Antimicrobial Resistance and Associated Risk Factors for Clostridium difficile in Patients Attending Tertiary Care Settings.

To determine the incidence of antimicrobial-resistant emerging pathogens, Clostridium difficile, and its associated risk factors in tertiary care setups of Pakistan. This cross-sectional prospective study was conducted from January 2019 to December 2020, to determine the prevalence and antimicrobial resistance patterns of C. difficile strains isolated from 450 stool specimens of patients suffering from diarrhea hospitalized in tertiary care hospitals in Peshawar, Pakistan. The stool samples of the patients were processed for culture and detection of toxin A and toxin B by enzyme-linked immunosorbent assay (ELISA) and tpi PCR. The drug sensitivity test was performed for antibiotics including ampicillin, cefixime, cefepime, amoxicillin, nalidixic acid, sulpha/TMP (SXT), chloramphenicol, metronidazole, vancomycin, ciprofloxacin, levofloxacin, and imipenem. Of 450 stool specimens, 108 (24%) were positive for C. difficile by stool culture, whereas 115 (25.5%) were only positive for C. difficile toxins based on ELISA and PCR (128 (28.6%). Of 108, 90.7% (n = 98) isolates were resistant to one antibiotic, and 90 (83.4%) were resistant to three or more antimicrobials. The highest resistance rates were found against penicillin (83.3%) followed by amoxicillin (70%), nalidixic acid (61%), and metronidazole (38%), and the lowest resistance was found against vancomycin (6.4%) and imipenem (3.7%). CDI was statistically significantly correlated with increased age, use of antibiotics, abdominal surgeries, use of proton pump inhibitors and H2a, and presence of comorbidities. The high frequency of C. difficile in Peshawar, Pakistan, indicates that CDI is an important nosocomial infection in different hospitals. The results will be helpful for clinicians to redesign control and therapeutic strategies in hospitals.

Clinical and genetic investigation of 14 families with various forms of short stature syndromes.

Skeletal dysplasias are a heterogeneous group of disorders presenting mild to lethal defects. Several factors, such as genetic, prenatal, and postnatal environmental may contribute to reduced growth. Fourteen families of Pakistani origin, presenting the syndromic form of short stature either in the autosomal recessive or autosomal dominant manner were clinically and genetically investigated to uncover the underlying genetic etiology. Homozygosity mapping, whole exome sequencing, and Sanger sequencing were used to search for the disease-causing gene variants. In total, we have identified 13 sequence variants in 10 different genes. The variants in the HSPG2 and XRCC4 genes were not reported previously in the Pakistani population. This study will expand the mutation spectrum of the identified genes and will help in improved diagnosis of the syndromic form of short stature in the local population.

Smoke-water obtained via different biotics: a cost-effective and safer approach to biochemically sound banana ripening with prolonged shelf-life.

This study was conducted to investigate the efficacy of smoke-water obtained from biotics, for example coconut shells, rice husk, and pine cones on banana ripening, and compared with calcium carbide. Bio-chemical composition and remarkable bactericidal effect towards ATCC cultures of Escherichia coli, Staphylococcus aureus, and Bacillus cereus discovered the biological safety of the smoke-water in all collected smoke-water samples. Further, inductively coupled plasma mass spectrometry (ICP-MS) was carried out to investigate heavy metals; however, no traces were found in all collected samples. Consequently, it is proposed that heavy metal-free smoke-water obtained from various biotics series might be employed as ultrasafe fruit ripening as compared to calcium carbide (CaC2) that was found with heavy metal traces.

Terminology and methods used to differentiate injury intent of hospital burn patients in South Asia: Results from a systematic scoping review.

