Digital Commons Network^™

Tennessee Blue Book 2023-2024, Tennessee. Secretary Of State.

Tennessee Blue Book

No abstract provided.

2024 Annual Report Tennessee Nutrient Reduction Task Force, Samuel D. Smith

Nutrient Strategy Taskforce

No abstract provided.

The Gci Vortex Spine: Integrated Vortex‑Induced Energy Platform Using Arachne V8.7 Smart‑Skin, Resonance‑Adaptive Logic, And Gyroid‑Lattice Structural Core, Michael Victor Caldwell Mr.

Defensive Publications Series

This disclosure describes the GCI “Vortex Spine,” a modular, solid‑state energy‑harvesting platform designed for long‑duration, low‑maintenance deployment in remote or resource‑limited environments. The system integrates three independently functional inventions: (1) a vortex‑induced vibration (VIV) mechanical tower with electromagnetic generation modules, (2) an adaptive resonance‑control logic engine, and (3) the Arachne v8.7 multi‑modal Smart‑Skin substrate. The mechanical subsystem uses a gyroid‑lattice structural core and helical J‑groove surface geometry to induce controlled vortex shedding at low wind speeds. The logic subsystem uses high‑frequency kinetic sensing and adaptive load modulation to maintain structural safety and optimize power output. The Arachne v8.7 Smart‑Skin provides …

Reengineering Cardiac Rehabilitation For Women: From Access To Equity, Juwairia Alali

Saudi Medical Journal

Cardiac rehabilitation (CR) is a corner stone intervention in secondary prevention of cardiovascular disease where a multidisciplinary team provides tailored management of lifestyle interventions, exercise and behavioural counselling. Participating in CR resulted in better rates of tobacco cessation, blood pressure and cholesterol lowering and better glycaemic control [1]. CR participation results in significant lower mortality and hospitalizationand improved quality of life. Despite the body of evidence and the robust recommendation by international guidelines it remains underutilized especially by women.

Bridging The Gender Gap In Cardiovascular Care: A Framework For Women's Heart Care, Julia Grapsa, Ana G Almeida

Saudi Medical Journal

No abstract provided.

Specificities Of Aortic Stenosis In Women – From Diagnosis To Management, Yasser Harb, Fadi Tohme, Hadi Ossaili, Karim Halabi, Ali Kanso, Elie Chammas, Samer Nasr, Mohammad Tahini, Nicole Karam

Saudi Medical Journal

Aortic stenosis (AS) is the most common valvular heart disease worldwide, with pathophysiology, clinical presentation, and management differing widely according to sex. Women demonstrate predominantly fibrotic valve modifications and less calcifications for given hemodynamic severity, with left ventricular concentric hypertrophy and smaller cavity size leading to a higher prevalence of paradoxical low-flow, low-gradient AS. These sex differences are modulated by hormonal changes, inflammatory and metabolic pathways, as well as genetic and epigenetic regulators. Atypical symptoms and hemodynamic specificities on echocardiography all combine to create diagnostic challenges that contribute to delayed recognition and intervention. Multimodality imaging, particularly the use of sex-specific …

Management Of Arrhythmias During Pregnancy In Africa, Mervat Aboulmaaty, Kirellos Mikhail, Bola Sogade

Saudi Medical Journal

Cardiac arrhythmias represent a significant clinical concern that have been always addressed. Moreover, Pregnancy introduces profound hormonal, autonomic, and hemodynamic changes that add more risk to cardiac patients and increase arrhythmia susceptibility. In our continent, Africa, there is an added risk because of the high prevalence of rheumatic heart disease, peripartum cardiomyopathy, and limited access to healthcare, contributing to adverse maternal and fetal outcomes. This article addresses the epidemics, mechanisms, and management of arrhythmias during pregnancy in African settings, highlighting high-yield real-life cases. We focus on guideline-based management strategies, emphasizing fetal safety, and discuss unique regional challenges, including limited access …

Women’S Cardiovascular Health In 2025: Advancements Achieved, Challenges Ahead, Jamilah S. Alrahimi

