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BackgroundAnesthesia providers face numerous occupational hazards, including exposure to anesthesia gases, which can lead to fatigue. These professionals face challenges such as night shifts, OR stress, limited mobility and sunlight access, high workload, inadequate rest breaks. Health-related sociodemographic variables, such as smoking, sleep patterns, and obesity. Our research aims to explore various risk factors associated with fatigue among operating theatre workers including sleep quality.MethodsA cross-sectional study was conducted on 227 of operating room healthcare professionals from five tertiary hospitals in Saudi Arabia, for a period of 6 months, between January 1, 2023 to June 1, 2023. The study used a five-point Likert scale sheet and the FSS “fatigue severity scale” to analyze and measure fatigue and sleep quality. The questionnaire included all socio-demographic variables, work conditions, and fatigue severity scale items.ResultsThe major findings revealed a significant correlation between fatigue severity scores and exposure to anesthesia gases. Socio-demographic variables such as smoking have showed major relevance to fatigue in the sample size, as (76.6%) of the participants that answered as regular smokers have showed result of positive correlation to fatigue and with a significant of (0.034). Out of the total sample, 76.1% were exposed to anesthesia gases once daily, showing a positive association with fatigue severity scores. Work-related factors like job experience and position also had a lower association with fatigue severity. p (0.031) Univariate logistic regression p (0.035).ConclusionThe study found that the work-related conditions like workload on Anesthesia technicians and technologists over 44 h per week and gas exposure is directly linked to fatigue severity and sleep quality so is the socio-demographic considerations. With poor sleep quality in younger staff which is documented in the study result a large-scale prospective analysis to understand the factors affecting OR staff’s sleep quality and fatigue severity and what can be done to regulate working hours and break time and incorporate naps in to enhance patient safety and well-being for anesthesia providers in Saudi Arabia.

Background and Objectives: Hepatocellular carcinoma (HCC) is a prevalent form of malignancy that is characterized by high mortality rates and prognosis that remain suboptimal, largely due to treatment resistance mechanisms. Recent studies have implicated cancer stem cells (CSCs), particularly those expressing epithelial cell adhesion molecule (EpCAM), in HCC progression and resistance. In the present study, we sought to assess EpCAM expression in HCC patients and its correlation with various clinicopathological parameters. Materials and Methods: Tissue samples from 42 HCC patients were subjected to immunohistochemical staining to evaluate EpCAM expression. Clinicopathological data were obtained including the size, grade and stage of tumors, vascular invasion status, alpha-fetoprotein levels, and cirrhosis status. The Chi square and Fisher’s exact tests were employed to assess the association between categorical groups. Independent Student-t test or Mann–Whitney U test was used to investigate the association between continuous patient characteristics and survival. Results: Immunohistochemical analysis revealed EpCAM expression in 52.5% of HCC cases. EpCAM-positive tumors exhibited characteristics indicative of aggressive disease, including larger tumor sizes (p = 0.006), greater tumor multiplicity (p = 0.004), higher grades (p = 0.002), more advanced stages (p = 0.003), vascular invasion (p = 0.023), elevated alpha-fetoprotein levels (p = 0.013), and cirrhosis (p = 0.052). Survival analysis demonstrated that EpCAM expression was significantly associated with lower overall rates of survival and higher rates of recurrence in HCC patients. Conclusions: Our findings suggest that EpCAM expression may serve as a prognostic biomarker for HCC with a potential role in patient management. Targeting EpCAM-positive CSCs may represent a promising approach to overcome treatment resistance and improve clinical outcomes in HCC. However, further investigation into the molecular mechanisms underlying EpCAM’s role in HCC progression is warranted to facilitate the development of personalized therapeutic interventions.

Idiopathic Sudden Sensorineural Hearing Loss(ISSNHL) is a an irritating problem that continues to pose a diagnostic and therapeutic enigma for the otologist. It is most commonly defined as sensorineural hearing loss of 30dB or greater over at least three contiguous audiometric frequencies occurring within a 72-hr period. It is not one of the more common causes of HL, disproportionate interest in ISSNHL exists most likely because it is one of the few reversible (sensorineural) hearing losses encountered by clinicians. Intratympanic steroid injection is increasingly used in the management of ISSNHL as it offers the potential for directed therapy of a high concentration to the inner ear with avoidance of systemic side effects. It also can improve hearing function in patients with ISSNHL after the failure of systemic steroid treatment.

