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The urban soundscape contributes significantly to defining human perception and experience. Several standard assessment methods for data collection refer to in situ evaluations to determine how people perceive urban acoustic qualities. These methods, which generally involve soundwalks accompanied by questionnaires, are valuable but need to be validated in different cultural contexts. To address this need, international efforts such as the Soundscape Attribute Translation Project (SATP) are underway to ensure the effectiveness of a data collection standard in non-English-speaking regions. As a part of the SATP project, this study explores potential variations in how people experience urban soundscapes in North Africa. A standardized listening experiment was used to compare how Arabic speakers and French speakers rate the perceived affective qualities (PAQ) of urban soundscapes. Using data collected in public urban spaces in London, participants from both language groups rated 27 recorded urban soundscapes using a PAQ questionnaire. Findings from the Kruskal–Wallis H-test suggest that the perception of pleasant, chaotic, and vibrant are significant, while the dimensions of eventful, monotonous, and quiet show no significant distinctions between the two PAQ groups. Furthermore, opposing Pearson correlations were observed for the attributes of pleasantness and eventfulness, along with contradictions for vibrant, monotonous, and calm. The two-dimensional circumplex models visually map the differences in perceptual responses between the two PAQ groups, displaying distinct circular distortions along the monotone-vibrant axis for Arabic PAQs and the chaotic-calm axis for the French PAQs. The findings of this study suggest that further investigations are needed to understand whether the differences in the urban soundscape perception between these two PAQs are due to linguistic factors or other factors.

The Montpellier protocol for intubating patients in the intensive care unit (ICU) is associated with a decrease in intubation-related complications. We sought to determine if implementation of a simplified version of the Montpellier protocol that removed selected components and allowed for a variety of pre-oxygenation modalities increased first-pass intubation success and reduced intubation-related complications. A prospective pre/post-comparison of a modified Montpellier protocol in two medical and one medical/surgical/cardiac ICU within a hospital system. The modified eight-point protocol included: fluid administration, ordering sedation, two intubation trained providers, pre-oxygenation with non-invasive positive pressure ventilation, nasal high flow cannula or non-rebreather mask, rapid sequence intubation, capnography, sedation administration, and vasopressors for shock. Patient characteristics and indications for intubation were similar for the 275 intubations in the control (137) and intervention (138) periods. In the intervention vs. control periods, the modified Montpellier protocol was associated with a significant 16.2% [95% CI: 5.1–30.0%] increase in first-pass intubation success and a 12.6% [95% CI: 1.2–23.6%] reduction in all intubation-related complications. A simplified version of the Montpellier intubation protocol for intubating ICU patients was associated with an improvement in first-pass intubation success rates and a reduction in the rate of intubation-related complications. •Our modified Montpellier Protocol is readily adapted and easily adhered to in the ICU setting.•Our modified Montpellier protocol was associated with a 16.2% [95% CI: 5.1-30.0%] increase in first-pass intubation success.•Additionally, it was associated with a 12.6% [95% CI: 1.2-23.6%] reduction in all intubation-related complications.

