Challenges of continuing medical education in Saudi Arabia's hospitals

Phd ThesisBackground Health care professionals are responsible for maintaining their proficiency throughout their careers. Continuing medical education (CME) is an integral part of the medical profession that aims to enhance physicians’ knowledge and skills. Health care services in Saudi Arabia are expanding rapidly. However, the country is struggling to cope with a shortage of competent health professionals. CME in the Kingdom is facing some challenges that are preventing learning programmes from responding appropriately to professionals’ demands and needs, and to the complexity of health care. Research questions The research questions addressed in this thesis are: 1. What is the current status of continuing medical education in Saudi Arabian governmental hospitals? 2. What are the barriers preventing continuing medical education from implementing competitive learning programmes? 3. How might Saudi culture be influencing the health context and how does this impact upon the field of CME? Methodology This study adopted a mixed methods approach supplemented by ethnography. Two forms of individual, semi-structured interviews targeted two groups of respondents; the interviews were followed up by a questionnaire (sent by email) listing all the challenges to CME identified by the interviewees, and asking the participants to rank them in order of importance. In addition, observation was conducted throughout the fieldwork. Sampling Three public hospitals were selected from different geographical areas (N=3). Judgemental approach resulted in the selection of 33 medical education representatives from different medical and paramedical departments (N=33). Purposive sampling resulted in the selection of 11 medical librarians (N=11). Results The major CME challenges were identified and grouped into four themes: 1. Management, including the lack of knowledge on the part of decision makers about the importance of lifelong learning, and their influence over learning programmes. 2. Poor status of medical libraries, in terms of location, space and services provided. 3. Lack of transparency in the CME budget, which leads to a too close relationship between the pharmaceutical industry and physicians. 4. Diversity of staff, including their different training backgrounds, and their resistance to making changes in their performance after training. Discussion and conclusions The study found a strong correlation between health stakeholders’ lack of managerial skills and knowledge of the significance of CME and the learning programme limitations in Saudi Arabia; this factor also received the highest ranking by the participants in the study. 3 Hospital officials lack the necessary knowledge about the importance of CME, and lifelong learning has become complex. Their negative attitude towards learning has resulted in several challenges: some of these have been identified in this study, including a lack of support for the learning process in hospitals, an inability to motivate staff to continue developing their skills, and a lack of transparency when allocating budgets to learning elements, including CME and library services. This ambiguity has resulted in poor libraries and a heavy reliance on pharmaceutical industry sponsorship for CME events and medical professionals’ trips, which can affect the quality of the events and/or cause bias. The study has also clarified the issue of staff diversity. Although the majority of health care professionals are foreigners, the concern is that health care stakeholders are recruiting professionals from developing countries where the quality of health care and training might be low. Despite the varied training and educational backgrounds among the staff, no efforts have been made to design learning programmes that meet their actual and wide-ranging needs. Rather, current activities are based on desires and wishes of chiefs of medical departments.The Government of Saudi Arabia

Metabolic Processes During Seed Germination

Seed germination is crucial stage in plant development and can be considered as a determinant for plant productivity. Physiological and biochemical changes followed by morphological changes during germination are strongly related to seedling survival rate and vegetative growth which consequently affect yield and quality. This study is aimed to focus on proceeding of the most vital metabolic processes namely reserve mobilization, phytohormonal regulation, glyoxylate cycle and respiration process under either stressful or non-stressful conditions that may be led to suggest and conduct the more successful experimental improvements. Seed imbibition triggered the activation of various metabolic processes such as synthesis of hydrolytic enzymes which resulted in hydrolysis of reserve food into simple available form for embryo uptake. Abiotic stresses potentially affect seed germination and seedling establishment through various factors, such as a reduction in water availability, changes in the mobilization of stored reserves, hormonal balance alteration and affecting the structural organization of proteins. Recent strategies for improving seed quality involved classical genetic, molecular biology and invigoration treatments known as priming treatments. H2O2 accumulation and associated oxidative damages together with a decline in antioxidant mechanisms can be regarded as a source of stress that may suppress germination. Seed priming was aimed primarily to control seed hydration by lowering external water potential, or shortening the hydration period

Plant growth regulators induced urease activity in Cucurbita pepo L. cotyledons

This study is aimed to investigate the activity of urease (EC 3.5.1.5, urea amidohydrolase) that catalyzes the hydrolysis of urea in 5-day-old Cucurbita pepo cotyledons subjected to various concentrations of different growth regulators. The treatment of C. pepo cotyledons with different concentrations (100–600 μmol) of different auxins [indole-3-acetic acid (IAA), indole butyric acid (IBA), indole propionic acid (IPA) and naphthalene acetic acid (NAA)]; or with different concentrations (100–300 μmol) of different cytokinins [kinetin, zeatin and benzyladenine (6-BA)] resulted in a significant increase of urease activity, compared to control. The optimal effects were recorded for each of 500 μmol of IAA and 300 μmol of zeatin treatments. A gradual increase in urease activity was detected in cotyledons treated with various concentrations (0.2–1.0 mM) of 28-homobrassinolide (HBL), in relative to control. A substantial increase in urease activity was observed in cotyledons subjected to different concentrations of triazole (10–60 mg L–1), containing either triadimefon (TDM) or hexaconazole (HEX), compared to control. The combination of 300 μmol zeatin with any of protein inhibitors, namely 5-fluorouridine (FUrd), cordycepin and α-amanitin, resulted in the alleviation of their inhibitory effect on the urease activity

Green synthesis of mixed metallic nanoparticles using room temperature self-assembly

Bimetallic nanoparticles of silver (Ag) and gold (Au) were synthesized at room temperature using Curcumin. Reduction process of silver and gold ions with different molar ratios leads to production of different nanostructures including alloys and core-shells. Produced nanoparticles were characterized simultaneously with FTIR, UV/vis. spectroscopy, transmission electron microscopy (TEM), and Energy-dispersive X-ray (EDAX). UV/vis. optical absorption spectra of as synthesized nanoparticles reveals presence of surface palsmon resonance (SPR) of both silver at (425 nm) and gold at (540 nm) with small shift and broadness of gold band after mixing with resucing and capping agent in natural extract which suggest presence of bimetallic nano structure (Au/Ag). FTIR and EDAX data approve the presence of bimetallic nano structure combined with curcumin extract. TEM micrographs shows that silver and gold can be synthesized separately in the form of nano particles using curcumin extract. Synthesis of gold nano particles in presence of silver effectively enhance and control formation of bi-metallic structure

Slip Effects on Peristaltic Transport in an Inclined Channel with Mass Transfer and Chemical Reaction

An analysis is carried out for the peristaltic flow in an inclined asymmetric channel when no-slip condition does not hold. The whole analysis has been carried out in the presence of mass transfer and chemical reaction. The channel asymmetry is generated because of peristaltic wave train on the walls through different amplitudes and phases. Long wavelength and low Reynolds number assumption is adopted in the whole mathematical analysis. Expressions for the stream function and longitudinal pressure gradient have been developed. Numerical integration is performed for the analysis of pressure rise per wavelength. Longitudinal velocity, pumping and trapping phenomena are analyzed in detail via plots

Curcumin and nano-curcumin mitigate copper neurotoxicity by modulating oxidative stress, inflammation, and akt/gsk-3β signaling

Copper (Cu) is essential for multiple biochemical processes, and copper sulphate (CuSO4) is a pesticide used for repelling pests. Accidental or intentional intoxication can induce multiorgan toxicity and could be fatal. Curcumin (CUR) is a potent antioxidant, but its poor systemic bioavailability is the main drawback in its therapeutic uses. This study investigated the protective effect of CUR and N-CUR on CuSO4-induced cerebral oxidative stress, inflammation, and apoptosis in rats, pointing to the possible involvement of Akt/GSK-3β. Rats received 100 mg/kg CuSO4 and were concurrently treated with CUR or N-CUR for 7 days. Cu-administered rats exhibited a remarkable increase in cerebral malondialdehyde (MDA), NF-κB p65, TNF-α, and IL-6 associated with decreased GSH, SOD, and catalase. Cu provoked DNA fragmentation, upregulated BAX, caspase-3, and p53, and decreased BCL-2 in the brain of rats. N-CUR and CUR ameliorated MDA, NF-κB p65, and pro-inflammatory cytokines, downregulated pro-apoptotic genes, upregulated BCL-2, and enhanced antioxidants and DNA integrity. In addition, both N-CUR and CUR increased AKT Ser473 and GSK-3β Ser9 phosphorylation in the brain of Cu-administered rats. In conclusion, N-CUR and CUR prevent Cu neurotoxicity by attenuating oxidative injury, inflammatory response, and apoptosis and upregulating AKT/GSK-3β signaling. The neuroprotective effect of N-CUR was more potent than CUR

