Understanding adherence to international and national surgical site infection prevention guidelines in Saudi Arabia: A qualitative study

Background: The most common healthcare-associated infections are surgical site infections (SSIs). Worldwide, their incidence rate is approximately 20% to 38%, with rates in Saudi Arabia ranging from 10% to 86%. SSIs result in increased mortality and morbidity rates, increased healthcare costs and extended hospital stays. International and national SSI guidelines were developed to improve the quality of care and outcomes for surgical patients by providing standardized practices to prevent SSIs based on evidence. However, studies show that there is poor adherence to the SSI guidelines during the pre-and intraoperative periods among surgical team members worldwide. Moreover, there is a paucity of evidence concerning this topic in Saudi Arabia where there is a high incidence of SSIs. Aim: The aim of this study is to explore adherence to international and national SSI prevention guidelines by surgical team members during the pre-and intraoperative periods in Saudi Arabia. Method: The researcher conducted a detailed review of relevant literature on the adherence to SSI guidelines to identify existing knowledge and gaps in the literature. This was followed by a focused ethnographic study using the following methods: observations of routine practice recorded with field notes describing behaviours, interactions between members of the surgical team and surgical patients during the pre and intraoperative periods, supported by a review of patients’ notes and semi-structured interviews. The research was conducted in two operating rooms (ORs) units of two hospitals in Saudi Arabia. Nineteen members of the surgical teams were observed for a total of 160 hours. Observations were followed by interviews with 18 surgical team members who had been observed. Observations and interviews data were analysed using thematic analysis inductively to investigate the reasons influencing adherence. The analysis was followed by a deductive ‘abductive’ approach in which themes were presented and organised where possible within the Consolidated Framework for Implementation Research (CFIR). Findings: Adherence to SSI guidelines at both hospitals and among surgeons and nurses was poor. Different reasons influenced adherence to the SSI guidelines, and the results illustrated that 19 CFIR constructs/themes impacted adherence across all five domains. Some reasons for adherence and non-adherence were specific to Saudi Arabia, including language barriers, culture and gender. Other reasons were more universal and included personal beliefs and behaviours, the nursing role, leadership, and organisational planning. Conclusion: Language, the culture of power and the influence of hierarchy, gender, beliefs, patients, behaviours, the OR nurses’ role, the influence of surgeons and leadership, and organisational influences are key reasons that influence the adherence to SSI guidelines. Some facilitators were suggested to assure best practice and encourage adherence, such as education and training on SSI guidelines for all members in the ORs, communication and cooperation between surgical team members and staff in other units, that SSI practices should be introduced by staff who speak Arabic to ensure patients understand, strong friendships among female nurses, the availability of up-to-date checklists for SSI practices, and the influence of heads and surgeons could all improve adherence. This study offers a unique contribution to expand CFIR. In addition, it has relevance for OR units in the southern region of Saudi Arabia, although, they might contribute further to bolstering understanding of the reasons influencing adherence to SSI guidelines among similar cultural groups of surgical team members in OR units in other Saudi Arabia regions or Arab countries

Phenotypic and genetic investigation of plant phenological development, architecture and yield in winged bean (Psophocarpus tetragonolobus (L.) DC.)

