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Rethinking Eco-evo Studies of Gene Expression for Non-model Organisms in the Genomic...
Adam Freedman
Timothy Sackton

Adam Freedman

and 1 more

June 09, 2024
Recent advances in genomic technology, including the rapid development of long-read sequencing technology and single-cell RNA-sequencing methods, are poised to significantly expand the kinds of studies that are feasible in ecological genomics. In this perspective, we review these new technologies and discuss their potential impact on gene expression studies in non-model organisms. Although traditional RNA-sequencing methods have been an extraordinarily powerful tool to apply functional genomics in an ecological context, bulk RNA-seq approaches often rely on de novo transcriptome assembly, and cannot capture expression changes in rare cell populations or distinguish shifts in cell type abundance. Advancements in genome assembly technology, particularly long-read sequencing, and improvements in the scalability of single-cell RNA-sequencing (scRNA-seq), offer unprecedented resolution in understanding cellular heterogeneity and gene regulation. We discuss the potential of these technologies enable disentangling differential gene regulation from cell type composition differences and uncovering subtle expression patterns masked by bulk RNA-seq. The integration of these approaches provides a more nuanced understanding of the ecological and evolutionary dynamics of gene expression, paving the way for refined models and deeper insights into the generation of biodiversity.
Successful Treatment of MDR Acinetobacter baumannii Meningitis in a Young Adult Patie...
Md Abdur  Rahim
Dr. Himel Kumar Biswas

Md Abdur Rahim

and 4 more

September 03, 2025
Successful Treatment of MDR Acinetobacter baumanniiMeningitis in a Young Adult Patient with Intraventricular and Intravenous Polymyxin B-Tigecycline Based CombinationsAuthors: Md Abdur Rahim1, Himel Kumar Biswas1, Md Abdul Kader Zilani1, Rama Biswas1, Sirazul Haque Ershad1Corresponding Author: Md Abdur Rahim, Specialist, Department of Neuro-ICU, Square Hospitals Ltd., Dhaka, Bangladesh, Email: raselofrmc48@gmail.com
Isolated Unilateral Renal Mucormycosis in a Patient presenting with Pyelonephritis an...
Bahar Darouei
Mohammad Mehdi  Zare

Bahar Darouei

and 3 more

June 09, 2024
A document by Bahar Darouei. Click on the document to view its contents.
Resveratrol and Curcumin restore anxiety behavior and motor skills by ameliorating Ac...
Chhavi Sharma
Maheep Bhatnaghar

Chhavi Sharma

and 1 more

June 09, 2024
Fluoride exposure results in several pathophysiological conditions associated with neurodegenerative changes, these include anxiety, memory loss, disturbance in cognition and motor learning, etc. Thus, the objective of the present study was to examine the protective effect of antioxidants Resveratrol (Resv) and Curcumin (Cur) on chronic NaF (Sodium Fluoride,120 ppm for 30 days) induced anxiety behavior and retarded exploratory motor activities, by using elevated plus maze (EPM), and open field test (OFT), as a behavioral paradigm. Effects on intracellular calcium concentration and cell viability were also studied in vitro. Histochemistry was done to assess the effect of treatments on Acetylcholine neurotransmitter. The data indicated that NaF-induced anxiety-like behavior was evident from decreased exploration activity in OFT with increased anxiety levels in EPM, whereas on providing the Resv or Cur (30mg/kg. body weight, for 30 days) these behavioral changes and the fibrous staining of acetylcholine neurons of brain subregions i.e. CA1, CA3, Perirhinal, and Dorsolateral entorhinal cortex, were restored. The beneficial effect of phytochemicals to improve neuronal connections was validated by performing immunohistochemical staining of doublecortin (DCX) and neuronal nuclei (NeuN), to evaluate neuronal migration and synaptic integration in the mentioned subregions of mice brain. The result suggests reparative potential of Resv and Cur, showing higher neuro-modulatory potential by ameliorating AChE to relieve stress and restoring synaptic plasticity in the cortical-hippocampal system offering great potential as a novel preventive therapeutic agent for anxiety and ameliorating exploratory motor activity.
A case of hypopharyngeal cancer with delayed suboccipital lymph node metastasis: Case...
Jianlin Yue
Huidong Zhang