Saudi Medical Journal

Cardiovascular disease (CVD) is the leading cause of death among women globally. Recognition of sex-specific risk factors, pathophysiology, and clinical presentations has established women's cardiovascular health as a research and clinical priority. Pregnancy complications, premature menopause, and autoimmune disease, are now identified as long-term contributors to cardiovascular risk, while female-predominant syndromes such as ischemia with non-obstructive coronary arteries and heart failure with preserved ejection fraction are increasingly acknowledged. Novel therapies and updated guidelines emphasize psychosocial determinants, reproductive history, and postpartum risk assessment in prevention and management. Despite these advances, women remain underdiagnosed, undertreated, and underrepresented in clinical trials. Diagnostic delays …

Advancing Research For Women’S Cardiovascular Health: A Clinical & Policy Priority Of The Middle East & Mediterranean Women’S Cardiovascular Research Consortium, Mirvat Alasnag

Saudi Medical Journal

No abstract provided.

National Heart Center – Saudi Health Council Acute Myocardial Infarction-Related Cardiogenic Shock Consensus Document, Mirvat Alasnag, Abdulrahman Asiri, Hazim Alrahbi, Nhatem Aloui, Ashraf M Anwar, Saad Alhassani, Maryam Mohamed Alqaseer, Ismail Raid Raslan, Ibrahim Albakri, Ahmed Almustafa, Rowa Attar, Faisal Katbi, Feras Khaleil, Alyaa Elhazmi, Adel Tash, Jehad Alburaiki

Saudi Medical Journal

Objective: Cardiogenic shock (CS) remains a serious complication of acute myocardial infarction (AMI) with persistently high mortality and significant variability in management across centers. Methods: A multidisciplinary panel convened by the National Heart Center used the GRADE framework to review evidence and develop consensus recommendations tailored to AMI-related CS. Results: The document emphasizes standardized CS definition and staging, prioritizing the SCAI classification. Key components include early recognition, haemodynamic assessment, lactate monitoring, and the central role of echocardiography. Recommendations support rapid culprit-vessel revascularization, early consideration of mechanical circulatory support, and structured Heart Team activation. The document also highlights the need for …

Evaluating The Diagnostic Accuracy Of Ultrasound And Clinical Predictors In Pediatric Acute Tip Appendicitis: A Retrospective Study From A Tertiary Center In Saudi Arabia, Abdullah M. Abu Qarnayn, Saud A. Aljadaan, Suliaman M. Alaqeel, Faisal S. Alshehri, Abdullrzak N. Algosear, Waleed A. Alharthi, Munirah A. Alsukait, Kholoud S Alshaya

Saudi Medical Journal

Objective: To examines the diagnostic accuracy of ultrasound (US) and the clinical characteristics of pediatric ATA. Acute tip appendicitis (ATA), a rare form of appendiceal inflammation confined to the distal tip, presents with atypical symptoms and is difficult to diagnose. The Confirmation often relies on imaging and surgical pathology. Methods: A Retrospective cross-sectional study conducted at a tertiary hospital in Riyadh, Saudi Arabia, from 2020 to 2024. Among 4,224 pediatric patients with acute appendicitis under 14 years, and our sample size of 59 patients were diagnosed with ATA by US. Firth logistic regression was used to reduce bias in the …

Risk Factors And Clinical Outcomes Of Abnormal Placental Localization: A Comprehensive Retrospective Analysis, Bessy Varghese, Alia Abdulla Abdullatif, Yusuf Khaled Hadi, Noor Ammar Alkhuzaei, Khawla Al Sendy, Marwa Abdulrahman Juma Salem, Youstina Georges, Amala Sunder

Saudi Medical Journal

Objectives: To evaluate maternal and neonatal complications associated with various types of placental abnormal localization. Methods: This retrospective study analysed obstetric and neonatal outcomes associated with placental abnormal localization at Bahrain Defence Force Hospital over a 12-month period (January–December 2022). Women were categorized into four groups based on placental localization: placenta previa with accreta, placenta previa with increta, minor previa, and major previa. Maternal demographics, obstetric history, and fetal outcomes were collected. Statistical analysis included Fisher's exact test for categorical variables, the Kruskal-Wallis test for non-parametric variables, and one-way ANOVA for parametric variables. A p-value of Results: A total …

