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Ammar K Alomran, Dalal A Bubshait, Ibrahim A Albrahim, Jaffar Saleh M Alsayigh, Ammar J Abusultan, Abdulraheem Altalib, Zaid A Alzaid, Mohammad M Alzahrani Department of Orthopaedic Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Mohammad M Alzahrani, Imam Abdulrahman Bin Faisal University, King Faisal Road, Dammam, 34212, Saudi Arabia, Tel +966 138966666 Ext 1647, Email mmalzahrani@iau.edu.saObjective: Supracondylar humeral fractures are among the most common pediatric fractures that require surgical intervention when displaced. Recent attention has been directed towards the utilization of serial radiographs in the post-operative period and their effect on decision-making. This study aimed to determine the usefulness of postoperative radiographs early post-operatively, with the goal of determining the optimal frequency for these radiographs.Methods: Pediatric patients who sustained a supracondylar humeral fracture and underwent operative intervention over a 15-year period were included in this study. Data were collected, including the baseline characteristics of the patients, fractures, and operative interventions. In addition, the time until healing, the total number of X-rays before K-wire removal, and postoperative function were evaluated.Results: A total of 122 pediatric patients were included, with a mean age of 5.33 ± 2.93 years. Most fractures were Gartland Type III (74.6%). Most fractures healed at 4 (36.1%) and 3 weeks (35.2%) after surgery. Of the cohort, 94.3% underwent four different x-rays before wire removal, with 4.9% requiring revision surgery. All revision cases were Gartland type 3, and for all cases, the decision to revise was made within three weeks of surgery.Conclusion: Routine post-fixation radiography should not be performed for surgically treated supracondylar humeral fractures before healing. An exception is the Gartland type 3 fracture, for which earlier imaging may be indicated.Keywords: supracondylar, pediatric humerus, closed reduction, fixation, post-operative x-ray

Rayyan Suqaty,1 Ammar K Alomran,2 Mohammed K Alkhalifah,3 Saad S Aldughaythir,4 Abdulrahman M Albeshry,5 Yousif Aldilaijan,6 Mohammed T Alzahrani,1 Thamer Alhussainan1 1Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; 2Department of Orthopedics, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia; 3Department of Family Medicine & Polyclinics King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; 4Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; 5Department of Family and Community Medicine, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia; 6Primary Health Care Centers, Eastern Health Cluster, Khobar, Saudi ArabiaCorrespondence: Thamer Alhussainan, Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Center, Al Mathar Ash Shamali, Riyadh, 11564, Saudi Arabia, Tel +966504181881, Fax +96614414839, Email alhussainan.t@gmail.comBackground: Developmental dysplasia of the hip (DDH) is one of the most common hip pathologies in pediatric age group and late diagnosis remains a major concern in Saudi Arabia.Objective: The aim of this study is to examine the ability of Saudi Arabian pediatricians and family physicians to conduct clinical screening for (DDH) by estimating their clinical knowledge and skills and analyzing the gaps therein to determine whether there is potential to launch a national screening protocol for DDH in Saudi Arabia.Methods: This is a multicenter cross-sectional study from three major regions in Saudi Arabia (Central, Eastern and Western provinces). The assessed aspects are risk factors, age of screening, incidence in Saudi Arabia, physical signs and diagnostic markers, and treatment, along with their ‘clinical knowledge and skills’ score.Results: Half of the participants were pediatricians, while the rest were family physicians. More than a third of the participants were considered to have adequate knowledge, ie, above the mean score. Dimensions with the most significant knowledge gaps included the incidence of DDH in Saudi Arabia, adverse effects of swaddling, and the management of a high-risk infants presenting with a negative physical examination. Additionally, there were relatively low rates of awareness regarding positive risk factors as well as a generally poor ability to identify physical signs. Clinical knowledge and skill levels were significantly lower among family physicians.Conclusion: Pediatricians and family physicians in Saudi Arabia still need further training to improve their clinical skills for DDH screening. The proper administration of training programs could eventually enable the gradual implementation of a national systematic screening program.Keywords: orthopedic, pediatrics, observational study, pediatricians, family physicians, developmental dysplasia of the hip

