motility, and progressive motility. Semen samples were analysed according to the WHO 2010 guidelines. Continuous variables were expressed as mean±standard deviation. Unpaired t-test was used to compare the groups. Results: The mean age in Group A and Group B was 30.18±4.5 and 28.27±4.35 years, respectively (p<0.08). The mean BMI in Group A and Group B was 27.01±2.94 kg/m2 and 20.29±1.69 kg/m2 , respectively (p<0.0001). The mean sperm concentration in Group A was 37.01±42.6 million, and in Group B, it was 90.24±56.11 million (p<0.0001). Total motility in Group A was 27.8±31.36%, and in Group B, it was 57.9±28.41% (p<0.0001). Progressive motility in Group A was 18.75±24.79%, and in Group B, it was 42.63±26.15% (p<0.0003). Conclusion: In the present study, high BMI (obesity and overweight) was significantly associated with low sperm concentration, count, and motility
Neuroleptic Sensitivity in Psychotic Patients on Stabilised Doses of Psychotropics during Coronavirus Infection: A Case Series
Authors: Ahluwalia Isha , Bobba Neeta Sagar , Ponangi Chytanya Deepak , Reddy MS
Published: November 2023

The emergence of the coronavirus pandemic has transformed into one of the significant health crises faced by the modern era. Its effects are not just limited to the respiratory system, but detrimental effects on the cardiovascular and neurological systems are also known to occur. While neurological complications such as encephalopathies and stroke are common, the neuropsychiatric effects are mostly described in terms of psychological effects only. The effect of coronavirus on both the pharmacodynamics and pharmacokinetics of various psychotropic medications remains debatable. The present case series aimed to highlight a rare and novel finding of the occurrence of neuroleptic sensitivity in three patients (three male patients) with psychotic illness who were previously on a well-adjusted dosage of psychotropic medications after they suffered from a coronavirus infection. It is only over the years, in the aftermath of the pandemic, that the serious and long-term neuropsychiatric complications and pharmacokinetic changes associated with coronavirus infection will be realised. Therefore, it is advisable to exercise caution when using higher doses of psychotropic medications, considering the increase in neuroleptic sensitivity
Calcified False Tendon Linked to Sudden Cardiac Death in a Young Adult: An Autopsy-based Case Report
Authors: Calaisselvane Umasankary , Kiran Chokka Mahesh , Phansalkar Manjiri Dilip , Ramdas Anita , Subramanyam Sunil
Published: November 2023

Left Ventricular False Tendons (LVFTs) are cord-like structures that traverse the cavity of the left ventricle, connecting the left ventricular free wall or papillary muscle and the ventricular septum without attachment to the mitral valve leaflets. They are incidentally found in autopsy heart specimens. False tendons are generally benign anatomic variants and can be associated with functional murmurs and electrocardiographic abnormalities. False tendons can also be a cause of ventricular arrhythmias. Two-dimensional echocardiography serves as a useful imaging modality in detecting false tendons. They should be differentiated from other entities such as thickened ventricular trabeculations, an accessory anterior mitral leaflet, thrombus, vegetation, and ventricular masses or tumours. Most LVFTs are transverse and are located in the apex. They are found to arise from the inner trabeculated layer of the myocardium. The exact prevalence of LVFTs remains unclear. Present report is a case of postmortem findings in the heart of a 34-year-old male who experienced a sudden collapse while walking after lunch. On gross examination, the left ventricular wall and the lower part of the interventricular septum showed focal grey-white areas. A well-defined, grey-white, hard polypoidal lesion was noted in the left ventricle near the apex, attached to the papillary muscles. The left anterior descending artery showed early atherosclerotic changes. LVFT was diagnosed, which could have been the reason for the arrhythmia. Hence, the evaluation of cardiac murmurs and arrhythmias by two-dimensional echocardiography and cardiac Magnetic Resonance Imaging (MRI) serves as helpful parameters in detecting LVFTs.
Gut-Lung Axis-A Compass to Navigate Microbiome Landscape in COVID-19
Authors: Kali Arunava , Charles Pravin
Published: November 2023

The waves of the Coronavirus Disease 2019 (COVID-19) pandemic have disrupted healthcare systems globally, with a staggering number of confirmed cases reaching 593 million and a death toll of six million. While the primary target organ of COVID-19 is the lungs, the novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) also shows a preference for the intestinal epithelium, which expresses Angiotensin Converting Enzyme 2 (ACE2), a receptor necessary for viral entry into host cells. The composition and abundance of beneficial gut microbiota play a critical role in protecting against severe disease and complications, whereas dysbiosis contribute to systemic inflammation and immune imbalances during SARS-CoV-2 infection. Recent insights into the microbiome have emphasised the importance of the gut-lung axis and the microenvironments of the gut and lungs in the context of COVID-19. These findings offer opportunities for the development of new diagnostic and therapeutic strategies. In this review, the significance of the gut-lung axis, as well as the intestinal and pulmonary microbiota, in COVID-19, were explored with a particular focus on their potential applications
Acinic Cell Carcinoma of the Breast: A Rare and Diagnostically Challenging Entity
Authors: Anila KR , Elsa Joy , Mathews Anitha , Joseph Rona
Published: November 2023

