Waste management in primary healthcare centers in Saudi Arabia: a policy analysis.

Medical waste poses high risks to healthcare workers, patients, the environment, and public health. Governments have adopted measures and enacted policies to ensure proper medical waste management. Through a retrospective policy analysis, we analyzed the waste management policy for primary healthcare centers in Saudi Arabia. By adopting Walt and Gilson's health policy analysis framework, we conducted a thematic analysis of documents to analyze the policy context, process, actors, and content. Contextual factors including accreditation, the Saudi Vision-2030 and the healthcare transformation plan contributed to the development of the policy. The policy was adapted from a regional policy that was enacted about 15 years ago. The policy content overlooked components relevant to the specific context of primary healthcare centers. Lack of training and cooperation among stakeholders challenged successful implementation and thus compliance with the policy. Respective stakeholders must take further actions to ensure implementation fidelity and sustainability of the policy.

Toxic Metals and Metalloids in Hassawi Brown Rice: Fate during Cooking and Associated Health Risks.

Rice has been a dietary staple for centuries, providing vital nutrients to the human body. Brown rice is well known for its nutrient-dense food profile. However, owing to multiple causes (anthropogenic and non-anthropogenic), it can also be a potential source of toxic heavy metals in the diet. Brown Hassawi rice samples were collected from the Al-Ahsa region and analyzed for its content of toxic metals. The results reveal that all the tested metals varied significantly in the brown rice samples, while As and Pb in all three samples exceeded their respective maximum allowable limits (MALs), followed by Cd, which nearly approached the MAL in two samples out of three. Brown rice samples were cooked in rice:water systems, viz., low rice:water ratios (1:2.5, 1:3.5) and high rice:water ratios (1:5, 1:6), along with soaking as a pre-treatment. Soaking was unproductive in removing the heavy metals from the rice, whereas cooking dissipated all metals from the rice, except for Cd, which was statistically non-significant. The high-water cooking of the rice was more effective in the dissipation of metals from the rice as compared to low-water cooking conditions. Through the consumption of rice, the estimated daily intake (EDI) of heavy metals is 162 g per person per day for As, which is above the provisional maximum tolerable daily intake (PMTDI) regardless of cooking circumstances. The hazard risk index (HRI) also highlighted the fact that As can be a potential health hazard to rice consumers in the Al-Ahsa region of Saudi Arabia. These results indicate the potential health risks caused by the consumption of this rice by humans. Regular monitoring is recommended to manage and control elevated concentrations and related health hazards as a result of the use of Hassawi rice contaminated by the accumulation of metals and metalloids.

Burden of Transport-Related Injuries in the Eastern Mediterranean Region: A Systematic Analysis for the Global Burden of Disease Study 2017.

BACKGROUND: Transport-related injuries (TIs) are a substantial public health concern for all regions of the world. The present study quantified the burden of TIs and deaths in the Eastern Mediterranean region (EMR) in 2017 by sex and age. METHODS: TIs and deaths were estimated by age, sex, country, and year using Cause of Death Ensemble modelling (CODEm) and DisMod-MR 2.1. Disability-adjusted life years (DALYs), which quantify the total burden of years lost due to premature death or disability, were also estimated per 100000 population. All estimates were reported along with their corresponding 95% uncertainty intervals (UIs). RESULTS: In 2017, there were 5.5 million (UI 4.9-6.2) transport-related incident cases in the EMR - a substantial increase from 1990 (2.8 million; UI 2.5-3.1). The age-standardized incidence rate for the EMR in 2017 was 787 (UI 705.5-876.2) per 100000, which has not changed significantly since 1990 (-0.9%; UI -4.7 to 3). These rates differed remarkably between countries, such that Oman (1303.9; UI 1167.3-1441.5) and Palestine (486.5; UI 434.5-545.9) had the highest and lowest age-standardized incidence rates per 100000, respectively. In 2017, there were 185.3 thousand (UI 170.8-200.6) transport-related fatalities in the EMR - a substantial increase since 1990 (140.4 thousand; UI 118.7-156.9). The age-standardized death rate for the EMR in 2017 was 29.5 (UI 27.1-31.9) per 100000, which was 30.5% lower than that found in 1990 (42.5; UI 36.8-47.3). In 2017, Somalia (54; UI 30-77.4) and Lebanon (7.1; UI 4.8-8.6) had the highest and lowest age-standardized death rates per 100,000, respectively. The age-standardised DALY rate for the EMR in 2017 was 1,528.8 (UI 1412.5-1651.3) per 100000, which was 34.4% lower than that found in 1990 (2,331.3; UI 1,993.1-2,589.9). In 2017, the highest DALY rate was found in Pakistan (3454121; UI 2297890- 4342908) and the lowest was found in Bahrain (8616; UI 7670-9751). CONCLUSION: The present study shows that while road traffic has become relatively safer (measured by deaths and DALYs per 100000 population), the number of transport-related fatalities in the EMR is growing and needs to be addressed urgently.

