Digital Commons Network^™

Influence Of Adiposity And Sex On Sars-Cov-2 Antibody Response In Vaccinated University Students: A Cross-Sectional Esfuerso Study, Adriana L. Perales-Torres, Lucia M. Perez-Navarro, Esperanza M. Garcia-Oropeza, Alvaro Diaz-Badillo, Yoscelina Estrella Martinez-Lopez, Marisol Rosas-Diaz, Octelina Castillo-Ruiz, Laura Yanneth Ramirez-Quintanilla, Leonel Vela, Beatriz Tapia, Juan C. Lopez-Alvarenga

School of Medicine Publications

Prior studies have identified various determinants of differential immune responses to COVID-19. This study focused on the Ig-G anti-RBD marker, analyzing its potential correlations with sex, vaccine type, body fat percentage, metabolic risk, perceived stress, and previous COVID-19 exposure. In this study, data (available in S1 Data) were obtained from 108 participants from the ESFUERSO cohort, who completed questionnaires detailing their COVID-19 experiences and stress levels assessed through the SISCO scale. IgG anti-RBD concentrations were quantified using an ELISA assay developed by UNAM. Multiple regression analysis was employed to control for covariates, including sex, age, body fat percentage, body …

Modeling The Effect Of Human Behavior On Disease Transmission, Katie Yan

Rose-Hulman Undergraduate Mathematics Journal

Many infectious disease models build upon the classic Susceptible-Infected-Recovered (SIR) model, a compartmental system that is used to simulate disease transmission in a population. The SIR model focuses on the transmission of disease but rarely includes behavioral or informational components that explore how disease perception influences transmission. In this paper, we propose a six-compartment behavioral SIR model that further segments the classic SIR system based on knowledge of information about the disease, and we explore how sharing information affects disease transmission. We designate two states as aware and unaware based on whether the relevant information is known by the population. …

Multimodal Data Integration For Oncology In The Era Of Deep Neural Networks: A Review, Asim Waqas, Aakash Tripathi, Ravi P. Ramachandran, Paul A. Stewart, Ghulam Rasool

Henry M. Rowan College of Engineering Departmental Research

Cancer research encompasses data across various scales, modalities, and resolutions, from screening and diagnostic imaging to digitized histopathology slides to various types of molecular data and clinical records. The integration of these diverse data types for personalized cancer care and predictive modeling holds the promise of enhancing the accuracy and reliability of cancer screening, diagnosis, and treatment. Traditional analytical methods, which often focus on isolated or unimodal information, fall short of capturing the complex and heterogeneous nature of cancer data. The advent of deep neural networks has spurred the development of sophisticated multimodal data fusion techniques capable of extracting and …

The College Campus, A Place Of Learning, And A Place Of Healing, Huma Bashir, Joshua Francis

Human Services Faculty Publications

The COVID-19 pandemic and its aftermath have precipitated a marked increase in mental health needs among college students. Lockdowns, the sudden shift to remote learning, and social distancing mandates have compounded existing challenges, highlighting a trend that has evolved over the past two decades. Despite heightened demand for mental health support, colleges struggle to meet these needs amid the emotional aftermath of COVID-19 effectively. Recognizing the pivotal role of higher education institutions in shaping future leaders and addressing and enhancing the mental well-being of the college community is imperative to foster an environment conducive to learning and healing. This paper …

Effect Of Esketamine On Hypotension In Women With Preoperative Anxiety Undergoing Elective Cesarean Section: A Randomized, Double-Blind, Controlled Trial, Qinyu Jiang, Yanyu Li, Xinghe Wang, Jia Sun, Hai Zhou, Zhengquan Hu, Liwei Wang

