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Arif Jameel,1 Sania Khan,2 Wadi B Alonazi,3 Ali Ahmed Khan4 1School of Management, Jiangsu University, Zhenjiang, 212013, People’s Republic of China; 2Department of Human Resource Management, College of Business Administration, Prince Sattam Bin Abdulaziz University, Al Kharj, 11942, Saudi Arabia; 3Health Administration Department, College of Business Administration, King Saud University, Riyadh, 11587, Saudi Arabia; 4Department of Management Information Systems, College of Business Administration, Prince Sattam Bin Abdulaziz University, Al Kharj, 11942, Saudi ArabiaCorrespondence: Sania Khan, Email sa.khan@psau.edu.saPurpose: This study aims to examine the influence of social media sites and television advertisements on compulsive shopping behavior, and whether this influence is mediated by materialism in the university students of Saudi Arabia.Methods: Data was collected from 487 students at Saudi universities. AMOS and Structural equation modeling (SEM) were utilized to examine the data. The research supports the Hypothesis that adolescents who are more materialistic are more prone than less materialistic adolescents to engage in compulsive shopping behavior.Results: The findings were consistent with other research, suggesting that the same remains true in the culture of Saudi Arabia. The research’s findings show that television advertisements and the use of social media sites positively related to compulsive shopping behavior among university students, and materialism mediated the relationship between television advertisements and social media sites.Conclusion: The research emphasizes the significance of comprehending the materialistic attitude and consumption choices of adolescents and offers crucial information for scholars, decision-makers, and management of top companies.Keywords: social media sites, materialism, compulsive behavior, internet use, university students

Eman A Alblowi, Mona Abdullah Shujaa, Wadi B Alonazi Health Administration Department, College of Business Administration, King Saud University, Riyadh, 11587, Saudi ArabiaCorrespondence: Wadi B Alonazi, Email waalonazi@ksu.edu.saIntroduction: Recently, the Saudi government has proposed several initiatives to promote mental health, including the national program named Wazen. The objective of this study was to observe the performance of mental hospitals using a balanced scorecard through this federal program.Methods: Secondary quantitative analysis was implemented utilizing the Wazen report program data in 2022. The report adopted a balanced scorecard (BSC) concept. The study focused on 19 mental health facilities (Eraddah Hospitals) in the Ministry of Health (MOH) regions. The MOH’s annual statistical report for 2018 and 2022 was reviewed to explore more about beds, staff, and the number of new mental disorder cases. Data were analyzed using Microsoft Excel 365 and the Statistical Package for Social Sciences (SPSS Version 25) software. Mental health hospitals were classified into three categories.Results: Most rural hospitals had lower performance in the yellow threshold value that might need improvement. The data shows that the mean of all hospital performance in some domains ranged, yielding 70% staff engagement and 77% continued educational activity, indicating unsatisfactory performance across public mental health services. The means score of access to care was 97.0% and 94.7%, marking the better mental health services provided. Between 2018 and 2022, there was a significant rise in the prevalence of mental disorders, as evidenced by the number of new patients and outpatients indicated by specific mental diseases, including conditions of psychological development (F80-F98).Discussion: The high quality of mental healthcare is manifested by therapeutic ethos with a high degree of interaction between professional careers and service users. The former is enhanced by highly educated, competent, compassionate, self-aware, and specialized healthcare professionals in mental health. When assessing mental healthcare services, we recommend considering providers’ and professionals’ conditions for successful implementation in alignment with patient experience.Keywords: rural mental health services, Eraddah Hospitals, Ministry of Health, mental health system, people and development, patient experience

Wadi B Alonazi Health and Hospital Administration, College of Business Administration, King Saud University, Riyadh 11587, Saudi ArabiaCorrespondence: Wadi B AlonaziHealth and Hospital Administration, College of Business Administration, King Saud University, PO Box 71115, Riyadh 11587, Saudi ArabiaEmail waalonazi@ksu.edu.saBackground: During a pandemic, healthcare professionals encounter various health hazards that affect their personal life and workplace. Emotional intelligence (EI) has a substantial impact on nurses’ success and performance in the healthcare industry. However, previous research studies report inconsistent findings regarding how different levels of EI affect job performance (JP), particularly during pandemics. The present study contributes to the literature on this contemporary topic by investigating the impact of EI on JP among nurses during COVID-19 crisis management in Saudi Arabia (SA).Methods: In a convenience sampling, 340 nurses from three tertiary hospitals completed an online survey assessing EI and JP during COVID-19 climax levels in March and April, 2020. Only nurses who had direct contact with patients diagnosed with COVID-19 were eligible. The Wong & Law EI scale (WLEIS) was used in a cross-sectional design to determine participants’ EI. Empirically, JP was measured by the Individual Work Performance Questionnaire (IWPQ). Data analysis was performed using SPSS statistical software version 20.0 (IBM Corp).Results: Generally, nurses reported, out of a 5-point Likert scale, moderate to high levels of EI (M = 3.99, SD = 0.434). Nurses in critical care units demonstrated the highest levels of EI, followed by nurses in intensive care, neonatal intensive care, then general nurses. Nurses working in respiratory therapy demonstrated the lowest levels. Across all groups during crisis, nurses reported a significant impact of EI on JP (β = 0.389, p < 0.01).Conclusion: Nurses reported satisfactory levels of EI, and most of their practices were aligned with national standards during COVID-19, but slightly in inverse to EI. However, more research is necessary to understand the greater impact of stressors influencing JP to the extent that levels of EI are no longer satisfactory.Keywords: emotional intelligence, nurses, job performance, COVID-19

Turky H Almigbal,1 Khalid M Almutairi,2 Jack B Fu,3 Jason M Vinluan,2 Eyad Alhelih,4 Wadi B Alonazi,5 Mohammed Ali Batais,1 Abdulaziz A Alodhayani,1 Murad A Mubaraki61College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Department of Community Health Science, College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia; 3Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas Md Anderson Cancer Center, Houston, TX, USA; 4College of Nursing, King Saud University, Riyadh, Saudi Arabia; 5College of Business Administration, King Saud University, Riyadh, Saudi Arabia; 6Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Jason M VinluanDepartment of Community Health Science, College of Applied Medical Science, King Saud University, P.O. Box 642, Riyadh 11421, Saudi ArabiaTel +966 55 765 1783Fax +966 469 3625Email Jvinluan@ksu.edu.saBackground: Cancer patients under psychological distress have reduced compliance with treatment and prolonged hospitalizations. Identifying cancer patients who may be more likely to suffer from psychological distress over the disease trajectory is essential to targeting the proper interventions and providing the best care. In this descriptive cross-sectional study, we aim to assess the levels of emotional and physical distress, depressive symptoms, and social concerns of cancer patients undergoing radiotherapy treatment in Saudi Arabia.Methods: A total of 148 cancer patients undergoing radiotherapy from five different public tertiary-level hospitals in Saudi Arabia participated in this study. The survey was conducted by a trained researcher from November 2015 through April 2016. The Psycho-Oncology Screening Tool was used to identify levels of distress of cancer patients undergoing radiotherapy. Emotional and physical distress, depressive symptoms, and social concerns in receiving psychosocial services were assessed.Results: The findings show above average levels of physical and emotional distress was (342.07±78.9) and social concerns was (7.27±1.68). Age was a significant predictor of psychological distress and in social concerns (P

Economy of Pakistan is heavily dependent upon agriculture and extensive use of pesticide is quiet common to enhance the crop yield. Imidacloprid is among the first choice pesticides in Pakistan and it has been reported that through run off along with water it ends up in water bodies affecting non target aquatic fauna. Through the present investigation, we are reporting the effects of Imidacloprid on the fatty acids composition of a non-target, commercially important carp: Labeo rohita . Fish were exposed to sub lethal concentration of Imidacloprid (120 mgL 1 ) for 2, 4 and 8 days (short term) as well as for 16, 32 and 64 days (long term experimental conditions). Pesticide untreated controls were also maintained for each treatment. Following the specific Imidacloprid exposure, fatty acid composition (%) was determined in the muscle of all experimental groups by using gas chromatography. Fish exposed to Imidacloprid for 8 days had reduced Palmitic acid ( p  = 0.02) and elevated muscle Arachidic acid ( p  < 0.001) than control group. Labeo rohita exposed to the pesticide for 32 days had elevated muscle Oleic ( p  = 0.02) and Linoleic acid ( p  = 0.02) while fish exposed to Imidacloprid to 64 days had reduced muscle Palmitic ( p  = 0.04) and Oleic acid ( p  = 0.03). In conclusion, we are reporting that the exposure to sub lethal concentration of Imidacloprid disturb the muscle fatty acid composition of Labeo rohita that may affect its food quality. The effects were more pronounced under long term experimental conditions and were probably due to potentiating lipid peroxidation and disturbed fish metabolism upon Imidacloprid exposure.