Advanced airway management and ventilation of trauma patients are often needed during acute stabilization and resuscitation and later, in those admitted. In addition to endotracheal intubation for advanced airway management, tracheostomy is commonly used in critically ill patients when prolonged mechanical ventilation is required. However, the outcomes associated with airway management approaches and the timing of a tracheostomy in critically ill patients are mixed. This protocol intended to compare the effect of tracheostomy in major trauma patients vs. management with non-invasive techniques and endotracheal intubation during admission, examine complications and outcomes associated with the three types of airway management approaches, and explore the association of clinical and social determinants of health variables with complications in patients requiring advanced airway management. A total of 911 adult trauma patients admitted to a Level 1 trauma center surgical intensive care unit (SICU) were included in this retrospective, single-center, quantitative study from 2019 to 2021. Descriptive and correlational analyses were used to examine outcomes of ventilator days, length of stay, pneumonia, readmission, mortality, and associations with the airway management approach. The outcomes of ventilator days and length of stay were compared between groups with a one-way ANOVA, and differences between groups on outcomes of pneumonia, readmission, and mortality were estimated using crosstabulations and chi-square (x²) statistics. Hypothesized relationships of clinical and social determinants of health variables associated with outcomes of ventilator days, hospital length of stay, pneumonia, readmission, and mortality in patients requiring advanced airway management ≥ four days were estimated. There was no significant difference in outcomes of pneumonia and mortality between the advanced airway management groups (p=0.856 and p=0.167, respectively). There were significant differences in ventilator days, length of stay (LOS), and readmission. Between the groups: endotracheal intubation only, early (<10 days post-intubation) tracheostomy, and late (>10 days post-intubation) tracheostomy in SICU patients (p <0.001, p=0.028, and p=0.003, respectively). Specifically, patients in the early tracheostomy group had a higher readmission rate (33.3%) as compared to endotracheal tube patients (2.3%) and late tracheostomy patients (0.0%). Social determinants of health variables (smoking and functional dependence) were also significantly correlated with readmission in the early tracheostomy and endotracheal tube airway management groups (p=.047 and p=.022, respectively). Additionally, clinical variables of injury severity scores, ED arrival systolic blood pressure (SBP), and presence of pre-existing comorbidities were found to be significantly associated with complications of pneumonia, readmission, and mortality within the patients (n=229) requiring advanced airway approaches. Adult trauma patients with early tracheostomy airway management may experience a higher readmission rate related to the complexity of their injuries than patients managed with endotracheal intubation or late tracheostomy. Clinical and social determinants of health factors may be associated with complications. Further studies examining these associations in larger samples are needed to examine the validity of these findings.

Cohousing began in Denmark in the late 1960's and early 1970's as an alternative to mainstream single-family housing options, and from there it spread to other parts of the world. The main intent of this study is to explore cohousing practices in the U.S. particularly in the Pacific Northwest. Another purpose is to explore the acceptance and the feasibility of the concept within the Muslim community in the Portland, Oregon area. A composite method was followed, where a qualitative multiple case study was developed to explore cohousing in the U.S. Three groups were presented, two from Portland, Oregon, and the third from Washington. To answer the cross-cultural questions, a focus group approach was followed where two sessions were conducted with Sunni Muslims in the Portland area. After reviewing the literature, the three cases were presented, and some themes were explored. A separate chapter was devoted to the cross-cultural study, where research questions, methods, and findings were presented. This study presented cohousing members' narratives through which their motives were defined. Next, the groups' physical and organizational forms were discussed and a link was made with the groups' visions. Different meanings inherent in these relations were identified as well. Finally, the term \"community\", its dimensions and images were presented as have been experienced with these groups. These images are not common among the three groups. They vary and change, even within the same group, as well as over the development process. As for the cross-cultural section of the study, focus group sessions revealed considerable support of the cohousing concept and the potential to espouse it among Muslims. However, two different designs were identified, one consonant to the traditional cohousing design, while the other is more open and integrated to the wider community. Possible explanations were considered as well. Finally, the study concluded with a multi-dimensional typology for cohousing practices as has been revealed through the cases. Also, some arguments were made that relate to cohousing and professionalism, societal change, and the search for utopia.

In the context of Arab cities, this study explores the intricate interplay between cultural, historical, and environmental elements that shape their unique soundscapes. The paper aims to shed light on this underrepresented field of study by employing a three-fold research approach: systematic review, a comprehensive literature review, and the formulation of a future research agenda. The first part of the investigation focuses on research productivity in the Arab world regarding soundscape studies. An analysis of publication trends reveals that soundscape research in Arab cities is still an emerging area of interest. Critical gaps in the existing body of literature are identified, highlighting the importance of addressing these gaps within the broader context of global soundscape research. The second part of the study delves into the distinctive features that inform the soundscapes of Arab cities. These features are categorized into three overarching groups: (i) cultural and religious life, (ii) daily life, and (iii) heritage and history, by exploring these factors, the study aims to elucidate the multifaceted nature of Arab urban soundscapes. From the resonating calls to prayer and the vibrant ambiance of traditional cafes to the bustling markets and architectural characteristics, each factor contributes to the auditory tapestry that defines Arab cities. The paper concludes with a forward-looking research agenda, proposing sixteen key questions organized into descriptive and comparative categories. These questions emphasize the need for a more profound understanding of sound perception, sources, and the impact of urban morphology on the soundscape. Additionally, they highlight the need for interdisciplinary research, involving fields such as urban planning, architecture, psychology, sociology, and cultural studies to unravel the complexity of Arab urban soundscapes.