Acinic Cell Carcinoma (AcCC) of the breast is a rare subtype of invasive breast carcinoma that falls under the category of salivary gland-type tumours of the breast. Histologically, it closely resembles AcCC of the salivary gland. Here, the authors report a case of AcCC of the breast in a 51-year-old woman who presented with a palpable lump in her right breast. Radiological investigation revealed a Breast Imaging Reporting and Data System (BIRADS) score V lesion. A core biopsy was performed, and the histopathological examination revealed relatively bland cells arranged in an acinar pattern within a myxoid stroma, closely resembling adenosis rather than a neoplasm. The diagnosis posed a challenge in the core biopsy due to its close resemblance to adenosis. However, the clinical and radiological findings strongly suggested malignancy. Immunostaining with p63 was conducted, which helped demonstrate the absence of myoepithelial cells around the tumour cell nests and supported the neoplastic nature of the lesion. Despite the bland and low-grade morphology, the tumour was found to be triple negative for Oestrogen Receptor (ER), Progesterone Receptor (PR), and Human Epidermal Growth Factor Receptor 2 (HER2), and it exhibited characteristic positivity for SRY-Box Transcription Factor 10 (SOX 10), S100, and CK7, which aided in making the diagnosis. The authors presented the case report to highlight the rarity of this subtype of breast carcinoma and to emphasise the importance of histomorphology and immunoprofile in reaching a diagnosis. To the best of the authors’ knowledge, the present case was the second reported case of AcCC of the breast from India, adding to the novelty of this case.
Labour Supply Responses to Income Tax Changes in Spain
Authors:   Universidad de Valencia, Sanchis Juan Alberto , Cutanda Antonio ,   Universidad de Valencia and ERICES
Published: November 2023

This paper simulates the response of the Spanish labour supply to income tax changes using estimates for the intertemporal elasticity of substitution of leisure, calculated using a pseudo-panel built combining information from the EPA and the ECPF, for the period 1987-1997. According to our findings, income tax reforms have an impact on Spanish labour market, although the effects are quite small, making this mechanism a restricted tool for addressing the country’s existing social security system deficit. Further, labour responses differ for men and women, across workers’ age, as well as between permanent and fixed-term contract workers.
Tackling Vulnerable Households through a Working Tax Credit Scheme: A Feasible Alternative to Cash Transfers
Authors:   Universidad Adolfo Ibáñez, Agostini Claudio A. , Perticara Marcela ,   Universidad Diego Portales, Selman Javiera ,   Tulane University
Published: November 2023

Conditional Cash Transfer Programs (CCTs) have been extremely popular strategies to fight poverty in developing countries for the last three decades. Although these programs can be effective to improve the welfare of the poor in the short run and even to guarantee basic health care and education services, they can also discourage employment and reduce formality rates. Furthermore, they can create welfare dependence and prevent the generation of autonomous income. Many developed countries have been using the income tax system not only to redistribute income but also to implement social policies. A good example is the Earned Income Tax Credit (EITC) in the United States, which offers a reimbursable credit conditioned on working to low-income individuals. This paper uses Chilean data to empirically analyze the effect that a system such as the EITC would have on poverty and inequality in a developing country. Our polity targets single 18-60 years old women, without a partner, with and without eligible children. The results show that a tax credit could increase employment while reducing poverty and inequality. Additionally, we show that an EITC design might be more cost-effective to increase the income of individuals below the poverty line and to reduce inequality. Given that a program like the EITC mostly benefits those who have a higher chance of seeking and obtaining employment in the formal sector, such policy should be implemented as a complementary tool to other social policy programs aimed at helping individuals out of the informal sector.
CONCEPT OF INDRIYA PANCHA PANCHAK WITH REFERENCE TO SENSATION AND PERCEPTION: A REVIEW
Authors: Phule Sharayu P , R Murade Harshali , B Patil Ganesh , K Mundada Ganesh
Published: November 2023

