To Admit or Not to Admit to the Emergency Department: The Disposition Question at a Tertiary Teaching and Referral Hospital.

BACKGROUND: Disposition decision-making in the emergency department (ED) is crucial to patient safety and quality of care. It can inform better care, lower chance of infections, appropriate follow-up care, and reduced healthcare costs. The aim of this study was to examine correlates of ED disposition among adult patients at a teaching and referral hospital based on patients' demographic, socioeconomic, and clinical characteristics. METHOD: A cross-sectional study conducted at the ED of the King Abdulaziz Medical City hospital in Riyadh. A two-level validated questionnaire was used-a patient questionnaire and healthcare staff/facility survey. The survey employed a systematic random sampling technique to recruit subjects at a pre-specified interval as patients arrived at the registration desk. We analyzed 303 adult patients visiting the ED, who were triaged, consented to participate in the study, completed the survey, and admitted to a hospital bed or discharged home. We used descriptive and inferential statistics to summarize and determine the interdependence and relationships of variables. We used logistic multivariate regression analysis to establish relationships and the odds of admission to a hospital bed. RESULTS: The mean age of the patients was 50.9 (SD = 21.4, Range 18 to 101). A total of 201 (66%) were discharged home while the rest were admitted to a hospital bed. Results of the unadjusted analysis suggest that older patients, males, patients with low level of education, and those with comorbidities and middle-income were more likely to be admitted to the hospital. The results of the multivariate analysis suggest that patients with comorbidities, urgent conditions, prior history of hospitalization, and higher triage levels were more likely to be admitted to a hospital bed. CONCLUSIONS: Having proper triage and timely stopgap review measures in the admission process can help new patients to locations that best support their needs and improve the quality and efficiency of the facility. The findings may be a sentinel indicator that informs overuse or inappropriate use of EDs for non-emergency care, which is a concern in the Saudi Arabian publicly funded health system.

Enhancement of Optical Telecommunication Bands: Pr3+-Doped Halide Phosphate Glasses Display Broadband NIR Photoluminescence Emission.

In the optical energy gap, visible and near-IR emission of halide phosphate glasses with a composition of 40P2O5-30ZnO-20LiCl-10BaF2 in mol% doped with 3.5 × 104 ppm Pr2O3, referred to as PZLBPr, were synthesized. The UV-VIS-NIR and spectroscopic properties of these glasses were also predicted. The current glasses had broadband emission photoluminescence covering a wavelength range of 1250 to 1700 nm when excited at 455 nm. These bands for near-infrared emission luminescence relate to the transitions 1G4 → 3H5, 1D2 → 1G4, and 3H4 → 3F3, 3F4 in the optical telecommunication window. The significant PL emission wideband was caused by the radiative transition from Pr3+: 1D2 to 1G4. At 445 nm excitation, these glasses exhibited emission bands that corresponded to blue/reddish orange spectral ranges in visible ranges. The prepared glass has a high lasing quality factor (Ω4/Ω6 = 0.9), high optical energy (4.72 eV), and quantum efficiency = 87.3% with FWHM = 156 nm of transition emission from the 1D2 → 1G4 level. As a result, broadband near infrared optical amplifiers can be fabricated from the prepared glasses.

Vibrational Emission Study of the CN and C2 in Nylon and ZnO/Nylon Polymer Using Laser-Induced Breakdown Spectroscopy (LIBS).

The laser-induced breakdown spectroscopy (LIBS) technique was performed on polymers to study the neutral and ionic emission lines along with the CN violet system (B2Σ+ to X2Σ+) and the C2 Swan system (d3 Пg-a3 Пu). For the laser-based emission analyses, the plasma was produced by focusing the laser beam of a Q-switched Nd: YAG laser (2ω) at an optical wavelength of 532 nm, 5 ns pulse width, and a repetition frequency of 10 Hz. The integration time of the detection system was fixed at 1-10 ms while the target sample was positioned in air ambiance. Two organic polymers were investigated in this work: nylon and nylon doped with ZnO. The molecular optical emission study of nylon and doped nylon polymer sample reveals CN and C2 molecular structures present in the polymer. The vibrational emission analysis of CN and C2 bands gives information about the molecular structure of polymers and dynamics influencing the excitation structures of the molecules. Besides, it was further investigated that the intensity of the molecular optical emission structure strongly depends on the electron number density (cm-3), excitation temperature (eV), and laser irradiance (W/cm2). These results suggest that LIBS is a reliable diagnostic technique for the study of polymers regarding their molecular structure, identification, and compositional analysis.