The worsening effects of climate change and malnutrition have significantly impacted global food and nutrition security. Diversifying food sources through the cultivation of underutilised crops could mitigate these challenges and promote resilient agricultural food systems. Winged bean (Psophocarpus tetragonolobus (L.) DC.) is a protein-rich crop grown in humid tropical regions. With its various edible plant parts, broad distribution in the tropics, and adaptation to diverse local environmental conditions, it has notable trait variations for exploration in crop improvement. Research on winged bean genetic diversity has been limited in the past 50 years, primarily relying on phenotypic assessments without the utilisation of molecular markers. However, recent advancements in genotyping techniques have enabled the integration of phenotypic and genetic data. Molecular breeding accelerates the characterisation of diverse core collections, leading to cultivar development, contributing to global initiatives for dietary diversity and nutritional resilience. A mini-core collection of winged bean comprising 22 accessions was formed from prior genetic diversity assessment of 91 accessions originating from seven countries, and two continents, using DArTseq SNP markers. Multi-locational trials of this mini core collection were carried out at three locations: the Field Research Centre of Crops for the Future Research Centre (CFF-FRC) in Semenyih, Malaysia (May 2019 to March 2020); the rainout shelter of the University of Nottingham Malaysia (UNM) in Semenyih, Malaysia (November 2020 to August 2021); and Fireflies Organic Farm (FF) in Broga, Malaysia (January to October 2021) in a randomised complete block design (RCBD). Among them, FP15 consistently exhibited shorter days to first flower (DtFF) and days to first pod (DtFP) within 79 and 81 days after sowing (DAS) at the CFF-FRC and 62 DAS and 64 DAS in the UNM rainout shelter, respectively with significant differences (p0.05) were found between phenological traits and yield traits. In contrast, significant positive correlations (p<0.05) were observed between architecture and yield-related traits, including stem length (StL) and pod length (PodLe) (r=0.791), PodLe and PodY (r=0.538), and PodLe and SY (r=0.526). These findings suggest that yield improvement could be achieved through selection based on plant architecture, particularly stem length, while phenological traits may have limited potential for direct yield selection. Nine accessions were identified based on their superior traits: FP15 and a57 for earliness in flowering and pod production, a10, a6, and a7 for consistent stem length, and a6, a13, a15, a35 and Ma3 for high pod yield and seed yield potential. An in-field evaluation of 192 F2 lines (TF2) from a cross between i10 (high above-ground biomass, shorter pods) and FP15 (early flowering, early maturity, high harvest index) was conducted at Beacon Eco Farm, Mantin, Malaysia, from June to December 2022. The study assessed plant phenology, architecture, yield, and yield components in an RCBD with four blocks. Significant differences (p<0.001) were observed between parents for flowering initiation, pod production, and seed harvest, with F2 progenies showing intermediate trait values. Significant positive correlations were found between DtFF and DtFP (rs=0.707), DtFF and DtMS (rs=0.455), and DtFP and DtMS (rs=0.554) at p<0.001. No significant differences were found between parents for architectural traits including number of branches (NoB), sum of branches length (SoBL), and StL, but transgressive segregation occurred in the TF2 population. Both parents differed (p<0.05) in yield components such as seeds per pod (SPP), above-ground biomass (AGB), and harvest index (HI) while significant differences (p<0.001) were observed for PodLe, pod width (PodWi), and below-ground biomass (BGB). Five TF2 lines — L012, L013, L014, L015, and L109— produced up to 15,120 kg/ha of pods and 5,725 kg/ha of seeds, with early flowering and seed harvest comparable to FP15, making them distinguished candidates for selection and advancement to the F3 stage. A genetic linkage map was constructed, followed by QTL analysis. Initially, a total of 4576 DArTseq SNP markers were filtered from 6025 SNP markers of 184 TF2 individual lines. A genetic linkage map consisting of ten linkage groups was constructed from 493 polymorphic SNP markers, with two linkage groups of Chromosome 03 were obtained. The map was 1053.3 cM in total. A total of 15 significant QTLs were identified for ten traits, including DtFF, DtFP, DtMS, 15th internode length (IntL15), 20th internode length (IntL20), NoB, pods per plant (PPP), PodLe, PodWi and seed colour (SC), distributed across six linkage groups: LG01, LG04, LG05, LG07, LG08, and LG09. These QTLs were major accounting for more than 15% of the phenotypic variation in each trait. Additionally, nine transcription factors potentially associated with germination, mature seed harvest, seed yield, seed colour and leaf chlorophyll content were identified. In-field evaluation of subsequent F3 and F4 generations will aid in selecting superior lines and refining QTL mapping for marker-assisted breeding. Further study of trait inheritance will provide deeper insights into winged bean yield traits. Multi-location trials will help identify key trait correlations in phenology, architecture, and yield, laying the foundation for developing improved cultivars with early maturity and high yield potential. QTL mapping of genetic regions responsible for trait expression will inform future breeding, not only for winged bean but also for other crops facing similar challenges. Ultimately, this project contributes to the efforts aimed at improving global food and nutrition security by expanding the range of crops available and improving their yield potential to address changing environmental conditions

