Nature of Implementing Response to Intervention in Fourth Grade

The ultimate goal of this concurrent embedded mixed-method study was to describe the implementation of Response to Intervention (RTI) and understand the role of Response to Intervention at the fourth-grade elementary school level on the academic performance. This study examined both qualitative and quantitative data. In the qualitative phase, a case-study method was utilized by collecting data in the form of interviews, observations, and corresponding data collection. The quantitative data examined student data based on progress monitoring in math and reading. The researcher analyzed and graphed the students’ data to determine a trend of student performance when provided with Response to Intervention services. From the qualitative phase, the researcher identified four major themes: Response to Intervention Implementation; Response to Intervention Evaluation and Identification; Collaboration; and the Participants’ Preparation for Response to Intervention. In the quantitative phase, the researcher found two general patterns of change on the students’ data. These patterns were growth and non-growth. The findings showed that general education teachers, special education teachers, and interventionists supported the implementation of Response to Intervention and its processes. The quantitative data reflected the successful practices of practitioners engaged in the implementation of Response to Intervention. The data showed that students did not fall further behind when they received interventions within the Response to Intervention framework. The interpretation of these findings led the researcher to examine the future implications for practitioners of Response to Intervention and policy makers. Overall, there was a need for further research into the implementation of Response to Intervention, how behavior should be included into the Response to Intervention framework, and the importance of in-depth quality training and professional development for educators. Keywords: Response to Intervention, progress monitoring, mixed-method, RTI Implementation

Effective stakeholder engagement in variation order management at the design stage of public sector construction projects in Saudi Arabia

Variation orders affect the progress of any construction project and can be one of the main factors which may cause failure in delivering a project successfully. It is relatively difficult to deliver a project without any variation orders, which are most likely to occur at the design stage. Variation orders are complex in nature, as they involve the key stakeholders, together with a lot of information that needs to be requested, sent, checked, corrected, approved, clarified, transmitted or submitted, among many other processe. This research aims to develop a model that better manages variation orders in Saudi public construction projects in the design stage by engaging the stakeholders effectively in the process of the variation order management, to save the management time for the variation, improve the communication and relationships among stakeholders and avoid disputes and conflicts. The methodology used to achieve the research aim, influenced by the pragmatic views of the researcher, combined several methods. A series of exploratory interviews investigated the current practice of variation order management in Saudi public construction projects, with its strengths and weaknesses. Then, a questionnaire survey measured the level of power and interest of the different stakeholders in order to develop a model for best practice. Finally, focus group sessions validated the performance and concept of the developed model. The findings indicate that there are currently no formalised approaches to the management of variation orders at the design stage. In addition, there is a general lack of knowledge about managing variation orders. However, the conceptual model of common practice, based on these responses, can be divided into six main stages: identifying the variation order, analysing and evaluating variation orders, estimation, approval, implementation and documentation. Furthermore, the findings reveal a need to develop an appropriate variation order management system in the Saudi construction industry, due to the present lack of stakeholder engagement. A model for best practice of variation order management was then developed. The developed model determines the levels of power and interest, location and position for each stakeholder involved in the process of variation order management. The outcomes of the validation workshop were very positive from the participants. However, the participants put forward some recommendations, which were applied in the final version of the model

The Determinants of Physical Activity, Self-Monitoring of Blood Glucose, and Poor Glycemic Control Among Individuals Diagnosed With Type 2 Diabetes in Saudi Arabia: A Cross-Sectional Study Based on the Saudi Health Interview Survey (SHIS)