Ammar K Alomran,1 Hadeel Almulhim,2 Shahad Alabdulqader,2 Danah S Almutairi,2 Danah F Alrusayyis,2 Sarah A Althwaiqb,2 Arwa Alumran3 1Orthopedics Department, Imam Abdulrahman bin Faisal University, College of Medicine, Dammam, Saudi Arabia; 2College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia; 3Health Information Management and Technology Department, Imam Abdulrahman bin Faisal University, College of Public Health, Dammam, Saudi ArabiaCorrespondence: Hadeel Almulhim, Tel +966501407070, Email 2170006025@iau.edu.saBackground: Hip spica tables are widely used among pediatric orthopedic surgeons to maintain the hip position during cast application and drying processes for a better outcome. Locally customized spica tables can be a significant concern if their limitations significantly interfere with the quality of care.Objective: This study aims to explore the current practice of pediatric hip spica table application among hospitals in the GCC countries and report comprehensive data that help surgeons enhance their practice.Methods: This is a cross-sectional study on pediatric orthopedic surgeons using a self-administered Online Questionnaire. The respondents were grouped as those using locally customized tables, where further information about the material and characteristics were collected, and those using company manufactured tables. Both groups answered analytical questions related to their current practice of hip spica tables.Results: Sixty-three surgeons completed the survey. More than half the physicians in this study are using locally customized spica tables (n= 41, 65%). Compared to company-manufactured tables, locally customized tables were associated with a higher rate of difficulties when taking an X-ray, when the patient weighs more than 50.0 kg, and with anesthesia, although not statistically significant.Conclusion: Obtaining a good quality spica table at a suitable price is a primary obstacle pediatric orthopedic surgeons face. This study shows no statistically significant difference between locally customized and company-manufactured tables regarding the outcomes and that spica tables have room for development to optimize their utilization.Keywords: spica tables, pediatric orthopedics, spica cast, developmental dysplasia of the Hip, DDH, fractures

Afnan Aljaffary,1 Fatimah AlAnsari,1 Abdulaleem Alatassi,2 Mohammed AlSuhaibani,3 Ammar Alomran4 1Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Preoperative Quality and Patient Safety Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; 3Operating Room Services Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; 4Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Afnan Aljaffary, Tel +9661333, Email aaljaffari@iau.edu.saBackground and Objectives: The operating room (OR) is considered the highest source of cost and earnings. Therefore, measuring OR efficiency, which means how time and resources are allocated precisely for their intended purposes in the operating room is crucial. Both overestimation and underestimation negatively impact OR efficiency Therefore, hospitals defined metrics to Measuring OR Effeciency. Many studies have discussed OR efficiency and how surgery scheduling accuracy plays a vital role in increasing OR efficiency. This study aims to evaluate OR efficiency using surgery duration accuracy.Methods: This retrospective, quantitative study was conducted at King Abdulaziz Medical City. We extracted data on 97,397 surgeries from 2017 to 2021 from the OR database. The accuracy of surgery duration was identified by calculating the duration of each surgery in minutes by subtracting the time of leaving the OR from the time of entering the OR. Based on the scheduled duration, the calculated durations were categorized as either underestimation or overestimation. Descriptive and bivariate analyses (Chi-square test) were performed using the Statistical Package for the Social Sciences (SPSS) software.Results: Sixty percent out of the 97,397 surgeries performed were overestimated compared to the time scheduled by the surgeons. Patient characteristics, surgical division, and anesthesia type showed statistically significant differences (p < 0.05) in their OR estimation.Conclusion: Significant proportion of procedures have overestimated. This finding provides insight into the need for improvement.Recommendations: It is recommended to enhance the surgical scheduling method using machine learning (ML) models to include patient characteristics, department, anesthesia type, and even the performing surgeon increases the accuracy of duration estimation. Then, evaluate the performance of an ML model in future studies.Keywords: efficiency, operating room, overestimation, underestimation, Saudi Arabia

Mir Sadat-Ali,1,&ast; Hussain K Al-Omar,2,&ast; Khalid W AlTabash,1,&ast; Ammar K AlOmran,1,&ast; Dakheel A AlDakheel,1,&ast; Hasan N AlSayed1,&ast; 1The Department of Orthopedic Surgery, King Fahd Hospital of the University, Imam AbdulRahman Bin Faisal University, Dammam, Saudi Arabia; 2Department of Orthopedic Surgery, King Fahd Military Medical City, Dhahran, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Mir Sadat-Ali, King Fahd Hospital of the University, POBOX 40071, AlKhobar, 31952, Saudi Arabia, Tel +966505848281, Fax +966138820887, Email drsadat@hotmail.com; smali@iau.edu.saPurpose: Nonunion of fractures occurs in about 15% of all fractures causing repeated surgical interference and prolonged morbidity. We performed this systematic review to assess genes and polymorphisms influencing fractures’ nonunion (FNU).Methods: We searched between 2000 and July 2022 in PubMed, EMBASE, the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, Genome Wide Association Studies (GWAS) Catalog, and the Science Citation Index, with the keywords nonunion of fractures, genetic influence, and GWAS. The exclusion criteria were review articles and correspondence. The data were retrieved to determine the number of studies, genes, and polymorphisms and the total number of subjects screened.Results: A total of 79 studies were reported on nonunion of fractures and genetic influence. After the inclusion and exclusion criteria, ten studies with 4402 patients’ data were analyzed. Nine studies were case-controlled, and 1 GWAS. It was identified that patients with polymorphisms in the genes ANXA3, BMP2, CALY, CYR61, FGFR1, IL1β, NOG, NOS2, PDGF gene, and TACR1 are prone to develop a nonunion of fractures.Conclusion: We believe that for patients who develop an early nonunion of fractures, a genetic study should be conducted for single nucleotide polymorphism (SNP) and genes so that alternative and more aggressive treatment can be performed to heal fractures without prolonged morbidity.Keywords: nonunion, fractures, genome wide association study, genes, influence, morbidity

Amal Alomran,1,2,&ast; Nada Alyousefi1,2,&ast; 1Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Department of Family and Community Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Amal Alomran, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, 11362, Saudi Arabia, Tel +966114670836, Email amal9alomran@gmail.comObjective: The interaction between physicians and patients is essential in clinical practice. Patient-centered care (PCC) is becoming popular in healthcare and provides an approach to deliver high-quality healthcare to yield positive clinical outcomes. This study explores family medicine residents’ attitudes toward the physician–patient relationship and patient-centered care and the possible influence of demographic characteristics, level of training, school of graduation, and previous training.Methods: A cross-sectional study was conducted among family medicine residents in Riyadh. They were invited to enroll in a web-based survey that includes demographic data, training details, and the “Patient Practitioner Orientation Scale (PPOS).”.Results: A total of 114 family medicine residents completed the survey. There were 68 (59.6%) males and 46 (40.4%) female residents. The overall PPOS was 4.23 ± 0.53. The mean score for sharing domain was 3.97 ± 0.66. The caring domain scored 4.49 ± 0.57. No correlations were found between the residents’ demographic data and other included variables, and the means of sharing domain, caring domain, and overall score.Conclusion: Family medicine residents were found to have positive attitudes toward patient-centeredness. Integrating patient-centered training early in the curriculum can improve healthcare students’ and trainees’ attitudes toward patient-centered care. Future research can explore the possible interventions in systematic assessment and training programs that can improve PCP.Keywords: physician–patient relations, medical residency, patient-centered care, Saudi Arabia

Saud A Alanazi,1 Abdullah A Alomran,1 Ali Abusharha,1 Raied Fagehi,1 Naji J Al-Johani,2 Gamal A El-Hiti,1 Ali M Masmali11Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia; 2Comprehensive Cancer Center, Department of Endocrinology and Thyroid Oncology, King Fahad Medical City, Riyadh, Saudi ArabiaObjective: To investigate the ocular tear film in patients with thyroid disorders using various tests.Methods: The study involved the assessment of the ocular tear film in 20 patients with thyroid disorders (6 men and 14 women) aged 18–43 years (mean±standard deviation=34.3±3.2 years). An age-matched control group consisting of 20 subjects (8 males and 12 females) ranging in age from 18 to 43 years (31.3±2.9 years) was also examined under similar conditions. All patients completed the Ocular Surface Disease Index questionnaire, followed by the tear ferning test within the right eye. A phenol red thread test was carried out 10 mins later followed by the fluorescein tear break-up test with a 10-min gap between the tests being implemented.Results: The median score for the Ocular Surface Disease Index (P

Abstract The rice weevil Sitophilus oryzae is one of the primary insects that infest stored grains, causing both quantitative and qualitative losses. The use of synthetic pesticides to control it has led to the emergence of several problems related to human health and the environment, which has prompted the search for safer alternatives for their control. In this study, the effectiveness of two essential oils, cumin (Cuminum cyminum) and basil (Ocimum basilicum), was evaluated as insecticides for controlling the rice weevil at three different times intervals and various concentrations. (GC-MS) analysis revealed that both oils contain several key compounds, such as procanal (26.07%), ˠ- terpinene (15.78%), for C. cyminum and linalool (56.7%), cadinol, epi-α (11.4%) for O. basilicum, in addition to some secondary components. The results showed that, the lethal concentration (LC50) of cumin was 49%, 45%, and 33% lower than that of basil at the 24, 48, and 72-h assessment periods, respectively demonstrating the superiority of cumin over basil. Regarding the effects on the levels of certain enzymes activity, the results indicated that both oils had a significant impact on the activity of both enzymes ALP and GOT, while there was no significant effect on (GOT), α-amylase, and acetylcholinesterase (AChE) compared to control. Based on the obtained results, it can be concluded that tested essential oils could be developed as a safe and effective alternatives for controlling rice weevil.

In the digital age, "kidfluencers," or child influencers, have emerged as significant figures in shaping the online experiences of children. This study explores their impact on the cultural identity of Kuwaiti middle school students, as perceived by their parents. Employing a quantitative research design, the researchers collected data via questionnaire from a random sample of 383 parents. The findings reveal the substantial perceived impact which kidfluencers have on various aspects of cultural identity for Kuwaiti middle school students. Notably, they have a significant effect on language acquisition, leading students to adopt non-Kuwaiti vocabulary and slang prevalent in online kidfluencer content. Additionally, kidfluencers affect moderate influences over cultural values, moral beliefs, national identity, and traditions amongst students. This study underscores the need for a nuanced understanding of the multifaceted powers which kidfluencers can wield, thus helping inform educational strategies and parental guidance for the online era.

PPHN is a common cause of neonatal respiratory failure and is still a serious condition that is associated with high mortality. Objectives: To analyze the clinical characteristics and outcomes of SARS-CoV-2 infection in neonates with PPHN to identify neonatal cases at risk to develop severe illness. Methods: For this systematic review, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched Medline, Embase, CINAHL, and PubMed for studies on the development of COVID-19 in neonates with PPHN, published from 1 December 2019 to 29 February 2024, with an English language restriction. Results: Of the 2406 papers that were identified, 21 articles were included in the systematic review. Studies involving thirty-six neonates with PPHN and infected with SARS-CoV-2 were analyzed (twenty-nine survived, six died, and one is still hospitalized). The main causes of PPHN in neonates who had COVID-19 were neonatal respiratory distress syndrome (NRDS) (41.7%), meconium-stained amniotic fluid (MSAF) (16.7%), preterm premature rupture of membranes (PPROM) (11.1%), hypoxic ischemic encephalopathy (HIE) (5.5%), pneumonia (5.5%), and idiopathic (2.8%). Most of those neonates were male (33.3%), belonged to Indian ethnicity (50%), and were delivered via caesarean section (44.4%). COVID-19 in cases with PPHN commonly occurred in neonates born with a pregnancy range from 32 to p = 0.026]. Neonates with PPHN and COVID-19 had a higher relative risk of death if they received more antibiotics (RR 4.14, 95% CI 0.64–6.88) and if their COVID-19 was defined as critical (RR 2.84, 95% CI 0.86–9.39). Male neonates with PPHN and COVID-19 (RR 2.60, 95% CI 0.30–1.17) and those requiring prolonged invasive positive pressure ventilation (RR 2.22, 95% CI 0.64–7.73) also showed an increased relative risk for death. Conclusions: COVID-19 in neonates with PPHN is challenging and may be associated with increased mortality, severity, ICU admission, ARDS, MIS-N, and MV usage. The results should be interpreted with caution owing to the small number of studies and substantial heterogeneity and indicate a need for future research in this area. Due to its benefits, testing for SARS-CoV-2 should be encouraged for newborns with symptoms consistent with COVID-19, especially in neonates with a history of SARS-CoV-2 exposure. Effective protection measures should be implemented during delivery and post-delivery care as necessary.

