Synthesis of the tricyclic core of manzamine A

An efficient synthetic approach to the core structure of the manzamine alkaloids is reported, particularly in relation to incorporating a one-carbon unit in ring B from which the aldehyde in ircinal A or the beta-carboline unit in manzamine A could potentially be generated. The key steps involve a Johnson–Claisen rearrangement, enolate alkylation, dithiane alkylation and a stereoselective intramolecular dipolar cycloaddition of an azomethine ylide, which provided the desired tricyclic ABC core structure

Access to and use of healthcare services by Palestinian women in the UK. Focusing on maternal and child healthcare services

The UK has a relatively large and increasing Black and Minority Ethnic (BME) population. It is acknowledged that this group has, until now, experienced poorer health, and that there have been barriers for them accessing certain services. There are an increasing number of women from Palestine currently living in the UK. Their access to, and use of, maternal and child healthcare (MCH) services have not been investigated before. From an initial review of the literature there does not appear to be any research which has examined Palestinian women’s access to and use of MCH services. This study will address these gaps and explore the access and use of MCH services by Palestinian women in the UK. The overall aim of the study is to investigate the access to, and use of, MCH in the UK by Palestinian women. The specific objectives are: to explore facilitators and barriers to care for Palestinian women in in the UK; to determine what provisions exist which are intended to facilitate access to healthcare services; to explore factors that may demonstrate effective and positive change to health services and to make recommendations for improving the health service provision for Palestinian women in the UK. The study was designed to use a sequential, exploratory, mixed-method, pragmatic approach. In phase one - twenty-two, in-depth, face-to-face, semi-structured interviews were conducted. In phase two - survey questionnaires were distributed through the Palestinian organisations to generalise the qualitative findings and 243 questionnaires were returned from responders. Four themes emerged from the findings of the qualitative interview, which were: ‘cultural variations’; ‘knowledge of the NHS and the UK healthcare system’; ‘healthcare services and their utilisation, focusing on maternal and child healthcare services,’ and ‘communication, information provision and needs’. The quantitative findings focused on issues specific to Palestinian women, although they might resonate with other BME groups. These include: cultural variations, such as the use of herbal medicine; self-prescribed medication (antibiotics); termination of pregnancy (fatalism); circumcision for male babies; breastfeeding practice and preference for a female GP and caregiver; knowledge of the UK health system; confidence in using the English language; interpreter services; late booking of pregnancy; not attending antenatal classes; duration of visit time and information needs. This study strives to reduce inequalities in MCH among Palestinian women in the UK by highlighting the issue surrounding Palestinian women’s access to, and use of, MCH services. It is important to have a culturally sensitive MCH service that is flexible, adequate and accessible. The study concludes with the following recommendations: Having cultural competence care and adaptive services for Palestinian and all minority ethnic groups are crucial to have equitable services. Culturally appropriate care could be satisfactorily achieved through effective and continuous training programmes based on culture, ethnicity and religion for all health professionals, in order to understand patient needs. Interpretation services should be provided to Palestinian women who have the need. Midwives or nurses should provide oral explanations as well as leaflets to allow patients a full choice when making a decision. An important implication for midwifery-nursing practice is that, when developing education interventions for this population, it may not be appropriate to implement a “One Size Fits All” programme. Another practical suggestion is to have a videotape/podcast provided explaining all the required information in English and Arabic languages. This could increase the patients’ knowledge about using and accessing healthcare service

Perspective of Women about Her Body after Hysterectomy

Hysterectomy is the most common major gynecological operation in worldwide and Arabic countries. However, the psychological, physical and sexual consequences of hysterectomy are conflicting and the findings are mixed. While, some studies report that patients have experience greater improvement in their mental health, sexual desire and overall satisfaction. Others show that patients report various negative outcomes, with detrimental effects on sexual functioning being the main concern. My previous study demonstrated that hysterectomy had significantly negative effects on patients’ body image, self-esteem, and identified common meanings and themes associated with hysterectomy stressors, which includes difficulties or limitations in physical and psychological aspects perceived by patients after hysterectomy. In this chapter, author will expand that discuss in details the different factors that influence the perspective of women about body after hysterectomy. Mainly, author will focus on religious, cultural, and psycho-social aspects. All of these factors are interacting with health status of women and effect the situation and productivity of women in her family and culture. Different strategy need to be adopted in order to overcome this problem using evidence and analysis of our Arabic culture and structure. Recommendation of study to health care profession as physician, nurses, midwives and other health care provider to be aware of these potential problematic issues in order to provide a competent health care for women based of her needs

A New Fault-Tolerant Topology and Operation Scheme for the High Voltage Stage in a Three-Phase Solid-State Transformer