Background and Objectives: Hepatocellular carcinoma (HCC) is a prevalent form of malignancy that is characterized by high mortality rates and prognosis that remain suboptimal, largely due to treatment resistance mechanisms. Recent studies have implicated cancer stem cells (CSCs), particularly those expressing epithelial cell adhesion molecule (EpCAM), in HCC progression and resistance. In the present study, we sought to assess EpCAM expression in HCC patients and its correlation with various clinicopathological parameters. Materials and Methods: Tissue samples from 42 HCC patients were subjected to immunohistochemical staining to evaluate EpCAM expression. Clinicopathological data were obtained including the size, grade and stage of tumors, vascular invasion status, alpha-fetoprotein levels, and cirrhosis status. The Chi square and Fisher's exact tests were employed to assess the association between categorical groups. Independent Student-t test or Mann–Whitney U test was used to investigate the association between continuous patient characteristics and survival. Results: Immunohistochemical analysis revealed EpCAM expression in 52.5% of HCC cases. EpCAM-positive tumors exhibited characteristics indicative of aggressive disease, including larger tumor sizes (p = 0.006), greater tumor multiplicity (p = 0.004), higher grades (p = 0.002), more advanced stages (p = 0.003), vascular invasion (p = 0.023), elevated alpha-fetoprotein levels (p = 0.013), and cirrhosis (p = 0.052). Survival analysis demonstrated that EpCAM expression was significantly associated with lower overall rates of survival and higher rates of recurrence in HCC patients. Conclusions: Our findings suggest that EpCAM expression may serve as a prognostic biomarker for HCC with a potential role in patient management. Targeting EpCAM-positive CSCs may represent a promising approach to overcome treatment resistance and improve clinical outcomes in HCC. However, further investigation into the molecular mechanisms underlying EpCAM's role in HCC progression is warranted to facilitate the development of personalized therapeutic interventions. [ABSTRACT FROM AUTHOR]

This study aims to examine and describe the integration of the psychological approach of transpersonal theory in Islamic education. The method used in this research is the Library Research method using documentation as a data collection method and analyzing it with Content Analysis. The results show that transpersonal psychology integrates psychological concepts, theories, and methods with material and practice from individual subjects' spiritual disciplines. Its application in Islamic education, peace of mind, and faith is the basis for carrying out learning activities well. So, if it is associated with religion, humans will have a peaceful soul if they have strong, firm, and true faith and always remember Allah. So it can be concluded that the psychological approach of transpersonal theory directs the achievement of education by focusing on happiness and peace of mind, maximizing the potential of reason by contemplating and relying on God for the results or outputs of the educational process.

Background: Total antioxidant capacity (TAC) is one of the biomarkers to determine a person's health condition through antioxidant and oxidant activity or oxidative stress so that it can help in determining the therapy needed. However, currently, TAC levels in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) and non-hemodialysis (non-HD) are still controversial, so further research is needed. Objective: To analyze the comparison of TAC in HD and non-HD CKD patient. Materials and Methods: This was an analytical cross-sectional study with clinical observation in CKD patient. A total of 71 CKD patients consisting of 28 CKD HD patients and 43 non-HD CKD patients were enrolled in this study. Data about the characteristics of the subjects were taken using the anamnesis method, while data about TAC were taken using the colorimetric method with COBAS C-501 0837-19 series and 0835-13 series to measure TAC levels in the serum of CKD patients. The data that has been obtained were analyzed using independent sample t-tests. Results: TAC levels were significantly higher in CKD patients undergoing HD compared to non-HD CKD patients (p

This study aims to measure the effectiveness of the use of assessment learning media based on online games which is Kahoot to improve student learning outcomes. This study uses a quantitative approach with the quasi experiment method. The number of samples in each group is 30 people. The results shows that Kahoot can be an alternative interactive learning media in higher education because it is proven to significantly improve student learning outcomes with F (1.58) = 0.001, p

Environmental care behavior can change the environment that is initially dry to be beautiful full of lush plants that thrive and a sense of comfort for schools and school residents. While these subjects have four pillars, namely: Fiqh, Ski, Al-Qur'an Hadist, and Akidah Akhlaq, which are muttering to each other. The school has also successfully integrated formal lessons with environmental education materials. From the description above, the authors formulated the focus of the study as follows: How the values of caring, implementation, inhibiting and supporting factors in the process of growing values of environmental concern in middle school. A. Wahid Hasyim. The research uses a case study qualitative research. Data collection techniques using observation, interviews, and documentation. For data analysis techniques using: data reduction, data display, data verification. To check the validity of the data by: (1) credibility: a. extension of participation, b. perseverance of observation, c. triangulation, d. Negative Case Analysis, e. Using reference material, f. using member check, (2) transferability, (3) dependability, (4) confirmation. The results showed that: The value of environmental care in AWH Middle School was applied both in theory and practice, while for constraints was financing and the formation of new personalities, for supporters in this case the participation of all school members in maintaining cleanliness.

