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Objectives: To determine the effectiveness of a clinical decision support system (CDSS) as indicated by a lower proportion of receiving contraindicated medications by patients with severe chronic kidney disease (CKD) compared with patients with less severe CKD. Materials and Methods: This was a retrospective analysis of inpatients with CKD (ICD9-CM 585.xx) admitted to a major tertiary hospital in Saudi Arabia and receiving one of the medications that were documented in the knowledge base of the hospital CDSS to be renally cleared and/or nephrotoxic. Using the Chi square test, the proportion of receiving contraindicated medication was compared between patients with severe CKD and patients with mild/moderate CKD. Multivariate logistic regression was then used to examine the adjusted risk of receiving contraindicated medications among patients with severe CKD despite the presence of guided medication by CDSS. Results: The final analysis was conducted on 346 patients who received prescriptions that were renally cleared and/or nephrotoxic. Of these patients, 17% (n = 58) had severe CKD and 83% (n = 288) had mild/moderate CKD. Among patients with severe CKD, 51.7% (n = 30) received contraindicated medications compared with patients with mild/moderate CKD, 4.9% (n = 14), P < 0.01. Multivariate logistic regression showed that the likelihood of receiving contraindicated medications was several folds higher among patients with severe CKD compared with patients with mild/moderate CKD (P < 0.001). Conclusion: Patients with severe CKD continued to receive contraindicated medications despite the availability of medication guidance by the CDSS to prescribing physicians. Improved compliance by physicians to CDSS alerts and better understanding of reasons for non-compliance is still needed, particularly for patients with severe CKD.

Objectives: Students who perceived their learning environment positively are more likely to develop effective learning strategies, and adopt a deep learning approach. Currently, there is no validated instrument for measuring the educational environment of educational programs on respiratory care (RC). The aim of this study was to develop an instrument to measure students′ perception of the RC educational environment. Materials and Methods: Based on the literature review and an assessment of content validity by multiple focus groups of RC educationalists, potential items of the instrument relevant to RC educational environment construct were generated by the research group. The initial 71 item questionnaire was then field-tested on all students from the 3 RC programs in Saudi Arabia and was subjected to multi-trait scaling analysis. Cronbach′s alpha was used to assess internal consistency reliabilities. Results: Two hundred and twelve students (100%) completed the survey. The initial instrument of 71 items was reduced to 65 across 5 scales. Convergent and discriminant validity assessment demonstrated that the majority of items correlated more highly with their intended scale than a competing one. Cronbach′s alpha exceeded the standard criterion of >0.70 in all scales except one. There was no floor or ceiling effect for scale or overall score. Conclusions: This instrument is the first assessment tool developed to measure the RC educational environment. There was evidence of its good feasibility, validity, and reliability. This first validation of the instrument supports its use by RC students to evaluate educational environment.

Background: Expenditure on medications represents significant proportion of the total hospital budget. Establishing an effective drug cost management program is a priority area for hospitals that must begin with determining the current costs and pattern of use of medications. Objectives: The aim of the present study is to determine the cost and pattern of drug utilization at the study hospital in order to identify cost reduction opportunities. Methods: A descriptive retrospective design was used to examine the cost and pattern of drug utilization for all admissions during the period from: 1st January 2006 to 30th June 2006 in a university hospital in Eastern Saudi Arabis. Electronic patient data as well as manual drug cost data were obtained and merged to create the analysis database. Results: The study revealed that the total drug cost at the study hospital was SR 11,823,666.9 (mean per admission = SR 2123.5 and median per admission= SR 357.3) during the study period. Antibiotics were responsible for 35.8% of the total inpatient drug costs followed by blood products which accounted for 20.6% of the total inpatient drug costs. Further investigation of both groups revealed that the combination of piperacillin and tazobactam represented 4.5% of prescribed drugs and accounted for almost half of the inpatient antibiotic costs (SR 2,064,916.8) and 17.4% of the total hospital’s inpatient drug costs. Human albumin and intravenous immunoglobulin were responsible for the majority of cost of blood products. Conclusions: Piperacillin and tazobactam, human albumin, and intravenous immunoglobulin other than Rho (D) immunoglobulin are responsible for high percentage of drug expenditure at the study hospital while being prescribed to a limited number of patients. Designing a drug cost management program to target these three drugs will increase the likelihood of achieving significant cost reduction.

Here, we sequenced the complete mitochondrial genome of 29 Egyptian river buffaloes collected in two breeding stations of Egypt. The genome is 16,357–16,359 base pairs in length and contains the 37 genes found in a typical mammalian genome. The overall base composition is A: 33.1%, C: 26.6%, G: 13.9%, and T: 26.4%. Our analyses confirm that the mitochondrial genomes of swamp and river buffaloes are divergent (mean nucleotide distance = 2.3%), and show that Indian river buffalo haplotypes cluster into three haplogroups, named RB1, RB2, and RB3 (mean distance = 0.25–0.26%) and that the 24 Egyptian buffalo haplotypes fall into RB1 (with the Bangladeshi, Chinese and Italian buffalo haplotypes) and RB2.

There has been significant interest in free-space optical (FSO) communication by the research community in recent years. This is due to its high data rate, unlicensed spectrum, low cost, and immense security for FSO systems. Due to these advantages, FSO can have broader applications that extend from terrestrial to satellite communication. Atmospheric turbulence (AT) induced fading is a primary problem in the FSO link since it significantly impairs its performance. Atmospheric turbulence occurs due to the random variation of the air refractive index with time. Several statistical models are introduced to characterize the AT. The Log-normal (LN) model represents weak and moderate turbulence, and the Gamma-Gamma (G-G) model is employed for strong turbulence. These models are used with the effect of weather attenuation, geometric losses, and misalignment errors. One possible solution is channel coding, such as low-density parity-check (LDPC) codes. This paper proposed employing Weighted Bit Flipping (WBF) and Implementation Efficient Reliability Ratio Weighted Bit Flipping (IERRWBF) decoding techniques to improve FSO link performance. The results show a superior improvement in the bit error rate (BER) than the uncoded FSO system. In addition, the obtained results prove that the IERRWBF technique is more optimized than WBF from the point of the number of iterations, especially in weak and moderate turbulence FSO channels. In the calculation of decoders processing time, the WBF maintained lower decoding time than the IERRWBF technique, while in higher $E_{b}/N_{o}\text{s}$ , they have the same level. The same response for both techniques in the case of resultant throughput. Finally, both methods are evaluated from the point of convergence. IERRWBF technique achieved faster convergence than WBF in all FSO channels under study.

A complete impulse radio-ultra wide band (IR-UWB) system is proposed to mitigate the impairments concerning on-body to off-body Wireless Body Area Networks (WBAN). The proposed system maintains the practical communication link between on-body sensors to the fusion center or the monitoring device held by the medical representative. Also, these sensors are assigned a recently proposed pulse shaping to mitigate the noise that existed in the IR-UWB WBAN channel. Furthermore, virtual multiple-input multiple-output (VMIMO) is proposed to perform spatial multiplexing between various sensors transmitted data. Moreover, low complex low density parity check (LDPC) encoding/decoding algorithms, including a new low complex hybrid LDPC decoding algorithm, are proposed to reduce the complexity and to enhance the bit error rate of the on-body sensors. Interestingly, low energy consumption at every sensor participating in the on-body to off-body WBAN was achieved by adopting the combination between LDPC decoders and VMIMO technique. According to simulation results, the new system enhanced the BER performance and reduced the complexity of the on-body to off-body IR-UWB communication system effectively.

Wireless body area network (WBAN) is a promising network aiming at enhancing the communication in medical applications. It is adopted by medical organizations due to its flexibility in remotely monitoring patient health status. WBANs suffer from many limitations due to excessive channel impairments. Low density parity check (LDPC) codes are proposed to mitigate WBAN's impairments concerning the bit error rate, complexity, and dissipated energy. In this paper, a comprehensive performance analysis of various LDPC decoding algorithms is used to improve communication and reduce complexity in implant to implant WBAN channel. Moreover, a novel low complex LDPC decoding algorithm, which has a performance close to soft decision and a decoding time close to hard decision algorithms is proposed to minimize the dissipated energy. The proposed algorithm can be classified as a hybrid decision algorithm. The results demonstrate extensive analysis and comparisons between hard, soft, and hybrid decision algorithms.

Cardiovascular disease is becoming the leading cause of mortality and morbidity worldwide, and developing countries are the main contributors to this trend. Saudi Arabia, which is considered a rapidly developing country, faces progressive urbanization and the adoption of a westernized lifestyle, factors which contribute to the rising burden of cardiovascular disease. Our study estimates the prevalence of coronary risk factors and predicts hard coronary artery events over 10 years in an urban Saudi cohort. Methods: A cross-sectional observational study was conducted on a Saudi population. The study involved Saudi subjects aged more than 20 years without a history of coronary heart disease. Demographic variables and Hard Coronary Events (HCE) risk factors were measured. Each subject’s 10-year HCE risk was estimated by means of the Framingham Risk Score (FRS). Results: A total of 4932 subjects (2215 men and 2717 women) were examined, the majority (85%) of whom were less than 40 years old. The risk of developing HCE within the next 10 years was low in 92.6% of subjects, intermediate in 3.2% and high in 4.1%. On considering diabetes as HCE risk-equivalent, 26% of subjects were at high risk for hard coronary events in 10 years, The HCE risk progressively increased with age and was higher in men. Conclusions: Our study is the first to estimate the 10-year risk of HCE among adults in an emerging country and discovered a significant proportion of younger aged population are at risk for development of hard coronary events. Public awareness programs to control risk factors are warranted.