Whipple disease caused by Tropheryma whipplei a gram-positive bacterium is a systemic disorder that impacts not only the gastrointestinal tract but also the vascular system, joints, central nervous system, and cardiovascular system. Due to the lack of an approved vaccine, this study aimed to utilize immunoinformatic approaches to design multiepitope -based vaccine by utilizing the proteomes of five representative T. whipplei strains. The genomes initially comprised a total of 4,844 proteins ranging from 956 to 1012 proteins per strain. We collected 829 nonredundant lists of core proteins, that were shared among all the strains. Following subtractive proteomics, one extracellular protein, WP&#95;033800108.1, a WhiB family transcriptional regulator, was selected for the chimeric-based multiepitope vaccine. Five immunodominant epitopes were retrieved from the WhiB family transcriptional regulator protein, indicating MHC-I and MHC-II with a global population coverage of 70.61%. The strong binding affinity, high solubility, nontoxicity, nonallergenic properties and high antigenicity scores make the selected epitopes more appropriate. Integration of the epitopes into a chimeric vaccine was carried out by applying appropriate adjuvant molecules and linkers, leading to the vaccine construct having enhanced immunogenicity and successfully eliciting both innate and adaptive immune responses. Moreover, the abilityof the vaccine to bind TLR4, a core innate immune receptor, was confirmed. Molecular dynamics simulations have also revealed the promising potential stability of the designed vaccine at 400 ns. In summary, we have designed a potential vaccine construct that has the ability not only to induce targeted immunogenicity for one strain but also for global T. whipplei strains. This study proposes a potential universal vaccine, reducing Whipple's disease risk and laying the groundwork for future research on multi-strain pathogens., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Cooling towers (CTs) are crucial to myriad industrial processes, supporting thermal exchange between fluids in heat exchangers using water from lakes and rivers as coolant. However, CT water can sometimes introduce microbial contaminants that adhere to and colonize various surfaces within the CT system. These microorganisms can form biofilms, significantly hindering the system's thermal exchange efficiency. Current treatment strategies employ oxidizing biocides to prevent microbial growth. However, despite their affordability, they do not eliminate biofilms effectively and can lead to corrosive damage within the system. Herein, we aim to devise an anti-biofilm strategy utilizing hydrolytic enzymes (such as α-amylase, glucoamylase, pectin-lyase, cellulase, protease, and DNase) alongside antibiotics (including meropenem, ciprofloxacin, gentamicin, erythromycin, chloramphenicol, and ceftriaxone) to combat microbial growth and biofilm formation in cooling systems., Results: All enzymes reduced the development of the biofilms significantly compared to controls (p < 0.05). The polysaccharidases exhibited biomass reduction of 90%, except for pectin-lyase (80%), followed by DNAse and protease at 43% and 49%, respectively. The antibiotics reduced the biofilms of 70% of isolates in concentration of > 2 mg/mL. The minimal biofilm eradication concentration (MBEC) lower than 1 mg/mL was detected for some 7-day-old sessile isolates. The enzymes and antibiotics were also used in combination against biofilms using the modified Chequerboard method. We found six synergistic combinations, with Fractional inhibitory concentrations (FIC) < 0.5, out of the ten tested. In the presence of the enzymatic mixture, MBECs presented a significant decrease (p < 0.05), at least 4-fold for antibiotics and 32-fold for enzymes. Moreover, we characterized high molecular weight (> 12 kDa) exopolysaccharides (EPS) from biofilms of ten isolates, and glycosyl composition analysis indicated a high frequency of glucose, mannose, erythrose, arabinose, and idose across isolates EPS contrasting with rhamnose, allose, and those carbohydrates, which were detected in only one isolate., Conclusion: The synergistic approach of combining enzymes with antibiotics emerges as a highly effective and innovative strategy for anti-biofilm intervention, highlighting its potential to enhance biofilm management practices., (© 2024. The Author(s).)

Background: The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing globally, impacting individuals in Western nations and rapid growing in Asian countries due to sedentary lifestyles; thus, NAFLD has emerged as a significant worldwide health concern. Presently, lifestyle changes represent the primary approach to managing NAFLD., Methods: This research aimed to identify the potential drug targets for treating NAFLD through comprehensive in silico computational analysis. These include the prediction of the three-dimensional structure of the protein, the prediction of inhibitors by PubChem and ZINC, molecular docking by Autodcok, pharmacophore modeling, molecular dynamics simulation by the OPLS&#95;2005 force field, and the orthorhombic box solvent model Intermolecular Interaction Potential 3 Points Transferable to the selected compound. The toxicity of the lead compounds was analyzed through AdmetSAR software., Results: The protein associated with the PNPLA3 gene, whose overall three-dimensional structure was 95% accurate, were retrieved following inhibitor selection via PubChem and ZINC. Among the selected inhibitors and docked compounds with ID 10033935 (ellagitannin) showed a minimum E-Score of -17.266. In docking and pharmacophore modeling the compound ellagitannin shows promise as a potential drug candidate. Moreover, the molecular dynamics and structural stability of the protein-ligand complex were evaluated with several metrics such as as root mean square fluctuation and root mean square deviation and resulted in the stability not only of PNPLA3-10033935 (ellagitannin) but also of compound PNPLA3-71448940 and PNPLA3-5748394 complexed proteins at 400 ns with very slight variation., Conclusion: Overall, ellagitannin was identified as the best druggable target with the best therapeutics profile. The findings of our study can pave the way for the development of a new drug against NALFD., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Advanced diagnostic technologies have made accurate and precise diagnosis of pathogens easy. Herein, we present a new diagnostic method, droplet digital PCR (ddPCR), to detect and quantify Acinetobacter baumannii in mini bronchoalveolar lavage (mini-BAL) samples. A. baumannii causes ventilator-associated pneumonia (VAP), a severe healthcare infection affecting patients' lungs. VAP carries a high risk of morbidity and mortality, making its timely diagnosis crucial for prompt and effective management. Methodology. The assay performance was evaluated by comparing colonization data, quantitative culture results, and different generations of PCR (traditional PCR and Real-Time PCR-qPCR Taqman ® and SYBR ® Green). The ddPCR and qPCR Taqman ® prove to be more sensitive than other molecular techniques. Reasonable analytical specificity was obtained with ddPCR, qPCR TaqMan ® , and conventional PCR. However, qPCR SYBR ® Green technology presented a low specificity, making the results questionable in clinical samples. DdPCR detected/quantified A. baumanni in more clinical samples than other methods (38.64% of the total samples). This emerging ddPCR technology offers promising advantages such as detection by more patients and direct quantification of pathogens without calibration curves.