INTRODUCTION: A key component in the classification of all injury types is to differentiate whether the injury was deliberately inflicted and by whom, commonly known as "intent" in the surveillance literature. These data guide patient care and inform surveillance strategies. South Asia is believed to have the greatest number of intentional burn injuries, but national surveillance data is not disaggregated by injury intent. Scientific literature can be used for injury surveillance where national data collection does not exist. In order to synthesise research findings, it is essential to assess the potential impact of misclassification bias. We therefore conducted a systematic scoping review to understand terminology and methods used to differentiate injury intent of hospital burn patients in South Asia. METHODS: We followed the methods in our registered protocol (https://doi.org/10.17605/OSF.IO/DCYNQ). Studies met defined population, concept, context, and study design criteria. The databases Embase, MEDLINE, CINAHL, PsycInfo, and PakMediNet were searched. Two reviewers independently screened results. Data were extracted in a standardised manner and verified. The rigour of the method used to differentiate injury intent was appraised. RESULTS: 1435 articles were screened. Of these, 89 met our inclusion criteria. Most articles were from India and Pakistan, and used an observational study design. There were 14 stem terms used in the articles. The most common was "cause". There were 40 classifier terms. The most common were "accident", "suicide", and "homicide". Few articles defined these terms. The method used to differentiate injury intent was only described explicitly in 17% of articles and the rigour of the methods used were low. Where methods of differentiation were described, they appear to be based on patient or family report rather than multidisciplinary assessment. CONCLUSION: The heterogeneity in terms, lack of definitions, and limited investigation of injury intent means this variable is likely to be prone to misclassification bias. We strongly recommend that the global burn community unites to develop a common data element, including definitions and methods of assessment, for the concept of burn injury intent to enable more reliable data collection practices and interstudy comparisons.

Terminology and methods used to differentiate injury intent of hospital burn patients in South Asia: a systematic scoping review protocol.

BACKGROUND: The greatest proportion of burn injuries globally occur in South Asia, where there are also high numbers of intentional burns. Burn injury prevention efforts are hampered by poor surveillance data on injury intent. There is a plethora of local routinely collected data in the research literature from South Asia that could be used for epidemiological purposes, but it is not known whether the definitions and methods of differentiation of injury intent are sufficiently homogenous to allow valid study comparisons. METHODS: We will conduct a systematic scoping review to understand terminology and methods used to differentiate injury intent of hospital burn patients in South Asia. The objectives of the study are to: determine the breadth of terminology and common terms used for burn injury intent; to determine if definitions are comparable across studies where the same term is used; and to appraise the rigour of methods used to differentiate burn injury intent and suitability for comparison across studies. The databases Embase, MEDLINE, CINAHL, PsycINFO, and PakMediNet will be searched. Screening and data extraction will be completed independently by two reviewers. To be included, the article must be as follows: peer reviewed, primary research, study cutaneous burns, based on hospital patients from a country in South Asia, and use intent terminology or discuss a method of differentiation of injury intent. Results will be restricted to English language studies. No date restrictions will be applied. A plain language summary and terminology section are included for non-specialist readers. DISCUSSION: Results will be used to inform stakeholder work to develop standardised terminology and methods for burn injury intent in South Asia. They will be published open access in peer-reviewed journals wherever possible. SYSTEMATIC REVIEW REGISTRATION: This review has been registered with the Open Science Framework ( https://doi.org/10.17605/OSF.IO/DCYNQ ).

Innovative production of value-added products using agro-industrial wastes via solid-state fermentation.

The prevalence of organic solid waste worldwide has turned into a problem that requires comprehensive treatment on all fronts. The amount of agricultural waste generated by agro-based industries has more than triplet. It not only pollutes the environment but also wastes a lot of beneficial biomass resources. These wastes may be utilized as a different option/source for the manufacturing of many goods, including biogas, biofertilizers, biofuel, mushrooms and tempeh as the primary ingredients in numerous industries. Utilizing agro-industrial wastes as good raw materials may provide cost reduction and lower environmental pollution levels. Agro-industrial wastes are converted into biofuels, enzymes, vitamin supplements, antioxidants, livestock feed, antibiotics, biofertilizers and other compounds via solid-state fermentation (SSF). By definition, SSF is a method used when there is little to no free water available. As a result, it permits the use of solid materials as biotransformation substrates. Through SSF methods, a variety of microorganisms are employed to produce these worthwhile things. SSFs are therefore reviewed and discussed along with their impact on the production of value-added items. This review will provide thorough essential details information on recycling and the use of agricultural waste.

Development of novel kinetic model based on microbiome and biochar for in-situ remediation of total petroleum hydrocarbons (TPHs) contaminated soil.

