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Entrepreneurial activities have been vital to economic growth as a feasible career option for many university graduates. Nonetheless, it has been recognised that the lowest intentions to undertake entrepreneurial activity are among female graduates. While entrepreneurship is claimed to be a reflection of creative activity from which individuals generate value, graduates' creativity can be a crucial aspect of entrepreneurship, with innovative concepts, products and services. This study examines the role of creativity skills in the entrepreneurial intentions of female university students attending business programs. Built on the Theory of Planned Behaviour, the survey results collected from 303 female business graduates identified the positive influence of creativity on entrepreneurial intentions. Recognising the need to embed creative skills and activities in the university curriculum is fundamental to encouraging entrepreneurial aspirations among female graduates.

AbstractThis study presents an analysis of O3, NO2, and PM10 variations in Sharjah City, UAE, from 2018 to 2021. Data from monitoring stations across the city showed consistent daily, weekly, and monthly trends. Ozone and NO2 were inversely related, with O3 increasing and NO2 decreasing from noon to sunset, and vice versa afterward. Weekends exhibited a weekend effect, with high O3 and low NO2 levels. Winters had high NO2 and low O3 levels, while summers showed the opposite trend. Urban and industrial stations had higher NO2 and lower O3 levels compared to sub-urban and rural stations. PM10 levels peaked in the afternoon to late evenings and decreased during nights and early mornings. They were lowest on weekends and highest at the start of the weeks, with July as the peak and December as the lowest month for PM10. During the COVID-19 restrictions of 2020-2021, O3, NO2, and PM10 levels significantly decreased compared to 2018-2019. Higher winds correlated with higher O3 and PM10 levels and lower NO2 levels. This study provides the first documentation of Sharjah’s air quality spatiotemporal variations pre-to-post COVID-19 restrictions using ground measurements. [ABSTRACT FROM AUTHOR]

Politically and economically unstable contexts have been associated with increased prevalence rates of depression. Despite high demand, the availability of mental health experts and care systems is limited in Arabic-speaking countries. Internet-based interventions might provide an opportunity to treat patients independently of location. Therefore, we investigated the efficacy of internet-based cognitive behavioral treatment (iCBT) and interpersonal treatment (iIPT) for depression in Arabic-speaking countries. In total, 743 Arabic-speaking adults with depression were randomly allocated to iCBT (n = 243), iIPT (n = 247), or waitlist (n = 253). Depressive, anxiety, and somatoform symptoms, perceived social support and quality of life (QoL) were assessed at pre-, and post-treatment and at three months follow-up. Multiple imputation was performed for missing data. Changes associated with treatment were analyzed using regression in the completer and intention-to-treat sample. Participants in both treatment groups showed lower depressive and anxiety symptom severity, higher QoL, and perceived social support compared to the waitlist group (p <.001). Somatoform symptom severity was significantly lower in participants receiving iIPT compared to waitlist (p <.001). Differences between the two treatments in all outcomes were non-significant (p >.05). Three-month follow-up treatment effects regarding depressive symptoms were indicated. The sample mainly consists of educated, single, female adults. Three-month follow-up results rely on a small subsample and must be interpreted with caution. This is the first randomized controlled trial to demonstrate the efficacy of iCBT and iIPT for depression in Arabic-speaking countries. It provides first indications that internet-based interventions might help specific individuals in this region. • Internet.based interventions seem to be effective in reducing depressive symptoms for people in Arabic-speaking countries. • Internet-based cognitive behavioral and interpersonal treatment seems to be equally effective in reducing depressive symptoms. • Both internet-based interventions, designed for people with depression, increase QoL and perceived social support from different sources. • Dropout rates in both interventions are similarly high. • Overall treatment satisfaction was high. [ABSTRACT FROM AUTHOR]

Internet‐based interventions have proven to be effective for the treatment of depression in different samples, but evidence from the Middle East and North Africa (MENA) region is scarce. The aim of this study was to investigate the acceptance and efficacy of an internet‐based cognitive behavioural writing intervention for Arabic‐speaking participants with depression living in the MENA region. A total of 259 participants (167 female, age in years: M = 25.58, SD = 6.39) with depressive symptoms indicative of clinical relevance were randomly allocated to a treatment group (TG; nTG = 128) or a waitlist control group (WG; nWG = 131). The TG received an internet‐based intervention over a 6‐week period. The primary outcome was depressive symptoms, and secondary outcomes were anxiety and quality of life (QoL). T‐tests with change scores from pre‐ to post‐treatment were used for data analyses. Intention‐to‐treat (ITT) as well as completer analyses were calculated. The ITT analysis revealed significant differences between the TG and WG in depression (T257 = −4.89, p < 0.001, d = 0.70) and QoL (T257 = 3.39, p < 0.001, d = 0.47). Significant differences regarding anxiety symptoms (T257 = 3.25, p < 0.05, d = 0.53) were identified for the completer sample. The general dropout rate was 39.9%. The results indicate the feasibility and efficacy of an internet‐based cognitive behavioural writing intervention in adults from Arabic‐speaking countries. The development and implementation of such interventions can be used to improve access to psychological help and adequate treatment. [ABSTRACT FROM AUTHOR]

Introduction: Mental health among medical students is an area that has been increasingly garnering world-wide attention. Yet, despite this increased attention, research related to anxiety disorders in Saudi Arabia remain limited. This study aims to address this gap by assessing the prevalence of generalized anxiety disorder (GAD) as well as explore its association with students' sociodemographic factors and academic performance among medical students in a Saudi Arabian institute that has a diverse, multicultural student body. Methods: The study takes place in a unique educational environment: a privately funded institute in Riyadh, the capital of Saudi Arabia, with 32% of its student body comprising international students from over 40 countries, during the COVID-19 pandemic. The study deploys the use of a survey that was sent to the students at this institute via their institutional emails. A survey containing 33 items assessing demographics, GAD using GAD-7 questionnaire, stress-relief measures, online learning experience during the pandemic, mental disorders, anxiety associated with the pandemic, two open-ended questions, and one item assessing sleep difficulty. Results: The results of the survey showed that a significant majority of the responders' scores in the GAD-7 assessment were in the range of moderate to severe anxiety. The results also suggest that low cGPA and the first academic years are significantly associated with higher GAD-7 scores. Students found severe time constraints, difficult educational content, and lack of psychological support to be major sources of stress. Furthermore, students suggested providing an in-house psychologist, personalized feedback, and guidance on study tactics as methods to reduce anxiety. Conclusion: These findings, among others, suggest a need for further studies and research in this field to uncover broader patterns and inform targeted mental health support strategies. [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) is a neurodegenerative condition that displays a high prevalence in Lebanon causing a local burden in healthcare and socio-economic sectors. Unfortunately, the lack of prevalence studies and clinical trials in Lebanon minimizes the improvement of AD patient health status. In this review, we include over 155 articles to cover the different aspects of AD ranging from mechanisms to possible treatment and management tools. We highlight some important modifiable and non-modifiable risk factors of the disease including genetics, age, cardiovascular diseases, smoking, etc. Finally, we propose a hypothetical genetic synergy model between APOE4 and TREM2 genes which constitutes a potential early diagnostic tool that helps in reducing the risk of AD based on preventative measures decades before cognitive decline. The studies on AD in Lebanon and the Middle East are scarce. This review points out the importance of genetic mapping in the understanding of disease pathology which is crucial for the emergence of novel diagnostic tools. Hence, we establish a rigid basis for further research to identify the most influential genetic and environmental risk factors for the purpose of using more specific diagnostic tools and possibly adopting a local management protocol. [ABSTRACT FROM AUTHOR]