Advanced techniques for postharvest disease detection, control, and quality enhancement in papaya: electronic nose analysis and chitosan-zinc oxide nanoparticle coatings

Papaya (Carica papaya), a valuable tropical fruit in Malaysia, is highly susceptible to postharvest fungal diseases that can severely affect its quality and lead to economic losses. To address these challenges, this study explored a novel, non-destructive approach using electronic nose (EN) technology, a biosensor capable of detecting quiescent fungal infections by sensing changes in volatile composition, thereby avoiding the invasiveness of traditional methods. Additionally, an eco-friendly and cost-effective edible coating has been investigated as a means to control fungal diseases, providing a comprehensive solution to reduce postharvest losses in papaya. EN was first investigated for its ability to differentiate between papaya ripening stages. Using the case-based reasoning (CBR) classification method, EN effectively detected differences in odour profiles across different storage days. The similarity percentages were 84.25% between days 1 and 3, 82.81% between days 1 and 5, and 94.19% between days 3 and 5—all below the 98% threshold, confirming distinct changes in volatiles over time. GC-MS analysis validated these findings by identifying potential biomarkers for each stage, including vinyl butyrate on day 1, acetone on day 3, and cyclobutanol on day 5, demonstrating EN's accuracy and sensitivity of EN in tracking papaya ripening. EN technology was then investigated to determine how early and accurately it could detect quiescent fungal diseases in papayas, focusing on pathogens such as Colletotrichum gloeosporioides (CG), Fusarium solani (FS), and Lasiodiplodia theobromae (BC). EN successfully distinguished volatile profiles between healthy and infected samples, with CG-infected samples showing 94.36% similarity between days 1 and 3, and 91.58% similarity between days 1 and 5, reflecting disease progression. By day 5, BC-infected papayas exhibited distinct profiles with only 83.40% similarity to CG, and GC-MS identified specific potential biomarkers for each pathogen, further supporting EN’s pathogen differentiation capability. Finally, an eco-friendly edible coating combining chitosan with green-synthesised zinc oxide nanoparticles (ZnO NPs) from pandan leaf extract was tested for its efficacy in controlling anthracnose disease in papaya. Increasing concentrations of ZnO NPs in the chitosan solution demonstrated a trend of progressively reduced disease incidence, with 2.5 g/L of ZnO NPs emerging as the optimal concentration. Papayas treated with this chitosan-2.5 g/L ZnO NP coating showed a 63% reduction in disease incidence compared to those treated with chitosan alone. Moreover, the disease severity was reduced by 36.5%, highlighting the effectiveness of the coating in delaying anthracnose onset. This study highlights EN technology as a rapid, non-destructive tool for detecting ripening stages and fungal infections in papayas, complemented by an eco-friendly ZnO-chitosan coating that offers a sustainable solution to mitigate postharvest losses by delaying onset of infections and extending shelf life, particularly in tropical regions where papaya is economically vital

The role of learning in the development and use of maritime technology in the Mediterranean 1500 BC to AD 200

The evidence available to the discipline of maritime archaeology, and the associated interpretation of textual and iconographic sources, has recently undergone a period of rapid growth due to the development of techniques used in underwater exploration. Unfortunately, the presentation and interpretation of this expanded evidence has neither a clear taxonomic structure within which to categorise vessels by type and capability, nor a comprehensive model for development that might explain how, why and when different vessel types arose. The result has been that most published works by specialists in the field do not clearly reference either topic. This in turn has resulted in a great deal of misunderstanding by scholars from outside the discipline regarding vessel types, capabilities and usage. My contention in this thesis is that an understanding of the nature of learning in the ancient world can provide a means to explain how the process of vessel development progressed. Any process of development based on learning will clearly be linked to both the construction and operation of the vessels in use. This in turn requires the definition of vessel types in the form of a system of taxonomy based on features related to their use. The aim and objectives of this thesis are to provide a model of this process of learning and system of taxonomy that fits the current evidence, while providing a basis of challenge for others researching in the field of maritime archaeology

