Saudi service users' perceptions and experiences of the quality of their mental health care provision in the Kingdom of Saudi Arabia (KSA): A qualitative inquiry.

This paper presents, as part of a larger mixed-methods design, a study generating a theoretical understanding of issues pertinent to the quality of mental health care in the KSA from the perspective of those using services. Semi-structured interviews were undertaken with thirty service users admitted to inpatient psychiatric wards, using an interview guide developed by the researchers, based on relevant literature. Findings from the thematic analysis showed five themes: (1) The hospital as a prison: a custody versus care dilemma, (2) quality of interactions between staff and service users, (3) quality of services, (4) staff qualities and (5) suggestions for achieving quality of care. A theoretical model drawing upon Donabedian Health Care Model for Evaluating quality of care and the Andersen Behavioural Model of Health Service Use is evident from the data. Structural aspects of care include staff experience and qualifications and key enablers around social and financial support, service users' health needs and status and the physical infrastructure and ward rules. These drive processes of care based upon robust rates of interaction between staff and service users and appear central to quality of mental health care in KSA. Quality of mental health care in KSA is manifested by a therapeutic ethos with a high degree of interaction between professional carers and service users, with the former being highly educated, competent, compassionate, with a high degree of self-awareness, and specialized in mental health. We have uncovered elements of Fanon and Azoulay's 'Cultural Originality' as well as contemporary examples of Goffman's mortification of the self. [Abstract copyright: © 2020 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd on behalf of Australian College of Mental Health Nurses Inc.

Current update of cerebral embolic protection devices

Carotid artery stenting (CAS) has evolved into a viable alternative to carotid endarterectomy. Although CAS outcomes have improved during the last decade, the associated stroke rate remains higher when compared with carotid endarterectomy. Therefore, the pivotal role of embolic protection devices (EPDs) in minimizing stroke risk cannot be underestimated as a vital component of CAS. As technology advances, EPDs continue to be refined, and each device currently on the market has its own advantages and disadvantages. This review provides an overview of the current status of EPDs and highlights the unique features of each device, followed by suggestions for application in specific clinical scenarios

IL-33 promotes ST2-dependent lung fibrosis by the induction of alternatively activated macrophages and innate lymphoid cells in mice

Background<p></p> The initiation and regulation of pulmonary fibrosis are not well understood. IL-33, an important cytokine for respiratory diseases, is overexpressed in the lungs of patients with idiopathic pulmonary fibrosis.<p></p> Objectives<p></p> We aimed to determine the effects and mechanism of IL-33 on the development and severity of pulmonary fibrosis in murine bleomycin-induced fibrosis.<p></p> Methods<p></p> Lung fibrosis was induced by bleomycin in wild-type or Il33r (St2)−/− C57BL/6 mice treated with the recombinant mature form of IL-33 or anti–IL-33 antibody or transferred with type 2 innate lymphoid cells (ILC2s). The development and severity of fibrosis was evaluated based on lung histology, collagen levels, and lavage cytology. Cytokine and chemokine levels were quantified by using quantitative PCR, ELISA, and cytometry.<p></p> Results<p></p> IL-33 is constitutively expressed in lung epithelial cells but is induced in macrophages by bleomycin. Bleomycin enhanced the production of the mature but reduced full-length form of IL-33 in lung tissue. ST2 deficiency, anti–IL-33 antibody treatment, or alveolar macrophage depletion attenuated and exogenous IL-33 or adoptive transfer of ILC2s enhanced bleomycin-induced lung inflammation and fibrosis. These pathologic changes were accompanied, respectively, by reduced or increased IL-33, IL-13, TGF-β1, and inflammatory chemokine production in the lung. Furthermore, IL-33 polarized M2 macrophages to produce IL-13 and TGF-β1 and induced the expansion of ILC2s to produce IL-13 in vitro and in vivo.<p></p> Conclusions<p></p> IL-33 is a novel profibrogenic cytokine that signals through ST2 to promote the initiation and progression of pulmonary fibrosis by recruiting and directing inflammatory cell function and enhancing profibrogenic cytokine production in an ST2- and macrophage-dependent manner