Studies have revealed that sex can predict differences in multiple aspects of atrial fibrillation (AF). These differences are underreported in the Middle East. This study aims to describe sex-specific differences in risk factors, symptomatology, management, and outcomes in Middle Eastern patients with AF. The JoFib (Jordan-Atrial-Fibrillation) study is an observational, prospective, multicenter, nationwide registry in AF. Comparisons were made between female and male patients using Pearson chi-square and Mann-Whitney U tests. Multivariable regression models were constructed to investigate whether the female sex was predictive of any AF-related outcomes (all-cause death, cardiovascular death, ischemic stroke or systemic embolism [IS/SE], major bleeding, and clinically relevant non-major bleeding). Of 2,020 patients with AF, 54% (n = 1091) were females. Females with AF were older (median age 71 vs. 69, p <.001), but had less heart failure (20.9% vs. 27.2%, p =.001) and coronary artery disease (7.5% vs. 14.7%, p <.001). Females with AF were more symptomatic (74.7% vs. 66.5%, p <.001) and frequently received anticoagulant therapy (84.4% vs. 78.9%, p =.001). Rhythm control was pursued less frequently in females (23.4% vs. 27.3%, p =.04). All studied outcomes occurred with similar frequencies in females and males, and sex was not significantly predictive of any outcome. Females with AF are more symptomatic, yet they are treated less with rhythm control. Despite higher risk, females have similar risk-adjusted all-cause cardiovascular death and stroke rates compared to males. Future studies should explore how treatments and interventions can influence quality-of-life and cardiovascular outcomes in females with AF. [ABSTRACT FROM AUTHOR]

Background: The current study explores the genetic underpinnings of cardiac arrhythmia phenotypes within Middle Eastern populations, which are under-represented in genomic medicine research. Methods: Whole-genome sequencing data from 14,259 individuals from the Qatar Biobank were used and contained 47.8% of Arab ancestry, 18.4% of South Asian ancestry, and 4.6% of African ancestry. The frequency of rare functional variants within a set of 410 candidate genes for cardiac arrhythmias was assessed. Polygenic risk score (PRS) performance for atrial fibrillation (AF) prediction was evaluated. Results: This study identified 1196 rare functional variants, including 162 previously linked to arrhythmia phenotypes, with varying frequencies across Arab, South Asian, and African ancestries. Of these, 137 variants met the pathogenic or likely pathogenic (P/LP) criteria according to ACMG guidelines. Of these, 91 were in ACMG actionable genes and were present in 1030 individuals (~7%). Ten P/LP variants showed significant associations with atrial fibrillation p < 2.4 × 10−10. Five out of ten existing PRSs were significantly associated with AF (e.g., PGS000727, p = 0.03, OR = 1.43 [1.03, 1.97]). Conclusions: Our study is the largest to study the genetic predisposition to arrhythmia phenotypes in the Middle East using whole-genome sequence data. It underscores the importance of including diverse populations in genomic investigations to elucidate the genetic landscape of cardiac arrhythmias and mitigate health disparities in genomic medicine. [ABSTRACT FROM AUTHOR]

Background: Resting electrocardiogram (ECG) is a valuable non-invasive diagnostic tool used in clinical medicine to assess the electrical activity of the heart while the patient is resting. Abnormalities in ECG may be associated with clinical biomarkers and can predict early stages of diseases. In this study, we evaluated the association between ECG traits, clinical biomarkers, and diseases and developed risk scores to predict the risk of developing coronary artery disease (CAD) in the Qatar Biobank. Methods: This study used 12-lead ECG data from 13,827 participants. The ECG traits used for association analysis were RR, PR, QRS, QTc, PW, and JT. Association analysis using regression models was conducted between ECG variables and serum electrolytes, sugars, lipids, blood pressure (BP), blood and inflammatory biomarkers, and diseases (e.g., type 2 diabetes, CAD, and stroke). ECG-based and clinical risk scores were developed, and their performance was assessed to predict CAD. Classical regression and machine-learning models were used for risk score development. Results: Significant associations were observed with ECG traits. RR showed the largest number of associations: e.g., positive associations with bicarbonate, chloride, HDL-C, and monocytes, and negative associations with glucose, insulin, neutrophil, calcium, and risk of T2D. QRS was positively associated with phosphorus, bicarbonate, and risk of CAD. Elevated QTc was observed in CAD patients, whereas decreased QTc was correlated with decreased levels of calcium and potassium. Risk scores developed using regression models were outperformed by machine-learning models. The area under the receiver operating curve reached 0.84 using a machine-learning model that contains ECG traits, sugars, lipids, serum electrolytes, and cardiovascular disease risk factors. The odds ratio for the top decile of CAD risk score compared to the remaining deciles was 13.99. Conclusions: ECG abnormalities were associated with serum electrolytes, sugars, lipids, and blood and inflammatory biomarkers. These abnormalities were also observed in T2D and CAD patients. Risk scores showed great predictive performance in predicting CAD. [ABSTRACT FROM AUTHOR]

Background: Mobile apps facilitate patients' access to portals and interaction with their healthcare providers. The COVID-19 pandemic accelerated this trend globally, but little evidence exists on patient portal usage in the Middle East, where internet access and digital literacy are limited. Our study aimed to explore how users utilize a patient portal through its related mobile app (MyChart by EPIC). Methods: We conducted a cross-sectional survey of MyChart users, recruited from a tertiary care center in Lebanon. We collected MyChart usage patterns, perceived outcomes, and app quality, based on the Mobile Application Rating Scale (user version, uMARS), and sociodemographic factors. We examined associations between app usage, app quality, and sociodemographic factors using Pearson's correlations, Chi-square, ANOVA, and t-tests. Results: 428 users completed the survey; they were primarily female (63%), aged 41.3 ± 15.6 years, with a higher education level (87%) and a relatively high crowding index of 1.4 ± 0.6. Most of the sample was in good and very good health (78%) and had no chronic illnesses (67%), and accessed the portal through MyChart once a month or less (76%). The most frequently used features were accessing health records (98%), scheduling appointments (67%), and messaging physicians (56%). According to uMARS completers (n = 200), the objective quality score was 3.8 ± 0.5, and the subjective quality was 3.6 ± 0.7. No significant association was found between overall app usage and the mobile app quality measured via uMARS. Moreover, app use frequency was negatively associated with education, socioeconomic status, and perceived health status. On the other hand, app use was positively related to having chronic conditions, the number of physician visits and subjective app quality. Conclusion: The patient portal usage was not associated with app quality but with some of the participants' demographic factors. The app offers a user-friendly, good-quality interface to patient health records and physicians, appreciated chiefly by users with relatively low socioeconomic status and education. While this is encouraging, more research is needed to capture the usage patterns and perceptions of male patients and those with even lower education and socioeconomic status, to make patient portals more inclusive. [ABSTRACT FROM AUTHOR]

