The Compatibility of Developed Mathematics Textbooks' Content in Saudi Arabia (Grades 6-8) with NCTM Standards

This study aimed to investigate the compatibility of developed mathematics textbooks' content (grades 6-8) in Saudi Arabia with NCTM standards in the areas of: number and operations, algebra, geometry, measurement, data analysis and probability.  To achieve that goal, a list of (NCTM) standards for grades (6-8) were translated to Arabic language, and a content analysis card was developed in the light of standards list for mathematics textbooks for the academic year 1434-1435 AH / 2013-2014 AD.  The study results revealed that the content of developed mathematics textbooks for grades (6-8) is compatible with 96.3% with NCTM standards, since the content anticipate 52 expectations from the standards list, while 3.7% from the NCTM standards expectations list were not achieved in the mentioned five areas. Keywords: compatibility, NCTM Standards, developed curriculum, mathematics textbook

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Caracterización de materiales y restauración de pinturas murales de las tumbas de El-Muzzawaka, Dakhla Oases, Egipto

The present study demonstrates scientific procedures applied to study mural paintings in two Graeco-Roman tombs of El-Muzzawaka, Dakhla Oases, Egypt. First, a series of analytical methods was applied to determine the chemical and mineralogical composition of pigment and plaster samples collected from the studied tombs. The analyses were performed by means of digitalized optical microscopy (OM), polarized light microscopy (PLM), scanning electron microscopy attached with X-ray microanalysis detector (SEM−EDS), X−ray diffraction analysis (XRD), and Fourier transform infrared spectroscopy (FT−IR). Analyses of the pigment samples revealed Egyptian blue, Egyptian green, green earth, black magnetite, and red/yellow ochres. The paintings were applied on a coarse plaster layer made of gypsum, anhydrite, calcite, and quartz. The preparation layer was made of two phases of calcium sulphate (gypsum and anhydrite). Further, the detection of an organic binder, of gum Arabic, confirms the application of tempera technique. The results showed that the bed rock samples contain variable amounts of quartz, anhydrite, montmorillonite, kaolinite, gypsum, and sodium chloride (halite). In situ observations showed several deterioration forms on the studied mural paintings. The destructive climatic condition of the region and the defects of the rock structure have contributed seriously in the deterioration process. Based on experimental tests, multi restoration procedures were applied in form of cleaning, reattaching paint flakes, applying injection grouts to detached layers, reconstruction of missing parts in the plaster, repair of wide-open cracks, and final protective consolidation of the painted surfaces. Further, recommendations to minimize any future damage were discussed.O presente estudo mostra os procedimentos científicos aplicados ao estudo de pinturas murais de duas tumbas greco-romanas de El-Muzzawaka, Dakhla Oásis, Egito. Numa primeira fase aplicaram-se diversos métodos analíticos para determinar a composição química e mineralógica de amostras de pigmento e gesso recolhidas das tumbas estudadas. As análises foram realizadas por meio de microscopia ótica (OM) digital, microscopia de luz polarizada (PLM), microscopia eletrónica de varrimento acoplada a detector de raios X (MEV - EDS), análise por difração de raios X (DRX) e espectroscopia de infravermelho por transformada de Fourier (FTIR). As análises das amostras de pigmento revelaram azul egípcio, verde egípcio, terra verde, magnetita preta e ocres vermelho / amarelo. As pinturas foram aplicadas sobre uma camada de gesso grosso constituída por gesso, anidrite, calcite e quartzo. A camada de preparação é composta por duas fases de sulfato de cálcio (gesso e anidrite). Além disso, o recurso à técnica a têmpera é confirmada pela deteção de um aglutinante orgânico, a goma-arábica. Os resultados mostraram que as amostras de leito rochoso contêm quantidades variáveis ​​de quartzo, anidrite, montmorilonite, caulinite, gesso e cloreto de sódio (halite). As observações in situ mostraram várias formas de deterioração nas pinturas murais estudadas. A condição climática destrutiva da região e os defeitos da estrutura rochosa têm contribuído seriamente para o processo de deterioração. Com base em testes experimentais forma usados múltiplos procedimentos de restauro, designadamente limpeza, fixações, consolidação por injeção, reconstrução de partes do gesso em falta, reparação de fissuras abertas e consolidação protetora final das superfícies pintadas. Além disso, foram discutidas recomendações para minimizar quaisquer danos futuros.El presente estudio demuestra procedimientos científicos aplicados al estudio de pinturas murales en dos tumbas grecorromanas en El-Muzzawaka, Dakhla Oásis, Egipto. Primero, se aplicó una serie de métodos analíticos para determinar la composición química y mineralógica de las muestras de pigmento y yeso recolectadas de las tumbas estudiadas. Los análisis se realizaron mediante microscopía óptica digital (OM), microscopía de luz polarizada (PLM), microscopía electrónica de barrido acoplada a un detector de microanálisis de rayos X (SEM-EDS), análisis de difracción de rayos X (XRD) y infrarrojo por transformada de Fourier. espectroscopia (FT-IR). El análisis de las muestras de pigmento reveló azul egipcio, verde egipcio, tierra verde, magnetita negra y ocre rojo / amarillo. Las pinturas se aplicaron sobre una gruesa capa de yeso a base de yeso, anhidrita, calcita y cuarzo. La capa de preparación estaba compuesta por dos fases de sulfato de calcio (yeso y anhidrita). Además, la detección de un aglutinante orgánico, la goma arábiga, confirma la aplicación de la técnica de revenido. Los resultados mostraron que las muestras de lecho rocoso contienen cantidades variables de cuarzo, anhidrita, montmorillonita, caolinita, yeso y cloruro de sodio (halita). Las observaciones in situ mostraron varias formas de deterioro en las pinturas murales estudiadas. La condición climática destructiva de la región y los defectos en la estructura de la roca han contribuido seriamente al proceso de deterioro. Sobre la base de pruebas experimentales, se aplicaron múltiples procedimientos de restauración en forma de limpieza, reposición de escamas de pintura, aplicación de juntas en capas desprendidas, reconstrucción de partes faltantes en el yeso, reparación de grietas abiertas y consolidación protectora final de superficies pintadas. Además, se discutieron recomendaciones para minimizar cualquier daño futuro