Jianlin Yue

and 5 more

June 09, 2024
During follow-up, close monitoring of lymph nodes outside the primary tumor drainage area is crucial for patients with severe cervical lymph node metastasis of hypopharyngeal cancer.
Omental metastases from uveal melanoma; an interesting intraoperative omental pattern...
Sofoklis Stavros
Athanasios Zikopoulos

Sofoklis Stavros

and 6 more

June 09, 2024
Case Image
Science-in-Brief: The 6 th Havemeyer Workshop on Rhodococcus equi - A Decade-Long Jou...
Michelle Coleman
John Prescott

Michelle Coleman

and 15 more

June 09, 2024
Science-in-Brief: The 6th Havemeyer Workshop on Rhodococcus equi - A Decade-Long Journey in Advancing Research into a Major Equine Pathogen (2012-2023)Michelle Coleman1, John Prescott2, Angela Bordin3, Noah Cohen3, Leticia Gressler4, Albert Haas5, Michal Letek6, Wim Meijer7, Gary Muscatello8, Clare Ryan1, Macarena Sanz9, Iain Sutcliffe10, Shinji Takai11, Jose Vazquez-Boland12, Monica Venner13, Londa Berghaus1
Management of cervical agenesis in low-resource settings: Two case reports from Malaw...
Tulsi Patel
Jennifer Draganchuk

Tulsi Patel

and 4 more

June 09, 2024
A document by Tulsi Patel. Click on the document to view its contents.
Improving cefazolin exposure in critically ill children using population pharmacokine...
Clémence Rivaud
Mehdi Oualha

Clémence Rivaud

and 13 more

June 09, 2024
Aim: Population pharmacokinetics (PK) models may be effective to improve antibiotic exposure with individualized dosing. The aim of the study is to assess cefazolin exposure using a population PK model in critically ill children. Methods: We conducted a single center observational study including children under 18 years old who had cefazolin plasma monitoring before and after the model implementation. First concentration at steady state of each cefazolin course was analyzed. Optimal exposure was defined by concentrations values ranged from free concentration over 4 times the MIC for 100% of the dosing interval to total trough or plateau concentration under 100 mg/L. Results: Fifty-eight patients were included, of whom 39 and 19 children received conventional dosing or model-informed dosing, respectively. Median [range] age was 2.3 [0.1-17] years old and median weight was 14.2 [2.9-72] kg. There were more continuous infusions (CI) in the model group than in the conventional group (n=19/19 (100%) vs n=23/39 (59%)). Compared to conventional dosing, model-informed dosing provided more optimal exposure (n=17/39 (44%) vs n= 15/19 (79%), p=0.01) and less underexposure (n= 18/39 (46%) vs n= 2/19 (10%), p=0.008), without increasing overexposure (n= 4/39 (10%) vs n= 2/19 (11%), p=1). Moreover, the time to reach a 50% decrease of C Reactive Protein levels was significantly shorter in the model group than the conventional group (3 [0.5-13] vs 4 [1-34]; p=0.045. Conclusions: Use of individualized cefazolin model-informed dosing improves critically ill children’s exposure. Further studies are needed to assess the clinical benefit of cefazolin PK model application.
Global Availability and Uptake of Psychological Services for Adults with Food Allergy
Rebecca Knibb
Screti C

Rebecca Knibb

and 12 more

June 09, 2024
Background. Food allergy (FA) is associated with poor quality of life and high levels of psychological distress. Psychological support is therefore extremely important but is not always available. As part of the Global Access to Psychological Services for Food Allergy (GAPS) Study, we aimed to assess distress and use of psychological services for adults with food allergy. Methods. Participants (n=1329 adults with FA) from >20 countries were recruited through patient organisations, social media adverts and online survey panels to complete an online survey. Surveys were offered in six languages. Results. A total of 67.7% of adults reported they had experienced FA-related psychological distress with the biggest issue being anxiety about having an allergic reaction (64.1%). Only 19.4% had been assessed for FA-related psychological distress; 22.9% had seen a mental health professional for treatment for their FA-related distress. There were significant differences across countries for levels of distress, screening for distress, seeing a mental health professional and being diagnosed with a FA-related mental health disorder (all p<0.001). The UK and Brazil had the highest number of adults reporting distress. The biggest barriers to seeing a mental health professional were cost, lack of insurance coverage, failure to provide a referral, and lack of practitioner in the area. Conclusions. FA-related distress is common in adults. Few have accessed the psychological care and support they need and there is significant variability across countries. Clinicians should consider routine assessment of adults for distress and easily accessible resources are needed to help support adult patients.
‘My face is listening to your smile’: Emotional contagion to vocal smile revealed by...
Annabelle Merchie
Zoé Ranty

