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Abstract Background Psychiatric nurses experience unique emotional and ethical challenges, including moral distress, associative stigma, and compassion fatigue, that can negatively affect their mental health and clinical performance. The complex relationship among these variables has not been clearly defined. Thus, this study aimed to determine the levels of compassion fatigue, associative stigma, and moral distress and to investigate how these factors interact with an emphasis on the role of compassion fatigue in mediating the relationship between associative stigma and moral distress. Methods A convenient sampling technique was used to recruit nurses from Erada Mental Health Complex in Riyadh. In addition to sociodemographic data, three validated tools were used to collect data: the Compassion Fatigue Scale, Clinician Associative Stigma Scale, and Moral Distress for Healthcare Professionals Scale. The structural equation modeling was used to examine the relationship among the three variables using the ‘lavaan’ package. Results Mediation analysis revealed that compassion fatigue significantly mediates the relationship between associative stigma and moral distress, with 80% of the total effect mediated (β = 6.38, p

Abstract Background Blended learning is a key educational methodology, particularly in medical education, and involves integration of online and face-to-face interactions to enhance flexibility and engagement. Blended learning gained increased popularity during the COVID-19 pandemic due to social restrictions. Following control of the pandemic, face to face teaching and learning activities have been restored. However, some institutions continue to deliver some teaching online. This study explores the perceptions and experiences of undergraduate medical students from 15 institutions across seven countries regarding remote online learning in the post-pandemic era. Methods This cross-sectional study utilized an online survey to gather insights into the use of learning resources, interactivity in online sessions, barriers to online learning, and preferences for learning modalities. Descriptive data were summarized by frequency, categorical comparisons were assessed with chi-squared tests, and t-tests were used for continuous data. Results The findings of the current study show a general preference for blended learning (47.78%) over traditional face-to-face instruction (41.48%). Key benefits of blended learning reported by the participants by comfort, flexibility, reduced travel, and ability to learn at own pace. The key barriers identified were internet connectivity issues and family distractions. The study also highlighted the limitations of online learning in replacing clinical experience and practical skills acquisition, with 69.26% of respondents affirming that online learning does not sufficiently substitute for direct patient contact. Conclusion The findings underscore the importance of integrating face to face and remote online teaching and learning frameworks to align with educational objectives, particularly in fostering interactivity and practical skill development. The study suggests that while blended learning has many benefits, its effectiveness is highly context-dependent and requires thoughtful implementation to meet the diverse needs of medical education.

Objective: To characterize mosquito larval habitats and the influence of meteorological factors on their prevalence, and to suggest alternatives for vector control in Makkah Al-Mukarramah. Methods: A mosquito survey was conducted within the 16 municipalities of Makkah Al-Mukarramah, from November 2022 to October 2023. The characteristics of larval habitats used by all reported species as oviposition sites were determined. Seasonal house, container, and breteau indices were used to determine larval abundance. Results: 16 Species belonging to five genera [Aedes (3 spp.), Anopheles (3 spp.), Culex (8 spp.), Culiseta (1 sp.), and Lutzia (1 sp.)] were collected. A total of 185 608 potential mosquito larval habitats were surveyed. Of these, 95 853 (67.4%) were Aedes, 45 522 (32%) were Culex, 718 (0.5%) were Anopheles, and 38 (0.03%) were other species; 154 726 (83.4%) were water sources for mosquito larvae, and among these sources, 7 663 (5.0%) were positive for larvae, with 45.9% indoors and 54.1% outdoors. Most of the positive larval habitats were recorded in Al-Shawqiya (1 093, 14.3%), Al-Sharayia (1 003, 13.1%) and Al-Umrah (984, 12.8%). A total of 142131 mosquito larvae and pupae were collected. The majority number of positive residences for all mosquito larvae was observed in January 2023 (1 658, 21.6%). Conclusions: New appropriate alternatives for vector control are proposed, such as mechanical, biological, and environmental control.

