Kuwaiti EFL Students’ Perceptions of the Effectiveness of the Remedial English Course 099 at the College of Technological Studies

The study aims to evaluate the English remedial course 099 taught in the College of Technological Studies (PAAET) as part of the English program which disseminates English Language Skills to EFL students studying at this college. This study is expected to provide sufficient information to policymakers and educators involved with this program at all levels, with the intention to help them evaluate this course and make useful decisions to improve English Language Teaching in order to combat the deficiency in the English language suffered by college students in Kuwait. A number of 155 students participated in a questionnaire of 15 statements divided into four areas: reading, grammar, writing, and speaking skills. The findings of the study showed that most EFL students benefited from the English course 099, and their language skills were improved. However, there were some drawbacks and weaknesses of the program in terms of learners’ assessments and follow up. The significance of the study arises from the fact that it would enable decision-makers and course evaluators to pinpoint the strengths and weaknesses of the course and hence find ways to improve it

Deep learning in computed tomography pulmonary angiography imaging: a dual-pronged approach for pulmonary embolism detection

The increasing reliance on Computed Tomography Pulmonary Angiography (CTPA) for Pulmonary Embolism (PE) diagnosis presents challenges and a pressing need for improved diagnostic solutions. The primary objective of this study is to leverage deep learning techniques to enhance the Computer Assisted Diagnosis (CAD) of PE. With this aim, we propose a classifier-guided detection approach that effectively leverages the classifier's probabilistic inference to direct the detection predictions, marking a novel contribution in the domain of automated PE diagnosis. Our classification system includes an Attention-Guided Convolutional Neural Network (AG-CNN) that uses local context by employing an attention mechanism. This approach emulates a human expert's attention by looking at both global appearances and local lesion regions before making a decision. The classifier demonstrates robust performance on the FUMPE dataset, achieving an AUROC of 0.927, sensitivity of 0.862, specificity of 0.879, and an F1-score of 0.805 with the Inception-v3 backbone architecture. Moreover, AG-CNN outperforms the baseline DenseNet-121 model, achieving an 8.1% AUROC gain. While previous research has mostly focused on finding PE in the main arteries, our use of cutting-edge object detection models and ensembling techniques greatly improves the accuracy of detecting small embolisms in the peripheral arteries. Finally, our proposed classifier-guided detection approach further refines the detection metrics, contributing new state-of-the-art to the community: mAP$_{50}$, sensitivity, and F1-score of 0.846, 0.901, and 0.779, respectively, outperforming the former benchmark with a significant 3.7% improvement in mAP$_{50}$. Our research aims to elevate PE patient care by integrating AI solutions into clinical workflows, highlighting the potential of human-AI collaboration in medical diagnostics.Comment: Published in Expert Systems With Application

Prevalence of overweight and obesity among saudi children: A comparison of two widely used international standards and the national growth references

ObjectiveTo compare three body mass index (BMI) classifications that are used to assess the prevalence of overweight and obesity among Saudi children aged 6–13 years: the International Obesity Task Force (IOTF) age and gender cutoffs, the World Health Organization (WHO) growth references for school-aged children, and the Saudi (KSA) national growth references.MethodsThe sample comprised 2,169 children (52.5% girls) derived from two cross-sectional studies conducted in Riyadh and Jeddah during the 2017 and 2019 school years, respectively. Body weight and height were measured, and BMI was calculated.ResultsThe proportions (%) of the participants who were classified as underweight, overweight, and obese varied according to the reference used: IOTF reference (13.8, 18.4, and 12.7), WHO reference (17.2, 19.1, and 18.9), and KSA reference (7.0, 22.4, and 9.3), respectively, indicating higher values for overweight and obesity prevalence when the WHO references were used. Kappa agreement measures between the three references were found to be high, with the coefficients ranging from 0.936 (between the IOTF and KSA references) to 0.849 (between the IOTF and WHO references). In all three classifications, girls exhibited lower overweight or obesity prevalence than boys. Family income, but not paternal or maternal education, was significantly (p = 0.015) associated with overweight/obesity when using the IOTF standards. In addition, having a small family in the house was significantly (p < 0.05) associated with obesity, irrespective of the classification system.ConclusionInconsistency was observed when estimating the prevalence of underweight, overweight, and obesity among Saudi children. However, when defining the overall prevalence of overweight plus obesity among Saudi children, the IOTF classification system performed in a similar way to the KSA references (31.1% versus 31.7%) compared to the WHO references (38.0%)