Annabelle Merchie

and 5 more

June 09, 2024
Interaction between the different components of emotional contagion (i.e. emotional state and facial motor resonance), whether during implicit or explicit appraisal of emotion remains controversial. The aim of this study was i) to separate between these components thanks to vocal smile processing and ii) to estimate how they reflect implicit processes and/or an explicit appraisal loop. Emotional contagion to discrete vocal emotions was studied in 25 adults, through motor resonance and Autonomic Nervous System (ANS) reactivity. Facial expressions (fEMG: facial electromyography) and pupil dilation were assessed during processing and judgement of artificially emotionally modified sentences. fEMG revealed that Zygomaticus major was reactive to perceived sounds valence while Corrugator supercilii activity rather reflected explicit judgement. Timing analysis of pupil dilation provided further insight into both the emotional state and the implicit and explicit processing of vocal emotion, showing an early activity for emotional stimuli compared to neutral ones, followed by variations based on sounds valence, and by a late additional increase of pupil diameter depending on judgement. This innovative combination of these electrophysiological measures shed new light on the debated central and peripherical views within the framework of emotional contagion.
Localized electrocortical activity as a function of single-leg squat phases and its r...
Scott Bonnette
Evi Wezenbeek

Scott Bonnette

and 8 more

June 09, 2024
This study investigated differences in electroencephalography (EEG) activity within motor-related brain areas during three phases of a single-leg squat (SLS)—i.e., descending, holding, and ascending phases. Specifically, utilizing advanced magnetic resonance imaging guided EEG source localization techniques and markerless motion capture technology, we explored the interplay between concurrently recorded lower-extremity biomechanics and brain activity. Among the phases of a nondominant leg SLS, differences in contralateral brain activity (right hemisphere) were found in the activity of the precentral gyrus, the postcentral gyrus, and the sensory motor area. Alternatively, during the dominant SLS leg, differences among the three SLS phases in contralateral brain activity were fewer. Hemispheric dependent brain activity also significantly correlated with participants’ knee valgus angle range of motion (right hemisphere) and peak knee valgus angles (left hemisphere). In addition to the novel brain and biomechanical findings, this study sheds light on the technical feasibility of recording EEG during complex multi-joint movements and its potential applications in understanding sensorimotor behavior.
A Small-Scale Observational Study into Sport and Spitting in the Era of COVID-19 - Ha...
Paul Illingworth
Parvez Igbal Haris

Paul Illingworth

and 1 more

June 09, 2024
COVID-19 virus is present in saliva and contact with saliva can be a risk factor for spreading the virus between people. Consequently, there has been fear regarding contact with saliva. Some people have capitalised on this and resorted to using spitting as a weapon. In some sports, spitting is common. In football, players often spit due to excessive saliva in the mouth from exercise. Football spitting incidences has included aggression between players and between fans. This qualitative study observed national, regional and international football matches including men & women world cups, between January 2022- March 2023. Additionally, we purposely sampled other sports on celestial TV in the UK, through to March 2024, to see if there were incidences of spitting. Analysis found, despite the knowledge COVID-19 is present in saliva, and the entire world went through a pandemic, football and some other sports have not abandoned spitting. This is of concern, since public health experts, including the WHO, have encouraged people, especially children, not to publically spit, as it is unhygienic and spreads disease. Children often see sports people as role models and seeing them spit, is a setback for public health and hygiene. More needs doing to address spitting in sporting events and could include education in schools and sporting academies. At the same time sportspersons and sporting authorities need to co-operate to find a way to eliminate, at best, or to find alternative solutions to this habit.
Model Reference Based Neural Controller for Transmission Line Inspection Robot
Zehra KARAGÖZ
Nazmi EKREN