Predicting the environmental suitability for onchocerciasis in Africa as an aid to elimination planning.

Recent evidence suggests that, in some foci, elimination of onchocerciasis from Africa may be feasible with mass drug administration (MDA) of ivermectin. To achieve continental elimination of transmission, mapping surveys will need to be conducted across all implementation units (IUs) for which endemicity status is currently unknown. Using boosted regression tree models with optimised hyperparameter selection, we estimated environmental suitability for onchocerciasis at the 5 × 5-km resolution across Africa. In order to classify IUs that include locations that are environmentally suitable, we used receiver operating characteristic (ROC) analysis to identify an optimal threshold for suitability concordant with locations where onchocerciasis has been previously detected. This threshold value was then used to classify IUs (more suitable or less suitable) based on the location within the IU with the largest mean prediction. Mean estimates of environmental suitability suggest large areas across West and Central Africa, as well as focal areas of East Africa, are suitable for onchocerciasis transmission, consistent with the presence of current control and elimination of transmission efforts. The ROC analysis identified a mean environmental suitability index of 0·71 as a threshold to classify based on the location with the largest mean prediction within the IU. Of the IUs considered for mapping surveys, 50·2% exceed this threshold for suitability in at least one 5 × 5-km location. The formidable scale of data collection required to map onchocerciasis endemicity across the African continent presents an opportunity to use spatial data to identify areas likely to be suitable for onchocerciasis transmission. National onchocerciasis elimination programmes may wish to consider prioritising these IUs for mapping surveys as human resources, laboratory capacity, and programmatic schedules may constrain survey implementation, and possibly delaying MDA initiation in areas that would ultimately qualify.

Global research on the air quality status in response to the electrification of vehicles.

Electric vehicles (EVs) can substantially decrease atmospheric pollutant emissions, thereby improving air quality, decreasing global warming, and improving human health. In this study, we performed a comprehensive bibliometric analysis using Web of Science to understand the research developments and future perspectives in EVs between 1974 and 2021. The analysis of indicators such as research trends, publication growth, and keywords revealed that most research in the selected timeframe was focused on applying and optimizing the existing technologies of different types of EVs to decrease air pollution and mortality. The changes in air quality owing to such electrification received special attention, with approximately 441 publications preferably in the English language. Among all the retrieved documents, research articles were most common (n = 295; 66.89% of the global output), dominated by the research domains of environmental sciences, followed by energy fuels and transportation science technology. Journal analysis revealed that Sustainability (n = 19, 4.30%) was the leading journal, followed by Journal of Cleaner Production and Science of the Total Environment. The most frequently used keywords were "electric vehicles," "air quality," and "air pollution." The most highly impactful article was published by Jacobson et al. (2005) in Science, with 620 total citations and 38.82 average annual citations. Furthermore, the United States (n = 118; 26.75% of the global output) had the highest publication rate, followed by China and the United Kingdom. The leading institutions were Tsinghua University (n = 16; 3.62% of the global research output) in China, followed by the University of Michigan and Cornell University in the United States. The current analysis warrants more focus on comprehensive analysis employing transport and chemistry modeling and using the latest technology for long life and sustainable batteries. This study provides a basis for future studies on improving air quality through innovative work in the electrification of vehicles.

Medical negligence in healthcare organizations and its impact on patient safety and public health: a bibliometric study.

