Enhancing Nurses' Disaster Management and Preparedness: Evaluating the Effectiveness of an Online Educational Program Through a Quasi-Experimental Study.

Background: Disaster management is an ongoing international concern, and nurses play essential roles in minimizing negative impacts on the health of communities. However, many nurses have limited knowledge and skills on how to respond to disasters effectively. Therefore, this study was conducted to determine the effectiveness of a newly developed educational program on improving nurses' disaster management and preparedness. Methods and Design: A quasi-experimental study was conducted on 88 nurses working at a public hospital. The educational program included six modules covering various aspects of disaster management. Pre-and post-tests were administered to evaluate changes in perceptions of disaster management competencies. Independent sample t-test, Pearson coefficient correlation, and One-way ANOVA tests were all run using SPSS. Results: A significant proportion of nurses (78.4%) reported ongoing training in disaster management, while a smaller percentage (21.6%) expressed a contrary opinion. Nurses also had a moderate level of agreement with the disaster preparedness program (Pretest: 2.26 ± 0.34; post-test: 2.29 ± 0.31). Further, the results showed small improvements in nursing perceptions of the operational plan after the educational program (Pretest: M=2.76, SD=0.63; Post-test: M=2.89, SD=0.44), although the differences between pre-and-post assessments were not significant (P > 0.05). The mean values for overall familiarity in the pre-test were 3.16 ± 1.39, while in the post-test, they slightly increased to 3.26 ± 1.18. The findings also showed no statistically significant differences reported in nurses' attitudes and familiarity towards disaster preparedness based on the gender, marital status, nationality, working shifts, and working hours variables (P > 0.05). Conclusion: This study demonstrated the significance of providing nurses with the essential knowledge that helps respond to disasters. Online educational programs can help improve nurses' preparedness to better manage disasters. Future research should investigate additional variables that could enhance nurses' knowledge and skills related to disaster response.

Development and Validation of a Cyber-Physical System Leveraging EFDPN for Enhanced WSN-IoT Network Security.

In the current digital era, Wireless Sensor Networks (WSNs) and the Internet of Things (IoT) are evolving, transforming human experiences by creating an interconnected environment. However, ensuring the security of WSN-IoT networks remains a significant hurdle, as existing security models are plagued with issues like prolonged training durations and complex classification processes. In this study, a robust cyber-physical system based on the Emphatic Farmland Fertility Integrated Deep Perceptron Network (EFDPN) is proposed to enhance the security of WSN-IoT. This initiative introduces the Farmland Fertility Feature Selection (F3S) technique to alleviate the computational complexity of identifying and classifying attacks. Additionally, this research leverages the Deep Perceptron Network (DPN) classification algorithm for accurate intrusion classification, achieving impressive performance metrics. In the classification phase, the Tunicate Swarm Optimization (TSO) model is employed to improve the sigmoid transformation function, thereby enhancing prediction accuracy. This study demonstrates the development of an EFDPN-based system designed to safeguard WSN-IoT networks. It showcases how the DPN classification technique, in conjunction with the TSO model, significantly improves classification performance. In this research, we employed well-known cyber-attack datasets to validate its effectiveness, revealing its superiority over traditional intrusion detection methods, particularly in achieving higher F1-score values. The incorporation of the F3S algorithm plays a pivotal role in this framework by eliminating irrelevant features, leading to enhanced prediction accuracy for the classifier, marking a substantial stride in fortifying WSN-IoT network security. This research presents a promising approach to enhancing the security and resilience of interconnected cyber-physical systems in the evolving landscape of WSN-IoT networks.

Evaluation of Xpert MTB/RIF Ultra for the Diagnosis of Extrapulmonary Tuberculosis: A Retrospective Analysis in Saudi Arabia.

