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The sudden and rapid changes in the world due to the COVID-19 pandemic have led to a shift in the educational methods used in educational facilities. Challenges faced by both students and lecturers have led to a quality difference in the education provided. This study was carried out on students who joined EFL English-99 and English-101 courses that enforced online learning during the 2019/2020 summer semester at Yarmouk University. A quantitative approach was used to answer the question of this study: What are the online learning challenges faced by English language students in an EFL context during COVID-19 Pandemic? A questionnaire of 52 items was sent online to 1,200 students to find the causes of the quality change. The items aimed to determine the effect on the student experience of the following challenges: infrastructure, computer skills, coordination, teaching methods, motivation & willingness, assessment methods and social aspects. The results showed the severity of the challenges as following: teaching methods, social aspects, infrastructure, computer skills and coordination all showed a high degree of challenge, and assessment methods, motivation & willingness came with a moderate degree of challenge. The researchers recommend conducting further research to determine solutions for the challenges faced by students in an EFL context in the online learning environment.

The purpose of this study is to investigate the effect of using a blended learning method on ninth grade students' achievements in English and their motivation towards learning it. The sample consisted of 100 female students selected purposefully and distributed into two groups: experimental and control. The experimental group studied English through a computerized program in the traditional method, while the control group was taught by the traditional method only. The results revealed statistically significant differences between the two groups in favor of the experimental group both in the achievement and the motivation towards learning English. The researchers recommended using computerized teaching in addition to the traditional method due to the positive results shown by the current study. In addition, they recommended conducting studies that measure the effect of blended learning on some aspects related to English language such as: vocabulary, spelling, pronunciation, or any other aspects.

Objective: The English‐language Postpartum Specific Anxiety Scale (PSAS) is a valid, reliable measure for postpartum anxiety (PPA), but its 51‐item length is a limitation. Consequently, the PSAS Working Group developed the PSAS Research Short‐Form (PSAS‐RSF), a statistically robust 16‐item tool that effectively assesses PPA. This study aimed to assess and validate the reliability of an Arabic‐language version of the PSAS‐RSF in Jordan (PSAS‐JO‐RSF). Methods: Using a cross‐sectional methodological design, a sample of Arabic‐speaking mothers (N = 391) with infants aged up to 6 months were recruited via convenience sampling from a prominent tertiary hospital in northern Jordan. Factor analysis, composite reliability (CR), average variance extracted (AVE), McDonald's ω, and inter‐item correlation measures were all examined. Results: Explanatory factor analysis revealed a four‐factor model consistent with the English‐language version of the PSAS‐RSF, explaining a cumulative variance of 61.5%. Confirmatory factor analysis confirmed the good fit of the PSAS‐JO‐RSF (χ2/df = 1.48, CFI = 0.974, TLI = 0.968, RMSEA = 0.039, SRMR = 0.019, p < 0.001). The four factors demonstrated acceptable to good reliability, with McDonald's ω ranging from 0.778 to 0.805, with 0.702 for the overall scale. The CR and AVE results supported the validity and reliability of the PSAS‐JO‐RSF. Conclusion: This study establishes an Arabic‐language version of the PSAS‐JO‐RSF as a valid and reliable scale for screening postpartum anxieties in Jordan. [ABSTRACT FROM AUTHOR]

This study aimed at comparing private and public schools in terms of students' achievement in English Language and parents' attitudes towards teaching their children in private schools. To achieve the aim of the study the researchers conducted a test to measure students' achievements in English language and they also distributed a questionnaire among the parents of the students in private schools. The sample of the study consisted of 165 students from two public schools and two private schools, and 66 parents. Means, standard deviations and T-test were used to analyze the results. Results showed that there are statistically significant differences in students' achievement in English language between students of private and public schools in favor of private schools, it also shows that there are statistically significant differences at (a = 0.05) in the parents' attitudes towards teaching their children in private schools due to the academic level, gender, and financial level variables.

