Universal Principles of Bioethics and Patient Rights in Saudi Arabia

In order to keep pace with international bioethical practices, and with international bioethical declarations, this dissertation will investigate challenges facing patients’ rights discourse in Saudi Arabia, and the adaptation of universal bioethics standards in the Saudi healthcare system. The role of religion and issues of human rights will be discussed further, given that religion and human rights affect patient’s rights profoundly. Specifically, the divergence between religious dictations and the secular language of human rights principles will provide a distinctive perspective on patients’ rights discourse, especially in a country such as Saudi Arabia where religion is integral to the national foundations, and were customs are vividly alive. This dissertation will examine patients’ rights as practiced in an international context in order to compare Saudi bioethics practices to other bioethics systems, while pinpointing the strengths and limitations. In addition, Saudi practices concerning patient’s rights are compared to the universal principles of bioethics, to show the variation between the existing and the desired ideal practices. Furthermore, this dissertation will highlight the organizational and cultural challenges that decrease the possibility for the full adoption of patients’ rights in Saudi hospitals in order to analyze the problems and formulate recommendations for future action. This study carries with it presumed significance as one of a few analyses of patients’ rights in one of the least studied countries in the field of bioethics, Saudi Arabia

The Nature of Difficulties in Learning English by the students at Secondary School level in Pakistan

This study was a comparative investigation into the nature of difficulties in learning English by the secondary school students of Provincial and Federal government schools in N.W.F.P (Khyber Pukhtunkhwa). The objectives of the study were (1)To find out the level of difficulties of secondary school students of Provincial and Federal government schools of N.W.F.P (Khyber Pukhtunkhwa) in tenses, active and passives voices, direct and indirect narrations, conjunctions, prepositions, articles, construction of sentences and reading with comprehension and (2)To compare the level of difficulties in learning English as a second language at secondary level of Provincial and Federal government schools in N.W.F.P (Khyber Pukhtunkhwa). The sample of the study was comprised of 654 randomly selected students from twenty four Provincial government schools and twenty two Federal government schools located in twenty four districts of N.W.F.P. (Khyber Pukhtunkhwa). An English language achievement test for secondary classes was administered to the sample students of the study. The data obtained were tabulated and analyzed through SPSS 17.0 software to compute mean, standard deviation, t-value and p-value (significance) level. The main findings of the study were; the students of Provincial government schools faced more difficulties in learning of verb forms, narration, conjunctions, prepositions, articles, sentence arrangements and reading comprehension. The students of both types of schools systems faced same difficulties in learning voices. Key words: Nature of Difficulties, Tenses, Voices, Narrations, Conjunctions, Prepositions, Articles

Adherence of Umm Al-Qura University Dental Students to Infection Control Guidelines: A Four Year – Auditing Report

BACKGROUND: Infection control auditing is an objective quality improvement process that evaluates current practice against already available standards and guidelines. AIM: The aim of the study was to assess the adherence of Umm Al-Qura University dental students to infection control guidelines by 4 years’ clinical auditing. MATERIALS AND METHODS: A cross-sectional observational study of audit checklists (n = 40725) at Dental Teaching Hospital, Umm Al-Qura University, throughout 4 academic years (2015–2018) was performed. Checklists item, total category, and overall adherence percentages were calculated based on recorded observations. The difference in adherence and violations was assessed using generalized estimating equations with the identity logit and an autoregressive correlation matrix. RESULTS: Overall adherence to all checklist categories was high except for 10–45% got out of the cubicle with used gloves and 15–60% not probably wore mask outside the cubicle. Overall violations among females were highly statistically significant lower than males (OR: 0.926, p < 0.01) and 4th grade were statistically significant lower than among 6th grade (OR: 0.932, p < 0.05) while no statistically significant difference in overall violation among 5th grade in comparison to 6th grade. However, along the 4 years of the study, statistically significant difference in overall violations was observed. CONCLUSION: Adherence of Umm Al-Qura University dental students to infection control guidelines in the past 4 years remained consistently high except for attitude in the clinic station outside the cubicle which improved along study years. Our results highlight the importance of continuous monitoring through clinical audits together with educational programs and counseling with students violating infection control policies to make corrective actions