Abstract Background Colorectal surgery is associated with a high risk of postoperative complications, including technical complications, surgical site infections, and other adverse events affecting patient safety and overall patient experience. “Enhanced Recovery After Surgery” (ERAS) is considered a new standard of care for streamlining the perioperative care of surgical patients with the goal of minimizing complications and optimizing timely patient recovery after surgery. This systematic review was designed to investigate the evidence-based literature pertinent to comparing patient outcomes after ERAS versus conventional perioperative care. Methods This systematic review evaluates the performance of ERAS protocols against conventional care in colorectal surgery, focusing on various postoperative outcome measures. An extensive search was conducted across multiple electronic databases and registers from July 2 to July 5, 2024, complemented by citation searching on November 30, 2024. This approach led to the identification of 11 randomized controlled trials (RCTs) from the past decade, involving 1,476 adult participants. To ensure methodological rigor and transparency, the review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines and was registered with PROSPERO (CRD42024583074). Results The implementation of ERAS protocols resulted in a notable decrease in hospital stay duration compared to conventional care, with reductions varying between 3 and 8 days across studies. ERAS patients also had faster gastrointestinal recovery, including quicker times to bowel movement, defecation, and resumption of normal diet. Furthermore, patients in ERAS groups showed notably reduced postoperative complications and opioid consumption, with patients experiencing lower pain scores on the Visual Analogue Scale (VAS) and reduced reliance on opioids. Additionally, nutritional recovery in ERAS patients was enhanced, with elevated albumin and total protein levels, alongside decreased inflammatory markers and improved immune function. Conclusion This systematic review provides compelling evidence supporting the integration of ERAS protocols into standard colorectal surgical practices. Future studies should aim to explore the variations in ERAS implementation, pinpoint the most impactful elements of ERAS, and work towards personalizing and standardizing these protocols across clinical settings. Additionally, evaluating long-term outcomes will help refine ERAS strategies, ensuring their enduring impact on patient recovery.

Abstract Background COVID-19, caused by the SARS-CoV-2 virus, is one of the most known pandemics ever affecting human life and global economics. Recently, it has shown several symptoms related to different organ systems, including the nervous system, represented in some reported neurological manifestations. Therefore, a smart prediction system that can determine the likelihood and certainty of having COVID-19 based on those neurological manifestations can help in early detection of the disease, which helps in diagnosis and limiting the prevalence of COVID-19. Patients and methods This study involved a comprehensive data collection process. We gathered information from thousands of patients, encompassing both neurological and non-neurological manifestations of COVID-19. This data, derived from various research works, including mild and moderate cases, was then subjected to rigorous statistical analysis. The results of this analysis formed the basis for the design of a fuzzy interference system (FIS), which utilizes a fuzzy logic approach to determine the certainty of COVID-19 based on neurological symptoms. Results Statistical analysis of the collected data showed neurological symptoms in all surveyed cases in the first week of the COVID-19 presentation. Headache has been reported in 70–80% of all cases; anosmia–dysgeusia showed up in 50–60% of total cases; Myalgia presented in 40–45% of all cases; Fatigue was there in 30–35% of the surveyed cases; dizziness was recorded in 30–35% of patients; 0–10% of subjects showed noncommon symptoms like numbness, migraine, loss of concentration, and seizures. By applying these statistical results to the fuzzification process and developing the rulesets, the fuzzy logic-based forecasting system could determine the certainty of COVID-19 with high accuracy, reaching 95% by comparing it with the clinical data. Conclusions Surveying neurological and non-neurological symptoms of thousands of COVID-19 patients in many related literature showed neurological manifestations in all patients with different ratios and weights, including mild and moderate cases, by statistically analyzing these data to form the rulesets of a predesigned fuzzy logic-based forecasting system. The fuzzy logic system was able to yield a successful prediction of the likelihood of having COVID-19 in a group of patients based on their neurological symptoms with an accuracy of 95% by comparing the predicted data with the clinical data.

Abstract Background Obsidio conformable embolic (OCE, Boston Scientific, MA) is a novel, radiopaque and conformable embolic. The purpose of this report is to describe its use for treatment of acute intra-abdominal hemorrhages. Methods and results Three patients presented with acute hemorrhage and were treated with OCE, including post-paracentesis hemorrhage, penetrating trauma to the liver, and blunt trauma in the spleen. All cases were performed under moderate sedation, with hemostasis achieved by end of procedure using less than 1 vial of OCE (0.2-0.4 ml). No severe adverse events occurred. None required repeated treatment. Short conclusion OCE is a safe and effective embolic agent for treatment of intra-abdominal or visceral hemorrhage. Future studies with larger sample sizes and longer follow-up are warranted.