Evaluation of the Radiation Shielding Properties of a Tellurite Glass System Modified with Sodium Oxide.

In this study, the X-ray and gamma attenuation characteristics and optical properties of a synthesized tellurite-phosphate-sodium oxide glass system with a composition of (85 - x)TeO2-10P2O5-xNa2O mol% (where x = 15, 20, and 25) were evaluated. The glass systems we re fabricated by our research group using quenching melt fabrication. The shielding parameters of as-synthesized systems, such as the mass attenuation coefficient (MAC), linear attenuation coefficient (LAC), effective atomic number (Zeff), half-value layer (HVL), tenth value layer (TVL), mean free path (MFP), and effective electron density (Neff) in a wide energy range between 15 keV and 15 MeV, were estimated using well-known PHY-X/PSD software and recently developed MIKE software. Herein, the optical parameters of prepared glasses, such as molar volume (VM), oxygen molar volume (VO), oxygen packing density (OPD), molar polarizability (αm), molar refractivity (Rm), reflection loss (RL), and metallization (M), were estimated using MIKE software. Furthermore, the shielding performance of the prepared glasses was compared with that of commonly used standard glass shielding materials. The results show that the incorporation of sodium oxide into the matrix TeO2/P2O5 with an optimum concentration can yield a glass system with good shielding performance as well as good optical and physical properties, especially at low photon energy.

The Effect of ZnO, MgO, TiO2, and Na2O Modifiers on the Physical, Optical, and Radiation Shielding Properties of a TeTaNb Glass System.

Novel glass samples with the composition 75TeO2-5Ta2O5-15Nb2O5-5x (where x = ZnO, MgO, TiO2, or Na2O) in mole percent were prepared. The physical, optical, and gamma radiation shielding properties of the glass samples were studied over a wide energy spectrum ranging between 0.015 and 20 MeV. The glasses' UV-vis spectra were utilized to evaluate the optical energy gap and refractive index. Glass samples had a refractive index ranging from 2.2005 to 2.0967. The results showed that the sample doped with zinc oxide (ZnO) recorded the highest density (ρglass), molar polarizability (αm), molar refraction (Rm), refractive index (n), and third-order nonlinear optical susceptibility (χ3) and the lowest optical energy gap (Eopt) among the samples under investigation. When comparing the current glass system with various standard glass shielding materials, the prepared glass system showed superior shielding performance at energies ranging between 40 and 85 keV. These findings indicate that the prepared glass systems can be used in diagnostic X-rays, especially in dental applications.

Prediction models based on soil properties for evaluating the heavy metal uptake into Hordeum vulgare L. grown in agricultural soils amended with different rates of sewage sludge.

The current study aims at forming new prediction models to be employed in the approximating the possible uptake of a range of 10 heavy metals (HMs) (Cd, Co, Cr, Cu, Fe, Mn, Mo, Ni, Pb and Zn) by Hordeum vulgare tissues including roots, shoots and grains following its growth in soil amended with sewage sludge (SS) using conditions employed in greenhouses. The present study determined an insignificant difference between the actual and predicted quantities of the HMs in the three tissues using t values. The majority of the predicted quantities of the HMs were acceptable with the exception of Cd in the shoots, Cu in grains and Pb in roots. Consequently, it is possible to use these models in assessing the cultivation of barley plants in soil amended with SS in a safe way, while simultaneously monitoring any potential risks to the health of humans.

Prevalence and clinical presentation of sinusitis in pediatric age group in Aseer, Saudi Arabia.