A novel kinetic model has been developed to explain the degradation of total petroleum hydrocarbons. Microbiome engineered biochar amendment may result in a synergistic impact on degradation of total petroleum hydrocarbons (TPHs). Therefore, the present study analyzed the potential of hydrocarbon-degrading bacteria A designated as Aeromonas hydrophila YL17 and B as Shewanella putrefaciens Pdp11 morphological characterized as rod shaped, anaerobic and gram-negative immobilized on biochar, and the degradation efficiency was measured by gravimetric analysis and gas chromatography-mass spectrometry (GC-MS). Whole genome sequencing of both strains revealed the existence of genes responsible for hydrocarbon degradation. In 60 days remediation setup, the treatment consisting of immobilization of both strains on biochar proved more efficient with less half-life and better biodegradation potentials compared to biochar without strains for decreasing the content of TPHs and n-alkanes (C12-C18). Enzymatic content and microbiological respiration showed that biochar acted as a soil fertilizer and carbon reservoir and enhanced microbial activities. The removal efficiency of hydrocarbons was found to be a maximum of 67% in soil samples treated with biochar immobilized with both strains (A + B), followed by biochar immobilized with strain B 34%, biochar immobilized with strain A 29% and with biochar 24%, respectively. A 39%, 36%, and 41% increase was observed in fluorescein diacetate (FDA) hydrolysis, polyphenol oxidase and dehydrogenase activities in immobilized biochar with both strains as compared to control and individual treatment of biochar and strains. An increase of 35% was observed in the respiration rate with the immobilization of both strains on biochar. While a maximum colony forming unit (CFU/g) was found 9.25 with immobilization of both strains on biochar at 40 days of remediation. The degradation efficiency was due to synergistic effect of both biochar and bacteria based amendment on the soil enzymatic activity and microbial respiration.

Treatment technologies for olive mill wastewater with impacts on plants.

Olive mill wastewater (OMW), produced during olive oil production, contains high levels of salt contents, organic matter, suspended particles, and toxic chemicals (particularly phenols), which all result in increased biological and chemical oxygen demand. Olive Oil Mills' Wastes (OMW), which have dark brown color with unpleasant smell, consist mainly of water, high organic (mainly phenols and polyphenols) and low inorganic compounds (e.g. potassium and phosphorus), as well as grease. OMW components can negatively affect soil's physical, chemical, and biological properties, rendering it phytotoxic. However, OMW can positively affect plants' development when it's applied to the soil after pretreatment and treatment processes due to its high mineral contents and organic matter. There are various approaches for removing impurities and the treatment of OMW including chemical, biological, thermal, physiochemical, and biophysical processes. Physical techniques involve filtration, dilution, and centrifugation. Thermal methods include combustion and pyrolysis; biological techniques use anaerobic and aerobic techniques, whereas adsorption and electrocoagulation act as physiochemical methods, and coagulation and flocculation as biophysical methods. In contrast, combined biological treatment methods use co-digestion and composting. A comparison of the effects of both treated and untreated OMW samples on plant development and soil parameters can help us to understand the potential role of OMW in increasing soil fertility. This review discusses the impacts of untreated OMW and treated OMW in terms of soil characteristics, seed germination, and plant growth. This review summarizes all alternative approaches and technologies for pretreatment, treatment, and recovery of valuable byproducts and reuse of OMW across the world.

Biodegradation of PAHs by Bacillus marsiflavi, genome analysis and its plant growth promoting potential.

The biodegradation of hazardous petroleum hydrocarbons has recently received a lot of attention because of its many possible applications. Bacillus marsiflavi strain was isolated from oil contaminated soil of Rawalpindi, Pakistan. Initial sequencing was done by 16s rRNA sequencing technique. Bac 144 had shown 78% emulsification index and 72% hydrophobicity content. Further, the strain displayed production of 15.5 mg/L phosphate sloubilization and 30.25 µg/ml indole acetic acid (IAA) in vitro assay. The strain showed 65% biodegradation of crude oil within 5 days by using Gas Chromatography-Mass Spectrometry (GC-MS) analysis. Whole Genome analysis of Bac 144 was performed by PacBio sequencing and results indicated that Bacillus marsiflavi Bac144 strain consisted of size of 4,417,505bp with closest neighbor Bacillus cereus ATCC 14579. The number of the coding sequence was 4662 and number of RNAs was 141. The GC content comprised 48.1%. Various genes were detected in genome responsible for hydrocarbon degradation and plant defense mechanism. The toxic effect of petroleum hydrocarbons in soil and its mitigation with Bac 144 was tested by soil experiment with three levels of oil contamination (5%, 10% and 15%). Soil enzymatic activity such as dehydrogenase and fluorescein diacetate (FDA) increased up to 49% and 40% with inoculation of Bac 144, which was considered to be correlated with hydrocarbon degradation recorded as 46%. An increase of 20%, 14% and 9% in shoot length of plant at 5%, 10% and 15% level of oil was recorded treated with Bac 144 as compared to untreated plants. A percent increase of 14.89%, 16.85%, and 13.87% in chlorophyll, carotenoid, and proline content of plant was observed by inoculation with Bac 144 under oil stress. Significant reduction of 14% and 18%, 21% was recorded in the malondialdehyde content of plant due to inoculation of Bac 144. A considerable increase of 21.33%, 19.5%, and 24.5% in super oxide dismutase, catalase, and peroxidase dismutase activity was also observed in plants inoculated with strain Bac 144. These findings suggested that Bac-144 can be considered as efficient candidate for bioremediation of hydrocarbons.