Background: Collection of real-world evidence (RWE) is important in achondroplasia. Development of a prospective, shared, international resource that follows the principles of findability, accessibility, interoperability, and reuse of digital assets, and that captures long-term, high-quality data, would improve understanding of the natural history of achondroplasia, quality of life, and related outcomes. Methods: The Europe, Middle East, and Africa (EMEA) Achondroplasia Steering Committee comprises a multidisciplinary team of 17 clinical experts and 3 advocacy organization representatives. The committee undertook an exercise to identify essential data elements for a standardized prospective registry to study the natural history of achondroplasia and related outcomes. Results: A range of RWE on achondroplasia is being collected at EMEA centres. Whereas commonalities exist, the data elements, methods used to collect and store them, and frequency of collection vary. The topics considered most important for collection were auxological measures, sleep studies, quality of life, and neurological manifestations. Data considered essential for a prospective registry were grouped into six categories: demographics; diagnosis and patient measurements; medical issues; investigations and surgical events; medications; and outcomes possibly associated with achondroplasia treatments. Conclusions: Long-term, high-quality data are needed for this rare, multifaceted condition. Establishing registries that collect predefined data elements across age spans will provide contemporaneous prospective and longitudinal information and will be useful to improve clinical decision-making and management. It should be feasible to collect a minimum dataset with the flexibility to include country-specific criteria and pool data across countries to examine clinical outcomes associated with achondroplasia and different therapeutic approaches. [ABSTRACT FROM AUTHOR]

Eocene larger benthic foraminifera including orthophragmines, nummulitids and alveolinids from the Jahrum and Pabdeh formations in the Zagros region are presented. The studied 20-m-thick stratigraphic interval contains, Asterocyclina Gümbel 1870, Nemkovella Less 1987, Orbitoclypeus Silvestri 1907, Discocyclina Gümbel 1870, Nummulites Lamarck 1801, Assilina d’Orbigny 1826 and Alveolina d’Orbigny 1826. This larger benthic foraminiferal assemblage testifies for the shallow benthic zones (SBZs) 15 to 17, which ranges from the middle Lutetian up to the early Bartonian. Further micropaleontological analysis made on intercalated planktonic-rich levels helps calibrate the larger foraminifera biostratigraphy, demonstrating a correlation with the E11 biozone. This confirms that the chronostratigraphic calibration of the SBZs made by previous authors for the peri-Mediterranean area can, through the middle Lutetian to the early Bartonian, be applicable in the Middle East as well [ABSTRACT FROM AUTHOR]

Fereydunkenar county hosts millions of migratory birds in the southern parts of the Caspian Sea in the second half of every year. Despite the global prevalence of environmental crime, there is still a dearth of large-scale, empirical analyses of environmental crime in the Middle East. This study compared two well-established criminological frameworks rooted in social learning (neutralization theory and differential association theory) to compare four environmental crimes in Iran: illegal bird hunting, fishing without a license, water pollution, and soil pollution. We surveyed male villagers (N = 400) in the county of Fereydunkenar, which is located in the Mazandaran Province of Iran and hosts millions of migratory birds every year. Variables from neutralization theory (condemnation of the condemners, denial of victim and injury, and appeal to higher loyalty) and differential association theory (frequency of differential association with family and friends, and intensity of differential association) were measured. Approximately 75% of respondents had engaged in illegal bird hunting and nearly 53% of respondents had engaged in fishing without a license. However, water and soil pollution behaviors among the respondents were at low levels. The independent variables explained ∼53, 20, and 18% of the variance in the variables of water/soil pollution, illegal bird hunting, and illegal fishing, respectively. The frequency of differential association with family and intensity of differential association had the largest influences on illegal bird hunting and illegal fishing. The intensity of differential association, appeal to higher loyalty, and condemnation of the condemners had significant positive effects on water and soil pollution behaviors. Based on our models, we concluded that, compared to neutralization variables, differential association variables had greater effects on numerous environmental crimes in Iran. [ABSTRACT FROM AUTHOR]

Water resources are the main component of natural systems affected by climate change in the Middle East. Due to a lack of water, steam power plants that use wet cooling towers have inevitably reduced their output power. This article investigates the replacement of wet cooling towers in Isfahan Thermal Power Plant (ITPP) with Heller natural dry draft cooling towers. The thermodynamic cycle of ITPP is simulated and the effect of condenser temperature on efficiency and output power of ITPP is evaluated. For various reasons, the possibility of installing the Heller tower without increasing in condenser temperature and without changing the existing components of the power plant was rejected. The results show an increase in the condenser temperature by removing the last row blades of the low-pressure turbine. However, by replacing the cooling tower without removing the blades of the last row of the turbine, the output power and efficiency of the power plant have decreased about 12.4 MW and 1.68 percent, respectively. [ABSTRACT FROM AUTHOR]

Aim Primary central nervous system lymphoma (PCNSL) is a rare extra nodal non-Hodgkin's lymphoma. The optimal treatment for PCNSL is still unclear. In this study, we present our experience with management of PCNSL in a tertiary care center in Iran. Methods In this retrospective study, 58 patients with tissue diagnosis of PCNSL were studied. All patients were treated with chemotherapy including intravenous high-dose methotrexate, rituximab and temozolomide and radiotherapy by the same oncologist. Statistical analysis was performed using SPSS. Results The mean overall survival (OS) in this study was 37.4 ± 13.6 months and the mean progression free survival (PFS) was 35.1 ± 9.8 months. The mean time to progression was 15.2 ± 8.79 months among 8 patients who experienced progression in this series. Finding of a positive CSF cytology was not linked with disease progression, while HIV infection and multifocal involvement at initial presentation were strongly linked to a lower PFS. The single most important factor affecting the OS was the histopathologic type of the PCNSL; two of the three patients who died from their disease in this series had non-B cell PCNSL, whereas only one patient with DLBCL died because of brainstem involvement. Conclusion The results of this study show a lower rate of HIV-infection in patients with PCNSL as compared to the series from the western countries. Non-B cell histopathology and HIV-infection were found to be associated with the dismal prognosis. [ABSTRACT FROM AUTHOR]

A period of about a decade has been estimated to pass for the emergence of a new infectious strain of a virus that may lead to the occurrence of a pandemic one. It is now suggested that the variants of the 1918 H1N1 and coronavirus disease-19 pandemics could have existed in humans after the initial cross-species introduction to humans and underwent multiple low-level seasonal epidemics before the occurrence of their outbreaks. They share similarities in the continuation, widespreadness due to high transmissibility, high fatality rate and clinical symptoms. They are assumed to share a similar principle of a zoonotic source and a cross-species pathway for transmission. They show some similarities in their pathogenesis with other enveloped viruses: Severe Acute Respiratory Syndrome Coronavirus-1 (SARS-CoV-1), Middle East respiratory syndrome coronavirus (MERS-CoV), human immunodeficiency virus, Ebola, Lassa and measles viruses. The highly pathogenic nature of these viruses and their genetic variants may depend on their binding affinity for host cell receptors, whereby they efficiently circumvent or block host cell immune responses triggered by cytokines (interferon). High transmission rates and viral pathogenicity are attributed to glycan moieties that facilitate virus binding to host multiple receptors and cell entry, thereby helping viruses to evade immune recognition and response. Also, mucosa glycotopes are a matter of concern that play as primary sites for virus attachment and body entry. Finding general lectins or ligands that block the viral–host receptors interaction or identifying individual glycotopes is the therapeutic and prognosis topic that demands the main focus. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the acceptance of Peer Physical Examination (PPE) in middle Eastern society with its associate factors, and PPE acceptance during Covid-19 pandemic. The acceptance of PPE is considered high in multiple studies carried out in the west, but there were nearly no studies investigating the acceptance of PPE in the middle east or low-income countries. Methods: A questionnaire was shared through social media with students with focus on clinical-year students. A total number of 657 medical students were collected with a 74.5% response rate. The questionnaire gathered demographic information and recorded previous experience of PPE. A 5-point-likert scale was used to assess acceptance of PPE, factors affecting it, and the influence of COVID-19 pandemic. It also considered body's areas students would accept to be examined. Associations between participants' demographic and other details were tested using independent-samples T Test and other tests, and a p-value of < 0.05 was considered significant. Results: Eighty percent of medical students accepted PPE, while 3% did not, and 17% were neutral. Males had statistically significantly higher acceptance rates of PPE (M = 3.94 out of 5). Also, females had lower acceptance of being examined by other gender than males but did not mind examining other gender. Furthermore, the groin area (thigh) was the most rejected area for examination (20% only accept it), followed by the breast (23%). There was no statistically significant difference between different Universities groups or between different academic performance groups, finally there was statistically significant effect of religion and society on acceptance of PPE and religion has affected females more than males (p- value = 0.002). 70.8% of students supported PPE during the COVID-19 pandemic, while 6.8% did not, and 22.4% were neutral. There was not a significant difference in acceptance and supporting of PPE during the COVID-19 pandemic between males and females. Conclusions: With an 80% acceptance rate, PPE represents an effective alternative to the absent life models in Syrian universities. The application of PPE is less likely to go without difficulties, but authors suggest the presence of a supervisor and single-gender groups with friends paired together if possible. [ABSTRACT FROM AUTHOR]

