Al Ain Oases Mapping Project: Qattārah Oasis, past and present (poster)

The Al Ain Oases Mapping Project is a collaboration between the Abu Dhabi Tourism and Culture Authority and Zayed University. It aims to document the present oasis landscape and identify surviving historic components, while at the same time engaging Emirati students with their heritage and building capacity for archaeology in the UAE. The project utilizes a non-intrusive field-walking methodology suitable for a class of undergraduate students. It further draws on the students\u27 community links and bilingualism to contact former residents of the oasis villages and undertake oral history interviews. The first season\u27s work focused on Qattārah Oasis and contributes to the established programme of works there; future seasons will expand the survey to neighbouring Jīmī Oasis and the other oases of al-\u27Ayn. The results will inform continued archaeological exploration of the oases by TCA

Is there a role for melatonin in fibromyalgia?

Fibromyalgia, characterised by persistent pain, fatigue, sleep disturbance and cognitive dysfunction, is a central sensitivity syndrome that also involves abnormality in peripheral generators and in the hypothalamic pituitary adrenal axis. Heterogeneity of clinical expression of fibromyalgia with a multifactorial aetiology has made the development of effective therapeutic strategies challenging. Physiological properties of the neurohormone melatonin appear related to the symptom profile exhibited by patients with fibromyalgia and thus disturbance of it’s production would be compatible with the pathophysiology. Altered levels of melatonin have been observed in patients with fibromyalgia which are associated with lower secretion during dark hours and higher secretion during daytime. However, inconsistencies of available clinical evidence limit conclusion of a relationship between levels of melatonin and symptom profiles in patients with fibromyalgia. Administration of melatonin to patients with fibromyalgia has demonstrated suppression of many symptoms and an improved quality of life consistent with benefit as a therapy for the management of this condition. Further studies with larger samples, however, are required to explore the potential role of melatonin in the pathophysiology of fibromyalgia and determine the optimal dosing regimen of melatonin for the management of fibromyalgia

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

An analytical study of the principles of sustainable development that are contained in the curricula of the human and the universe in the basic education. Sudan

The study aimed to identify the values and principles of sustainable development, in its economic, social and environmental dimension that contained in the courses of the human and universe in the basic education in Sudan, researchers used the descriptive analytical method through content analysis, by using analysis form included (26) factor represent economic, social and environmental dimension, the analysis covered (48) academic subject, researchers used the statistical package for social science (SPSS) to analyze the data of the study, the most important results are: 1. economic dimension principles of sustainable development are included in the | courses with rates ranged between (%18.8) and (% 2.1). 2. social dimension principles of sustainable development are included in the courses with rates ranged between (% 20.8) and (% 4.2). 3. environmental dimension principles of sustainable development are included in the courses with rates ranged between (% 22.9) and (% 6.2). The important ‎recommendation: is that courses has to include values and urges that encourage directly sustainability principle

ChatGPT across Arabic Twitter: A Study of Topics, Sentiments, and Sarcasm

While ChatGPT has gained global significance and widespread adoption, its exploration within specific cultural contexts, particularly within the Arab world, remains relatively limited. This study investigates the discussions among early Arab users in Arabic tweets related to ChatGPT, focusing on topics, sentiments, and the presence of sarcasm. Data analysis and topic-modeling techniques were employed to examine 34,760 Arabic tweets collected using specific keywords. This study revealed a strong interest within the Arabic-speaking community in ChatGPT technology, with prevalent discussions spanning various topics, including controversies, regional relevance, fake content, and sector-specific dialogues. Despite the enthusiasm, concerns regarding ethical risks and negative implications of ChatGPT’s emergence were highlighted, indicating apprehension toward advanced artificial intelligence (AI) technology in language generation. Region-specific discussions underscored the diverse adoption of AI applications and ChatGPT technology. Sentiment analysis of the tweets demonstrated a predominantly neutral sentiment distribution (92.8%), suggesting a focus on objectivity and factuality over emotional expression. The prevalence of neutral sentiments indicated a preference for evidence-based reasoning and logical arguments, fostering constructive discussions influenced by cultural norms. Sarcasm was found in 4% of the tweets, distributed across various topics but not dominating the conversation. This study’s implications include the need for AI developers to address ethical concerns and the importance of educating users about the technology’s ethical considerations and risks. Policymakers should consider the regional relevance and potential scams, emphasizing the necessity for ethical guidelines and regulations

Clinical And Pharmacokinetic Evaluation Of Optimal Monitoring Parameters And Sampling Schemes For Vancomycin Therapeutic Drug Monitoring In Qatar