Zehra KARAGÖZ

and 4 more

June 09, 2024
The regular inspection of the power transmission lines is essential for the uninterrupted transmission of electrical energy to demand points. This quickly requires actions with economically, efficiently, and safely. Therefore, the transmission line inspection robots are inevitable solution as an alternative to existing line inspection methods. This study present design and control of a transmission line inspection robot (I-Robot). Since the I-Robot exhibits nonlinear behaviour and has multiple inputs and multiple outputs, a model reference-based neural controller is determined to achieve nonlinear control. The robot design process consists of 4 stages which are kinematic modelling, dynamic modelling, actuator modelling and controller design. To meet inspection requirements, the conceptual design of the I-Robot is performed, and the kinematic model are calculated in terms of the transformation matrices. According to the design requirements and system constraints, the dynamic model of the I-Robot is created. To provide desired motions and trajectory tracking, the actuator models are determined. Then, the I-Robot is prototyped. According to the dynamics of joint, robot and constraints, the system identification is performed to create reference model. During the system identification, the logged data are used the train the reference model. Finally, the desired trajectory for the driving cycles is created by manual excitation of the I-Robot. During the manual excitation, the logged data are used to train the neural network-based controller. Eventually, the I-Robot is assessed under the test scenarios in term of the trajectory tracking performance as regression value and mean squared errors.
HIV Transmission Dynamics: Insights from Molecular Cluster Analysis of Genetic Sequen...
Yangyang Liu
Lichun Hua

Yangyang Liu

and 5 more

June 09, 2024
Objective In order to improve knowledge of HIV transmission dynamics and guide preventive and control strategies, this work uses molecular cluster analysis to objectively detect clusters of HIV genetic sequence similarity. Methods 89 HIV-positive couples provided blood samples, and plasma was separated for pol region gene sequence amplification. Furthermore, analysis was done on HIV-1 pol fragment sequences from Nanjing patients between 2015 and 2019. HYPHY and Cytoscape were used to generate and illustrate molecular networks. Results In this investigation of 89 double-positive pairs, it was discovered that the pairwise gene distance approach properly detected 82.02% of positive couples at an ideal gene distance of 0.014 substitution/loci. With an accuracy of 86.25%, the optimal parameter for the phylogenetic tree and gene distance approach was 90+0.045 substitution/loci. A molecular network was built for the Nanjing samples (2015–2019) using the optimum threshold of the previous technique. This network had 487 sequences with one misconnected cluster. There were 565 sequences in the network created by the latter approach that were not incorrectly connected. Conclusion For HIV research, molecular cluster analysis provides novel insights. It helps with preventive and control methods by objectively identifying clusters with comparable genetic sequences, which enhances our knowledge of HIV transmission. Further developments will increase its importance for HIV/AIDS research and worldwide prevention.
Farmers’ perception on agricultural land degradation and their investments in farm la...
Almaz Deche

Almaz Deche

June 09, 2024
Agricultural land degradation in most developing countries has become a major constraint to future economic growth and development of rural livelihoods. Thus, improving the livelihood of smallholder farmers through the sustainable agricultural land management technologies can protect and improve long-term agricultural land productivity and habitats of all organisms including, human population. This study was aimed to assess farmers’ perception on agricultural land degradation and their investments in farm land management technologies and then it’s implication for developing sustainable farmland management in Wolmera District, Central Ethiopia. To achieve this open and close-ended questionnaire were employed for 105 household heads and FGD and in-depth interview with key informants were made. Data were analyzed in both qualitative and quantitative methods. The result indicates that about 99% of farmers perceived soil erosion and fertility decline as the major environmental problem in their cultivated land and its effect on water resources (95%), loss of crop production (100%) and result in increases the requirement of fertilizer (94%). Additionally, 80% of the respondents believed that land degradation can be controlled. Accordingly, crop rotation (100%), compost (20%) and animal manure (40%) were recognized as they maintain soil fertility. While, Contour plowing, Traditional ditches, Soil bund, Check dam, Cutoff drains and Water way which accounts 96, 98, 93, 60, 52 and 96 use respectively to prevented soil erosion Causes like deforestation, steep slope, over cultivations and population growth, poor agricultural activity and overgrazing were perceived by the most farmers as the main causes of agricultural land degradation. Therefore attention should be given for such factors, during preparation of promising agricultural land management plan that considers suitability and adaptability to local environmental conditions.
Semantic Schema Extraction in NoSQL Databases using BERT Embedding
SAAD BELEFQIH
AHMED ZELLOU