Acharya Charaka introduced the concept of Indriya pancha panchak to explore the physiology of sense organs. Indriya pancha panchaka assembles twenty-five structural and functional components related to the Indriya (sense faculty). It consists of five sense faculties (pancha janendriyas), five sense materials (pancha indriya dravya), five seats of sense organs (pancha indriya adhisthana), five objects of sense faculties (pancha indriya artha) and five sense perceptions (pancha indriya buddhi). Five sense perceptions result from conjugating the soul, mind, sense organs and their respective objects. In light of modern science, sense organs are the specialised units of the human body that can transform information about the external environment and inside environment into a form suitable for processing by the central nervous system. Sensory organs are equipped with specialised receptors that get stimulated by light, sound waves, mechanical deformation, temperature change or certain chemicals. The information is transformed through a series of propagated nerve impulses. These neural impulses get transmitted as action potentials via specialised sensory nerves towards the central nervous system that finally arrive at the sensory cortices in the brain. At this site, sensory signals are processed and interpreted. The processes through which we experience and interpret the stimuli are known as sensation and perception. The present paper aims to explore the concept of Indriya pancha panchak critically and highlight its significance in sensation and perception.
Development of Microlearning Content for Software Engineering Courses by Using ADDIE Model
Authors: Safaruddin  , Syam Husain , Darmawang
Published: November 2023

This research aims to: (1) Develop an e-learning design model based on micro-learning content, (2) Analyze the validity of the developed micro-learning content-based e-learning design model, (3) Analyze the practicality of the microlearning content-based e-learning design model for Engineering courses Software, (4) Analyzing the effectiveness of e-learning design models based on microlearning content for Software Engineering courses. This type of research is Research and development (R&D) with the Analysis, Design, Development, Implementation, Evaluation (ADDIE) development model. Data collection techniques used questionnaires and tests. The data analysis technique used qualitative descriptive statistical analysis. The resulting product was validated by model experts, material experts and media experts, while the trials carried out were small group trials and expanded trials. The results of the research are: (1) producing an e-Learning Design Development Model based on Microlearning Content and model supporting products with research and development stages consisting of 5 stages, namely Analysis, Design, Development, Implementation. and Evaluation which are divided into 3 major stages, namely a) Microlearning Modeling; b) Microlearning Development; c) Microlearning Implementation, (2) The results of assessing the validity of model and model product by experts respectively produced an average score of 87.1% and 84.5%, both of which were categorized as very feasible or valid, in order that the model product is suitable for testing in field, (3) The results of the practicality test of the model from student and lecturer respondents respectively obtained an average score of 87.5% and 87.2%, both of which were categorized as very good or very practical, (4) The model was declared effective based on the results of the score calculation N-Gain is based on student pre-test and post-test scores. The N-Gain score obtained was more than 76% or categorized as effective. This showed an increase in students' abilities before and after using the model for the Software Engineering course.
Assessment of the Thermal Efficiency of a Concentrated Photovoltaic/Thermal (CPV/T) Hybrid System with Water as Heat Transfer Fluid
Authors: Amadou Konfe , Bruno Korgho , Gilbert Nana G. , Eloi Bagbila , Fati Amadou Oumarou , Sié Kam
Published: November 2023

Interest in solar energy is growing by the day, because it is clean and unlimited. Concentrated photovoltaic-thermal (CPV/T) systems are one of the systems that are attracting a great deal of attention among solar energy systems. In this work, a study of a hybrid concentrated photovoltaic-thermal (CPV/T) system that enables the simultaneous production of electrical and thermal energy has been presented. As the experimental realization of such devices is costly, it is necessary to develop numerical models.

The aim of this work is to evaluate the thermal efficiency of the system based on the thermal model, using an iterative simulation procedure.

Propose a numerical model to evaluate the thermal efficiency of a CPV/T hybrid system.

Starting from the energy conservation equations, a numerical modelling and simulation of the concentrated photovoltaic-thermal hybrid (CPV/T) system is carried out. A parametric analysis is carried out to study the influence of concentration, water mass flow rate, cell surface area and Reynolds number on the system's thermal and electrical performance.

The results show that thermal efficiency decreases with increasing Reynolds number and mass flow rate. However, it increases when the water mass flow rate is equal to 0.0001kg/s, from 0.4% to 0.7%, for a flow rate equal to 0.0010kg/s.

An interesting and useful finding was that the proposed numerical model allow the determination of the electrical as well as thermal efficiency of the hybrid CPV/T.
Soil Quality Indicators: A Comprehensive Review
Authors: Sharma Sahil , Lishika Balara , Shubham  , Kaushal Shilpa
Published: November 2023