Autism spectrum disorder (ASD) is characterized by defects in social communication and interaction along with restricted interests and/or repetitive behavior. Children with ASD often also experience gastrointestinal (GI) problems in fact incidence of GI problems in ASD is estimated up to 80 percent. Intestinal microbiota, which is a collection of trillions of microorganisms both beneficial and potentially harmful bacteria living inside the gut, has been considered one of the key elements of gut disorders. The goal of this review is to explore potential link between gut microbiota and ASD in children, based on the recently available data. This review discusses recent advances in this rapidly expanding area of neurodevelopmental disorders, which focuses on what is known about the changes in composition of gut bacteria in children with ASD, exploration of possible mechanisms via which gut microbiota might influence the brain and thus lead to appearance of ASD symptoms, as well as potential treatments that involve modulation of gut flora to improve symptoms in children with ASD, i.e., probiotics, postbiotics or changes in the diet. Of course, it's important to keep in mind inherent difficulties in proving of existence of causal relationships between gut bacteria and ASD. There are significant gaps in understanding of the mechanism of gut-brain axis and the mechanisms that underlie ASD. Standardized approaches for research in this area are needed. This review would provide an overview of this exciting emerging field of research., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Trypsin inhibitors are known to act against insect pests by inhibiting proteases of the digestive tract. In this study, we report structural and functional characterization of ∼ 19 kDa Albizia procera Kunitz-type trypsin inhibitor (ApKTI) protein with potential bio-insecticidal applications. Crystal structure of ApKTI protein has been refined to 1.42 Å and molecular structure (8HNR) showed highly beta sheeted conformation including 12 beta sheets, 15 loops and two small alpha helices. Docking between predicted model of Tribolium castaneum trypsin (TcPT) and 8HNR produced a stable complex (-11.3 kcal/mol) which reflects the inhibitory potential of ApKTI against insect gut trypsin. Significant mortality was observed in all life stages of T. castaneum including egg, larvae, pupae and adults with a 3.0 mg native ApKTI treatment in comparison to negative control. Although standard trypsin inhibitor ( Glycine max trypsin inhibitors; GmKTI; 3.0 mg) produced maximum reduction against all above life stages; however, a non-significant mortality difference was observed in comparison to 3.0 mg native ApKTI. The study further explores the synthesis and characterization of Graphene (GNPs) and Zinc oxide (ZnONPs) nanoparticles, followed by the optimization of ApKTI and GmKTI loading on both nanoparticles to evaluate their enhanced insecticidal effectiveness. Encapsulated proteins showed significant mortality against T. castaneum across all concentrations, with GNPs proving more effective than ZnONPs. Additionally, encapsulated GmKTI produced significant mortality of eggs compared to loaded ApKTI treatments while other life stages were non-significantly affected by two proteins. This research highlights the importance of encapsulated ApKTI protein for eco-friendly pest management strategies., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests, Dr. Ahmed Akrem reports a relationship with Bahauddin Zakariya University that includes: employment. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Neisseria meningitidis, commonly known as the meningococcus, leads to substantial illness and death among children and young adults globally, revealing as either epidemic or sporadic meningitis and/or septicemia. In this study, we have designed a novel peptide-based chimeric vaccine candidate against the N. meningitidis strain 331,401 serogroup X. Through rigorous analysis of subtractive genomics, two essential cytoplasmic proteins, namely UPI000012E8E0(UDP-3-O-acyl-GlcNAc deacetylase) and UPI0000ECF4A9(UDP-N-acetylglucosamine acyltransferase) emerged as potential drug targets. Additionally, using reverse vaccinology, the outer membrane protein UPI0001F4D537 (Membrane fusion protein MtrC) identified by subcellular localization and recognized for its known indispensable role in bacterial survival was identified as a novel chimeric vaccine target. Following a careful comparison of MHC-I, MHC-II, T-cell, and B-cell epitopes, three epitopes derived from UPI0001F4D537 were linked with three types of linkers-GGGS, EAAAK, and the essential PADRE-for vaccine construction. This resulted in eight distinct vaccine models (V1-V8). Among them V1 model was selected as the final vaccine construct. It exhibits exceptional immunogenicity, safety, and enhanced antigenicity, with 97.7 % of its residues in the Ramachandran plot's most favored region. Subsequently, the vaccine structure was docked with the TLR4/MD2 complex and six different HLA allele receptors using the HADDOCK server. The docking resulted in the lowest HADDOCK score of 39.3 ± 9.0 for TLR/MD2. Immune stimulation showed a strong immune response, including antibodies creation and the activation of B-cells, T Cytotoxic cells, T Helper cells, Natural Killer cells, and interleukins. Furthermore, the vaccine construct was successfully expressed in the Escherichia coli system by reverse transcription, optimization, and ligation in the pET-28a (+) vector for the expression study. The current study proposes V1 construct has the potential to elicit both cellular and humoral responses, crucial for the developing an epitope-based vaccine against N. meningitidis strain 331,401 serogroup X., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Vandammella animalimorsus is a Gram-negative and non-motile bacterium typically transmitted to humans through direct contact with the saliva of infected animals, primarily through biting, scratches, or licks on fractured skin. The absence of a confirmed post-exposure treatment of V. animalimorsus bacterium highlights the imperative for developing an effective vaccine. We intended to determine potential vaccine candidates and paradigm a chimeric vaccine against V. animalimorsus by accessible public data analysis of the strain by utilizing reverse vaccinology. By subtractive genomics, five outer membranes were prioritized as potential vaccine candidates out of 2590 proteins. Based on the instability index and transmembrane helices, a multidrug transporter protein with locus ID A0A2A2AHJ4 was designated as a potential candidate for vaccine construct. Sixteen immunodominant epitopes were retrieved by utilizing the Immune Epitope Database. The epitope encodes the strong binding affinity, nonallergenic properties, non-toxicity, high antigenicity scores, and high solubility revealing the more appropriate vaccine construct. By utilizing appropriate linkers and adjuvants alongside a suitable adjuvant molecule, the epitopes were integrated into a chimeric vaccine to enhance immunogenicity, successfully eliciting both adaptive and innate immune responses. Moreover, the promising physicochemical features, the binding confirmation of the vaccine to the major innate immune receptor TLR-4, and molecular dynamics simulations of the designed vaccine have revealed the promising potential of the selected candidate. The integration of computational methods and omics data has demonstrated significant advantages in discovering novel vaccine targets and mitigating vaccine failure rates during clinical trials in recent years.

The healthcare sector faces several challenges, such as rising costs, rising demand, and the need for sustainability. A new area of healthcare has emerged due to these problems, focusing on long-term improvements in management, social policy, and health economics. This research explores the cutting edge of healthcare, concentrating on long-term advancements in management, social policy, and health economics. To better understand the problems affecting the healthcare sector and to pinpoint the areas where sustainable solutions are most required, a survey of 2000 healthcare professionals and policymakers was performed. The data were analyzed using structural equation modeling (SEM), and a thorough sustainable healthcare model was created. According to the survey's findings, the healthcare sector now faces three significant challenges: growing prices, increased demand, and the need for sustainability. According to the respondents, the three main areas where sustainable innovations are most required are management, social policy, and health economics. These conclusions were supported by the (SEM) analysis, which also showed that sustainable practices in these fields significantly impact the sustainability of the healthcare system. These findings lead this research to conclude that to guarantee the accessibility and affordability of healthcare for everyone, a move towards sustainable practices in health economics, social policy, and management is needed. Cooperation between healthcare providers, policymakers, and other stakeholders is required to create creative solutions that support sustainability in the healthcare sector. This study offers a thorough framework for sustainable healthcare that may act as a guide for further research and the formulation of new regulations., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s).)

Objective: Multi-drug resistance (MDR) has notably increased in community acquired uropathogens causing urinary tract infections (UTIs), predominantly Escherichia coli. Uropathogenic E. coli causes 80% of uncomplicated community acquired UTIs, particularly in pre-menopausal women. Considering this high prevalence and the potential to spread antimicrobial resistant genes, the current study was conducted to investigate the presence of clinically important strains of E. coli in Pakistani women having uncomplicated cystitis and pyelonephritis. Women belonging to low-income groups were exclusively included in the study. Seventy-four isolates from urine samples were processed, phylotyped, and screened for the presence of two Single Nucleotide Polymorphisms (SNPs) particularly associated with a clinically important clonal group A of E. coli (CgA) followed by antibiotic susceptibility testing and genome sequence analysis., Results: Phylogroup B2 was most prevalent in patients and 44% of isolates were positive for the presence of CgA specific SNPs in Fumarate hydratase and DNA gyrase subunit B genes. Antibiotic susceptibility testing showed widespread resistance to trimethoprim-sulfamethoxazole and extended-spectrum beta-lactamase production. The infection analysis revealed the phylogroup B2 to be more pathogenic as compared to the other groups. The genome sequence of E. coli strain U17 revealed genes encoding virulence, multidrug resistance, and host colonization mechanisms., Conclusions: Our research findings not only validate the significant occurrence of multidrug-resistant clonal group A E. coli (CgA) in premenopausal Pakistani women suffering from cystitis and pyelonephritis but also reveal the presence of genes associated withvirulence, and drug efflux pumps. The detection of highly pathogenic, antimicrobial-resistant phylogroup B2 and CgA E. coli strains is likely to help in understanding the epidemiology of the pathogen and may ultimately help to reduce the impact of these strains on human health. Furthermore, the findings of this study will particularly help to reduce the prevalence of uncomplicated UTIs and the cost associated with their treatment in women belonging to low-income groups., (© 2024. The Author(s).)

Urinary tract infections (UTIs) are among the most prevalent bacterial infections affecting people in inpatient and outpatient settings. The current study aimed to sequence the genome of uropathogenic Escherichia coli strain CUI-B1 resourced from a woman having uncomplicated cystitis and pyelonephritis. Followed by deductive genomics towards potential drug targets using E. coli strain CUI-B1, strain O25b: H4-ST131, Proteus mirabilis strain HI4320, Klebsiella pneumoniae strain 1721, and Staphylococcus saprophyticus strain ATCC 15305 uropathogenic strains. Comparative genome analysis revealed that genes related to the survival of E. coli, P. mirabilis, K. pneumoniae, and S. saprophyticus, such as genes of metal-requiring proteins, defense-associated genes, and genes associated with general physiology, were found to be highly conserved in the genomes including strain CUI-B1. However, the genes responsible for virulence and drug resistance, mainly those that are involved in bacterial secretion, fimbriae, adherence, and colonization, were found in various genomic regions and varied from one species to another or within the same species. Based on the genome sequence, virulence, and antimicrobial-resistant gene dataset, the subtractive proteomics approach revealed 22 proteins mapped to the pathogen's unique pathways and among them, entB, clbH, chuV, and ybtS were supposed to be potential drug targets and the single drug could be utilized for all above-mentioned strains. These results may provide the foundation for the optimal target for future discovery of drugs for E. coli-, P. mirabilis-, K. pneumoniae-, and S. saprophyticus-based infections and could be investigated further to employ in personalized drug development., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Rapid urban developmental growth is a heated debate worldwide due to environmental challenges. This research has examined the spatiotemporal trend of informal built-up growth in Karachi city. Using a geo-information system, the past twenty years (2000-2020) trends of informal built-up growth are examined. For attaining the research objectives, geo-referenced high-resolution maps and satellite images are used for accuracy based spatial data. Karachi is divided into five different land use and land cover (LULC): formal built-up, informal built-up, vacant, water bodies, and green spaces. Spatial data of informal built-up growth change of five different years, 2000, 2005, 2010, 2015, and 2020 are generated through acquired maps digitization using ArcMap. Subsequently, the gains and transfers of Karachi's informal built-up growth based on five years 2000-2005, 2005-2010, 2010-2015, and 2015-2020 are analyzed using the Land Change Modeler (LCM) in IDRISI software. Also, land use land cover changes (LULCC) are predicted for the next 40 years (2020-2060) using the integrated Cellular Automata Markov (CA-Markov) simulation model in IDRISI. The results revealed that Karachi's built-up is expanding rapidly. Land conversion into the informal built-up area is alarming, as it has changed from 144.31 km 2 to 217.19 km 2 with 72.88 km 2 in the past twenty years (2000-2020) and has occupied green and agricultural land. Most informal built-up areas have transitioned from vacant (71.01 km 2 ) land use land cover (LULC). The informal built-up area could expand from 217.19 km 2 to 317.63 km 2 , with about 100.44 km 2 up to 2060. The planned and unplanned development will be towards the city's East (E) direction and will convert and ruin agriculture and vacant land. The present study provides suggestions to urban planners, administrative authorities, and policymakers to control informal growth and achieve sustainable development goals in developing countries., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors.)