Background: Medical negligence is an increasing public health concern among healthcare providers worldwide as it affects patient safety. It poses a significant risk of patient injury, disease, disability, or death. The WHO has recognized deficiencies in patient safety as a global healthcare issue to be addressed. This study aimed to analyze various components of medical negligence research literature. Methods: Bibliographic data visualizations tools like Biblioshiny (RStudio) and VOSviewer were used besides MS Excel to examine the types of documents, annual scientific production, top contributing authors and their impact, authorship patterns and collaboration, top contributing countries and organizations, most significant sources of publication, most cited documents, and most frequently used keywords. Bibliometric methods were used to analyze the bibliographic records of research output on medical negligence downloaded from the Web of Science Core Collection. Results: The annual productivity of medical negligence research was increasing gradually. The most productive period for medical negligence research was 2011-2020. Bird contributed the highest number of publications to medical negligence literature while Brennan emerged as the highly cited author. Single-authored publications on medical negligence were not highly cited. The United States was the highest contributing country and the University of South Florida was the highest contributing organization while Harvard University was a highly cited organization. Nine out of the top ten contributing organizations were academic institutions and most of them belonged to the United States. The most important sources of publication on this topic were The Lancet and British Medical Journal. Localio et al. was the most important research article on medical negligence research. Conclusion: Due to increasing attention on this topic, there was a sharp increase in the research output on medical negligence. This is of significance as the WHO set in motion a patient safety program almost two decades ago.

Profiling of Essential Mineral Content, Heavy Metals, and Bacterial Contaminants in Conventional and Organic Eggs Available in the Hypermarkets of the Eastern Province of Saudi Arabia.

BACKGROUND: Eggs are commonly regarded as one of the best sources of various macro and micronutrients, in particular, high biological value (BV) proteins and both saturated and unsaturated fatty acids. Apart from proteins, eggs are excellent sources of various high health value lipid components, carotenoids, minerals, and both water and lipid-soluble vitamins. However, the nutrient-rich nature of this 'superfood' also makes them susceptible to microbial contamination from various sources, such as fecal matter, drinking water for layer chicken, and the surrounding environment. Moreover, drinking water and chicken feed are also sources of heavy metal contamination. The presence of both factors poses serious health concerns for consumers. OBJECTIVE: The main aim of this research was to proximate heavy metals and bacterial contaminants in nine different brands of brown organic and conventional white eggs available in the hypermarkets of the Eastern Province of Saudi Arabia. METHODS: An Inductively Coupled Plasma-Optical Emission Spectrometer (ICP-OES) was used to determine the concentration of metals with high sensitivity. Standard plate count was followed by enrichment of bacterial contaminants in a double-strength nutrient broth medium for microbiological assessment. RESULTS: The results indicated that Pb, Cd, Al, and As were present in high concentrations in all egg brands of both types (organic and conventional). The estimated daily intake (EDI) values for Ca, Fe, Mn, and Mg were within the range of WHO-recommended thresholds, and these essential minerals were present in adequate amounts in all egg brands. The two major groups predominating the microbial loads were the family Enterobacteriaceae and Pseudomonas sp. CONCLUSION: The presence of heavy metals, such as Al, As, Pb, and Cd, in nearly all the brands in amounts that exceeded the established ADI and EDI thresholds was considerably concerning. In particular, the elevated levels of Cd and Pb in group 1 and group 2A probable human carcinogens, respectively, demands that local regulatory authorities investigate the sources of heavy metal contamination and alleviate this considerable risk to human health. Furthermore, this study could be a benchmark for establishing food safety and hygiene standards for local egg production, storage, handling, and transport in Saudi Arabia.

Insights on comparative bacterial diversity between different arid zones of Cholistan Desert, Pakistan.

The present study was conducted to analyze bacterial diversity profile of Cholistan desert located in Pakistan. The study investigates the influence of physicochemical parameters of soil on distribution of different bacteria at all taxonomic levels and also study the distribution pattern between different desert environments, particularly rhizospheric and bulk desert sands. Species richness showed phyla Proteobacteria and Chloroflexi as the dominant OTUs in all the samples. Besides the two phyla, the rhizospheric soils with root remnants were dominated by Firmicutes, Deinococcus-Thermus, Actinobacteria and Acidobacteri, while phylum Thermotogae was present in significant quantity in rhizosheaths devoid of roots. In non-rhizospheric desert soils, a considerable number of OTUs belonged to phyla Proteobacteria, Chloroflexi, Bacteroidetes and Acidobacteria. An important finding from this study is that a bulk portion of the OTUs were assigned to unclassified taxa, indicating a large repertoire of unexplored taxa in the desert ecology of Pakistan. Distribution of taxonomic groups among various regions of the desert was collaborating well with the physicochemical parameters of the sites. The findings of this study establish the fundamental relationships between desert ecosystem, specific native plant and the total bacterial flora. This is the first study of microbial community analysis of any desert in Pakistan and thus, will serve as a future platform to explore further on desert ecosystem functioning by employing the ever-changing biotechnological tools.

Formulation and characterization of oil-in-water nanoemulsions stabilized by crude saponins isolated from onion skin waste.

In the current work, a detailed study of crude saponins isolated from onion skin waste (OSW) was carried out to minimize the interfacial tension (γ) at oil-water interfaces, and to evaluate important factors on the formulation and characterization of nanoemulsions (NEs) stabilized by OSW saponins as a new natural emulsifier. It was found that OSW saponins are moderately strong surface-active agents. The droplet size of OSW saponin-stabilized NEs formulated by a high-pressure homogenizer was significantly dependent on processing parameters, where volume mean droplet diameter (d 4,3) decreased as homogenization pressure and emulsifier concentration increased. The d 4,3 of NEs formulated from soybean oil, sunflower oil, and medium-chain triglyceride (MCT) oil was <140 nm, which was much smaller than those prepared using orange oil (d 4,3 > 800 nm). The OSW saponin-coated droplets in soybean-based NEs showed stability against thermal treatment (30-90 °C, 30 min), pH (7-9), and ionic strength (NaCl < 50 mM). The NEs exhibited instability with droplet coalescence at relatively low pH (3-6), and high ionic strength (NaCl > 50 mM). The NEs stabilized by 0.5-1% (w/w) OSW were highly stable without an increase in d 4,3 during the storage (60 days) at 25 °C. Overall, these results suggest that OSW saponins are an efficient natural emulsifier, with significant potential to replace synthetic emulsifiers in certain practical applications.

Biochar application for the remediation of salt-affected soils: Challenges and opportunities.

Soil salinization and sodification are two commonly occurring major threats to soil productivity in arable croplands. Salt-affected soils are found in >100 countries, and their distribution is extensive and widespread in arid and semi-arid regions of the world. In order to meet the challenges of global food security, it is imperative to bring barren salt-affected soils under cultivation. Various inorganic and organic amendments are used to reclaim the salt-affected lands. The selection of a sustainable ameliorant is largely determined by the site-specific geographical and soil physicochemical parameters. Recently, biochar (solid carbonaceous residue, produced under oxygen-free or oxygen-limited conditions at temperatures ranging from 300 to 1000°C) has attracted considerable attention as a soil amendment. An emerging pool of knowledge shows that biochar addition is effective in improving physical, chemical and biological properties of salt-affected soils. However, some studies have also found an increase in soil salinity and sodicity with biochar application at high rates. Further, the high cost associated with production of biochar and high application rates remains a significant challenge to its widespread use in areas affected by salinity and sodicity. Moreover, there is relatively limited information on the long-term behavior of salt-affected soils subjected to biochar applications. The main objective of the present paper was to review, analyze and discuss the recent studies investigating a role of biochar in improving soil properties and plant growth in salt-affected soils. This review emphasizes that using biochar as an organic amendment for sustainable and profitable use of salt-affected soils would not be practicable as long as low-cost methods for the production of biochar are not devised.

Opportunities and challenges in the use of mineral nutrition for minimizing arsenic toxicity and accumulation in rice: A critical review.

Growing rice on arsenic (As)-contaminated soil or irrigating with As-contaminated water leads to significant accumulation of As in grains. Moreover, rice accumulates more As into grains than other cereal crops. Thus, rice consumption has been identified as a major route of human exposure to As in many countries. Inorganic As species are carcinogenic and could pose a considerable health risk to humans even at low dietary concentration. Genotypic variation and concentration of nutrients such as iron, manganese, phosphate, sulfur and silicon are the two main factors that affect As accumulation in rice grains. Therefore, in addition to better growth and yield of plants, application of specific nutrients in optimum quantities offers an added benefit of decreasing As content in rice grains. These nutrient elements influence speciation of As in rhizosphere, compete with As for root uptake and interfere with As translocations to the shoot and ultimately accumulation in grains. This papers critically appraises the methods, forms and rate of application, mechanisms and extent of efficiency of different mineral nutrients in decreasing As accumulation in rice grains.