BACKGROUND: Paediatric rhinosinusitis is mostly different than that in adults. More frequently, children presented with cough, bad breath, crankiness, low energy, and swelling around the eyes, besides a thick yellow-green nasal or post-nasal discharge. About 5- 13% of childhood viral upper respiratory tract infections may advance to acute rhinosinusitis, with some of them developing a chronic condition. AIM: To assess prevalence and clinical presentation of sinusitis in the paediatric age group in Aseer, Saudi Arabia. METHODOLOGY: A retrospective record-based study was conducted in Abha Maternity and Children Hospital in Abha city, Saudi Arabia between January 2015 and January 2018. All medical records during the study period for children whose from to 15 years old attended the hospital and diagnosed as having sinusitis were included. RESULTS: The study included 100 children with complete files whose ages ranged from less than 1 year to up to 13 years old with a mean age of 5.3 4.2 years. Nearly 51% of the children aged 4 years or less and male were 53 (53%). Past history for chronic rhinosinusitis (CRS) was positive among 30 children. Regarding clinical presentations of rhinosinusitis (RS) as reported by the children caregivers, fever was the most reported complaint (50%) followed by red eye (44%), ringing nose (42%), cough (41%) and headache (36%). Mucous culture was positive among 58 cases. The most isolated pathogens were streptococcus pneumoniae (45.6%), Haemophilis influenza (24.6%). CONCLUSIONS: In conclusion, the study revealed that CRS is a common disease in children at different ages, especially, maxillary and frontal sinuses. In most of the cases, medical treatment is highly appreciated; though, surgical intervention may be needed in a small percentage.

Acacia honey from different altitudes: total phenols and flavonoids, laser-induced fluorescence (LIF) spectra, and anticancer activity.

OBJECTIVE: To investigate Acacia honey from different altitudes regarding total phenols and flavonoids, laser-induced fluorescence (LIF) spectra and anticancer activity against human cancer cell lines. METHODS: Anticancer activity was investigated using sulforhodamine B cytotoxicity assays in the following human cancer cell lines: HCT116 (colon); MCF7 (breast), and HepG2 (liver). Total phenols and flavonoids were measured using spectrophotometric methods and LIF was used to differentiate between low and high-altitude honey. RESULTS: The LIF spectra differed between low and high-altitude Acacia honey. High altitude Acacia honey was characterized by significantly lower total phenol content (81.47 ± 1.25 mg gallic acid equivalent [GAE]/100 g) and increased total flavonoids (10.63 ± 0.53 mg quercetin equivalent [QE]/100 g) versus low altitude Acacia honey (91.33 ± 0.96 mg GAE/100 g and 8.78 ± 0.23 mg QE/100 g, respectively). Low altitude Acacia honey displayed increased IC50 values against HCT116 and MCF7 cells (264.17 ± 10.5 and 482.65 ± 20.3 µg/ml, respectively) versus high altitude Acacia honey (117.99 ± 12.7 and 189.82 ± 15.8 µg/ml, respectively). CONCLUSIONS: High altitude Acacia honey had significantly more effective anticancer activity against HCT116 and MCF7 cells compared with low altitude honey.

Knowledge, Awareness, and Attitudes Toward Obstructive Sleep Apnea among the Population of the Asir Region of Saudi Arabia in 2019.

Background Obstructive sleep apnea (OSA) is a sleep disorder that involves the cessation or significant decrease in airflow along with a distinct effort to breathe. While there are several types of sleep apnea, OSA is the most common. Methodology This descriptive online cross-sectional study assessed knowledge, awareness, and attitudes towards OSA over 30 days in a nonrandomized sample of the general population of the Asir region of Saudi Arabia. Subjects were included if they lived in the Asir region and were aged >18 years. Results Of the respondents who participated in the study, 64% were aware of OSA, whereas 36% were not. Most respondents reported that OSA was dangerous, whereas 24% did not know whether OSA was dangerous. Moreover, 81% of respondents reported that they did not know about methods of diagnosing OSA, and 84% did not know about the methods to treat OSA. Conclusions Subjects living in the Asir region of Saudi Arabia showed a low level of awareness of all aspects of OSA. Their lack of sources of knowledge indicates the need for medical staff to improve awareness and knowledge of OSA.

Biomonitoring potential of the native aquatic plant Typha domingensis by predicting trace metals accumulation in the Egyptian Lake Burullus.