Cardiovascular disorders are the world's major cause of death nowadays. To treat cardiovascular diseases especially coronary artery diseases and hypertension, researchers found potential ROCK2 (Rho-associated coiled-coil-containing protein kinase 2) target due to its substantial role in NO-cGMP and RhoA/ROCK pathway. Available drugs for ROCK2 are less effective and some of them depict side effects. Therefore, a set of novel compounds were screened that can potentially inhibit the activity of ROCK2 and help to treat cardiovascular diseases by employing In-silico techniques. In this study, we undertook ligand based virtual screening of 50 million compound's library, to that purpose shape and features (contain functional groups) based pharmacophore query was modelled and validated by Area Under Curve graph (AUC). 2000 best hits were screened for Lipinski's rule of 5 compliance. Subsequently, these selected compounds were docked into the binding site of ROCK2 to gain insights into the interactions between hit compounds and the target protein. Based on binding affinity and RMSD scores, a final cohort of 15 compounds were chosen which were further refined by pharmacokinetics, ADMET and bioactivity scores. 2 potential hits were screened using density functional theory, revealing remarkable biological and chemical activity. Potential inhibitors (F847-0007 and 9543495) underwent rigorous examination through MD Simulations and MMGBSA analysis, elucidating their stability and strong binding affinities. Results of current study unveil the potential of identified novel hits as promising lead compounds for ROCK2 associated with cardiovascular diseases. These findings will further investigate via In-vitro and In-vivo studies to develop novel druglike molecules against ROCK2., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ali et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The stomach's colonization by Helicobacter pylori ( H. pylori ) results in gastritis, ulcers, and stomach cancer. Frequently, pain is treated with medication, but resistant H. pylori infections are not. Therefore, it is important to find pharmacological targets and improved treatments for resistant H. pylori strains. The aim of the current study was sampling, identification, drug susceptibility testing following genome sequencing and comparative genome-wide analysis of selected H. pylori strains from Pakistan with three representative strains for virulence and drug-resistant characteristics. Based on culture, biochemistry, and molecular biology, 84 strains of H. pylori were identified, which made up 47% of the enrolled cases. Among all H. pylori strains, the highest resistance was reported for metronidazole with 82 H. pylori strains (98%), followed by clarithromycin with 62 resistant strains (74%). Among metronidazole-resistant strains, 38 strains (46%) were also resistant to clarithromycin, contributing 61% of clarithromycin resistant cases. Two strains, HPA1 and HPA2, isolated from 'gastritis' and 'gastric ulcer' patients, respectively, were further processed for WGS. The draft genome sequences of H. pylori strains HPA1 and HPA2 encode 1.66 Mbp and 1.67 Mbp genome size, 24 and 4 contiguous DNA sequences, and 1650 and 1625 coding sequences, respectively. Both the genomes showed greater than 90% similarity with the reference strain H. pylori ATCC 43504/PMSS1. The antibiotic-resistant genes were identified among all the strains with overall similarity above 95%, with minor differences in the sequence similarity. Using the virulent gene data obtained from the Virulence Factor Database, 75 to 85 virulent genes were identified in the five genome assemblies with various key genes such as cytolethal distending toxin ( cdt ), type IV secretion system, cag PAI, plasticity region, cell-motility- and flagellar-associated genes, neutrophil-activating protein (HP-NAP), T4SS effector cytotoxin-associated gene A ( cagA ), and urease-associated genes ureA and ureB, etc. Sequence similarity between the virulence factors found in this study and reference genes was at least 90%. In summary, the results of our study showed the relationship between clinical results and specific H. pylori strains' (HPA1 and HPA2) genetics such as antibiotic resistance and specific virulence factors. These findings provide valued understanding of the epidemiology of H. pylori -associated diseases. Moreover, identification and genomics analysis have provided insights into the epidemiology, genetic diversity, pathogenicity, and potential drug resistance genes of H. pylori strains, offering a foundation for developing more targeted and effective medical interventions, including anti-virulent medications.

In the past two decades, there have been three coronavirus outbreaks that have caused significant economic and health crises. Biologists predict that more coronaviruses may emerge in the near future. Therefore, it is crucial to develop preventive vaccines that can effectively combat multiple coronaviruses. In this study, we employed computational approaches to analyze genetically related coronaviruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its variants, focusing on the spike glycoprotein as a potential vaccine candidate. By predicting common epitopes, we identified the top epitopes and combined them to create a multi-epitope candidate vaccine. The overall quality of the candidate vaccine was validated through in silico analyses, confirming its antigenicity, immunogenicity, and stability. In silico docking and simulation studies suggested a stable interaction between the multi-epitope candidate vaccine and human toll-like receptor 2 (TLR2). In silico codon optimization and cloning were used to further explore the successful expression of the designed candidate vaccine in a prokaryotic expression system. Based on computational analysis, the designed candidate vaccine was found to be stable and non-allergenic in the human body. The efficiency of the multi-epitope vaccine in triggering effective cellular and humoral immune responses was assessed through immune stimulation, demonstrating that the designed candidate vaccine can elicit specific immune responses against multiple coronaviruses. Therefore, it holds promise as a potential candidate vaccine against existing and future coronaviruses.

Extreme cold environments, such as polar regions or high-altitude mountains, are known for their challenging conditions including low temperatures, high salinity, and limited nutrient availability. Microbes that thrive in these environments have evolved specialized strategies to survive and function under such harsh conditions. The study aims to identify, sequence the genome, perform genome assembly, and conduct a comparative genome-wide analysis of Acinetobacter sp. strain P1, which was isolated from the Batura glacier regions of Pakistan. A basic local alignment search tool of NCBI using 16 s RNA gene sequence confirmed the strain Acinetobacter following phylogenetic analysis revealed that strain P1 clustered with Acinetobacter sp. strain AcBz01. The high-throughput Genome sequencing was done by the NovaSeq 6000 sequencing system following de novo genome assembly reported 23 contigs, a genome size of 3,732,502 bp containing approximately 3489 genes and 63 RNAs (60 tRNA, 3 rRNA). The comparative genome analysis revealed that Acinetobacter sp. strain P1 exhibited the highest homology with the Acinetobacter baumannii ATCC 17978 genome and encompassed 1668 indispensable genes, 1280 conserved genes 1821 specific genes suggesting high genomic plasticity and evolutionary diversity. The genes with functional assignments include exopolysaccharide phosphotransferase enzyme, cold-shock proteins, T6SS, membrane modifications, antibiotic resistance, and set of genes related to a wide range of metabolic characteristics such as exopolysaccharides were also present. Moreover, the structural prediction analysis of EPS proteins reveals that structural flexibility allows for conformational modifications during catalysis, which boosts or increases the catalytic effectiveness at lower temperatures. Overall, the identification of Acinetobacter, a cold-adapted bacterium, offers promising applications in bioremediation, enzyme production, food preservation, pharmaceutical development, and astrobiology. Further research and exploration of these microorganisms can unlock their full biotechnological potential and contribute to various industries and scientific endeavors., (© 2023. The Author(s), under exclusive licence to Springer Nature Japan KK, part of Springer Nature.)

This study focused on the exploration of microbial communities inhabiting extreme cold environments, such as the Passu and Pisan glaciers of Pakistan, and their potential utilization in industrial applications. Among the 25 initially screened strains, five were found to be suitable candidates for exopolysaccharide (EPS) production, with strain CUI-P1 displaying the highest yield of 7230.5 mg/L compared to the other four strains. The purified EPS from CUI-P1 was tested for its ability to protect probiotic bacteria and E. coli expressing green fluorescence protein (HriGFP) against extreme cold temperatures, and it exhibited excellent cryoprotectant and emulsification activity, highlighting its potential use in the biotechnological industry. Furthermore, the genome of Acinetobacter sp., CUI-P1 comprised 199 contigs, with a genome size of 10,493,143bp and a G + C content of 42%, and showed 98.197% nucleotide identity to the type genome of Acinetobacter baumannii ATCC 17978. These findings offer promising avenues for the application of EPS as a cryoprotectant, an essential tool in modern biotechnology.

Stroke-related disabilities can have a major negative effect on the economic well-being of the person. When left untreated, a stroke can be fatal. According to the findings of this study, people who have had strokes generally have abnormal biosignals. Patients will be able to obtain prompt therapy in this manner if they are carefully monitored; their biosignals will be precisely assessed and real-time analysis will be performed. On the contrary, most stroke diagnosis and prediction systems rely on image analysis technologies such as CT or MRI, which are not only expensive but also hard to use. In this study, we develop a machine learning algorithm for the prediction of stroke in the brain, and this prediction is carried out from the real-time samples of electromyography (EMG) data. The study uses synthetic samples for training the support vector machine (SVM) classifier and then the testing is conducted in real-time samples. To improve the accuracy of prediction, the samples are generated using the data augmentation principle, which supports training with vast data. The simulation is conducted to test the efficacy of the model, and the results show that the proposed classifier achieves a higher rate of classification accuracy than the existing methods. Furthermore, it is seen that the rate of precision, recall, and f -measure is higher in the proposed SVM than in other methods., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2022 R. Pitchai et al.)