Podocyte infolding glomerulopathy (PIG) is a rare pathological finding that has gained more recognition recently. Most of the reported cases have been associated with connective tissue diseases especially systemic lupus erythematosus (SLE). Here we report the first case of Infolding Glomerulopathy associated with SLE in the Middle East. Podocyte infolding glomerulopathy (PIG) is a type of kidney injury that might be missed due to lack of available data and unfamiliarity with the disease. Having more cases of PIG reported, especially when successfully treated, will help understanding the pathophysiology of the disease, its clinical manifestations, and the prognosis with varied implemented treatment. [ABSTRACT FROM AUTHOR]

Dermatophytosis corresponds to a broad series of infections, mostly superficial, caused by a group of keratinophilic and keratinolytic filamentous fungi called dermatophytes. These mycoses are currently considered to be a major public health concern worldwide, particularly in developing countries such as those in the Middle East and North Africa (MENA) region. Here we compiled and discussed existing epidemiologic data on these infections in the MENA region. Most of the available studies were based on conventional diagnostic strategies and were published before the last taxonomic revision of dermatophytes. This has led to misidentifications, which might have resulted in the underestimation of the real burden of these infections in the MENA countries. Our analysis of the available literature highlights an urgent need for further studies based on reliable diagnostic tools and standard susceptibility testing methods for dermatophytosis, which represents a major challenge for these countries. This is crucial for guiding appropriate interventions and activating antifungal stewardship programs in the future. [ABSTRACT FROM AUTHOR]

Using 30 years of satellite observations, two sand and dust storms (SDS) source locations (hotspots) were detected on the southern side of the Mesopotamian Flood Plain. Around 40 million people in the region are affected by the two hotspots, including populations in Iraq, Iran, Kuwait, Saudi Arabia, Qatar, Bahrain, and Emirates. Both hotspots encompass roughly 8212 km2 and contribute 11% to 85% in 2005 and 2021, respectively, of the total SDS in the region. Dust physical (particle surface area and size percentages) and chemical (mineralogy, major and trace elements, and radionuclides) properties show close similarities between source and downwind samples during SDS originated solely from the two hotspots. Deposited dust size particles show a finning trend towards the north in the Middle East compared to the south. A comprehensive assessment of the chemical and physical properties of soil and dust samples was conducted as an essential step in developing and implementing a mitigation plan in order to establish a success story in reducing SDS, improving air quality, and benefiting the gulf countries and neighboring regions. [ABSTRACT FROM AUTHOR]

Immunotherapy poses new considerations and alterations to the management of metastatic colorectal carcinoma (mCRC), where chemotherapy achieves complete radiological response but yields complete pathological response in few patients only. Immunotherapy may be superior in the conversion of unresectable disease to resectable liver lesions from mCRC and downsizing borderline lesions for more feasible resectability and achieving complete pathologic response, with the potential for cure and to alter current, established guidelines for surgical resection with a shift from chemotherapy. We present two patients with hepatic lesions from mCRC characterized by deficient mismatch repair (dMMR) which were unresectable after traditional chemotherapy but were converted to resectable lesions with a complete histopathological response following immunotherapy. Complete histopathologic response and radiologic regression or disappearance of liver lesions was observed in patients with dMMR mCRC after pembrolizumab. Immunotherapy exhibits notable potential for cure, achieving complete, successful surgical resection and improving prognosis. [ABSTRACT FROM AUTHOR]

Background: The use of simulated patient (SP) methodology in pharmacy practice settings has increased recently. However, its applications can vary significantly within a region, hence affecting the quality of the SP methodology. Objective: The purpose of this systematic review is to critically assess the use of the SP methodology for assessing the practice of community pharmacists (CP) in the Middle East and North Africa (MENA) region. Methods: A comprehensive literature search was conducted using EMBASE, MEDLINE, ProQuest, and SCOPUS to identify articles published from 2011 to 2022. The selection of relevant studies for inclusion in the systematic review was based on the pre-determined inclusion criteria. The Mixed Method Appraisal Tool (MMAT) was used to assess the methodological quality of the included studies. Results: Electronic search yielded 478 publications. A total of 45 studies were reviewed. The studies were conducted in 12 countries of the MENA region. The sample size between the reviewed articles ranged from 20 to 1000 (median= 129). A greater number of the included studies measured the adequacy of skill (pre-dispensing and/or post-dispensing) 38 (84.4%). The vast majority of the studies reported unsatisfactory results regarding the competencies of CP. The number of the SP ranged from 1 to 37 (median= 2). Most of the studies recruited only one SP per pharmacy 35 (77.8%). The most common data collection method was written data collection form 42 (93.3%). Few studies only had a detection system for SP visits 11 (24.4%), and only six studies incorporated performance feedback (13.3%). More than two-thirds of the studies provided a training session for SP 37 (82.2%). There was variation in the symptoms and drugs used in the SP scenarios in the studies. Conclusion: Although the results demonstrate the growth in the use of the SP method in MENA region countries, studies showed high variability in the level of reporting the study methodology. Consequently, we argue the need for standardized reporting of these studies. [ABSTRACT FROM AUTHOR]

In this study, levels and sources of aliphatic hydrocarbons and hopanes in surface sediments collected from rivers and estuaries of Peninsular Malaysia were assessed. The concentrations of total n-alkanes ranged from 21.19 to 364.54, and the concentrations of hopanes ranged from 0.23 to 2.45 mg kg−1 dry weight. Evaluation of aliphatic diagnostic indices including Carbon Preference Index (CPI), low molecular weight/high molecular weight ratio (LMW/HMW), terrigenous to aquatic ratio (TAR), carbon preference index (CPI), average chain length (ACL) and pristine to phytane indicate mostly petrogenic input especially in estuaries, which is indicative of anthropogenic activities in the study areas. The results also indicate biogenic origin n-alkanes masked by the anthropogenic features in some stations. The hopane ratios indicate hopanes from the Prai and Malacca Rivers were similar to Middle East Crude Oil (MECO), indicating MECO as one of the sources of petroleum hydrocarbons. [ABSTRACT FROM AUTHOR]