Competing Interests: Funding Support and Author Disclosures Dr Wood is a consultant for Edwards Lifesciences and Abbott; and has received research funding from Edwards Lifesciences and Abbott. Dr Leipsic is supported by a Canadian Research Chair in Advanced Cardiopulmonary Imaging; is a consultant for MVRX, Heartflow Inc, and Circle Cardiovascular Imaging; and provides CT core lab services for Edwards Lifesciences, Medtronic, Neovasc, Boston Scientific, and Tendyne Holdings for which no direct compensation is received. Dr Sathananthan has received speaker fees from Edwards Lifesciences; is a consultant for Edwards Lifesciences, Boston Scientific, NVT Medical, and Medtronic; and has received research support from Medtronic, Vivitro Labs, and Edwards Lifesciences. Dr Sellers is a consultant for Edwards Lifesciences, Anteris, Excision Medical, and Medtronic; and has received research support from Medtronic, Vivitro Labs, and Edwards Lifesciences. Dr Webb is a consultant for Edwards Lifesciences; and has received research funding from Edwards Lifesciences, Medtronic, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Competing Interests: Funding Support and Author Disclosures Dr Wood is a consultant to and has received research funding from Edwards Lifesciences and Abbott. Dr Webb is a consultant for Edwards Lifesciences; and has received research funding from Edwards Lifesciences, Medtronic, and Boston Scientific. Dr Leipsic is supported by a Canadian Research Chair in Advanced Cardiopulmonary Imaging; is a consultant for MVRx, HeartFlow, and Circle Cardiovascular Imaging; and provides computed tomographic core lab services for Edwards Lifesciences, Medtronic, Neovasc, Boston Scientific, and Tendyne Holdings, for which no direct compensation is received. Dr Sathananthan has received speaking fees from Edwards Lifesciences; has received research support from Medtronic, Vivitro Labs, and Edwards Lifesciences; and is a consultant for Edwards Lifesciences, Boston Scientific, NVT, and Medtronic. Dr Sellers is a consultant to Edwards Lifesciences, Anteris Technologies, Excision Medical, and Medtronic; and has received research support from Medtronic, Vivitro Labs, and Edwards Lifesciences. Drs Moss and Boone are consultants for Edwards Lifesciences; and have received speaking fees from Edwards Lifesciences and Abbott Vascular. Dr Akodad is a consultant for Medtronic and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Competing Interests: Funding Support and Author Disclosures Dr Wood is a consultant to, and has received research funding from Edwards Lifesciences and Abbott. Dr Sellers is a consultant to Edwards Lifesciences, Anteris, Excision Medical, and Medtronic; and has received research support from Medtronic, Vivitro Labs, and Edwards Lifesciences. Dr Leipsic is supported by a Canadian Research Chair in Advanced Cardiopulmonary Imaging, consults for MVRX, HeartFlow Inc., and Circle Cardiovascular Imaging; and provides CT core lab services for Edwards Lifesciences, Medtronic, Neovasc, Boston Scientific, and Tendyne Holdings, for which no direct compensation is received. Dr Sathananthan has received speaking fees from Edwards Lifesciences; has received research support from Medtronic, Vivitro Labs, and Edwards Lifesciences; and is a consultant for Edwards Lifesciences, Boston Scientific, NVT Medical and Medtronic. Dr Webb is a consultant for Edwards Lifesciences and receives research funding from Edwards Lifesciences, Medtronic, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Background: Trans-radial access has rapidly become the standard for percutaneous coronary procedures in the last decade. As proceduralists overcome the learning curve and become more competent in trans-radial access, alternative safe access sites such as the ulnar artery have been increasingly used for emergent and elective procedures. The aim of this study was to synthesize the best available evidence of the impact on major adverse cardiac events (MACE) of ulnar artery compared to radial artery cardiac catheterization., Methods: This review considered randomized controlled trials that included adult patients who had a percutaneous coronary procedure via the radial or ulnar artery. The intervention of interest was the use of ulnar compared to radial artery for cardiac catheterization. An extensive search was undertaken for published and unpublished trials up to May 2017. Methodological quality was assessed independently by two reviewers using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) checklist. Data were analyzed using Review Manager., Results: A total of six trials were included in the review. There was no statistically significant difference in the incidence of MACE between patients who underwent trans-ulnar or trans-radial artery catheterization (OR 0.90; 95% CI 0.65-1.25). Complications associated with access including hematoma formation, (n = 6 trials) pseudo-aneurysm, and arterio-venous fistulae formation (n = 5 trials), were investigated in a total of 5,276 patients, with no difference in these complications noted between the two groups. There were no differences in arterial access time, fluoroscopy time, and contrast load between the two groups., Conclusions: There is evidence to support safe use of the ulnar artery as an alternative to the radial artery for access for cardiac catheterization., (© 2018 Wiley Periodicals, Inc.)