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Abdulaziz A Alahmari,1 Sarah H AlShawaf,2 Huda A Meshikhes,2 Bedour A Aleid,2 Raghad M Aldossari,2 Marwa M Shafey,3 Ahmed A Aladsani,1 Abdulazeem A Al-ibraheem,4 Nawal M AlRubia,5 Saleh A AlQahtani1 1Department of Pediatrics, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia; 2College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia; 3Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia; 4Department of Pediatrics, Maternal and Children’s Hospital, Ministry of Health, Alhassa, Kingdom of Saudi Arabia; 5Department of Pediatrics, Maternal and Children’s Hospital, Ministry of Health, Dammam, Kingdom of Saudi ArabiaCorrespondence: Abdulaziz A Alahmari, Department of Pediatrics, King Fahd Hospital of the University, Imam Abdulrahman bin Faisal University, Dammam, 34212, Kingdom of Saudi Arabia, Tel +966 59 884 0373, Email aahmari@iau.edu.saPurpose: The aim of this study was to investigate the quality of life in children and adolescents aged 7– 18 years with inflammatory bowel disease and identify the factors that influence it.Patients and Methods: A multi-center cross-sectional study in which participants were recruited from 3 governmental hospitals in the Eastern Province of Saudi Arabia. A total of 61 children with inflammatory bowel disease were approached, 44 participants were included according to their age (7– 18 years), disease duration of at least 6 months, and without any other co-morbidities. A translated Arabic version of the IMPACT-III questionnaire was used to assess the quality of life of the participants with inflammatory bowel disease. In addition, disease-specific indices were used to measure their disease activity; Harvey Bradshaw for patients with Crohn’s disease and Pediatric Ulcerative Colitis Activity Index for ulcerative colitis patients.Results: The mean age of the 44 participants was 13.36 ± 2.85. Crohn’s disease accounted for 56.8% of the sample, while 36.4% had ulcerative colitis and 6.8% had unclassified type. The majority were males and in disease remission. The mean total score of the questionnaire was 74.10 ± 12.21, where the domain of social functioning scored the highest and the domain of emotional functioning scored the lowest. Children who are 11 years or older scored significantly higher in emotional functioning and total mean scores. Statistical significance was also observed between the well-being domain and not having flare-ups in the past year, as well as disease severity with emotional functioning, body image, and total mean scores. It was found that corticosteroid utilization is a predictor of poorer quality of life and was statistically significant with the body image domain.Conclusion: Measuring the quality of life in children with inflammatory bowel disease can aid in reducing its burden and help address its factors.Keywords: quality of life, IMPACT-III, pediatrics, Crohn’s disease, ulcerative colitis

Learner-generated comics are powerful communication tools that allow students to convey complex thoughts and emotions through both verbal and visual modes. In this study, comics were used to explore students' experiences with and perceptions of distance learning (DL) during the COVID-19 pandemic. Female university students were chosen as a purposive sample to discover deep sociocultural meanings in society that could be invisible to men. This study analyzed thirty-two comics created by students using a suggested new analytical framework that draws on systemic functional linguistics theory. The findings were categorized into three dimensions: ideational (who, where, and what), interpersonal (relationships and emotions), and textual (main themes of the comics' stories). Quantitative content analysis was applied to analyze ideational and interpersonal dimensions (frequency), and qualitative analysis was applied to analyze textual dimensions (themes). Thematic analyses were categorized into three themes: challenges, advantages, and disadvantages. The findings were interpreted through a cultural lens in a style that presents the chief subjects that should be carefully considered in future scenarios of digital education. Several implications and future studies are suggested, especially about cultural issues in education, the quality of DL, and addressing the challenges and disadvantages associated with it.