IntroductionAlthough late initiation of antenatal care has been linked with adverse pregnancy outcomes, a significant number of pregnant women in resource-limited regions are seeking this care late. There has been a lack of information on the extent and factors influencing late initiation of antenatal care in the African context following the implementation of the new antenatal care model in 2016. Thus, we aimed to determine the pooled prevalence of late antenatal care visit and its determinants among women in Sub-Saharan Africa (SSA) using national surveys conducted after the implementation of new guidelines.MethodsWe analyzed data from the recent demographic and health survey (DHS) conducted in 16 SSA between 2018 and 2022 using a weighted sample of 101,983 women who had antenatal care follow-up during their index pregnancy. A multilevel logistic regression models were fitted and likelihood and deviance values were used for model selection. In the regression model, we used adjusted odds ratios along with their corresponding 95% confidence intervals to determine the factors associated with late antenatal care visit.ResultsThe pooled prevalence of late antenatal care visit among pregnant women in SSA was 53.8% [95% CI: 46.2% - 61.3%], ranging from 27.8% in Liberia to 75.8% in Nigeria. Women's age and education, working status, partner's education, health insurance coverage, birth order, household wealth, age at marriage, decision on health care, residence, and community-level women's illiteracy were the factors associated with late antenatal care visit.ConclusionMore than half of pregnant women in SSA initiated attending antenatal care during late pregnancy, with significant differences seen among countries. These results underscore the necessity for focused interventions to tackle these issues and enhance prompt access to antenatal services for better maternal and child health outcomes in the area. Moreover, creating tailored interventions for younger women, those with multiple previous births, employed women, and those who experienced early marriage to address their specific challenges and obstacles in seeking care is crucial.

Introduction Recent decades have seen a growth in multisectoral and transdisciplinary approaches to improving global health, particularly across human, animal and environmental health-related sciences that advocate for participatory, systems-based perspectives to understanding and promoting health and well-being in the context of social and ecological interactions. For several issues, including human health, animal health and food security, researchers have highlighted the need for transdisciplinary One Health approaches to assess the sustainability of interventions. To understand the current thinking and conceptualisation of sustainability across One Health disciplines, we present a protocol paper for an umbrella systematic review study planned in 2024.Methods and analysis A search strategy based on Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines was developed. The Medline, Embase, Global Health and Web of Science Core Collection were the four databases interrogated through the search strategy and included all articles found in the English language up to 14 April 2024. Meta-analyses, systematic, structured literature reviews and narrative reviews on sustainability will be included and a full-text review of all articles will be undertaken. The articles will be quality appraised using the AMSTAR 2 tool. Data that cover proposed factors influencing and characterising sustainability will be extracted across One Health disciplines including similarities and differences, and a summative content analysis will be completed to identify any emerging themes and develop an analytical framework. The conceptualisation of sustainability in the context of One Health multisectoral approaches will be summarised, a definition of sustainability proposed and include an identification of tools for measuring and assessing sustainability.Ethics and dissemination No primary data will be collected; therefore, ethical approval will not be required. The results will be disseminated in peer-reviewed literature and conference presentations. The findings will also be directly disseminated to the Quadripartite agencies.Prospero registration number CRD42018094031

In this study, the effects of waste steel wire ratios, granulated blast furnace slag (GBFS) ratios, and different curing methods on geopolymer concrete (GPC) were investigated. For this purpose, 12 mixtures were produced and eight of them were cured under ambient conditions and the remaining four were cured in an oven. Steel wire ratios and GBFS ratios were added to GPC as 0–1–2–3 % and 0–10–20 % by volume and weight, respectively. As a result of the mixtures, cubes, cylinders, and beams were obtained and these elements were subjected to compression, tensile, and flexural tests. As a result of the tests, the compressive strengths of the specimens were obtained as 8.5 %, 19.7 %, and 24.9 % for ambient curing and 10.4 %, 23.2 %, and 32.2 % for oven curing, respectively, as the steel wire fiber increased from 0 % to 3 %. The maximum compressive strength of the oven-cured specimen with 3 % steel wire fiber was measured as 42.56 MPa. The tensile strength of GPC also increased as the steel wire increased. The highest tensile strength was obtained with 3 % steel wire. In addition, oven curing conditions increased the tensile strength more than ambient curing. The flexural strength (FS) increased by 21.3 %, 29.4 %, and 33.8 % with increasing steel wire ratios of 1 %, 2 %, and 3 %, respectively. The FS was further increased by oven curing conditions and the maximum FS was achieved with 3 % steel wire. In ambient curing conditions, a successful geopolymerization was achieved due to the high calcium content in the samples containing 20 % GBFS. This allowed to obtain similar strengths between ambient curing and oven curing. Although the oven curing values were higher, similar results were obtained for the samples cured in an ambient containing 20 % GBFS. As a result of the study, mixtures containing 3 % steel wire and 20 % GBFS provided sufficient strength without oven curing and increased the usability of GPC under ambient conditions.