Faculty, Staff and Student Publications

To investigate the effect of low-doses esketamine on spinal anesthesia-induced hypotension in women with preoperative anxiety undergoing elective cesarean section, the randomized controlled trial enrolled 120 women aged 18-35 years who preoperative State-Trait Anxiety Inventory State scores > 40, conducted from September 2022 to August 2023 in Xuzhou Central Hospital, China. Women in the esketamine group received a single intravenous injection of 0.2 mg/kg esketamine after sensory block level achieved. The incidence of hypotension in the esketamine group was significantly lower than the control group at T2 (10% [6 of 60]; P < 0.001), T3 (5.0% [3 of 60]; P = 0.007) and T4(5.0% [3 of 60]; P = 0.004). Despite being higher in the esketamine group, the overall rates of hypertension (11.7% [7 of 60]; P = 0.186), tachycardia (23.3% [14 of 60]; P = 0.246), and bradycardia (0.0% [0 of 60]; P = 0.079) were no significantly difference between the two groups. STAI-S scores was significantly lower in the esketamine group (mean [SD] 37.52[7.14]) than in the control group (mean [SD] 41.03[9.66], P = 0.39) in postoperative day 1. Spinal anesthesia combined with intravenous low-doses esketamine infusion can significantly reduce the incidence of hypotension in women with preoperative anxiety undergoing elective cesarean section.

Trust Criteria For Artificial Intelligence In Health: Normative And Epistemic Considerations, Kristin Kostick-Quenet, Benjamin H Lang, Jared Smith, Meghan Hurley, Jennifer Blumenthal-Barby

Center for Medical Ethics and Health Policy Staff Publications

Rapid advancements in artificial intelligence and machine learning (AI/ML) in healthcare raise pressing questions about how much users should trust AI/ML systems, particularly for high stakes clinical decision-making. Ensuring that user trust is properly calibrated to a tool's computational capacities and limitations has both practical and ethical implications, given that overtrust or undertrust can influence over-reliance or under-reliance on algorithmic tools, with significant implications for patient safety and health outcomes. It is, thus, important to better understand how variability in trust criteria across stakeholders, settings, tools and use cases may influence approaches to using AI/ML tools in real settings. As …

Student Nurse Experiences Of Retention Strategies And The Perceived Contribution To Academic Progress, Jessica Dugas

Walden Dissertations and Doctoral Studies

There is a worldwide nursing shortage that has been heightened by the COVID-19 pandemic. Several factors have contributed to the worsening shortage, including high attrition rates in nursing programs. Retention strategies have been suggested to support nursing students during their education to have success and graduate. The purpose of this descriptive qualitative study was to explore how nursing students experience retention strategies and their perceived contributions to academic progress. Bandura’s social cognitive theory was the theoretical framework used to guide the study. Data were collected from one-on-one interviews with 12 nursing students recruited using purposeful and snowball sampling. Data were …

Multi-Antigen Intranasal Vaccine Protects Against Challenge With Sarbecoviruses And Prevents Transmission In Hamsters, Ankita Leekha, Arash Saeedi, K M Samiur Rahman Sefat, Monish Kumar, Melisa Martinez-Paniagua, Rohan Kulkarni, Ali Rezvan, Shalaleh Masoumi, Xinli Liu, Laurence J N Cooper, Manu Sebastian, Courtney M Sands, Vallabh E Das, Nimesh B Patel, Brett Hurst, Navin Varadarajan

Faculty, Staff and Student Publications

Immunization programs against SARS-CoV-2 with commercial intramuscular vaccines prevent disease but are less efficient in preventing infections. Mucosal vaccines can provide improved protection against transmission, ideally for different variants of concern (VOCs) and related sarbecoviruses. Here, we report a multi-antigen, intranasal vaccine, NanoSTING-SN (NanoSTING-Spike-Nucleocapsid), eliminates virus replication in both the lungs and the nostrils upon challenge with the pathogenic SARS-CoV-2 Delta VOC. We further demonstrate that NanoSTING-SN prevents transmission of the SARS-CoV-2 Omicron VOC (BA.5) to vaccine-naïve hamsters. To evaluate protection against other sarbecoviruses, we immunized mice with NanoSTING-SN. We showed that immunization affords protection against SARS-CoV, leading to protection …

Psychological Impact Of Ebola Disease On Survivors: A West Africa Study, Babatunde Moses Irinoye

Walden Dissertations and Doctoral Studies

Survivors of Ebola virus disease often experience social isolation. Understanding the psychological impact of Ebola virus disease on these survivors was the focus of this study. The study encompasses assessment of experiences in re-integration back into communities, and psychological implications (post-recovery), among Ebola infection survivors (EIS) in Republic of Liberia. The purpose of the study was to explore the psychological impact of Ebola as the EIS continue their re-integration journey in their communities in Liberia. The conceptual framework for this study was based on principles of system theory, based on interrelatedness of the biopsychological experience of the EIS, and the …