Solid-state transformers (SSTs) are comprised of several cascaded power stages with different voltage levels. This leads to more challenges for operation and maintenance of the SSTs not only under critical conditions, but also during normal operation. However, one of the most important reliability concerns for the SSTs is related to high voltage side switch and grid faults. High voltage stress on the switches, together with the fact that most modern SST topologies incorporate large number of power switches in the high voltage side, contribute to a higher probability of a switch fault occurrence. The power electronic switches in the high voltage stage are under very high voltage stress, significantly higher than other SST stages. Therefore, the probability of the switch failures becomes more substantial in this stage. In this research, a new technique is proposed to improve the overall reliability of the SSTs by enhancing the reliability of the high voltage stage.The proposed method restores the normal operation of the SST from the point of view of the load even though the input stage voltages are unbalanced due to the switch faults. On the other hand, high voltage grid faults that result in unbalanced operating conditions in the SST can also lead to dire consequences in regards to safety and reliability. The proposed method can also revamp the faulty operation to the pre-fault conditions in the case of grid faults. The proposed method integrates the quasi-z-source inverter topology into the SST topology for rebalancing the transformer voltages. Therefore, this work develops a new SST topology in conjunction with a fault-tolerant operation strategy that can fully restore operation of the proposed SST in the case of the two aforementioned fault scenarios. The proposed fault-tolerant operation strategy rebalances the line-to-line voltages after a fault occurrence by modifying the phase angles between the phase voltages generated by the high voltage stage of the proposed SST. The boosting property of the quasi z source inverter topology circuitry is then used to increase the amplitude of the rebalanced line-to-line voltages to their pre-fault values. A modified modulation technique is proposed for modifying the phase angles and controlling the quasi z source inverter topology shoot-through duty ratio. The specific contributions of this work are as follows: • The proposed method enables the SST to operate normally in case of switch fault occurrences due to high voltage stress. The function of faulty cells is compensated for without adding any extra legs or backup power cells. The remaining healthy cells are used to modify and balance the output voltage. • Using the proposed method, the delivered power by the SST after fault occurrence will be the same as the pre-fault conditions. Modifying the angles of phase voltages and using the feature of the proposed SST to boost the voltages lead to deliver the same power as in the pre-fault conditions. • Using the quasi-z-source inverter topology in the proposed method increases the reliability of the proposed SST topology since the transformer will have the ability to generate balanced three phase voltages using only two phase voltages. • The proposed method increases the lifetime of the SST after fault occurrence by distributing the voltage stress symmetrically between all cells of the high voltage stage in the three phases . • The proposed method guarantees the regulation of the output voltage of the SST, since the proposed SST topology can isolate the load from any disturbances in the grid. Also, the obtained output voltage of the proposed SST is balanced. As a result of this, there is no difference between the pre-fault voltage and post-fault voltage. Therefore, the obtained voltages will be synchronized well with the grid

Experience of Having a Vaginal Birth After Cesarean Section in Order to Prevent Postpartum Complication Using Narrative Review

Vaginal birth after cesarean (VBAC) is defined as a vaginal delivery by a woman who has had a previous cesarean delivery. Vaginal birth can lead to quicker post birth recovery, less operative trauma, shorter length of hospital stays, and improved feelings of wellness. It is well-known that C-section now, hysterectomy complications later. This review aims to explore the existing research on VBAC in order to prevent postpartum complication. This review commences with the exploration of women’s attitudes around VBAC, education and decision on their mode of birth. Eight main themes were: Women’s attitudes and views of VBAC; VBAC education and decision-making programs; previous VBAC; maternal morbidity and mortality; short inter-pregnancy interval; induction of labor; neonatal morbidity and mortality; and birth trauma. Evidence shows that midwives have a positive influence on VBAC rates without an increase in maternal or neonatal morbidity. Review revealed the limited comprehension and awareness regarding the factors influencing women’s decision to opt VBAC, and the viewpoints held by midwives. The recommendation is to increase the number of VBAC by emphasizing on midwifery role, continuity of care, education program, and conducting more research

The prevalence of smartphone addiction and its related risk factors among Palestinian high school students: a cross-sectional study

BackgroundSmartphone addiction is a significant social and health problem. There is limited research on smartphone addiction in Palestine. The current study aimed to assess the prevalence of smartphone addiction and its association with sociodemographic variables, depression, anxiety, and social support among 12th grade students.MethodsThe study utilized a cross-sectional research design. A self-reported questionnaire, including the Smartphone Addiction Scale (SPAS), the OSLO Social Support Scale, and the Hospital Anxiety and Depression Scale (HADS), was used to gather data.ResultsA total of 1,083 participants were recruited, of whom 27.3% had depression, 50.5% had anxiety, 57.3% experienced smartphone addiction, and 17.6% had strong social support. The study found that students with weak or moderate teacher relationships (AOR: 2.854, p < 0.001), disrupted sleep with smartphones (AOR: 2.143, p < 0.001), negative impact of smartphone usage on studies (AOR: 3.016, p < 0.001), and poor or weak social support (AOR: 3.051, p < 0.001) were at risk of smartphone addiction. Participants who reported no impact on their sleep time (AOR: 0.478, p-value = 0.001), used smartphones for less than 2 hours daily (AOR: 0.347, p < 0.001), and used smartphones for 2 to 3 hours daily (AOR: 0.684, p = 0.037) were less likely to develop smartphone addiction.ConclusionSmartphone addiction was prevalent in high school students in this study. Weak teacher relationships, sleep disturbances, negative academic effects, and insufficient social support may lead to smartphone addiction. Programs that educate students, parents, and educators on smartphone addiction can prevent it and help detect and manage smartphone use problems