Impact Of Nursing Program Structure On Academic Stress Levels And Self-Concept: A Cross-Sectional Study Of Nursing Students' Experiences With 2- And 3-Semester Academic Calendars, Alaa Ayyadhah Alanazi, Amany Anwar Saeed Alabdullah, Hanan Hamdanalshehri, Abrar M. Almutairi

Saudi Medical Journal

Objective: To investigate undergraduate nursing students' perceptions of their transition from a 2-semester to a 3-semester academic calendar and examine its impact on academic stress and self-concept. Methods: A cross-sectional study was conducted between April and December 2023 among 185 undergraduate nursing students in Saudi Arabia who had completed at least their foundational year. Participants completed an online questionnaire containing Likert-type scales measuring academic stress and academic self-concept. Data were analyzed using t-tests and ANOVA to explore associations between perceptions and demographic variables. Results: Most students reported low levels of academic stress and maintained a positive academic self-concept. Perceived …

Challenges Of Electronic Medical Record Implementation From The Perspective Of Hospital Leaders In Riyadh, Kingdom Of Saudi Arabia's Public Hospitals: A Mixed-Methods Study, Atheer A. Alghamdi, Samiha H. Sayed

Saudi Medical Journal

Objectives: To assesses the challenges of implementing electronic medical records (EMR) from the leaders' perspective in public hospitals in Riyadh, Kingdom of Saudi Arabia (KSA), and explores their suggestions for improvement. Methods: A concurrent mixed research approach using a purposive sample of all hospital leaders (61) involved in EMR in 5 randomly selected public hospitals utilizing EMR in Riyadh. The researchers deployed a semi-structured interview schedule to collect the data. They used descriptive statistics and ordinal regression analysis for quantitative data, and thematic analysis for qualitative data. Results: Indicate that 80.3% of the hospital leaders had a good perception of …

Investigating The Use Of Antidepressants In Treating Major Depressive Disorder: Insights From A Retrospective Study In Saudi Arabia, Hassan A Alsaad, Wajd A Alfaraj, Maryam M Alrababi, Ali M Sonbaa, Dalal M Albakr, Ali Saleh Abensaad, Fadhel A Alomar

Saudi Medical Journal

Objectives: To investigate patterns of antidepressant prescribing and continuation rates among patients with major depressive disorder (MDD) in Saudi Arabia and to identify factors associated with treatment persistence. Method: A retrospective study was conducted at King Fahad Hospital of the University between May 2023 and February 2025. Data on patients' demographic characteristics, diagnostic information, and prescribed medications were collected. Initial antidepressant therapy and treatment continuation were evaluated, and potential influencing factors were analyzed. Results: Selective serotonin reuptake inhibitors (SSRIs) accounted for most first-line prescriptions (71%), followed by SSRI/atypical combinations (11%) and serotonin–norepinephrine reuptake inhibitors (SNRIs) (5%). Of the 220 patients …

Prognostic Significance Of Lymphovascular Invasion In Breast Cancer: Insights From A Retrospective Analysis At A Tertiary Care Center, Nora Trabulsi, Shayma Alotaibi, Mohammed Bahabri, Hussain A. Alkhalifah, Ghady D. Alshehri, Sultan K. Alshali, Ali Farsi, Marwan Alhajeili, Hassan Al-Turki, Salma Sait, Alaa Shabkah, Rana Ajaboor, Hessa Aljhdali

Saudi Medical Journal

Objective: To explore the relationship between lymphovascular invasion (LVI) and outcomes across different histopathological subtypes, tumor grades, clinical stages, hormone receptor profiles, and treatment modalities. Lymphovascular invasion is a well-recognized histopathological feature associated with tumor dissemination in breast cancer. However, its prognostic weight is under-reported in Middle Eastern cohorts. Methods: We retrospectively reviewed data from 828 women treated for invasive breast carcinoma at King Abdulaziz University Hospital from 2010 to 2020. Clinicopathologic variables, treatments, and outcomes were extracted. Overall survival (OS) and event-free survival (EFS) were estimated and tested using Kaplan–Meier curves; independent predictors were identified with stepwise Cox models. …

Growing Evidence For Distinct Clinical Features And Early Diagnostic Age Of Cutaneous T-Cell Lymphoma In Saudi Arabia: A Retrospective Study In A Tertiary Care Center, Abdulhadi Jfri, Renad Fayez Alharthy, Mariya Yahya Ashqan, Hassan Omar Bogari, Al-Anoud Yousef Alkhashan