Flexural Response of Concrete Beams Reinforced with Steel and Fiber Reinforced Polymers

This paper numerically investigates the flexural response of concrete beams reinforced with steel and four types of Fiber-Reinforced Polymers (FRP), i.e., Carbon FRP (CFRP), Glass FRP (GFRP), Aramid FRP (AFRP), and Basalt FRP (BFRP). The flexural responses of forty beams with two boundary conditions (simply supported and over-hanging beams) were determined using ABAQUS. Subsequently, the finite element models were validated using experimental results. Eventually, the impact of the reinforcement ratios ranging between 0.15% and 0.60% on the flexural capacity, crack pattern, and fracture energy were investigated for all beams. The results revealed that, for the low reinforcement ratios, the flexural performance of CFRP significantly surpassed that of steel and other FRP types. As the reinforcement ratio reached 0.60%, the steel bars exhibited the best flexural performance

Safety and efficacy of tezepelumab vs. placebo in adult patients with severe uncontrolled asthma: a systematic review and meta-analysis

Abstract Patients with severe uncontrolled asthma still experience acute asthma symptoms and exacerbations, particularly those with non-eosinophilic inflammation who take the maximum amount of standard drug therapy. Tezepelumab, a human monoclonal antibody, can improve lung function and enhance control of asthma symptoms in those patients, regardless of the disease’s baseline characteristics. This study aims to investigate the safety and efficacy of using tezepelumab in controlling severe symptoms of uncontrolled asthma. We performed a comprehensive literature search in several databases, including PubMed, Scopus, Web of Science, Cochrane Library, and clinicaltrial.gov, using a well-established search strategy to include all relevant publications. According to our inclusion criteria, we searched for randomized controlled trials comparing tezepelumab versus placebo in patients with severe, uncontrolled asthma. We analyzed the data using The Revman 5.4 program software. The search identified 589 potential articles. After excluding studies inconsistent with selection criteria, four studies were included and analyzed qualitatively and quantitatively. The pooled effect demonstrated the better performance of tezepelumab over the placebo regarding the decrease in annualized asthma exacerbation rate (MD = − 0.74, (95% CI [− 1.04, − 0.44], p < 0.00001)), asthma control questionnaire-6 (ACQ-6) Score MD = − 0.32, (95% CI [− 0.43, − 0.21], p < 0.00001)), blood eosinophil count (MD = − 139.38 cells/mcL, (95% CI [− 150.37, − 128.39], p < 0.00001)), feNO (MD = − 10 ppb, (95% CI [− 15.81, − 4.18], p = 0.0008)) and serum total IgE (MD = − 123.51 UI/ml, (95% CI [− 206.52, − 40.50], p = 0.004)). All tezepelumab groups had higher pre-bronchodilator forced expiratory volume in 1 s than the placebo group (MD = 0.16, (95% CI [0.10, 0.21], p < 0.00001)). Higher efficacy and safety profile was detected for tezepelumab to control the exacerbations of severe uncontrolled adult asthmatics