Coronary heart disease (CHD) is a major cause of death in Middle Eastern (ME) populations, with current studies of the metabolic fingerprints of CHD lacking in diversity. Identification of specific biomarkers to uncover potential mechanisms for developing predictive models and targeted therapies for CHD is urgently needed for the least-studied ME populations. A case-control study was carried out in a cohort of 1001 CHD patients and 2999 controls. Untargeted metabolomics was used, generating 1159 metabolites. Univariate and pathway enrichment analyses were performed to understand functional changes in CHD. A metabolite risk score (MRS) was developed to assess the predictive performance of CHD using multivariate analysis and machine learning. A total of 511 metabolites were significantly different between the CHD patients and the controls (FDR p < 0.05). The enriched pathways (FDR p < 10−300) included D-arginine and D-ornithine metabolism, glycolysis, oxidation and degradation of branched chain fatty acids, and sphingolipid metabolism. MRS showed good discriminative power between the CHD cases and the controls (AUC = 0.99). In this first study in the Middle East, known and novel circulating metabolites and metabolic pathways associated with CHD were identified. A small panel of metabolites can efficiently discriminate CHD cases and controls and therefore can be used as a diagnostic/predictive tool. [ABSTRACT FROM AUTHOR]

Background: Type 2 Diabetes (T2D) remains a world epidemic. Obtaining accurate estimates of its incidence and their predictors will aid in targeting preventive measures, allocating resources, and strategizing its management. The Middle East North Africa region has high T2D prevalence and rates of rise. Few incidence studies exist for the region, and none from Lebanon. The current study objective was to determine diabetes incidence and diabetes predictors in a community-based Lebanese sample. A secondary objective was to describe the metabolic control over time in adults with preexisting diabetes. Methods: This is a five-year (2014–2019) follow-up study on a random sample of 501 residents of the Greater Beirut area. Out of 478 people eligible to participate in the follow-up study, 198 returned (response rate 39.5%). Assessment included medical history, anthropometric measures, food frequency, sleep, and lifestyle questionnaires. Laboratory data included glycemic indices (fasting glucose and HbA1C) and other biological markers. The diagnosis of probable diabetes (PD) was based on one abnormal test for either fasting glucose ≥ 126 mg/dL or HbA1C ≥ 6.5% or having history of diabetes. Results: The incidence of diabetes was 17.2 (95% CI 9.6–28.7) per 1000 person-years. Cardiometabolic risk factors independently associated with diabetes were: older age, higher BMI, family history of diabetes, metabolic syndrome, higher CRP and triglyceride level; whereas an independent predictor of diabetes was previous BMI. In addition, the 42 participants with preexisting diabetes had worsening of their metabolic profile over a five-year period. Conclusions: The incidence of diabetes was high as compared to some reported world rates, and in line with the high prevalence in the MENA region. The risk was highest in those with positive family history and the presence of the metabolic syndrome or its components. Preventive measures should particularly target participants with that specific risk profile. This becomes particularly important when observing that metabolic control gets worse over time in individuals with diabetes. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) pandemic had a striking impact on healthcare services in the world. The present study aimed to investigate the impact of the COVID-19 pandemic on the presentation management and outcomes of acute appendicitis (AA) in different centers in the Middle East. Methods: This multicenter cohort study compared the presentation and outcomes of patients with AA who presented during the COVID-19 pandemic in comparison to patients who presented before the onset of the pandemic. Demographic data, clinical presentation, management strategy, and outcomes were prospectively collected and compared. Results: Seven hundred seventy-one patients presented with AA during the COVID pandemic versus 1174 in the pre-COVID period. Delayed and complex presentation of AA was significantly more observed during the pandemic period. Seventy-six percent of patients underwent CT scanning to confirm the diagnosis of AA during the pandemic period, compared to 62.7% in the pre-COVID period. Non-operative management (NOM) was more frequently employed in the pandemic period. Postoperative complications were higher amid the pandemic as compared to before its onset. Reoperation and readmission rates were significantly higher in the COVID period, whereas the negative appendicectomy rate was significantly lower in the pandemic period (p = 0.0001). Conclusion: During the COVID-19 pandemic, a remarkable decrease in the number of patients with AA was seen along with a higher incidence of complex AA, greater use of CT scanning, and more application of NOM. The rates of postoperative complications, reoperation, and readmission were significantly higher during the COVID period. [ABSTRACT FROM AUTHOR]

Measurements of dust in the atmosphere have long been used to calibrate dust emission models. However, there is growing recognition that atmospheric dust confounds the magnitude and frequency of emission from dust sources and hides potential weaknesses in dust emission model formulation. In the satellite era, dichotomous (presence = 1 or absence = 0) observations of dust emission point sources (DPS) provide a valuable inventory of regional dust emission. We used these DPS data to develop an open and transparent framework to routinely evaluate dust emission model (development) performance using coincidence of simulated and observed dust emission (or lack of emission). To illustrate the utility of this framework, we evaluated the recently developed albedo-based dust emission model (AEM) which included the traditional entrainment threshold (u*ts) at the grain scale, fixed over space and static over time, with sediment supply infinite everywhere. For comparison with the dichotomous DPS data, we reduced the AEM simulations to its frequency of occurrence in which soil surface wind friction velocity (us*) exceeds the u*ts, P(us* > u*ts). We used a global collation of nine DPS datasets from established studies to describe the spatio-temporal variation of dust emission frequency. A total of 37,352 unique DPS locations were aggregated into 1,945 1° grid boxes to harmonise data across the studies which identified a total of 59,688 dust emissions. The DPS data alone revealed that dust emission does not usually recur at the same location, are rare (1.8 %) even in North Africa and the Middle East, indicative of extreme, large wind speed events. The AEM over-estimated the occurrence of dust emission by between 1 and 2 orders of magnitude. More diagnostically, the AEM simulations coincided with dichotomous observations ~71 % of the time but simulated dust emission ~27 % of the time when no dust emission was observed. Our analysis indicates that u*ts was typically too small, needed to vary over space and time, and at the grain-scale u*ts is incompatible with the us* scale (MODIS 500 m). During observed dust emission, us* was too small because wind speeds were too small and/or the wind speed scale (ERA5; 11 km) is incompatible with the us* scale. The absence of any limit to sediment supply caused the AEM to simulate dust emission whenever P (us* > u*ts), producing many false positives when and where wind speeds were frequently large. Dust emission model scaling needs to be reconciled and new parameterisations are required for u*ts and to restrict sediment supply varying over space and time. Whilst u*ts remains poorly constrained and unrealistic assumptions persist about sediment supply and availability, the DPS data provide a basis for the calibration of dust emission models for operational use. As dust emission models develop, these DPS data provide a consistent, reproducible, and valid framework for their routine evaluation and potential model optimisation. This work emphasises the growing recognition that dust emission models should not be evaluated against atmospheric dust. [ABSTRACT FROM AUTHOR]