Saudi Medical Journal

Objectives: To examine trends in Cutaneous T-cell Lymphoma (CTCL) disease presentation in the Western Region of the Kingdom of Saudi Arabia (KSA). Cutaneous T-cell lymphomas (CTCLs) have heterogeneous clinical presentation, and disease characteristics can vary between regions and ethnic groups. Methods: We conducted a local observational study at the Princess Noorah Oncology Center and King Abdulaziz Medical City, Jeddah, with CTCL patients referred to and treated in the Saudi Arabian National Guard facilities from January 2017 to December 2023. Medical records of included patients were retrospectively reviewed. Main outcome measures were demographics and clinical characteristics. Results: The cohort comprised 69 …

Incidence And Risk Factors For Post-Thyroidectomy Hypocalcemia: A National Study From Saudi Arabia, Saad M. Alqahtani, Bader E. Alsharari, Abdulaziz H. Al-Shahrani, Shehata F. Shehata, Moneer E. Almadani, Yousef S. Alalawi

Saudi Medical Journal

Objectives: Post-thyroidectomy hypocalcemia is the leading cause of post-thyroidectomy hospitalization, adversely affecting patient quality of life. The current study sought to determine the incidence of post-thyroidectomy hypocalcemia, identify risk factors and their clinical significance, and provide an overview of the incidence in different Saudi Arabian cities. Methods: This retrospective analysis included all patients who underwent thyroidectomies at King Salman Armed Forces Hospital Northwestern Region, Tabuk, Saudi Arabia between 2015 and 2021 and had available pre- and post-operative calcium levels and clinical, surgical, and pathological data. Various risk factors were evaluated using binary logistic regression to determine their impact on the …

Evaluation Of Neutrophil-To-Lymphocyte Ratio And Platelet-To-Lymphocyte Ratio As Biomarkers In Missed Abortions, Ayse Yigit Sonmez, Defne Ay Tuncel

Saudi Medical Journal

Objectives: To evaluate the usability and clinical significance. Missed abortion, a common complication in early pregnancy. Diagnosis typically relies on ultrasonographic findings and clinical criteria. The neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio have attracted considerable interest. Methods: A total of 120 women participated, with 60 diagnosed with missed abortion and 60 with healthy intrauterine pregnancy. This is a retrospective case-control study. Information for the study was gathered from patient file records. Mann-Whitney U Test was used. Logistic regression analysis assessed the magnitude and direction of the relationships between the variables. Results: The youngest participant was 23, while the oldest was 42. …

An Examination Of The Effect On Health Protective Behaviour Of Diabetes And Obesity Awareness And Personal Characteristics In Adults: Structural Equation Modeling, Ayşe Soylu, Pinar Şahin

Saudi Medical Journal

Objectives: The World Health Organization has reported that obesity-related diabetes cases are increasing rapidly. The aim of this study was to examine the effect on health protective behaviour of diabetes and obesity awareness and personal characteristics in adults. Method: This descriptive, cross-sectional, correlational study was conducted with 1241 participants. Data were collected using a Personal Information Form, the Diabetes and Obesity Awareness Scale and Health Protective Behaviour Scale. Data analysis was performed with IBM SPSS vn.23 and IBM AMOS vn.24 software. STROBE was used in reporting. Results: Of the total participants, 45.4% had no diabete and obesity awareness and in …

Clinical Significance Of Ikbkb Mutations: A Focus On Ikbkb-Related Immunodeficiency, Alhomidi Almotiri

Saudi Medical Journal

Inhibitory kappa B kinase beta (IKBKB, IKK2, or IKKβ ) acts as an activator of the nuclear factor (NF)-κ B signaling cascade that is involved in regulating normal physiological processes and is dysregulated in several pathological processes including immunological disorders. Mutations in IKBKB have been found to cause immune deficiency syndromes. Inherited loss-of-function mutations in IKBKB lead to severe or lethal immune deficiency. In this review, the clinical significance of IKBKB mutations will be reviewed in the context of immune deficiency syndromes. All published clinical cases of IKBKB mutations relevant to immune deficiency, either caused by loss- or gain-of-function mutations …

