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Abstract Background In Saudi Arabia, approximately one-third of colorectal cancer (CRC) patients are diagnosed at an advanced stage. Late diagnosis is often associated with a worse prognosis. Understanding the risk factors for late-stage presentation of CRC is crucial for developing targeted interventions enabling earlier detection and improved patient outcomes. Methods We conducted a retrospective cohort study on 17,541 CRC patients from the Saudi Cancer Registry (1997–2017). We defined distant CRCs as late-stage and localized and regional CRCs as early-stage. To assess risk factors for late-stage CRC, we first used multivariable logistic regression, then developed a decision tree to segment regions by late-stage CRC risk, and finally used stratified logistic regression models to examine geographical and sex variations in risk factors. Results Of all cases, 29% had a late-stage diagnosis, and 71% had early-stage CRC. Young (

الملخص: أهداف البحث: مقارنة أداء فلوريد ثنائي أمين الفضة المعالج بالضوء مع فلوريد ثنائي أمين الفضة غير المعالج بالضوء من حيث الخصائص المختلفة. طريقة البحث: بعد استرجاع الأوراق البحثية (حتى أبريل 2023) من قواعد البيانات الإلكترونية (''بابميد'' و ''سكوبس'' و ''ساينس دايركت'') باستخدام العوامل المنطقية، تم البحث يدويا في قوائم الاقتباسات الخاصة بالأوراق المضمنة. كانت جميع المقالات المضمنة عبارة عن دراسات أصلية نصية كاملة أجريت باللغة الإنجليزية والتي قيمت تأثير فلوريد ثنائي أمين الفضة المعالج بالضوء وقارنته بفلوريد ثنائي أمين الفضة وحده. تم تقييم خطر التحيز في الدراسات المختبرية على مواد طب الأسنان باستخدام القائمة المرجعية المعدلة للمعايير الموحدة لتجارب إعداد التقارير. النتائج: تم تضمين ست دراسات في المجموع للتحليل النوعي بعد البحث اليدوي الشامل والبحث في قاعدة البيانات الإلكترونية. وكانت خمس دراسات عبارة عن دراسات في المختبر وواحدة كانت دراسة خارج الجسم الحي. قارنت كل دراسة فلوريد ثنائي أمين الفضة المعالج بالضوء مقابل فلوريد ثنائي أمين الفضة غير المعالج بالضوء من حيث الخصائص المختلفة مثل عمق الاختراق، وترسيب أيونات الفضة، وصلابة العاج، وتشكل السطح، والخصائص المضادة للبكتيريا. تم تصنيف غالبية الدراسات (4/6) على أنها ذات جودة منخفضة وتحيز عالي المخاطر، في حين تم الحكم على الدراستين المتبقيتين بأنها ذات جودة عالية وتحيز منخفض المخاطر. الاستنتاجات: في حدود هذا البحث، أظهر فلوريد ثنائي أمين الفضة المعالج بالضوء أنه طريقة فعالة لتعزيز خصائص فلوريد ثنائي أمين الفضة بالمقارنة مع فلوريد ثنائي أمين الفضة غير المعالج بالضوء. لا تزال الدراسات المستقبلية عالية الجودة ضرورية للتحقق من هذه النتائج، وخاصة التجارب السريرية العشوائية. يمكن أن يكون استخدام المعالجة الضوئية بفلوريد ثنائي أمين الفضة بمثابة استراتيجية مفيدة تعزز الاستخدام السريري لفلوريد ثنائي أمين الفضة. إن مراجعة المقارنة بين الخصائص المختلفة لفلوريد ثنائي أمين الفضة المعالج بالضوء وفلوريد ثنائي أمين الفضة غير المعالج بالضوء ستساعد الأطباء على تعزيز استخدامه السريري وقبول المريض. Abstract: Objective: This study was aimed at comparing the performance of light-cured (LC) silver diamine fluoride (SDF) to non-LC SDF in dental applications, in terms of various properties. Methods: Articles published until April 2023 were retrieved from electronic databases (PubMed, Scopus and Science Direct) according to Boolean operators, and the reference lists of the included articles were manually searched. The included articles were all full-text, original studies in English that assessed the effects of LC SDF compared with SDF alone. The risk of bias in the in vitro studies on dental materials was evaluated with the modified Consolidated Standards of Reporting Trials (CONSORT) checklist. Results: Six studies (five in vitro and one ex vivo) were included in qualitative analysis after a comprehensive manual search and electronic database search. Every study compared LC SDF versus non-LC SDF in terms of properties such as penetration depth, silver ion precipitation, dentine hardness, surface morphology and anti-bacterial characteristics. Four studies were categorised as low quality with a high risk of bias, whereas the remaining two studies were considered high quality with a low risk of bias. Conclusion: In this investigation, LC SDF, compared with non-LC SDF, was found to be an efficacious approach for enhancing SDF properties. Future high-quality studies, particularly randomised clinical trials, remain necessary to verify these findings. Clinical significance: The use of light curing with SDF can be a beneficial strategy that enhances SDF's clinical use. This review comparing various properties of LC SDF and non-LC SDF may help clinicians enhance clinical use and patient acceptance of LC SDF.

Objective While the Gulf Cooperation Council (GCC) countries have demonstrated a strong commitment to strengthening primary healthcare (PHC), the costs of delivering these services in this region remain relatively unexplored. Understanding the costs of PHC delivery is essential for effective resource allocation and health system efficiency.Design We used an ingredient-based method to estimate the cost of delivering a selection of services at PHC facilities in the six GCC countries in 2019. Services were categorised into eight programmes: immunisation; non-communicable diseases (NCDs); oral and dental care; child health; nutrition; mental health; reproductive, maternal, neonatal and child health and general practice. The cost estimation focused on two key ingredients: the costs of drugs and supplies and the healthcare workforce cost. The coverage rates of specific types of health services, including screening and mental health services, were also estimated. Data for the analysis were obtained from ministries of health, health statistics reports, online databases, national surveys and scientific literature.Results The estimated costs of delivering the selected services at public PHC facilities in the six GCC countries totalled US$5.7 billion in 2019, representing 0.34% of the combined 2019 GDP. The per capita costs varied from US$69 to US$272. General practice and NCD programmes constituted 79% of the total costs modelled while mental health ranged between 0.0% and 0.3%. Over 8 million individuals did not receive NCD screening services, and over 30 million did not receive needed mental health services in public PHC facilities across the region.Conclusions To our knowledge, this is the first study to estimate the costs of services delivered at PHC facilities in the GCC countries. Identifying the main cost drivers and the services which individuals did not receive can be used to help strengthen PHC to improve efficiency and scale up needed services for better health outcomes.

Background: Physical activity is a very positive behavior that has many health benefits, so understanding current physical activity levels in specific populations is important for health policy planning. Objective(s): to estimate physical activity patterns and to investigate the relationship between physical activity performance and using smartphone health applications among university students in Riyadh, Saudi Arabia. Methods: This cross-sectional study estimated physical activity patterns among King Saud University students. An online survey was distributed to all students attending King Saud University. The survey included questions on socio-demographic characteristics and the International Physical Activity Questionnaire Short Form (IPAQ-SF). Results: A total of 427 students were enrolled in the study. More than half of the students were low in physical activity (56.2%) followed by moderate and high levels (30.7 %, and 13.1% respectively). More than half of them used their smartphones five hours or more per day (53.6%), and the majority (65.1%) used applications to monitor physical activity. Bivariable analysis revealed a significant association between physical activity and using applications to monitor health and using applications or wearable devices to monitor physical activity. Additionally, a significant association between physical inactivity and hours of using a smartphone per day was detected. Conclusion: Low physical activity was prevalent among students at King Saud University. Targeted interventions are needed to enhance physical activity and prevent sedentary behaviors to prevent long-term adverse health consequences.