Electroencephalography (EEG) is crucial for epilepsy detection; however, detecting abnormalities takes experience and knowledge. The electroencephalogram (EEG) is a technology that measures brain motion and represents the brain's function. EEG is an effective instrument for deciphering the brain's complicated activity. The information contained in the EEG signal pertains to the electric functioning of the brain. Neurologists have typically used direct visual inspection to detect epileptogenic abnormalities. This method is time-consuming, restricted by technical artifacts, produces varying findings depending on the reader's level of experience, and is ineffective at detecting irregularities. As a result, developing automated algorithms for detecting anomalies in EEGs associated with epilepsy is critical. The construction of a novel class of convolutional neural networks (CNNs) for detecting aberrant waveforms and sensors in epilepsy EEGs is described in this research. In this study, EEG signals are analyzed using a convolutional neural network (CNN). For the automatic detection of abnormal and normal EEG indications, a novel deep one-dimensional convolutional neural network (1D CNN) model is suggested in this paper. The regular, pre-ictal, and seizure categories are detected using this approach. The proposed model achieves an accuracy of 85.48% and a reduced categorization error rate of 14.5%., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this article., (Copyright © 2022 Thalakola Syamsundararao et al.)

Objective: This study investigated the prevalence of substance use (SU), and its risk factors, among women attending psychiatric outpatients center in Saudi Arabia., Design: A retrospective cross-sectional design., Materials and Methods: We reviewed outpatients' records of 200 female patients with a history of SU from a psychiatric unit in Jeddah, Saudi Arabia from December 2018 to February 2019. The researchers developed the pro forma , and 2 psychiatrists and a family medicine physician validated the form., Results: The most common and widely used were psychoactive substances (58%), followed by central nervous system (CNS) depressants (22%), and finally cannabinols (9.5%). Overall, the highest substance use was the amphetamine-cannabis-nicotine (ACN) representing nearly half of the illicit items (46.6%), followed by heroine-alcohol-benzodiazepine (16.4%), and with the lowest being benzodiazepine-nicotine (1.7%). There was a significant difference between the single substance and multiple substance use in terms of age ( p = 0.001), smoking behavior ( p = 0.001), patients past history ( p = 0.005), and age of the patient at the start of drug use ( p = 0.005)., Conclusion: Although the prevalence of substance use among women is low in Saudi Arabia, screening of substance use disorders risks and building a rehabilitation program to control drug dependence are needed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Alodhayani, Almutairi, Vinluan, Alonazi, Alzahrani, Batais, Kaki, Almigbal and Alsaad.)

All organisms contain antimicrobial peptides (AMPs), which are a critical component of the innate immune system. These chemicals have the ability to suppress the growth of a variety of fungi, bacteria, and viruses. Because AMPs interact with structural components of the microbial cell membrane and have a wide range of cellular targets, bacteria are unlikely to be able to develop resistance to them in the short term. The underlying structure of AMPs is critical in determining the selectivity with which they target their respective targets. As far as we know, peptides have not been tested in a lab to see if they can fight bacteria, fungus, and viruses in real life. In this paper, we develop an artificial neural network (ANN) using a back propagation neural network (BPNN) that enables optimal classification of tendency of a peptide sequence that involves the activities of antifungal, antibacterial, or antiviral. The BPNN is trained on the datasets collected across different repositories and then the overfitting is avoided using particle swarm optimization (PSO) algorithm. Hence, at the time of testing, the BPNN clearly finds the predicted samples belonging to the same classes and this avoids the problem of finding the false positives. The simulation is conducted to test the efficacy of the model against various metrics that includes accuracy, precision, recall, and f1-measure. The effectiveness of the BPNN-PSO model in classifying instances at a faster rate than other techniques is demonstrated by its performance. The principle is straightforward, it is not difficult to programme, it converges more quickly, and it generally offers a superior solution., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2022 M. Rajkumar et al.)

COVID-19 vaccines are crucial to control the pandemic and avoid COVID-19 severe infections. The rapid evolution of COVID-19 variants such as B.1.1.529 is alarming, especially with the gradual decrease in serum antibody levels in vaccinated individuals. Middle Eastern countries were less likely to accept the initial doses of vaccines. This study was directed to determine COVID-19 vaccine booster acceptance and its associated factors in the general population in the MENA region to attain public herd immunity. We conducted an online survey in five countries (Egypt, Iraq, Palestine, Saudi Arabia, and Sudan) in November and December 2021. The questionnaire included self-reported information about the vaccine type, side effects, fear level, and several demographic factors. Kruskal−Wallis ANOVA was used to associate the fear level with the type of COVID-19 vaccine. Logistic regression was performed to confirm the results and reported as odds ratios (ORs) and 95% confidence intervals. The final analysis included 3041 fully vaccinated participants. Overall, 60.2% of the respondents reported willingness to receive the COVID-19 booster dose, while 20.4% were hesitant. Safety uncertainties and opinions that the booster dose is not necessary were the primary reasons for refusing the booster dose. The willingness to receive the booster dose was in a triangular relationship with the side effects of first and second doses and the fear (p < 0.0001). Females, individuals with normal body mass index, history of COVID-19 infection, and influenza-unvaccinated individuals were significantly associated with declining the booster dose. Higher fear levels were observed in females, rural citizens, and chronic and immunosuppressed patients. Our results suggest that vaccine hesitancy and fear in several highlighted groups continue to be challenges for healthcare providers, necessitating public health intervention, prioritizing the need for targeted awareness campaigns, and facilitating the spread of evidence-based scientific communication.

In recent times, humans who have been exposed to influenza A viruses (IAV) may not become hostile. Despite the fact that KLRD1 has been discovered as an influenza susceptibility biomarker, it remains to be seen if pre-exposure host gene expression can predict flu symptoms. In this paper, we enable the examination of flu using deep neural networks from input human gene expression datasets with various subtype viruses. This study enables the utilization of these datasets to forecast the spread of flu and can provide the necessary steps to eradicate the flu. The simulation is conducted to test the efficiency of the model in predicting the spread against various input datasets. The results of the simulation show that the proposed method offers a better prediction ability of 2.98% more than other existing methods in finding the spread of flu., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 B. Tarakeswara Rao et al.)

Background: This study aimed to describe the demographic characteristics and determine the risk factors associated with disease severity and length of hospital and intensive care unit (ICU) stay in a cohort of COVID-19 patients admitted into ICU in Saudi Arabia., Methods: This was a national, multi-center, retrospective cross-sectional study of all COVID-19 cases admitted into different ICUs in Saudi Arabia between March 2020 and September 202l. Demographic, clinical features, comorbidities, and length of stay (LOS) data were retrieved from the national Health Electronic Surveillance Network (HESN) and Taqassi databases at the Saudi Ministry of Health (MOH) for subsequent analyses. We used multiple linear regression models to determine risk factors associated with critical outcomes (including LOS in ICU) among COVID-19 cases., Results: A total of 12,436 COVID-19 patients were included in this study, with a mean age of 59.57 ± 18.30 years and 7,679 (62%) were <65 years old. COVID-19 was more common in males ( N = 7,686, 61.9%) and Saudi nationals ( N = 8,516, 68.5%). The clinical characteristic findings showed that 36.3% of patients required invasive ventilation whilst 65.4% received tracheostomies for ventilation, and 4% were on dialysis. Our analysis revealed that 2,978 (23.9%) patients had one comorbidity, 4,977 (47.4%) had two or more comorbidities, and diabetes (48.2%) was the most prevalent comorbidity, followed by hypertension (44.2%), and chronic cardiovascular disease (10.5%). Thirteen variables emerged as significant predictors of LOS in ICU using multiple linear regression analyses, with invasive ventilation as the strongest predictor of LOS in the ICU (beta = -0.68, p = 0.001) and hospital admission (beta = -0.65, p = 0.001)., Conclusions: COVID-19 continues to affect millions of people around the world, with a mortality rate of about 2-3% of all infected patients. Our analysis revealed that comorbidities such as chronic kidney disease, cardiovascular disease, diabetes, and older age were significant risk factors associated with a poorer prognosis and longer duration of stay in hospitals and ICU., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Al-Otaiby, Almutairi, Vinluan, Al Seraihi, Alonazi, Qahtani, Aljeri, Alhumud, Alobaidi and Alhurishi.)

In this paper, we develop a detection module with strong training testing to develop a dense convolutional neural network model. The model is designed in such a way that it is trained with necessary features for optimal modelling of the cancer detection. The method involves preprocessing of computerized tomography (CT) images for optimal classification at the testing stages. A 10-fold cross-validation is conducted to test the reliability of the model for cancer detection. The experimental validation is conducted in python to validate the effectiveness of the model. The result shows that the model offers robust detection of cancer instances that novel approaches on large image datasets. The simulation result shows that the proposed method provides analyzes with 94% accuracy than other methods. Also, it helps to reduce the detection errors while classifying the cancer instances than other methods the several existing methods., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2022 S. V. N. Sreenivasu et al.)