Formulation and efficacy testing of bio-organic fertilizer produced through solid-state fermentation of agro-waste by Burkholderia cenocepacia.

Bio-organic fertilizers (BIOs), prepared from inoculating plant growth-promoting rhizobacteria (PGPR) into agro-industrial wastes, are gaining more attention due to their tremendous positive effects on soil health. This study was conducted to prepare and evaluate the effect of bio-organic fertilizers on maize. Plant growth-promoting rhizobacteria were isolated from rhizospheric soil of farmer's field near Islamabad, Pakistan and were screened for plant growth promotion characters and one strain Burkholderia cenocepacia was selected based on PGPR's characteristics. In-vitro characterization, the whole genome sequence analysis, RAST and antiSMASH analysis were performed. The number of coding sequences was 7157 with the number of subsystems 382. The GC contents included 66.96%. The sequence was submitted to NCBI with BioProject submission number PRJNA730996. Inoculum of selected bacterial strain Burkholderia cenocepacia was used for carrying solid-state fermentation of organic wastes. Four different agro-industrial wastes with a good amount of crude protein were selected: black gram husks (BGH) (15-22% Crude protein CP), rice bran (RB) (10-15% CP), peanut shell (PS) (6-7% CP), and dry leaves (DL) (as conventional fertilizers for comparison) were collected, dried, ground and sieved. Different parameters like pH, moisture content, particle size, temperature etc. were optimized. Inductively coupled plasma - optical emission spectrometry (ICP-OES) analysis of bio-organic fertilizers was performed. In general, concentration of nitrogen was higher in the first three biofertilizers i.e. BGH, RB and PS as compared to DL. Germination and glasshouse experiments were conducted to evaluate the effect of four different BIOs on maize growth. The results showed that agro-industrial wastes inoculated with PGPR (BIOs) significantly enhanced (ϸ 0.05) germination percentage (100%) as compared to control (80%), whereas germination index, promptness index and seedling vigour index showed 32%, 34% and 21% increase respectively as compared to control. In the pot experiment, chlorophyll content increased by 28%, relative water content by 39.28%, protein by 3% and amino acid increased by 20.73% as compared to control. It was concluded that there is a positive effect of BIOs on germination parameters and the growth of maize. Thus, these BIOs can be recommended to farmers for the production of maize.

Biostimulation potential of biochar for remediating the crude oil contaminated soil and plant growth.

Crude oil contamination is a serious environmental threat to soil and plants growing in it. Biochar has the potential of biostimulation for remediation of crude oil-contaminated soil. Therefore, the current research was designed to analyze the bio-stimulatory impact of biochar for remediating the crude oil contaminated soil (10%, and 15%), and growth of maize under glasshouse conditions. Biochar was produced by pyrolysis of Australian pines at 350 °C. Soil incubations were done for 20 days. The results of soil analysis showed that the crude oil degradation efficiency of biochar was 34%. The soil enzymatic activities had shown 38.5% increase in fluorescein diacetate (FDA) hydrolysis and 55.6% increase in dehydrogenase activity in soil incubated with biochar in comparison to control. The soil microbial diversity was improved to 41% in biochar treated soil with respect to untreated one, while microbial respiration rate had shown a 33.67% increase in soil incubated with biochar with respect to control under oil stress. Gas Chromatography Mass spectrometry (GC-MS) analysis had shown the high content of low molecular weight hydrocarbons (C9-C13) in the soil incubated with biochar in comparison to untreated soil. Biochar showed a significant increase in fresh and dry biomass (25%, 14.61%), leaf area (10%), total chlorophyll (11%), water potential (21.6%), osmotic potential (21%), and membrane stability index (12.7%). Moreover, biochar treatment showed a higher increase in the contents of proline (29%), total amino acids (18%), soluble sugars (30.4%), and antioxidant enzymes like superoxide dismutase (16.5%), catalase (11%), and peroxidase (12%). Overall, the results of the present study suggest the bio-stimulating potential of biochar for degradation of hydrocarbons in crude oil contaminated soil and their growth-stimulating effects on maize.

