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Background:This study aimed to evaluate the effectiveness of left bundle branch-optimized cardiac resynchronization therapy (LOT-CRT) in patients diagnosed with heart failure and reduced ejection fraction due to ischemic cardiomyopathy.Methods:A total of 78 patients with ischemic cardiomyopathy who underwent pacemaker implantation at a single center between March 2020 and March 2022 were randomly assigned to two groups based on different pacing methods: LOT-CRT group (n = 39) and biventricular pacing (BVP) group (n = 35). Pacing threshold, impedance, electrocardiogram QRS wave duration during pacing, ventricular pacing ratio during follow-up, and cardiac ultrasound-related indicators were compared immediately after surgery and at the six-month follow-up.Results:The two groups were similar regarding baseline characteristics, cardiac ultrasound and magnetic resonance imaging (MRI) parameters, and overall cardiac function. However, the BVP group demonstrated higher pacing thresholds and impedance levels immediately after surgery and at the six-month follow-up (p < 0.001). Moreover, the X-ray exposure time was significantly longer in the BVP group compared to the LOT-CRT group. While no significant differences in QRS duration were observed between the groups preoperatively, the QRS duration in the LOT-CRT group was significantly shorter both immediately after surgery and during follow-up (p < 0.001). No significant differences were found between the groups in terms of the New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF), or left ventricular end-diastolic diameter (LVEDD). Six months post-surgery, both groups showed modest improvements in NYHA class, LVEF, and LVEDD, with the LOT-CRT group demonstrating significant improvements (p < 0.001).Conclusions:LOT-CRT may be an alternative treatment for patients with heart failure complicated by left bundle branch block due to ischemic cardiomyopathy in whom BVP is ineffective.

Drought is one of the leading impediments to development in Africa. Much of the continent is dependent on rain-fed agriculture, which makes it particularly susceptible to climate variability. Monitoring drought and providing timely seasonal forecasts are essential for integrated drought risk reduction. Current approaches in developing regions have generally been limited, however, in part because of unreliable monitoring networks. Operational seasonal climate forecasts are also deficient and often reliant on statistical regressions, which are unable to provide detailed information relevant for drought assessment. However, the wealth of data from satellites and recent advancements in large-scale hydrological modeling and seasonal climate model predictions have enabled the development of state-of-the-art monitoring and prediction systems that can help address many of the problems inherent to developing regions. An experimental drought monitoring and forecast system for sub-Saharan Africa is described that is based on advanced land surface modeling driven by satellite and atmospheric model data. Key elements of the system are the provision of near-real-time evaluations of the terrestrial water cycle and an assessment of drought conditions. The predictive element takes downscaled ensemble dynamical climate forecasts and provides, when merged with the hydrological modeling, ensemble hydrological forecasts. We evaluate the overall skill of the system for monitoring and predicting the development of drought and illustrate the use of the system for the 2010/11 Horn of Africa drought. A key element is the transition and testing of the technology for operational usage by African collaborators and we discuss this for two implementations in West and East Africa.

This study investigates the relationship between Hofstede’s cultural dimensions—Power Distance, Uncertainty Avoidance, Collectivism, Masculinity, and Long-Term Orientation—and perceptions of global branding strategies among 262 international students at a private foundation university in Istanbul. Employing a quantitative research design, the study utilized descriptive statistics, reliability testing, correlation analysis, Mann-Whitney U tests, and Kruskal-Wallis analyses to examine how cultural values and demographic characteristics influence attitudes toward global branding. The findings reveal that gender, age, and education level do not significantly affect perceptions of global branding strategies, whereas monthly income demonstrates meaningful differences. Correlation results indicate that Long-Term Orientation shows the strongest positive association with global branding strategies, followed by Masculinity and Uncertainty Avoidance, while Power Distance exhibits little to no relationship. These results highlight those cultural values centered on future orientation, achievement, and structured decision-making play a central role in shaping international students’ evaluation of global brands. The study provides valuable insights for marketers and brand managers seeking to develop culturally sensitive global branding strategies. The findings also contribute to the academic understanding of the interplay between cultural orientations and global brand perceptions, offering a foundation for future research in international marketing and cross-cultural consumer behavior

Climate changes will have an impact on food production and will require costly adaptive responses. Adapting to a changing environment will be particularly challenging in sub-Saharan Africa where climate change is expected to have a major impact. However, one important phenomenon that is often overlooked and is poorly documented is the ability of agro-systems to rapidly adapt to environmental variations. Such an adaptation could proceed by the adoption of new varieties or by the adaptation of varieties to a changing environment. In this study, we analyzed these two processes in one of the driest agro-ecosystems in Africa, the Sahel. We performed a detailed study in Niger where pearl millet is the main crop and covers 65% of the cultivated area. To assess how the agro-system is responding to recent recurrent drought, we analyzed samples of pearl millet landraces collected in the same villages in 1976 and 2003 throughout the entire cultivated area of Niger. We studied phenological and morphological differences in the 1976 and 2003 collections by comparing them over three cropping seasons in a common garden experiment. We found no major changes in the main cultivated varieties or in their genetic diversity. However, we observed a significant shift in adaptive traits. Compared to the 1976 samples, samples collected in 2003 displayed a shorter lifecycle, and a reduction in plant and spike size. We also found that an early flowering allele at the PHYC locus increased in frequency between 1976 and 2003. The increase exceeded the effect of drift and sampling, suggesting a direct effect of selection for earliness on this gene. We conclude that recurrent drought can lead to selection for earlier flowering in a major Sahelian crop. Surprisingly, these results suggest that diffusion of crop varieties is not the main driver of short term adaptation to climatic variation.

We analyze and intercompare the performance of a set of ten regional climate models (RCMs) along with the ensemble mean of their statistics in simulating daily precipitation characteristics during the West African monsoon (WAM) period (June–July–August–September). The experiments are conducted within the framework of the COordinated Regional Downscaling Experiments for the African domain. We find that the RCMs exhibit substantial differences that are associated with a wide range of estimates of higher-order statistics, such as intensity, frequency, and daily extremes mostly driven by the convective scheme employed. For instance, a number of the RCMs simulate a similar number of wet days compared to observations but greater rainfall intensity, especially in oceanic regions adjacent to the Guinea Highlands because of a larger number of heavy precipitation events. Other models exhibit a higher wet-day frequency but much lower rainfall intensity over West Africa due to the occurrence of less frequent heavy rainfall events. This indicates the existence of large uncertainties related to the simulation of daily rainfall characteristics by the RCMs. The ensemble mean of the indices substantially improves the RCMs’ simulated frequency and intensity of precipitation events, moderately outperforms that of the 95th percentile, and provides mixed benefits for the dry and wet spells. Although the ensemble mean improved results cannot be generalized, such an approach produces encouraging results and can help, to some extent, to improve the robustness of the response of the WAM daily precipitation to the anthropogenic greenhouse gas warming.

Background Central venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a commonly employed strategy to support patients in refractory postcardiotomy cardiogenic shock (RPCS). This support can be provided using either indirect central ECMO (icECMO) with a closed thorax or direct central ECMO (dcECMO) with an open thorax. Methods This single-center retrospective analysis included 60 patients undergoing central VA-ECMO for RPCS from January 2019 to December 2020. The primary endpoint of this study is to compare 30-day survival outcomes between the icECMO and dcECMO approaches in RPCS patients. Secondary endpoints include the evaluation of adverse events and the identification of predictors that influence 30-day mortality. Results The study included 60 patients, 25 received icECMO and 35 treated with dcECMO due to RPCS. The icECMO group demonstrated significantly better 30-day survival rates (icECMO; 10 [40%] vs. dcECMO; 5 [14.3%], log-rank test; p=0.042). Despite comparable ECMO flow rate and ECMO RPM (rotations per minute) in the first day between the study groups ([icECMO; 4.5 l/min vs. dcECMO; 4.6 l/min, p=0.124], [icECMO; 3510 rpm vs. dcECMO; 3800 rpm, p=0.115], respectively), lactate levels were significantly higher in the dcECMO group on the 1st and 3rd post-extracorporeal life support (ECLS) days (p=0.006 and p=0.008, respectively). Gastrointestinal ischemia was more common in the dcECMO group (p=0.036). Successful ECMO weaning was more frequent in the icECMO group (56% vs. 22.9%, p=0.014). Multivariable logistic regression identified arterial lactate on the first day with a cutoff 4 mmol/l as an independent risk factor for 30-day mortality with Exp(B) of 8.9 (p=0.007). Conclusions Our findings suggest a potential survival advantage with the icECMO technique in patients undergoing central ECMO cannulation after RPCS. However, larger prospective studies are essential to confirm this observation.