Dengue fever modelling in endemic locations is critical to reducing outbreaks and improving vector-borne illness control. Early projections of dengue are a crucial tool for disease control because of the unavailability of treatments and universal vaccination. Neural networks have made significant contributions to public health in a variety of ways. In this paper, we develop a deep learning modelling using random forest (RF) that helps extract the features of the dengue fever from the text datasets. The proposed modelling involves the data collection, preprocessing of the input texts, and feature extraction. The extracted features are studied to test how well the feature extraction using RF is effective on dengue datasets. The simulation result shows that the proposed method achieves higher degree of accuracy that offers an improvement of more than 12% than the existing methods in extracting the features from the input datasets than the other feature extraction methods. Further, the study reduces the errors associated with feature extraction that is 10% lesser than the other existing methods, and this shows the efficacy of the model., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2022 Jackson Daniel et al.)

Healthcare systems are increasingly required to utilize effective approaches, apply evidence-based practice, and consequently sustain successful strategic management. Document analysis provides insights into the effective management tools applied by agencies to respond to crises. This article provides a practical exploration of how the Saudi health authority applied effective measures to eventually reduce the administrative and clinical consequences while managing the COVID-19 pandemic. The conceptual descriptive framework was based on health policy triangle of Walt and Gilson. Official reports and supporting documents issued by the Saudi government toward COVID-19 were operationally analyzed. Moreover, five healthcare professional experts were invited in a semistructured interview to assess the strategic steps that have been utilized to minimize the health risk by conducting a healthcare risk analysis. Various documents showed that two major entities were responsible for managing regulations and medications of COVID-19 in addition to six other entities that were partially involved. Although each entity was approved to work independently, their efforts were cohesively associated with each other. Most documents were well-applied on personal, social, organizational, and national strata. However, it is unclear how lessons identified became affirmative, while the collaboration remains vague, especially under the emergence of a new entity such as the Public Health Authority. Healthcare professional experts also positively supported the effectiveness of such policies to confront COVID-19 through the following three domains: health guidelines, utilizing simulation (telehealth/telecommunication) services, and ensuring continuity of services., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Alonazi and Altuwaijri.)

Clean technology-based natural fiber composite fabrication is the prime aim of this piece of research. Natural fibers highly replace metal usage in industries and automobile, marine, medical applications, and so on. Vast amounts of natural fibers are freely available in all areas. In this research, work nanofiller material such as nano form waste coir fiber is collected from used car seat. The 10 wt.% of nanofiller material is added to the preparation of natural nanocomposites (ramie and abaca fiber). Hybrid composites are fabricated with the influence of different process parameters, namely, fiber weight percentage (20 wt.%, 30 wt.%, 40 wt.%, and 50 wt.%), NaOH action % (4%, 6%, 8%, and 10%), compression pressure (9 MPa, 12 MPa, 15 MPa, and 18 MPa), and temperature (100°C, 120°C, 140°C, and 160°C). Furthermore, the strength of this hybrid composite has analyzed by conducting flexural, impact, and shore hardness tests. These tests have provided the influence of selected parameters and their effects on the results of experimental work. In the flexural analysis, 6% of NaOH action has offered maximum flexural strength of the specimens. Correspondingly in the impact test, 30 wt.% of fiber is produced higher impact strength. Finally, applying 15 Mpa of compression pressure records the maximum shore hardness., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this article., (Copyright © 2022 T. Sathish et al.)

Objective: To compare gender differences in pain management among adult cancer patients in Saudi Arabia and to explore the predictors associated with attitudinal barriers of cancer patients to pain management., Methods: A descriptive cross-sectional study was conducted among 325 cancer patients from tertiary hospitals in Saudi Arabia., Result: Of the total participants, 67.4% were women ( N = 219) and 32.6% were men ( N = 106). The overall mean scores of the attitudinal barriers questionnaire were 49.51 ± 13.73 in men and 54.80 ± 22.53 in women. The analysis shows significant differences in scores in subscales of tolerance (men = 7.48 ± 2.37), (women = 8.41 ± 3.01) ( p = 0.003) and fear of distraction in the course of treatment (men = 6.55 ± 1.34), and (women = 7.15 ± 2.63) ( p = 0.008). Female patients reported a more moderate to severe level of pain than men (worst pain in last week of 7.07 ± 1.50, worst pain in last week of 5.84 ± 2.65, respectively). Splitting by gender, the significant predictor for physiology effect domains in male cancer patients includes age, marital status, employment status, monthly income, cancer type, and presence of comorbid disease ( p < 0.050). Age was a significant predictor of the domains of fatalism, communication, and harmful effects ( p < 0.050) among female cancer patients., Conclusion: The present study revealed significant differences between men and women with attitudinal barriers to cancer pain management. Managing pain requires the involvement of all methods in a comprehensive manner, thus unalleviated pain influences the patient's psychological or cognitive aspect., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Alodhayani, Almutairi, Vinluan, Alsadhan, Almigbal, Alonazi and Batais.)

Background: The Capability Assessment for Diet and Activity (CADA) is a questionnaire that was developed in English and designed to measure the practical barriers and opportunities for diet and physical activity., Objective: This study aimed to translate, culturally adapt, and validate the CADA questionnaire for the Arabic context in a sample of Saudi women employed at a university., Methods: The CADA was translated into Arabic using the forward and backward translation process. The Arabic version was then validated with a sample of 125 female Saudi participants. In order to evaluate the psychometric properties of the Arabic version, Spearman's rank correlation coefficient was assessed, and a principal component analysis was performed., Results: The translated CADA had good psychometric quality. The content validity analysis revealed a representativeness score of 99.3% and a degree of clarity of 98.6%, indicating excellent compatibility. The principal component analysis showed a single-factor structure., Conclusions: The Arabic version of the CADA questionnaire is now available to assess opportunities to achieve a healthy diet and physical activity level as part of health behavior management, which can lead to more effective interventions for improving people's health in Arabic-speaking countries.

Background: Hospitals and healthcare institutions should be observant of the ever-changing environment and be adaptive to learning practices. By adopting the steps and other components of organizational learning, healthcare institutions can convert themselves into learning organizations and ultimately strengthen the overall healthcare system of the country. The present study aimed to examine the influence of several organizational learning dimensions on organization culture in healthcare settings during the COVID-19 outbreak., Methods: During COVID-19 crisis in 2020, an online cross-sectional study was performed. Data were collected via official emails sent to 1500 healthcare professionals working in front line at four sets of hospitals in Saudi Arabia. Basic descriptive analysis was constructed to identify the variation between the four healthcare organizations. A multiple regression was employed to explore how hospitals can adopt learning process during pandemics, incorporating several Dimensions of Learning Organizations Questionnaire (DLOQ) developed by Marsick and Watkins (2003) and Leufvén and others (2015)., Results: Organizational learning including system connections (M = 3.745), embedded systems (M = 3.732), and team work and collaborations (M = 3.724) tended to have major significant relationships with building effective learning organization culture. Staff empowerment, dialogues and inquiry, internal learning culture, and continuous learning had the lowest effect on building health organization culture (M = 3.680, M = 3.3.679, M = 3.673, M = 3.663, respectively). A multiple linear regression was run to predict learning organization based on the several variables. These variables statistically significantly predicted learning organization, F (6, 1124) = 168.730, p < .0005, R 2  = 0.471, (p < .05)., Discussion: The findings concluded that although intrinsic factors like staff empowerment, dialogues and inquiry, and internal learning culture, revealed central roles, still the most crucial factors toward the development of learning organization culture were extrinsic ones including connections, embed system and collaborations., Conclusions: Until knowledge-sharing is embedded in health organizational systems; organizations may not maintain a high level of learning during crisis.

Objective: In this cross-sectional study, we aimed to determine the association of self-care management practices and glycemic control of type 2 diabetes mellitus in Saudi Arabia., Methods: A total of 352 type 2 diabetes mellitus (T2DM) patients from two public tertiary hospitals in Saudi Arabia participated in this study. All T2DM patients were recruited and interviewed by a researcher between January to April 2018 from the outpatient diabetes clinics. All respondents answered a four-part questionnaire which includes demographics data, Diabetes Self-Management Questionnaire (DSMQ). Linear Regression was performed to assess the significance of predictors and compute the coefficient of determination., Results: The mean age of the participants was 51.89 ± 10.94. Of the 352 participants, 52% were obese (BMI: ≥30 kgm 2 ) and 77% of the participants had glycated haemoglobin (HbA1c) over 7%. The analysis showed that subscale of Glucose management was the strongest predictor of Hba1c levels of participants' followed by physical activity. Gender and marital status emerged as significant predictors for their self-care management practices. Female patients had more self-care management practices than male patients (B 0.20; 95CI 0.10- 0.96 (p = 0.015)., Conclusion: This study provides an evidence on the self-care management of T2DM patients in Saudi Arabia. The high self-care management found in the study highlights that the patients are aware of the severity of and possible complications associated with T2DM., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author(s).)