The prevalence of diabetes and poor glycemic control in Saudi Arabia has increased that contributed to the growing number of deaths in Saudi Arabia. It is known that type 2 diabetes (T2DM) can be prevented but there is a lack information about the magnitude of the of diabetes at national level as well as the risk factors for physical activity (PA), self-monitoring of blood glucose (SMBG), and poor glycemic. Thus, through utilizing Health promotion model (HPM), the aims are to examine the personal factors, cognitive-perceptual, and behavioral determinants of three outcomes; physical activity, SMBG, and poor glycemic control. A secondary data (Saudi health interview survey-2013) was used with two sample sizes for examining PA and SMBG (808 participants who reported to have T2DM and were 18 year or older) and poor glycemic control (391 participants who reported to have T2DM and had data about their blood glucose level) outcomes. Bivariate and multivariate logistic regression were conducted to address the research questions at alpha level of 0.05. The results showed that the prevalence of physical activity, SMBG, and poor glycemic control, were 9.1%, 55.4%, and 34%, respectively. Younger age (Adjusted odds ratio [AOR] = 2.84), and higher education (AOR = 3.14) were associated with PA, while health professional support for treatment (HPST) was inversely associated with PA (AOR = 0.35). Factors associated with SMBG were obesity (Adjusted prevalence ratio [APR] = 1.20), middle (APR = 1.30) and higher (APR =1.49) education, while shorter diabetes duration (AOR = 0.78 for \u3c 5 years and 0.78 for 5-9 years) and Eastern region (AOR = 0.66) were inversely associated with SMBG. For poor glycemic control, the only predictor was Eastern region (AOR = 1.55) compared to the Central region. Further analysis showed that region of residence, education, diabetes duration, and age were prominent predictors of all cognitive-perceptual and behavioral outcomes. The study suggested individualizing plan of care for diabetic patients due to disparity in the personal factors. The study supported the urgent change in the healthcare system to adapt healthcare professional team-based care. Finally, longitudinal studies at both national and regional levels are needed to determine the causal relationship focusing on both personal and psychological factors

Blended social network to promote citizen preparedness and engagement in sustainability

The overall aim of this research is to devise a climate change engagement modelling with an associated platform that would contribute to successfully engage the public and prompt them to move away from anti-environmental behaviour and closer to a sustainable lifestyle. The research model relies on the creation of new types of online social networks (‘Blended Social Network (BSN)), which comprises the new type of online social network with featured ICT techniques, including: context-aware user profiling, individual social marketing, social learning, location-based services and the ‘attraction modules’. The new model are able to support a bottom-up approach through adopting persuasive techniques that will likely lead to an enhanced public acceptance of environmental sustainability. The methodology design has four main phases, which are the literature review and conceptual model development, followed by three empirical stages: the empirical field study of public perceptions survey, development of prototype platform and the testing and validation of the conceptual model of the study. The first phase undertaken: (i) to identify a gap in the research, conceptualise a research engagement model, identify the key perception constructs that are used in phase two of this research, formulate the comprehensive theoretical validation framework to check the validity of the conceptual model, and measure the influence of the model on people’s intentions to change negative behaviour to be compatible with a sustainable lifestyle. In the second phase, the large survey (n=1173), was conducted to investigate public perception to provide information about public understanding towards sustainability issues and their perceptions related to components of the conceptual model in general. The outcomes were employed to underpin the model with necessary aspects of engagement in local context and revised it to reflect the real situation. In the phase three, a new prototype ‘Blended Social Network’ (BSN) platform was developed to assist and enable the researcher to explain and validate all of the concepts involved in the conceptual model. The prototype platform was used to assess the capability of the BSN platform to engage people to adopt a new and sustainable lifestyle. The research hypotheses, thesis conceptual model, and its components were assessed and validated using both quantitative and qualitative approaches. The findings of the empirical study reveal that the conceptual model, is preliminarily accepted by the respondents and has potential positive effects to bridge most of the apparent barriers. For instance, the Blended Social Networks and the ICT modules proposed in this research model may assist people in overcoming most of the obstacles regarding cognition, affective and intention to change behaviour attributes including facilitating conditions and perceived behaviour control. This provides evidence of the significant role of the proposed the BSN platform and the ICT techniques in engaging people toward sustainability. The detailed validation results of this study show that the three engagement constructs considered in the model account for 71% of the dependent variable of users’ preparedness to engage, relying on the use of the BSN itself, 69% for the dependent variable of users’ preparedness to engage relying on Context-aware technique, 72.8% rely on Place-based technique, 51.3% rely on Social learning technique,73.2% rely on Individual social marketing technique, 34.5% rely on Profile-sustainable-labelling technique, 69.2% rely on Participate-current-trends technique and 76.2% rely on the Permanent-incentive technique within the integrated BSN. Variance in a person’s perceptions towards the overall effect of innovation on preparedness to engage was entirely explained by cognitive (ranging between 39.2% and 69.1%), affective factors (ranging between 37.9% and 72.0%) and the intention to change behaviour (ranging between 37.6% and 73.9%)