SAAD BELEFQIH

and 2 more

June 09, 2024
NoSQL databases, valued for flexibility and scalability, pose analytics challenges due to their schema-less nature. Automatic schema extraction is crucial, with existing techniques limited in handling nested structures. Leveraging Natural Language Processing (NLP) advancements, this paper introduces a novel BERT embedding-based approach for extracting schemas from NoSQL databases. The method analyzes semantic relationships within triplets from JSON documents through four stages: triplet extraction, preprocessing, BERT embedding generation, and similarity analysis. Evaluation on real datasets demonstrates over 83% accuracy in extracting valid nested schema components. The study reveals interdisciplinary intersections, using NLP to unveil structures in scenarios lacking explicit schemas, showcasing significant potential for autonomous schema extraction from raw, unstructured data formats.
Equity in evidence synthesis: you can’t play on broken strings
Tamara Lotfi
Vivian Welch

Tamara Lotfi

and 18 more

June 10, 2024
The 2022 Cochrane Lecture challenged Cochrane and its community to enhance their equity efforts and presented specific issues needing attention. We have created an actionable plan to address these challenges. These include: 1. Setting priorities for reviews based on health equity and global burden of disease 2. Advocate and support initiatives to promote equity, diversity, and inclusion in Cochrane 3. Actively seek global representation in the governance of the Campbell and Cochrane Health Equity Thematic Group We advocate for the inclusion of health equity considerations in all Cochrane systematic reviews. To achieve this, we need the cooperation of all those involved, such as journal editors, funders, and researchers. We invite the global community to work with us to address these equity gaps in research and practice.
Bidirectional transfer of human cytomegalovirus strains in donor and recipient seropo...
Büsra Külekci
Madlen Mollik

Büsra Külekci

and 9 more

June 08, 2024
Donor and recipient HCMV-seropositive (D+R+) lung transplant recipients (LTRs) often harbour multiple human cytomegalovirus (HCMV) strains, likely due to transmitted donor (D) strains and reactivated recipient (R) strains. To date, the extent and timely occurrence of each likely source in shaping the post-transplantation (post-Tx) strain population is unknown. Here, we deciphered the D and R origin of the post-Tx HCMV strain composition in blood, bronchoalveolar lavage (BAL), and CD45+ BAL cell subsets. We investigated either D and/or R formalin-fixed paraffin-embedded blocks or fresh D lung tissue from four D+R+ LTRs obtained prior to transplantation. HCMV strains were characterised by short amplicon deep sequencing. In two LTRs, we show that the transplanted lung is reseeded by R strains within the first six months after transplantation, likely by infiltrating CD14+ CD163+/- alveolar macrophages. In three LTRs, we demonstrate both rapid D-strain dissemination and persistence in the transplanted lung for >1 year post-Tx. Broad inter-host diversity contrasts with intra-host genotype sequence stability upon transmission, during follow-up and across compartments. In D+R+ LTRs, HCMV strains of both, D and R origin can emerge first and dominate long‑term in subsequent episodes of infection, suggesting no replication advantage of one source over the other despite pre-existing R strain-specific immunity.
A Meta-Analysis of Adverse Events in the Phase I Clinical Trials Conducted at Fortrea...
Alicia Barton
Oren Cohen

Alicia Barton

and 2 more

June 08, 2024
Aim Tragic incidents in Phase I trials have been cited to suggest that trials put participants at high levels of risk. This meta-analysis aimed to evaluate risks to Phase I trial participants at the Fortrea Clinical Research Unit (FCRU) (UK) between 2016-2021. Methods Sixty-Five FCRU Phase I trials enrolling 3194 participants were included (99% healthy volunteers). Analysed trials tested active drugs, had finalised clinical study reports (CSRs), and standardised AE reporting procedures. Data on drug type, study design, participant numbers, and AEs were extracted from CSRs. A chi-square test of homogeneity tested mild, moderate, and severe AE probability distributions between placebo and active groups. A negative binomial regression examined relationships of administration route (parenteral vs non-parenteral), drug type (small molecule vs biologic), and trial type (First in Human (FIH) vs non-FIH) to number of AEs reported. Results Over 55% of participants reported at least one AE. 5051 AEs were reported; classified as mild (90.1%), moderate (9.4%), severe (0.4%), or unknown (0.1%). Proportion of AEs by severity category was similar between active and placebo groups (χ2(2)=3.942, p=0.139). Fifteen serious AEs were reported. Parenteral administration and biological drugs had no significant effect on AE incidence. FIH trials were a significant predictor of lower AE risk. Conclusion AEs were commonly reported in these Phase I trials. Trial features perceived to increase AE risks (parenteral administration, biologic drugs) did not and AE risk in FIH trials was lower compared with non-FIH trials. The trials analysed posed a low risk of serious harm to participants.
Osteopoikilosis, the incidental finding of a rare bone dysplasia: a case report.
Rosa Tejera
Ana Aguilar

