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In this study, we report on the novel growth of nanodiamond composite (NDC) films on titanium (Ti) substrates using the coaxial arc plasma deposition (CAPD) at room temperature, which offers several advantages over conventional growth techniques. CAPD employs a unique coaxial arc plasma gun structure that provides a supersaturated condition of highly energetic carbon ions (C + ) for ultrafast quenching on the substrate, promoting the growth of nanodiamond grains. This allows for NDC films’ growth on diverse substrates without the need for initial seeding or substrate heating. However, the growth of NDC films on Ti substrates at room temperature is challenging due to the native oxide layer (TiO 2 ). Here, we grew NDC films on Ti substrates using three different pretreatments: (i) hydrofluoric acid (HF) etching, (ii) insertion of a titanium carbide (TiC) intermediate layer, and (iii) in situ Ar + plasma etching. The morphology and structure of the grown NDC films were examined by 3D laser, high-resolution scanning electron microscopies (HR-SEM), Raman, and x-ray photoelectron (XPS) spectroscopies. Our results demonstrate that in situ Ar + plasma etching is the most effective pretreatment method for completely removing the native TiO 2 layer compared to the other two ex situ pretreatments, in which re-oxidation is more likely to occur after these pretreatments. Furthermore, NDC films grown using the hybrid Ar + ion etching gun (IG) and CAPD exhibit the highest sp 3 content (63%) and adhesion strength (16 N).

Background Exposomes are critical drivers of carcinogenesis. However, how they modulate tumor behavior remains unclear. Extensive clinical data show cigarette smoke to be a key exposome that promotes aggressive tumors, higher rates of metastasis, reduced response to chemoradiotherapy, and suppressed anti-tumor immunity. We sought to determine whether smoke itself can modulate aggressive tumor behavior in head and neck squamous cell carcinoma (HNSCC) through reprogramming of the cellular reductive state. Methods Using established human and murine HNSCC cell lines and syngeneic mouse models, we utilized conventional western blotting, steady state and flux metabolomics, RNA sequencing, quantitative proteomics and flow cytometry to analyze the impact of smoke exposure on HNSCC tumor biology and anti-tumor immunity. Results Cigarette smoke persistently activated Nrf2 target genes essential for maintenance of the cellular reductive state and survival under conditions of increased oxidative stress in HNSCC regardless of human papillomavirus (HPV) association. In contrast to e-cigarette vapor, conventional cigarette smoke mobilizes cellular metabolism toward oxidative stress adaptation, resulting in development of cross-resistance to cisplatin. In parallel, smoke exposure modulates expression of PDL1 and the secretory phenotype of HNSCC cells resulting in an altered tumor immune microenvironment (TIME) in syngeneic mouse models and downregulated expression of antigen presentation and costimulatory genes in myeloid cells. Conclusion The cigarette smoke exposome is a potent activator of the Nrf2 pathway and appears to be the primary trigger for a tripartite phenotype of aggressive HNSCC consisting of: (1) reduced chemotherapy sensitivity, (2) enhanced metastatic potential and (3) suppressed anti-tumor immunity.

Effective coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises is required to ensure efficiency of services, avoid duplication, and improve equity. The objective of this review was to assess how, during and after humanitarian crises, different mechanisms and models of coordination between organizations, agencies and bodies providing or financing health services compare in terms of access to health services and health outcomes. We registered a protocol for this review in PROSPERO International prospective register of systematic reviews under number PROSPERO2014:CRD42014009267. Eligible studies included randomized and nonrandomized designs, process evaluations and qualitative methods. We electronically searched Medline, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and the WHO Global Health Library and websites of relevant organizations. We followed standard systematic review methodology for the selection, data abstraction, and risk of bias assessment. We assessed the quality of evidence using the GRADE approach. Of 14,309 identified citations from databases and organizations' websites, we identified four eligible studies. Two studies used mixed-methods, one used quantitative methods, and one used qualitative methods. The available evidence suggests that information coordination between bodies providing health services in humanitarian crises settings may be effective in improving health systems inputs. There is additional evidence suggesting that management/directive coordination such as the cluster model may improve health system inputs in addition to access to health services. None of the included studies assessed coordination through common representation and framework coordination. The evidence was judged to be of very low quality. This systematic review provides evidence of possible effectiveness of information coordination and management/directive coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises. Our findings can inform the research agenda and highlight the need for improving conduct and reporting of research in this field.