Effect of acidity and salt content on the keeping quality of butter

Szerzők kísérletei szerint a vaj eltarthatósága a tejszín aciditásának növekedésével fokozatosan csökken. Édes tejszínből, ill. közepes és nagy aciditású tejszínből készült sózatlan vaj 5 C°-on jól eltartható volt 135, ill. 105 és 75 napig. Sózott vajak eltarthatósága rosszabb volt amint a sózatlan vajaké. Édes tejszínből, ill. közepes és nagy aciditású tejszínből készült sózott vajak eltarthatósága 5 C°-on való tárolásakor 105, ill. 90 és 45 nap volt. Nach den Versuchsangaben vermindert sich die Lagerfähigkeit der Butter stufenweise mit der Erhöhung der Azidität der Sahne. Aus süsser Sahne bzw. aus Sahne von mittlerer und hoher Azidität hergestellte ungesalzte Butter war bei 5°C 135 bzw. 105 und 75 Tage lang lagerfähig. Die Lagerfähigkeit von gesalzten Buttern war schlechter als die der ungesalzten Butter. Gesalzte Butter aus süsser Sahne bzw. aus Sahne von mittlerer und hoher Azidität war bei Lagerung bei 5 °C 105 bzw. 90 und 45 Tage lang lagerfähig. According to the experimental results the keeping quality of butter gradually decreased with the increase of acidity of the cream. Unsalted butter manufactured from sweet cream and cream of moderate and high acidity, respectively, exhibited a keeping quality of 135, 105 and 75 days on storage at 5°C. Salted butters showed lower keeping quality than unsalted butters.Salted butter manufactured from sweet cream and cream of moderate and high acidity, respectively, showed a keeping quality of 105, 90 and 45 days on storage at 5 °C. Selon les expériences des auteurs la stockabilité du beurre diminue avec I’augmentation de l’acidité de la creme. Les beurres non salés, produits ä partir des cremes douce, ä acidité faible et forte se faisaient bien entreposer ä 5°C pendant des périodes respectives de 135, 105 et 75 jours. La stickabilité des beurres sales était inférieure ä celle des non salés. La stockabilité des beurres salés, fabriqués ä partir de cremes douce, d’acidité faible ou forte durait, ä 5°C, 105, 95 et 45 jours

Nano-curcumin prevents copper reproductive toxicity by attenuating oxidative stress and inflammation and improving Nrf2/HO-1 signaling and pituitary-gonadal axis in male rats

Copper is essential for several cellular processes and is an important catalytic factor for many proteins. However, excess copper can provoke oxidative stress and reproductive toxicity. This study evaluated the effect of liposomal nano-curcumin (N-CUR) and CUR on testicular oxidative injury, inflammation, and apoptosis, and altered steroidogenesis and Nrf2/HO-1 signaling induced by copper sulfate (CuSO4). Rats received CuSO4 and N-CUR or CUR via oral gavage for 7 days. CuSO4 induced histopathological changes and altered pituitary-gonadal axis manifested by decreased serum gonadotropins and testosterone. Testicular steroidogenesis genes (StAR, 3β-HSD, CYP17A1, and 17β-HSD) and androgen receptor (AR) were downregulated in rats that received CuSO4. N-CUR and CUR prevented testicular tissue injury, increased circulating FSH, LH, and testosterone, and upregulated testicular steroidogenesis genes and AR. Additionally, N-CUR and CUR decreased testicular MDA, NO, NF-κB, iNOS, TNF-α, Bax, and caspase-3 while enhanced Bcl-2, Nrf2, and the antioxidants GSH, HO-1, SOD, and catalase. In conclusion, N-CUR and CUR prevented CuSO4-induced reproductive toxicity in male rats by suppressing oxidative injury and inflammatory response and boosting steroidogenesis, sex hormones, and Nrf2/HO-1 signaling. N-CUR was more effective in ameliorating tissue injury, oxidative stress, inflammation, and apoptosis and enhancing steroidogenesis and Nrf2/HO-1 than the native form