Cyanobacterial blooms are increasingly common during winters, especially when they are mild. The goal of this study was to determine the summer and winter phytoplankton community structure, cyanotoxin presence, and toxigenicity in a eutrophic lake susceptible to cyanobacterial blooms throughout the year, using classical microscopy, an analysis of toxic cyanometabolites, and an analysis of genes involved in biosynthesis of cyanotoxins. We also assessed whether cyanobacterial diversity in the studied lake has changed compared to what was reported in previous reports conducted several years ago. Moreover, the bloom-forming cyanobacterial strains were isolated from the lake and screened for cyanotoxin presence and toxigenicity. Cyanobacteria were the main component of the phytoplankton community in both sampling times, and, in particular, Oscillatoriales were predominant in both summer (Planktothrix/Limnothrix) and winter (Limnothrix) sampling. Compared to the winter community, the summer community was denser; richer in species; and contained alien and invasive Nostocales, including Sphaerospermopsis aphanizomenoides, Raphidiopsis raciborskii, and Raphidiopsis mediterranea. In both sampling times, the blooms contained toxigenic species with genetic determinants for the production of cylindrospermopsin and microcystins. Toxicological screening revealed the presence of microcystins in the lake in summer but no cyanotoxins in the winter period of sampling. However, several cyanobacterial strains isolated from the lake during winter and summer produced anabaenopeptins and microcystins. This study indicates that summer and winter blooms of cyanobacteria in the temperate zone can differ in biomass, structure, and toxicity, and that the toxic hazards associated with cyanobacterial blooms may potentially exist during winter.

Abstract Background This systematic review was conducted to identify health beliefs and modifying factors influencing physical (in) activity among adult women in Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). Methods A comprehensive search of the Medline (Ovid), EMBASE, Cochrane Central, Web of Science, and Google Scholar databases was conducted to identify relevant articles published between 2009 and 2019. The quality of included studies was assessed using the Mixed Methods Appraisal Tool. Data collection and analysis based on the health belief model were performed to systematically examine the relationships of health beliefs and modifying factors to physical activity. Results The sample comprised 15 studies (Saudi Arabia, n = 6; Oman, n = 5; Qatar, n = 2; Kuwait, n = 2). Reported physical activity prevalences were low (nearly 0% to 50%) and depended on the location, subpopulation, and measurement instrument. Evidence for relationships of modifying factors and health beliefs to physical activity was scarce and sometimes inconclusive. Among modifying factors, middle age and employment were associated positively with physical activity; marital status, educational level, income, and body mass index were not associated. Regarding health beliefs, the only conclusive evidence reported was that a lack of time was not associated significantly with physical activity in a population of men and women. Women reported a lack of social support and lack of skills significantly more frequently than men; these factors may explain the gender difference in physical activity prevalence. Differences in the reporting of fear of injury and lack of willpower were not significant. Conclusions Robust qualitative and quantitative research on the contributions of health beliefs and modifying factors to the low prevalence of physical activity among women in GCC countries is urgently needed. Current evidence indicates that unemployed women, women aged

Abstract Background Health education specialists play a major role in promoting a healthy lifestyle, preventing, and managing diseases. This study aimed at identifying the needed skills and knowledge of health education specialists with an interest in disease prevention and the transformation of healthcare in Saudi Arabia. Methods This study employed a qualitative case study approach, using focus group interviews. The study was conducted at King Saud University with three different stakeholder groups (alumni, employers, and faculty members) using convenience sampling. Data was analyzed using thematic analysis. Results We have conducted four focus group interviews with a total of 29 participants. We have identified five main themes from the data; Medical and clinical related knowledge and skills, Communication and engagement with the community, Planning and evaluating health programs, Health systems and health policy, and Marketing and technological skills. Participants highlighted the need to respond to the changing demands of the labor market, the different roles of health education specialists, and patient education vs. public education. Counseling and behavior change were viewed as key roles of health education specialists. In addition to the skills needed to create content and conduct research. Furthermore, equipping health education graduates in the fields of digital health and occupational health was viewed as a key factor in improving their employability and readiness for the labor market. Conclusion Study participants identified multiple skills and knowledge gaps which were deemed important to improve the quality of graduates from the health education program. Future studies are recommended to estimate their importance based on the rating of alumni, faculty staff, and employers.

Introduction: Recently, clinical trials have assessed the effectiveness of Silver Diamine Fluoride (SDF) as an indirect pulp capping material (IPC) in primary teeth. This systematic review aimed to assess the evidence presented in these trials. Data sources: A comprehensive search identified relevant studies through five electronic databases (PubMed, Scopus, ClinicalTrials.gov, ScienceDirect, and Cochrane). Search strategies were designed using the PICO model to identify all studies that investigated SDF as an IPC compared to calcium hydroxide (CaOH) or mineral trioxide aggregate (MTA). Quality assessment and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were used to assess the level of evidence. Study selection: Four clinical trials were found to be suitable for inclusion in the qualitative synthesis and three studies were included in the quantitative analysis. Three studies compared SDF with CaOH and only one study compared SDF, CaOH, and MTA. Only one randomized controlled trial (RCT) had a low risk of bias, and the non-RCT study had a moderate risk of bias. The level of evidence based on the GRADE was low. Three out of four studies showed higher clinical and radiographic outcomes with SDF than with CaOH. One non-RCT study showed that SDF resulted in the least reparative dentin at the 6-months follow-up. The meta-analysis showed a non-significant difference between the SDF and CaOH groups (P = 0.36). Conclusion: There is little evidence showing a higher clinical and radiographic outcome of SDF compared to CaOH as an IPC material in primary molars. Clinical significance: This systematic review updates pediatric dentists regarding the effectiveness of using SDF as indirect pulp caping in primary teeth.

Trichotillomania (TTM) is a less addressed cause of alopecia. Refusal to accept this condition as a psychiatric illness causes marked delay in seeking help. This article aims to evaluate the treatment response of TTM patients. This is a case series study on 5 patients (4 females, 1 male) of TTM, of whom 3 patients took treatment on an outpatient basis (obsessive-compulsive and related disorders clinic) and 2 patients at indoor (orange unit) at the Department of Psychiatry, Bangabandhu Sheikh Mujib Medical University, from January 2022 to July 2023. Out of 7 cases, 2 patients did not come after the 1st follow-up. Pharmacological management was chosen according to established guidelines. All patients were given basic psychoeducation and relevant psychological intervention. A total of 5 cases were described. The median time to receive effective psychiatric treatment is 8.6 years (4–15 years). The median time to respond after starting therapy is 6 weeks. All patients responded well to selective serotonin reuptake inhibitors. Augmentation with low-dose antipsychotics and the addition of specific pharmacologic agents have been shown to improve outcomes. Psychological management helped patients most in achieving long-term remission. Despite the prolonged treatment gap, patients of TTM showed marked improvement with combined pharmacological and psychological intervention in a short time. Further study involving a more significant number of cases is needed to support the findings.

Abstract Background The 2021 American College of Rheumatology (ACR) rheumatoid arthritis (RA) guideline considers the specific context of the United States which differs from that of Saudi Arabia in many aspects that may impact recommendations. The objective of this project was to adapt a set of prioritized recommendations from the 2021 ACR guideline for the treatment of rheumatoid arthritis RA for the context of Saudi Arabia, by the Saudi Society for Rheumatology (SSR). Methods The process followed the GRADE-ADOLOPMENT methodology, and the reporting adhered to the RIGHT-Ad@pt checklist. Working groups included a coordination group and a 19-member panel representing different stakeholder groups. The Evidence to Decision (EtD) tables included evidence on health effects from the source guideline and contextual information from the Saudi setting. Results The panel prioritized and adapted five recommendations from the source guideline. The process led to modifying two out of the five prioritized recommendations, all listed here. In naive patients with low disease activity, methotrexate (MTX) is conditionally recommended over sulfasalazine (SSZ) (modified direction); hydroxychloroquine (HCQ) is conditionally recommended over SSZ (unmodified). Initiation of csDMARDs with short-term glucocorticoids is conditionally recommended over csDMARDs alone in naive patients with moderate to high disease activity (modified direction). Switch to subcutaneous MTX is conditionally recommended over addition/switch to alternative DMARD(s) in patients taking oral MTX who are not at target (unmodified). Discontinuation of MTX is conditionally recommended over gradual discontinuation of the bDMARD or tsDMARD for patients taking MTX plus a bDMARD or tsDMARD who wish to discontinue a DMARD (unmodified). Conclusion Rheumatologists practicing in Saudi Arabia can use the adoloped recommendations generated by this project while adopting the rest of the recommendations from the 2021 ACR guidelines.