The ability of the native emergent macrophytes Typha domingensis for monitoring pollution with trace metals in Egyptian Lake Burullus was investigated through developing regression models for predicting their concentrations in the plant tissues. Plant samples (above-ground shoot and below-ground root and rhizome) as well as sediment samples were collected monthly during one growing season and analyzed. The association of trace metals concentration with several sediment characteristics (pH, organic matter, clay and silt) was also studied using the simple linear correlation coefficient (r). The concentration of some trace metals was significantly proportional to its values in the sediment such as Cd in the shoot, rhizome and root, Fe in the rhizome, and Ag in the root. There was positive relationship between the bioaccumulation factor (BAF) of Ag, Cd, Fe, Pb and Zn and sediment pH, organic matter and clay content. The developed regression models were significantly valid with high model efficiency and coefficient of determination, and low mean normalized average error. Trace metals were accumulated in the below-ground root and rhizome rather than in the shoot. Only Ag, Co and Ni provided bioaccumulation factor (BAF) < 1, while Ag was the only trace metal that could be transferred to some extend from the root to the rhizome and from there to the shoot [translocation factor (TF) 2.55 and 1.15, respectively]. Typha domingensis in Lake Burullus could be regarded as a bioindicator of trace metals pollution, and a good candidate as phytoremediator for Ag. The information on the phytoremediation capacity of T. domingensis certainly helps to solve contamination problems at Egyptian Lake Burullus region using this native plant.

Capacity and readiness of primary health care centers for implementation of the basic strategy for prevention and control of non-communicable diseases in Saudi Arabia. A case study from the Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.

OBJECTIVE: To assess the capacity and readiness of primary healthcare centers (PHC) for the implementation of basic strategies for the prevention and control of non-communicable diseases (NCDs) at the Ministry of National Guard-Health Affairs (MNG-HA) in Saudi Arabia. METHODS: Facility-based face-to-face interviews were conducted in 41 PHCs included in this survey, using the World Health Organization (WHO) questionnaire. Main area survived were: availability of human resources, medical equipment, infrastructure, medicines, service utilization, referral systems, and community outreach.   Results: Approximately 90% of the PHC centers were located in urban areas of the country. The level of staff training on NCD prevention and control strategies was reported to be inadequate, particularly for nurses and other healthcare providers. As for diagnostic equipment, diagnostic tests, essential medication, access to referral facilities and medical records most of them were available in all the PHCs among the different categories. CONCLUSIONS:   The MNG-HA PHCs appear to have the capacity to integrate strategies for the prevention and control of NCDs as part of their daily functions. However, improvements are required in some areas to facilitate the integration process and training the health care workers (HCWs) on prevention and control of NCDs as part of their daily practice.

Controllable biogenic synthesis of intracellular silver/silver chloride nanoparticles by Meyerozyma guilliermondii KX008616.

Intracellular synthesis of silver/silver chloride nanoparticles (Ag/AgCl-NPs) using Meyerozyma guilliermondii KX008616 is reported under aerobic and anaerobic conditions for the first time. The biogenic synthesis of Ag-NP types has been proposed as an easy and cost-effective alternative for various biomedical applications. The interaction of nanoparticles with ethanol production was mentioned. The purified biogenic Ag/AgCl-nanoparticles were characterized by different spectroscopic and microscopic approaches. The purified nanoparticles exhibited a surface plasmon resonance band at 419 and 415 nm, confirming the formation of Ag/AgCl-NPs under aerobic and anaerobic conditions, respectively. The planes of the cubic crystalline phase of the Ag/AgCl-NPs were confirmed by X-ray diffraction. Fourier-transform infrared spectra showed the interactions between the yeast cell constituents and silver ions to form the biogenic Ag/AgCl-NPs. The intracellular Ag/AgCl-NPs synthesized under aerobic condition were homogenous and spherical in shape, with an approximate particle size of 2.5-30nm as denoted by the transmission electron microscopy (TEM). The reaction mixture was optimized by varying reaction parameters, including temperature and pH. Analysis of ultrathin sections of yeast cells by TEM indicated that the biogenic nanoparticles were formed as clusters, known as nanoaggregates, in the cytoplasm or in the inner and outer regions of the cell wall. The study recommends using the biomass of yeast that is used in industrial or fermentation purposes to produce Ag/AgCl-NPs as associated by-products to maximize benefit and to reduce the production cost.

Ultra-high density optical data storage in common transparent plastics.