Introduction: Although Jordan has made significant progress toward expanding the utilization of facility‐based intrapartum care, prior research highlights that poor service quality is still persistent. This study aimed to identify quality gaps between women's expectations and perceptions of the actual intrapartum care received, while exploring the contributing factors. Methods: Utilizing a pre–post design, quality gaps in intrapartum care were assessed among 959 women pre‐ and postchildbirth at a prominent tertiary hospital in northern Jordan. Data were gathered using the SERVQUAL scale, measuring service quality across reliability, responsiveness, tangibles, assurance, and empathy dimensions. Results: The overall mean gap score between women's expectations and perceptions of the quality of intrapartum care was −0.60 (±0.56). The lowest and highest mean gap scores were found to be related to tangibles and assurance dimensions, −0.24 (±0.39) and −0.88 (±0.35), respectively. Significant negative quality gaps were identified in the dimensions of assurance, empathy, and responsiveness, as well as overall service quality (p < 0.001). The MLR analyses highlighted education (β = 0.61), mode of birth (β = −0.60), admission timing (β = −0.41), continuity of midwifery care (β = −0.43), physician's gender (β = −0.62), active labour duration (β = 0.37), and pain management (β = −0.33) to be the key determinants of the overall quality gap in intrapartum care. Conclusion: Our findings underscore the importance of fostering a labour environment that prioritizes enhancing caregivers' empathetic, reassuring, and responsive skills to minimize service quality gaps and enhance the overall childbirth experience for women in Jordan. Patient or Public Contribution: This paper is a collaborative effort involving women with lived experiences of childbirth, midwives, and obstetrics and gynaecologist physicians. The original idea, conceptualization, data generation, and coproduction, including manuscript editing, were shaped by the valuable contributions of stakeholders with unique perspectives on intrapartum care in Jordan. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your understanding of the relationships between workplace stressors and job performance • To familiarise yourself with validated scales that can be used to measure stress, resilience and job performance • To consider measures that could be implemented to mitigate stressors, increase resilience and foster effective coping mechanisms among nurses. Background: Nurses are a crucial part of healthcare organisations, constituting around half of the global healthcare workforce. Therefore, it is important to examine the factors that may affect their job performance, which is central to the delivery of effective healthcare services. Aim: To examine the relationships between stress, resilience and job performance within the nursing context in Jordan. Method: A cross-sectional descriptive correlational design was used. A self-administered questionnaire comprising stress, resilience and job performance scales was completed by a convenience sample of 207 nurses working in five hospitals in the northern and middle regions of Jordan. Results: Overall, respondents self-reported moderate stress levels, normal resilience levels and moderate job performance. The study identified: a moderate positive correlation between stress and resilience; a weak negative correlation between stress and job performance; and a weak positive correlation between resilience and job performance. Conclusion: It is essential that nurse managers, leaders and policymakers implement measures to mitigate the stressors encountered by nurses, increase resilience and foster effective coping mechanisms. Such measures could enhance nurses’ resilience and job performance, ultimately improving patient care. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this paper is to examine a model that combines barriers, drivers, government responses, recovery expectations, expected future changes in performance and the extent of digitalisation as a moderator in SMEs. Design/methodology/approach: This study uses exploratory causal methodologies. The study employs a quantitative methodology based on utilising an electronic questionnaire to gather the opinions of home workers and entrepreneurs in Jordan. The cross-sectional data collection approach was conducted in a single time frame, and a total of 1,179 valid questionnaires were analysed using Smart PLS along with SPSS. Findings: The findings demonstrate that the barriers lower the expectations of recovering performance, whilst the drivers and government responses raise the expectations of both performance recovery and change in performance. Concerning digitalisation, this study discovered that firms going digital had a significant positive direct impact on expectations of performance change. This paper also found that expectations of performance change are significantly positively impacted by the interaction between drivers and digitalisation. However, the moderating influence of digitalisation on the positive impact of government responses on expectations of performance change was not verified. Practical implications: The study's conclusions led to the formulation of several policy recommendations aimed at easing the burden on SMEs. Originality/value: This study adds something new to the body of knowledge on SMEs by investigating the effects of barriers, drivers and government responses on expectations of performance recovery and the expected future change in performance moderated by digitalisation. [ABSTRACT FROM AUTHOR]

Jameed is a traditional dried dairy product in Jordan that is known under different names in the Middle East, Turkey, Central Asia, China, and Mongolia. It has been produced in the region for centuries and makes a significant contribution (up to 20%) to the income of small-scale traditional dairy processors who are based in sheep-producing districts. This study aims to assess the nutritional value of Jameed as a model for traditional dried fermented dairy products and to highlight the safety of the product quality and some of the health risks that may arise. For this purpose, 80 samples of Jameed were collected from the market covering all regions of the Kingdom of Jordan. The samples were analyzed for nutritional value and health risks by standard and approved methods. Results show that the total solids were 84.57%, with a large variation from 73 to 92%. Producers use a lot of salt to control elevated acidity during the drying of Jameed. The salt concentrations in collected samples were 15.68%. The average acidity was 6.79%. Moreover, farmers heavily use antibiotics to control mastitis without observing milk withdrawal. The residues of antibiotics were detected in 50.65% of the analyzed samples. The samples show large variations in measured values, reflecting differences in processing methods, homogeneity, and standardization. [ABSTRACT FROM AUTHOR]

The teachings and writings of John Dewey, an American philosopher and educator, offer insightful influences on contemporary education, not only in the United States but also worldwide. His philosophy of education, commonly referred to as Pragmatism, focused on learning by doing as an alternative to rote knowledge and strict teaching. The purpose of this study is to investigate the extent to which this philosophical thought is implemented in Jordanian public schools according to Jordanian teachers. Both quantitative and qualitative methods were employed in this study. The findings reveal that Jordanian teachers believe Pragmatism is implemented in Jordan to a moderate degree. (Contains 4 tables.)

Background: Adverse birth outcomes, such as preterm birth and low birth weight (LBW), are leading causes of neonatal morbidity and mortality. In this study, we aimed to estimate the association between inter‐pregnancy interval (IPI) and the risks of adverse birth outcomes in a subsequent pregnancy. Methods: We conducted a retrospective analysis involving 630 mothers who delivered a singleton live infant at a leading tertiary hospital in northern Jordan from March to August 2021. Outcome variables were preterm birth (<37 weeks of gestation) and LBW (<2.5 kg). Using multivariable logistic regression, the association between IPI and these two adverse birth outcomes was investigated. Results: The rates of preterm birth and LBW were 12.4% and 16.8%, respectively. Compared with an optimal IPI (24–36 months), a short IPI (<24 months) was positively associated with preterm birth (aOR: 4.09; 95% CI: 1.48–6.55) and LBW (aOR: 3.58; 95% CI: 1.57–5.15). Infants conceived after a long IPI (≥ 60 months) had increased odds of preterm birth (aOR: 3.78; 95% CI: 1.12–5.78) and LBW (aOR: 2.65; 95% CI: 1.67–4.03). Preterm delivery was also significantly associated with the mother's age (aOR: 1.10; 95% CI: 1.04–1.17), history of multiple cesarean births (aOR: 2.67; 95% CI: 1.14–4.29), prolonged rupture of membranes (aOR: 2.46; 95% CI: 1.10–5.52), and perinatal death (aOR: 3.42; 95% CI: 1.10–5.49). A mother's history of prior LBW (aOR: 4.39; 95% CI: 1.08–6.80), hypertensive disorders (aOR: 1.95; 95% CI: 1.03–3.89), and multiple cesarean births (aOR: 4.35; 95% CI: 2.10–6.99) was associated with LBW. Conclusions: Both short and long IPIs were related to preterm delivery and LBW. Optimal birth spacing is recommended to improve birth outcomes and must be considered when designing effective family planning programs. [ABSTRACT FROM AUTHOR]

