Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Importance of Knowledge Management in Establishing Organization Strategy: Study on Saudi Arabian Airlines HR Division, Jeddah

&lt;p&gt;This study was aimed at determining the awareness of the Saudi Arabian Airlines (Saudia) human resources (HR) division employees about the role of knowledge management in the company. In addition, their understanding of the concept of knowledge management was also evaluated. Further, the degree to which knowledge management processes were practically employed by the HR employees in the company was also determined. A descriptive and analytical course was employed as a proper method in this study. The study sample was selected from Saudi employees working in Jeddah; owing to their large number, a random sample of 60 employees was chosen. The questionnaire method was employed in this study, and several results were obtained. Some of the main results are as follows. The system encouraged the participants to follow the best practices of other organizations and ensure that managers understand that successful knowledge depends on organizational culture. Further, knowledge management is considered as information management, and study participations agreed to some extent to the knowledge management concept for HR employees. In addition, it was pointed out that good and creative ideas for improving competitive advantage are supported and an individual and group initiative culture is spread between employees.&lt;/p&gt;</jats:p

The extent of applying transparency standard as one of the standards of governance in the human resources recruitment process: – A practical study on the Development Authority of Makkah Al-Mukarramah Region –: مدى تطبيق معيار الشفافية كأحد معايير الحوكمة في عملية توظيف الموارد البشرية – دراسة ميدانية على هيئة تطوير منطقة مكة المكرمة –

This study came with several objectives, most notably to discuss the impact of transparency as one of the standards of governance on the human resources recruitment process. To achieve the objectives of the study, the researcher followed the descriptive analytical approach, to conduct this study. The questionnaire was used as a main for collecting data from members of the study population. The study population consists of the employees of the Development Authority of Makkah Al-Mukarramah Region, whose number is 177 employees. The study found several results, the most prominent of which is the existence of a statistically significant correlation between transparency as one of the governance criteria and the human resources recruitment process in its various stages (recruitment, selection, appointment) in the Development Authority of Makkah Al-Mukarramah Region, where the correlation coefficient between transparency and the human resources recruitment process in its various stages reached a value of (0.910), Which is a very strong correlation coefficient. In light of the results of the study, the researcher recommends the need to announce in advance in all the advertising and media outlets available in the best possible way all the criteria and the criteria used to select applicants for jobs. It is also necessary to increase attention to the process of stimulating the external recruitment process to attract the best human competencies by examining the different labor market conditions.</jats:p

"Knowledge management applications in human capital investment "Case Study on the Human Resources Sector of Saudi Air Lines Company: تطبيقات إدارة المعرفة في استثمار رأس المال البشري

The study aimed to identify to clarify the role that can be played by Knowledge Management in human capital investment applications company Saudi Arabian Airlines,  furthermore the study aimed to identify the Recognize reality of Knowledge Management in the field of human capital investment applications, As well as to identify the most serious obstacles Knowledge Management applications for the investment and development of human resources, to fulfill these objectives the descriptive analytical method is used in this study, where the researcher used the questionnaire to collect primary data through direct questions and inquiries. The study population consisted of personnel management of human resources in the company reached (586) employee, and researcher selected a simple random sample of the total overall society for the study size was (296) employee of the total community individual. the study concluded that the results of the study concluded that there are many positive indicators suggest that Knowledge Management applications for human capital investment available air transport sector is very high degree, the study also pointed that there are some Knowledge Management for the investment of human capital need to activate up to fit and perform its vital role in the development of human resources of the company. the study also showed that the most important human resource management needs to support Knowledge Management applications represented in the existing knowledge of the staff need to modern techniques to be published, also through the importance of spreading knowledge and culture through seminars, workshops, training programs. The study results revealed that the technologies of Knowledge Management is very vital role in the development of investment in human capital and by providing a work environment that encourages creativity and excellence. the main recommendations of  the  study that need to maintain the current ratio of Knowledge Management, and encourage a culture of acquiring new knowledge and information among workers, and need that the administration working to provide advanced systems for service personnel, and the need for attention to the deployment of knowledge and culture through seminars, workshops, training programs and need to focus on knowledge management techniques as they have a very vital role in the development of investment in human capital through the dissemination of information and disseminating them among employees where this will contribute to make them aware of, and that the administration need to working to open the channels of effective communication between them and the staff through the activation of all media and means of communication between them. And the need to provide a working environment that encourages creativity and excellence, the researcher recommended further studies on the subject as there is scarcity in such studies in the local environment of the Kingdom of Saudi Arabia.</jats:p

The Retention Policy Determinants and Physicians Job Satisfaction and Organizational Commitment: A Study of Hospitals in Saudi Arabia