Rosa Tejera

and 3 more

June 08, 2024
Osteopoikilosis, the incidental finding of a rare bone dysplasia: a case report
Navigating the Digital World: A Guide to Becoming a Responsible Digital Citizen

Nitish S

and 1 more

June 25, 2024
A document by Issac Veshal. Click on the document to view its contents.
The present is more important than the past: associations between developmental stabi...
Shu Wang
Ray Callaway

Shu Wang

and 1 more

June 08, 2024
The relationships among developmental stability, canalization and phenotypic plasticity are not straightforward, but may be better understood in the context of temporally heterogeneous environments. Our objective was to investigate the effects of early experience with temporally heterogeneous water availability on the associations between developmental stability, canalization and phenotypic plasticity. We subjected eight plant species to a first round of alternating inundation and drought vs. constantly moderate water treatments and a second round of water conditions. Fluctuating asymmetry (FA), intra- and inter-individual variation (CVintra and CVinter), and plasticity in traits were measured and correlations between variables were calculated for each species. Early temporally heterogeneous experience decreased the leaf size of half of the species, but had complex effects on leaf fluctuating asymmetry (FA) and inter-individual variation (CVinter) in traits immediately or in late conditions, with little effects on intra-individual variation (CVintra). There were several positive correlations between FA and CVinter, positive correlations between CVinter and plasticity in early treatments, but negative correlations in late treatments. Our results suggested complexity and variability in the relationships between different mechanisms. Decreased canalization may promote plastic responses in traits before or during the induction of plasticity, whereas canalization may reflect phenotypic convergence after plastic responses. Temporally heterogeneous experiences may facilitate positive correlations or attenuate negative correlations between decreased canalization and plasticity. We provide direct evidence for relationships between developmental stability, canalization and plasticity as well as the role of temporally heterogeneous environments in modifying these processes. The integrative way that plants deal with environmental variation demonstrates their ability to evolve in multiple directions via many flexible adjustments in response to varying environmental signals over a plant’s lifetime.
Knowledge of Neonatal Danger Signs among Mothers attending Vaccination Centers in Cen...
Zeina Sinnokrot
Sanaa Zeidan

Zeina Sinnokrot

and 4 more

June 08, 2024
Abstract Objectives: Worldwide, the neonatal age group bears high mortality risk that is attributed to diverse causes. In Palestine, there is a scarcity of studies investigating the determinants of neonatal deaths. Through this research, we investigated the level of mothers’ knowledge and awareness in recognizing neonatal danger signs (NDS) and associated factors. Hypothesis: There is no difference in mothers’ knowledge regarding NDS with regard to diverse socio-demographic characteristics and reproductive factors including antenatal and postnatal care. Methodology: A community-based descriptive cross-sectional study was conducted among 377 mothers who gave birth in the last year and attended primary care centers for child vaccination in Ramallah and Jerusalem Governance from December 2023 to January 2024. This was done using structured questionnaires completed through face-to-face interviews covering socio-demographic variables, mothers’ reproductive history, and NDS knowledge assessment. Results: Among the 377 mothers, only 51% had good knowledge, reporting at least three danger signs. The most frequently mentioned were difficulty breathing (73.21) and fever (64.72%), while hypothermia (2.65%) and convulsions (11.67%) were the least mentioned. Statistical analysis indicated that having a national health insurance card ( p=0.002) and an educated husband ( p=0.020) are significantly associated with mothers’ knowledge of NDS. These factors could potentially be important to consider in intervention and educational programs aimed at improving mothers’ knowledge. Conclusion: This study showed that mothers’ knowledge of NDS is relatively low, impacting public health in Palestine as in other developing countries. Therefore, collective efforts are needed to educate mothers on the importance of early NDS identification.
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