Soil health is a critical determinant of ecosystem sustainability and agricultural productivity.  This review article examines the significance of soil indicators, microbial community dynamics, soil enzymes, and their relationship with essential soil properties, including organic carbon content, bulk density, soil penetration resistance, water holding capacity, temperature, and pH. Traditional agricultural practices, such as conventional tillage, have been shown to significantly alter soil structure and physical properties. Bulk density, a key parameter, is used to gauge the compaction and porosity of soil, which directly influences water and nutrient transfer, as well as aeration. Conservation tillage practices, including the incorporation of crop residues into the soil, play a pivotal role in reducing bulk density. Soil temperature is a significant factor influencing the physical, chemical, and biological processes in soil, ultimately impacting plant growth. Soil pH, often referred to as the 'master soil variable,' has a far-reaching impact on various biological, chemical, and physical characteristics within the soil. It significantly influences biogeochemical processes and the activity of enzymes involved in the degradation of organic materials. Alterations in soil pH can directly affect microbial activity, microbial diversity, and the efficiency of enzyme-driven processes. This comprehensive review synthesizes the current knowledge of these biological indicators, emphasizing their interconnections and implications for soil health and sustainable land management practices. Understanding the multifaceted relationships between these indicators is crucial for the development of effective strategies to enhance soil health and ecosystem resilience.
Using Time Series Models and Neural Networks to Predict the Sales of Motor Oils in Iraq
Authors: Tuama Hayder Sabah , Abdulameer Ruqayah Yasir
Published: November 2023

Time series are the basis for statistical forecasting through building models that depend as a basis in economic analysis, and the most important of these models are Box-Jenkins models, which depends on the interpretation of the relationship between autocorrelation and partial autocorrelation, and when compared with the Artificial Neural Network (ANN) methodology which is considered as one of the new important means in building models, analyzing, evaluating data, forecasting and controlling it without referring to a common statistical model or method to pre-diagnose the behavior of the phenomenon, where the data is processed to reach the best model. This leads to the least possible number of errors and is close to reality and can be used in most cases. One of the goals of time series analysis is to obtain an accurate description of the time series, build a model to explain its behavior, and use the results for the purpose of predicting the series’ behavior in the future, and to achieve this, it requires an analytical study of time series models based on statistical and computer methods.
Adopting Total Quality Management in the Application of Electronic Governance in Iraqi Universities
Authors: Hadi Dr. Muhammad Jabbar , Bannay Dr. Dheyaa Falih
Published: November 2023

Current research seeks to quantify comprehensive quality management and its contribution to establishing universities e-governance through dimensions (continuous improvement, Top management commitment, learning and training, employee empowerment, strategic planning), The research problem has been identified through a set of questions, with the aim of identifying the relationship and impact of TQM in achieving electronic governance. In light of this, a set of hypotheses have been formulated to diagnose the reality of TQM. As for the dependent variable, electronic governance, was measured through dimensions represented by (Transparency, effective participation, accountability, and independence) and to accomplish the descriptive and analytical method was employed to achieve these goals. The research tool was distributed to a randomly chosen sample of academic leaders and faculty members from the following institutions: Al-Furat Al-Awsat Technical University, University of Baghdad, Babel University, Al-Qadisiyah University, and Karbala University via the Internet (132 We came to a number of conclusions, the most significant of which is the acceptance of the main research hypotheses that confirm the existence of a relationship and influence between total quality management and electronic governance. A number of statistical methods have been relied upon for the purpose of accessing the scientific results related to the use of the statistical program SPSS V.25 and program Smart pls. Additionally, there are a number of recommendations, the most important of which is that academic and administrative bodies understand the importance of TQM and how it might help them achieve electronic governance.
The Role of Social Capital in Enhancing Financial Support for Capital Investments: An Analytical Study of the Opinions of a Sample of Employees in Private Banks in the Middle Euphrates Region
Authors: Balchat Baqer Ali
Published: November 2023

The research to identify the role of social capital and its components (relational, cognitive, and structural) in enhancing financial support for capital investments, which in turn will contribute to directing individuals working in private banks in the middle euphrates region to find the strengths and weaknesses in their performance in relation to the research variables. The questionnaire was adopted as a main tool in collecting data related to the field side of the study, and the sample size was (149), and many statistical methods were used in the research, such as standard deviations, arithmetic averages, with the help of programs (spss.var.27), and a set of conclusions were reached from the most important of which is that social capital has a correlation and a significant impact on capital investments, and the research concluded with a set of recommendations.
Visionary Leadership and its Role in Promoting Organizational Excellence: An Analytical Study of the Opinions of Senior Leaders and Employees of the General Fertilizer Company in the Province of Basra
Authors: Al-frijawy Dr. Jawad , Mahssn Haider Jerry , Waham Dr. Mohammed Ahmed
Published: November 2023