PPHN is a common cause of neonatal respiratory failure and is still a serious condition that is associated with high mortality. Objectives: To analyze the clinical characteristics and outcomes of SARS-CoV-2 infection in neonates with PPHN to identify neonatal cases at risk to develop severe illness. Methods: For this systematic review, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched Medline, Embase, CINAHL, and PubMed for studies on the development of COVID-19 in neonates with PPHN, published from 1 December 2019 to 29 February 2024, with an English language restriction. Results: Of the 2406 papers that were identified, 21 articles were included in the systematic review. Studies involving thirty-six neonates with PPHN and infected with SARS-CoV-2 were analyzed (twenty-nine survived, six died, and one is still hospitalized). The main causes of PPHN in neonates who had COVID-19 were neonatal respiratory distress syndrome (NRDS) (41.7%), meconium-stained amniotic fluid (MSAF) (16.7%), preterm premature rupture of membranes (PPROM) (11.1%), hypoxic ischemic encephalopathy (HIE) (5.5%), pneumonia (5.5%), and idiopathic (2.8%). Most of those neonates were male (33.3%), belonged to Indian ethnicity (50%), and were delivered via caesarean section (44.4%). COVID-19 in cases with PPHN commonly occurred in neonates born with a pregnancy range from 32 to <37 weeks (moderate to late preterm) (36.1%). The maternal severity of COVID-19 was reported to be severe in three cases only (8.3%); however, SARS-CoV-2 infection in neonates with PPHN was either severe (44.4%) or critical (22.2%). Most of these neonates experienced acute respiratory distress syndrome (ARDS) (58.3%). Early and late multisystem inflammatory syndrome in neonates (MIS-N) were reported in 50% and 11.1%, respectively. A high proportion of neonates were admitted to the intensive care unit (ICU) (58.3%) or needed mechanical ventilation (MV) (47.2%). Neonates with concurrent PPHN and SARS-CoV-2 infection who died had worse severity of COVID-19 [i.e., severity of COVID-19 was critical in 10% (neonates with PPHN who survived group) vs. 83.3% (neonates with PPHN who died group); p = 0.026]. Neonates with PPHN and COVID-19 had a higher relative risk of death if they received more antibiotics (RR 4.14, 95% CI 0.64–6.88) and if their COVID-19 was defined as critical (RR 2.84, 95% CI 0.86–9.39). Male neonates with PPHN and COVID-19 (RR 2.60, 95% CI 0.30–1.17) and those requiring prolonged invasive positive pressure ventilation (RR 2.22, 95% CI 0.64–7.73) also showed an increased relative risk for death. Conclusions: COVID-19 in neonates with PPHN is challenging and may be associated with increased mortality, severity, ICU admission, ARDS, MIS-N, and MV usage. The results should be interpreted with caution owing to the small number of studies and substantial heterogeneity and indicate a need for future research in this area. Due to its benefits, testing for SARS-CoV-2 should be encouraged for newborns with symptoms consistent with COVID-19, especially in neonates with a history of SARS-CoV-2 exposure. Effective protection measures should be implemented during delivery and post-delivery care as necessary. [ABSTRACT FROM AUTHOR]