Picture fuzzy set is the generalization of fuzzy set and intuitionistic fuzzy set. It is useful for handling uncertainty by considering the positive membership, neutral membership and negative membership degrees independently for each element of a universal set. The main objective of this article is to develop some picture fuzzy mean operators, including Picture Fuzzy Harmonic Mean (PFHM), Picture Fuzzy Weighted Harmonic Mean (PFWHM), Picture Fuzzy Arithmetic Mean (PFAM), Picture Fuzzy Weighted Arithmetic Mean (PFWAM), Picture Fuzzy Geometric Mean (PFGM) and Picture Fuzzy Weighted Geometric Mean (PFWGM), to aggregate the picture fuzzy sets. Moreover, we discuss some relevant properties of these operators. Furthermore, we apply these mean operators to make decisions with practical examples. Finally, to show the efficiency and the validity of the proposed operators, we compare our results with the results of existing methods and concluded from the comparison that our proposed methods are more effective and reliable.

Background There has been an increase in the number of policy support organizations (PSOs) that have been created to foster the systematic use of evidence in health system policymaking. Our aim was to identify approaches for establishing a PSO or similar entities by soliciting insights from those with practical experience with developing and operationalizing PSOs in real-world contexts. Methods We used a sequential mixed method approached. We first conducted a survey to identify the views and experiences of those who were directly involved in the establishment of PSOs that have been developed and implemented across a variety of political-, health- and research-system contexts. The survey findings were then used to develop a purposive sample of PSO leaders and refine an interview guide for interviews with them. Results We received 19 completed surveys from leaders of PSOs in countries across the WHO regions and that operate in different settings (eg, as independent organization or within a university or government department) and conducted interviews with 15 senior managers from nine PSOs. Our findings provide in-depth insights about approaches and strategies across four stages for establishing a PSO, which include: (i) building awareness for the PSO; (ii) developing the PSO; (iii) assessing the PSO to identify potential areas for enhancement; and (iv) supporting maturation to build sustainability in the long-term. Our findings provide rich insights about the process of establishing a PSO from leaders who have undertaken the process. Conclusion While all PSOs share the same objective in supporting evidence-informed policy-making (EIPM), there is no single approach that can be considered to be the most successful in establishing a PSO, and each country should identify the approach based on its context.

Global climate variations induce extreme temperatures and significantly decrease crop production, leading to food insecurity worldwide. Temperature extremes (mainly cold stress (CS): chilling 0–15 °C and freezing

angladesh is an agro-based country. Several vegetables and fruits contribute greatly to the national economy. Fruit fly species (Diptera: Tephritidae) have been a serious threat to agriculture in Bangladesh as well as worldwide. Morphological identification sometimes creates misidentification in adult stages, while in eggs, larvae and pupal stages are totally difficult. Nowadays, molecular identification based on DNA barcoding is an effective and rapid identification tool. However, this technique is very limited use in Bangladesh. In this study, adult samples were collected (trapping with ME and CUE) from three different geographic locations (Dhaka, Chittagong and Barisal) of Bangladesh. Adult flies were identified based on DNA barcoding (amplify the sequences with COI gene), and larvae were identified based on species-specific primers. Bactrocera dorsalis (Hendel), Zeugodacus tau (Walker) and Zeugodacus cucurbitae (Coquillett) were identified adult species found in all the locations, whereas B. dorsalis was found in a higher number. In case of host fly identification on the basis of larvae, B. dorsalis was identified from guava in three locations, indicating guava fruit is the suitable host in Bangladesh. Proper management should be taken to control these pest species; otherwise, they will become a great threat to the agriculture of Bangladesh.

BackgroundIn response to worldwide calls for the need to support evidence-informed policy-making (EIPM), more countries are increasingly interested in enhancing their efforts to use research to inform policy-making. In order to inform the efforts of those asked to lead the support of EIPM, our aim is to develop a conceptual framework to guide the process of establishing a policy support organization (PSO). MethodsWe conducted a critical interpretive synthesis (CIS). We conducted a two steps literature review. In the second step, we systematically searched OVID EMBASE, PsychInfo, HealthStar, CINAHL, Web of Science, Social Science Abstract, Health Systems Evidence, and ProQuest Dissertations and Theses Global databases for documents reporting the establishment of PSOs and the contextual factors influencing the process of establishing these organizations. We assessed the eligibility of the retrieved articles and synthesized the findings iteratively. ResultsWe included 52 documents in the synthesis. Our findings suggest that a PSO establishment process has four interconnected stages: awareness, development, assessment, and maturation. The process of establishing a PSO is iterative and influenced by political, research and health systems contextual factors, which determine the availability of the resources and the trust between researchers and policy-makers. The contextual factors have an impact on each other, and the challenges that arise from one factor can be mitigated by other factors. ConclusionFor those interested in establishing a PSO, our framework provides a road map for identifying the most appropriate starting point and the factors that might influence the establishment process. Leaders of such PSOs can use our findings to expand or refine their scope of work. Given that this framework focuses only on PSOs in the health sector, an important next step for research would be to include other sectors from social systems and identify any additional insight that can enhance our framework.

Abstract Background Epidemiological studies of incidence play an essential role in quantifying disease burden, resource planning, and informing public health policies. A variety of measures for estimating cancer incidence have been used. Appropriate reporting of incidence calculations is essential to enable clear interpretation. This review uses colorectal cancer (CRC) as an exemplar to summarize and describe variation in commonly employed incidence measures and evaluate the quality of reporting incidence methods. Methods We searched four databases for CRC incidence studies published between January 2010 and May 2020. Two independent reviewers screened all titles and abstracts. Eligible studies were population-based cancer registry studies evaluating CRC incidence. We extracted data on study characteristics and author-defined criteria for assessing the quality of reporting incidence. We used descriptive statistics to summarize the information. Results This review retrieved 165 relevant articles. The age-standardized incidence rate (ASR) (80%) was the most commonly reported incidence measure, and the 2000 U.S. standard population the most commonly used reference population (39%). Slightly more than half (54%) of the studies reported CRC incidence stratified by anatomical site. The quality of reporting incidence methods was suboptimal. Of all included studies: 45 (27%) failed to report the classification system used to define CRC; 63 (38%) did not report CRC codes; and only 20 (12%) documented excluding certain CRC cases from the numerator. Concerning the denominator estimation: 61% of studies failed to state the source of population data; 24 (15%) indicated census years; 10 (6%) reported the method used to estimate yearly population counts; and only 5 (3%) explicitly explained the population size estimation procedure to calculate the overall average incidence rate. Thirty-three (20%) studies reported the confidence interval for incidence, and only 7 (4%) documented methods for dealing with missing data. Conclusion This review identified variations in incidence calculation and inadequate reporting of methods. We outlined recommendations to optimize incidence estimation and reporting practices. There is a need to establish clear guidelines for incidence reporting to facilitate assessment of the validity and interpretation of reported incidence.

The influx of immigrants has led to increased cultural and ethnic diversity in classrooms, presenting unique challenges for teachers who work with pupils with varying linguistic, social, and cultural backgrounds. This paper examines the impact of these challenges on the wellbeing of teachers who work with newly arrived immigrant pupils. It is argued that a lack of knowledge and skills in this area can be educationally, socially, and psychologically demanding for teachers, negatively affecting their wellbeing. Teachers’ wellbeing can be influenced by two main factors: personal and internal factors such as perceptions and ideology and contextual and external factors such as workload, low student motivation, lack of support, conflict with colleagues, and role ambiguity. Despite the importance of teacher wellbeing, it has received less attention than pupils’ wellbeing. Using an ethnographic study that collected data over a school year in two phases, this paper investigates the perceptions and self-constructed pedagogies of the teacher working with newly arrived immigrant pupils. Findings reveal that the teacher’s emphasis on her wellbeing, as well as her pupils’ wellbeing, emerged as the center of her self-constructed approaches. We posit that ‘diversity-related teacher wellbeing’ is crucial in wellbeing pedagogy, given that diversity is one of the main elements in reception classes. For the successful education of newly arrived immigrant pupils, the wellbeing of teachers who work with this group should be prioritized. This paper contributes to the field of wellbeing education by highlighting the importance of teacher wellbeing as a part of wellbeing pedagogy for newcomer pupils. Improving teacher wellbeing may have a positive effect on the wellbeing of newly arrived immigrant pupils, creating a win-win situation. The paper concludes with suggestions for professional support and directions for future research.