The incidence of extrapulmonary tuberculosis (EPTB) in low- and middle-income countries, as well as, high-income countries has increased over the last two decades. The acid-fast bacillus (AFB) smear test is easy to perform and cost-effective with a quick turnaround time but the test has low sensitivity. Culture remains the gold standard for detecting TB; however, it has low sensitivity and slow bacterial growth patterns, as it may take up to 6 to 8 weeks to grow. Therefore, a rapid detection tool is crucial for the early initiation of treatment and ensuring an improved therapeutic outcome. Here, the Xpert Ultra system was developed as a nucleic acid amplification technique to accelerate the detection of MTB in paucibacillary clinical samples and endorsed by the World Health Organization. From March 2020 to August 2021, Xpert Ultra was evaluated for its sensitivity and specificity against EPTB and compared with those of the routinely used Xpert, culture, and AFB tests in 845 clinical samples in Saudi Arabia. The results indicate the overall sensitivity and specificity of Xpert Ultra to be 91% and 95%, respectively, compared with the Xpert (82% and 99%, respectively) and AFB smear (18% and 100%, respectively) tests. The results also indicated that despite the low microbial loads that were categorized as trace, very low, or low on Xpert Ultra, yet, complete detection was achieved with some sample types (i.e., 100% detection). Consequently, Xpert Ultra has great potential to replace conventional diagnostic approaches as a standard detection method for EPTB.

Is peri-transplant blood transfusion associated with worse transplant outcomes? A retrospective study.

BACKGROUND: Blood transfusion is common during the peri-transplantation period. The incidence of immunological reactions to blood transfusion after kidney tran splantation and their consequences on graft outcomes have not been extensively studied. AIM: To examine the risk of graft rejection and loss in patients who received blood transfusion in the immediate peri-transplantation period. METHODS: We conducted a single-center retrospective cohort study of 105 kidney recipients, among them 54 patients received leukodepleted blood transfusion at our center between January 2017 and March 2020. RESULTS: This study included 105 kidney recipients, of which 80% kidneys were from living-related donors, 14% from living-unrelated donors, and 6% from deceased donors. Living-related donors were mostly first-degree relatives (74.5%), while the rest were second-degree relatives. The patients were divided into transfusion (n = 54) and non-transfusion (n = 51) groups. The average hemoglobin level at which blood transfusion was commenced was 7.4 ± 0.9 mg/dL. There were no differences between the groups in terms of rejection rates, graft loss, or death. During the study period, there was no significant difference in creatinine level progression between the two groups. Delayed graft function was higher in the transfusion group; however, this finding was not statistically significant. A high number of transfused packed red blood cells was significantly associated with increased creatinine levels at the end of the study. CONCLUSION: Leukodepleted blood transfusion was not associated with a higher risk of rejection, graft loss, or death in kidney transplant recipients.

Testicular Neuroendocrine Tumors: A Case Report and Literature Review.

Testicular neuroendocrine tumors (TNETs) are extremely rare. We report a case of a primary TNET and discuss the clinical and histological characteristics, treatment, and prognosis of this tumor. A 47-year-old man had a painless right testicular mass. All tumor markers were negative. The patient underwent a high inguinal radical orchidectomy. Histopathology revealed a well-differentiated neuroendocrine tumor. Radiological investigations showed multiple prominent axillary, supraclavicular, mediastinal, and hilar lymph nodes and no bowel or mesenteric lesions suggesting carcinoid. Once a TNET is diagnosed, it is necessary to rule out the secondary origin in the gastrointestinal tract and lungs. Radical orchiectomy is the treatment of choice for TNETs. Somatostatin analogs can be useful in patients with carcinoid syndrome, induce symptomatic improvement, and control disease progression. As this case highlights, physicians should consider TNETs in the differential diagnosis of testicular masses, as early diagnosis and treatment are crucial for good patient outcomes.

Experimental Investigation and Modeling for the Influence of Adding Date Press Cake on Drinkable Yogurt Quality.