BackgroundInfluenza imposes a substantial global health burden, particularly among high-risk populations such as the elderly, young children, and individuals with chronic conditions. In Saudi Arabia, a national influenza sentinel surveillance program was established in 2017 to monitor respiratory virus trends, yet comprehensive estimates of the influenza-associated burden remain limited. This study aims to address this gap by quantifying influenza-associated severe acute respiratory infection (SARI) hospitalization rates and estimating the broader influenza burden across severity levels.MethodsData from four sentinel hospitals in three regions of Saudi Arabia were analyzed across three influenza seasons: 2017–2018, 2018–2019, and 2022–2023. Weekly SARI case counts were combined with census population data to calculate SARI hospitalization rates per 100,000 population. Influenza positivity rates, derived from laboratory-confirmed cases, were used to estimate influenza-associated SARI hospitalization rates, stratified by age and season. The John Hopkins University/WHO Seasonal Influenza Burden Disease Estimator (Flutool) was employed to extrapolate national estimates of influenza-associated hospitalizations, deaths, and mild/moderate cases. Confidence intervals and age-specific stratifications were computed to enhance precision and comparability.ResultsThe average annual SARI hospitalization rate was 294 per 100,000 population (95% CI: 288–300). Influenza-associated SARI hospitalization rates averaged 48 per 100,000 population (95% CI: 45–50), with the highest burden observed in individuals aged 65 years and older (269 per 100,000, 95% CI: 240–301) and children aged 0–4 years (118 per 100,000, 95% CI: 107–131). Seasonal variation was noted, with the highest rates in the 2017–2018 season. National estimates suggested a substantial burden, with influenza-associated hospitalizations totaling 17,678 in 2017–2018, 7,683 in 2018–2019, and 13,982 in 2022–2023. The flutool analysis estimated annual influenza-associated deaths ranging from 30 to 4,441 and mild/moderate cases reaching up to 6.3 million in the most severe season.ConclusionsThis study demonstrates a significant burden of influenza-associated SARI hospitalizations in Saudi Arabia, with the highest rates observed in the elderly and young children. Seasonal variation was evident, highlighting the urgent need to enhance influenza vaccination coverage, particularly among high-risk groups such as the elderly and young children, to reduce severe outcomes. Expanding sentinel surveillance to more regions and incorporating detailed clinical and economic data are recommended to better inform public health policies. Strengthening pandemic preparedness and tailoring vaccination campaigns based on seasonality and age-specific risk will be critical for mitigating the influenza burden in Saudi Arabia.

To develop an Arabic version of Intensive Care Delirium Screening Checklist (ICDSC) and assess its validity and reliability among critically ill patients. Multicentered study of convenience sample of adult ICU patients. Arabic translation was performed with rigorous back-to-back translation methods. Concurrent validity was established by calculating the sensitivity and specificity of two examiner assessments compared to a psychiatric evaluation. Kappa coefficients describe interrater reliability, whereas Cronbach α and composite reliability depict internal consistency. Three hundred critically ill patients were enrolled. Of these, validity testing was assessed in 180 patients. ICDSC screening was positive for delirium in 11% of enrolled patients. The area under the receiver operator characteristic (ROC) curve is 0.9413, with predicted sensitivity 70% (95% confidence interval [CI]: 60–81%) and specificity 99% (95% CI: 98–100%). The Arabic ICDSC showed acceptable internal consistency (Cronbach α = 0.63 and composite reliability = 0.64). Interrater agreement was excellent (Kappa coefficient [ҡ] = 0.85). Arabic ICDSC is a valid and reliable delirium-screening tool among Arabic-speaking ICU population. Future studies could address whether these findings are generalizable to a higher proportion of mechanically ventilated patients, and address acceptability and reliability in other Arabic language critical care settings. •Delirium is similarly common in Arabic critically ill patients.•Arabic ICDSC is a valid delirium detection tool among Arabic ICU patients.•Arabic ICDSC demonstrates good to excellent inter-rater reliability.