Background: GLP-1 receptor agonists (GLP-1RA) are used in the management of type II diabetes mellitus or obesity, although its role in patients with type I diabetes mellitus (T1DM) has been debated. This study aimed to investigate the efficacy and safety of GLP-1RA in patients with T1DM using real-world data. Methods: This multicenter, retrospective study was conducted at three tertiary medical centers in Riyadh, Saudi Arabia. The study followed up patients (>16 years old) with T1DM treated with insulin followed by GLP-1RA add-on therapy. The efficacy outcomes included changes in HbA1c, body weight, and insulin requirements from baseline to each follow-up visit. The main safety outcomes assessed included hypoglycemic events and gastrointestinal (GI) adverse events. Results: The study included 144 patients with a mean age of 33.0 ± 10.1 years. Semaglutide was the most used GLP-1RA (63.9%) followed by liraglutide (34.0%). From baseline to 3-month follow-up, HbA1c (mean difference (MD) = −0.8%; p = 0.0053), weight (MD = −2.4 kg; p = 0.0253), and daily basal insulin dose (MD = −2.1 units; p = 0.0349) were significantly reduced. Likewise, HbA1c (MD = −0.5%; p = 0.0004), weight (MD = −3.6 kg; p < 0.0001), and daily basal insulin (MD = −2.4 units; p = 0.0282) were significantly reduced at the 4–6-month follow-up. The significant reductions in HbA1c, weight, and daily basal insulin levels were consistent for up to 18-month follow-up. Only one patient had a major hypoglycemic event, whereas 8.3% of the patients had GI adverse events. Conclusions: Overall, significant improvements in glycemic control, weight loss, and insulin requirements were observed with the use of GLP-1RA in patients with T1DM, with a limited number of GI adverse events. [ABSTRACT FROM AUTHOR]

This paper aims to measure the impact of ECSR activities on employee job performance in the hospitality and tourism industry in the city of Hail, Saudi Arabia. Despite the growing importance of corporate social responsibility (CSR) and employee work performance, little is known about the correlations between socially responsible actions taken by businesses and the job performance of their employees. To overcome this gap, we explore the impact of ECSR on job performance, with an emphasis on chosen tourist and hospitality establishments in Hail, Saudi Arabia. Through structured questionnaires which were distributed during the period (March-May 2021), direct effects of predictors were tested using partial least square–structure equation modeling (PLS-SEM) with data from employees of hospitality and tourism establishments at Hail city, KSA. Overall, 300 questionnaires were distributed, and 242 were returned, resulting in the inclusion of 174 valid survey responses in the final data analysis. The PLS-SEM results show that the direct effects on job performance of initiatives related to awareness, charities, and support of basic projects are significant. This study adds to the CSR literature by demonstrating the sequential mechanism whereby employees’ perceptions of ECSR affect their job performance. This study is conducted for the first time at Hail city, thus rendering it unique.

Air pollution poses major disease burdens globally and accounts for approximately 10% of deaths annually through its contribution to a variety of respiratory, cardiovascular, and other diseases. The burden of disease is particularly acute in Saudi Arabia, where a mix of anthropogenic and natural sources of air pollution threatens public health. Addressing these burdens requires careful study of the costs and effectiveness of available technologies and policies for reducing emissions (mitigation) and avoiding exposure (adaptation). To help evaluate these options, we conduct a semi-systematic literature review of over 3,000 articles published since 2010 that were identified by searches of literature focused on pollution mitigation and pollution adaptation. We identify a wide variety of effective mitigation and adaptation technologies and find that cost-effectiveness information for policy design is highly variable in the case of mitigation, both within and across pollution source categories; or scarce, in the case of adaptation. While pollution control costs are well studied, policy costs differ; these may vary more by location because of factors such as technology operating conditions and behavioral responses to adaptation initiatives, limiting the generalizability of cost-effectiveness information. Moreover, potential cost advantages of multipollutant control policies are likely to depend on the existing mix of pollution sources and controls. While the policy literature generally favors more flexible compliance mechanisms that increase the cost of polluting to reflect its costs to society, important policy design factors include policy co-benefits, distributional concerns, and inter-regional harmonization. In addition to these key themes, we find that further study is needed both to improve the availability of cost information for adaptation interventions and to localize technology and policy cost estimates to the Saudi context.