Purpose: The study sought to diagnose the causal relationship between the insight leadership and organizational excellence. By developing the hypothetical model and concepts for the study through an extensive and in-depth review of the literature related to the two axes of the study. Research Design: The researcher adopted the descriptive analytical approach in his study by employing the implications of deductive analysis in the areas of the theoretical side and practical tests of the model and hypotheses of the study. The researchers also adopted the methodology of the exploratory study in the procedural measurement of the study variables and their dimensions, the independent variable, the insight leadership and its dimensions (vision, flexibility, conscience, team spirit) and its impact on the dimensions of the dependent variable organizational excellence (subordinates excellence, structure excellence, strategy excellence), and where researchers used the questionnaire as a tool main of data collection by selecting a random sample of workers and leaders in the General Fertilizer Company in Basra Governorate, with a size of (115) respondents, in order to present and analyze the responses of the sample members and their perceptions of the study variables and its sub-dimensions. Results: The results of the analysis showed that insight leadership has a strong correlation and influence between the dimensions of the independent variable, insight leadership and its dimensions (vision, flexibility, conscience, team spirit) and the dependent variable, organizational excellence (subordinate's excellence, structure excellence, strategy excellence). Originality/value: This is the first study of its kind to properly investigate visionary leadership and its role in promoting organizational excellence.
Audit Quality of Financial Statements of Commercial Banks in Vietnam
Authors: Trang Ha Huyen , Huyen Le Thi Thu , Hoa Nguyen Thi
Published: November 2023

Financial statements are a means of presenting the profitability and current state of corporate finance to interested persons. Commercial banks in Vietnam are required to prepare honest and reliable financial statements as a basis for effective decision making by stakeholders. However, the quality of auditing financial statements of commercial banks in Vietnam has been a topic of concern in recent years. In this article, the author explores the situation of audit quality of financial statements of commercial banks in Vietnam. From there, focus on proposing a number of measures to improve the quality of auditing financial statements of commercial banks in the coming time.
Power Distance and Strategic Decision Implementation: Exploring the Moderative Influence of Organizational Context
Authors: Atiyah Dr. Abbas Gatea
Published: November 2023

This study examined the strategic decision implementation process. It focused on the factors affecting its implementation. Aiming at exploring the moderative role of the organizational context. As well as the power distance supporting the implementation of the strategic decision. To reach the goal of the study, and address the gap. Two hypotheses have been put. The first focused on the role of power distance in implementing strategic decisions. The second focused on the moderative role of the organizational context and its impact on the relationship between them. Where these two hypotheses were examined in one of the educational institutions (Al-Kufa University). The study sample consisted of (75) individuals. The study data were processed using SmartPLS. The results revealed that there is an effect of the power distance in the implementation of the strategic decision. Supported by the moderative effect of the organizational context. Some of the recommendations of the study, pay attention to the motives that the administration urges in the process of implementing the strategic decision. Enabling middle management to deal with strategic decisions.
The Availability of Green Transformational Leadership in the General Company for Electrical and Electronic Industries: A Field Study
Authors: Jasim Batool Munshid , Mustafa Alaa Abdulsalam
Published: November 2023

Due to the absence of previous studies discussing the availability of transformational leadership in the General Company for Electrical and Electronic Industries / Baghdad - Al-Waziriyah, this study develops a research framework to fill the research gap. This study explores the effects of green transformational leadership on the company under consideration. Green transformational leadership, which can successfully stimulate the innovation performance of organizations, contributes to the development of new ideas in the innovation process. Through its four dimensions (ideal influence, inspirational motivation, intellectual stimulation, individual considerations). The results of the current study generally indicate that the company's leadership must possess sufficient capabilities that enable it to motivate human resources and that the leader behaves in an exemplary manner that human resources seek to emulate and gain Through it the trust, respect and appreciation of human resources and encourages them all to discover solutions to the complex problems facing the company. The results of the statistical analysis of the current study indicate The general arithmetic mean is average for the variable green transformational leadership, which indicates that the data is homogeneous, this means that the level of green transformational leadership is within a somewhat average level in the company under study according to the respondents' point of view. We recommend that the management of the company under study possess a green transformational leadership that enables it to motivate its human resources.
The Range Availability of Dimensions of Production Efficiency in the Maysan Oil Company
Authors: Najm Ali Hasan , Mustafa Alaa Abdulsalam , Makttoof Nawar Ali
Published: November 2023

This study sought to know the availability of dimensions of production efficiency in the Maysan Oil Company, as the problem of the study lies in the lack of knowledge of the dimensions of production efficiency and how the impact of its dimensions is reflected in the production efficiency in the company. The study sample included (205) officials in the Maysan Oil Company, and for the purpose of achieving the goal of the study, the questionnaire was adopted to collect data related to the study, and the questionnaire collected was analyzed using the statistical programs (SPSS.V.23), (Amos V. 23) and the results appear. The company in the field of study seeks to reduce the time of the production process constantly and control the total costs, especially with regard to production costs, to be able to enhance its capabilities in the face of unexpected conditions and reduce defective rates in products and production processes.
The Effect of Strategic Planning on the Success of e-learning: Al-Nisour University College as a Case Study
Authors: Ahmed Hameed Ali
Published: November 2023