Sumac is the wine-colored ground spice, belonging to the cashew family (Anacardiaceae). The most important components of sumac ethanolic extract obtained from sumac are Trans-Caryophyllene, diethyl ester, Butanedioic acid, Cembrene, 1,7-Nonadien-4-ol,4,8-dimethyl, Malate, Palmitate, 9-Octadecenoic acid, Ethyl Linoleic acid, Phytol and Ethyl Linoleate. In the Middle East, sumac is used as a spice and is extensively consumed with Kebabs and grilled meats. It is traditionally used by native Indians of North America in the treatments of bacterial diseases, such as syphilis, gonorrhea, gangrene and dysentery. In traditional medicine of Middle Eastern countries, it has been used for cholesterol reduction and sweating because it has shown antibacterial, hypoglycemic activities and even antioxidant properties due to the presence of tannin fractions in both of their fruits and leaves. The most important health benefits of sumac are reduced cholesterol, balance blood sugar levels, rich in antioxidants, calms muscle aches, reduce the chance of bone depletion, and it can help in the fight against cancer. In this review article all relevant papers of different scholars and researchers were searched in Google Scholar, Science Direct, Scopus and PubMed. Sumac has numerous health benefits and important pharmacological activities, and it can be considered as a valuable source of nutraceuticals, and an efficient natural drug. [ABSTRACT FROM AUTHOR]

This study investigated the concentration of trace metals in surface sediments of Parishan Lake. Parishan Lake is one of the biggest freshwater lakes in the Middle East, situated in Kazerun area (Fars Province, Iran). This preliminary study concerns the mineralogy, enrichment level, and trace elements source identification in surface sediment of this lake. The geochemical Enrichment Factor (EF) and Geo-accumulation index (Igeo) and sedimentological approaches were applied to characterize the contamination by heavy metals, comparing with Average Shale. Multivariate statistical analysis was also used to identify probable studied elements sources in collected samples. The XRD and microscopic analysis show that main mineral of surface sediments is aragonite with small amounts quartz and nepheline. Chemical analysis of sediments showed that the mean concentrations of As, Cd, Cr, Cu, Ni, Pb, Zn, and Sr were 1.88, 27.2, 32.4, 18.6, 8.1, 38.4, and 3934.9 mg/kg, respectively, and average concentrations of Cd, Cu, and Sr exceeded the corresponding values of upper continental crust (UCC) values. The outcomes of this study indicate that geochemical indices (EF and Igeo) revealed an extremely high enrichment for Sr, whereas other elements had minimal enrichment. The levels of potential ecological risk index (RI) for studied trace elements in all sampling locations were 41.13 and 23.76, lower than baseline value (150), signifying that ecological risks displayed by those elements in sediments were moderate. The multivariate statistical analysis indicated that Sr had a geogenic source (natural source), while As and Cd came probably from Industrial source (chemical fertilizers), Ni and Cr were likely derived from vehicle emissions, particularly agricultural machinery, and Pb originated from exhaust and non-exhaust traffic emissions. [ABSTRACT FROM AUTHOR]

Arab populations are largely understudied, notably their genetic structure and history. Here we present an in-depth analysis of 6,218 whole genomes from Qatar, revealing extensive diversity as well as genetic ancestries representing the main founding Arab genealogical lineages of Qahtanite (Peninsular Arabs) and Adnanite (General Arabs and West Eurasian Arabs). We find that Peninsular Arabs are the closest relatives of ancient hunter-gatherers and Neolithic farmers from the Levant, and that founder Arab populations experienced multiple splitting events 12–20 kya, consistent with the aridification of Arabia and farming in the Levant, giving rise to settler and nomadic communities. In terms of recent genetic flow, we show that these ancestries contributed significantly to European, South Asian as well as South American populations, likely as a result of Islamic expansion over the past 1400 years. Notably, we characterize a large cohort of men with the ChrY J1a2b haplogroup (n = 1,491), identifying 29 unique sub-haplogroups. Finally, we leverage genotype novelty to build a reference panel of 12,432 haplotypes, demonstrating improved genotype imputation for both rare and common alleles in Arabs and the wider Middle East. Arab populations are relatively understudied, especially their genetic architecture and historical relationship with early founders of the ancient Near East. Here, the authors examine 6,218 Qatari whole genomes, revealing insights on migration, population history and genetic structure of populations across the Middle Eastern region. [ABSTRACT FROM AUTHOR]

This paper examines the effect of geopolitical risk (GPR) on return and volatility dynamics in Middle East and North African (MENA) countries by using an ADCC-GARCH model and a spillover approach. Unlike previous studies, we include the GPR index to capture risk associated with wars, terrorist acts, and political tensions. Moreover, we test for both static and dynamic analysis using a rolling window. In brief, the findings highlight that GPR does not contribute to the return spillovers among MENA financial markets. However, the dynamic analysis provides evidence of the high level of responsiveness of the total spillover index to major political events (e.g., the Arab Spring uprising and political tension between Qatar and other Gulf Cooperation Council countries). More interestingly, Qatar, Kingdom of Saudi Arabia, and the United Arab Emirates are identified as the main transmitters of return spillovers to the rest of the MENA markets. Overall, our results are essential in understanding the impact of the GPR on return spillover among MENA countries, and are of particular importance to policymakers, market regulators, portfolio managers and investors. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) has rapidly spread globally, forcing countries to apply lockdowns and strict social distancing measures. The aim of this study was to assess eating habits and lifestyle behaviours among residents of the Middle East and North Africa (MENA) region during the lockdown. A cross-sectional study among adult residents of the MENA region was conducted using an online questionnaire designed on Google Forms during April 2020. A total of 2970 participants from eighteen countries participated in the present study. During the pandemic, over 30 % reported weight gain, 6·2 % consumed five or more meals per d compared with 2·2 % before the pandemic (P < 0·001) and 48·8 % did not consume fruits on a daily basis. Moreover, 39·1 % did not engage in physical activity, and over 35 % spent more than 5 h/d on screens. A significant association between the frequency of training during the pandemic and the reported change in weight was found (P < 0·001). A significantly higher percentage of participants reported physical and emotional exhaustion, irritability and tension either all the time or a large part of the time during the pandemic (P < 0·001). Although a high percentage of participants reported sleeping more hours per night during the pandemic, 63 % had sleep disturbances. The study highlights that the lockdown due to the COVID-19 pandemic caused a variety of lifestyle changes, physical inactivity and psychological problems among adults in the MENA region. [ABSTRACT FROM AUTHOR]