Background: Dental anxiety is marked by intense and irrational fear of dental procedures affecting millions of individuals worldwide. The purpose of this study was to investigate the relationship between dental anxiety, its influencing factors, and the preferred management techniques among adults seeking dental care in Riyadh. Methods: A cross-sectional questionnaire study was carried out among 1734 patients who visited dental clinics in Riyadh. A self-administered questionnaire was developed and validated, comprising 28 closed-ended questions; it demonstrated good reliability and internal consistency (Cohen's kappa coefficient = 0.90, Cronbach's alpha coefficient = 0.86), it contained pre-validated Modified Dental Anxiety Scale to quantitatively assess the level of dental anxiety. Data analysis involved descriptive analysis, Chi-square test, Pearson correlation coefficient and multiple linear regression. Results: Majority (59.2%) of participants reported moderate anxiety, while 10.9% experienced high anxiety which was significantly linked to factors such as fear of pain (37.8%) and anaesthetic needles (25.8%). Topical anaesthetic gel (64.5%), pre-treatment explanations (78.9%), and conducive clinic environment (79.4%) were perceived as effective anxiety alleviators. A negative correlation existed between dental anxiety and preferred management techniques. Dental anxiety had significant association between gender (β = 0.910) and age (β = 0.263). Conclusion: This study revealed that majority of participants had moderate dental anxiety, linked significantly to influencing factors like frequency and purpose of dental visits and past dental experiences. The study also found the preferred anxiety management methods among participants which included topical anaesthetic gel, pre-treatment explanations, and a comfortable clinic environment. [ABSTRACT FROM AUTHOR]

In the digital age, "kidfluencers," or child influencers, have emerged as significant figures in shaping the online experiences of children. This study explores their impact on the cultural identity of Kuwaiti middle school students, as perceived by their parents. Employing a quantitative research design, the researchers collected data via questionnaire from a random sample of 383 parents. The findings reveal the substantial perceived impact which kidfluencers have on various aspects of cultural identity for Kuwaiti middle school students. Notably, they have a significant effect on language acquisition, leading students to adopt non-Kuwaiti vocabulary and slang prevalent in online kidfluencer content. Additionally, kidfluencers affect moderate influences over cultural values, moral beliefs, national identity, and traditions amongst students. This study underscores the need for a nuanced understanding of the multifaceted powers which kidfluencers can wield, thus helping inform educational strategies and parental guidance for the online era. [ABSTRACT FROM AUTHOR]

This article critically analyzes the ethical and legal implications of adopting predictive analytics by the French administrative justice system. It raises a key question: Is it wise to integrate artificial intelligence into the administrative justice system, considering its potential benefits, despite the associated risks, ethical dilemmas, and legal challenges? The research employs a method based on an extensive literature review, a qualitative analysis of the adoption by the French administrative justice of predictive analytics tools, and a critical evaluation of the benefits and issues these tools bring. The study finds that AI can make the administrative justice system more efficient, reduce backlogs, and enhance the consistency and predictability of judicial decisions. However, the study also identifies important risks and serious ethical and legal issues associated with integrating AI tools into the justice system. Especially, AI utilization can lead to the dehumanization of justice and poses real risks to the independence and impartiality of justice. While AI can offer significant benefits to all the stakeholders of the administrative justice system, its integration must be approached with caution. A progressive and responsible approach to AI adoption is necessary to avoid compromising judicial integrity and upholding fundamental justice values. [ABSTRACT FROM AUTHOR]