Failure, Repair and Overhaul of 5 MW Right Angle Reduction Gear Box

Case StudiesL-1403A &B are 5 MW Right Angle –Double reductions gearboxes installed between Turbine (TP-1403) and Cooling water Pump (P-1403). Both gearboxes reported high vibration after 15 months of continuous operation one after the other. Vibration had a continuous increasing trend. CSI® was used to check the gearboxes that both showed looseness spectrum. During inspection of L-1403 B Gear Box, broken tooth of LS Bevel Gear was observed. While L-1403 A inspection revealed pitting on HS gears. Gearboxes were repaired in house by increasing interference of bevel pinion with shaft

Radiological and clinical outcomes in patients undergoing anterior cervical discectomy and fusion: Comparing titanium and PEEK (polyetheretherketone) cages

Objectives: To study clinical and radiological outcomes in patients who had undergone the procedure of anterior cervical discectomy and fusion with titanium or PEEK (polyetheretherketone) cages for cervical disc prolapse.Methods: This is a retrospective/non-randomized study which was conducted at the Combined Military Hospital Peshawar. Study interval was four years from 1st October, 2010 to 31st September, 2014. Total number of included patients were 149. All of the patients had undergone the procedure of anterior cervical discectomy and fusion with titanium or PEEK (polyetheretherketone) cages. All of the patients had plain MRI cervical spine done for diagnosis of anterior cervical disc prolapse.Results: Most of the patients had stenosis at the C5 / C6 (PEEK cage group 63% and titanium cage group 47.6%) and C6 / C7 (PEEK cage group 15.38% and titanium cage group 19.04%) cervical level. Bi-level involvement was also seen. In the patients who complained of brachialgia, total resolution of symptoms was seen after the operation. Three (2.01%) of the patients in titanium cage group, who presented with axial neck pain, continued to complain of pain after the operation. Four (2.6%) of the patients in PEEK (polyetheretherketone) cage group and 2 (1.3%) in titanium cage group complained of pain at the donor site (iliac crest). Fusion rate was 100% with both titanium and PEEK (polyetheretherketone) cages at one year.Conclusion: Results with titanium and PEEK (polyetheretherketone) cages are excellent. There was no significant difference in clinical and radiological outcome between two groups of patients (p \u3e 0.05). Fusion rate was 100% at one year with both cages

Assessment of genetic diversity and genetic characterization of Nili Ravi buffalo breed utilizing microsatellite markers

Background: Livestock contribution to Pakistan’s GDP is 11.2% and it engages 8 million of rural families for their livelihood. Estimated population of buffalo is 40.00 million heads in Pakistan mostly consisting of low genetic worth population resulting in low productivity and pressure on natural resources. Assessment of genetic diversity and genetic characterization of indigenous livestock resources is an essential step towards conservation and to gauge effects of various breed improvement efforts on population genetics.Methods: In present study genetic diversity of Nili Ravi buffalo population was assessed. A total of 196 unrelated Nili Ravi buffaloes from Punjab, Pakistan were sampled in this study. Genomic DNA was extracted and subjected to amplification using FAO recommended 12 Short Tandem Repeats (STRs) microsatellite markers. Among 12 microsatellite loci, 11 were successfully amplified (TGLA227, BM2113, ETH10, SPS115, TGLA126, TGLA122, INRA23, BM1818, ETH3, ETH225 and BM1824) whereas microsatellite locus TGLA53 was not amplified. Amplicons were resolved by genetic analyzer instrument and gene mapper software. Allele count, frequencies, gene diversity, heterozygosity, polymorphic information content (PIC) and linkage disequilibrium values were calculated by using Microsatellite toolkit v3 and Power Marker version 3.25.Results: A total of 96 alleles were detected in 196 samples with average of 8.73 alleles per locus and range of 5 alleles (ETH 3) to 18 alleles (ETH 225) per locus. Gene diversity ranged from 0.198 (BM1824) to 0.841 (ETH225), observed heterozygosity values ranged from 0.081 (ETH10) to 0.831 (BM2113) and PIC values ranged from 0.191 (BM1824) to 0.825 (ETH225).Conclusion: This study which will serve as a baseline to understand genetic dynamics of Nili Ravi buffalo breed. Highly polymorphic nature of STR markers will help in understanding effects of various breed improvements efforts on genetic diversity of Nili Ravi breed in future studies.Keywords: Microsatellite; STR; Nili Ravi Buffalo; Genetic Characterization; Punja