Testing environment Kuznets curve (EKC) hypothesis in different regions.

This study examines the association between air pollution and economic growth based on the idea of environment Kuznets curve (EKC) hypothesis which suggests an inverted U-shaped link between air pollution and economic growth in six different regions including Latin America and the Caribbean, East Asia and the Pacific, Europe and Central Asia, South Asia, the Middle East and North Africa, and Sub-Saharan Africa over the period 2000 to 2018. This regional classification is done to investigate the regional differences of the EKC relationship for carbon emissions. Models based on panel data econometric models are employed to obtain empirical results. Random effect and fixed effect models are used in the present study. A multivariate framework is used in which carbon dioxide emission, per capita gross domestic product, trade openness, foreign direct investment, primary school enrollment, financial development indicator, and institutional quality that is measured by six indicators are included. The result is that the EKC hypothesis is supported in all the abovementioned regions except in the Sub-Saharan Africa region. Thus, the hypothesis that different regions have dissimilar EKC relationships is supported through the results of this research study.

Synergistic Effect of Bacillus thuringiensis IAGS 199 and Putrescine on Alleviating Cadmium-Induced Phytotoxicity in Capsicum annum.

Plant growth-promoting bacteria (PGPB) and putrescine (Put) have shown a promising role in the mitigation of abiotic stresses in plants. The present study was anticipated to elucidate the potential of Bacillus thuringiensis IAGS 199 and Put in mitigation of cadmium (Cd)-induced toxicity in Capsicum annum. Cadmium toxicity decreased growth, photosynthetic rate, gas exchange attributes and activity of antioxidant enzymes in C. annum seedlings. Moreover, higher levels of protein and non-protein bound thiols besides increased Cd contents were also observed in Cd-stressed plants. B. thuringiensis IAGS 199 and Put, alone or in combination, reduced electrolyte leakage (EL), hydrogen peroxide (H2O2) and malondialdehyde (MDA) level in treated plants. Synergistic effect of B. thuringiensis IAGS 199 and Put significantly enhanced the activity of stress-responsive enzymes including peroxidase (POD), ascorbate peroxidase (APX), catalase (CAT) and superoxide dismutase (SOD). Furthermore, Put and microbial interaction enhanced the amount of proline, soluble sugars, and total soluble proteins in C. annum plants grown in Cd-contaminated soil. Data obtained during the current study advocates that application of B. thuringiensis IAGS 199 and Put establish a synergistic role in the mitigation of Cd-induced stress through modulating physiochemical features of C. annum plants.

Morphological assessment of glutamate zerovalent iron nanoparticles by scanning electron microscopy and its combined effect with indole acetic acid on amelioration of lead toxicity in maize (Zea mays L.).

Food safety is a priority issue for sustainable global development that can be affected by heavy metals, contributing to morbidity and even mortality in crop growth. Heavy metals often accumulate in the soil due to the use of extensive chemical fertilizers and pesticides; therefore, the current experiment was aimed to determine the effect of glutamate zerovalent iron nanoparticles (Glu-ZVFeNPs) and indole acetic acid (IAA) on physiological mechanism of lead (Pb+2 ) stress tolerance at 4 and 8 ppm in Zea mays variety. Seeds of the selected variety were collected from Cereal Crop Research Institute Persabaq Nowshera and planted in earthen pots in triplicate in the greenhouse of the Botany Department of the University of Peshawar. Nanoparticles were analyzed via scanning electron microscopy and energy dispersive X-ray analysis. Maximum growth responses were recorded from T12 (untreated + NPs + IAA), while minimum were recorded from T5 (8 ppm) indicating from the minimum amplitude of chlorophyll "a" and "b" contents, root length, shoot length, and root/shoot ratio. T5 (8 ppm) enhanced the values of osmolytes and antioxidant enzymes peroxidase and superoxide dismutase which has been ameliorated by the combined application of Glu-ZVFeNPs + IAA, indicating that the plant may resist the toxic effects of heavy metal stress at high concentration. From the present study, we concluded that adverse result of Pb+2 has been condensed by application of Glu-ZVFeNPs + IAA treatment as compared to the foliar application of IAA and Glu-ZVFeNPs individually.