The extraction of date syrup produces a large quantity of by-product known as date press cake (DPC). This study aimed to utilize valuable ingredients of the DPC by adding 0 (Control), 2, 4, and 6% (g/100 g) of its powder to drinkable yogurt before fermentation. The physicochemical properties, texture profile, and sensory evaluation of the treated DPC-based drinkable yogurt (DPC drinkable yogurt) were measured after fermentation and 5, 10, and 15 days of storage at 4 °C. The modeling of the most critical quality attributes, i.e., pH, acidity, syneresis, water holding capacity (WHC), viscosity, and color difference (ΔE), was conducted to predict their values based on the DPC percentage and storage period. The DPC drinkable yogurt's total solids, protein, and fat ranged between 11.19-11.83, 3.10-3.42, and 2.26-2.34%, respectively. Adding 2-6% DPC slightly increased the pH of DPC drinkable yogurt and decreased its acidity (p > 0.05) during storage. Increasing the DPC percent in DPC drinkable yogurt decreased the syneresis value, and WHC increased during storage. The color parameters and viscosity of DPC drinkable yogurt recorded the highest value at the end of the storage period for all treatments and increased steadily with the increase in DPC. The evaluation of the prediction models indicated that the predicted values were close to the actual experimental values for pH (R2 = 0.779), acidity (R2 = 0.973), syneresis (R2 = 0.961), WHC (R2 = 0.989), viscosity (R2 = 0.99), L* (R2 = 0.919), a* (R2 = 0.995), b* (R2 = 0.922), and ΔE (R2 = 0.921). The textural analysis indicated that increasing the concentration of DPC in the DPC drinkable yogurt increased hardness (g), springiness, cohesiveness, and gumminess and decreased adhesiveness and resilience during cold storage. The evaluation of sensory acceptance during the cold storage of the DPC drinkable yogurt was conducted by 30 expert panelists. Each panelist received four cups of 10 mL drinkable yogurt treatments at 5-10 °C. The evaluation results indicated that adding 2% of DPC was closest in overall sensory acceptability to the control sample (p < 0.05). This study revealed the potential use of DPC in drinkable yogurt as a natural, functional, and low-cost ingredient to improve the fiber content, physicochemical properties, and overall acceptability. Therefore, the fermented DPC-based yogurt drink has the potency to be a practical, value-added, and novel alternative to dairy-based yogurt.

Prevalence of white spot lesions and gingival index during orthodontic treatment in an academic setting.

INTRODUCTION: The objective of this study was to determine the prevalence of white spot lesions (WSL) in orthodontic patients in an academic setting. Specific aims include using a novel combination to measure plaque accumulation (PA) and detect the association between WSL and PA and the associations between multiple independent variables. METHODS: Cross-sectional data were collected on 111 patients. To enhance standardization, a combination of plaque-disclosing agents and standardized intraoral photographs was used to analyze plaque index (PI) and WSL for all teeth except molars. Factors including time in fixed appliances (FA), number of teeth, location of the lesions, and demographic information were reported. A multiple linear regression model was used to detect associations between the PI and WSL and the independent variables (P <0.05). RESULTS: Approximately 79.3% of participants had at least one WSL, with a mean of 4 affected teeth per patient. A significant association was found between time in FA and the more severe PI reporting (P <0.001). There was no significant association between WSL and PI or the other variables. WSL was greater in the maxilla than in the mandible. PI was greater on the left than on the right side. Interexaminer reliability was assessed for PI and WSL (κ = 0.93 and 0.92). CONCLUSIONS: The prevalence of WSL for orthodontic patients treated at this institution was greater than previously reported in the literature. In addition, the severity of PI was associated with increased time in FAs. Combining the proposed method of reporting PA facilitates standardization, calibration, and documentation in an academic environment.

Evaluation of dry eye subtypes and characteristics using conventional assessments and dynamic tear interferometry.

BACKGROUND/AIMS: To evaluate subtypes and characteristics of dry eye (DE) using conventional tests and dynamic tear interferometry, and to investigate determinants of disease severity in each DE subtype. METHODS: 309 patients diagnosed with DE and 69 healthy controls were prospectively enrolled. All eyes were evaluated using Ocular Surface Disease Index (OSDI), Schirmer's test I (ST1) and Meibomian gland dysfunction (MGD) grade were analysed. The tear interferometric pattern and lipid layer thickness were determined using DR-1α and LipiView II, respectively. RESULTS: Dynamic interferometric analysis revealed 56.6% of patients with DE exhibited Jupiter patterns, indicative of aqueous-deficiency, while 43.4% exhibited crystal patterns, indicative of lipid deficiency. These findings were in accordance with classification based on ST1 scores and MGD grade. Conventional assessment indicated 286 patients exhibited evidence of evaporative DE (EDE) due to MGD, while only 11 exhibited signs of pure aqueous-deficient DE (pure ADDE, only ST1 ≤5 mm). Interestingly, of 286 patients with EDE, 144 were categorised into the mixed-ADDE/EDE group, in which ST1 was identified as a strong negative determinant of OSDI. In contrast, 72.2% of patients with mixed-ADDE/EDE exhibited Jupiter patterns (Jupiter mixed), while 27.8% exhibited crystal patterns (crystal mixed). OSDI values were significantly higher in the crystal-mixed group than in the Jupiter mixed, in which OSDI scores were independently associated with ST1 values only. CONCLUSIONS: Our findings indicate that majority of EDE patients also exhibit aqueous deficiency, which can aggravate symptoms even in patients with lipid-deficient mixed-ADDE/EDE. Conventional assessments should be combined with interferometric tear analysis to determine the most appropriate treatment for each DE patient.

The correction of conjunctivochalasis using high-frequency radiowave electrosurgery improves dry eye disease.

We aimed to determine the clinical impact of conjunctivochalasis (CCh) and its correction using high-frequency radiowave electrosurgery (HFR-ES), for signs and symptoms of dry eye disease (DED). Forty patients diagnosed with symptomatic CCh were prospectively enrolled. As a result, patients with CCh had moderate to severe DED and most of them exhibited meibomian gland dysfunction (MGD). Corneo-conjunctival fluorescein staining score (CFS) and all lid-parallel-conjunctival-folds scores (LIPCOFs) were positively correlated. Nasal LIPCOF significantly correlated with symptoms and tear volume. Central, temporal, and total LIPCOF significantly correlated with MG loss, MGD stage, and lipid layer thickness. Independent significant factors associated with total LIPCOF included CFS, tear break-up time, and MGD stage. One month following HFR-ES, CCh was completely resolved in all cases. Patient age and preoperative nasal LIPCOF were determinants of outcomes associated with postoperative improvements in symptoms. Ocular surface parameters significantly improved, but MGD-related signs did not. Collectively, CCh associated with MGD severity deteriorates not only tear film stability and reservoir capacity, leading to DED exacerbation. Therefore, CCh should be corrected in patients with DED and MGD. Younger patients with nasal CCh are likely to experience more symptomatic relief after HFR-ES. Particularly, management for MGD should be maintained after CCh correction.

Assessing the Outcome of Adult Kidney Transplantation from a Deceased Expanded Criteria Donor: A Descriptive Study.

Background End-stage renal disease (ESRD) creates a great burden on the quality of life. Patients after kidney transplantation have been reported to have a greater quality of life and better outcomes health outcomes. Therefore, it is important to optimize the best method of following well-constructed criteria such as the expanded criteria donor (ECD) to reduce the chances of rejection rate and deaths post-transplantation particularly in elderly patients in conjunction with the kidney profile donor index (KDPI). Methods This is a retrospective descriptive study of all patients who received kidney transplantation from a deceased donor from the ECD as well as ECD with donation after cardiac death (DCD) at St. Joseph Health Care Hospital over a 24 month time period from January 2017 to January 2019. All adult recipients from standard criteria donor (SCD) and living donors were excluded from the study. Results The study included 60 patients with 36 (60%) from the ECD and 24 (40%) were from the ECD/DCD group. The most common cause of ESRD among recipients was diabetes mellitus (DM) involving 23 (38.3%) of the patients. The creatinine outcome was the highest in the ECD/DCD group at one month (211 ± 71) and the lowest creatinine recorded was also in the ECD/DCD at 12 months (160 ± 78). Lastly, only four patients died in 12 months and only six recipients reported graft loss over 12 months. Conclusion Descriptive data of the included ECD/DCD showed increase trend in survivability of the recipients when used among the elderly, giving us more insight on the benefits of ECD/DCD transplantation.

Meibum Expressibility Improvement as a Therapeutic Target of Intense Pulsed Light Treatment in Meibomian Gland Dysfunction and Its Association with Tear Inflammatory Cytokines.

Many recent studies have demonstrated the efficacy of intense pulsed light (IPL) for the treatment of meibomian gland dysfunction (MGD); however, its effective treatment targets have not yet been elucidated. This study aimed to investigate the baseline characteristics associated with an improvement in symptoms after IPL treatment; to examine the course of change in inflammatory tear cytokines, meibomian gland function, and tear stability; and to investigate the correlation between cytokines and ocular surface parameters. Thirty participants underwent three sessions of IPL treatment. During each examination, tear film lipid layer interferometry, meibography, tear meniscus height measurement, tear sampling, and slit-lamp examination were performed, and the Ocular Surface Disease Index (OSDI) questionnaire was administered. Meibum quality, meibum expressibility, lid margin abnormality, tear film break-up time (TBUT), ocular surface staining, and the OSDI significantly improved after treatment. Poor meibum expressibility and short TBUT were associated with greater recovery in the OSDI after IPL. Tear levels of IL-4, IL-6, IL-10, IL-17A, and TNF-α decreased after IPL, and IL-6, and TNF-α were correlated with the improvement in meibum expressibility. Therefore, IPL treatment improved meibomian gland function, stabilized the tear film, and decreased ocular surface inflammation. Patients with obstructive MGD and tear instability were more likely to experience an improvement in ocular discomfort after IPL treatment.

Necrotizing Scleritis After Cosmetic Conjunctivectomy With Mitomycin C.

PURPOSE: To report cases of necrotizing scleritis, a sight-threatening complication that can result from cosmetic conjunctivectomy procedures. DESIGN: Retrospective case series. METHODS: The medical records of consecutive patients who underwent eye-whitening conjunctivectomy with mitoycin C (MMC) treatment performed by 1 surgeon in South Korea and were referred to the authors' clinic between January 2011 and December 2015 were reviewed. The patients in whom findings of necrotizing scleritis with active inflammation were detected in an avascular area of previous conjunctivectomy were included. RESULTS: Of a total of 231 patients who had received cosmetic eye whitening, 4 patients who met the inclusion criteria were identified. The average length of time from cosmetic eye surgery to a diagnosis of necrotizing scleritis was 51 months and all patients had unilateral findings of necrotizing scleritis. There was no underlying systemic autoimmunity or infectious etiology in all cases. Three of these 4 patients were treated with a conjunctival flap; however, all 4 received systemic anti-inflammatory treatment with oral corticosteroids. The mean follow-up duration of the patients was 22.75 months. CONCLUSIONS: Necrotizing scleritis is a severe complication that can arise after cosmetic eye-whitening conjunctivectomy with MMC. Because of the large area of the ocular surface that is treated in eye-whitening with MMC, the necrotizing scleritis that can ensue may be more extensive and severe than the surgically induced necrotizing scleritis following other periocular surgeries such as pterygium removal. Proper anti-inflammatory treatment and surgical intervention should be required for management of this complication.