Background: Creating a holistic approach in healthcare services is the ultimate aim for the integrated healthcare system. Theoretically, healthcare policy makers constantly expected optimal operations within the hospitals through capitalizing the maximum potential of healthcare expertise, professionals, practitioners, and supporting staff. The objective of this study is to explore the role of healthcare individuals to sustain effective palliative care programs in a safe environment with high-quality of care. Methods: This study employed a mixed method (qualitative and quantitative) to accomplish the set objective. For this purpose, a balanced sampling technique was adopted and 28 healthcare professionals were selected in two stages (last week of January and the 1st week of February, 2020). These respondents were playing significant role in palliative care policy making process. In the first stage, respondents were classified into three parallel groups to document the major factors affecting palliative care reforms. To minimize the chance of individual biases, each group was supervised by an independent healthcare professional who was not involved in the study. Then, in the second stage, respondents were divided into two clusters for further abstraction of themes to analysis the data. In this phase, each group was comprised on 14 individuals. Data were transcribed, coded, and analyzed (subjectively and objectively) by using NVivo 12 to extract the final themes. These themes were described and analyzed quantitatively for further catchphrases abstraction to identify significant components. Findings: The initial results incorporated 36 key factors in building effective and sustained palliative healthcare centers. The domains were feasible and practical as they homogeneously patterned within cultural change. These were quality of care, effective management, institute of medicine criteria, and health governance. The Spearman correlation matrix showed significant relationships between the four critical components ( P < 0.01 and P < 0.05). Conclusions: This study explored and identified the significant factors that healthcare professional might consider to make their role more productive and effective in palliative care centers. The key findings also indicated the need of comprehensive periodic assessment especially from the perspective of managerial implications and quality of care., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Alonazi.)

Objective: This study aims to identify the prevalence of aspirin use among type 2 diabetic (T2DM) patients and assess the concordance in aspirin use among these patients as prescribed by physicians and as recommended by the Aspirin-Guide app., Methods: A total of 301 T2DM patients from King Khalid University Hospital in Riyadh, Saudi Arabia participated in this cross-sectional study. Patient's electronic medical records through eSihi system were reviewed and all data included in the free online and mobile app called Aspirin-Guide were collected in a specially designed data checklist., Result: The prevalence of aspirin use was more common in patients who were in the age group of 51 to 59 and male participants' with T2DM. Males were nearly twice more likely to use aspirin compared to females ( P = 0.001). Based on recommendations from the Aspirin-Guide app, 26% of the patients who were on aspirin (N = 51) were not eligible for aspirin therapy, while 37.7% (N = 40) of the patients eligible for aspirin therapy had not been put on aspirin by their physicians ( P = 0.039). Male sex ( P = 0.003), use of statins ( P = 0.001), and being advised to use aspirin ( P = 0.041), were significantly associated with aspirin use in T2DM patients., Conclusion: There was a significant difference in the proportion of patients currently on aspirin as prescribed by their physicians and those eligible for aspirin therapy as per the Aspirin-Guide app. The use of an app to uniformized aspirin use among eligible patients should be based on up-to-date guidelines and account for patient acceptability and willingness to commence treatment.

In the insurance industry, the majority of fraud and abuse cases fall into a limited number of patterns, yet false claims normally lead to negative national, local, and organizational effects. Through monitoring the exploitative and abusive behavior commonly found in healthcare services, this paper aims to analyze initiatives implemented by governmental and related healthcare insurance agencies in Saudi Arabia to reduce moral offenses. To accomplish this objective, major governmental health insurance policy documents were analyzed at the macro-level. At the meso-level, semi-structured interviews were conducted with five health insurance professionals on measures undertaken to prevent such incidents. At the micro-level, the critical factors of fraudulent behaviors were analyzed using a retrospective analysis. Data were retrieved from anti-fraud records of ten leading health insurance companies and the focus was mainly on individuals involved in unethical practices between 2014 and 2019. After a full audit was completed, the results concluded that the Saudi healthcare system is composed of twenty-six cooperative health insurance agencies and over 5,202 health services providers. The official documents contain the details of various moral hazard measures. On annual average, more than 196 fraudulent cases were reported with a claim rejection rate of approximately 15%. The majority of fraud cases were reported in dental services with invalid card usage, followed by obstetrics-gynecology services (47 and 113 cases, respectively). Females tended to make up most deceit cases in obstetrics-gynecology with a high level of abuse (95% confidence interval: -83.398 to -24.202; P  < .003 and -28 > 638 to -7.362; P  < .005, respectively). This study ultimately identifies basic measures employed at the macro-level to reduce moral hazards. However, such measures are not intended to be coherently implemented at the micro-level, especially by health insurance companies and healthcare providers.

Objectives: To determine the association between sociodemographic, clinical, and health literacy and the presence of depressed mood and their relationships  to diabetes self-management among type 2 diabetes mellitus (T2DM) patients in Saudi Arabia., Methods: A total of 352 T2DM patients from 2 public tertiary hospitals in Saudi Arabia participated in this descriptive cross-sectional study between December 2016 and February 2017. All respondents answered a 4-part questionnaire, which includes demographic data, Diabetes Self-Management Questionnaire (DSMQ), 36-item test based Short Test of Functional Health Literacy in Adults, and a 2-item Patient Health Questionnaire (PHQ-2). The Chi-square test and logistic regression analysis were conducted to determine the relationship and significant predictors for self-management among T2DM patients. Results: The analysis showed that majority of the participants had low to marginal functional health literacy. The overall DSM-16 score was good, indicating more effective self-care, while 20% of the participants had a score of 2 or more in the PHQ-2 indicating presence of depressed mood.  No significant association was found between DSM and health literacy among the study participants while age, gender, educational level, employment status, and level of the depressive symptom were significantly associated with differences in the level of functional literacy of the participants. Conclusion: The study shows that nearly half of the T2DM patients that exhibited low level of functional health literacy had low diabetes self-management.  Our findings also show that gender significantly affects diabetes self-management in which odds are a lot higher among females than males with diabetes self-management. This study underscores the importance of proper counselling and education about diabetes control on both patients and family members.

Background: College is a critical time where students are more prone to engage in risky health behaviors known to negatively affect well-being, such as physical inactivity, stress, and poor dietary habits. A health promoting lifestyle is an important determinant of health status and is recognized as a major factor for the maintenance and improvement of health. This study was designed to assess the health-promoting lifestyle of students in health colleges and non-health colleges in Saudi Arabia., Methods: A total of 1656 students participated in this descriptive cross-sectional study. Data gathering was conducted from November 2016 to February 2017 at King Saud University. Participating students completed a self-reported questionnaire that included questions regarding their demographic characteristics and their health-promoting behaviors., Results: The majority of participants were females (70.4%), 20% of the participants were overweight and 11.3%, were obese. The analysis showed that there was a significant difference between health colleges and non-health colleges with regards to the factor of health responsibility. Students at both schools were found to have an inadequate level of adherence to recommendations regarding physical activity and healthy eating habits. The analysis also found that majority of the students in both colleges do not attend educational programs on health care. The model shows that gender, type of college, year in school, and family structure were significant predictors of the health lifestyle of students in Saudi Arabia., Conclusion: The results of the current study indicate that university students are leading unhealthy lives, where the majority of them have unhealthy eating habits and poor physical activity level. Universities are ideal settings for implementing health promotion programs. Therefore, planning and implementing programs to motivate students to be more responsible for their own health, to engage more in physical activity, and to practice healthy eating habits and other forms of wellness are of paramount importance.

This study aims to explore the association between functional health literacy and awareness for, beliefs, and attitudes of patients with colorectal cancer (CRC) and CRC screening test in Riyadh, Saudi Arabia. A total of 256 participants from two different tertiary level hospitals in Riyadh, Saudi Arabia were recruited in this study. The participants were interviewed by a trained researcher between October and December 2015. All respondents answered a three-part questionnaire which included demographic data, questions related to CRC awareness, attitude, behaviour, and short Test of Functional Health Literacy in Adults (STOFHLA). More than half of the participants had an inadequate awareness of functional health literacy skills (FHLS), 16.4 % had marginal of FHLS awareness and 17.6 % had adequate awareness about FHLS as assessed by the STOFHLA. Overall, the majority of the participants in both marginal and adequate aware groups showed a limited awareness about colorectal cancer screening and testing. A significant association was found on awareness of the patients about frequencies that they should have been tested for colorectal cancer and functional health literacy. No significant association was found between functional health literacy as assessed by STOFHLA and concerns of Faecal Occult Blood Test (FOBT) (p = 0.384) and sigmoidoscopy or colonoscopy might cause embarrassment (p = 0.089), harm (p = 0.917), and pain (p = 0.849). The present study revealed a low level of health literacy among Saudi adults in Riyadh region. Although the level of literacy was low, the bigger concern is that of the poor awareness and beliefs of Saudi adults about CRC and CRC screening.