07.08.2024 Orsp Connect, Liz Williamson

ORED Newsletter

NSF research infrastructure, IDS (Institute for Data Science), NSF Mentoring Plan Requirement, NSF Pilot for Startups and Small Businesses

Predicting Choroidal Nevus Transformation To Melanoma Using Machine Learning, Prashant D. Tailor, Piotr K. Kopinski, Haley S. D'Souza, David A. Leske, Timothy W. Olsen, Carol L. Shields, Jerry A. Shields, Lauren A. Dalvin

Wills Eye Hospital Papers

PURPOSE: To develop and validate machine learning (ML) models to predict choroidal nevus transformation to melanoma based on multimodal imaging at initial presentation.

DESIGN: Retrospective multicenter study.

PARTICIPANTS: Patients diagnosed with choroidal nevus on the Ocular Oncology Service at Wills Eye Hospital (2007-2017) or Mayo Clinic Rochester (2015-2023).

METHODS: Multimodal imaging was obtained, including fundus photography, fundus autofluorescence, spectral domain OCT, and B-scan ultrasonography. Machine learning models were created (XGBoost, LGBM, Random Forest, Extra Tree) and optimized for area under receiver operating characteristic curve (AUROC). The Wills Eye Hospital cohort was used for training and testing (80% training-20% testing) with …

Efficient Matrix Profile Computation With Euclidean Distance Using Eigen Transformation: Performance Evaluation Based On Beat-To-Beat Interval (Bbi) Data

Faculty, Staff and Student Publications

The matrix profile serves as a fundamental tool to provide insights into similar patterns within time series. Existing matrix profile algorithms have been primarily developed for the normalized Euclidean distance, which may not be a proper distance measure in many settings. The methodology work of this paper was motivated by statistical analysis of beat-to-beat interval (BBI) data collected from smartwatches to monitor e-cigarette users’ heart rate change patterns for which the original Euclidean distance (L2-norm) would be a more suitable choice. Yet, incorporating the Euclidean distance into existing matrix profile algorithms turned out to be computationally challenging, especially …

Innovation Path At Institute For Protein Design Of Washington University And Its Enlightenment For Construction Of New Life Sciences R&D Institutions, Runzhou Zhao, Ming Ni, Yunzhi Fa, Xiaochen Bo, Jian Jiao

Bulletin of Chinese Academy of Sciences (Chinese Version)

The Institute for Protein Design (IPD) at the University of Washington is a pioneering local and state-supported non-profit scientific research institution. Since its establishment in 2012, IPD has seized the opportunity of AI for Science and open science, and continuously enhanced its capabilities of fundamental innovations, breakthrough technologies, and industrial impact. We summarized five factors contributing to IPD’s development, including focusing on the cutting-edge issues of basic scientific research to gain a first-mover advantage and then further expand, integrating AI-enhanced digital tools and solid experimental validations, facilitating the integrated development of innovation and industrial chains, giving full play to the …

Low Skeletal Muscle Mass Is Associated With Inferior Preoperative And Postoperative Shoulder Function In Elderly Rotator Cuff Tear Patients, Yongzhi Ye, Haixiao Chen, Xiaobo Zhou

Faculty, Staff and Student Publications

BACKGROUND: The age-related loss of skeletal muscle mass is an important characteristic of sarcopenia, an increasingly recognized condition with systemic implications. However, its association with shoulder function in elderly patients with rotator cuff tears (RCT) remains unknown. This study aimed to investigate the relationship between low skeletal muscle mass and shoulder function in elderly RCT patients.

METHODS: A retrospective analysis was conducted on RCT patients who underwent chest computed tomography (CT) scans for clinical evaluation. Preoperative CT scan images of the chest were used to calculate the cross-sectional area (CSA) of thoracic muscle at the T4 level. The medical records …

Deepface: Deep-Learning-Based Framework To Contextualize Orofacial-Cleft-Related Variants During Human Embryonic Craniofacial Development, Yan Chu, Xiaoqian Jiang, Seth M Weinberg, Nandita Mukhopadhyay, Mary L Marazita, Lukas M Simon, Peilin Jia, Zhongming Zhao