Background Although the health benefits of breastfeeding are well established, early introduction of formula remains a common practice. Cultural beliefs and practices can have an important impact on breastfeeding. This paper describes some common beliefs that may discourage breastfeeding in Lebanon. Methods Participants were healthy first-time mothers recruited from hospitals throughout Lebanon to participate in a study on usage patterns of a telephone hotline for postpartum support. The hotline was available to mothers for the first four months postpartum and patterns of usage, as well as questions asked were recorded. Thematic analysis of the content of questions which referred to cultural beliefs and practices related to breastfeeding was conducted. Results Twenty four percent of the 353 women enrolled in the study called the hotline, and 50% of the calls included questions about breastfeeding. Mothers expressed concern about having adequate amounts of breast milk or the quality of their breast milk. Concerns that the mother could potentially harm her infant though breastfeeding were rooted in a number of cultural beliefs. Having an inherited inability to produce milk, having \"bad milk\", and transmission of abdominal cramps to infants through breast milk were among the beliefs that were expressed. Although the researchers live and work in Lebanon, they were not aware of many of the beliefs that are reported in this study. Conclusion There are a number of cultural beliefs that could potentially discourage breastfeeding among Lebanese women. Understanding and addressing local beliefs and customs can help clinicians to provide more culturally appropriate counselling about breastfeeding.

Unintentional injuries are the leading cause of childhood injuries and result in thousands of deaths annually. However, children are at higher risk due to their increased curiosity and the time they spend at home. This study aimed to assess maternal knowledge regarding preventive measures for household injuries, including their frequency and severity. Using an electronic, self-administered questionnaire, this cross-sectional study assessed the knowledge and awareness of 433 mothers of children aged 1 to 12 years in our population between March 22 and July 31, 2023. Participants' awareness levels were the main outcome. Of the participants, 54% reported that their children had experienced domestic injuries. The most frequently reported injuries were falls, burns, and wounds caused by sharp objects. Moreover, more than 50% of the children needed to visit the emergency department, of whom 10% required hospitalization. Regarding the awareness level score, 55% of mothers had moderate knowledge of home-related injuries. Furthermore, attending first-aid courses and other health education programs predicted higher awareness scores among the mothers. More than half of the children in our study population had injuries that had occurred recently or in previous years. There was a significant discrepancy between the mothers' reported knowledge and their safety practices.