In this work, we introduce a new definition for the fractional differential operator that generalizes several well-known fractional differential operators. In fact, we introduce the notion of the p-proportional ω-weighted κ-Hilfer derivative includes an exponential function, Da,λσ,ρ,p,κ,ω, and then we consider a non-instantaneous impulse differential inclusion containing Da,λσ,ρ,p,κ,ω with order σ∈(1,2) and of kind ρ∈[0,1] in Banach spaces. We deduce the relevant relationship between any solution to the studied problem and the integral equation that corresponds to it, and then, by using an appropriate fixed-point theorem for multi-valued functions, we give two results for the existence of these solutions. In the first result, we show the compactness of the solution set. Next, we introduce the concept of the (p,ω,κ)-generalized Ulam-Hyeres stability of solutions, and, using the properties of the multi-valued weakly Picard operator, we present a result regarding the (p,ω,κ)-generalized Ulam-Rassias stability of the objective problem. Since many fractional differential operators are particular cases of the operator Da,λσ,ρ,p,κ,ω, our work generalizes a number of recent findings. In addition, there are no past works on this kind of fractional differential inclusion, so this work is original and enjoyable. In the last section, we present examples to support our findings.

COVID-19 has affected the everyday educational lives of students, teachers, administrators, and parents. Parents who are living in low-income and disadvantaged communities are probably more likely than others to have been affected by the pandemic in relation to their children's distance learning. This study focused on the perceptions, predictions, and suggestions of female breadwinner parents from low-income families regarding their children's distance learning. Data were collected from 12 mothers who participated in a three-stage focus group study. The data from the focus group discussions were thematically analyzed into three categories: (1) financial issues, (2) social and cultural issues, and (3) educational issues. Additionally, the findings presented the breadwinners' general and technological reasons for their predictions for enhancing education in the future if schools return to face-to-face learning or pursue a blended learning approach. The breadwinners suggested three approaches to teaching and learning for the following academic year. The findings of this study may be useful in the development of educational policies and training programs to provide essential social and technological support to low-income families to address their needs in the online learning environment and to improve digital equity for low-income families who are likely to be educationally disadvantaged.

The COVID-19 pandemic affected all aspects of human life, with significant impacts on education, as higher education institutions across the world were forced to make rapid transition to a fully online education format with no time to prepare. This qualitative study applied the narrative approach to examine the stories of six university instructors regarding their experiences with promoting student engagement during the COVID-19 emergency remote teaching. The study findings present the instructors' feelings during the transition to distance education, the challenges they faced, and their efforts to promote their students' engagement by using various strategies and assessments and by providing the students with emotional support. The findings also present the effect of local culture and millennial generation student status on students' engagement.

This piece theorises the limitations of transitioning reflection from individualistic to participatory practice. It addresses the question: what are the challenges of introducing crowd-reflecting into Arab academia? To answer this question, 140 Arabs from an academic organisation were invited to crowd-reflect, online, on their institution, using a five-phase model. The data analysis showed that limited cultures of collaboration, healthy conflict, cross-gender communication, integrity and critical thinking in Arab academia challenged crowd-reflecting. Despite implementing strategies to overcome these challenges, crowd-reflecting resulted in chaos at the institution, forcing management to intervene to stop the project. This chaos ensued because crowd-reflecting, unlike individualistic reflection, entailed numerous individuals and intersubjectivity -- which complicated reflectiveness, turned thoughtful Arab individuals into a mob and jeopardised the well-documented gains of individualistic reflection. Although crowd-reflecting was initiated to improve organisations, it destabilised the institution and turned it into a counter-learning organisation. This implies that, in Arab academia, beyond micro-level small groups, the more participants there are in reflection, the less effective the learning outcomes may be. In Arab academia, meso-level reflection (and, by implication, macro-level reflection such as the mega-reflecting of the Twittersphere) can risk ruining the art of reflectiveness.

Employing social network sites (SNSs) for academic purposes has been investigated in the literature; however, there is not enough scientific knowledge about university instructors' behavioral perceptions and values that drive their academic use of SNSs. Therefore, a systematic cognitive framework, regarding SNSs academic usage, is beneficial to understand these behavioral perceptions. This research utilizes the means-end chain (MEC) analysis approach to investigate university instructors' cognitive structure toward the academic use of SNSs. It identifies important requirements for the effective academic use of SNSs by recognizing the relationship between the critical features of SNSs and instructors' perceived values derived from these features. The findings show that seven significant features of SNSs form 45 MECs that appear to be the most useful features used by university instructors for academic purposes. These seven features were found to be cognitively associated with 10 positive benefits, which are crucial to the fulfillment of nine of the instructors' personal values. Of the seven features, following others and being a group member were used most frequently by instructors in their academic practices. These two features were of significant value for the instructors to achieve a sense of accomplishment. The findings have practical implications for instructors and educational institution policy makers to enhance the effectiveness of SNSs use in academic settings.