Identification of material sustainability matters in the property development industry by analysing stakeholder perspectives on ten sustainable elements

Despite the global emphasis on sustainability, property developers in Malaysia face significant challenges in implementing sustainable practices due to the multifaceted consideration of the risk of incremental cost, instability of advanced technology, lack of skilled experts, and shortage of green materials. The author of this paper aims to address the gap in understanding the perceived value of sustainable practices among various stakeholders, which may not align with the principles of the sustainability frameworks. The objective of this research paper is to assess the awareness and adoption level of sustainability practices among the stakeholders including definitive stakeholders, dependent stakeholders, and other stakeholders through the lens of salience stakeholder theory. The research methodology is divided into two parts, which the first part puts the focal point into the comprehensive literature reviews on the historical evolution of sustainability, critical challenges, and various widespread-used green rating frameworks such as LEED, GBI, Green Mark, and GreenRE. Adopting the qualitative research methodology, author conducted semi-structured interviews with 18 interviewees from diverse stakeholder groups individually. The interview contents were critically analysed through content analysis with reference to Self-Determination Theory (SDT) and ten sustainable themes that branch from the green rating frameworks. The research findings reveal both consensus and disparities in the stakeholder expectations, which are able to provide insights for property developers and relevant stakeholders in designing the material sustainability matters and assessing the feasibility. While ecological aspects remain universally valued, the research outcomes show that the perspectives are prone to be limited to human own benefit over the broader impact on planetary health, particularly concerning the UN SDG Goal-14 and Goal-15. The author of this paper suggests further studies to explore these discrepancies and enhance alignment among stakeholders regarding sustainability practices. Results also outline the cost and value of money aspects ranked top of the motivation to predominantly drive both primary definitive stakeholders and dependent stakeholders to the broader adoptions. Potential future research could consider the empirical study on the correlation between sustainable property development practices and tangible outcomes such as company revenue growth and property value appreciation

Negative thermal expansion of cold-rolled Ti-Nb over a wide temperature range

Anisotropic negative thermal expansion (NTE) of martensitic β-isomorphous Ti-alloys has been discovered to be one of the largest in magnitude among other NTE materials. Exhibition of macroscale NTE was shown to be achievable through texturing, but studies reporting on this behaviour have been conservative and have only reported within the purely martensitic region. Studies have not yet revealed the effects of phase transformation and thermomechanical property changes on the textured material when heated above the martensitic region. This work aims to study the NTE thermal stability, phase transformation sequence, and resulting mechanical properties of a cold-rolled Ti-22Nb (at.%) elevated to temperatures outside the purely martensitic region. The evolution of macroscale thermal expansion of cold-rolled Ti-22Nb was uncovered by thermal cycling to 150, 250, 350, 450, 550 °C. The magnitude of contraction along the rolling direction increased with temperature until a maximum contraction was achieved at 320 °C. Expansion was observed beyond that temperature and the specimen retained NTE at 150-250 °C, zero thermal expansion at 350 °C, and positive thermal expansion at 450-550 °C. Long-term NTE thermal stability of cold-rolled Ti22Nb was investigated through isothermally aging the specimen at 150, 250 °C for 10, 100, 1000 hours. In both cases, the NTE of the sample decreased with duration. Diffusional rejection of Nb was behind the minimal loss of NTE after 1000h at 150 °C, while zero thermal expansion was achieved after 1000h at 250 °C. An unusual destruction and precipitation of ω phase was detected while aging at 150 °C. The phase transformations leading to the deterioration of NTE when heating to 350-550 °C was studied and sequenced according to the occurring temperatures. The non-linear nature of macroscale NTE was reasoned to stem from direct translation of the lattice NTE. Diffusional rejection of Nb was the main mechanism leading to loss of NTE and eventually leading to a duplex α+β microstructure. An unusual occurrence of the same diffusion occurring at staggered temperatures was observed was reasoned to be due to the cold-work nature of the specimen