The purpose of this study is to investigate the impact of using music on teaching English Poetry in Jordanian universities on students' performance. The researchers followed the equivalent pre/post T test two group designs. To achieve the aim of the study, a pre/post-test was constructed to measure students' performance in English poetry. The sample of this study consisted of 120 students (56 males and 64 females) from the third year students in Al Zaytoonah University during the first semester of the academic year 2011/2012. The subjects of the study were distributed into two groups (experimental group and control group). The experimental group was taught poetry accompanied with music while the control group was taught poetry using the traditional way of teaching. The subjects were 30 male students for the experimental group and 26 male students for the control group, while the female students for the experimental and control group were 31 and 33 respectively. Those subjects were distributed into two purposefully selected sections in Al Zaytoonah University in Amman. Descriptive statistical analyses were used (means and standard deviation) for the pre and post- tests of students' poetry test to experimental and control groups. Comparison statistical methods were used (Two Way ANOVA) analysis of variance to make a comparison between the control and the experimental groups and gender variable (male and female). The findings of the study indicated that there were statistically significant differences in the post- test between the control and the experimental groups in favor of the experimental group, and there was no statistically significant difference in the students' achievement due to gender. There was no statistically significant difference due to the interaction between gender and group. The researchers proposed some recommendations to enhance the effect of using music in teaching poetry on students' performance such as conducting further studies in other universities. (Contains 4 tables.)

Enhancing adherence to medication has the potential to improve clinical outcomes and decrease healthcare cost. The role of clinical pharmacist-led education on adherence to short-term antibiotic has never been investigated in Jordan. This study aimed to evaluate the impact of an educational intervention on antibiotic short-term adherence and to assess the antibiotic utilization pattern. A prospective, single blinded, randomized controlled study was conducted in a tertiary referral hospital in Jordan. Adult patients diagnosed with acute infection and prescribed a short-term antibiotic course (< 30 day) were included in the study. Recruited patients were randomly allocated into control and intervention groups. Pharmaceutical education about the correct use of antibiotic/s was provided to the intervention group. The results showed that penicillins were the most prescribed antibiotics (38.7%) followed by fluoroquinolones (23.9%) and cephalosporines (20.9%). Patients in the intervention group were more likely to be adherent to the prescribed antibiotics compared to control group (OR = 1.445, 95CI% = 1.029–2.030, p = 0.033). Employed patients, less frequent administration of antibiotic, and searching information related to the prescribed antibiotics were factors associated with better adherence to short-term antibiotic (p<0.05). The most common reasons for non-adherence were feeling better and forgetfulness to take medication. These findings highlighted that pharmacist-led educational intervention significantly enhance adherence to prescribed short-term antibiotics which is a major drive to control antibiotic resistance. Initiatives should be adopted to include patient education as a regular element in the medication dispensing process. Clinical trial registration: The trial is registered at ClinicalTrials.gov (identifier: NCT05293977). [ABSTRACT FROM AUTHOR]

This study seeks to develop a sustainable urban assessment tool for the central districts of cities in developing countries such as Jordan. The study employed a mixed-methods approach that included examining existing and well-known urban sustainable assessment tools to identify areas of convergence and distinction; conducting a focus group discussion with sustainable development experts to identify relevant local conditions; and disseminating a web-based questionnaire to sustainability experts. The Delphi technique and analytic hierarchy process were implemented to combine the opinions of sustainability experts, define the weightings of the assessment items, and reach a consensus. Finally, the outputs were analysed to create a tool suitable for the local conditions of Jordanian city centres. The outcome of this study is a sustainable urban assessment checklist composed of 11 categories, 75 criteria, and 485 measurements. The findings show that "site categories" are regarded as the most relevant and important, followed by "site analysis" and "land planning", together accounting for more than half of the total assessment points (51%). The results show that to ensure the city centre's sustainability, a framework for assessing such central districts is urgently required to direct the awareness of specialists, developers, and decision-makers towards urban sustainability. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this research is to determine the impact of a learning organisation (LO) on developing quality improvement practices (QIPs) and to propose knowledge-sharing (KS) as a moderator which is anticipated to support the beneficial effect of a LO on QIP. A further objective is to establish whether training provision raises the abilities of healthcare organisations (HCOs) to attain greater standards of QIP via a LO and KS. Design/methodology/approach: A total of 240 responses, obtained from employees working at private HCOs in Jordan, comprised the valid dataset. Structural equation modeling (SEM) was utilised for data analysis. Multigroup analysis (MGA) was performed to compare the impact of workers who had or had not undergone training. Findings: The findings indicated that QIP was significantly enhanced by LO. HCOs with the objective of converting a KS-moderated LO could attain improved QIP standards, but within the surveyed establishments, this effect was only appreciated at modest degrees. By performing MGA, no variations were identified in the impact of workers. Practical implications: Managers should place more emphasis on training and learning within HCOs. However, respondents did indicate that their establishments had notable degrees of KS, suggesting a potential strength that could be used positively by the managerial hierarchy. Originality/value: This study encompasses an original contribution to contemporary scholarship in the field of knowledge management and quality through its examination of the moderating effect of KS on LO and QIP. [ABSTRACT FROM AUTHOR]

