A study investigating the level of satisfaction with the health services provided by the Pharmacist at ENT hospital, Eastern Region Alahsah, Kingdom of Saudi Arabia

AbstractThe current study aims to evaluate the patient’s level of satisfaction with health care services provided by the pharmacist at Aljaber ENT hospital, Eastern Region Alahsah, Kingdom of Saudi Arabia. A cross sectional study was planned from 1st March 2011 until 31st May 2011. A 27 item questionnaire was used, scoring of the responses was done to classify the patient satisfaction into sublevels. The maximum possible score was 36; those scoring less than twenty were graded as poor satisfaction level followed by moderate satisfaction level 21–25, good satisfaction level 26–30 and high satisfaction level 31–36. Statistical package for social science version 13® was used to analyze data, One-way ANOVA and independent sample t-test were applied to see the differences in the level of satisfaction. Every third patient visiting pharmacy was given a chance to participate in this study. A total of N=991 patients were randomized using the pharmacy appointment number. Of whom 657 patients have shown willingness to participate in this study. The response rate of this study was 66.30%, most of the respondents 383 (58.1%) were male ranging from the age group of 21–40years with a mean age of 32years SD 9.73. The mean score for all patients was 26.15 SD ±3.4. Among all the demographic variables a significant difference in satisfaction level was found among in terms of age (df=8, F=8.36, p=<0.001∗), gender (t=−4.089, df=656, p=<0.001∗) and race (df=2, F=8.47, p=<0.001. The satisfaction level among Saudi nationals was least in comparison to Egyptians and others. In general, it is seen that respondents of age 56–60years were most satisfied with the healthcare services provided by the pharmacist. In addition, the satisfaction level was higher among female patients in comparison to men

The Translation of God's Names in the Quran: A Descriptive Study

This thesis explores the translation of God’s names in the Quran. It centres around many of the common issues that the translators of divine attributes face. Since these are sensitive cultural items, translators should ideally give special treatment to divine designations. God’s names are not just stock names but rather they are nominalized adjectives with a descriptive content. As such divine names can enter into a variety of semantic relations such as synonymy, polysemy, hyponymy and hyperonymy (also termed ‘hypernymy’ and ‘superordinateness’). Divine names’ highly-nuanced semantic, syntactic and morphological makeup means that they require delicate treatment on the part of translators. Quran translators realize that God’s names are culture-bound terms and employ different techniques to give faithful renditions. Often they make use of an amalgamation of strategies to accurately reflect their meaning(s) and offset any loss thereof. By and large, literal translation seems to take a rather safe precedence over any other strategy, which gives a safeguard against any misrepresentation of divine attributes. Sometimes the presence of recognized or cultural equivalents is a sufficient warrant to depart from literal matches. This thesis shows how selected Quran translators exhibit varying degrees of consistency in their renditions of divine names, which may be attributable to the absence of hard-and-fast rules for the interlingual transfer of culturally laden lexemes. A convoluted issue that Quran translators face is how to tackle near-synonymous expressions. The situation is aggravated when they deal with divine names where near-synonymy exists in abundance. Quite often, the selected translators in this study have not been able to successfully replicate the more pronounced differences between near-synonymous divine names. Finding matchable polysemous items between languages is a familiar quandary that interpreters have to grapple with. Data in this study demonstrates how it is a taxing task trying to find a single item in English that bears the īe range of senses that a polysemous divine name has. Quran translators are often confronted with the task of picking up a single sense out of the multiple senses that the divine name can designate; the onus in such a pursuit is typically on the Quran exegeses. Usually, the primary (or literal) sense is the translators’ first port of call to the exclusion of any other secondary sense. It is uncommon to find a translator who is keen on conveying the semantic polyvalence of God’s appelations. In this way, Quran translators, inadvertently, do not do justice to the richness of the Quran text despite many readers’ eagerness to become illuminated about the various meanings of their Sacred Book. It is perhaps translators’ proclivity for brevity that is the overriding factor that has stopped them in their tracks. It is reasonable to assume that the brushing aside of (intended) secondary meanings of divine names by many Quran translators to chase ‘structural fidelity’ has come at the expense of more accurate glosses

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

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

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 middle-income 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 low-income 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 low-income, 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

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

Factors associated with glycemic control in type 2 diabetic patients in Saudi Arabia