Achondroplasia is the most common type of skeletal dysplasia, caused by a recurrent pathogenic variant in the fibroblast growth factor receptor 3 (FGFR3). The management of achondroplasia is multifaceted, requiring the involvement of multiple specialties across the life course. There are significant unmet needs associated with achondroplasia and substantial differences in different countries with regard to delivery of care. To address these challenges the European Achondroplasia Forum (EAF), a network of senior clinicians and orthopaedic surgeons from Europe and the Middle East representative of the achondroplasia clinical community, came together with the overall aim of improving patient outcomes. The EAF developed a consensus on guiding principles of management of achondroplasia to provide a basis for developing optimal care in Europe. All members of the EAF were invited to submit suggestions for guiding principles of management, which were consolidated and then discussed during a meeting in December 2020. The group voted anonymously on the inclusion of each principle, with the requirement of a 75% majority at the first vote to pass the principle. A vote on the level of agreement was then held. A total of six guiding principles were developed, which cover management over the lifetime of a person with achondroplasia. The principles centre on the lifelong management of achondroplasia by an experienced multidisciplinary team to anticipate and manage complications, support independence, and improve quality of life. There is focus on timely referral to a physician experienced in the management of achondroplasia on suspicion of the condition, shared decision making, the goals of management, access to adaptive measures to enable those with achondroplasia to access their environment, and the importance of ongoing monitoring throughout adolescence and adulthood. All principles achieved the 75% majority required for acceptance at the first vote (range 91-100%) and a high level of agreement (range 8.5-9.6). The guiding principles of management for achondroplasia provide all healthcare professionals, patient advocacy groups and policy makers involved in the management of achondroplasia with overarching considerations when developing health systems to support the management of achondroplasia. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic is a major health crisis that has changed the life of millions globally. The purpose of this study was to assess the effect of the pandemic on mental health and quality of life among the general population in the Middle East and North Africa (MENA) region. A total of 6142 adults from eighteen countries within the MENA region completed an online questionnaire between May and June 2020. Psychological impact was assessed using the Impact of Event Scale-Revised (IES-R) and the social and family support impact was assessed with questions from the Perceived Support Scale (PSS). The IES-R mean score was 29.3 (SD = 14.8), corresponding to mild stressful impact with 30.9% reporting severe psychological impact. Most participants (45%–62%) felt horrified, apprehensive, or helpless due to COVID-19. Furthermore, over 40% reported increased stress from work and financial matters. Higher IES-R scores were found among females, participants aged 26–35 years, those with lower educational level, and participants residing in the North Africa region (p<0.005). About 42% reported receiving increased support from family members, 40.5% were paying more attention to their mental health, and over 40% reported spending more time resting since the pandemic started. The COVID-19 pandemic was associated with mild psychological impact while it also encouraged some positive impact on family support and mental health awareness among adults in the MENA region. Clinical interventions targeted towards vulnerable groups such as females and younger adults are needed. [ABSTRACT FROM AUTHOR]

Purpose: Assess international interventional radiology (IR) training standards and trainee satisfaction to identify challenges and drive positive change. Materials and Methods: An anonymous survey was created using Survey Monkey and distributed as a single-use web link via eight IR national and international societies around the world. It consisted of two parts: the first assessed the general exposure of radiology trainees to IR and whether this influenced their decision to pursue a career in IR; the second focussed on satisfaction and quality of training by those who are in training or have recently completed an IR training program. Results: There were 496 participants of which 274 were eligible to complete part one of the survey and 222 were eligible to complete the whole survey. UK and Europe contributed 52% of the responses. The USA and Middle East contributed 23%, and the rest of the world 9%. Over half of responders expressed that exposure early in their career was the main inspiration to pursue a career in IR. Overall satisfaction with training was high across all regions; however, satisfaction regarding vascular training varied. The negative impact of competition from other specialities ranged from 9% (USA) to 61% (UK). Great variability was reported regarding the amount of time spent dedicated to IR and IR on call. Conclusion: Despite significant progress in creating structured and comprehensive IR training, there is still room for improvement. Early promotion of IR is essential for on-going high-quality recruitment. Monitoring and standardization of the training environment at a national and international level are necessary to equip IR trainees and to consolidate IR's speciality status in the medical field. [ABSTRACT FROM AUTHOR]

Background: Medicinal plants are potential source of natural products that play an important role in preventing different human diseases. P. harmala is used traditionally as emmenagogue and an abortifacient agent in the Middle East, North of Africa and West of China. It belongs to the family of Zygophyllaceae and it is a wild growing flowering plant. Its seeds are main medicinal part of the plant. Methods: The current searching was done by the keywords in main indexing systems including PubMed/MEDLINE, Scopus, and Institute for Scientific Information Web of Science as well as the search engine of Google Scholar. The keywords were wild rue, traditional medicine, Harman, health benefits, and pharmaceutical science. Results: The most important uses of P. harmala in traditional pharmaceutical sciences are in cardiovascular, gasterointestinal, nervous, endocrine, neoplasm and tumors, pain relieving, organisms, diabetes, respiratory, disinfectant, anti-pyretic, skin and hair, rheumatism, arthritis and inflammation, and ulcers. Pharmacological effects of P. harmala are in cardiovascular system, nervous system, antimicrobial effects, antineoplasm, nervous system, endocrine, gastrointestinal effects, osteocytes, endocrine and respiratory system. Phenolic compounds are the main reason of antioxidant capacity. Conclusions: Due to its pharmacological activities, P. harmala is a high potential medicinal herb and the suggestion is to increases by doing research in efficacy and safety. [ABSTRACT FROM AUTHOR]

Background: High numbers of violence incidents against physicians are reported annually in both developing and developed countries. In Jordan, studies conducted on healthcare workers involved small number of physicians and showed higher percentages of violence exposure when compared to other investigations from the Middle East. This is a large study aiming to comprehensively analyze the phenomenon in the physicians' community to optimize future strategies countering it. Methods: The study has a cross sectional, questionnaire-based design. It targeted 969 doctors from different types of healthcare Jordanian institutions in Amman, between May to July, 2019. The questionnaire was designed to evaluate properties of reported abuse cases in terms of abusers, timing, and type of abuse, in addition to the consequences of this abuse. Results: Prevalence of exposure to violence in the last year among doctors was 63.1% (611 doctors). 423 (67.2%) of male doctors had an experience of being abused during the last 12 months, compared to 188 (55.3%) of females (p< 0.001). Governmental centers showed the highest prevalence. Among 356 doctors working in governmental medical centers, 268 (75.3%) reported being abused (p< 0.001), and they were more abused verbally (63.5%) and physically (10.4%) compared to other medical sectors (p <0.001). The mean score of how worried doctors are regarding violence at their workplace from 1 to 5 was 3.1 ± 1.3, and only 129 (13.3%) believed that they are protected by law. Conclusions: The study emphasized on the higher rate of violence against physicians in the governmental sector, in addition to the negative effect of abuse on their performance. Moreover, male physicians had higher incidence of workplace abuse. Therefore, strategies that ease and promote the real application of anti-violence policies should become our future target. [ABSTRACT FROM AUTHOR]

This study contributes new evidence on why the Middle East and North Africa (MENA) region has failed to create decent jobs for decades. The growth accounting exercise reveals that the region suffered from an acute total factor productivity (TFP) deficit in the 1990s; it improved remarkably in the 2000s, before deteriorating significantly in the period between 2010 and 2017. Throughout the three subperiods, the region's growth relied heavily on capital accumulation. The severe deficit in TFP and the heavy reliance on physical capital for decades impaired the region's ability to sustain economic growth and to create decent jobs in the long run. The study recommends more government interventions in knowledge accumulation as a critical precondition for employment generation in developing countries. [ABSTRACT FROM AUTHOR]

Background: Iron deficiency (ID) and ID anemia (IDA) are common in the member states of the Gulf Cooperation Council (GCC). The unique genetic and lifestyle factors of the patient population in the region have necessitated the development of recommendations to help educate health-care professionals on appropriate diagnosis and management of ID/IDA.Methods: A panel of regional experts, including gastroenterologists and hematologists with expertise in the treatment of IDA, was convened to develop regional practice recommendations for ID/IDA. After reviewing the regional and international literature, the expert panel developed consensus recommendations for screening, diagnosis, and treatment of patients with IDA in the GCC region.Results: The recommendations proposed were customized to the patient population keeping in view the increasingly recognized burden of coeliac disease, high fertility and obesity rates, high prevalence of alpha- and beta-thalassemia traits, and poor tolerance and low treatment compliance with oral iron therapy.Conclusions: This consensus statement proposes recommendations for screening, diagnosis, and treatment of IDA in the GCC region. [ABSTRACT FROM AUTHOR]