Background and objective: A cross-sectional research, the questionnaire-based study aimed to investigate the association between patient safety culture and patient satisfaction through pharmacist performance, between patient safety culture and pharmacist performance, between pharmacist performance and patient satisfaction, and between patient safety culture and patient satisfaction. Methods: Pharmacists and pharmacy technicians working in the community pharmacies evaluated the patient safety culture using an online self-administrated questionnaire filled out by participants. The first research questionnaire was adopted from the agency of healthcare research and quality (AHRQ), which was reliable and valid. Pharmacist performance and patient satisfaction were measured by using an online self-completion questionnaire that patients filled out. To measure performance, a previously validated questionnaire was used. For measuring patient satisfaction, The Patient Satisfaction with Pharmacist Clinical Services Questionnaire the final version (PSPSQ 2.0) was used. A total of 204 pharmacists, pharmacy technicians, and 204 patients constitute the research sample. Results: The results showed that there is a significant association between the patient safety culture and the pharmacist's performance; an insignificant association between the patient safety culture and patient satisfaction; a significant association between the pharmacist's performance and patient satisfaction; and a pharmacist's performance mediates the relationship between patient safety culture and patient satisfaction. Conclusion: The pharmacy sector may effectively reinforce patient safety culture in community pharmacies and enhance pharmacists' performance to improve the quality of care and increase patient satisfaction. [ABSTRACT FROM AUTHOR]

Non-adherence to antibiotics is a well-known, core player to antibiotic resistance. The current adherence behavior toward short-term antibiotic regimens has never been investigated before in Jordan. This study assessed the prevalence and predictors of non-adherence to short-term antibiotics among Jordanians and investigated participants' views about different reasons related to antibiotics non-adherence. A cross-sectional face-to-face survey-based interview was conducted in three hospital pharmacies in Jordan. Adults and mother of children (≤12 years old) who completed their short course treatment (<30 day) of oral antibiotic within the last month were recruited. A total of 2000 participants (adults: 1000 and mothers of children: 1000) were included in the study with a response rate of 91.60%. The prevalence of non-adherence was estimated to be 32.10%. Non-adherent respondents scored a lower Medication Adherence Report Scale [16.76±5.02 vs. 23.04 ±3.24] than adherent respondents (p<0.001). Adults without comorbidity and children with higher number of doses per regimen were significantly less adherent to antibiotic [(OR = 0.615, 95%CI = 0.444–0.853, p = 0.004) and (OR = 0.965, 95%CI = 0.950–0.981, p<0.001)], respectively. Patients-related factors were the most common antibiotic non-adherence reason reported by the participants. The multivariate analysis for all the participants (adults and children), indicated that mothers were 2.6 times more likely to be adherent in giving antibiotics to their children than adults (p<0.001). These findings highlight that more than half of the participants were adherent to short-term antibiotics. However, improving the current prescription-related practices and implementing pharmaceutical consultation services upon antibiotic dispensing are encouraged. [ABSTRACT FROM AUTHOR]

The study aimed to figure out the impact of the employee engagement on the continuous improvement through the innovative behavior as a mediating variable in the public sector in the Hashemite Kingdom of Jordan. The study adopted the descriptive, analytical approach. To achieve the objectives of the study, the researchers distributed a questionnaire to (411) members of the study population. After analyzing the data using the (AMOS), the study concluded a statistically significant impact at sig. (α≤0.05) for the employee engagement on the continuous improvement of the employees in light of the innovative behavior as a mediating variable. [ABSTRACT FROM AUTHOR]

aimed to evaluate the association between perceived social support during pregnancy and levels of anxiety among postpartum women using an anxiety-specific screening instrument. Methods: Using a prospective cohort design, a two-stage methodology was conducted to collect data from women seeking maternal care at the King Abdullah University Hospital in northern Jordan. In the first stage, perceived social support was assessed among pregnant women using the Medical Outcomes Study Social Support Survey. During the first six months after childbirth, postpartum women were contacted to complete the second stage, wherein their perceptions of infant-focused anxieties were assessed using the Postpartum Specific Anxiety Scale. In our study, two types of infant-focused anxieties were investigated among a final sample of 419 mothers: infant safety and welfare anxieties and practical infant care anxieties. Results: The results of multivariate linear regression analysis indicated that providing pregnant women with high levels of emotional support from close social networks (β= − 0.08, p= 0.01) and perceiving informational support from health care providers (β= − 0.71, p< 0.01) were protective factors for reducing the levels of postpartum anxiety concerning infant safety and welfare. Our findings also demonstrated that pregnant mothers who perceived high informational support from health care providers had a lower level of postpartum anxiety about practical infant care (β= − 0.20, p< 0.01). In contrast, mothers who reported receiving high tangible support from close social networks during pregnancy had a significantly higher level of perceived anxiety concerning practical infant care after delivery (β= 0.13, p= 0.02). Conclusion: Our study suggests that postpartum anxiety would be reduced if effective informational support were readily available for pregnant women. There is a clear need for building bridges between women, their families, and providers to distinguish the specific type and amount of support that should be provided to mothers during pregnancy. [ABSTRACT FROM AUTHOR]

Background Treatment related problems are any event or circumstance involving patient treatment that actually or potentially interferes with an optimum outcome for a patient. Hemodialysis patients have on average 5–6 comorbid conditions and require 8–12 medications each day making them vulnerable to treatment related problems. Objective This study aimed to investigate treatment related problems affecting Jordanian hemodialysis patients, as well as assessing the factors associated with them. Setting Three hemodialysis centers in Jordan. Method A cross sectional multi-centered study was conducted. Direct interviews and patient files were used to collect patient information. A validated data collection form was used. Main outcome measure The average number of treatment related problems per patient. Results 160 patients from three different Jordanian dialysis centers were included. The cohort was 53 ± 15.2 years old, been on dialysis for 5.9 ± 5.3 years, had 3.9 ± 1.8 comorbid conditions and took 10.2 ± 2.8 different medications. There were a total of 1018 treatment related problems, a treatment related problem occurred once every 1.47 drug exposures. Adverse events were the most commonly occurring treatment related problems (27%), followed by indication related errors and dosing errors (24% and 21%, respectively). The number of treatment related problems is positively associated with age, the number of comorbid conditions, the number of hospital admissions in the previous year and the number of medications taken by the patient. Conclusion In the Jordanian hemodialysis population, treatment related problems affect virtually all patients. Most patients suffered adverse drug events and/or had drug indication problems. The number of treatment related problems correlated positively with age and the number of medications taken by the patient. Those with more treatment related problems also had higher hospital admissions and longer admission periods. Serious measures should be made in order to reduce the number of treatment related problems affecting this vulnerable population. [ABSTRACT FROM AUTHOR]

Objective: To investigate the characteristics and medical expenditures of patients with Asthma- chronic obstructive pulmonary disease (COPD) overlap (ACO) compared to asthma and COPD patients. Methods: This was a retrospective cohort study involving patients diagnosed with ACO, asthma or COPD as of January 2016. Medical records for patients attending King Abdullah University Hospital (KAUH), in northern Jordan, during the years 2015–2016 were used to identify eligible patients and all relevant clinical characteristics. Both respiratory and all-cause charges were extracted from KAUH billing system during the year 2016. Total, inpatient, outpatient, and pharmacy charges were described and compared across the three disease categories. Charges were measured in Jordanian Dinar (JOD, equal to 1.41 US Dollar). Results: Of a total of 761, 87 ACO patients, 494 asthmatic patients and 180 COPD patients were identified and included in this study. The average total respiratory-related charges were significantly higher in patients with ACO compared to patients with asthma (601.4 versus 354.3 JODs; P value < 0.001). Average all-cause charges were higher in case of ACO and COPD compared to patients with asthma (1830.8 and 1705.4 versus 1251.7 JODs; P value < 0.001). ACO was a significant predictor of higher respiratory and all-cause related charges. Respiratory charges were also higher in older patients and those with higher disease severity. Conclusions: ACO is a risk factor for incurring higher health expenditures in Jordan. Higher respiratory expenditures are also associated with older ages and higher disease severity. [ABSTRACT FROM AUTHOR]

Objective: Rare disease. Background: Myxomas are rare benign tumors of the heart. These tumors are commonly located in the left atrium, but rarely can affect the right side of the heart. Although it is a relatively rare tumor, it is the most common primary cardiac tumor, accounting for 75-80% of them. Secondary or metastatic cardiac tumors are much more common than primary tumors, accounting for more than 95% of cardiac tumors. Case Report: A 38-year-old woman presented with shortness of breath and syncope. Upon investigation, she was found to have a right atrioventricular myxoma. It was associated with tricuspid regurgitation, right-sided heart failure, and pulmonary hypertension. The syncopal attacks and shortness of breath resolved completely after tumor resection. Tricuspid regurgitation (grade 1) and mild pulmonary hypertension (right ventricular systolic pressure 35 mmHg) remained as sequelae of delayed presentation. These may be due to recurrent embolization of tumor fragments to segments of the pulmonary artery. Conclusions: Cardiac myxomas should be considered in patients presenting with unexplained shortness of breath and syncope. Early diagnosis and tumor resection may prevent serious complications such as pulmonary hypertension and right-sided heart failure. [ABSTRACT FROM AUTHOR]

Background: Examining cognitive medical errors (MEs) and their contributing factors is vital in health systems research, as it provides baseline data that can be used to develop appropriate interventions to prevent and/or minimize errors. The primary aim of this study was to investigate the association between cognitive MEs and hospitals' organizational factors and the individual psychological and functional factors. Methods: This cross-sectional study was conducted in three main hospitals in Northern Jordan. A proportional sampling technique was employed to decide the number of participants from each hospital. Data from physicians and nurses (n=400) were collected using a self-administered questionnaire, which was developed based on pertinent literature review. Exploratory and confirmatory factor analyses were conducted to validate the study instrument. The relationships between the variables were analyzed through structural equation modeling (SEM) using AMOS. Multi-group analysis was also performed to examine the differences in the participants' perceptions towards the respective variables between the three selected hospitals. Results: Our results showed a non-significant negative association between MEs and hospital organizational factors. Also, the SEM analysis showed a positive significant correlation between MEs and psychological and functional factors, whereby excessive workload, complexity of tasks, stress, sleep deprivation, and fatigue were found to be predictors of MEs occurrence. In comparison to the results from the university hospital, the multi-group analysis results from the governmental public hospital and the private hospital showed a significant impact of psychological and functional factors on MEs. Conclusion: To reduce the occurrence of MEs in hospitals, there is a need to enhance organizational safety culture. Efforts should be directed at both organizational and individual levels. Also, it is essential that health decision makers develop strategies to reduce work-related stress and improve healthcare staff well-being, as work stress may cause cognitive impairments among healthcare workers and hence threaten patients' safety. [ABSTRACT FROM AUTHOR]

Objectives: The overall objective of this study is to assess the views and attitudes of Jordanian pharmacists on expanded pharmacist prescribing role. Methods: A cross‐sectional, questionnaire‐based study was conducted using a web‐based questionnaire. Pharmacists were invited to take part in this study through pharmacists' Facebook groups for pharmacists in Jordan. Descriptive statistics were used to analyze the data in addition to the t‐test to compare the mean difference of support levels toward supplementary and independent prescribing. Key findings: A total of 521 pharmacists took part in this study. The majority of respondents (n = 482; 92.5%) believe that pharmacists in Jordan should have an expanded prescribing role. Respondents were significantly in favour of supplementary prescribing (P < 0.05) than independent prescribing for various medical condition (e.g. diabetes and asthma). Respondents identified securing more roles in healthcare (n = 464; 89%) and increasing pharmacy profits (n = 420; 80.7%) as key facilitators to adopt this new role. Whereas inadequate training in the diagnosis of disease (n = 457; 87.7%), and inadequate training in patient assessment and monitoring (n = 453; 86.9%) were reported as the most likely barriers. Conclusion: Overall, Jordanian pharmacists strongly supported the expanded prescribing role and favoured supplementary prescribing for chronic conditions (e.g. diabetes). The study highlighted the need for additional training in various areas (e.g. diagnosing and managing some clinical conditions) to prepare Jordanian pharmacists for this new role. [ABSTRACT FROM AUTHOR]

Background: There are many challenges facing Syrian refugee children with heart disease. In this report, we present the spectrum, management, and outcome of heart disease in Syrian refugee children over six-year period, highlighting challenges in management and availability of funding. Methods: Data on Syrian refugee children with heart disease diagnosed between 2012 and 2017 were collected. Patients were followed until January 2019. Data reported included age, diagnosis, recommended treatment, types of procedures done, mortality, cost, financial sources for procedures, and outcome. Results: 415 Syrian refugee children were diagnosed with heart disease at our institution. Median age was 1·9 years (0·4–6·05) years. Children were either born in Syria and fled to Jordan with their families (224, 54%), or born in Jordan to refugee parents (191, 46%). Follow-up was established for 335 patients (81%). Of 196 patients needing surgery, 130 (72%) underwent Surgery, and of 97 patients needing interventional catheterization, 95 underwent the procedure. Waiting time was 222(± 272) days for surgery and 67(± 75) days for catheterizations. Overall mortality was 17% (56 patients), of which 28 died while waiting for surgery. Cost of surgical and interventional catheterization procedures was $7820 (± $4790) and $2920 (± $2140), respectively. Funding was obtained mainly from non-government organizations, private donors, and United Nations fund. Conclusion: Despite local and international efforts to manage Syrian refugee children with heart disease, there is significant shortage in providing treatment resulting in delays and mortality. More organized efforts are needed to help with this ongoing crisis. [ABSTRACT FROM AUTHOR]

Irbid city witnessed a rapid population growth starting from 2003 up to now, which affected the expansion of the city form. This led to awareness of an urgent need to evaluate the current urban planning practices which have been implemented and how responsive they are to land use changes. This paper investigates the role of land use change in determining the spatial model of urban growth in Irbid. The study outlines the development of planning stages from 1970 to 2017. It also explores the temporal and spatial characteristics of urban expansion by analyzing Irbid city maps at different time intervals. Quantitative methods are used by employing GIS. The literature presents the impact of developing land uses on the expansion of the city borders, and identifies the spatial patterns of urban growth. The study concludes with a spatial model of the city comprising structural plans and practical recommendations for Irbid urban development for a better understanding of the city expansion pattern. It also predicts the way of city urban development, thereby identifying its influence on land use changes. This model is, therefore, valuable for informing policy or responding to current planning practices in Irbid and other similar cities nearly considered irregular pattern. [ABSTRACT FROM AUTHOR]

Introduction: prevalence of obesity among adolescents constitutes a serious public health problem. We aimed to investigate the association between socioeconomic factors and obesity perceptions, and prevalence of overweight and obesity among school adolescents. Methods: a cross-sectional study that included students 12 to 17 years old participating from six schools that were randomly selected in Northern Jordan. Body mass index (BMI) measurements and interview questions were completed by trained researchers. A total of 701 were successfully involved in the analysis. Results: students involved were 53.6% males and 46.4% females. Students with normal BMI had a mean BMI of 21.45 (+1.76). Those who were obese, or overweight were 202 (28.8%) students and had a BMI of 29.1 (+4.05). Family monthly income, mother's education and working status among other socioeconomic status factors were significantly associated with children’s overweight or obesity. Perceptions about obesity including meal choices, interest in self body weight, considering someone in family as obese and instructions at school were statistically significant as well. Conclusion: family factors, adolescents' pocket money and perceptions about obesity were significant predictors of obesity among adolescents in Jordan. Effective intervention strategies should be implemented in schools and other primary care settings to reduce the relatively high prevalence of adolescent's obesity observed in this study. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the incidence of preeclampsia among Jordanian pregnant women, determine its risk factors and its associated neonatal morbidity and mortality.Methods: The study is a part of a comprehensive national study of perinatal mortality that was conducted in Jordan. This study included all women who gave birth in the selected hospitals during the study period. Maternal and medical conditions during pregnancy and neonatal outcomes were compared between women who developed preeclampsia and who did not.Results: This study included a total of 21,928 women. The overall incidence rate of preeclampsia was 1.3%. Obesity (OR = 2.6) and high blood pressure (OR = 11.9) were significantly associated with increasing odds of preeclampsia. The risk of preeclampsia was 2.3 times higher in first pregnancies than that in second or more pregnancies. The rates of low birth weight (LBW) delivery (32.5% vs. 8.3%), and prematurity (30.8% vs. 7%), and the neonatal mortality rate (81 vs. 12 per 1000 live births) were significantly higher among women with preeclampsia.Conclusions: The overall incidence rate of preeclampsia was 1.3%. Preeclampsia was significantly associated with maternal and neonatal morbidity and mortality as well as increasing vaginal operative delivery, cesarean section, LBW, and birth asphyxia. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives: Reducing the rate of hospital readmissions, particularly avoidable ones, has significant implications on patient outcomes, cost containment, and quality of care. Given that the reason of readmission may differ from the patient's main diagnosis in the index admission, this study aims to assess the influence of index comorbidities on the primary readmission diagnoses and explore the risk of deemed avoidable readmission because of prior comorbidities. Methods: A retrospective review of 3962 discharges was conducted at a 527-bed teaching hospital in Jordan, utilizing data related to 2025 internal medicine patients. Results: Among all discharges, 29% were followed by a 30-day readmission, of which 13% were identified as potentially avoidable. Of all readmissions, 36% of patients were readmitted because of one of the comorbidities that had been identified at index admission. In addition, 47% of the potentially avoidable readmissions had a main diagnosis that was one of the index comorbidities. The results also showed an association between readmission for one of the index stay's comorbidities and being avoidable, with an adjusted odds ratio of 2.12 (95% confidence interval, 1.65-2.72). Overall, the presence of certain diseases, being identified as one of the preceding comorbidities, was found to have a substantial influence on the risk of potentially avoidable readmission. These diseases included digestive, circulatory, respiratory, genitourinary systems, and infectious and parasitic diseases (adjusted relative risks = 1.57,1.49, 1.36,1.30, and 2.30, respectively). Conclusion: To help reduce the rates of readmission, potential gains seem available if hospitals adopt clinical practices that support the patient's care during the post-discharge transition. This implies that health care providers need to pay more attention to the comorbidities of high-risk patients to be closely monitored after discharge. [ABSTRACT FROM AUTHOR]

Abstract: Jordan lacks companies that provide local medical facilities with products that are of help in daily performed medical procedures. Because of this, the country imports most of these expensive products. Consequently, a local interest in producing such products has emerged and resulted in serious research efforts in this area. The main goal of this paper is to provide local (the north of Jordan) clinics with a computer-aided electrocardiogram (ECG) diagnostic tool in an attempt to reduce time and work demands for busy physicians especially in areas where only one general medicine doctor is employed and a bulk of cases are to be diagnosed. The tool was designed to help in detecting heart defects such as arrhythmias and heart blocks using ECG signal analysis depending on the time-domain representation, the frequency-domain spectrum, and the relationship between them. The application studied here represents a state of the art ECG diagnostic tool that was designed, implemented, and tested in Jordan to serve wide spectrum of population who are from poor families. The results of applying the tool on randomly selected representative sample showed about 99% matching with those results obtained at specialized medical facilities. Costs, ease of interface, and accuracy indicated the usefulness of the tool and its use as an assisting diagnostic tool. [Copyright &y& Elsevier]

Groundwater over-exploitation has been on the rise in Jordan. Competing demands have grown in the face of perennial water shortages, a situation which has been exacerbated by drought conditions in the past decade. This paper reports findings of a project in which management options to address over-exploitation were developed for one of Jordan?s principal aquifer systems, the Amman-Zarqa Basin. Options for addressing the situation were developed through a participatory approach that involved government officials and various public and private sector interest groups. Particular efforts were made to involve well irrigators, who are likely to be heavily impacted by the changes required to reduce groundwater pumping to a sustainable level. With information obtained from a rapid appraisal survey as well as from interviews with farmers, community groups, government officials, and technical experts, an extensive set of options was identified for evaluation. Based on integrated hydrogeologic, social, and economic analysis, five complementary management options were recommended for implementation. These included the establishment of an Irrigation Advisory Service, buying out farm wells, placing firm limits on well abstraction and irrigated crop areas, exchanging treated wastewater for groundwater, and measures to increase the efficiency of municipal and industrial water use. Various combinations and levels of these options were grouped in scenarios, representing possible implementation strategies. The scenarios were designed to assist decision makers, well owners and other stakeholders in moving gradually towards a sustainable abstraction regime. Social and economic aspects of each option and scenario were analyzed and presented to stakeholders, together with a summary of legal, institutional and environmental ramifications. Combining scientific analysis with a participatory approach in the Amman Zarqa Basin groundwater management was devised as a prototype to be used in the management of other groundwater basins in Jordan. This participatory management approach would also be useful in other parts of the world that are experiencing similar groundwater over-exploitation problems. [ABSTRACT FROM AUTHOR]

Jordan is extremely water-scarce with just 167 m³ per capita per year to meet domestic, industrial, agricultural, tourism, and environmental demands. The heavy exploitation of water resources has contributed to declines in the levels of aquifers and the Dead Sea. Rapid growth in demand, particularly for higher quality water for domestic, industrial and tourism uses, is significantly increasing pressure on agricultural and environmental uses of water, both of which must continue to adapt to reduced volumes and lower quality water The agricultural sector has begun to respond by improving irrigation efficiency and increasing the use of recycled water Total demand for water still exceeds renewable supplies while inadequate treatment of sewage used for irrigation creates potential environmental and health risks and presents agricultural marketing challenges that undermine the competitiveness of exports. The adaptive capability of the natural environment may already be past sustainable limits with oasis wetlands having been most seriously affected. Development of new water resources is extremely expensive in Jordan with an average investment cost of USS4 to $5 per cubic meter This paper examines four integrated water resources management (IWRM) approaches of relevance to Jordan: water reuse, demand management, energy-water linkages, and transboundary water management. While progress in Jordan has been made, the Ministry of Water and Irrigation continues to be concerned about the acute water scarcity the country faces as well as the need to continue working with concerned stakeholders to assure future water supplies. [ABSTRACT FROM AUTHOR]