Background The dyslipidemia and changes in D-dimer values that occur in children with severe sepsis remain unidentified. Objective The current research aimed to explore the relationship between D-dimer and lipid profile values, including total cholesterol (TC), lipoproteins, apolipoprotein A-V (Apo A-5), triglycerides (TG), and in-hospital nonsurvival in children with severe sepsis or septic shock in pediatric intensive care. Study design The study design is as follows: prospective cohort study. Participants Children with severe sepsis or septic shock who were admitted to the intensive care unit of a university pediatric hospital. Intervention Vital signs, sepsis assessment, pediatric sequential organ failure assessment (PSOFA) score, high-density lipoprotein (HDL), Apo A-5, TG, low-density lipoprotein (LDL), TC, D-dimer, mortality outcome, and pediatric risk of mortality (PRISM) III score were evaluated. Outcomes The primary outcome was in-hospital nonsurvival. Results The nonsurvivors had significantly higher D-dimer levels than the survivors, with a significant cutoff level of 0.87 μg/mL (AUC: 0.85, sensitivity: 93.3%, PVN: 90.6%, accuracy: 79.0%, PVP: 72.5%, and specificity: 64.7%). D-dimer was inversely correlated with WBC count and positively correlated with patient age, PRISM III score, PSOFA score, and INR. However, nonsurvivors had higher TG levels and lower TC, HDL, LDL, and Apo A-5 levels than survivors, but this variation was insignificant. Apo A-5 levels were inversely correlated with HDL and positively correlated with TG levels. Conclusions This study suggests that D-dimer is a promising biomarker for severe sepsis in children, with a mortality cutoff level of 0.87 μg/mL. However, lipid profiles are not predictors of sepsis-related mortality.

This study aimed at developing EFL inferential comprehension among Al-Azhar secondary institute students through using info-graphics. The participants of the study consisted of 30 first year secondary students in Al-Azhar Daraw institute for girls, Daraw, Aswan Governorate during the first semester of the school year 2020-2021. The study was a pre-post test quasi-experimental study. The study followed the one group (the study group). The study group was tested before conducting the experiment (pre- test), and after implementing the experiment (posttest). They were taught through using infographics. The instruments of the study included an EFL inferential comprehension skills pre-post test. The results of the study revealed a statistically significant difference between the mean scores of the study participants in the pre and post administrations of the EFL inferential comprehension skills tests in favor of the post administrations. Results showed that Using Infographics improved EFL inferential Comprehension Skills among Al-Azhar Secondary Institute Students.

The assessment of natural hazards such as floods and droughts is a complex issue that demands integrated approaches and high-quality data. Especially in African developing countries, where information is limited, the assessment of floods and droughts, though an overarching issue that influences economic and social development, is even more challenging. This paper presents an integrated approach to assessing crucial aspects of floods and droughts in the transboundary Mékrou River basin (a portion of the Niger River basin in West Africa), combining climatic trends analysis and the findings of a household survey. The multivariable trend analysis estimates, at the biophysical level, the climate variability and the occurrence of floods and droughts. These results are coupled with an analysis of household survey data that reveals the behaviour and opinions of local residents regarding the observed climate variability and occurrence of flood and drought events, household mitigation measures, and the impacts of floods and droughts. Based on survey data analysis, the paper provides a per-household cost estimation of floods and droughts that occurred over a 2-year period (2014–2015). Furthermore, two econometric models are set up to identify the factors that influence the costs of floods and droughts to impacted households.

In the last decades since the dramatic increase in flood frequency and magnitude, floods have become a crucial problem in West Africa. National and international authorities concentrate efforts on developing early warning systems (EWS) to deliver flood alerts and prevent loss of lives and damages. Usually, regional EWS are based on hydrological modeling, while local EWS adopt field observations. This study aims to integrate outputs from two regional hydrological models—Niger HYPE (NH) and World-Wide HYPE (WWH)—in a local EWS developed for the Sirba River. Sirba is the major tributary of Middle Niger River Basin and is supported by a local EWS since June 2019. Model evaluation indices were computed with 5-day forecasts demonstrating a better performance of NH (Nash–Sutcliffe efficiency NSE = 0.58) than WWH (NSE = 0.10) and the need of output optimization. The optimization conducted with a linear regression post-processing technique improves performance significantly to “very good” for NH (Heidke skill score HSS = 0.53) and “good” for WWH (HSS = 0.28). HYPE outputs allow to extend local EWS warning lead-time up to 10 days. Since the transfer informatic environment is not yet a mature operational system 10–20% of forecasts were unfortunately not produced in 2019, impacting operational availability.