Emergency Medical Services (EMS) are crucial for immediate medical assistance during life-threatening situations. However, insufficient public awareness about EMS services can impede their effectiveness. This study aimed to assess EMS knowledge and trust among the population of Eastern Saudi Arabia while identifying factors contributing to low awareness. A cross-sectional study was conducted in Eastern Saudi Arabia from September 2022 to September 2023. The study included participants aged 18 to 60 from diverse backgrounds. Using a convenience sampling approach, data was collected using a validated questionnaire covering demographics, hypothetical scenarios, EMS knowledge, and trust in EMS. We conducted the Chi-square tests and logistic regression using Jamovi software, with significance levels set at p < 0.05. Our study yielded 435 participants; 55% were males. Gender-based analysis showed significant differences in responses regarding first aid provision and EMS services (P < 0.001). Expectations for EMS response times also varied by gender (P = 0.01). Knowledge-based analysis revealed that age and education significantly influenced EMS knowledge (P < 0.001). Respondents with EMS knowledge were more likely to know how to provide first aid, understand the importance of emergency number 112, and trust EMS (P < 0.001). Trust-based analysis showed age and education-related differences in EMS trust (P < 0.001). Respondents with EMS knowledge and awareness of emergency numbers displayed higher trust in EMS (P < 0.001). This study underscores the need for enhanced public awareness of EMS services in Eastern Saudi Arabia. Age, education, and gender emerged as critical factors affecting EMS knowledge and trust. Bridging this awareness gap necessitates tailored educational campaigns and continuous monitoring. Policymakers should prioritise EMS awareness within broader healthcare strategies, contributing to improved public health outcomes and community well-being. [ABSTRACT FROM AUTHOR]

Objectives: this study sheds light on disciplinary evidence and defines its features to ascertain if an employee has committed a disciplinary offence while carrying out his job duties. It demonstrates how the Administrative Investigation Committee can establish the burden of proof. Research Problem: the adequacy of organising special rules of evidence before the Administrative Investigation Committee to detect behavioural violations. The Jordanian legislator addressed these rules in Article 146/b/2 of the Jordanian Civil Service Law No. 9 of 2020. However, these rules are not integrated, as it is assumed that the administration has complete evidence of claims of behavioural violations. It does not have the right to accuse the employee of deviating from his job mandate without evidence. The employee is also entitled to present evidence refuting such claims. Thus, it falls to investigation committees to search for the necessary evidence to clarify the truth. Methods: this study adopts a descriptive and analytical approach that compares the Jordanian, Egyptian and Emirati legislation concerning the rules of evidence. Results and Conclusions: the paper concludes by with the following results such as: Jordanian Civil Service Law fails to organise the means of evidence and administrative papers, as the legislator did not explicitly grant the Administrative Investigation Committee the authority to review documents related to the violation. In contrast, they were expressly formulated in the Egyptian and Emirati legislations. As well as, the Jordanian legislator did not deal with the method of inspection before the administrative investigation committee in the Civil Service Law, unlike the Egyptian legislator who regulated that method in the law and provided instructions to the Administrative Prosecution. Such was also the case for the UAE federal legislator within the framework of the executive regulations of the human resources law in the federal government. [ABSTRACT FROM AUTHOR]

The immense volume of online content linked to digital libraries has given emergence to the advancement of screening and recommendation systems. A recommendation system is vitally important in both academic institutions and elibraries to assist professors, instructors, students, and researchers in finding appropriate sources of information. Distributed or collaborative screening is the most common method used in current recommendation systems. However, collaborative approaches cannot promote library repositories, including unrated or unpurchased electronic information. Thus, this paper deals with the automated classification and recommendation of a multiclass corpus found in virtual repositories (cloud databases). In various stages, Neuro-Fuzzy (NF) and Support Vector Machine (SVM) techniques are used as the base classifiers for the categorization of the essential subjects (contents). Later, a high-level ensemble learning strategy is utilized to recommend appropriate subjects from the available multiclass corpus. The methods use a CoC (Coherence of Content)-based inference mechanism to extract and filter the critical components before beginning the recommendation process. Experiments demonstrated that a recommended approach based on detailed conceptual descriptions instead of a handful of phrases/words might help academic and research communities to find relevant sources. Observing the results over a period of months shows that the suggested method increases user comfort, proving the system's acceptability to users in this way. In addition, compared to previous models, the accuracy in categorizing the requisite subjects is more than 97.16 per cent. [ABSTRACT FROM AUTHOR]