Brief Geriatric Assessment (Bga): An Evidence-Based Tool For Improving Care Of Older Adults, Assim M. Alabdulkader

Saudi Medical Journal

The Brief Geriatric Assessment is an approach for rapidly identifying high-risk older adults and guiding timely interventions in busy clinical settings. Unlike the Comprehensive Geriatric Assessment, albeit the gold standard, which is resource-intensive, the Brief Geriatric Assessment offers a scalable alternative by using validated, time-efficient tools to screen for common geriatric syndromes. This narrative state-of-the-art review synthesizes the evidence and best practices regarding the concept, structure, and clinical application of the Brief Geriatric Assessment. It compares the Brief Geriatric Assessment and Comprehensive Geriatric Assessment from theoretical and practical perspectives and outlines how the former can be integrated into healthcare settings, …

Sleep Disorder Phenotypes And The Risk Of Incident Heart Failure: A Meta-Analysis With Mendelian Randomization Validation, Fang Yan, Lihua Fan, Yunhu Chen

Saudi Medical Journal

Objectives: To quantify how specific sleep-disorder phenotypes are related to incident heart failure (HF) using a meta-analysis of cohort data and to probe causal relevance via 2-sample Mendelian randomization (MR). Methods: Fourteen cohorts comprised of participants without HF at baseline were pooled (49,501 exposed; 337,317 controls). A random effects meta-analysis produced pooled hazard ratios (HRs) with 95% confidence intervals (CIs). A bidirectional two-sample MR was used to evaluate the causal effects of sleep phenotypes on HF. Results: Overall, sleep disorders were linked to a higher incidence of HF (pooled HR 1.46; 95% CI 1.30–1.63; pp < 0.001), whereas insomnia was not independently associated with HF (pooled HR 1.11; 95% CI 0.75–1.62; p = 0.609). The …

Beberapa Pemikiran Tentang Hak Milik Dalam Sistem Hukum Kita (Khusus Tentang Hak Milik Atas Tanah), Abdurrahman S.H.

Jurnal Hukum & Pembangunan

Abstract

Sekitar Penyanderaan Dalam Hukum Pajak, Muchtar Rosyidi, S.H.

Jurnal Hukum & Pembangunan

Abstract

Hukum Laut Dan Undang-Undang Perikanan, Prof. Frans E. Likadja, S.H.

Jurnal Hukum & Pembangunan

Abstract

Beberapa Aspek Hukum Perdata Internasional Dalam Perjanjian Lisensi Pesawat, Hendarmin, S.H.

Jurnal Hukum & Pembangunan

Abstract

Penerbangan Dan Angkutan Udara Di Indonesia Dan Pengaturannya, E. Suherman S.H.

Jurnal Hukum & Pembangunan

Abstract

Industrial-Grade Hardening Of J-Groove Plasma Systems: Enhancing Durability And Environmental Resilience For V8.5 Commercial Deployment, Michael Victor Caldwell Mr.

Defensive Publications Series

This disclosure describes GCI Invention #18 v8.4, an adaptive helical groove geometry (“J‑Groove Forced Shedding”) designed to significantly increase the aerodynamic lift coefficient and broadband lock‑in range of vortex‑induced vibration (VIV) energy harvesters. The invention introduces a variable‑pitch J‑profile, plasma‑infused groove walls, and embedded fiber‑optic strain gauges to enable real‑time resonance tuning. The system increases vortex energy extraction by up to 40%, expands lock‑in from 3–25 mph, and provides a durable, manufacturable solution using PCB‑etched electrodes and fractal‑morphology triboelectric surfaces. This disclosure establishes prior art for adaptive forced‑shedding geometries used in bladeless wind harvesters, structural …

Premature Narrative Closure And Drift In Recursive Multi-Agent Reasoning Systems, Thom Pham

Defensive Publications Series

While experimenting with recursive reasoning systems composed of multiple agents exchanging intermediate beliefs, a recurring structural behavior was observed. Even when outputs remained syntactically valid and deterministic decoding was used, belief reinforcement cycles sometimes produced premature narrative closure before any explicit error appeared. Once such closure occurred, later perturbations could propagate and amplify through the recursive interaction loop. This note describes the phenomenon and proposes a simple stability principle governing epistemic authority in recursive reasoning systems.