Background Weaning is a complex procedure that gradually introduces complementary foods to the baby's diet. Solid food should be started between the ages of 6 and 12 months. Weaning is a challenging and crucial stage in an infant's development. Extreme caution should be used during weaning an infant because delaying it can cause issues like sluggish growth, difficulties feeding, malnutrition, and iron deficiency. Objective The current study aims to determine the impact of delayed or early weaning practices on the nutritional status of preschool children in Saudi Arabia. Data was gathered about the time of complementary food introduction, preferred foods in the initial stages, and a child's health compared to those practices. Methodology By convenient sampling, a cross-sectional study was conducted to gather data from 385 parents of Saudi children at preschool age. Questionnaires were shared online. Data were recorded and analyzed on IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. Descriptive analysis and multivariate ANOVA (MANOVA) tests were performed. Results Only 6.23% of the infants were introduced to complimentary food at optimal age (6 to 12 months), whereas 85% were found to have delayed weaning. As per the BMI, 74.4% of preschool children were severely underweight, 53.6% of infants consumed pureed vegetables early during weaning, and 64% of infants were introduced to eggs and cheese within the first year of life. The timing, pattern, and food items of weaning had a significant (p<0.05) impact on general physical health, as 48.8% of children had pale skin, 46.9% felt tired, 36.5% had swollen joints, and 42% complained of itching and an upset stomach. Conclusion This study couldn't define the direction of significance. Further studies can be done on a larger scale where biochemical tests, and screening can be done on children to find if any significant health problem is prevailing, and the direction of association can be defined.Background Weaning is a complex procedure that gradually introduces complementary foods to the baby's diet. Solid food should be started between the ages of 6 and 12 months. Weaning is a challenging and crucial stage in an infant's development. Extreme caution should be used during weaning an infant because delaying it can cause issues like sluggish growth, difficulties feeding, malnutrition, and iron deficiency. Objective The current study aims to determine the impact of delayed or early weaning practices on the nutritional status of preschool children in Saudi Arabia. Data was gathered about the time of complementary food introduction, preferred foods in the initial stages, and a child's health compared to those practices. Methodology By convenient sampling, a cross-sectional study was conducted to gather data from 385 parents of Saudi children at preschool age. Questionnaires were shared online. Data were recorded and analyzed on IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. Descriptive analysis and multivariate ANOVA (MANOVA) tests were performed. Results Only 6.23% of the infants were introduced to complimentary food at optimal age (6 to 12 months), whereas 85% were found to have delayed weaning. As per the BMI, 74.4% of preschool children were severely underweight, 53.6% of infants consumed pureed vegetables early during weaning, and 64% of infants were introduced to eggs and cheese within the first year of life. The timing, pattern, and food items of weaning had a significant (p<0.05) impact on general physical health, as 48.8% of children had pale skin, 46.9% felt tired, 36.5% had swollen joints, and 42% complained of itching and an upset stomach. Conclusion This study couldn't define the direction of significance. Further studies can be done on a larger scale where biochemical tests, and screening can be done on children to find if any significant health problem is prevailing, and the direction of association can be defined.

National and international humanitarian relief organizsations play an important part in humanitarian crises. There is evidence of lack of coordination between organisations providing health services in public health emergencies. Our objective was to identify published models of coordination between organisations funding or delivering health services in situations of humanitarian crisis worldwide. We followed standard systematic review methodology. We searched Medline (1946 to week 1 of March, 2014), PubMed, EMBASE (1980 to week 10 of 2014), the Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and the WHO Global Health Library. We only included papers published in English. We used search terms such as “refugee”, “disaster”, “conflict”, “coordination”, “cooperation”, “international organization” and “non profit organization”. Two teams of two reviewers screened titles and abstracts in duplicate and independently for potential eligibility, retrieved full texts of citations judged as potentially eligible by at least one reviewer, screened full texts in duplicate and independently for eligibility, and resolved disagreement by discussion. When disagreement was not resolved, a third reviewer made the final decision. We also searched websites of relevant organisations. One reviewer reviewed titles of search hits. We then obtained full texts of articles identified as potentially eligible, and two reviewers screened them in duplicate and independently, compared their results, and resolved any disagreement by discussion. We included reports describing models of coordination in sufficient detail to allow reproducibility. We also included reports describing implementation of identified models as case studies. Our search captured 14 309 citations. The screening process identified five models of coordination of delivering health services: the health cluster approach (with 15 case studies), the “who is where, when, doing what” mapping tool (4Ws; four case studies), the sphere project model (two case studies), the 5×5 model (one case study), and the model of information coordination (one case study). The 4Ws and 5x5 models focused on coordination of services for mental health, while the remaining models did not focus on a specific health topic. The health cluster approach appeared to be the most widely used. One case study used a mixed implementation of the health cluster approach and the sphere model. We did not identify any model of coordination related to funding of health services. This systematic review identified three proposed coordination models that have been implemented by organisations funding or delivering health services in situations of humanitarian crisis. There is a need to compare the effectiveness and efficiency of these different models. Alliance for Health Policy and Systems Research, National Council for Scientific Research.