Objectives: Patient ‘no-shows’ (failure to keep or cancel appointments) is a global problem that impacts healthcare systems by delaying patient access to healthcare, reducing quality of care, and wasting resources. The no-show phenomenon has not yet been studied in Oman despite it having grown in importance ever since the appointments system was implemented in 2014. This study aimed to characterize the no-shows in primary healthcare facilities in Oman. Methods: We collected and analyzed administrative data during the period 2014–2017 from 14 primary healthcare institutions in Oman focusing on the ophthalmology, ear, nose, and throat, and dermatology clinics therein. Results: The overall no-show rates were > 50.0%. No-show probabilities were higher in males, younger adults, new appointments, early morning appointments, appointments during Ramadan, and appointments scheduled farther in advance. Patient experience with the appointment system reduced the no-show probability. Conclusions: Policymakers should consider these trends to optimize the number of appointments per day, and researchers should further investigate no-shows for other specialties and levels of care.

The education of immigrant students, particularly newcomers, must be considered from a holistic framework. The conceptual article aims to highlight other important aspects of newcomers’ education, in addition to language and subject content learning. The three overlooked yet most important components of holistic education for newcomers are the following: (1) well-being pedagogy, (2) positive and comprehensive collaboration with newcomer parents, and (3) teachers’ positive ideology of newcomers and their families. This article begins with a brief presentation of the issue in newcomers’ education demonstrating an emphasis on some important yet overlooked elements in newcomer education. Consequently, in Norway, despite educational efforts aimed at supporting immigrant students, they continue to perform poorly compared with ethnic Norwegian students. Then, the paper defines what well-being pedagogy is and why well-being should be included in the comprehensive and successful schooling of newcomers. Here, well-being pedagogy is not limited to newcomer students’ well-being; rather, it includes teachers (who work with newcomers) and newcomer parents’ well-being. The why and how of comprehensive and successful collaboration with newcomer parents is discussed as a second important component. The third building block is teachers’ positive ideology of newcomers and their parents. The paper establishes that the positive ideology and perceptions of newcomer students and their families are the core of the holistic education of immigrant students. This paper contributes to knowledge development for the education of newly arrived immigrant students by engaging in a discussion that can foster teacher motivation and commitment, resulting in greater support for newcomer students. Second, even though this paper is framed in the context of Norwegian society, the aim is to inspire the international community of educators and researchers committed to an equitable learning environment for immigrant students to consider the topic for further exploration. The article concludes with teachers’ practice recommendations for schools and some directions for future research.

Gender disparity in higher education is changing whereby female are dominating male students. This paper is an attempt to identify the factors that are causing less male participation in higher education based on a systematic review of the literature. To conduct a systematic review, PRISMA statement guidelines are used. Electronic databases were searched resulting in retrievals of 4050 articles. Due to the limited literature on male disparity, 18 highly relevant peer-reviewed studies were selected from 2010 to 2019. The review of selected studies suggested factors that are categorized into eight segments. Based on the identified factors, a comprehensive conceptual framework has been developed. The findings of this paper are substantial and identified factors that can be used strategically to comprehensively study the gender disparity in higher education as a future way forward.

BackgroundMonitoring cancer trends in a population is essential for tracking the disease’s burden, allocating resources, and informing public health policies. This review describes variations in commonly employed methods to estimate colorectal cancer (CRC) incidence trends.MethodsWe performed a systematic literature search in four databases to identify population-based studies reporting CRC incidence trends, published between January 2010 and May 2020. We extracted and described data on methods to estimate trends and assess model validity, and the software used.ResultsThis review included 145 articles based on studies conducted in five continents. The majority (93%) presented visual summaries of trends combined with absolute, relative, or annual change estimates. Fourteen (10%) articles exclusively calculated the relative change in incidence over a given time interval, presented as the percentage of change in rates. Joinpoint regression analysis was the most commonly used method for assessing incidence trends (n= 65, 45%), providing estimates of the annual percentage change (APC) in rates. Nineteen (13%) studies performed Poisson regression and 18 (12%) linear regression analysis. Age-period-cohort modeling- a type of generalized linear models- was conducted in 18 (12%) studies. Thirty-nine (37%) of the studies modeling incidence trends (n=104, 72%) indicated the method used to evaluate model fitness. The joinpoint program (52%) was the statistical software most commonly used.ConclusionThis review identified variation in the calculation of CRC incidence trends and inadequate reporting of model fit statistics. Our findings highlight the need for increasing clarity and transparency in reporting methods to facilitate interpretation, reproduction, and comparison with findings from previous studies.

In Norway, newly arrived immigrant children often start their schooling in special groups called reception classes. This study aims to examine one Norwegian reception teacher’s perceptions and practices of collaborating with the children’s parents. The empirical analyses are based on a qualitative approach with interviews and video observations of the teacher. Affirming earlier research about parent–teacher collaboration in Norway, the study shows that the teacher has developed her own practices of parent–teacher collaboration. Contradicting earlier research, the findings highlight that despite challenges, the teacher experiences collaboration with newcomer parents positively. This article presents activities the teacher engages in within and outside the classroom to foster mutual learning and parental involvement. In the discussion, the teacher’s approaches are not judged as right or wrong, perfect or imperfect, but rather appreciated as self-constructed and self-initiated approaches to collaborating with newcomer parents. The main result is that despite challenges, if the teacher appears to be motivated and has positive/pluralistic perceptions of immigrant pupils and their parents, then s/he finds ways to collaborate with newcomer parents. This article concludes with teachers’ practice recommendations for schools and some directions for future research.

One of the greatest environmental concerns in the world is thought to be the effluents from the textile industry. The use of synthetic dyes in textiles makes the traditional method of treating textile effluents more difficult. Microorganisms can be used to remediate the damage that textile dyes do to the environment. In this investigation, two bacterial strains with the capacity of degrading dye were isolated from textile waste and identified as Pseudomonas sp. (Accession no. NR 117,678.1) and Bacillus sp. (Accession no: NR148248.1) through morphological, biochemical, and molecular test. The cytotoxicity of this wastewater on Artemia salina and phytotoxicity on Triticum aestivum were also investigated using brine shrimp lethality assay and plant growth analysis, respectively. Wheat seed germination was adversely affected by wastewater containing dyes, but subsequently germination was enhanced when the wastewater was treated by the isolated strains. Pseudomonas sp. degraded pink and green dyes more effectively than Bacillus sp., according to results of a comparison of the two bacteria's dye-degrading capacities using the spectrophotometric method. The dye degrading capacity of the bacteria was validated by the HPLC analysis. Therefore, both Pseudomonas species and Bacillus species could be used as efficient bacteria in the large-scale treatment of textile effluents.