Faculty, Staff and Student Publications

Orofacial clefts (OFCs) are among the most common human congenital birth defects. Previous multiethnic studies have identified dozens of associated loci for both cleft lip with or without cleft palate (CL/P) and cleft palate alone (CP). Although several nearby genes have been highlighted, the "casual" variants are largely unknown. Here, we developed DeepFace, a convolutional neural network model, to assess the functional impact of variants by SNP activity difference (SAD) scores. The DeepFace model is trained with 204 epigenomic assays from crucial human embryonic craniofacial developmental stages of post-conception week (pcw) 4 to pcw 10. The Pearson correlation coefficient between …

Prediction Of Mild Cognitive Impairment Status: Pilot Study Of Machine Learning Models Based On Longitudinal Data From Fitness Trackers, Assaf Gottlieb

Faculty, Staff and Student Publications

BACKGROUND: Early signs of Alzheimer disease (AD) are difficult to detect, causing diagnoses to be significantly delayed to time points when brain damage has already occurred and current experimental treatments have little effect on slowing disease progression. Tracking cognitive decline at early stages is critical for patients to make lifestyle changes and consider new and experimental therapies. Frequently studied biomarkers are invasive and costly and are limited for predicting conversion from normal to mild cognitive impairment (MCI).

OBJECTIVE: This study aimed to use data collected from fitness trackers to predict MCI status.

METHODS: In this pilot study, fitness trackers were …

Gender-Specific Mental Health Outcomes In Central America: A Natural Experiment, Thea Nagasuru

Computer Science Summer Fellows

While COVID lockdown measures have had varying effects on the mental health of different demographics, several bodies of research have noted their disparate effect on women. Why is women's mental health more negatively impacted by lockdown measures, and how much more are they impacted than men? How can we predict and mitigate these negative effects on women? This paper aims to contribute to answering those questions by comparing COVID stringency measures and their effect on the gap in depression rates between men and women in two neighboring countries: Nicaragua and Honduras.

Association Between Psychological Distress And Diabetic Retinopathy Among U.S. Adults, Claret Ijeoma Onukogu

Walden Dissertations and Doctoral Studies

Diabetes can lead to diabetic retinopathy, an eye disease that causes damaged blood vessels and the growth of abnormal ones, leading to vision loss. The two stages of the disease are non-proliferative and proliferative diabetic retinopathy. In the non-proliferative stage, diabetics develop macular edema and ischemia with shortage of blood in the macula region of the eye, and the vision eventually becomes blurry. However, the proliferative stage is the advanced stage of the disease involves neovascularization and retinal detachment. The quantitative study employed the socioecological model as the theoretical framework to examine the relationship between psychological distress and diabetic retinopathy …

Stress, Resilience, And Coping: A Cross-Sectional Study Of Black Male Osteopathic Medical Students’ Experiences In Medical School, Eboni Anderson

Graduate Theses, Dissertations, and Capstones

This quantitative study investigated stress, coping, and resilience among Black male osteopathic medical students (BMOMS), focusing on the unique challenges that affect their academic success, mental and physical health, and professional development. This study was contextualized within the shifting demographics of U.S. osteopathic medical schools and the underrepresentation of Black males. Utilizing Moos’ Integrative Model of Stress and Coping, survey data from BMOMS (n = 85) were analyzed through descriptive statistics, correlations, and multiple linear regressions. Research questions addressed BMOMS’ specific stressors, the relationship between resilience and coping, and the influence of demographic variables. Out of 101 initial survey …

Epigenome-Wide Association Study Of Lung Cancer Among Never Smokers In Two Prospective Cohorts In Shanghai, China, Batel Blechter, Andres Cardenas, Xuting Wang, Bu-Tian Ji, Wei Hu, Qiuyin Cai, H Dean Hosgood, Gong Yang, Jianxin Shi, Jirong Long, Yu-Tang Gao, Douglas A Bell, Wei Zheng, Nathaniel Rothman, Qing Lan

Faculty, Staff and Student Publications

BACKGROUND: The aetiology of lung cancer among individuals who never smoked remains elusive, despite 15% of lung cancer cases in men and 53% in women worldwide being unrelated to smoking. Epigenetic alterations, particularly DNA methylation (DNAm) changes, have emerged as potential drivers. Yet, few prospective epigenome-wide association studies (EWAS), primarily focusing on peripheral blood DNAm with limited representation of never smokers, have been conducted.