Smoking Tobacco Prevalence Among College Students in the Kingdom of Saudi Arabia: Systematic Review and Meta-Analysis

INTRODUCTION: During the last two decades, several studies have been published regarding the prevalence of tobacco smoking among college students in the Kingdom of Saudi Arabia (KSA). This systematic review and meta-analysis is intended to determine and examine the smoking prevalence in Saudi college students from 2010-2018. METHODS: PubMed, Science Direct, APA PsycNET, Web of Science, and CINAHL were used to search for published articles reporting the smoking prevalence among Saudi college students. After eliminating irrelevant articles, investigators independently assessed the quality of each article, based on Russell & Gregory guidelines. MetaXL software was used to calculate the pooled prevalence among included studies, using the IVhert model. Heterogeneity among the included studies was evaluated, using I2 statistic. Sensitivity analyses were conducted between male and female genders. RESULTS: Of the 295 published articles, 29 articles used a cross-sectional design to determine smoking prevalence among Saudi college students. Most of the studies were conducted in Riyadh at health-science-related colleges; the rest were performed in different cities and colleges. The meta-analysis showed that the pooled estimate of smoking prevalence among college students in the KSA was 17% (95% CI: 11-23%). Saudi male students had a prevalence rate of 26% (95% CI: 24-29%), whereas for Saudi female students the prevalence was 5% (95% CI: 3-7%). CONCLUSIONS: Smoking among Saudi college students was higher than in the majority of regional countries (e.g. Iran). Saudi male students had a higher smoking prevalence than Saudi female college students. Additionally, studies that reported a high prevalence targeted students in specific disciplines. Public health authorities in the KSA should develop a surveillance system that monitors the prevalence of tobacco smoking on campuses. A surveillance system of monitoring tobacco use among Saudi college students could be beneficial in determining the degree of the tobacco problem and in improving current tobacco control programs

Role of human interleukin-17 producing T cells (Th17) and regulatory (Foxp3+) T cells in graft versus host disease (GvHD)

Allogeneic stem cell transplantation (AHSCT) remains the only curative option for a number of patients with haematological malignancies. The interplay between a number of T cell subsets including Th1, Th2, Th17 and regulatory-T cells (Treg) has been linked to the establishment of graft-versus-leukaemia (GvL) as well as its deleterious counterpart graft-versus-host-disease (GvHD). A recent study defined a subset of memory antigen-specific CD8+T cells, with the ability to efflux cytotoxic drugs through the (ABC)-superfamily multidrug efflux complex. I hypothesized that a subset of CD4+T cells, capable of drug efflux through the MDR pump also exists. I confirmed the existence of CD4+T cells with "stem-like" properties, capable of rapidly effluxing Rhodamine123 as well as cytotoxic drugs such as daunorubicin. I confirmed that the effluxing properties of these cells are through ABCB1 and ABCC1 transporters. Similar to their CD8 counterpart, the rhodamine-effluxing subset of CD4+T cells had a memory phenotype and was enriched within the CD161+T cell compartment. Lastly, using CMV and Flu as model antigens, I showed that viral-specific memory CD4+T cells are enriched within the rhodamine-effluxing CD4+CD161+T cell population. Once I characterized these cells, I hypothesized that, through effluxing corticosteroids and other immunosuppressant drugs,CD161+CD4+ T cells may also play a role in acute GvHD. CD161+CD4+ T cells are precursors of Th17 cells. I demonstrated that, whereas Tregs are prone to apoptosis when exposed to corticosteroids, CD4+CD161+Th17 cells rapidly efflux and survive exposure to corticosteroids and other immunosuppressive drugs in vitro. Inhibition of the ABCB1 and ABCC1 with inhibitors such as vinblastine induced apoptosis of this CD4+CD161+Th17 steroid-refractory T cell subset. I observed that patients with steroid-refractory GvHD had significantly higher frequencies of CD161+CD4+ T cells compared to patients with no or steroid-responsive GvHD. I also enumerated CD161+CD4+ T cells and Foxp3+T cells in the stem cell graft and donor lymphocytes and found an association between higher CD4+CD161+ and lower Foxp3+T cells frequencies and the risk of GvHD post-transplant. These data advance our understanding of potential mechanisms of steroid-refractory GvHD and have important implications for the development of novel therapeutic approaches for the treatment of this challenging group of patients

