Lateral fricatives and lateral emphatics in southern Saudi Arabia and Mehri

Arabic was traditionally described as lughat al-Ρād ‘the language of Ρād’ due to the perceived unusualness of the sound. From Sībawayhi’s description, early Arabic Ρād was clearly a lateral or lateralized emphatic. Lateral fricatives are assumed to have formed part of the phoneme inventory of Proto-Semitic, and are attested in Modern South Arabian languages (MSAL) today. In Arabic, a lateral realization of Ρād continues to be attested in some recitations of the QurΜān. For Arabic, the lateral Ρād described by Sībawayhi was believed to be confined to dialects spoken in ДaΡramawt. Recent fieldwork by Asiri and al-Azraqi, however, has identified lateral and lateralized emphatics in dialects of southern ΚAsīr and the Saudi Tihāmah. These sounds differ across the varieties, both in their phonation (voicing) and manner of articulation — sonorants and voiced and voiceless fricatives — in their degree of laterality, and in their phonological behaviour: the lateralized Ρād in the southern Yemeni dialect of GhaylΉabbān, for example, has a non-lateralized allophone in the environment of /r/ or /l/. Recent phonetic work conducted by Watson on the Modern South Arabian language, Mehri, shows a similar range of cross-dialect variety in the realization of the lateral(ized) emphatic. In this paper, we discuss different reflexes of lateral(ized) emphatics in four dialects of the Saudi Tihāmah; we show that some of these dialects contrast cognates of *Ρ and *·; and we show that lateral emphatics attested in dialects of the Modern South Arabian language, Mehri, spoken in areas considerably to the south of the Saudi Tihāmah, show a similar degree of variation to that of the Arabic dialects of the Saudi Tihāmah

Aspects of the syntax of the dialect of Abha (south west Saudi Arabia).

Available from British Library Document Supply Centre-DSC:DXN018605 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Knowledge & Misconceptions about ADHD among Female Primary School Teachers in Aseer, Saudi Arabia

Background: Attention deficit/ hyperactivity disorder (ADHD) defined as physical movements which exceed the normal limit or the acceptable limit, and it shows in the form of a group of behavioral disorders arise as a result of many psychological and organic causes. Hyperactivity includes random, involuntary and unsuitable movements appear as a result of organic or psychological causes, and it is accompanied with an attention deficit. The Ministry of Health in the United States showed that males are more susceptible to this disorder than females four times. Despite the importance of the teacher's knowledge in the symptoms of the ADHD and the ways to deal with it; a small number of previous studies have examined this area. Past studies have shown that teachers did not have enough knowledge of ADHD and they often have fundamental misperceptions about the nature, causes and results of ADHD. Objective: to reveal the level of the teachers' knowledge & misconceptions about ADHD among primary school female teachers in Aseer, Saudi Arabia. Methods: This is a descriptive research using self-reported questionnaire method. It is quantitative in nature. It was done on randomly selected Saudi females teachers of primary schools in Aseer region. Results: Nearly twenty eight (27.6%) of the teachers responded correctly, while (36.5%) responded incorrectly, and (35.9%) responded “don’t know” to the first subscale which include 15 items assessing general knowledge about the nature, causes and outcome of ADHD. Fifty nine and three-tenth percent (59.3%) of the teachers responded correctly, while (17.7%) responded incorrectly, and (23%) responded “don’t know” to the second subscale of KADDS which include 9 items assessing symptoms/diagnosis of ADHD. Thirty three and two-tenth percent (33.2%) of the teachers responded correctly, while (24.5%) responded incorrectly, and (42.3%) responded “don’t know” to the third subscale of KADDS which include 12 items assessing the treatment of ADHD. Conclusion: Teachers have a major role in the identification and assessment of students with ADHD. This study was intended to examine teachers’ knowledge and misperceptions of ADHD. Teachers’ scores on KADDS were fairly good, pointing to relatively lack of knowledge about ADHD. Moreover, teachers’ level of knowledge of ADHD was positively related to their prior training and experience with ADHD. Results from this study concur with the findings of previous studies

Modern South Arabian: Conducting Field work in Dhofar, Mahrah and Eastern Saudi Arabia

In this paper, we discuss conducting community-based fieldwork with speakers of the Modern South Arabian languages (MSAL) in southern Oman, eastern Yemen and eastern Saudi Arabia for a Leverhulme-funded project: The Documentation and Ethnolinguistic Analysis of Modern South Arabian. The paper begins with a brief introduction to the languages, their varying degrees of language endangerment, and the traditional lifestyle of their speakers. In section 2 we discuss the decline and erosion of the languages, and the rationale this provides not only for documenting the languages, but also for closely involving native speakers and community members in the data collection, transcription, translation, analysis, and dissemination. This vital community participation is considered in section 3, which also includes a description of the equipment we used, the software packages and the orthography devised for the project. We describe the collection of audio, audio-visual and photographic material, file identification and metadata, identifying speakers, obtaining ethical consent, training community participants, analysing and archiving the data, and the project website. Section 4 discusses language revitalisation and the joint dissemination of research

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

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 &lt; 0⋅001) or low (363 of 860, 42⋅2 percent; OR 0⋅08, 0⋅07 to 0⋅10, P &lt; 0⋅001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P &lt; 0⋅001), but the relationship was reversed in low-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P &lt; 0⋅001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; P &lt; 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

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

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

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)