This research aims at identifying the effect of strategic planning with the dimensions (strategic orientation, strategic analysis, and strategic choice) within e-learning and the dimensions (personal dimensions, environmental dimensions, and system dimensions) at Al-Nisour University College. The importance of study stemmed from the instrumental role of strategic planning before the transition from traditional education to e-learning. The study used the descriptive analytical curriculum. In order to collect the required data, the form of questionnaire was adopted and applied to a sample of (60) teaching staff at the university, in addition to adopting the method of interviews. The study used a set of statistical methods, the most important ones are (arithmetic mean, standard deviation, coefficient of variation, Pearson correlation coefficient, and multiple linear regression coefficients). This study came up with a set of conclusions, including a correlation and effect between strategic planning variables and e-learning variables.
We Matched
Authors: Bravo-Jaimes Katia
Published: November 2023

In this essay, the author discusses the importance of a Match system that supports and keeps families together while in training.
Developing Safe Harbors to Address Malpractice Liability and Wasteful Health Care Spending
Authors: Blumstein James F. , McMichael Benjamin J. , Storrow Alan B.
Published: November 2023

This Viewpoint discusses the feasibility of developing safe harbors that account for the role of medical malpractice liability and go beyond generic guidelines discouraging the overuse of health care resources.
Use of Disease-Modifying Treatments in Patients With Sickle Cell Disease
Authors: Newman Terri Victoria , Yang Jingye , Suh Kangho , Jonassaint Charles R. , Kane-Gill Sandra L. , Novelli Enrico M.
Published: November 2023

Importance

Despite hydroxyurea being an established treatment for sickle cell disease (SCD), it remains underused. The recent approval of the disease-modifying treatments (DMTs) l-glutamine, crizanlizumab, and voxelotor underscores the need to understand the uptake of DMTs in the current treatment landscape.

Objective

To explore characteristics that may be associated with DMT use and to describe observed patterns of yearly DMT use from 2014 to 2021.

Design, Setting, and Participants

This cross-sectional study used administrative claims data from Optum’s deidentified Clinformatics Data Mart Database from January 1, 2014, to September 30, 2021, to identify adults and children with SCD. Data were analyzed from August 1, 2022, to August 28, 2023.

Exposure

Use of DMTs.

Main Outcomes and Measures

Patient characteristics across groups with varying patterns of DMT use and yearly patterns of prescription fills for hydroxyurea, crizanlizumab, voxelotor, and l-glutamine.

Results

A total of 5022 beneficiaries with SCD (2081 [41.4%] aged 18-45 years; 2929 [58.3%] female) were included in sample A (144 [2.9%] inconsistent users, 274 [5.5%] incident users, 892 [17.8%] consistent users, and 3712 [73.9%] non-DMT users). Inconsistent users had a higher prevalence of vaso-occlusive crises (mean [SD], 3.7 [4.7]), splenic complications (6 of 144 [4.2%]), pulmonary complications (36 of 144 [25.0%]), kidney disease (21 of 144 [14.6%]), acute chest syndrome (18 of 144 [12.5%]), and health care visits (eg, mean [SD] inpatient visits, 7.0 [10.7]) compared with the other use groups. Non-DMT users had the lowest prevalence of vaso-occlusive crises (mean [SD], 0.8 [2.4]), acute chest syndrome (109 of 3712 [2.9%]), and inpatient (mean [SD], 2.0 [6.6]) and emergency department (mean [SD], 0.7 [3.1]) visits and the highest proportion of adults 65 years and older (593 of 3712 [16.0%]). In sample B (6387 beneficiaries with SCD), hydroxyurea use modestly increased from 428 of 2188 participants (19.6%) in 2014 to 701 of 2880 (24.3%) in 2021. Use of l-glutamine increased briefly but gradually decreased throughout the study period. In 2021, out of 2880 participants, 102 (3.5%) had at least 1 fill for crizanlizumab and 131 (4.6%) had at least 1 fill for voxelotor. Overall, total DMT use increased from 428 of 2188 participants (19.6%) in 2014 to 815 of 2880 patients (28.3%) in 2021.

Conclusions and Relevance

In this cross-sectional analysis of adults and children with SCD, uptake of DMTs remained low from 2014 to 2021, despite the approval of newer therapies. Notable differences in patient characteristics across varied DMT exposure types necessitate further exploration into factors that facilitate DMT use and the creation of strategies to enhance DMT uptake.
System-Level Factors and Time Spent on Electronic Health Records by Primary Care Physicians
Authors: Rotenstein Lisa S. , Holmgren A. Jay , Horn Daniel M. , Lipsitz Stuart , Phillips Russell , Gitomer Richard , Bates David W.
Published: November 2023

Importance

Primary care physicians (PCPs) spend the most time on the electronic health record (EHR) of any specialty. Thus, it is critical to understand what factors contribute to varying levels of PCP time spent on EHRs.