Metallation–substitution of an α-oxygenated chiral nitrile

Deprotonation of a chiral alpha-oxygenated nitrile with the base 2,2,6,6-tetramethylpiperidylmagnesium chloride, TMPMgCl, gives rise to a chiral magnesiated nitrile, and this anion has sufficient configurational stability at low temperature to allow the formation of highly enantiomerically enriched substituted nitrile products after electrophilic quench

Surveillance and Security:Protecting Electricity Utilities and other Critical Infrastructures

Critical infrastructures – such as electricity networks, power stations and Smart Grids – are increasingly monitored and controlled by computing and communication technologies. The need to address security and protection of electricity infrastructures with a high priority has broadly been recognized. This is driven by many factors, including the rapid evolution of threats and consistent technological advancements of malicious actors as well as potentially catastrophic consequences of disruptions of such systems. Surveillance and security technologies are traditionally used in these contexts as a protection mechanism that maintains situational awareness and provides appropriate alerts. Surveillance is a cumbersome process because of the need to monitor a diverse set of objects, but it is absolutely essential to detect promptly the occurrence of adverse events or conditions. The aims of this paper are twofold: First, we describe two surveillance architectures in which different technologies can be used jointly for boosting the safety and security of electricity utilities and other key resources and critical infrastructures. Second, we review the typical surveillance and security technologies and evaluate them in the context of critical infrastructures, which may help in making recommendations and improvements for the future. To accomplish these aims, we extracted and consolidated information from major survey papers. This led to identifying the surveillance and security technologies, their application areas, and challenges that they face. We also investigate the perceived performance of the identified technologies in critical infrastructures. The latter comes from interviewing experts who operate in critical infrastructures, and thus provide indications for protecting critical infrastructures, not least because of their increasing use of cyber-physical elements

Depression, anxiety and coping strategies among Palestinian university students during political violence: a cross sectional study

Background: There are numerous wars and ongoing political violence in Palestine and little is known about how they have affected Palestinian undergraduate students’ mental health and coping strategies. This study aimed to assess the prevalence of depression, and anxiety symptoms and coping mechanisms among Palestinian university students during the times of current political violence in Palestine after October 7, 2023. Methods: A cross-sectional descriptive study design was utilized for a sample of students from 3 universities in Palestine (Al Quds University, Hebron University, and An-Najah University) and 1815 participants responded. Data were collected using self-reported questionnaires, including Hospital Anxiety and Depression Scale (HADS) and Brief COPE scale. Person correlation test, chi-square test, and bivariate analysis were performed to examine the associations between research variables. Results: The estimated prevalence of depression was 65.9, and 60.9% for anxiety. The logistic regression showed that students from the Arts Faculty, females, and those with working parents were significantly more likely to experience depression and anxiety symptoms. Also, active coping, emotional support, and humor reduced the likelihood of experiencing depression symptoms, while active coping, positive reframing, humor, and acceptance decreased the likelihood of developing anxiety symptoms. Further, the study found that using religion, self-blame, denial, and behavioral disengagement increased the likelihood of depression symptoms while planning, venting, religion, self-blame, denial, and behavioral disengagement increased the likelihood of anxiety symptoms. Conclusion: The study found that political violence often leads to symptoms of depression and anxiety among undergraduates. Furthermore, the use of maladaptive coping mechanisms increases the likelihood that these symptoms will occur. Providing immediate assistance to university students affected by political violence and conflicts is crucial for their emotional and mental recovery and coping with difficulties

Thoracolumbar spine fracture patterns, etiologies, and treatment modalities in Jordan

Purpose Spine fractures are a significant cause of long-term disability and socioeconomic burden. The incidence of spine fractures tends to increase with age, decreased bone density, and fall risk. In this study, we evaluated thoracolumbar fractures at a tertiary hospital in Jordan regarding their frequency, etiology, patterns, and treatment modalities. Methods The clinical and radiological records of 469 patients with thoracolumbar fracturesadmitted to King Hussein Medical City from July 2018 to August 2022 were evaluated regarding patients’ age, sex, mechanism of injury, fracture level and pattern, and treatment modalities. Results The mean age of patients was 51.24±20.22 years, and men represented 52.7%. Compression injuries accounted for 97.2% of thoracolumbar fractures, and the thoracolumbar junction was the most common fracture location. Falling from the ground level was the most common mechanism and accounted for half of the injuries. Associated neurological injuries were identified in 3.8% of patients and were more common in younger patients. Pathological fractures were found in 12.4% and were more prevalent among elderly patients and women. Conclusions Traffic accidents and falling from height were the most common causes of spine fractures in patients younger than 40. However, 70% of spine fractures in women were caused by simple falls, reflecting the high prevalence of osteoporosis among women and the elderly. Therefore, traffic and work safety measures, as well as home safety measures and osteoporosis treatment for the elderly, should be recommended to reduce the risk of spine fractures