The Risk Factors for Self-Monitoring of Blood Glucose Among Individuals Diagnosed with Type 2 Diabetes in Saudi Arabia

Background: Lack of self-monitoring of blood glucose (SMBG) is a known risk factor for controlling type 2 diabetes mellitus (T2DM). Nevertheless, little research has been conducted on SMBG among Saudis with T2DM. Aim: The study aimed to investigate personal and cognitive-perceptual factors for SMBG among Saudis with T2DM guided by Health Promotion Model. Methods: A cross-sectional study was conducted with a sample size of 808 Saudi adults with T2DM utilizing secondary data from the Saudi Health Interview Survey for 2013. Statistical Analysis: Bivariate and multivariate logistic regressions were applied to examine the risk factors for SMBG among Saudis with T2DM. Results: The prevalence of SMBG was 55.5% in Saudi adults with T2DM. In the multivariate analysis, obesity (adjusted prevalence ratio [APR] = 1.20), middle (APR = 1.30) and higher (APR = 1.49) education where predictors of SMBG, whereas shorter diabetes duration (APR = 0.78 for \u3c5 years and 0.78 for 5–9 years) and Eastern region (APR = 0.66) were inversely associated with SMBG. Conclusions: The study suggested the future design of interventional programs related to self-care practices should focus on diabetic individuals with low education, obesity, and longer duration of diabetes, and regional differences, specifically when considering limited access to health care during the COVID-19 pandemic. In addition, longitudinal studies with a large sample size at national and regional levels are needed to further examine the personal and psychological risk factors in Saudis with T2DM

Body composition, blood pressure and dietary habits among young qatari male adults

Introduction: Due to a rapidly changing lifestyle in Qatar, determinants of non-communicable diseases and linked levels of risk factors have risen. These facts pose a national challenge (1). Information about Qatari adults` (19-30yr.) dietary habits is essential because of the increase in the incidence and prevalence of obesity in Qataris. In 2006, the percentage of Qatari boys who are overweight and obese is 28.6%, and 7.9%, respectively (3). Aim of this study was to determine body composition, blood pressure and dietary habits of the next cohort, those 18-29 yrs old. Methods: 80 Qatari male students, 18-29 yrs of age, from Qatar University (QU) participated. Blood pressure (BP) was measured by Omron HEM-780, body composition (body weight and percent of body fat (BF), were measured by OMRON BF-400. Dietary habits were evaluated using the NHANES Food Frequency Questionnaire. For data analysis, Chi-square test and univariate analyses of variance were conducted using SPSS version 20. Results: The mean systolic and diastolic BP was 128.6±1.42 mmHg, 73.32±1.1 mmHg, respectively. The mean arterial pressure (MAP) was 91.74±1.06 mmHg. The mean BF is 23.79±1.19%. 30.77% of the subjects were classified as overweight, 38.46% as obese. The crosstab statistical analyses yielded a difference between fast food (FF) vs. seafood (SF) consumptions (p=.007). No statistical difference between vegetables consumption vs. pasta intake occur. However, the subjects` soda consumption was greater than fruit juices (p=.05). The BF is expressed by an interaction between salad and SF consumption, p=.047, ηp2=.409, but these main effects are not qualified by a separate interaction on BF (p=.234, ηp2=.181 vs. p=.34, ηp2=.149, respectively). No interaction was found between FF, SF or sweets and blood pressure values. Conclusion: Obesity is uniformly considered to be the most important factor in developing non-communicable diseases in Qatar (2). Our study supports the results. In our sample, the prevalence of overweight and obesity was higher compared to previously published studies. No correlation between dietary habits and MAP occurred though, due to the wide range of nutrients consumed. High caloric diets are prevalent among QU students