Integrin-Mediated Adhesion and Chemoresistance of Acute Lymphoblastic Leukemia Cells Residing in the Bone Marrow or the Central Nervous System.

Acute Lymphoblastic Leukemia (ALL) is the most common cancer in childhood. Despite a significantly improved prognosis over the last decade with a 5-years survival rate of ~90%, treatment-related morbidity remains substantial and relapse occurs in 10-15% of patients (1). The most common site of relapse is the bone marrow, but early colonization and subsequent reoccurrence of the disease in the central nervous system (CNS) also occurs. Integrins are a family of cell surface molecules with a longstanding history in cancer cell adherence, migration and metastasis. In chronic lymphoblastic leukemia (CLL), the VLA-4 integrin has been acknowledged as a prognostic marker and mounting evidence indicates that this and other integrins may also play a role in acute leukemia, including ALL. Importantly, integrins engage in anti-apoptotic signaling when binding extracellular molecules that are enriched in the bone marrow and CNS microenvironments. Here, we review the current evidence for a role of integrins in the adherence of ALL cells within the bone marrow and their colonization of the CNS, with particular emphasis on mechanisms adding to cancer cell survival and chemoresistance.

Population reference ranges of urinary endogenous sulfate steroids concentrations and ratios as complement to the steroid profile in sports antidoping.

The population based Steroid Profile (SP) ratio of testosterone (T) and epitestosterone (E) has been considered as a biomarker approach to detect testosterone abuse in '80s. The contemporary Antidoping Laboratories apply the World Antidoping Agency (WADA) Technical Document (TD) for Endogenous Androgenic Anabolic Steroids (EAAS) in the analysis of SP during their screening. The SP Athlete Biological Passport (ABP) adaptive model uses the concentrations of the total of free and glucuronide conjugated forms of six EAASs concentrations and ratios measured by GC/MS. In the Antidoping Lab Qatar (ADLQ), the routine LC/MS screening method was used to quantitatively estimate the sulfate conjugated EAAS in the same analytical run as for the rest qualitative analytes. Seven sulfate EAAS were quantified for a number of routine antidoping male and female urine samples during screening. Concentrations, statistical parameters and selected ratios for the 6 EAAS, the 6 sulfate EAAS and 29 proposed ratios of concentrations from both EAAS and sulfate EAAS, which potentially used as SP ABP biomarkers, population reference limits and distributions have been estimated after the GC/MSMS analysis for EAAS and LC/Orbitrap/MS analysis for sulfate EAAS.

Assessing the Clinical Learning Environment in an Institution in the United Arab Emirates: The Resident Perspective.

BACKGROUND: A new accreditation model in the United States has increased focus on the clinical learning environment (CLE). There is limited research on trainee perceptions of the CLE in international settings. OBJECTIVE: We surveyed residents to obtain their perspective on the CLE at 1 sponsoring institution in the United Arab Emirates (UAE). METHODS: We surveyed residents at Tawam Hospital, UAE, a sponsoring institution with 142 trainees, on their perspectives in the 6 focal areas of the US Clinical Learning Environment Review (CLER) to gather baseline information. We administered a 26-item questionnaire to residents through an audience response system in November 2018. RESULTS: Of 100 residents in postgraduate year 2 and above, 72 (72%) responded. The perspective of the majority of respondents was favorable in the areas of reporting patient safety incidents, engaging in quality improvement activities, using a standardized form for care transition, and using professional guidelines for electronic health record documentation. In contrast, only half of the respondents perceived there is honesty in the reporting of duty hours, and only 36% felt the organization supported fatigue management. Other areas for improvement included residents' understanding of the concept of health disparities and activities to address health disparities. CONCLUSIONS: Our findings suggest that in key focal areas related to patient safety, health care quality, care transitions, and professionalism, UAE residents have similar perceptions of their CLE as US trainees. Opportunities for improvement include duty hour reporting, fatigue mitigation, and addressing health disparities.

Meeting report: managing peristomal skin complications.

A group of experts in stoma care attended a round-table discussion to identify prevention and management techniques on peristomal skin issues. Fatima Bibi, Project Manager at MA Healthcare, reports.