Objective: To identify factors associated with glycemic control in type 2 diabetes mellitus patients in tertiary academic hospital. Research design and methods: This was a retrospective cross-sectional study of adults with type 2 diabetes mellitus. Data were extracted from the electronic health record (EHR) database for the period from 1st of January to 31st of December 2016. Participants were considered to have a glucose control if the HbA1c level was less than 7% [53 mmol/L]. Descriptive analysis and multivariable logistic regression model were performed to assess the factors associated with glycemic control. Results: A total of 728 patients were included in the study for which (65%) were female, and about 60% of the sample size was between 45 and 60 years old. Multivariate logistic regression model showed participants older than the age of 65 were less likely to have controlled diabetes compared to the younger participants (OR: 0.53 [CI: 0.30–0.93]). Moreover, those who had hypertension (OR: 0.61 [CI: 0.43–0.86]) and dyslipidemia (OR: 0.53 [CI: 0.38–0.74]) were less likely to have controlled diabetes, while those with asthma (OR: 2.06 [CI: 1.16–3.68]) were more likely to have controlled diabetes. The model also showed that vitamin D deficiency was not associated with glycemic control in type 2 diabetes patients (OR 0.80 [95% CI 0.58–1.12]). Conclusion: These findings highlighted the need for appropriate management in older adult patients to prevent the complication of type 2 diabetes. Furthermore, attention should be exercised for patients with factors associated with poor glycemic control such as hypertension and dyslipidemia. Keywords: Saudi Arabia, Type 2 diabetes, Factor

The Possibility of Using Superconducting Magnetic Energy Storage/Battery Hybrid Energy Storage Systems Instead of Generators as Backup Power Sources for Electric Aircraft

The annual growth rate of aircraft passengers is estimated to be 6.5%, and the CO2 emissions from current large-scale aviation transportation technology will continue to rise dramatically. Both NASA and ACARE have set goals to enhance efficiency and reduce the fuel burn, pollution, and noise levels of commercial aircraft. However, such radical improvements require radical solutions. With the current traditional aircraft designs based on gas turbines or piston engines, these goals are infeasible. Small-scale aircraft have successfully proven emission reductions using energy storage systems, such as Alice aircraft. This paper involves an investigation of the possibility of using superconducting magnetic energy storage (SMES)/battery hybrid energy storage systems (HESSs) instead of generators as backup power sources to improve system efficiency and reduce emissions. Two different power system architectures of electric aircraft (EA) were compared in terms of reliability and stability in a one-generator failure scenario. As weight is crucial in EA designs, the weights of the two systems were compared, including the generators and energy storage systems. The two EA systems were built in Simulink/MATLAB to compare their reliability and stability. With the currently available technologies, based on the energy density of 250 Wh/kg for lithium-ion batteries and a power density of 8.8 kW/kg for generators, the use of the generators as backup sources proved more efficient than the use of HESS. The break-even point was observed at 750 Wh/kg for battery energy density. Any value more than the 750 Wh/kg energy density makes HESS lighter and more efficient than generators

Impact of Copper Stabilizer Thickness on SFCL Performance with PV-Based DC Systems Using a Multilayer Thermoelectric Model

Utilizing renewable energy sources (RESs) to their full potential provides an opportunity for lowering carbon emissions and reaching a state of carbon neutrality. DC transmission lines have considerable potential for the integration of RESs. However, faults in DC transmission lines are challenging due to the lack of zero-crossing, large fault current magnitudes and a short rise time. This research proposes using a superconducting fault current limiter (SFCL) for effective current limitation in PV-based DC systems. To properly design an SFCL, the present work investigates the effect of copper stabilizer thickness on SFCL performance by using an accurate multilayer thermoelectric model. In the MATLAB/Simulink platform, the SFCL has been modeled and tested using different copper stabilizer thicknesses to demonstrate the effectiveness of the SFCL model in limiting the fault current and the impact of the copper stabilizer thickness on the SFCL’s performance. In total, four different thicknesses of the copper stabilizer were considered, ranging from 10 μm to 80 μm. The current limitation and voltage profile for each thickness were evaluated and compared with that without an SFCL. The developed resistance and temperature profiles were obtained for various thicknesses to clarify the mechanisms behind the stabilizer-thickness impact. An SFCL with an 80 µm copper stabilizer can reduce the fault current to 5.48 kA, representing 71.16% of the prospective current. In contrast, the fault current was reduced to 27.4% of the prospective current (2.11 kA) when using a 10 µm copper stabilizer