Germline determinants of the immune response in Asian breast cancer

Breast cancer is a complex disease with heterogeneity in tumour characteristics and treatment response. Recently, Asian breast cancer patients were reported to have elevated immune scores in comparison to Caucasian breast cancer patients, however, germline genetic determinants associated with immune scores in Asian breast cancer patients remain undercharacterised. This study aims to identify the germline genetic variants associated with heritable immune scores in Asian breast tumours and determine the cellular pathways that drive immune scores within this population. By evaluating 112 immune scores that have previously been described in literature, we observed significantly higher heritability in Asian breast tumours compared to Caucasians. The major histocompatibility complex class-I (MHC-I) immune score had high heritability in both cohorts. By conducting a genome-wide association study (GWAS), the findings revealed, as predicted, the HLA locus on chromosome (chr) 6 in both Asian and Caucasian cohorts. Regulatory T (Treg) cells, Immune non-small cell lung cancer (NSCLC) score, Triggering receptor expressed on myeloid cells 1 (TREM1) score and T follicular helper (Tfh) cells were the most heritable immune scores in Asian breast tumours. A total of 37 candidate SNPs were identified through GWAS. Expression quantitative trait loci (eQTL) analysis and a review of current literature revealed variants in TNFRSF13B, PRKCQ, IL2RA, and MIR149 as candidate cis-eQTL loci with potential roles in immune function and immune scores. Taken together, these findings suggest that there may be a population-specific genetic influence on heritable immune traits. This study identifies candidate variants that may underlie these observed differences

Research and implementation on optical wireless communication technologies

Continuous global growth and increasing demand for wireless communication cause a shortage of radio frequency (RF) spectrum. Optical wireless communication (OWC) is expected to alleviate this looming spectrum crisis. Among OWC technologies, free space optic (FSO) and visible light communication (VLC) have rapidly become a research hot spot because of significant development and application prospects. This study aims to investigate the characteristics of OWC technologies and offer theoretical support for enhancing the transmission performance. To achieve this goal, simulation models are set up, and better system parameters and modulation schemes are selected. In the FSO model, an established modulation, absolute added correlative coding (AACC), is compared with four-level pulse amplitude modulation (4-PAM) in terms of transmission distance, eye diagram and bitrate. The results indicate that AACC transmits longer distance and at a higher bitrate than 4-PAM. Using the bit error rate (BER) with an estimation of 10-9, the transmission distance achieved by AACC is 1.12 km, compared to 1.09 km for 4-PAM. And the bitrate of AACC is 18.7 Gbit/s, while it of 4-PAM is 16.7 Gbit/s. From the above results, the AACC modulation gives an improvement of 3% in the distance and 12% in the bitrate compared to 4-PAM modulation. In indoor VLC model, simulation results like illumination distribution, received power, signal-to-noise ratio (SNR) and root-mean-square (RMS) delay are evaluated. The illumination distribution between one light emitting diode (LED) array and four LED arrays is compared. It shows that four LED displays provide more uniform illumination. And the received power in LOS channel and NLOS channel are analysed. It shows that the contribution of LOS channel is decisive for the received power, and the assistance of NLOS channel is concentrated near the walls. In addition to these simulation results, measure algorithms of indoor positioning system (IPS) based on the same model are also investigated. It provides an experimental foundation for the construction of a robust and high data rate light fidelity (Li-Fi) system as well as a more accurate IPS. With the continuous improvement of OWC technologies, a more efficient and secure wireless communication network will be widely used

Recombinant expression of native Tritrypticin and optimisation of an In vivo biosynthesis platform for high-throughput peptide therapeutics discovery