Youth unemployment in the Middle East and North Africa (MENA) region is the highest in the world surpassing all geopolitical regions. The MENA region witnessed sweeping changes negatively affecting the labor market and markedly increasing unemployment rates following the so-called Arab Spring that began in 2011. This paper meticulously examines the microeconomic determinants of youth unemployment in the MENA region using a unique and novel data on young people aged 15–29 from the year 2016. The results show that being a male and graduated from a public school increase the probability of being unemployed. Moreover, job concerns, corruption, and unequal rights in the society are also found to have a positive incidence on unemployment. However, we find that enhancing gender equality in the labor market, education, family codes, and political participation decreases the probability of employment. Similarly, the results indicate that improving economic inclusion in the post-Arab Spring decreases the probability of unemployment. [ABSTRACT FROM AUTHOR]

Background: It has been identified that ineffective nurse-patient communication in the emergency department can lead to frustration, mistrust and inadequate pain management. Therefore, it is important to recognise the potential barriers to effective communication, including nurse and patient-related factors. Aim: To identify what emergency nurses perceive as barriers to nurse-patient communication, and if there is any difference in the perception of communication barriers between nurses' demographic subgroups. Method: A total of 199 emergency nurses were recruited using convenience sampling, from nine hospitals in the West Bank, Palestine. These nurses completed a 27-item questionnaire that encompassed six domains of barriers that may affect nurse-patient communication: demographic, knowledge-related, environmental, social, economic and psychological factors. Results: Of the six domains covered by the questionnaire, environmental factors scored the highest, meaning that emergency nurses perceived these to be the most significant barriers to effective nurse-patient communication. This was followed by knowledge-related and psychological factors. Knowledge-related factors were perceived to be a greater communication barrier by male nurses more than female nurses, and by younger nurses more than older nurses. Conclusion: To enhance nurse-patient communication, it is important to establish a comfortable working environment and to provide ongoing training for nurses to develop their communication skills. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity is one of the most serious public health issues of the twenty-first century affecting even low- and middle-income countries. Overweight and obese children are more likely to stay obese into adulthood. Due to the paucity of data on local practices, our study aimed to assess the knowledge and practices of physicians from the Middle East and North Africa region with respect to early-onset obesity.Methods: A specific questionnaire investigating the perception and knowledge on early-onset obesity was circulated to healthcare providers (general physicians, pediatricians, pediatric gastroenterologist, neonatologists) practicing in 17 Middle East and North African countries.Results: A total of 999/1051 completed forms (95% response) were evaluated. Of all respondents, 28.9% did not consistently use growth charts to monitor growth during every visit and only 25.2% and 46.6% of respondents were aware of the correct cut-off criterion for overweight and obesity, respectively. Of those surveyed, 22.3, 14.0, 36.1, 48.2, and 49.1% of respondents did not consider hypertension, type 2 diabetes, coronary heart disease, fatty liver disease, and decreased life span, respectively, to be a long-term complication of early childhood obesity. Furthermore, only 0.7% of respondents correctly answered all survey questions pertaining to knowledge of early childhood overweight and obesity.Conclusion: The survey highlights the low use of growth charts in the evaluation of early childhood growth in Middle East and North Africa region, and demonstrated poor knowledge of healthcare providers on the short- and long-term complications of early-onset obesity. This suggests a need for both continued professional education and development, and implementation of guidelines for the prevention and management of early childhood overweight and obesity. [ABSTRACT FROM AUTHOR]

Amid the rise in conflict and war and their ensuing repercussions, traumatic injuries, psychological distress, and communicable diseases spread widely. Today, health-care providers in the Middle East are faced with new and unfamiliar cases resulting from the use of new and advanced types of weapons. In addition, there has not been enough emphasis on hands-on experiences in medical school, which can be imperative in times of war. Lack of academia is another inadequacy that limits the transmission of knowledge onto the newer generations. Here, we will shed light on the inadequacies in medical curricula in the Middle East when it comes to addressing patients of war. We also call for action to advance medical education in war-ridden areas by incorporating "conflict medicine" as an integral module in medical curricula. [ABSTRACT FROM AUTHOR]

The paper investigates the effect of oil price change and other cyclical factors on the stability difference of conventional and Islamic banks. The study espouses to two separate stability measurement in order to differentiate the effect of change in oil price on bank stability. The results of the paper provide evidence that oil price change affects the stability of conventional banks better when measured with accounting approach, while the change of oil price affects the banking stability when measured with market-based stability measures. Moreover, the result reveals a positive relationship between banking stability of Islamic banks and GDP coexists with a negative relationship on the conventional banks. It reveals that banking stability is affected by inflation negatively. The findings of this paper have significant policy implication for banking stability in Middle East and other oilproducing emerging countries. [ABSTRACT FROM AUTHOR]

Background: Although staff spiritual care provision plays a key role in patient-centered care, there is insufficient information on international variance in attitudes toward spiritual care and its actual provision.Methods: A cross-sectional survey of the attitudes of Middle Eastern oncology physicians and nurses toward eight examples of staff provision of spiritual care: two questionnaire items concerned prayer, while six items related to applied information gathering, such as spiritual history taking, referrals, and encouraging patients in their spirituality. In addition, respondents reported on spiritual care provision for their last three advanced cancer patients.Results: Seven hundred seventy responses were received from 14 countries (25% from countries with very high Human Development Index (HDI), 41% high, 29% medium, 5% low). Over 63% of respondents positively viewed the six applied information gathering items, while significantly more, over 76%, did so among respondents from very high HDI countries (p value range, p < 0.001 to p = 0.01). Even though only 42-45% overall were positively inclined toward praying with patients, respondents in lower HDI countries expressed more positive views (p < 0.001). In interaction analysis, HDI proved to be the single strongest factor associated with five of eight spiritual care examples (p < 0.001 for all). Significantly, the Middle Eastern respondents in our study actually provided actual spiritual care to 47% of their most recent advanced cancer patients, compared to only 27% in a parallel American study, with the key difference identified being HDI.Conclusions: A country's development level is a key factor influencing attitudes toward spiritual care and its actual provision. Respondents from lower ranking HDI countries proved relatively more likely to provide spiritual care and to have positive attitudes toward praying with patients. In contrast, respondents from countries with higher HDI levels had relatively more positive attitudes toward spiritual care interventions that involved gathering information applicable to patient care. [ABSTRACT FROM AUTHOR]

Water scarcity has been well pronounced in the Middle East Region; however, Lebanon is still characterized by wet climate and sufficient water resources. It is a paradox that Lebanon is now under water stress, and many contradictory studies on the climate of Lebanon attributed water stress to the changing climate. Most of these studies were applied with incomplete climatic data records. Therefore, all management approaches were implemented after considering climate as a major influencer on water resources. In this study, the Emberger Aridity Index (EAi) was employed to investigate the climate regime of Lebanon over more than 30 years focusing on ten representative meteorological stations where comprehensive climatic records were analysed and supported by remotely sensed data. The EAi indicates that Lebanon is still characterized by humid climate, which conflicts with the concept of drought existence. Thus, 47% of the Lebanese territory is characterized by humid to sub-humid climate and 29% by semi-arid climate according to Emberger classification. This obviously shows that even the climate impact has a role on water scarcity, but it is not the principal influencer. The results of this study help applying new approaches for water management where the negative human interference should be accounted. It guides stakeholder and decision-maker to follow appropriate water and agricultural policies and strategies for better sustainable development. [ABSTRACT FROM AUTHOR]