Objective

To characterize variation in EHR time across PCPs and primary care clinics, and to describe how specific PCP, patient panel, clinic, and team collaboration factors are associated with PCPs’ time spent on EHRs.

Design, Setting, and Participants

This cross-sectional study included 307 PCPs practicing across 31 primary care clinics at Massachusetts General Hospital and Brigham and Women’s Hospital during 2021. Data were analyzed from October 2022 to October 2023.

Main Outcomes and Measures

Total per-visit EHR time, total per-visit pajama time (ie, time spent on the EHR between 5:30 pm to 7:00 am and on weekends), and total per-visit time on the electronic inbox as measured by activity log data derived from an EHR database.

Results

The sample included 307 PCPs (183 [59.6%] female). On a per-visit basis, PCPs spent a median (IQR) of 36.2 (28.9-45.7) total minutes on the EHR, 6.2 (3.1-11.5) minutes of pajama time, and 7.8 (5.5-10.7) minutes on the electronic inbox. When comparing PCP time expenditure by clinic, median (IQR) total EHR time, median (IQR) pajama time, and median (IQR) electronic inbox time ranged from 23.5 (20.7-53.1) to 47.9 (30.6-70.7) minutes per visit, 1.7 (0.7-10.5) to 13.1 (7.7-28.2) minutes per visit, and 4.7 (4.1-5.2) to 10.8 (8.9-15.2) minutes per visit, respectively. In a multivariable model with an outcome of total per-visit EHR time per visit, an above median percentage of teamwork on orders was associated with 3.81 (95% CI, 0.49-7.13) minutes per visit fewer and having a clinic pharmacy technician was associated with 7.87 (95% CI, 2.03-13.72) minutes per visit fewer. Practicing in a community health center was associated with fewer minutes of total EHR time per visit (5.40 [95% CI, 0.06-10.74] minutes).

Conclusions and Relevance

There is substantial variation in EHR time among individual PCPs and PCPs within clinics. Organization-level factors, such as team collaboration on orders, support for medication refill functions, and practicing in a community health center, are associated with lower EHR time for PCPs. These findings highlight the importance of addressing EHR burden at a systems level.
Control Groups in RCTs Supporting Approval of Drugs for Systemic Rheumatic Diseases, 2012-2022
Authors: Liu Yang , Xie Yan , Qin Yunhe , Xie Qibing , Chen Xiaoyuan
Published: November 2023

Importance

Randomized clinical trials (RCTs) testing innovative drugs must strive to use optimal control groups to reflect the best available treatments. A comprehensive evaluation of the quality of control groups in pivotal RCTs supporting systemic rheumatic disease (SRD) drug approvals by the Food and Drug Administration (FDA) is lacking.

Objective

To examine the proportion of pivotal RCTs that used optimal control groups among RCTs supporting newly approved SRD drugs in the US over the past decade.

Design, Setting, and Participants

In this study, individual RCTs supporting SRD new drug approvals by the FDA between January 2012 and October 2022 were analyzed for design, study duration, control group, and primary end point. The quality of control groups was determined by comparison with published guidelines before and during the trial.

Main Outcomes and Measures

The primary measure was the proportion of RCTs using optimal control groups. Differences in response rate between investigating and control groups and the response rate of placebo control groups were also examined.

Results

Between January 2012 and October 2022, the FDA approved 44 SRD drugs, involving 65 pivotal RCTs. Overall, 16 RCTs used optimal control groups. In 55 trials, no active groups were used, and more than 80% of these trials were suboptimal (47 trials [85.5%]). Among 56 trials for systemic arthritis, 49 trials used suboptimal control groups, mainly placebo or dose-response controls (47 trials), with a few active controls (2 trials). Studies of other SRDs frequently used placebo or dose-response controls but were considered optimal controls (8 trials). There was significant improvement in response rates of investigating compared with placebo groups, with relative risk mostly exceeding 1.50 (range, 0.90; 95% CI, 0.69-1.17 for anifrolumab to 11.00; 95% CI, 2.69-44.96 for mepolizumab). In all placebo-controlled trials, the median (IQR) response rate in placebo groups was 26.0% (19.2%-32.3%).