The ever-increasing demand for high data storage capacity has spurred research on development of innovative technologies and new storage materials. Conventional GByte optical discs (DVDs and Bluray) can be transformed into ultrahigh capacity storage media by encoding multi-level and multiplexed information within the three dimensional volume of a recording medium. However, in most cases the recording medium had to be photosensitive requiring doping with photochromic molecules or nanoparticles in a multilayer stack or in the bulk material. Here, we show high-density data storage in commonly available plastics without any special material preparation. A pulsed laser was used to record data in micron-sized modified regions. Upon excitation by the read laser, each modified region emits fluorescence whose intensity represents 32 grey levels corresponding to 5 bits. We demonstrate up to 20 layers of embedded data. Adjusting the read laser power and detector sensitivity storage capacities up to 0.2 TBytes can be achieved in a standard 120 mm disc.

Advanced trends in controlling Helicobacter pylori infections using functional and therapeutically supplements in baby milk.

Helicobacter pylori is a common human pathogen infecting about 30 % of children and 60 % of adults worldwide. It is responsible for diseases such as gastritis, peptic ulcer and gastric cancer. H. pylori treatment based on antibiotics with proton pump inhibitor, but therapy failure is shown to be higher than 20 % and is essentially due to an increasing in prevalence of antibiotic-resistant bacteria, which has led to the search for alternative therapies. In this study, we discuss the usage of natural extracts mixture as alternative or complementary agents in controlling H. pylori infection so here, we focused on the plant extracts of (Cloves, Pepper, Cumin, Sage, Pomegranate peel, Ginger, Myrrh and Licorice). To that end, Phytochemical constituents detection like Tannins, Glycosides, Alkaloids, Flavonoids, Terpenoids, Saponins, Phenolic compounds, Reducing sugars, Volatile oils, Amino acids and Proteins was demonstrated. Each plant extract was examined individually or in combination for its antimicrobial activity against H. pylori. Out of the used extracts, four mixes were prepared and tested against H. pylori. The antibacterial activities of the four mixes, represented by the diameter of inhibition clear zone, recorded 21, 39, 23 and 28 mm. The most potent mix (mix2) was chosen and mixed with baby milk as a new combination for H. pylori infections treatment in babies.

Implementation of pharmacist-managed anticoagulation clinic in a saudi arabian health center.

BACKGROUND: During the past 2 decades, a paradigm shift in the management of oral anticoagulation therapy has occurred. A multidisciplinary approach has been used and has proved beneficial from both a cost and quality perspective. However, this approach to anticoagulation therapy is not well established in Saudi Arabia and the Middle East, and the traditional way of managing anticoagulation patients is still the mainstay of care. The Pharmacy Services Division (PSD) in collaboration with physician, nursing, and medical support enterprises at the Dhahran Health Center established the pharmacy-managed anticoagulation clinic (ACC). OBJECTIVE: To describe the implementation process of the first pharmacist-managed anticoagulation clinic in the eastern province of Saudi Arabia and its impact on patient care. METHODS: The PSD in collaboration with medical staff successfully created a care delivery model utilizing clinical pharmacists' expertise to provide comprehensive anticoagulation management services at Saudi Aramco Medical Services Organization (SAMSO). Planning included analyzing existing practices, reviewing the relevant literature, obtaining physician input, formulating a business proposal, and developing clinical protocols and guidelines. Collaborative relationships were established with the center laboratory, scheduling services, and nursing and medical departments. Clinic services include patient assessment, anticoagulation monitoring, warfarin dosage adjustment, medication dispensing at the clinic, patient education, and feedback to referring physicians. Data (2 years before and after clinic inception) for all patients enrolled at the anticoagulation clinic were reviewed to evaluate the impact of the clinic on anticoagulation management, adverse events, and patient satisfaction. RESULTS: A total of 578 patients were enrolled in the ACC. The total percentage of international normalized ratio (INR) within the target range was 59% versus 48% when compared to the previous traditional practice. The number of INR tests per patient dropped by 19%. Minor and major adverse events occurred in 10% and 1.5% of patients, respectively. Overall, the patients were very satisfied with the new clinic compared to the previous practice. CONCLUSION: Implementation of the pharmacist-managed ACC in the eastern province of Saudi Arabia had a positive impact on patient care based on the improvements in the number of patients whose INR was within therapeutic range and patient satisfaction scores.