METHODS: We conducted a nested case-control study of 80 never-smoking incident lung cancer cases and 83 never-smoking controls within the Shanghai Women's Health Study and Shanghai Men's Health Study. DNAm was measured in prediagnostic oral rinse …

Low Remnant Cholesterol And In-Hospital Bleeding Risk After Ischemic Stroke Or Transient Ischemic Attack, Zhiyuan Wu, Haiping Zhang, Yi Xu, Xia Li, Xingang Li, Lois Balmer, Xiuhua Guo, Qi Zhang, Xiang Han, Lixin Tao

Research outputs 2022 to 2026

BACKGROUND: Bleeding risk brought by intensive lipid-lowering therapy and low low-density lipoprotein cholesterol is concern-ing, while evidence regarding the relationship between remnant cholesterol and bleeding is frightening. This study aimed to investigate the association between remnant cholesterol at admission and an in-hospital bleeding event after acute ischemic stroke or transient ischemic attack (TIA). METHODS AND RESULTS: A total of 3222 eligible patients admitted to Shanghai Huashan Hospital between 2015 and 2021 with complete lipid data were analyzed. Patients were classified into low (<20.0 mg/dL), moderate (20.0–29.9 mg/dL), and high (≥30 mg/dL) groups by remnant cholesterol. The mean age of patients was 63.0± 13.1 years, including 2301 (71.4%) men and 651 (20.2%) with TIA. The median (interquartile range) of remnant cholesterol was 18.6 (13.5–25.9) mg/dL. After adjustment for confounding variables, patients with low remnant cholesterol had a higher risk of bleeding events (odds ratio, 2.56 [95% CI, 1.12–6.67]) than those with moderate remnant cholesterol. The high remnant cholesterol group was not significantly associated with bleeding risk. Combined assessment of low-density lipoprotein cholesterol and remnant cholesterol further identi-fied patients with the highest risk of bleeding events. CONCLUSIONS: Low remnant cholesterol levels were associated with bleeding events during the acute stage of ischemic stroke and TIA. The assessment of remnant cholesterol could inform the bleeding risk during hospitalization both for patients and physicians in clinical practice.

Iron Oxide Nanozymes Enhanced By Ascorbic Acid For Macrophage-Based Cancer Therapy, Zhongchao Yi, Xiaoyue Yang, Ying Liang, Sheng Tong

Markey Cancer Center Faculty Publications

In recent years, using pharmacological ascorbic acid has emerged as a promising therapeutic approach in cancer treatment, owing to its capacity to induce extracellular hydrogen peroxide (H2O 2) production in solid tumors. The H2 O 2 is then converted into cytotoxic hydroxyl free radicals (HO•) by redox-active Fe2+ inside cells. However, the high dosage of ascorbic acid required for efficacy is hampered by adverse effects such as kidney stone formation. In a recent study, we demonstrated the efficient catalytic conver- sion of H2 O2 to HO• by wüstite (Fe 1−xO) nanoparticles (WNPs) through a heterogenous Fenton reaction. Here, we explore …

The Potential Anti-Arrhythmic Effect Of Sglt2 Inhibitors, Hong-Yi Duan, Hector Barajas-Martinez, Charles Antzelevitch, Dan Hu

Department of Medicine Faculty Papers

Sodium-glucose cotransporter type 2 inhibitors (SGLT2i) were initially recommended as oral anti-diabetic drugs to treat type 2 diabetes (T2D), by inhibiting SGLT2 in proximal tubule and reduce renal reabsorption of sodium and glucose. While many clinical trials demonstrated the tremendous potential of SGLT2i for cardiovascular diseases. 2022 AHA/ACC/HFSA guideline first emphasized that SGLT2i were the only drug class that can cover the entire management of heart failure (HF) from prevention to treatment. Subsequently, the antiarrhythmic properties of SGLT2i have also attracted attention. Although there are currently no prospective studies specifically on the anti-arrhythmic effects of SGLT2i. We provide clues from …

Editorial: Ethical Considerations In Electronic Data In Healthcare, Dheya Mustafa, Mousa Al-Kfairy

All Works

No abstract provided.