Background: Therapeutic drug monitoring (TDM) of vancomycin has been proven to maximize therapeutic outcomes and minimize toxicity when conducted appropriately. The quality of vancomycin TDM services in many settings remains to be explored. Vancomycin still poses many questions regarding its clinical pharmacokinetic parameters, optimal dosing, and TDM strategies in unstudied populations. Objectives: This project comprised three distinct sequential phases. Phase I aimed to evaluate the appropriateness of routine vancomycin TDM service in Qatar and its impact on clinical outcomes. Phase II aimed to evaluate the relationship between vancomycin 24-hr-AUC/MIC ratios and cure; and to compare the clinical outcomes between peak-trough-based and trough-onlybased vancomycin TDM approaches. Phase III aimed to determine vancomycin population pharmacokinetics considering patient-specific covariates and to assess the need for vancomycin dosing nomograms that are specific to Qatar’s population. Methods: Phase I was a retrospective chart review that was conducted on adult non-dialysis vancomycin TDM cases electronically documented between January 2014 and August 2016 in Al-Wakrah Hospital (AWH), Al- Khor Hospital (AKH), and Hamad General Hospital (HGH). Evidence-based criteria were applied to evaluate TDM appropriateness. Descriptive and inferential statistical analyses were applied using SPSS v.23. Phase II was a multicenter pragmatic parallel prospective randomized controlled trial (RCT) that was conducted from February 2016 to September 2016 in HGH, AWH and AKH. Adult non-dialysis patients who were initiated on vancomycin treatment were randomized to intervention arm (peak-trough-based vancomycin TDM) or control arm (trough-only-based vancomycin TDM). Multiple steady-state vancomycin blood samples were obtained for AUC determination. 24-hr-AUC calculation was conducted using NONMEM version 7.3 (ICON,USA) and PDx-Pop version 5.2 (ICON,USA), utilizing the population pharmacokinetic model developed in Phase III. Descriptive, inferential, and CART statistical analyses were applied using SPSS v.23. Phase III was a population pharmacokinetic analysis that was conducted based on the principles of non-linear-mixed-effects-modeling. Internal validation of the final model was applied by bootstrap analysis of 500 data replicates. The agreement between the final parameter estimates, 95%confidence intervals of the developed final model and the bootstrap results were compared. To evaluate the need for population-specific dosing nomograms, the generated population parameter estimates were compared against literature reported values in similar populations. Phase III procedures were conducted using NONMEM v.7.3, (ICON,USA) and PDx-Pop v.5.2 (ICON,USA). Results: Phase I: Two hundred eight vancomycin TDM cases involving 99 patients were evaluated. Most of the evaluated TDM cases (90.4%, n=188) were inappropriately conducted. The indications for TDM requests were appropriate in most of the cases (77.4%, n=161). Most of the blood samples were collected at incorrect times (70.7%, n=147), and incorrectly labelled (81.7%, n=170). Overall, the actual sampling times revealed that most vancomycin blood samples (61.5%, n=128) corresponded to vancomycin random concentrations. Furthermore, high rates of inappropriate post- analytical actions were recorded (65.9%, n=137). Inappropriate compared to appropriate vancomycin TDM practices were associated with significantly lower therapeutic cures [47.3% vs .75%; p-value=0.009] and longer hospitalizations [median[IQR]: 26[31] vs. 13[47.7] days; p-value=0.103]. All patients who experienced neutropenia (100%, n=6) received inappropriate vancomycin TDM service. Similarly, of all patients who experienced nephrotoxicity, 84.6% (n=11) received inappropriate vancomycin TDM service. Phase II: Sixty-five patients were enrolled in the RCT [trough-only-group:35 patients vs. peak-trough-group:30 patients]. Peak-trough-based vancomycin TDM was significantly associated with higher therapeutic cure rates compared to control group [76.7% vs .48.6%; p-value=0.02]. Compared to the control group, peak-trough-based vancomycin TDM recipients required less average vancomycin single doses and total daily doses by 370mg/dose and 927mg/day, respectively [p-value<0.05]. Similarly, trough-only-based vancomycin TDM recipients required higher cumulative vancomycin doses versus the intervention group [median[IQR]: 19500[25860] mg vs. 13250[14925] mg; p-value>0.05]. CART identified creatinine clearance(CrCl), 24-hr-AUC and TDM approach as significant determinants of therapeutic outcomes. All patients with CrCl≤7.85L/hr who achieved 24- hr- AUC≤1255.98mg.hr/L and received peak-trough-based vancomycin TDM achieved clinical success [100%, n=19]. In contrast, patients with CrCl≤7.85L/hr who maintained 24-hr-AUC≤1255.98mg.hr/L but received trough-only-based vancomycin TDM experienced 29.4% (n=5) failure rates. Maintenance of 24-hr-AUC>564.117mg.hr/L was identified as the breakpoint of cure in trough-only-based TDM recipients [84.6%, n=11]. Phase III: A total of 769 vancomycin blood concentrations obtained from 156 subjects were analyzed. A two-compartment model with a proportional residual error and between-subject variability modeled on clearance (Cl), central compartment volume of distribution (Vc) and intercompartmental clearance (Q) best described vancomycin disposition. The physiologic parameters Cl and Vc, were estimated with good precision [Cl:5.23L/h, 95%CI: 4.72-5.74; Vc:44L, 95%CI: 37.7-50.3]. CrCl and age were significant covariates in the final model (p-value<0.01). Interindividual variability for Cl, Vc and Q was 38.9%, 42.7%, and 97% in the final model, respectively. Fixed effects parameters were estimated with reasonable precision and lied within 95%CI of bootstrap analysis. The population parameter estimates were similar to literature reported 2-compartment model estimates in adult non-dialysis patients. Conclusion: This work suggests that the improvement of the quality of vancomycin TDM practices, maintenance of a 24-hr-AUC between 564.117- 1255.98 mg.hr/L, and the implementation of peak-trough-based vancomycin TDM, are three main strategies that will potentially improve health-care outcomes associated with vancomycin treatment. The findings have important implications on developing strategies that will improve rational TDM practices in Qatar, the Middle East region and possibly worldwid