The global increase in antibiotic-resistant bacteria poses a public health threat, heightened by overuse of antibiotics in livestock farming, the food industry, and healthcare. This demands for novel antimicrobial compounds to address the diminishing inefficacy of current antibiotics. Antimicrobial peptides (AMPs) ubiquitous in organisms' innate immune systems show potential with their broad-spectrum activity. This study investigates on Tritrypticin (TTC), a 13-residue bactericidal peptide rich in tryptophan. Derived from the C-terminal domain of the porcine bone marrow precursor molecule C12, that demonstrates antimicrobial properties against pathogens like Escherichia coli and Salmonella typhimurium. This study addresses the challenges in producing AMPs using recombinant expression in E. coli BL21 (DE3) and utilisation of the inducible, self-cleavable fusion protein, Synechocystis sp. (Ssp) DnaB intein, demonstrating potential for higher yields and scalable recombinant expression of AMP. The study identified the optimal recombinant protein expression conditions at low induction parameters (0.1 mM IPTG, 15°C, 200 rpm agitation, and 18 hours). Induction of the Ssp DnaB intein cleavage to release TTC was observed at pH 5, incubated at 25°C for 8 hours, and further enhanced with supplementation of non-ionic detergent and solvents such as Tween-20, Triton X-100, and dimethyl sulfoxide (DMSO). The extracellular secretion of the TTC peptides mediated by incorporating signal peptides (SPs), Outer Membrane Protein A (OmpA) and novel signal peptide 4 (NSP4), enabled the identification of antibacterial activity of TTC towards Bacillus subtilis ATCC 6633 through bacterial agar screening, demonstrating the excretion of TTC from E. coli BL21 (DE3) host. Utilising directed evolution techniques, error-prone PCR (epPCR) with imbalanced nucleotides and MnCl2 supplement, accelerated the generation of a diverse pool of mutant TTC producers, identification up to 66% of candidates and identified peptide mutations with arginine that enhanced antibacterial activity with larger inhibition zones against B. subtilis through the high-throughput bacterial screening method. Overall, the study investigates the potential of expressing AMPs in recombinant expression systems to allow more efficient peptide production and generate mutant peptides with potentially enhanced antimicrobial activity, rapidly identified by the high-throughput screening method. This research contributes to ongoing efforts to identify novel antibiotics to combat antibiotic-resistant pathogens and address the growing threat of antimicrobial resistance

Business proposal: Codedsphere solutions development platform

This dissertation presents the business plan for Codedsphere, a Malaysia based custom software development company founded in 2024. Codedsphere aims to revolutionize the software development industry by creating a global platform that fosters a community of skilled developers who are treated as partners rather than employees. The company’s innovative model emphasizes transparency, fairness, and collaboration, positioning it to capitalize on the rapidly growing demand for customized software solutions. The plan outlines Codedsphere's vision to become the world’s premier platform for innovation, transforming ideas into powerful solutions across industries. The company’s mission is to revolutionize the delivery of technology innovation by fostering a global community of developers and clients, collaboratively transforming ideas into groundbreaking solutions. Codedsphere’s business strategy focuses on building a robust developer community, sourcing clients through quality networking, and ensuring fair and transparent operations. The market analysis indicates significant opportunities within the global IT outsourcing industry, which is projected to grow from $512.5 billion in 2024 to$777.80 billion by 2028. Codedsphere plans to leverage this growth by strategically positioning itself with its proprietary software development platform and a global network of developers. The financial analysis shows a positive Net Present Value (NPV) of $2,566,090 and an Internal Rate of Return (IRR) of 36.95%, emphasize the profitability and sustainability of the business. Key risks identified include market competition, underperforming partners, and clients unwilling to pay for services rendered. To mitigate these risks, Codedsphere will implement a comprehensive evaluation and support system, ensuring high-quality service delivery and client satisfaction. The plan also details Codedsphere's organizational structure, emphasizing a flat and scalable model that supports both full-time employees and partners. Finally, the financial forecast aligns with Codedsphere's phased business strategy, projecting substantial revenue growth over five years. The company’s equity distribution plan ensures that founders, early team members, and investors are incentivized for long-term growth, with additional equity reserved for future employees and strategic partners. This business plan illustrates how Codedsphere is poised to become a leader in the custom software development industry, offering a unique value proposition that aligns with market demands and technological advancements