Employing Interactive Architecture Techniques In Architectural Design Methodologies To Retrieve Ancient Egyptian Identity, Dina Elwy Aly Hamed Hussein Dr. Lobna Abd-Allah Abd-Elfattah Agha , Dr. Azza Sobhi Ragab Elsakka

Journal of Engineering Research

Architectural projects often rely on modern technologies like smart architecture and environmental treatments, neglecting the principles and philosophy that reflect civilization, ideas, culture, and traditions. This leads to short-lived buildings that depend on these technologies without any purpose of preserving them. Technicians must constantly renew technology to improve production and without benefits, as threats of superior artificial intelligence have been warned, that autonomous machines may perform tasks without programmers understanding how to reach this level. Instead of relying solely on environmental or smart technology, we should make technology serve the design idea rather than relying solely on it. Considering this, …

The Effect Of Lighting In Color In The Interior Space Of The Residential Unit, Abd Elbary Eldininy Abd Elbary Eldininy

Journal of Engineering Research

ABSTRACT: Humanity is spending more and more time indoors, both at work and at home - with studies showing that we now spend 87% of our lives indoors. Residential environ ments both positively affect the mood and well-being of its occupants, just as places with poor and uncomfortable lighting and colors can make life miserable. This is why we are interested in this issue. The importance of knowing the issues of lighting and colors in order to obtain a well thought-out interior design. The interior designer has the ability to control in the quality of lighting of various types, artificial …

Green Facade Strategy To Mitigate Heat Islands, Arch. Aya Gamal Abdel Hamid Muhammad Prof. Mai Wahba Madkour... Dr. Rania Elghamry Ashmawy Tolba Elakab

Journal of Engineering Research

In the beginning of the twentieth century and the occurrence of the economic crisis that accompanied by a climate crisis, that one of its indicators the rise in temperatures and the formation of hot zones, especially in crowded cities, including Cairo in particular, as it is considered one of the crowded cities in the world, and this noticeable rise in temperatures in Some areas where hot zones form are called heat islands. This results because of the nature of the urban environment, which has a high building density, little natural landscape, and human and industrial activities that has a negative …

Light Structure Building Technology Towards Sustainable Environmental Design, Sally El-Sayed Prof. Dr. Mai Wahba Madkour2, Prof. Dr. Marwa Ahmed Kamer El-Dawla3

Journal of Engineering Research

The building and construction industry is one of the most important sectors globally , as it plays a vital role in providing housing and infrastructure that meets the needs of various communities , However , this industry is considered one of the largest contributors of negative environmental impacts in terms of consuming huge amounts of natural resources in an unsustainable manner and a subsequent increase in energy consumption .Therefore, it was necessary to find solutions and explore for new and sustainable construction methods to alleviate these problems .This research paper will focus on the use of light buildings and their …

Available Building Technology As A Tool For Developing Construction And Structure Systems., J. Q. . Nader Ibrahim Ismael

Journal of Engineering Research

The research aims to study the impact of available building technology in each era in the development of the constructional thought and implementation techniques used and its impact on the development of different types of buildings, through the emergence of different types of buildings and the development of buildings types in terms of shape and height, through the development of building materials used Whether construction materials or finishing materials, as well as used construction techniques and equipment, and the impact of all on the development of construction thought and construction systems through different eras . The research also represents an …

Increasing Occupancy Rates In Coastal Tourism Development At The Regional Level In Support Of A Sustainable Quality Of Life In Egypt, عبدالرحمن محمد عبدالقادر موسي

Journal of Engineering Research

إن استغلال الفراغات التي تمثل أكثر من 80% من مساحة المنتجعات السياحية الساحلية في الأنشطة الرياضية والترفيهية والثقافية والاجتماعية وتوفير الخدمات المختلفة عن طريق دعم الخدمات الإلكترونية التي تساعد الزائرين في قضاء وقت أكبر بتلك القري السياحية، مع تعلم السباحة وركوب الدرجات والتجديف والتسلق وركوب الخيل دعما لجودة الحياة ، حيث التمتع بالهواء المتجدد القادم من البحر بعيدا عن التلوث والضوضاء، ولزيادة الاستفادة والدعم يتم توفير وحدات فندقة لغير الملاك لزيادة الزوار والاتفاق مع المدارس والجامعات لتنشيط تلك الرحلات للشواطئ وممارسة الأنشطة المميزة لهؤلاء الشباب والاستفادة من الخدمات الجيدة والفراغات الصحية والهواء المتجدد وتعلم الرياضات الشاطئية المفيدة وذلك الاتجاه من …