Abstract Background Effective management of the spread of a novel infectious disease, such as the COVID-19 virus can be achieved through influencing people’s behavior to adopt preventive measures. The public’s perceptions and attitudes towards the virus, governmental guidance and preventive measures were unknown in Saudi Arabia. Objectives 1) investigate the public perception of COVID-19, anxiety level, the COVID-19 information sources sought, adoption of preventive measures, and ability and willingness to self-isolate during and post-lockdown periods of the COVID-19 pandemic in Saudi Arabia; 2) investigate socio-demographic factors associated with adoption of preventive measures against COVID-19 and self-isolation practices. Method Between April 22nd and June 21st 2020, Saudi adults aged ≥18 years voluntarily completed a self-administered web-based cross-sectional survey, distributed through social media (WhatsApp) and emails to representatives in education, health, business, and social sectors across all Saudi Arabian regions. The survey included questions on anxiety level, COVID-19 risk perceptions and adoption of preventive measures. Weighted percentages, Pearson’s chi-square tests, and multiple logistic regression were applied to evaluate associations between these factors and socio-demographic variables. Results A total of 2393 respondents completed the survey. A majority (74%) were worried about the COVID-19 outbreak and of those, 27% reported that it was likely that they would be infected with COVID-19; 16% believed it would be life-threatening or severe. However, only 11% of respondents reported high anxiety level. Adoption of hygiene practices and social distancing were lower among older (> 65 years) compared to younger (18–24 years) respondents (OR: 0.06; 95% CI: 0.01, 0.28 and OR 0.06; 95% CI: 0.01, 0.27 respectively). High percentages of respondents reported being able to (88%) and were willing to (82%) self-isolate. Those with the lowest gross household income and those with at least one flu symptom were less able and willing to self-isolate. A significant increase in levels of anxiety, perceived effectiveness of social distancing and hygiene practices was reported in the post-lockdown compared to during the lockdown. Conclusions The study reported high levels of adoption of preventive measures, willingness and perceived ability to self-isolate during the early phase of the pandemic. Vulnerable groups such as the elderly, and those with low socio-economic status reported lower adoption of preventive measures or ability and willingness to self-isolate. Tailored public health messages and interventions are needed to achieve high adherence to these preventive measures in these groups.

BackgroundThis study aimed to describe the demographic characteristics and determine the risk factors associated with disease severity and length of hospital and intensive care unit (ICU) stay in a cohort of COVID-19 patients admitted into ICU in Saudi Arabia.MethodsThis was a national, multi-center, retrospective cross-sectional study of all COVID-19 cases admitted into different ICUs in Saudi Arabia between March 2020 and September 202l. Demographic, clinical features, comorbidities, and length of stay (LOS) data were retrieved from the national Health Electronic Surveillance Network (HESN) and Taqassi databases at the Saudi Ministry of Health (MOH) for subsequent analyses. We used multiple linear regression models to determine risk factors associated with critical outcomes (including LOS in ICU) among COVID-19 cases.ResultsA total of 12,436 COVID-19 patients were included in this study, with a mean age of 59.57 ± 18.30 years and 7,679 (62%) were

Abstract Background The admissions criteria for colleges of medicine and allied health professions include several cognitive predictors. Little is known of the admissions criteria for the allied health professions and their correlation with students’ academic performance. This study investigates predictors for students’ academic achievements at allied health colleges at King Saud University. Design Retrospective cohort study. Settings College of Applied Medical Sciences, College of Nursing, and Prince Sultan bin Abdulaziz College for Emergency Medical Services, Saudi Arabia. Participants The sample comprised 1634 students. Method The high school grade average (HSGA), aptitude test (APT) score, achievement test (ACT) score, and current grade point average (GPA) were retrieved. The data were analysed using Pearson’s correlation coefficient and regression analysis. Results HSGA, ACT, and APT were significantly positively associated with students’ academic performance in colleges for all allied health professions. Multivariate regression analysis showed that the most predictive variable for all allied healthcare professions was HSGA (β = 0.347), followed by ACT (β = 0.270) and APT (β = 0.053) scores. The regression model indicated that the HSGA, APT, and ACT together predicted 26.5% of the variation in students’ cumulative GPAs at the time of graduation. Conclusion The admissions criteria for the allied health colleges at King Saud University predicted only 26.5% of the students’ cumulative GPA at the time of graduation. Other noncognitive admission criteria should be taken into consideration to improve the prediction of students’ academic potential.

The concept of wellbeing in education is complex and multifaceted, with inconsistent definitions, philosophical conceptualizations, and research approaches. This paper proposes a theoretical framework for understanding and promoting comprehensive wellbeing in school education, drawing insights from global in general and the Norwegian context in particular. The paper begins by reviewing the literature on wellbeing and wellbeing in educational policies to identify common threads in contemporary understandings and approaches to wellbeing, highlighting important issues in its conceptualization. The analysis shows the need for a holistic understanding of wellbeing, encompassing its multiple dimensions, which should be introduced and advocated in schools. The paper contributes to a more comprehensive and holistic concept of wellbeing that should be an integral part of school education. The discourse highlights the emergence of an alternative, commonly agreed theoretical framework for holistic wellbeing, drawing together different dimensions of wellbeing and interconnectedness and focusing on students’ strengths. The paper concludes by discussing the implications of the framework for future research and practice. The framework offers a comprehensive and integrative approach to understanding and promoting wellbeing in school education, which can guide the development of interventions and policies that address the multiple factors influencing students’ wellbeing. The framework also highlights the need for interdisciplinary collaboration and a systems approach to wellbeing in education, which can promote a holistic and sustainable approach to education that benefits both students and society.

Bangladesh, the smallest but populous country in the South Asia region with 160 million people, More than 60% of its citizens live in the villages, and 50% of the total population depends on agriculture. Rural people also control more than 30% of the entire economy. Most of the village people are highly interested in cultivation and other production where needs physical effort, but they were suffering from the fund crisis that hinders the production of crops and the cultivation of fisheries and livestock. Due to the financial crisis, they involved their children in cultivating and farming instead of sending them to school. According to the necessity of financing to planting different aspects, they are collect petty cash as a short term loan from neighborhood moneylenders and other various NGOs at a high rate of interest. This orientation carries unlimited agonies to the country based business visionaries. The Trending Microfinance Institutions (MFIs) provides small loans among low salaries in Bangladesh with the end goal of lightening neediness and enabling poor people. Commercial business banks in Bangladesh are likewise connected to offer smaller-scale money related administrations. Islami Bank Bangladesh Limited, a private Islamic oriented bank, offered the Rural Development Scheme (RDS). This imaginative Islamic microfinance system answers the interest of the country Muslim poor in Bangladesh, who were forgotten about from ordinary smaller scale financing because of religious convictions. The RDS's key empowering agents are social condition, a helpful strategy condition, institutional and authoritative limit, and a devoted administration with the vision to scale up the RDS program in Bangladesh. In contrast to customary NGOs and microfinance organizations (MFI), Islamic MFIs lend advance cash in kind; the product's responsibility carefully lies with the store to the supplier until the client has wholly reimbursed the agent. The reason for this paper is to analyze the capability of Islamic Microfinance as an elective apparatus for destitution lightening. This RDS microfinance's analysis examined both economic and social effects and invested at a general end that this program remarkably affects the chosen financial parts of the customers. Data have been collected through questionnaires from the needy rural beneficiaries from selected three areas in Chittagong district named Boalkhali, Banskhali, and Baroyiarhat. The choice of selected these three areas is located in the surround of the section from three sides. So the outcome of this questionnaire gave an approximate picture of the district. Collected data have been analyzed using different statistical tools to get the results and suggest policy implications, if any.

Introduction and Objective Interferential current IFC is one of the common electrotherapeutic modalities used in the treatment of painful conditions. Patients with musculoskeletal pain seek medical help in order to reduce their pain that could be achieved using IFC.The current review aims to analyze the recently available information regarding the efficacy of the IFC in alleviating the pain of musculoskeletal origin. State of knowledge IFC, as one of the medium frequency currents, has the advantage of being more comfortable and deeply penetrating so that it can reach deeper painful tissues. It has been proposed that IFC can relieve pain through stimulating different body mechanisms, such as the gate mechanism and the release of body opioids. However, the evidence behind the effectiveness of IFC as a pain-relieving modality for musculoskeletal pain has been poorly studied and still not conclusive Conclusions This systematic review will summarize the effects of IFC on relieving musculoskeletal pain as reported through improvement in visual analog scale, numeric pain rating scale, or the McGill pain questionnaire. Through searching multiple databases and including randomized controlled trials published during the last ten years, the findings of the current systematic review and meta-analysis will establish the quality of the recently available evidence and demonstrate if there will be a need for further studies.