Conclusions and Relevance

These findings suggest that the quality of control groups in RCTs leading to SRD drug approval needs improvement and that despite challenges in translating scientific theories to clinical scenarios, it is crucial to consistently prioritize efforts to promote appropriate control group selection to ensure the accurate assessment of innovative drug efficacy.
Telehealth facilitates better care for OTP clients with hepatitis C
Authors: Enos Gary
Published: November 2023

Opioid treatment program (OTP) patients who received hepatitis C virus (HCV) care on‐site via telemedicine showed substantially greater virological response than patients who were referred to an off‐site specialist for HCV care, according to results of a study conducted at 12 New York‐based OTPs. The study's lead author told ADAW that the noteworthy results for HCV care via telehealth could suggest the value of providing care virtually for other chronic illnesses that can affect patients with opioid use disorder (OUD).
Review: Oral naltrexone and acamprosate effective for AUD
Authors: Knopf Alison
Published: November 2023

A systematic review including 118 clinical trials found that only acamprosate and oral naltrexone (50 mg/day, the standard dose recommended by the U.S. Food and Drug Administration) were effective for alcohol use disorder (AUD) using the following measures.
Removing PA requirements for buprenorphine did not increase prescriptions
Authors: Knopf Alison
Published: November 2023

A study of 23 states from 2015 to 2019 found that the removal of prior authorization (PA) requirements, thought to be a barrier to buprenorphine prescribing, in Medicaid programs did nothing to increase prescribing. The study, “Removal of Medicaid Prior Authorization Requirements and Buprenorphine Treatment for Opioid Use Disorder,” which published in JAMA Health Forum on Oct. 4, did show some association in increased prescribing in states with low prescribing levels at baseline, but not in states with higher baseline prescribing. The findings do not mean that prior authorization—a technique used by payers to control utilization—is not a barrier, but rather, that it is not the only barrier, and that other barriers must be removed in order to increase prescribing of buprenorphine. Study results showed that: 1) six states in the sample removed Medicaid PAs for at least one buprenorphine formulation; 2) states that kept their PA requirements had lower buprenorphine prescribing and lower Medicaid managed care penetration, but similar opioid overdose rates to states that removed the PA requirements; and 3) for states with below‐median baseline buprenorphine prescribing, PA removal was associated with increased buprenorphine prescriptions, while states with above‐median prescribing showed no change. The researchers concluded that more efforts are needed to increase availability of buprenorphine. The lead author is Paul J. Christine, M.D., Ph.D., of the University of Colorado School of Medicine.
Behavior of Different β Stabilizers on the Microstructure and Properties of Ternary Ti‐3Sn‐X Alloys
Authors: Bolzoni Leandro , Raynova Stella , Yang Fei , Dahm Karl
Published: November 2023

The manufacturing of Ti alloys via powder metallurgy and the development of novel compositions are two strategies to reduce the cost of Ti, which is still the primary factor deterring its wider use in engineering applications. In this study, new Ti alloys based on the combined addition of Sn with Nb, Mo, or Mn are manufactured via powder metallurgy to gain an understanding of the role of these β stabilizers on the performance achievable. It is found that the designed alloys have a fully homogeneous chemistry regardless of their actual composition and a lamellar or β‐type microstructure depending on the actual β stabilizer used. This study confirms that the β‐stabilizing power effect decreases from Mn to Mo and, eventually, Nb. The compressibility and sinterability of the alloys increase with the progressive addition of the selected powders, generally leading to stronger and more ductile materials. It is also found that the proposed Ti‐3Sn‐Mo alloys are characterized by the best strength/ductility pairs compared to a variety of sintered or cast binary/ternary Ti alloys bearing the alloying elements considered in this work.
Pyridyl Porphyrin as Electrocatalyst: Regulating the Redox Conversion of Lithium Polysulfides under Voltage
Authors: Zhou Peng , Liu Xiaolin , He Yongqian , Xu Ye , Liu Jiali , Liu Min , Su Jincang , Luo Zhigao , Wu Tianjing , Gao Ping , Chen Manfang , Shu Hongbo , Pei Yong , Liu Hong , Wang Xianyou
Published: November 2023

The binding correlation between electrocatalyst and lithium polysulfides (LiPSs) determines the regulation of LiPSs’ redox conversion. However, how the correlation works on the LiPSs under voltage remains obscured. In this paper, the π‐conjugated aromatic pyridyl porphyrin with nitrogen of a lone pair of electrons is introduced as electrocatalyst to accelerate redox kinetics and inhibit polysulfides shuttle. On the foundation of DFT calculation and experimental tests, it is stated that the chemical binding between pyridyl porphyrin and lithium polysulfides is beefed up under higher voltage, which facilitates the charge transfer. Moreover, the molecular dynamics (MD) simulation of the solid‐liquid model shows that the presence of pyridyl porphyrin increases the binding chances between Li+ and S62− and forms clusters rather than dissolving in electrolyte, which is good for charge transfer and polysulfides localization. By hybridizing the pyridyl porphyrin with conductive cathode matrix of carbon nanotube and graphene oxide, the as‐fabricated Li2S‐T4PP‐GO‐CNT cathode delivers a high initial discharge capacity of 996.4 mAh g−1 at 0.1 C. The as‐made batteries with good electrochemical performance therefore show potential for trouble‐shooting and commercial utilization of lithium‐sulfur batteries (LSBs) in the future.