Tinea capitis in adults: not so rare

Background: Tinea capitis is the dermatophyte infection of the scalp with varied clinical presentation. Tinea capitis is predominantly seen in preadolescent adults and is rare in adults. Growing number of authors have reported increase in incidence among adults. Clinical presentation in such case is often atypical leading to delay in diagnosis.Methods: The study included all patients older than 18 years. Informed consent was obtained from all patients. Clinical material was microscopically examined with the use of 20% KOH for hyphae and arthroconidia. The Samples were also inoculated on Sabourauds Agar and Mycosel Agar for 15 days. For each patient we collected information about sex, menstrual status, predisposing factor, symptoms and etiological agent.Results: Out of 457 cases of tinea capitis 14 patients were adults and represented 3.06% of all cases. All patients were females. The most common etiological agent was T. violaceum (35%), followed by T. mentagrophytes (21.43%), T. tonsurans (14.29%), T. rubrum (14.29%) and T. schoenleinii (14.29%).Conclusions: Tinea capitis in adults is not so rare, particularly in post-menopausal women. The presentation is often atypical mimicking other inflammatory conditions of scalp and should be included as a differential diagnosis of inflammatory conditions not responding to conventional treatment

Estimation of Serum Potassium and Calcium Concentrations from Electrocardiographic Depolarization and Repolarization Waveforms

Chronic kidney disease (CKD), a condition defined by a gradual decline in kidney function over time, has become a global health concern affecting between 11 and 13% of the world population [1]. As renal function declines, CKD patients gradually lose their ability to maintain normal values of potassium concentration ([K+]) in their blood. Elevated serum [K+], known as hyperkalemia, increases the risk for life-threatening arrhythmias and sudden cardiac death [2].An increase in serum [K+] outside the physiological range is commonly silent and is only detected when hyperkalemia is already very severe or when a blood test is performed. Maintenance and monitoring of [K+] in the blood is an important component in the treatment of CKD patients because therapies for hyperkalemia management in CKD patients are designed to prevent arrhythmias and to immediately lower serum [K+] to safe ranges. However, this is currently only possible by taking a blood sample and is associated with a long analysis time. Therefore it is useful to have a simple, noninvasive method to estimate serum [K+], particularly using the electrocardiogram (ECG). Indeed, variations in serum electrolyte levels have been shown to alter the electrical behavior of the heart and to induce changes in the ECG [3¿6]. However, large inter-individual variability existsin the relationship between ion concentrations and ECG features. Previous attempts to estimate serum [K+] from the ECG have therefore shown limitations [7¿9], such as not being applicable to some common types of ECG waveforms or relying on specific ECG characteristics that may present large variations not necessarily associated with hyperkalemia.The aim of this thesis is to develop novel estimates of serum [K+] that are robust enough to detect hypokalemia (reduced [K+]) or hyperkalemia in a timely manner to provide life-saving treatment. Additionally, the effect of changes in other electrolyte levels, like calcium concentration ([Ca2+]), and in heart rate are investigated. These aims are achieved by combining novel ECG signal processing techniques with in silico modeling and simulation of cardiac electrophysiology.The specific objectives are:1. Characterization of hypokalemia or hyperkalemia and hypocalcemia (reduced [Ca2+]) or hypercalcemia (elevated [Ca2+])-induced changes in ventricular repolarization from ECGs (T wave) of CKD patients. This is addressed in chapter 3 and chapter 4. In these chapters, we describe how T waves are extracted from ECGs and how we characterize changes in T waves at varying potassium, calcium and heart rate using analyses based on time warping and Lyapunov exponents. Next, univariable and multivariable regression models including markers of T wave nonlinear dynamics in combination with warping-based markers of T wave morphology are built and their performance for [K+] estimation is assessed.2. Characterization of hypo- or hyperkalemia and hypo- or hypercalcemia-induced changes in ventricular depolarization from the QRS complex of CKD patients. This is reported in chapter 5. In this chapter, we present how QRS complexes from ECGs of CKD patients are processed and how we measure changes at varying [K+], [Ca2+] and heart rate. Univariate and multivariate regression analyses including novel QRS morphological markers in combination with T wave morphological markers are performed to assess the contribution of depolarization and repolarization features for electrolyte monitoring in CKD patients.3. Identification of potential sources underlying inter-individual variability in ECG markers in response to changes in [K+] and [Ca2+]. In silico investigations of cardiac electrophysiology are conducted and ECG features are computed. Simulation results are compared with patient data. This is explained in chapter 3 using one-dimensional (1D) fibers and in chapter 6 using three-dimensional (3D) human heart-torso models. Chapter 6 includes the development of a population of realistic computational models of human ventricular electrophysiology, based on human anatomy and electrophysiology, to better understand how changes in individual characteristics influence the ECG (QRS and T wave) markers that we introduced in previous chapters. ECG waveforms are characterized by their amplitude, duration and morphology. Simulations are performed with the most realistic available techniques to model the electrophysiology of the heart and the resulting ECG. We establish mechanisms that contribute to inter-individual differences in the characterized ECG features.In conclusion, we identify several markers of ECG morphology, including depolarization and repolarization features, that are highly correlated with serum electrolyte (potassium and calcium) concentrations. ECG morphological variability markers vary significantly with [K+] and [Ca2+] in both simulated and measured ECGs, with a wide range of patterns observed for such relationships. The proportions of endocardial, midmyocardial and epicardial cells have a large impact on ECG markers, particularly for serum electrolyte concentrations out of their physiological levels. This suggests that transmural heterogeneities can modulate ECG responses to changes in electrolyte concentrations in CKD patients. Agreement between actual potassium and calcium levels and their estimates derived from the ECG is promising, with lower average errors than previously proposed markers in the literature. These findings can have major relevance for noninvasive monitoring of serum electrolyte levels and prediction of arrhythmic events in these patients.<br /

