Characterizing toxicity and chemical profile of acidic,basic and neutral fractions of oil sands process affected water

There is concern about toxicity of Oil Sands-Affected Process Water (OSPW). Results of previous studies have shown that toxicity is caused primarily by organic chemicals in the aqueous phase. Most research has focused on acute and chronic toxicity of the acid-extractable organic fraction to aquatic organisms. It has been shown that acute toxicity is caused by organic acids commonly known as naphthenic acids (NAs) as well as other sulfur- and nitrogen-containing compounds. Also, chemical analyses of OSPW have been focused only on the acid extractable fraction, however, little is known about sub-lethal effects and chemical profiles of species of chemicals other than NAs or the “acid-extractable organics (AEOs)” extracted from OSPW. The aim of this research was to evaluate effects of acidic and non-acidic compounds in OSPW. First, a comprehensive chemical extraction method was developed to simultaneously isolate acidic, basic and neutral fractions from an end-pit lake known as Base Mine Lake (BML-OSPW; fresh OSPW) and an experimental reclamation pond known as Pond 9 or Tailings Pond Water (P9-OSPW or aged OSPW). Second, these fractions were analysed using ultrahigh resolution mass spectrometry (Orbitrap), which possess high resolution and superior selectivity and covered an extensive range of chemical components. Third, these fractions, which contain structurally different chemicals, were assessed for acute and sub-lethal toxicity of aquatic species with respect to functions and expression of genes for ABC transporter proteins as well as modulation of toxic potencies of polycyclic aromatic hydrocarbons (PAHs). The acidic fraction of BML but not P9-OSPW was acutely toxic to larvae of Japanese medaka. However, there is a lack of information about the reasons for lesser toxic potency of P9-OSPW. Profiles of relative proportions of organic chemicals in the acidic fractions of BML and P9-OSPW were investigated in detail, by use of ultrahigh resolution mass spectrometry (Chapter 2). In both ionization modes, mass spectra were similar between the acidic fractions of BML and P9 extracts. However, relative abundances of chemicals between the two fractions were different. The profile of homologs containing heteroatoms in each fraction revealed that the profile of nitrogen, sulfur, and oxygen (NSO) containing chemicals was not very different. Acidic fractions were dominated by Ox chemicals. Sulfur and nitrogen-containing chemicals were detected in the acid fraction with high abundances in ESI+. The ATP-binding cassette (ABC) superfamily of transporter proteins are essential for detoxification of xenobiotic. Effects of acidic, basic and neutral compounds from BML-OSPW and P9-OSPW on activities of ABC transporters in Japanese medaka (Oryzias latipes) at the fry stage of development were investigated (Chapter 3). The neutral and basic fractions, but not the acidic fraction, of BML-OSPW, and neither fraction of P9-OSPW, caused inhibition of ABC proteins in fry of Japanese medaka. Neutral and basic fractions of BML-OSPW contained relatively greater amounts of several oxygen-, sulfur, and nitrogen-containing chemical species. Naphthenic acids (O2−), which were dominant in the acidic fraction, did not appear to be the cause of inhibition. Solubility, bioavailability, and toxicity of PAHs might be modulated in the presence of surfactants. Effects of organic compounds extracted from BML-OSPW or P9-OSPW on toxicity of the model alkyl-PAH, retene, to early life-stages of Japanese medaka was determined (Chapter 4). Effects of retene were greater when larvae were co-exposed to OSPW compared to retene alone. However, those effects would not be expected to occur at current concentrations of OSPW and is attenuated by aging of OSPW. Detailed studies on effects of OSPW on functions of ABC transporters (specifically P-gp) were performed in vitro by use of Caco-2 cells, and in vivo with larvae of Japanese medaka (Chapter 5). Neutral and basic fractions of BML-OSPW inhibited activity of ATP binding cassette protein ABCB1 (permeability-glycoprotein, P-gp) in Caco-2 cells, while the acidic fraction had the least effect. Co-exposure to chlorpyrifos (a substrate of P-gp), but not malathion (not a substrate of P-gp) and an extract of OSPW containing basic and neutral compounds reduced survival of larvae, increased the internal concentration, bioconcentration and terminal elimination half-life compared to survival of larvae exposed only to chlorpyrifos. Effects of acidic, basic and neutral compounds from BML-OSPW on expression of genes encoding biotransformation enzymes and proteins were quantified (Chapter 6). Abundances of transcripts of phase I, II and III genes were significantly different in larvae of medaka exposed to basic and neutral compounds compared to acidic compounds. Changes in abundance of transcripts in response to the pooled sample and the acidic fraction were correlated, whereas changes in abundance of transcripts in larvae exposed to the basic fraction and the neutral fraction were correlated. From results presented in this thesis, it can be concluded that besides acute toxicities of acidic compounds (i.e. NAs) in OSPW, other compounds in basic and neutral fractions from OSPW can have adverse effects at sub-lethal levels, and may interact with the different molecular target in fish that can cause specific endpoints of toxicity. These results provide new insights into the sub lethal effects of non-acidic compounds regarding the detoxification mechanisms such as ABC transporters, which can decrease the effective protection mechanism against xenobiotic in aquatic species. Also, the toxicity of PAHs is expected to increase in the presence of OSPW, however, aging of OSPW was shown to be effective in attenuating the adverse effects of not only the acutely toxic acidic fraction but also the effects of non-acutely toxic basic and neutral fractions. This thesis explores new concepts, methods and approaches that contribute to the risk assessment of OSPW

Predicting Patients’ Intention to Use a Personal Health Record Using an Adapted Unified Theory of Acceptance and Use of Technology Model: Secondary Data Analysis

BackgroundWith the rise in the use of information and communication technologies in health care, patients have been encouraged to use eHealth tools such as personal health records (PHRs) for better health and well-being services. PHRs support patient-centered care and patient engagement. To support the achievement of the Kingdom of Saudi Arabia's Vision 2030 ambitions, the National Transformation program provides a framework to use PHRs in meeting the triple aim for health care - increased access, reduced cost, and improved quality of care - and to provide patient- and person-centered care. However, there has been limited research on PHR uptake within the country.ObjectiveUsing the Unified Theory of Acceptance and Use of Technology (UTAUT) as the theoretical framework, this study aims at identifying predictors of patient intention to utilize the Ministry of National Guard-Health Affairs (MNG-HA) PHR (MNGHA Care) application.MethodsUsing secondary data from a cross-sectional survey, data measuring intention to use the MNGHA Care application along with its predictors, were collected from adults (N=324) visiting MNG-HA facilities in Riyadh, Jeddah, Dammam, Madinah, Al Ahsa, and Qassim. The relationship of predictors (main theory constructs) and moderators (age, gender, experience with health applications) with the dependent variable (intention to use MNGHA Care) was tested using hierarchical multiple regression.ResultsOf the eligible population, a total of 261 adult patients were included in the analysis with a mean age of 35.07 years (± 9.61), male (n=132, 50.6%), university-educated (n=118, 45.2%), and at least one chronic medical condition (n=139, 53.3%). The model explained 48.9% of the variance in behavioral intention to use the PHR (P=.377). Performance expectancy, effort expectancy, and positive attitude were significantly associated with behavioral intention to use the PHR (PConclusionsThis research contributes to the existing literature on PHR adoption broadly as well as in the context of the Kingdom of Saudi Arabia. Understanding which factors are associated with patient adoption of PHRs can guide future development and support the country's aim of transforming the health care system. Similar to other studies on PHR adoption, performance expectancy, effort expectancy, and positive attitude are important factors, and practical consideration should be given supporting these areas.</p

Predicting patients' intention to use a personal health record using an adapted unified theory of acceptance and use of technology model : secondary data analysis

Background: With the rise in the use of information and communication technologies in health care, patients have been encouraged to use eHealth tools such as personal health records (PHRs) for better health and well-being services. PHRs support patient-centered care and patient engagement. To support the achievement of the Kingdom of Saudi Arabia’s Vision 2030 ambitions, the National Transformation program provides a framework to use PHRs in meeting the 3-fold aim for health care—increased access, reduced cost, and improved quality of care—and to provide patient- and person-centered care. However, there has been limited research on PHR uptake within the country. Objective: Using the Unified Theory of Acceptance and Use of Technology (UTAUT) as the theoretical framework, this study aims at identifying predictors of patient intention to utilize the Ministry of National Guard-Health Affairs PHR (MNGHA Care) app. Methods: Using secondary data from a cross-sectional survey, data measuring the intention to use the MNGHA Care app, along with its predictors, were collected from among adults (n=324) visiting Ministry of National Guard-Health Affairs facilities in Riyadh, Jeddah, Dammam, Madinah, Al Ahsa, and Qassim. The relationship of predictors (main theory constructs) and moderators (age, gender, and experience with health apps) with the dependent variable (intention to use MNGHA Care) was tested using hierarchical multiple regression. Results: Of the eligible population, a total of 261 adult patients were included in the analysis. They had a mean age of 35.07 (SD 9.61) years, 50.6 % were male (n=132), 45.2% had university-level education (n=118), and 53.3% had at least 1 chronic medical condition (n=139). The model explained 48.9% of the variance in behavioral intention to use the PHR (P=.38). Performance expectancy, effort expectancy, and positive attitude were significantly associated with behavioral intention to use the PHR (P Conclusions: This study contributes to the existing literature on PHR adoption broadly as well as in the context of the Kingdom of Saudi Arabia. Understanding which factors are associated with patient adoption of PHRs can guide future development and support the country’s aim of transforming the health care system. Similar to previous studies on PHR adoption, performance expectancy, effort expectancy, and positive attitude are important factors, and practical consideration should be given to support these areas

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

Bacterial Infections among Patients with Chronic Diseases at a Tertiary Care Hospital in Saudi Arabia

Infections caused by multi-drug-resistant bacteria in patients with chronic diseases have been associated with high mortality and morbidity. While few reports have evaluated bacterial infections in multiple chronic disease patients, the focus of the current study was to investigate the prevalence of bacterial infections and the susceptibility profiles of causative strains among various groups of patients suffering from chronic diseases. Microbiological reports of patients suffering from cancer, diabetes mellitus, cardiovascular diseases, kidney diseases, and skin burns were retrospectively collected from a tertiary hospital in Saudi Arabia. Approximately 54.2% of recruited patients were males, and positive urine was the most prevalent specimen associated with kidney disease patients (25%). Escherichia coli isolates were predominant among cardiovascular, kidney, and cancer patients. Staphylococcus aureus was commonly detected in diabetics and those with burns. Although resistance patterns varied based on the type of specimens and underlying diseases, Escherichia coli showed limited resistance to colistin, carbapenems, and tigecycline, while S. aureus demonstrated susceptibility to ciprofloxacin, gentamicin, and rifampin. These observations are crucial for clinicians and policymakers to ensure effective treatment plans and improve outcomes in these patients with comorbidity

Adoption of a personal health record in the digital age: Cross-sectional study

Background: As health care organizations strive to improve health care access, quality, and costs, they have implemented patient-facing eHealth technologies such as personal health records to better engage patients in the management of their health. In the Kingdom of Saudi Arabia, eHealth is also growing in accordance with Vision 2030 and its National Transformation Program framework, creating a roadmap for increased quality and efficiency of the health care system and supporting the goal of patient-centered care. Objective: The aim of this study was to investigate the adoption of the personal health record of the Ministry of National Guard Health Affairs (MNGHA Care). Methods: A cross-sectional survey was conducted in adults visiting outpatient clinics in hospitals at the Ministry of National Guard Health Affairs hospitals in Riyadh, Jeddah, Dammam, Madinah, and Al Ahsa, and primary health care clinics in Riyadh and Qassim. The main outcome measure was self-reported use of MNGHA Care. Results: In the sample of 546 adult patients, 383 (70.1%) reported being users of MNGHA Care. MNGHA Care users were more likely to be younger (P<.001), high school or university educated (P<.001), employed (P<.001), have a chronic condition (P=.046), use the internet to search for health-related information (P<.001), and use health apps on their mobile phones (P<.001). Conclusions: The results of this study show that there is substantial interest for the use of MNGHA Care personal health record with 70% of participants self-reporting use. To confirm these findings, objective data from the portal usage logs are needed. Maximizing the potential of MNGHA Care supports patient engagement and is aligned with the national eHealth initiative to encourage the use of technology for high-quality, accessible patient-centered care. Future research should include health care provider perspectives, incorporate objective data, employ a mixed-methods approach, and use a theoretical framework

Cord Blood Plasma and Placental Mesenchymal Stem Cells-Derived Exosomes Increase Ex Vivo Expansion of Human Cord Blood Hematopoietic Stem Cells While Maintaining Their Stemness

Background: Mesenchymal stem cells (MSCs) have been used for ex vivo expansion of umbilical cord blood (UCB) hematopoietic stem cells (HSCs) to maintain their primitive characters and long-term reconstitution abilities during transplantation. Therapeutic effects of MSCs mainly rely on paracrine mechanisms, including secretion of exosomes (Exos). The objective of this study was to examine the effect of cord blood plasma (CBP)-derived Exos (CBP Exos) and Placental MSCs-derived Exos (MSCs Exos) on the expansion of UCB HSCs to increase their numbers and keep their primitive characteristics. Methods: CD34+ cells were isolated from UCB, cultured for 10 days, and the expanded HSCs were sub-cultured in semisolid methylcellulose media for primitive colony forming units (CFUs) assay. MSCs were cultured from placental chorionic plates. Results: CBP Exos and MSCs Exos compared with the control group significantly increased the number of total nucleated cells (TNCs), invitro expansion of CD34+ cells, primitive subpopulations of CD34+38+ and CD34+38−Lin− cells (p p < 0.01). Conclusion: CBP- and placental-derived exosomes are associated with significant ex vivo expansion of UCB HSCs, while maintaining their primitive characters and may eliminate the need for transplantation of an additional unit of UCB

The association between tocilizumab therapy and the development of thrombosis in critically ill patients with COVID-19: a multicenter, cohort study

Abstract The use of tocilizumab for the management of COVID-19 emerged since it modulates inflammatory markers by blocking interleukin 6 receptors. Concerns regarding higher thrombosis risk while using tocilizumab were raised in the literature. The aim of this study is to investigate the association between tocilizumab therapy and the development of thromboembolic events in critically ill COVID-19 patients. A propensity score-matched, multicenter cohort study for critically ill adult patients with COVID-19. Eligible patients admitted to ICU between March 2020 and July 2021 were categorized into two sub-cohorts based on tocilizumab use within 24 h of ICU admission. The primary endpoint was to assess the incidence of all thrombosis cases during ICU stay. The secondary endpoints were 30-day mortality, in-hospital mortality, and the highest coagulation parameters follow-up (i.e., D-dimer, Fibrinogen) during the stay. Propensity score matching (1:2 ratio) was based on nine matching covariates. Among a total of 867 eligible patients, 453 patients were matched (1:2 ratio) using propensity scores. The thrombosis events were not statistically different between the two groups in crude analysis (6.8% vs. 7.7%; p-value = 0.71) and regression analysis [OR 0.83, 95% CI (0.385, 1.786)]. Peak D-dimer levels did not change significantly when the patient received tocilizumab (beta coefficient (95% CI): 0.19 (− 0.08, 0.47)), while there was a significant reduction in fibrinogen levels during ICU stay (beta coefficient (95% CI): − 0.15 (− 0.28, − 0.02)). On the other hand, the 30-day and in-hospital mortality were significantly lower in tocilizumab-treated patients (HR 0.57, 95% CI (0.37, 0.87), [HR 0.67, 95% CI (0.46, 0.98), respectively). The use of tocilizumab in critically ill patients with COVID-19 was not associated with higher thrombosis events or peak D-dimer levels. On the other hand, fibrinogen levels, 30-day and in-hospital mortality were significantly lower in the tocilizumab group. Further randomized controlled trials are needed to confirm our findings