Chitogel with deferiprone following endoscopic sinus surgery: improved wound healing and microbiome

BackgroundAdhesion formation, sinus ostial narrowing, and presence of pathogenic bacteria are associated with poor outcomes following endoscopic sinus surgery (ESS) for chronic rhinosinusitis. Chitogel has been shown to improve wound healing, restore a healthier microbiome, and reduce post-operative infections post ESS. Deferiprone has antibacterial properties and has been shown to reduce adhesion formation. The aim of the study was to assess whether the addition of low concentration deferiprone to Chitogel further improves surgical outcomes following ESS compared with Chitogel alone.MethodsIn this double-blinded trial, 45 patients undergoing ESS were prospectively recruited. At the end of the surgery, patients were randomised to receive Chitogel alone, Chitogel with 1 mM of deferiprone, or Chitogel with 5 mM of deferiprone to one side of the sinuses (allowing the other side to serve as control). Patients underwent routine follow-ups with symptom questionnaires and nasoendoscopies performed at 2, 6, and 12 weeks post-operatively. Sinus ostial measurements, microbiology, and microbiome swabs from bilateral middle meatuses were collected intraoperatively and at 12 weeks post-operatively.ResultsA significant improvement in the endoscopic appearance of the sinuses and frontal ostial patency was noted at 12 weeks post-operatively (p < 0.05) in all three treatment groups compared with the control. There was no significant difference noted between patients who received Chitogel alone and those who received Chitogel with 1 or 5 mM deferiprone.ConclusionChitogel alone, Chitogel with 1 mM deferiprone, and Chitogel with 5 mM deferiprone used following ESS led to a significant improvement in endoscopic appearance of the sinuses and frontal ostial preservation at 12 weeks post-operatively. No significant difference was found with the addition of deferiprone to Chitogel

Evidence for B cell exhaustion in chronic graft-versus-host disease

Chronic graft-versus-host disease (cGvHD) remains a major complication of allogeneic hematopoietic stem cell transplantation (HSCT). A number of studies support a role for B cells in the pathogenesis of cGvHD. In this study, we report the presence of an expanded population of CD19+CD21− B cells with features of exhaustion in the peripheral blood of patients with cGvHD. CD21− B cells were significantly increased in patients with active cGvHD compared to patients without cGvHD and healthy controls (median 12.2 versus 2.12 versus 3%, respectively; p < 0.01). Compared with naïve (CD27−CD21+) and classical memory (CD27+CD21+) B cells, CD19+CD21− B cells in cGvHD were CD10 negative, CD27 negative and CD20hi, and exhibited features of exhaustion, including increased expression of multiple inhibitory receptors such as FCRL4, CD22, CD85J, and altered expression of chemokine and adhesion molecules such as CD11c, CXCR3, CCR7, and CD62L. Moreover, CD21− B cells in cGvHD patients were functionally exhausted and displayed poor proliferative response and calcium mobilization in response to B-cell receptor triggering and CD40 ligation. Finally, the frequencies of circulating CD21− B cells correlated with cGvHD severity in patients after HSCT. Our study further characterizes B cells in chronic cGVHD and supports the use of CD21−CD27−CD10− B cell frequencies as a biomarker of disease severity