ОBJЕCTІVЕ: Tо compare thе іmpаct оf monthly versus quarterly monitoring vіsіts оn thе ІMNCІ case management skills of health workers іn thе hеаlth fаcіlіtіеs оf dіstrіct Jаmshоrо. METHODOLOGY: Comparative Crоss-sеctіоnаl study was conducted at 4 Hеаlth fаcіlіtіеs оf Dіstrіct Jаmshоrо, from January to December 2015. There were total four Integrated Management of Childhood and Neonatal Illness (IMNCI) trained staff, one at each health facility. Hеаlth fаcіlіties having Integrated Management of Childhood and Neonatal Illness (IMNCI) trained stаff were іncludеd іn thіs study; while Hеаlth fаcіlіtieshaving IMNCI untrained mеdіcаl stаff were еxcludеd. Staff were trained by trainors during nine days IMNCI workshop. During training they were trained specifically about the detectoion of general danger signs, respiratory distress, dehydration, Throat / Ear infections, malaria and measles. RЕSULTS: Monthly monitoring visits had better results than the quarterly monitoring visits; regarding the detectoion of general danger signs, respiratory distress, dehydration, Throat / Ear infections, malaria and measles. Оut оf 4 hеаlth fаcіlіtіеs 2 hеаlth fаcіlіtіеs wеrе vіsіtеd оn mоnthly bаsіs (Taluka head Quarters Kоtrі and Government Dispensary Lower Sindh Barrage) аnd оthеr 2 оn quаrtеrly bаsіs (Government Dispensary Petaro ОPD and Government Dispensary Chrіstіаn cоlоny), competency of staff was assessed and compared. Gеnеrаl Dаngеr Sіgns (11.5±2.646 versus 8.67±3.367) Cоugh оr Dіffіcult Brеаthіng (13±1.826 versus 8.83±3.070), Dіаrrhеа (13±1.826 versus 8.83±3.070), Sоrе Thrоаt (11.5±2.646 versus 8.67±3.367), Еаr Prоblеm (11.5±2.64 versus 8.67±3.367), mаlаrіа (12.25±3.096 versus 8.83±3.070) and mеаslеs (11.75±2.630 versus 8.75±3.223) CОNCLUSІОNS: We concluded that monthly follow-up visits had very good impact on the IMNCI strategy implementation in health facilities. Monitoring progress and evaluating results are key functions to improve the performance of those responsible for implementing health services.

Central Business Districts (CBDs) are impeccable areas of traffic attractions exacerbated by the increase of rapid population density, enormous urbanization, and increasing economic and commercial activities. Traffic congestion in the CBD areas is a perpetual problem for sustainable urban development. This study detailed the traffic congestion states and the factors influencing traffic congestion in the CBD areas of Khulna City. In this regard, spot speed, journey speed, running speed, and volume of all types of vehicles in the four CBD areas during peak and off-peak hours on both weekends and weekdays have been measured through manual counting and video recording methods. The traffic congestion state in the study area has been assessed through Level of Service, Speed Performance Index, Road Segment Congestion Index. The outcome of these indices revealed the worst congestion state in all CBD areas with breakdown flow. The Active Road Performance Index explained that inadequate parking facilities, illegal road occupancy by roadside vendors, and on-street parking decreased the road efficiency by 32 to 82% in different areas. The regular road users believed that congestion occurs mostly between 6.00 PM and 9.00 PM. This study found that rapid increase in vehicle population, poor public transport, pedestrians’ behavior, illegal road occupancy, and fragile enforcement of laws are leading the traffic condition of Khulna towards an unsustainable future. The outcome of this study will provide useful information for urban planners, policymakers, and practitioners to devise appropriate strategies for reducing congestion that would help to ensure a sustainable urban transport system.

Cyanobacteria of the order Nostocales, including Baltic Sea bloom-forming taxa Nodularia spumigena, Aphanizomenon flosaquae, and Dolichospermum spp., produce resting stages, known as akinetes, under unfavorable conditions. These akinetes can persist in the sediment and germinate if favorable conditions return, simultaneously representing past blooms and possibly contributing to future bloom formation. The present study characterized cyanobacterial akinete survival, germination, and potential cyanotoxin production in brackish water sediment archives from coastal and open Gulf of Finland in order to understand recent bloom expansion, akinete persistence, and cyanobacteria life cycles in the northern Baltic Sea. Results showed that cyanobacterial akinetes can persist in and germinate from Northern Baltic Sea sediment up to >40 and >400 years old, at coastal and open-sea locations, respectively. Akinete abundance and viability decreased with age and depth of vertical sediment layers. The detection of potential microcystin and nodularin production from akinetes was minimal and restricted to the surface sediment layers. Phylogenetic analysis of culturable cyanobacteria from the coastal sediment core indicated that most strains likely belonged to the benthic genus Anabaena. Potentially planktonic species of Dolichospermum could only be revived from the near-surface layers of the sediment, corresponding to an estimated age of 1–3 years. Results of germination experiments supported the notion that akinetes do not play an equally significant role in the life cycles of all bloom-forming cyanobacteria in the Baltic Sea. Overall, there was minimal congruence between akinete abundance, cyanotoxin concentration, and the presence of cyanotoxin biosynthetic genes in either sediment core. Further research is recommended to accurately detect and quantify akinetes and cyanotoxin genes from brackish water sediment samples in order to further describe species-specific benthic archives of cyanobacteria.

Objective: In this descriptive cross-sectional study we aimed, to assess the level of depression, anxiety, insomnia and distress symptoms experienced by healthcare providers during the COVID-19 pandemic in Saudi Arabia.Methods: All healthcare providers currently working in different hospitals were invited to participate in this study. Data gathering started in March 2020 to May 2020. The participants answered a five-part questionnaire which includes demographic data, a 9-item Patient Health Questionnaire, a 7-item Generalized Anxiety Disorder, a 7-item Insomnia Severity Index, and a 22-item Impact of Event Scale-Revised, which assess the level of depression, anxiety, insomnia, and distress.Results: Out of 200 healthcare providers, 40% were males. 52% were aged 31–40 years old, 61% were married. The majority of the participants were Saudi nationals (84%), 74% were nurses, 11% were physicians and 15% were other healthcare providers. More than half of the participants worked as front-liners (57%). Overall, 73, 69, 62, and 83% of all healthcare providers reported symptoms of depression, anxiety, insomnia, and distress, respectively. The analysis showed severe symptoms level of depression for physicians and nurses was 35% and 20% (p < 0.05), respectively. Only three of the independent variables made a unique contribution to the model (gender, profession, and working position) (p < 0.05).Conclusion: COVID-19 pandemic has a significant impact on the mental health of healthcare providers in Saudi Arabia. Female nurses and healthcare providers working in the frontline who were directly treating patients with COVID-19 are at increased risk of severe depression, anxiety and distress.

Liberation size plays a significant role to select a correct and successful concentration method for natural iron ores. This paper aims to evaluate the liberation size of two newly discovered iron ores, namely Zard Koh and Kulli Koh, existing in Chagai region of Pakistan. Zard Koh iron ore is mainly composed of maghemite along with the pyrite, chlorite, grossular and admontite as gangue minerals, whereas, Kulli Koh iron ore is comprised of hematite mostly with quartz, dravite and kaolinite as the gangue minerals. The representative samples of ores were pulverized and sieved to different size fractions. The liberation size of iron bearing minerals and gangues was investigated by analyzing the different size fractions of each ore using XRF (X-Ray Fluorescence), SEM (Scanning Electron Microscope) attached with EDS (Energy Dispersive Spectroscope). The XRF results revealed that the most probable liberation size of Zard Koh and Kulli Koh ores is most likely existing at -75+45 and -150+106 m, respectively. In order to confirm this liberation size, further evidences were collected using SEM and EDS examinations. It is interesting to note that the results obtained from SEM and EDS were quite in agreement with XRF results

This study was aimed to produce a culturally validated scale to determine the presence of stressful life events among adolescents in Bangladesh, and formulate the relative life change units for each event. The study used qualitative research, including a focus group and questionnaire, and quantitative analysis in the validation process. Researchers first developed a provisional stress scale that was translated in Bangla through a translation exercise. Using an open-ended question along with this provisional scale on a school sample of 449 (228 rated on imagination and 221 on actual experience) adolescents, researchers developed Dhaka stress scale– adolescent with 56 items and predictive interpretation of the overall score was made. Content validity was found excellent as item level content validity index was around 1 and the scale level validity index was 0.93. The correlation coefficient was 0.72 between this scale and adolescent life events stress scale. For reliability, Cronbach’s alpha values were ranged from 0.83 to 0.97. The scale is simple to administer to assess stress in adolescents and usable in both clinical and research settings.

Increasing human population and changing climate, which have given rise to frequent drought spells, pose a serious threat to global food security, while identification of high yielding drought tolerant genotypes remains a proficient approach to cope with these challenges. To offer a methodology for the evaluation of the drought-tolerant wheat genotypes based on the pheno-physiological traits, a field experiment was executed, entailing four wheat genotypes viz. BARI Gom 26, BAW 1158, BAW 1167, and BAW 1169 and two water conditions viz. control treatment (three times irrigation at 20, 50, and 70 DAS, i.e., 100% field capacity) and stressed treatment (no irrigation during the entire growing season). The results revealed that drought stress drastically reduced the days to booting, heading, anthesis and physiological maturity, relative water content (RWC), chlorophyll content, canopy temperature depression (CTD), and photo-assimilates-spike dry matter (SDM), grains spike−1 and grain yield of all wheat genotypes. In addition, the genotypes BAW 1167 and BARI Gom 26 remained more prone to adverse effects of drought as compared to BAW 1169 and BAW 1158. Furthermore, DS induced biosynthesis of compatible solutes such as proline, especially in BAW 1169, which enabled plants to defend against oxidative stress. It was inferred that BAW 1169 remained superior by exhibiting the best adaptation as indicated by the maximum relative values of RWC, total chlorophyll, CTD, proline content, SDM, grains spike−1, and grain yield of wheat. Thus, based on our findings, BAW 1169 may be recommended for general adoption and utilization in future wheat breeding programs aimed at developing potent drought-tolerant wheat genotypes to ensure food security on a sustainable basis.

Abstract Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with genetic and clinical heterogeneity. The interplay of de novo and inherited rare variants has been suspected in the development of ASD. Here, we applied whole exome sequencing (WES) on 19 trios from singleton Saudi families with ASD. We developed an analysis pipeline that allows capturing both de novo and inherited rare variants predicted to be deleterious. A total of 47 unique rare variants were detected in 17 trios including 38 which are newly discovered. The majority were either autosomal recessive or X-linked. Our pipeline uncovered variants in 15 ASD-candidate genes, including 5 (GLT8D1, HTATSF1, OR6C65, ITIH6 and DDX26B) that have not been reported in any human condition. The remaining variants occurred in genes formerly associated with ASD or other neurological disorders. Examples include SUMF1, KDM5B and MXRA5 (Known-ASD genes), PRODH2 and KCTD21 (implicated in schizophrenia), as well as USP9X and SMS (implicated in intellectual disability). Consistent with expectation and previous studies, most of the genes implicated herein are enriched for biological processes pertaining to neuronal function. Our findings underscore the private and heterogeneous nature of the genetic architecture of ASD even in a population with high consanguinity rates.

Stress is an integral part of daily life and inevitable. This study was aimed to produce a culturally validated scale for measuring stressful life events of adults in Bangladesh and formulate the relative life change units of each event. The study used qualitative research, including a focus group and questionnaire, as well as quantitative statistical analysis in the validation process. Researchers first developed a provisional scale with 62 items that were translated in Bangla through a translation exercise. Using an open-ended question along with this provisional scale on 518 (260 rated on imagination and 258 on experience) subjects, researchers developed Dhaka Stress Scale-Adult with 58 items and the predictive interpretation of the overall score was made. Content validity was found excellent as I-CVI was 1 except 3 items and S-CVI was 0.91. In factor analysis on the two-factor model, no item had salient loading on more than one factor and there were 3 items failed to load on either factor. The correlation coefficient was 0.84 between this scale and the Presumptive Stressful Life Events Scale. In term of reliability, Cronbach’s alpha values were ranging from 0.53-0.88. The scale is simple to administer to assess stress and usable for both clinical and research purpose.

The coronavirus 2019 (COVID-19) pandemic has a direct and indirect effect on the different healthcare systems around the world. In this study, we aim to describe the impact on the utilization of emergency medical services (EMS) in Saudi Arabia during the COVID-19 pandemic. We studied cumulative data from emergency calls collected from the SRCA. Data were separated into three periods: before COVID-19 (1 January–29 February 2020), during COVID-19 (1 March–23 April 2020), and during the Holy Month of Ramadan (24 April–23 May 2020). A marked increase of cases was handled during the COVID-19 period compared to the number before pandemic. Increases in all types of cases, except for those related to trauma, occurred during COVID-19, with all regions experiencing increased call volumes during COVID-19 compared with before pandemic. Demand for EMS significantly increased throughout Saudi Arabia during the pandemic period. Use of the mobile application ASAFNY to request an ambulance almost doubled during the pandemic but remained a small fraction of total calls. Altered weekly call patterns and increased call volume during the pandemic indicated not only a need for increased staff but an alteration in staffing patterns.

The complexity and diversity of clinical manifestations of obsessive-compulsive disorder have intrigued psychiatrists for a long time. Various differences have been noted in the presentation of obsessive-compulsive disorder of different age group. It was aimed to assess the variations of presentation of symptoms in children and adults in a tertiary level hospital. This study was done in an outpatient department from May 2015 to April 2017. Four hundred patients were included in the study consecutively after considering the inclusion and exclusion criteria. Respondents were interviewed with a semi-structured questionnaire which includes demographic variables, psychiatric diagnoses (DSM-IV-TR) and Y-BOCS symptom checklist. Obsessive-compulsive disorder started before adulthood in 41.5% of patients and onset after 18 years was found to be 58.5%. In this study, cases of obsessions, dirt and contamination was seen to predominate in both early- and late-onset obsessive compulsive disorder (68.3 and 71.4% respectively) and among the cases of compulsions, cleaning variety was found to be highest in both early- and late-onset (65.8 and 73.3% respectively). Age should be taken into account when evaluating obsessive compulsive disorder patients. The results suggest that more studies are necessary to determine whether in fact, it defines a homogeneous and particular group in obsessive-compulsive disorder.

Periodontitis is a chronic inflammatory disease of the periodontal tissues (periodontium) which surround and support the teeth, that results in attachment loss and alveolar bone destruction leads to ultimate tooth loss. It is caused by the bacteria present in dental plaque, which is a tenacious substance that forms on teeth and gingiva just after teeth are brushed. Periodontal treatment is aimed at controlling the infection in order to stop the progression of the disease and to be able to maintain a healthy periodontium. Mechanical debridement of supragingival and subgingival biofilms, together with adequate oral hygiene measures is the standard periodontal therapy. This mechanical subgingi- val biofilm debridement consists of an initial (nonsurgical /phase I) phase involving scaling and root planing (SRP) and the elimination of plaque retentive factors, followed by a surgical phase (if needed) including the elevation of a tissue flap and bone remodeling in further stages. The adjunct use of antibiotics has proven to additionally improve the outcome of periodontal treatment. A clinical case of a 40-years-old male patient with generalized severe chronic periodontitis with localized gingival swell- ing was treated with nonsurgical (phase I) periodontal therapy that was confined to oral hygiene instruction (OHI), SRP with an adjunct antimicrobial regimen. Update Dent. Coll. j: 2017; 7 (2): 33-37