Meta-analysis of honey bee neurogenomic response links deformed wing virus type A to precocious behavioral maturation

Crop pollination by the western honey bee Apis mellifera is vital to agriculture but threatened by alarmingly high levels of colony mortality, especially in Europe and North America. Colony loss is due, in part, to the high viral loads of Deformed wing virus (DWV), transmitted by the ectoparasitic mite Varroa destructor, especially throughout the overwintering period of a honey bee colony. Covert DWV infection is commonplace and has been causally linked to precocious foraging, which itself has been linked to colony loss. Taking advantage of four brain transcriptome studies that unexpectedly revealed evidence of covert DWV-A infection, we set out to explore whether this effect is due to DWV-A mimicking naturally occurring changes in brain gene expression that are associated with behavioral maturation. Consistent with this hypothesis, we found that brain gene expression profiles of DWV-A infected bees resembled those of foragers, even in individuals that were much younger than typical foragers. In addition, brain transcriptional regulatory network analysis revealed a positive association between DWV-A infection and transcription factors previously associated with honey bee foraging behavior. Surprisingly, single-cell RNA-Sequencing implicated glia, not neurons, in this effect; there are relatively few glial cells in the insect brain and they are rarely associated with behavioral plasticity. Covert DWV-A infection also has been linked to impaired learning, which together with precocious foraging can lead to increased occurrence of infected bees from one colony mistakenly entering another colony, especially under crowded modern apiary conditions. These findings provide new insights into the mechanisms by which DWV-A affects honey bee health and colony survival

Future of Microgrids with Distributed Generation and Electric Vehicles

This chapter examines the current energy scenario for microgrids over the world and discusses the challenges and opportunities due to the increasing penetration of distributed power generation systems and electric vehicles (EVs) into the microgrids. Wind power and solar power can be generated by wind turbines and photovoltaics, respectively, while these are intermittent in nature. EVs and hybrid EVs use a battery energy storage system and charging facilities while the latter also include an Internal Combustion Engine (ICE) to provide an extra energy source. The features of these systems in the context of microgrids are studied in detail, in terms of their components, efficiency, reliability, charging and discharging arrangements, active and reactive power control. The chapter provides a reference to the development of microgrid systems especially for developing countries