Calcium polysulphide, its applications and emerging risk of environmental pollution-a review article.

Easy availability, preparation technique, and economic value make calcium polysulphide (CaS x ) a very useful inorganic chemical for various field and industrial applications. In this article, disparate applications of CaS x solution have been reviewed to suggest potential and future consolidation. This article also encompasses the physiochemical properties and production of CaS x solution, with critical appraisal on research focusing on CaS x application in agriculture industries and removal of potentially toxic elements (PTEs) from the environment. The kinetics of CaS x , technical issues associated with optimization of its dosage and environmental fate is also discussed in detail. This study covers almost all of the peer-reviewed research that has been performed since 1914. Some of the critiques in this article include the lack of integration between the exposure effect and the efficiency of treatment method, effects of oxidizing environments on the long-term performance of CaS x solution, and kinetics of CaS x solution with the PTEs. The working model of CaS x with PTEs is still system dependent, and therefore cannot be used with other applications. The kinetics of CaS x is described in detail with various phase stoichiometric reactions. Environmental fate is discussed based on applications, government reports, peer-reviewed articles and kinetics of CaS x , which provides a clear picture of emerging contaminants in the environment in relation to the insect resistance and ecotoxicology. Real time, lab based research articles are needed to identify toxicity limits of CaS x in environment in order to describe its effective permissible limit in environmental system. This review article provides a risk assessment of environmental pollution by CaS x based on its physicochemical characteristic, stoichiometry, kinetics, field, and industrial applications.

Timing of foliar Zn application plays a vital role in minimizing Cd accumulation in wheat.

Due to chemical and biochemical similarities between cadmium (Cd) and zinc (Zn), application of Zn may minimize Cd uptake by plants and ameliorate its toxicity. However, there is poor understanding of the comparative effectiveness of the foliar Zn application at different growth stages on Cd toxicity and accumulation in wheat. The present study was carried out to compare the effectiveness of foliarly applied Zn at different stages of plant growth to minimize Cd accumulation in wheat grains. Wheat (cv AARI-2011) was grown at three levels of soil Cd (0, 2.5, and 5.0 mg kg(-1)). Foliar application of Zn was carried out at either tillering, jointing, booting, heading, or grain filling stage using 0.05 % w/v aqueous solution of ZnSO4 · 7H2O. Increasing soil Cd had a negative effect on growth and yield attributes, including tiller production, root length and dry weight, plant height, 100-grain weight and grain and straw yield. Zinc foliar spray increased grain yield by increasing tiller production; importantly, an application at booting was more effective than at other stages. Foliarly applied Zn decreased Cd concentration in the roots, straw, and grain. Similar to grain yield, the largest decrease (74 %) in Cd concentration was associated with Zn foliar spray at booting. Grain yield was negatively related to grain Cd concentration which in turn showed a negative relationship with Zn concentration in leaves and grains. It is concluded that the booting stage is the suitable time for foliar application of Zn to (i) effectively minimize a Cd-induced loss in grain yield and (ii) decrease grain Cd concentration.

Elemental sulfur improves growth and phytoremediative ability of wheat grown in lead-contaminated calcareous soil.

Little is known about the effect of elemental sulfur on lead uptake and its toxicity in wheat. A pot experiment was conducted with the purpose to examine the impact of sulfur on improving Pb solubility in soil, and uptake and accumulation in wheat plants. The effect of three levels of lead (0, 50, and 100 mg/kg soil) and sulfur (0, 150, and 300 mmol/kg soil) was tested in all possible combinations. Root dry matter, straw, and grain yields, and the photosynthetic and transpiration rates decreased significantly with increase in the concentration of Pb in the soil. However, sulfur fertilization in the presence of Pb improved the photosynthetic and transpiration rates and consequently increased the straw and grain yields of wheat. It also enhanced Pb accumulation in roots, its translocation from roots to shoot, and accumulation in grain. S and Zn contents of different plant parts were also enhanced. Thus, by mitigating the toxic effect of Pb and improving wheat growth, sulfur enhances Pb accumulation by the aboveground plant parts and hence the phytoextraction capacity of wheat. However, total accumulation of Pb shows that wheat plant cannot be considered as a suitable candidate for phytoremediation.