Simple and cost-effective methods with sufficient sensitivities for preliminary screening of cyanobacterial toxins are in high demand for assessing water quality and safety. We have recently developed a highly sensitive and rapid time-resolved fluorometry based non-competitive immunoassay for detection of microcystins and nodularins. The assay is based on a synthetic broad-specific anti-immunocomplex antibody SA51D1 capable of recognizing the immunocomplex formed by a generic anti-Adda monoclonal antibody (mAb) bound to either microcystins or nodularins. Using the same antibody pair, here we describe a very simple and cost-efficient non-competitive ELISA test for microcystins and nodularins based on conventional alkaline phosphatase (AP) activity measurement. The recombinant SA51D1 single-chain fragment of antibody variable domain (scFv) was produced as a fusion with bacterial alkaline phosphatase in Escherichia coli. After one step affinity purification through His-tag, the scFv-AP fusion protein could directly be used in the assay. For the assay, toxin standard/sample, biotinylated anti-Adda mAb and the scFv-AP were incubated together for one hour on streptavidin-coated microtiter wells, washed and AP activity was then measured by incubating (1 h at 37 ˚C) with chromogenic substrate para-nitrophenylphosphate (pNPP). The assay was capable of detecting all the eleven tested toxin variants (microcystin-LR, -dmLR, -RR, -dmRR, -YR, LA -LY, -LF -LW, -WR, and nodularin-R) below WHO guide line value of 1 µg L-1. The detection limit (based on blank+3SD response) for microcystin-LR was ~0.2 µg L-1. The assay was verified using spiked (0.25 - 4 µg L-1 of microcystin-LR) tap, river and lake water samples with recoveries from 64 to 101%. The assay showed good correlation (r2>0.9) with four reference methods for its performance in detecting extracted intracellular microcystin/nodularin from 17 natural surface water samples. The described easy-to-perform assay has a high potential to be used in resource-poor settings as quantitative measurements can be obtained using a simple ELISA reader or easy-to-interpret qualitative results by visual readout. Based on the non-competitive format, the assay does not need any chemical toxin conjugates and offers robustness as compared to the currently available competitive format assays.

Cyanobacterial blooms cause local and global health issues by contaminating surface waters. Microcystins and nodularins are cyclic cyanobacterial peptide toxins comprising numerous natural variants. Most of them are potent hepatotoxins, tumor promoters, and at least microcystin-LR is possibly carcinogenic. In drinking water, the World Health Organization (WHO) recommended the provisional guideline value of 1 µg/L for microcystin-LR. For water used for recreational activity, the guidance values for microcystin concentration varies mostly between 4−25 µg/L in different countries. Current immunoassays or lateral flow strips for microcystin/nodularin are based on indirect competitive method, which are generally more prone to sample interference and sometimes hard to interpret compared to two-site immunoassays. Simple, sensitive, and easy to interpret user-friendly methods for first line screening of microcystin/nodularin near water sources are needed for assessment of water quality and safety. We describe the development of a two-site sandwich format lateral-flow assay for the rapid detection of microcystins and nodularin-R. A unique antibody fragment capable of broadly recognizing immunocomplexes consisting of a capture antibody bound to microcystins/nodularin-R was used to develop the simple lateral flow immunoassay. The assay can visually detect the major hepatotoxins (microcystin-LR, -dmLR, -RR, -dmRR, -YR, -LY, -LF -LW, and nodularin-R) at and below the concentration of 4 µg/L. The signal is directly proportional to the concentration of the respective toxin, and the use of alkaline phosphatase activity offers a cost efficient alternative by eliminating the need of toxin conjugates or other labeling system. The easy to interpret assay has the potential to serve as a microcystins/nodularin screening tool for those involved in water quality monitoring such as municipal authorities, researchers, as well as general public concerned of bathing water quality.

The aim of this study was to compare the specific psychiatric diagnosis, frequency, and types of stressors, and the level of awareness about marriage law between married (cases; n=80) and unmarried girls (control; n=80) with one or more psychiatric disorders below the age of 18 years. The psychiatric diseases were diagnosed according to Axis One of ICD-10 clinical diagnoses of multi-axial classification of childhood and adolescent psychiatric disorder. Psychosocial stressors were considered on the basis of Axis Five of this classification. Of the cases, major depressive disorder was the highest (n=47) and next was a dissociative (conversion) disorder (n=24). Among the controls, generalized anxiety disorder (n=31) was the most prevalent followed by obsessive-compulsive disorder (n=17). The difference was highly significant (p>0.001). The cases reported a significant excess of psychosocial stressors than that of the controls to the onset of the psychiatric disorder. All the cases had associated stressors. In contrast, 77 out of 80 control patients had stressors. Marriage itself played as a stressor in the 78 cases. Beside this, other highly frequent stressors were marital discord followed by drop out from study and trouble with in-laws. Among the controls, the highest reported stressor was increased academic workload and next two commonest stressors were poor academic performance and discord with peers. Interestingly, 52.5% of the cases were having knowledge about the law on the age of marriage and that was 32.5% among the controls. It was significant that most of the girls breached their continuity of education after marriage (p>0.001). In conclusion, psychosocial stressors including marriage have a causal relationship with depressive and conversion disorder.

Bipolar mood disorder is a mental disorder with a lifetime prevalence rate of about 1% in the general population and there are still a proportion of individuals who suffer from bipolar mood disorders that are resistant to standard treatment. Reporting clozapine responsive mania that was not responding to two previous consecutive atypical antipsychotics and one typical antipsychotic was aimed at. A 17-year-old male manic patient was admitted into the psychiatry inpatient department and was nonresponsive to Risperidone 12 mg daily for 4 weeks, Olanzapine 30 mg daily for 3 weeks, and Haloperidol 30 mg daily for 3 weeks, along with valproate preparation 1500 mg daily. He was started on clozapine as he was nonresponsive to Lithium in previous episodes and did not consent to starting Electroconvulsive Therapy (ECT). He responded adequately to 100 mg clozapine and 1500 mg valproate preparation and remission happened within 2 weeks of starting clozapine. Clozapine can be a good option for resistant mania and further RCT based evidences will strengthen the options in treating resistant mania.

Nodularin (NOD) is a cyclic penta-peptide hepatotoxin mainly produced by Nodularia spumigena, reported from the brackish water bodies of various parts of the world. It can accumulate in the food chain and, for safety reasons, levels of NOD not only in water bodies but also in food matrices are of interest. Here, we report on a non-competitive immunoassay for the specific detection of NOD. A phage display technique was utilized to interrogate a synthetic antibody phage library for binders recognizing NOD bound to an anti-ADDA (3-Amino-9-methoxy-2,6,8-trimethyl-10-phenyldeca-4(E),6(E)-dienoic acid) monoclonal antibody (Mab). One of the obtained immunocomplex binders, designated SA32C11, showed very high specificity towards nodularin-R (NOD-R) over to the tested 10 different microcystins (microcystin-LR, -dmLR, -RR, -dmRR, -YR, -LY, -LF, -LW, -LA, -WR). It was expressed in Escherichia coli as a single chain antibody fragment (scFv) fusion protein and used to establish a time-resolved fluorometry-based assay in combination with the anti-ADDA Mab. The detection limit (blank + 3SD) of the immunoassay, with a total assay time of 1 h 10 min, is 0.03 µg/L of NOD-R. This represents the most sensitive immunoassay method for the specific detection of NOD reported so far. The assay was tested for its performance to detect NOD using spiked (0.1 to 3 µg/L of NOD-R) water samples including brackish sea and coastal water and the recovery ranged from 79 to 127%. Furthermore, a panel of environmental samples, including water from different sources, fish and other marine tissue specimens, were analyzed for NOD using the assay. The assay has potential as a rapid screening tool for the analysis of a large number of water samples for the presence of NOD. It can also find applications in the analysis of the bioaccumulation of NOD in marine organisms and in the food chain.

West Indian scholars have overlooked the role played by the Muslim leadership in West Africa in bringing an end to the transatlantic trade in Africans. The jihād movements in West Africa in the late eighteenth century gave political unity to West Africa challenging the collaboration of European trade in Africans with the pagan slave traders. West Indian historiography, while emphasizing European abolitionist movements, ignores the Islamic unity (tawhīd) of humankind, which brought together many ethnically heterogeneous enslaved African Muslims to successfully challenge the West Indian plantation system. The exploitation of the human resources and the immense wealth of the then Moghul India and Imperial China by British colonialism helped develop the British industrial capitalism, which controlled most of the world until the end of World War II. The security of the British industrial capitalist complex could no longer depend on the small-scale West Indian plantation economies but on the large-scale economies of Asia protected by the British imperial forces under the British imperial flag.