The current research aims to examine the retention policy determinants and physician's job satisfaction and organizational commitments in Saudi Arabia hospitals. The current &nbsp;research consists of the independent variables signified by retention policy determinants (namely organizational components, job analysis and design, organizational career opportunities, rewards, and employee relationships) and dependent variable which signified by job satisfaction and organizational commitment. In order to investigate the association between independent and dependent variables the quantitative technique was used to gather primary data through a questionnaire, which was administered in all the hospital sectors in Jeddah city with hospital physicians. The research population consists of 2870 physicians (consultant, specialist, and resident) from 5 public and private hospitals in Jeddah. The sample of this study was 10% of the total research population accounted 287 physicians. The researcher retrieves 198 valid research questionnaires. A purposive sampling technique was used to select the participants. The results validate significant differences have an effect on of the retention policy determinants have a significant influence on the physician job satisfaction. The result shows that five out of five variables are significant (organizational components, job analysis and design, organizational career opportunities, rewards, and employee relationships) on physician job satisfaction and also physician organization commitment. The current research contributes to the academic and medical filed knowledge as being one of the first attempts to explore practically the impact of retention policy determinants on physician job satisfaction. Additionally to distinguishing the fundamental roles of human resources and retention policy in enhancing the physician job satisfaction, this research amalgamates, purifies and expands the experiential work conducted in the field of health services marketing in Saudi Arabia. It elevates many inferences for executives in these hospitals, such as considering the importance of influences retention policy on physician job satisfaction.&nbsp

Unveiling the Efficacy of Sesquiterpenes from Marine Sponge Dactylospongia elegans in Inhibiting Dihydrofolate Reductase Using Docking and Molecular Dynamic Studies

Dihydrofolate reductase (DHFR) is a crucial enzyme that maintains the levels of 5,6,7,8-tetrahydrofolate (THF) required for the biological synthesis of the building blocks of DNA, RNA, and proteins. Over-activation of DHFR results in the progression of multiple pathological conditions such as cancer, bacterial infection, and inflammation. Therefore, DHFR inhibition plays a major role in treating these illnesses. Sesquiterpenes of various types are prime metabolites derived from the marine sponge Dactylospongia elegans and have demonstrated antitumor, anti-inflammation, and antibacterial capacities. Here, we investigated the in silico potential inhibitory effects of 87 D. elegans metabolites on DHFR and predicted their ADMET properties. Compounds were prepared computationally for molecular docking into the selected crystal structure of DHFR (PDB: 1KMV). The docking scores of metabolites 34, 28, and 44 were the highest among this series (gscore values of −12.431, −11.502, and −10.62 kcal/mol, respectively), even above the co-crystallized inhibitor SRI-9662 score (−10.432 kcal/mol). The binding affinity and protein stability of these top three scored compounds were further estimated using molecular dynamic simulation. Compounds 34, 28, and 44 revealed high binding affinity to the enzyme and could be possible leads for DHFR inhibitors; however, further in vitro and in vivo investigations are required to validate their potential.</jats:p

Unveiling the Efficacy of Sesquiterpenes from Marine Sponge <i>Dactylospongia elegans</i> in Inhibiting Dihydrofolate Reductase Using Docking and Molecular Dynamic Studies

Dihydrofolate reductase (DHFR) is a crucial enzyme that maintains the levels of 5,6,7,8-tetrahydrofolate (THF) required for the biological synthesis of the building blocks of DNA, RNA, and proteins. Over-activation of DHFR results in the progression of multiple pathological conditions such as cancer, bacterial infection, and inflammation. Therefore, DHFR inhibition plays a major role in treating these illnesses. Sesquiterpenes of various types are prime metabolites derived from the marine sponge Dactylospongia elegans and have demonstrated antitumor, anti-inflammation, and antibacterial capacities. Here, we investigated the in silico potential inhibitory effects of 87 D. elegans metabolites on DHFR and predicted their ADMET properties. Compounds were prepared computationally for molecular docking into the selected crystal structure of DHFR (PDB: 1KMV). The docking scores of metabolites 34, 28, and 44 were the highest among this series (gscore values of −12.431, −11.502, and −10.62 kcal/mol, respectively), even above the co-crystallized inhibitor SRI-9662 score (−10.432 kcal/mol). The binding affinity and protein stability of these top three scored compounds were further estimated using molecular dynamic simulation. Compounds 34, 28, and 44 revealed high binding affinity to the enzyme and could be possible leads for DHFR inhibitors; however, further in vitro and in vivo investigations are required to validate their potential

Unveiling the Efficacy of Sesquiterpenes from Marine Sponge Dactylospongia elegans in Inhibiting Dihydrofolate Reductase Using Docking and Molecular Dynamic Studies

Dihydrofolate reductase (DHFR) is a crucial enzyme that maintains the levels of 5,6,7,8-tetrahydrofolate (THF) required for the biological synthesis of the building blocks of DNA, RNA, and proteins. Over-activation of DHFR results in the progression of multiple pathological conditions such as cancer, bacterial infection, and inflammation. Therefore, DHFR inhibition plays a major role in treating these illnesses. Sesquiterpenes of various types are prime metabolites derived from the marine sponge Dactylospongia elegans and have demonstrated antitumor, anti-inflammation, and antibacterial capacities. Here, we investigated the in silico potential inhibitory effects of 87 D. elegans metabolites on DHFR and predicted their ADMET properties. Compounds were prepared computationally for molecular docking into the selected crystal structure of DHFR (PDB: 1KMV). The docking scores of metabolites 34, 28, and 44 were the highest among this series (gscore values of &minus;12.431, &minus;11.502, and &minus;10.62 kcal/mol, respectively), even above the co-crystallized inhibitor SRI-9662 score (&minus;10.432 kcal/mol). The binding affinity and protein stability of these top three scored compounds were further estimated using molecular dynamic simulation. Compounds 34, 28, and 44 revealed high binding affinity to the enzyme and could be possible leads for DHFR inhibitors; however, further in vitro and in vivo investigations are required to validate their potential