In this work, we introduce a new definition for the fractional differential operator that generalizes several well-known fractional differential operators. In fact, we introduce the notion of the p -proportional ω -weighted κ -Hilfer derivative includes an exponential function, D a , λ σ , ρ , p , κ , ω , and then we consider a non-instantaneous impulse differential inclusion containing D a , λ σ , ρ , p , κ , ω with order σ ∈ (1 , 2) and of kind ρ ∈ [ 0 , 1 ] in Banach spaces. We deduce the relevant relationship between any solution to the studied problem and the integral equation that corresponds to it, and then, by using an appropriate fixed-point theorem for multi-valued functions, we give two results for the existence of these solutions. In the first result, we show the compactness of the solution set. Next, we introduce the concept of the (p , ω , κ) -generalized Ulam-Hyeres stability of solutions, and, using the properties of the multi-valued weakly Picard operator, we present a result regarding the (p , ω , κ) -generalized Ulam-Rassias stability of the objective problem. Since many fractional differential operators are particular cases of the operator D a , λ σ , ρ , p , κ , ω , our work generalizes a number of recent findings. In addition, there are no past works on this kind of fractional differential inclusion, so this work is original and enjoyable. In the last section, we present examples to support our findings. [ABSTRACT FROM AUTHOR]

BackgroundThe epidemiology and outcomes of biliary atresia (BA) have been well-documented in national cohorts from two main ethnicities, namely, the Asian Orientals and Caucasians, with incidence ranging from 1 in 5,000 to 1 in 9,000 live births in East Asia and 1 in 15,000 to 19,000 live births in Europe and North America.ObjectiveWe report the first nationwide BA study outside North America, Europe, and East Asia to describe the epidemiology and outcomes of BA in Saudi Arabia.MethodsA national database of BA cases diagnosed between 2000 and 2018 was analyzed. We assessed clearance of jaundice (bilirubin 90 days showed a SNL rate at 51.6, 33, and 12.5%, respectively, at 5 years (P < 0.001). The 2-, 5-, and 10-year post-LT survival rates were 92.5, 90.6, and 90%, respectively. Undergoing an initial KPE did not impact negatively on the overall LT survival rate when compared to BA cases that underwent primary LT (P = 0.88).ConclusionThe incidence rate of BA in Saudi Arabia is lower than the incidence reported elsewhere. Late referral of BA cases remains a problem in Saudi Arabia; as a result, the SNL rate was lower than reported by other national registries. Hence, national policies devoted to timely referral and earlier age at KPE are needed.

In the present study, established fixed-point theories are utilized to explore the requisite conditions for the existence and uniqueness of solutions within the realm of sequential fractional differential equations, incorporating both Caputo fractional operators and nonlocal boundary conditions. Subsequently, the stability of these solutions is assessed through the Ulam-Hyers stability method. The research findings are validated with a practical example that corroborate and reinforce the theoretical results. [ABSTRACT FROM AUTHOR]

Employing social network sites (SNSs) for academic purposes has been investigated in the literature; however, there is not enough scientific knowledge about university instructors’ behavioral perceptions and values that drive their academic use of SNSs. Therefore, a systematic cognitive framework, regarding SNSs academic usage, is beneficial to understand these behavioral perceptions. This research utilizes the means–end chain (MEC) analysis approach to investigate university instructors’ cognitive structure toward the academic use of SNSs. It identifies important requirements for the effective academic use of SNSs by recognizing the relationship between the critical features of SNSs and instructors’ perceived values derived from these features. The findings show that seven significant features of SNSs form 45 MECs that appear to be the most useful features used by university instructors for academic purposes. These seven features were found to be cognitively associated with 10 positive benefits, which are crucial to the fulfillment of nine of the instructors’ personal values. Of the seven features, following others and being a group member were used most frequently by instructors in their academic practices. These two features were of significant value for the instructors to achieve a sense of accomplishment. The findings have practical implications for instructors and educational institution policy makers to enhance the effectiveness of SNSs use in academic settings.