The main aim of this paper is to identify critical success factors (CSFs) and investigate whether they are the same or not across different project organization structures. The organization structures under the study are: functional, project, and matrix. The study is based on a survey that was conducted on a large number of software projects in Jordan. To rank success factors (SFs) and identify critical ones, we use the importance index of SFs, which is calculated based on the likelihood and impact across different structures. For deeper analysis, we carry out statistical experiments with an ANOVA test and Spearman's rank correlation test. Analysis results of an ANOVA test partially indicates that the values of the SF importance index are slightly different across the three organization structures. Moreover, the Spearman's rank correlation test results show a high degree of correlation of the SF importance index between the function and project organization structures and a low degree of correlation between the function and matrix organization structures. [ABSTRACT FROM AUTHOR]

Background: We aimed to explore the surgical outcomes of major lower extremity amputation (MLEA) and influencing factors at an academic tertiary referral centre in north Jordan, optimistically providing a platform for future health care policies and initiatives to improve the outcomes of MLEA in Jordan.Methods: Clinical records of patients who had undergone MLEA between January 2012 and December 2017 were identified and retrospectively reviewed. International Classification of Diseases codes were used to identify the study cohort from a prospectively maintained computerised database. We included adult patients of both genders who underwent amputations for ischemic lower limb (acute and chronic) and diabetic foot syndrome (DFS). We excluded patients for whom MLEA surgery was performed for other indications (trauma and tumors). Outcomes of interest included patient demographics and comorbidities, type of amputation and indications, length of hospital stay (LOS), the need for revision surgery (ipsilateral conversion to a higher level of amputation), and cumulative mortality rate at 1 year. The impact of the operating surgeon's specialty (vascular vs. non-vascular surgeon) on outcomes was evaluated.Results: The study cohort comprised 140 patients who underwent MLEA (110 below-knee amputations [BKA] and 30 above-knee amputations [AKA]; ratio: 3:1; 86 men; 54 women; mean age, 62.9 ± 1.1 years). Comorbidities included diabetes, hypertension, dyslipidaemia, ischaemic heart disease, congestive heart failure, chronic kidney disease, stroke, and Buerger disease. The only associated comorbidity was chronic kidney disease, which was more prevalent among BKA patients (p = 0.047). Indications for MLEA included DFS, and lower limb ischaemia. Acute limb ischaemia was more likely to be an indication for AKA (p = 0.006). LOS was considerably longer for AKA (p = 0.035). The cumulative mortality rate at 1 year was 30.7%. Revision surgery rates and LOS improved significantly with increased rate of vascular surgeon-led MLEA.Conclusions: In developing countries, the adverse impact of MLEA is increased because of limited resources and increased prevalence of diabetes-related foot complications. Vascular surgeon-led MLEA is associated with decreased revision rates, LOS and possibly improved outcomes, particularly when it is performed for vascular insufficiency. It is important to formulate national health care policies to improve patient outcomes in these countries. [ABSTRACT FROM AUTHOR]

Background: One of the major reproductive health challenges among disadvantaged populations is to provide pregnant women with the necessary antenatal care (ANC). In this study, we suggest applying an integrated conceptual framework aimed at ascertaining the extent to which attendance at ANC clinics may be attributed to individual determinants or to the quality of the care received. Methods: Using a cross-sectional design, data were collected from a sample of 831 women residing in nine sub-districts in three northern governorates of Jordan and designated according to national categorization as persistent poverty pockets. All of the sampled women were recruited from public maternal and child health centers and interviewed using a structured pre-tested survey. This tool covered certain predictors, ranging from the user's attributes, including predisposing, enabling, and need factors, to the essential components of the experience of care. These components assessed the quality of ANC in terms of five elements: woman–provider relations, technical management, information exchange, continuity of care, and appropriate constellation of services. Adequate ANC content was assessed in relation to the frequency of antenatal visits and the time of each visit. Results: The results of multivariate logistic regression analyses show that the use of ANC facilities is affected by various factors related to the quality of service delivery. These include receiving information and education on ANC during clinic visits (OR = 9.1; 95% CI = 4.9–16.9), providing pregnant women with opportunities for dialogue and health talks (OR = 7.2; 95% CI = 4.1–12.8), having scheduled follow-up appointments (OR = 6.5; 95% CI = 3.5–12.0), and offering dignified and respectful care (OR = 5.7; 95% CI = 2.5–13.1). At the individual level, our findings have identified a woman's education level (OR = 1.2; 95% CI = 1.1–1.3), desire for the pregnancy (OR = 1.7; 95% CI = 1.1–2.7), and living in a district served by an ANC clinic (OR = 4.3; 95% CI = 2.3–8.1) as determinants affecting ANC utilization. Conclusion: Taking women's experiences of ANC as a key metric for reporting the quality of the care is more likely to lead to increased utilization of ANC services by women in highly disadvantaged communities. Our findings suggest that the degree to which women feel that they are respected, informed, and engaged in their care has potential favorable implications for ANC. [ABSTRACT FROM AUTHOR]