is an opportunistic pathogen that rapidly develops antibiotic resistance against commonly prescribed antimicrobial agents in hospitalized patients worldwide. Aminoglycosides are commonly used in the treatment of health care-associated infections (HAIs). Aminoglycosides resistance mechanisms are varied and commonly involve production of aminoglycoside-modifying enzymes (AME) and efflux systems. This study aimed to provide an insight into the frequency of genes encoding AME in strains isolated from different clinical specimens in intensive care units (ICU). A total of 52 multidrug-resistant (MDR) strains were isolated from ICU, Suez Canal University Hospitals. Species identification and antibiotics susceptibility testing were done by the automated system VITEK 2. The genes encoding AME were detected by PCR. Aminoglycosides resistance (amikacin, gentamicin and tobramycin) was observed in 35 isolates (67.3%). We found that aacC1 gene was the predominant AME resistance gene among isolates, detected in 14 isolates (40%), aphA6 in 11 isolates (31.4%) and addA1 in 5 isolates (14.2%). We found 5 isolates containing 2 AME genes, 3 of them with aacC1 and aphA6 and the remaining 2 with both aacC1 and aadA1 genes. Nearly, 5 isolates (14.2%) were negative for all AME resistance genes. Our study indicated that AME encoding genes are predominant in strains in our region which stressed on the importance of preventive measures to control spreading of resistance genes.

This paper investigates a nano-enhanced wireless sensing framework for dissolved oxygen (DO). The system integrates a nanosensor that employs cerium oxide (ceria) nanoparticles to monitor the concentration of DO in aqueous media via optical fluorescence quenching. We propose a comprehensive sensing framework with the nanosensor equipped with a digital interface where the sensor output is digitized and dispatched wirelessly to a trustworthy data collection and analysis framework for consolidation and information extraction. The proposed system collects and processes the sensor readings to provide clear indications about the current or the anticipated dissolved oxygen levels in the aqueous media.

Background Thoracic and abdominal aortic aneurysms and dissection often develop in hypertensive elderly patients. At higher risk are smokers and those who have a family history of aortic aneurysms. In most affected families, the aortic aneurysms and dissection is inherited in an autosomal dominant manner with decreased penetrance and variable expressivity. Mutations at two chromosomal loci, TAA1 at 11q23 and the TAA2 at 5q13–14, and eight genes, MYLK , MYH11 , TGFBR2 , TGFBR1 , ACTA2 , SMAD3 , TGFB2 , and MAT2A , have been identified as being responsible for the disease in 23% of affected families. Results Herein, we inform on the clinical, genetic and pathological characteristics of nine living and deceased members of a large consanguineous Arab family with thoracic aortic aneurysm and dissection who carry a missense mutation c.4471G > T (Ala1491Ser), in exon 27 of MYLK gene. We show a reduced kinase activity of the Ala1491Ser protein compared to wildtype protein. This mutation is expressed as aortic aneurysm and dissection in one of two distinct phenotypes. A severe fatal and early onset symptom in homozygous or mild late onset in heterozygous genotypes. Conclusions We found that MYLK gene Ala1491Ser mutation affect the kinase activity and clinically, it presents with vascular aneurysms and dissection. We describe a distinct genotype phenotype correlation where; heterozygous patients have mild late onset and incomplete penetrance disease compared with the early onset severe and generally fatal outcome in homozygous patients.