Background: We utilized the data from the Saudi national biliary atresia (BA) study (2000–2018) to describe the clinical, biochemical, imaging, and histopathological features of BA and the perioperative clinical practices among local pediatric gastroenterologists. Methods: This is a retrospective, multicenter, nationwide study that included 10 tertiary care governmental hospitals including the four liver transplant (LT) centers in different regions across Saudi Arabia. Results: BA was diagnosed in 204 infants (106 females; 10% preterm). The median age at referral was 65 days. Congenital anomalies were present in 68 patients (33%); 22 were splenic malformation (10.8%). The medians of laboratory investigations were total bilirubin (189 μmol/l), direct bilirubin (139 μmol/l), ALT (164 u/l), and GGT (472 u/l). The level of serum GGT was normal in 26 cases (12.7%). The ultrasound findings included hypoplastic or atrophic gall bladder (GB) (65%), normal GB (30%), and cord sign (5%). A HIDA scan was performed in 99 cases (48.52%). Magnetic resonance cholangiopancreatography (MRCP) was performed in 27 cases (13%). A total of 179 liver biopsies (88%) were obtained. The most common histopathologic findings were bile duct proliferation (92%), canalicular cholestasis (96%), bile plugs (84%), and portal fibrosis (95%). Cholangiography was performed in 139 cases (68%): operative in 122 (60%) and percutaneous in 17 (8%). A total of 143 children (70%) underwent Kasai portoenterostomy (KPE) at a median age of 70 days. After KPE, steroid was used in 37% of the cases and 100 cases (70%) were prescribed prophylactic antibiotics for variable duration (ranging between 3 and 12 months). Conclusion: Our data show marked variation in the diagnostic evaluation and perioperative management of BA cases among the different tertiary centers. There is a need to establish a national BA registry in Saudi Arabia aiming to standardize pre- and postoperative clinical practices. Additionally, normal serum GGT level, normal GB size on ultrasound, and being a premature baby should not preclude the diagnostic workup for BA. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the effects of the Self-Determined Career Development Model (SDCDM) on progress towards three goals of a young adult with autism spectrum disorder (ASD), using a multiple probe across goals design. Following the intervention, the young adult made progress towards each of his three goals that exceeded the expectations of his supervisor and behavior specialist. Implications for future research and practice are discussed.

Background: Outcomes in biliary atresia (BA) have been well-documented in large national cohorts from Europe, North America, and East Asia. Understanding the challenges that preclude success of the Kasai portoenterostomy (KPE) is the key to improve the overall outcomes of BA and implementing intervention strategies. Here, we analyzed the data from the Saudi national BA study (204 BA cases diagnosed between 2000 and 2018) to identify the prognostic factors of BA outcomes. Methods: One hundred and forty-three cases underwent KPE. Several prognostic factors (center case load, congenital anomalies, serum gamma-glutamyl transferase, use of steroids, ascending cholangitis post-operatively, and degree of portal fibrosis at time of KPE) were investigated and correlated with the primary outcomes of interest: 1) success of KPE (clearance of jaundice and total serum bilirubin <20 mmol/l after KPE), 2) survival with native liver (SNL), and 3) overall survival. Results: Use of steroids after KPE was associated with clearance of jaundice, 68% vs. 36.8% in the BA cases that did not receive steroids (P = 0.013; odds ratio 2.5) and a significantly better SNL rate at 2 - and 10-year of 62.22% and 57.77% vs. 39.47% and 31.57%, respectively (P = 0.01). A better 10-year SNL was observed in centers with caseload <1/year (group 1) as compared to centers that performed ≥1/year (group 2) [45.34% vs. 26.66%, respectively; P = 0.047]. On comparison of the 2 groups, cases in group 1 had KPE at significantly earlier age (median 59.5 vs. 75 days, P = 0.006) and received steroids after KPE more frequently than group 2 (69% vs. 31%, P < 0.001). None of the remaining prognostic variables were identified as being significantly related to BA outcome. Conclusion: Steroids use post-KPE predicted clearance of jaundice and better short- and long-term SNL. There is a need to establish a national BA registry in Saudi Arabia aiming to standardize the pre- and post-operative clinical practices and facilitate clinical and basic research to evaluate factors that influence BA outcome. [ABSTRACT FROM AUTHOR]