Original Article

It has been the general practice to employ culture methods in discerning whether Ascaris eggs are alive or dead. Although culture methods are most reliable, they are not without shortcomings- -the time required in going through the procedures is very long. The discovery of some reliable and simple methods, therefore, has eagerly been awaited. However little research has been done on this subject and no better methods have ever been developed. Sudan III staining method is one of the methods developed so far, but its reliability is doubted by many researchers. In an effort to devise a new staining method, the author carried out a series of experiments; sudan III staining method was first checked on the attempts were made to enhance the ability of eggs to stain by pre-treating them with acid and alkali, and finally a number of dyes, especially fatty dyes, were experimented on. As a result of these experiments, the author has developed anew staining method using Lugol\u27s solution and has proved that it is superior to sudan III staing method. Further experiments were carried out in order to investigate into the mechanism of staining. A comparative study of this method with the staining method using fluoroscopic dye, which had recently been developed, was also performed. The results of the experiments are summarized as follows: 1. The eggs killed by heating stained well by sudan III staining method, but the eggs killed by other means did not stain well. Attemts were made to enhance the ability to stain by applying various pre-treatment but without success. 2. The live eggs stained with Lugol\u27s solution are not decolorized by alcohol, but the dead eggs stained with Lugol\u27s solution are decolorized by alcohol. It would thus be possible to discern by this method whether eggs are dead or alive. Although it has no absolute value, this method is superior to sudan III staining method and is availabe for experimental purposes.3. It seems that the permeability of the egg-shell plays an important part in Lugol\u27s solution staining method. Although results vary with the change in the methods used for killing eggs, it seems that the permeability of shells of eggs are enhanced when they are dead, thereby promoting decolorization. 4. It is assumed that it is the .third layer that plays a significant role in the permeability of the eggshell. 5. It seems that the staining method using fluoroscopic dyes, which has more or less similar value as sudan III staining method, is inferior to Lugol\u27s .solution staining method in discerning whther Ascaris eggs are dead or alive

Appropriate Use of Venous Imaging and Analysis of the D- Dimer/Clinical Probability Testing Paradigm in the Diagnosis and Location of Deep Venous Thrombosis

Background—The D-dimer (DD) level combined with the pretest Wells criteria probability (WCP) score can safely exclude deep venous thrombosis (DVT). The objective of this study was to examine the correlation between DD results alongside WCP score with findings on venous duplex ultrasound (VDU). The hypothesis is that VDU remains overutilized in low-risk patients with negative DD and that higher DD levels may correlate with thrombus burden and location. Methods—Patients who presented to a high-volume tertiary care center with lower limb swelling with or without associated pain were retrospectively examined through June and July for 4 consecutive years (2012 to 2015). After calculating WCP, patients were divided into low-, moderate-, and high-risk categories. Electronic DD results utilizing enzyme linked immunosorbent assay, WCP data, and VDU analysis data were merged and analyzed based on receiver operator characteristic curve to determine the DD cutoff point for each WCP. Abnormal DD with an average value ≥ 0.6 mg/L fibrinogen equivalent units (FEUs) was correlated to positive DVT to differentiate proximal DVT (above popliteal vein) from distal DVT (below popliteal vein). Results—Data of 1,909 patients were analyzed, and 239 (12.5%) patients were excluded secondary to serial repeat visits or follow-ups, surveillance screens, and if they had a previous history of DVT. The average age was 62.1 ± 16.3 years with more women (55.7%) and the majority presented with limb pain and edema (87%). DD studies were ordered and completed in 202 patients and correlated with all positive and negative DVT patients (100% sensitivity and negative predictive value, with specificity and positive predictive value of 14.9% and 15.9%, respectively). Twenty-six of 202 patients had DD that were in the normal range 0.1–0.59 mg/L (FEU), all of which were negative for DVT (100% sensitive). Fifty one of 202 patients had DD values of 0.6–1.2 mg/L FEU, of which only 3 DVTs were recorded, and all of them were distal DVTs. In addition, 685 patients with WCP Thus, 762 patients had an unnecessary immediate VDU (Wells ≤1 and –DD) study during their initial presentation. Potential charge savings for VDU for all patients are 762 × $1,557 =$1,186,434 and DD for all patients are 762 × $182 =$138,684, with total potential savings of $1,047,750 (USD 2016). Conclusions—This study suggests that DD is still underutilized, and DD in conjunction with WCP could significantly reduce the number of unnecessary immediate VDUs. Higher value of DD (\u3e1.2 mg/L FEU) may raise concern for proximal DVT. Concern on cost-effectiveness exists and raises the demand for a proposed algorithm to be followed

Non-linear time delay saturation controller for reduction of a non-linear vibrating system via 1:4 internal resonance

In this paper, active control with time delay was implemented for eliminating the vibration of the non-linear system excited by external and parametric forcing amplitude in the presence of 1:4 internal resonances. Multiple time scale method is applied to determine first-order approximations of the controlled system. The stability of the system is investigated analytically using Lyapunov first method and numerically using frequency, force-response curves and phase-plane method for the considered resonance case. Effects of different parameters on the steady state response of the controlled system are investigated. Variation of some parameters leads to the bending of the frequency, force-response curves and hence to the jump phenomenon occurrence

Hip Fracture and Disabilities among Elderly in Gaza Governorates, Palestine

Hip fracture is the most common fracture in the elderly people and causes many disabilities for people who don't receive appropriate rehabilitation after fracture or surgery. Objective: The general objective of this study is to recognize the disabilities arising as a result of hip fracture among the elderly in Gaza Strip. Methods: a descriptive correlation cross sectional design was used. Face to face structured questionnaire and international Barthel index tool were used to determine the disabilities among hip fracture population. One hundred one patients with old hip fracture were included. Sixty patients were from Khan Younis city and forty-one patients from Rafah city. Descriptive statistics, ANOVA test, t-test, correlation coefficient and Scheffe Multiple Comparisons test were used to analyze results in the study. Results: the results revealed that 82.2% of patients complaint from disability. 15.8% had total disability, 30.7% had severe disability, 19.8% had moderate disability, 9.9% had mild disability and 5.9% had minimal disability. Eighty-five percent of patients suffered from pain. 24.8% had mild pain, 36.6% had moderate pain, 17.8% had severe pain and 5.9% suffered from intolerable pain. The most common cause of hip fracture was falling down (81.2%). Also, the most common complications were failure of operation (32.3%), wound infection (29%) and bed sores (29%). The most common type of hip fracture operation was Plate & screw fixation which represented 63.1% from the operated patients. There were significant statistical differences between age and pain slope with development of disability. Conclusion: hip fractures among the elderly caused a high percent of disability, complications and pain which can be reduced by improving operation's techniques and good rehabilitation programs

Amino-Functionalized Silica Nanoparticles: In Vitro Evaluation for Targeted Delivery and Therapy of Pancreatic Cancer

We report a method of synthesis and optimization of amino-functionalized silica nanoparticles (SiNPs) and their in vitro evaluation as targeted delivery vehicles for the potential treatment of pancreatic cancer. SiNPs can efficiently encapsulate doxorubicin and can be attached to a targeting moiety such as anti-Claudin-4 (CLN4). The preferential uptake in pancreatic cancer cells, where CLN4 is overexpressed, of SiNPs when conjugated to CLN4 antibody (compared to nonconjugated SiNPs) was confirmed by confocal microscopy. SiNPs encapsulating doxorubicin had greater efficacy in MTT assays than free doxorubicin, and when conjugated to CLN4, the efficacy was dramatically increased (at 1 μM). No apparent carrier toxicity was observed when void SiNPs were used. SiNPs carrying a chemotherapeutic drug have the potential to be used as a targeted therapy for lethal cancers, such as pancreatic cancer. Also, incorporation of fluorescent probes in these SiNPs creates the possibility of their use as an imaging probe for diagnostic purposes