Background: The natural assimilation of the process through which health partners sustain long-term relationships is a key issue in maintaining social well-being, reducing health risk factors, and sustaining public health programs. One global initiative in building effective healthcare systems is public-private partnerships (PPPs). This study elucidates the proposed key performance indicators initiated by the Ministry of Health of Saudi Arabia based on the projections of the government, known as Vision 2030, from the perspective of health risk factors., Methods: Through an inductive content analysis, this study assessed primary and secondary data in relation to the Saudi National Transformation Program (NTP). To identify the institutions that played a role in formulating the new Saudi Healthcare System, health policies, regulations, and reports published between 1996 and 2016 were categorized. After ranking the risk factors, the investigator selected 13 healthcare professionals in four focus group interviews to insightfully explore the challenges that the NTP faces from a health risk perspective. Thus, the study employed qualitative data gathered through focus group interviews with key figures as well as data extracted from written sources to identify distinct but interrelated partnerships practiced within risk management., Results: A methodological overview of NTP priority and implementation offered practical guidance in the healthcare context. The five critical factors in maintaining successful and sustainable PPPs were (1) trustworthiness, (2) technological capability, (3) patient-centeredness, (4) competence, and (5) flexibility. Concession on primary and secondary healthcare services might be a good option based on the literature review and considering its popularity in other countries. A high outcome-based risk of PPPs was found as the most commonly shared perspective in risk management., Conclusions: Although the impact of the NTP rise has yet to be explored, its potential for challenging health consequences requires consideration and substantial regulatory action. This study contributes to the emerging critical analysis on local health initiatives by highlighting how integration may only be possible with a more radical conceptualization of national health governance.

This study aims to determine the factors that act as barriers to Saudi cancer patients in participating in a clinical trial (CT). A total of 244 patients from two different tertiary level hospitals (King Khalid University Hospital and King Fahad Medical City Hospital) in Riyadh, Saudi Arabia, participated in this cross-sectional study. The participants were interviewed by a trained researcher between September and November 2015. All respondents answered a three-part questionnaire which includes demographics, clinical information, and questions related to awareness of CTs, willingness to participate, and factors affecting participation in CTs. The mean age of the participants was 50.83, and 57 % of the participants were females. Most of the participants (63.5 %) were currently being treated for cancer, and 28 % were diagnosed with breast cancer followed by colorectal cancer. Health status or quality of life was self-reported as acceptable by 27.9 % of the participants, and 25 % of the participants at stage II of cancer. The factors that act as barriers to Saudi cancer patients in participating in a CT can be categorized into patient- and physician-related factors. Patient factors include lack of awareness, misconception and fear in participating in CTs; physician-related factors comprise of lack of encouragement from physician to patients in participating in a CT. The study identified few major barriers to participation in CTs. Increased patient awareness and recruitment strategies are required to increase accrual of patients including training for physicians and disseminating easy-to-read tools to the public.

A descriptive cross-sectional survey was conducted over 5 months in two tertiary hospitals in Riyadh, Saudi Arabia. The 5-month period was from November 2014 to March 2015. The survey instrument used was a Short-Form Health Survey SF-36 (the RAND 36-item) questionnaire that measure QOL of the caregivers. Our study subjects included 289 randomly selected Saudi caregivers. Almost all the mean scores were increased (higher than 50) with the exception of levels of energy/fatigue. Role functioning/physical scored the highest (81.02 ± 35.33) followed by physical functioning (76.34 ± 29.83). Other domains of QOL scored (71.02 ± 35.33) for the role functioning/emotional; pain (71.15 ± 28.48), emotional well-being (60.58 ± 18.44); social functioning (58.39 ± 25.83), and general health (54.32 ± 17.08). In multivariate regression analysis, the model predicts that the contributions of age, gender, and the cancer type of patients were a statistically significant predictor with the QOL domains of caregivers. Cancer caregivers in Saudi Arabia caring for patients more than 1 year after diagnosis reported favorable QOL. Factors associated with QOL domains included age, gender of the caregivers, and the types of cancer patients. These findings are encouraging as a baseline for providing more information to future studies in QOL of caregivers.

Aim: To compare patients' assessment of quality of care provided by public tertiary hospitals grouped according to accreditation status., Background: Healthcare institutions worldwide are increasingly adopting accreditation as continuing initiative aimed at improving structures, processes and outcomes associated with quality of care. Patients being recipients of health care need to participate in assessing the quality of care they experienced while confined for therapeutic management., Design: Comparative, cross-sectional., Method: Data were collected from patients confined in public tertiary hospitals (n = 517 in four with accreditation and n = 542 in four without accreditation) in Riyadh, Saudi Arabia between February 2011-June 2011. Patients rated key performance indicators grouped under the dimensions of structure, process and outcome. Mann-Whitney U-test, Spearman Correlation Coefficient and coefficient of determination were used in analysing data., Results: Patients in accredited public tertiary hospitals perceived structure, outcome and overall quality of care statistically higher than patients in non-accredited hospitals. No statistical differences were found in process (access and communication) indicators. Accreditation status is marginally associated with structure; outcome; and overall quality of care. The proportion of variance in the ranks of accreditation status explained the proportion of variance in the ranks of structure; outcome; and overall quality of care., Conclusion: The results apparently showed better structure, outcome and overall quality of care in accredited hospitals. Accreditation's association in the overall quality of care apparently remained unclear. Further studies are needed to appreciate the contribution of accreditation., (© 2016 John Wiley & Sons Ltd.)

Background: Owing to a scarcity of data or other causes, patient research on the orphan population is lacking in most societies. Consequently, the primary goal of this study was to explore quality of life (QOL) and quality of care (QOC) among orphan patients (OPs) receiving tertiary healthcare services in Saudi Arabia (SA)., Method: This study used a cross-sectional, quantitative survey design. Participants included 216 OPs either currently undergoing or who had undergone treatment for common chronic diseases (CDs) (e.g. cardiovascular disease, cancer, stroke and arthritis) during the past 12 months. The survey utilised the brief form from the World Health Organization Quality of Life (WHOQOL-BREF) tool and evaluated healthcare access and effectiveness domains to scrutinise the socio-medical patterns of OPs based on their current medical episodes., Results: The descriptive analysis indicated that OPs' overall QOL reached a moderate level (M = 3.90). Similarly, participants reported relatively high levels of healthcare access and treatment effectiveness (M = 4.14 and M = 4.29, respectively). Stroke patients reported the highest QOL score (M = 3.95), and groups of patients with other CDs reported greater access to healthcare and more effective treatment maintenance compared to the other groups (M = 4.19 and M = 4.43, respectively). Regression analysis was conducted to predict overall QOL based on perceived QOC, and access explained only 6.5 % of the variance. An analysis of variance showed significant differences only between OPs with cardiovascular disease and cancer (P = .001), with the former reporting better access to tertiary healthcare services than the latter., Conclusions: Although some CD patients reported relatively acceptable levels of access to healthcare and receipt of effective treatment, the improvement of OPs' QOL and QOC poses a serious challenge for health policymakers.

This study was conducted to assess the level of health awareness (HA) among students attending three undergraduate programs in the Colleges of Applied Medical Sciences (CAMS) in Riyadh, Saudi Arabia (SA). A modified self-reported survey was utilized to measure HA demonstrating four domains: Nutrition (NU), Personal Health (PH), Physical Exercise (PE), and Body Build (BB). The questionnaire was distributed to 302 female students attending the first semester of the academic year 2014-2015 BS degree in Radiology Sciences (RS), Clinical Laboratory (CL), and Health Education (HE) departments. Bloom's taxonomy was utilized to describe the three cognitive levels. Synthesizing, creating, and evaluating were grouped to represent high level indicators; applying cognitive skills only revealed an intermediate level; while memorizing and listing demonstrated low levels. In a 5-point Likert scale, the overall mean (M) of HA among CAMS students was 3.82 with the highest among students attending HE (M = 3.89). The domain of PH ranked first with a high average (M = 4.30). There were significant differences (α = 0.05), in the level of HA in PH and BB domains, among students in terms of program specialty only, but no such significant differences were found for other characteristics. The study recommended incorporating health promotion concepts within teaching curricula and conducting health and education campaigns by health education institutions.

The aim of this study was to explore the impact of quality of care (QoC) on patients' quality of life (QoL). In a cross-sectional study, two domains of QoC and the World Health Organization Quality of Life-Bref questionnaire were combined to collect data from 1,059 pre-discharge patients in four accredited hospitals (ACCHs) and four non-accredited hospitals (NACCHs) in Saudi Arabia. Health and well-being are often restricted to the characterization of sensory qualities in certain settings such as unrestricted access to healthcare, effective treatment, and social welfare. The patients admitted to tertiary health care facilities are generally able to present themselves with a holistic approach as to how they experience the impact of health policy. The statistical results indicated that patients reported a very limited correlation between QoC and QoL in both settings. The model established a positive, but ultimately weak and insignificant, association between QoC (access and effective treatment) and QoL (r = 0.349, P = 0.000; r = 0.161, P = 0.000, respectively). Even though the two settings are theoretically different in terms of being able to conceptualize, adopt, and implement QoC, the outcomes from both settings demonstrated insignificant relationships with QoL as the results were quite similar. Though modern medicine has substantially improved QoL around the world, this paper proposes that health accreditation has a very limited impact on improving QoL. This paper raises awareness of this topic with multiple healthcare professionals who are interested in correlating QoC and QoL. Hopefully, it will stimulate further research from other professional groups that have new and different perspectives. Addressing a transitional health care system that is in the process of endorsing accreditation, investigating the experience of tertiary cases, and analyzing deviated data may limit the generalization of this study. Global interest in applying public health policy underlines the impact of such process on patients' outcomes. As QoC accreditation does not automatically produce improved QoL outcomes, the proposed study encourages further investigation of the value of health accreditation on personal and social well-being.