The Importance of Preventive Medicine in Family Practice: A Review of Current Guidelines and Recommendations

Prevention is seen as a critical topic in family practice. Primordial prevention, primary prevention, secondary prevention, tertiary prevention, and quaternary prevention are all part of this strategy to disease prevention. To avoid the formation and development of risk factors, primary prevention focuses on addressing the fundamental causes and social determinants of disease. Primary prevention is the practice of preventing illnesses before they arise via the use of treatments such as immunizations and health education. Secondary prevention focuses on illness identification and intervention as early as possible to avoid disease development. Tertiary prevention addresses illness outcomes by restoring health and offering rehabilitation. Finally, quaternary prevention seeks to safeguard patients against needless medical treatments and the harm caused by over-medicating. Risks frequently rise in tandem with frailty and comorbidities. In contrast, advantages frequently drop as life expectancy increases. Preventive management strategies should consider the patient's viewpoint and be mutually agreed upon. Healthcare providers must prioritize the deployment of preventive care services, even when clinical treatments are required, in order to overcome preventive care hurdles. Healthcare practitioners may play a critical role in illness prevention and contribute to family well-being by investing in preventive care and executing these measures

Left Main Coronary Artery Revascularization in Patients with Impaired Renal Function: Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting

Introduction: The evidence about the optimal revascularization strategy in patients with left main coronary artery (LMCA) disease and impaired renal function is limited. Thus, we aimed to compare the outcomes of LMCA disease revascularization (percutaneous coronary intervention [PCI] vs. coronary artery bypass grafting [CABG]) in patients with and without impaired renal function. Methods: This retrospective cohort study included 2,138 patients recruited from 14 centers between 2015 and 2,019. We compared patients with impaired renal function who had PCI (n= 316) to those who had CABG (n = 121) and compared patients with normal renal function who had PCI (n = 906) to those who had CABG (n = 795). The study outcomes were in-hospital and follow-up major adverse cardiovascular and cerebrovascular events (MACCE). Results: Multivariable logistic regression analysis showed that the risk of in-hospital MACCE was significantly higher in CABG compared to PCI in patients with impaired renal function (odds ratio [OR]: 8.13 [95% CI: 4.19–15.76], p < 0.001) and normal renal function (OR: 2.59 [95% CI: 1.79–3.73]; p < 0.001). There were no differences in follow-up MACCE between CABG and PCI in patients with impaired renal function (HR: 1.14 [95% CI: 0.71–1.81], p = 0.585) and normal renal function (HR: 1.12 [0.90–1.39], p = 0.312). Conclusions: PCI could have an advantage over CABG in revascularization of LMCA disease in patients with impaired renal function regarding in-hospital MACCE. The follow-up MACCE was comparable between PCI and CABG in patients with impaired and normal renal function

Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer

BackgroundRecent advance of endoscopic techniques has allowed surgeons to perform thyroidectomy via an incision placement at hidden places which lead to better cosmetic acceptability compared with conventional open thyroidectomy.AimsThis study was conducted to summarize the current evidence that compare open thyroidectomy with endoscopic ‎thyroidectomy in treatment of papillary thyroid cancer‎.‎Methods An electronic literature review, including PubMed, Google Scholar, and EBSCO that examining randomized trials of endoscopic thyroidectomy (ET), conventional open thyroidectomy (COT), and management of papillary thyroid carcinoma was carried out.Results The review included 8 randomized studies that compare total endoscopic thyroidectomy versus conventional open thyroidectomy in treatment of papillary thyroid cancer. The findings showed endoscopic thyroidectomy had statically significant cosmetic appearance, less amount of blood loss and occurrence of transient hypocalcaemia than conventional open thyroidectomy in form of cosmetic outcome, amount lower blood loss.ConclusionThe current review showed that, ET has a better cosmetic outcome and lower blood loss compared with COT. While COT was associated with significantly low operation time, hospital stay, drainage time, amount of drainage fluid and transient recurrent laryngeal nerve (RLN) palsy

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials.

Funder: laura and john arnold foundationBACKGROUND: Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX ). METHODS: In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung-Knapp-Sidik-Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. RESULTS: A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. CONCLUSIONS: Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions