Visible light- and dark-driven degradation of palm oil mill effluent (POME) over g-C3N4 and photo-rechargeable WO3.

The investigations of real industrial wastewater, such as palm oil mill effluent (POME), as a recalcitrant pollutant remain a subject of global water pollution concern. Thus, this work introduced the preparation and modification of g-C3N4 and WO3 at optimum calcination temperature, where they were used as potent visible light-driven photocatalysts in the degradation of POME under visible light irradiation. Herein, g-C3N4-derived melamine and WO3 photocatalyst were obtained at different calcination temperatures in order to tune their light absorption ability and optoelectronics properties. Both photocatalysts were proven to have their distinct phases, crystallinity levels, and elements with increasing temperature, as demonstrated by the ultraviolet-visible spectroscopy (UV-Vis), X-ray diffraction analysis (XRD), thermogravimetric analysis (TGA), Fourier-transform infrared spectroscopy (FTIR), Brunauer-Emmett-Teller (BET), transmission electron microscopy (TEM), and X-ray photoelectron spectroscopy (XPS) results. Significantly, g-C3N4 (580 °C) and WO3 (450 °C) unitary photocatalysts exhibited the highest removal efficiency of POME without dilution due to good crystallinity, extended light absorption, high separation, and less recombination efficiency of electron-hole pairs. Furthermore, surprisingly, the superior energy storage photocatalytic performance with outstanding stability by WO3 achieved an approximately 10% increment during darkness, compared with g-C3N4 under visible light irradiation. Moreover, it has been proven that the WO3 and g-C3N4 photocatalysts are desirable photocatalysts for various pollutant degradations, with excellent visible-light utilization and favorable energy storage application.

Development of potential dysgraphia handwriting dataset.

This report presents a dataset of offline handwriting samples among Malaysian schoolchildren with potential dysgraphia. The images contained Malay sentences written by primary school students and children under intervention by the Malaysia Dyslexia Association (PDM). Students were expected to copy and write the sentences provided on the paper form that was used to gather data. Students were required to write three sets of sentences. The paper was digitalized by scanning it and converting it into digital form. Furthermore, the images were pre-processed using image processing techniques by converting the images into binary format and interchanging the foreground and background colors. The images were then classified into two categories, namely potential dysgraphia and low potential dysgraphia. The dataset comprised a total of 249 handwriting images, obtained from a sample of 83 participants who were selected in the data collection process, with 114 for potential dysgraphia and 135 for low potential dysgraphia. Both categories of handwriting images were prepared in black and white images.

APPaRENT 3: Asthma Patients' and Physicians' Perspectives on the Burden and Management of Asthma in Seven Countries.

INTRODUCTION: Asthma management is strongly dependent on physician and patient beliefs and perceptions about the disease and its long-term treatment. The APPaRENT 3 study was conducted to explore factors influencing treatment choice and to understand patients' and physicians' attitudes and perspectives on the use of controller inhalers in regular versus flexible dosing for asthma management. METHODS: This cross-sectional survey of patients with asthma and treating physicians was conducted in seven countries: Indonesia, Malaysia, Philippines, Thailand, Vietnam (patient survey only), Saudi Arabia, and the United Arab Emirates. Assessment was carried out through an online/face-to-face questionnaire, where patients' viewpoints were focused on their attitudes and beliefs about asthma and treatment adherence, whereas physicians' viewpoints were gathered on their attitudes and beliefs about asthma management, knowledge of and adherence to asthma treatment guidelines, and asthma treatment regimens. RESULTS: Overall, 1400 patients (mean age, 34 years) and 599 physicians (mean age, 43 years) were included in the survey. Physicians similarly prioritised symptom control (39%) and exacerbation reduction (40%) in moderate asthma, whereas patients prioritised symptom control (41%) over exacerbation reduction (22%). Although both groups (physicians, 86%; patients, 84%) perceived asthma as well-controlled, poor management was evident based on Asthma Control Test (ACT) scores (mean, 15.7; standard deviation, 4.14; 82% had an ACT score < 20) and high symptom burden (39% reported nighttime awakenings or early mornings ≥ 2 nights/week). Most patients (76%) with moderate asthma were prescribed regular dosing, with the most common treatment being inhaled corticosteroid (ICS)/long-acting ß2-agonist (LABA) with as-needed inhaled short-acting ß2-agonist (SABA; 20%). Among patients on maintenance and reliever therapy, 93% of patients received a separate inhaled reliever. CONCLUSIONS: Despite high symptom burden, patients overestimated their level of asthma control. Physicians prioritised controlling symptoms and reducing exacerbations as treatment goals for moderate asthma, often prescribing regular dosing with ICS/LABA with as-needed inhaled SABA.

Managing asthma depends a lot on what doctors and patients think about the illness and its long-term treatment. This study looked into what influences treatment decisions and what patients and doctors think about using inhalers regularly or on an as-needed basis to manage asthma across seven countries (Indonesia, Malaysia, Philippines, Thailand, Vietnam [patient survey only], Saudi Arabia, and the United Arab Emirates). In this study, patients with asthma and doctors managing asthma completed an online/face-to-face questionnaire. The study aimed to understand what patients think about asthma and their treatment plan. Meanwhile, the doctors were asked what they think about managing asthma and how much they apply clinical guidelines for treating patients with asthma. Doctors believed it is equally important to control symptoms and prevent worsening of symptoms in patients with moderate asthma, while patients cared more about controlling symptoms than preventing worsening of symptoms. While doctors and patients both regarded asthma as well-controlled, many patients had low Asthma Control Test scores and experienced a lot of symptoms, suggesting that they are poor perceivers of asthma control. Most patients with moderate asthma were given regular treatment, usually with inhaled corticosteroid combined with long-acting ß₂-agonist along with as-needed short-acting ß₂-agonist as a reliever. Most patients who were prescribed the same inhaler for regular use and as a reliever also had a separate inhaler for quick relief of symptoms. This study shows the need for patients and doctors to have better conversations about asthma, its treatments, and what to expect from them.

Delivery of Probiotic-Loaded Microcapsules in the Gastrointestinal Tract: A Review.

Probiotics are live microorganisms that inhabit the gastrointestinal tract and confer health benefits to consumers. However, a sufficient number of viable probiotic cells must be delivered to the specific site of interest in the gastrointestinal tract to exert these benefits. Enhanced viability and tolerance to sublethal gastrointestinal stress can be achieved using appropriate coating materials and food matrices for orally consumed probiotics. The release mechanism and interaction of probiotic microcapsules with the gastrointestinal tract have been minimally explored in the literature to date. To the authors' knowledge, no review has been published to discuss the nature of release and the challenges in the targeted delivery of probiotics. This review addresses gastrointestinal-related complications in the formulation of targeted delivery and controlled release of probiotic strains. It investigates the impacts of environmental stresses during the transition stage and delivery to the target region in the gastrointestinal tract. The influence of factors such as pH levels, enzymatic degradation, and redox conditions on the release mechanisms of probiotics is presented. Finally, the available methods to evaluate the efficiency of a probiotic delivery system, including in vitro and in vivo, are reviewed and assessed. The paper concludes with a discussion highlighting the emerging technologies in the field and emphasising key areas in need of future study.

Comparative Analysis of Frailty Scores for Predicting Adverse Outcomes in Hip Fracture Patients: Insights from the United States National Inpatient Sample.

The aim of the current investigation was to compare the ability of several frailty scores to predict adverse outcomes in hip fracture patients. All adult patients (18 years or older) who suffered a hip fracture due to a fall and underwent surgical fixation were extracted from the 2019 National Inpatient Sample (NIS) Database. A combination of logistic regression and bootstrapping was used to compare the predictive ability of the Orthopedic Frailty Score (OFS), the Nottingham Hip Fracture Score (NHFS), the 11-factor modified Frailty Index (11-mFI) and 5-factor (5-mFI) modified Frailty Index, as well as the Johns Hopkins Frailty Indicator. A total of 227,850 patients were extracted from the NIS. In the prediction of in-hospital mortality and failure-to-rescue (FTR), the OFS surpassed all other frailty measures, approaching an acceptable predictive ability for mortality [AUC (95% CI): 0.69 (0.67-0.72)] and achieving an acceptable predictive ability for FTR [AUC (95% CI): 0.70 (0.67-0.72)]. The NHFS demonstrated the highest predictive ability for predicting any complication [AUC (95% CI): 0.62 (0.62-0.63)]. The 11-mFI exhibited the highest predictive ability for cardiovascular complications [AUC (95% CI): 0.66 (0.64-0.67)] and the NHFS achieved the highest predictive ability for delirium [AUC (95% CI): 0.69 (0.68-0.70)]. No score succeeded in effectively predicting venous thromboembolism or infections. In summary, the investigated frailty scores were most effective in predicting in-hospital mortality and failure-to-rescue; however, they struggled to predict complications.

Internet addiction among school adolescents in Jeddah-Saudi Arabia.

BACKGROUND: Internet addiction is increasing among adolescents worldwide. There is a lack of research assessing internet addiction and factors contributing to it among adolescents in Jeddah city. The current study aimed to assess the rate of internet addiction among adolescents in Jeddah, Saudi Arabia, and the potential factors associated with it. METHODS: A cross-sectional online survey, hosted by SurveyMonkey, was used to capture data on internet use from 462 adolescents aged 12-18 years between March and May 2022. Young's Internet Addiction Scale was used to assess the degree of internet addiction as perceived by adolescents. Multiple linear regression analysis was used to identify possible predictors of internet addiction among adolescents in Jeddah. RESULTS: The mean age of the participants was 15.5 ± 1.9 years. The majority were females (75%) from public schools (63%), spent an average of six hours on the internet daily, owned smartphones (98%), accessed the internet via a smartphone (94%), and used the internet for socializing (82%). Internet addiction mean score was 39.20 ± 15.20 out of 100. More than two-thirds of the participants had mild to moderate levels of internet addiction (68%). Significant predictors contributing to internet addiction were using the internet for socialization and playing online games. The more hours spent on the internet daily, the more the internet addiction was (p ≤ 0.05). CONCLUSIONS: The internet addiction rate is high among school adolescents in Jeddah. The majority of high school adolescents had mild to moderate levels of internet addiction. Interventional multidisciplinary programs are needed to mitigate the factors that influence internet addiction.

Treatment Outcomes of Pulpotomy in Primary Teeth with Irreversible Pulpitis: A Systematic Review and Meta-Analysis.

AIM: This systematic review and meta-analysis aimed to evaluate the success rates of pulpotomy treatment for irreversible pulpitis in primary teeth. METHODS: This study was registered and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Relevant studies published between January 1980 and April 2023 were identified across eight online databases and two paediatric dentistry textbooks. Study selection, data extraction, and quality assessment were conducted by multiple investigators independently. Data analysis involved single-arm and two-arm meta-analyses, leave-one-out sensitivity analysis, meta-regression, and assessment of publication bias. The risks of bias were evaluated using the Cochrane Collaboration's assessment tools. The levels of evidence were determined using the Oxford Centre for Evidence-Based Medicine (OCEBM) tool. RESULTS: Five primary studies were included. The weighted mean overall success rates at 6-month and 12-month follow-ups were 97.2% and 94.4%, respectively. Two-arm meta-analysis revealed no significant difference (p > 0.05) between the use of mineral trioxide aggregate (MTA) and non-MTA bioceramic-based materials as pulpotomy medicaments. The sample size of each study did not affect the degree of data heterogeneity. Egger's test revealed no significant publication bias. CONCLUSIONS: Pulpotomy may be regarded as an alternative modality for treating primary teeth with irreversible pulpitis. Nevertheless, future well-designed trials and extended follow-up periods are warranted.

Efficiency of magnetic zeolitic imidazolate framework-8 (ZIF-8) modified graphene oxide for lead adsorption.

Simple and efficient removal of Pb(II) ion from aqueous solution through adsorption has accelerated the development of many new composites to improve this popular method. In this study, the composites of graphene oxide (GO), zeolitic imidazolate framework-8 (ZIF-8), and magnetic materials were synthesized via coprecipitation method utilizing a different molar ratio between FeCl2 and FeCl3 of 1:0.5, 2:1, 3:1.5, and 4:2. The ZIF-8/GO was prepared via room temperature synthesis method prior to its further modification with magnetic materials for ease of separation. It was observed that the MZIF-8/GO2 of molar ratio 2:1 showed the best performance in adsorbing Pb(II) ion. As confirmed by FESEM image, it appeared to be ZIF-8 particles that have grown all over the GO platform and overlayed with Fe3O4 granular-shaped particles. The MZIF-8/GO2 successfully achieved 99% removal of Pb(II) within 10 min. The optimum values obtained for the initial concentration of Pb (II) were 100 mg/L, pH of 4 to 6, and adsorbent dosage used was 10 mg. The Langmuir isotherm and the pseudo-second-order kinetic model were deemed suitable to evaluate the adsorption of Pb(II) using MZIF-8/GO2. Results showed that MZIF-8GO2 achieved a maximum adsorption capacity of 625 mg/g of Pb(II) adsorption. All parent materials demonstrated a good synergistic effects, while exhibiting a significant contribution in providing active sites for Pb(II) adsorption. Therefore, this ternary composite of MZIF-8/GO2 is expected to be a promising adsorbent for Pb(II) adsorption from aqueous solution with an added value of ease of post phase separation using external magnetic field.

Accuracy of different dental age assessment methods to determine chronological age among children with special needs.

AIM: This study aimed to validate the accuracy of dental age (DA) based on the dental development of permanent teeth in children with special needs using Demirjian, Willems, and London Atlas methods and to correlate the dental and chronological age (CA) of children with special needs in Malaysia. MATERIALS AND METHODS: The panoramic radiographic images belonging to children with special needs from the two teaching dental hospitals in Malaysia aged between 5 and 16 years were included in the study. The evaluation was performed by two observers using three methods (London Atlas, Demirjian, and Willems methods) to estimate the accurate DA. The outcome was determined by comparing the mean of the DA and CA. RESULTS: A total of 52 panoramic radiographs were available for the analysis. The London Atlas and Demirjian methods overestimated the DA with a mean of 0.05 and 0.20 years, respectively, while the Willems method underestimated by 0.19 years. The London Atlas method was highly precise and accurate, while Demirjian and Willems methods were the least precise and accurate. CONCLUSION: The London Atlas method of DA estimation is highly accurate and valid for children with special needs in the Malaysian population, followed by the Willems and Demirjian methods.

Removal of multiple pesticides from water by different types of membranes.

Pesticides are used in agriculture to protect crops from pathogens, insects, fungi and weeds, but the release of pesticides into surface/groundwater by agriculture runoff and rain has raised serious concerns not only for the environment but also for human health. This study aimed to investigate the impact of surface properties on the performance of seven distinct membrane types utilized in nanofiltration (NF), reverse osmosis (RO) and forward osmosis (FO) processes in eliminating multiple pesticides from spiked water. Out of the membranes tested, two are self-fabricated RO membranes while the rest are commercially available membranes. Our results revealed that the self-fabricated RO membranes performed better than other commercial membranes (e.g., SW30XLE, NF270, Duracid and FO) in rejecting the targeted pesticides by achieving at least 99% rejections regardless of the size of pesticides and their log Kow value. Despite the marginally lower water flux exhibited by the self-fabricated membrane compared to the commercial BW30 membrane, its exceptional ability to reject both mono- and divalent salts renders it more apt for treating water sources containing not only pesticides but also various dissolved ions. The enhanced performance of the self-fabricated RO membrane is mainly attributed to the presence of a hydrophilic interlayer (between the polyamide layer and substrate) and the incorporation of hydrophilic nanosheets in tuning its surface characteristics. The findings of the work provide insight into the importance of membrane surface modification for the application of not only the desalination process but also for the removal of contaminants of emerging concern.

Neonatal Intensive Care Nurses' Knowledge of Neonatal Pain Assessment in Private and Public Hospitals in Jeddah, Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: Neonatal Intensive Care Unit (NICU) nurses with adequate neonatal pain assessment knowledge are crucial in effective neonatal pain management. There is limited research that assessed the knowledge of NICU nurses in Saudi Arabia regarding neonatal pain assessment. OBJECTIVE: To assess the knowledge of NICU nurses in Saudi Arabia regarding neonatal pain assessment. DESIGN AND METHODS:  A cross-sectional design using an online survey was conducted to capture information regarding neonatal pain assessment knowledge from 125 NICU nurses in Saudi Arabia. Knowledge of pain assessment was assessed using a modified version of the knowledge, attitudes, and practice scale. Knowledge scores were classified as high, average, and low. RESULTS: Participants' knowledge regarding neonatal pain assessment was inadequate (Mean = 63/100). The majority of the participants had a low to average level of knowledge (n= 97, 78%). CONCLUSION: A significant proportion of NICU nurses had inadequate knowledge regarding neonatal pain assessment, which can be improved. Educational interventions are needed to boost these nurses' knowledge regarding neonatal pain assessment.

Nurses' Assessment of Pain in Saudi Neonatal Intensive Care Units.

BACKGROUND: Research reveals that neonatal pain management in Neonatal Intensive Care Units (NICUs) is suboptimal. There is limited research that assessed NICU nurses' pain assessment practices in Saudi Arabia. AIM: To assess the nurses' pain assessment practices in the NICU in Saudi Arabia. DESIGN: This study used a descriptive cross-sectional design. SETTINGS: Research was conducted using an online survey. PARTICIPANTS/SUBJECTS: This study was carried out on 65 NICU nurses. The participants were recruited from one governmental and one private hospital in Saudi Arabia. METHODS: Data on pain assessment practices were collected, including the frequency of pain assessment, pain assessment scales used for preterm and term neonates, and pain assessment documentation. Data were analyzed using frequencies and percentages. RESULTS: The majority of the participants (94%) routinely assessed pain and documented pain assessment (97%). One-third of the participants assessed pain regularly every hour (32%). The most used pain assessment scales for term neonates were the neonatal infant pain scale (40%) and the cry, required oxygen, increased vital signs, expression, and sleeplessness scale (23%). The most used pain assessment scales for preterm neonates were the neonatal infant pain scale (31%), the cry, required oxygen, increased vital signs, expression, sleeplessness scale (19%), and the premature infant pain profile (17%). CONCLUSIONS: NICU nurses in Saudi Arabia consistently assessed for and documented pain; however, the tools chosen were sometimes suboptimal. A substantial number of NICU nurses used invalid tools to assess pain in term and preterm neonates. An interventional program is needed to enhance the use of evidence-based practice recommendations regarding neonatal pain assessment by nurses in the Neonatal Intensive Care Units in Saudi Arabia.

Association between passive smoking and dental caries status in children: A cross-sectional analytical study.

BACKGROUND: Several risk factors contribute to the development of dental caries in children, including sociodemographic, dietary, oral hygiene-related and other miscellaneous factors. Maternal smoking was highly associated with dental caries when compared to smoking by fathers or other household members. OBJECTIVES: The aim of the study was to determine the prevalence of dental caries and their association with exposure to environmental tobacco smoke (ETS) among 5- to 10-year-old students attending private and government schools. MATERIAL AND METHODS: A cross-sectional analytical study was conducted among schoolchildren. Data was collected from the primary caregivers using a pre-tested form to assess the ETS exposure under 5 domains based on history: antenatal exposure; exposure during the index period; exposure in the school neighborhood; exposure in restaurants/roadside stalls; and exposure in bus stops/railway stations. Dental caries was assessed based on the World Health Organization (WHO) guidelines from 1997. The association was reported using prevalence ratios (PRs) (95% confidence interval (CI)). RESULTS: Data was obtained from 211 schoolchildren attending government (39.8%) and private schools (60.2%). The overall prevalence (95% CI) of dental caries was 49.3% (42.5-56.1%). Among all the risk factors evaluated in the study, exposure to ETS was associated with a significantly increased risk of dental caries. The adjusted prevalence ratio (APR) of ETS exposure varied with the mother's educational status and high sugar exposure, although this was statistically insignificant. CONCLUSIONS: The prevalence of dental caries among schoolchildren aged 5 to 10 years in the city was moderate and similar to the national average. Among the risk factors assessed in the study, antenatal exposure to ETS was found to significantly increase the prevalence of dental caries by 41% after adjusting for other factors. Therefore, it is important to educate parents on the causal role of ETS exposure in dental caries.

Parents' Perception and Use of Skin-to-Skin Care in Jeddah, Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: Skin-to-skin care (SSC) between newborns and their parents provides many positive outcomes for both newborns and their parents. However, there is a lack of research assessing the perception of parents, especially fathers, of SSC in Saudi Arabia. PURPOSE: The aim of the study is to assess parents' perception of SSC in Saudi Arabia. METHODS: This cross-sectional study used an online survey. Data were collected from a convenience sample of 140 parents of hospitalized neonates between January and June 2023. Data were collected from one private hospital (Dr. Soliman Fakeeh Hospital) and one public hospital (King Abdulla Medical Complex) in Jeddah, Saudi Arabia. The parents' perceptions of SSC were assessed using the Parents' Perceptions of SSC tool. An independent t-test was used to compare mothers and fathers in their perceptions of SSC. RESULTS: One hundred and forty parents completed the online survey (70 females and 70 males). The majority of the parents did not use SSC with their babies (n=102, 73%), did not read or hear about the use and benefits of skin-to-skin care (n=100, 71%), and did not receive information or training on SSC from healthcare professionals (n=112, 80%). Mothers' perception of SSC was significantly higher than that of fathers (p ≤ 0.05). CONCLUSION: Fathers' perception of SSC was lower than that of mothers. Awareness and training programs are needed to inform parents, especially fathers, regarding SSC and its benefits in Saudi Arabia.

KCO: Balancing class distribution in just-in-time software defect prediction using kernel crossover oversampling.

The performance of the defect prediction model by using balanced and imbalanced datasets makes a big impact on the discovery of future defects. Current resampling techniques only address the imbalanced datasets without taking into consideration redundancy and noise inherent to the imbalanced datasets. To address the imbalance issue, we propose Kernel Crossover Oversampling (KCO), an oversampling technique based on kernel analysis and crossover interpolation. Specifically, the proposed technique aims to generate balanced datasets by increasing data diversity in order to reduce redundancy and noise. KCO first represents multidimensional features into two-dimensional features by employing Kernel Principal Component Analysis (KPCA). KCO then divides the plotted data distribution by deploying spectral clustering to select the best region for interpolation. Lastly, KCO generates the new defect data by interpolating different data templates within the selected data clusters. According to the prediction evaluation conducted, KCO consistently produced F-scores ranging from 21% to 63% across six datasets, on average. According to the experimental results presented in this study, KCO provides more effective prediction performance than other baseline techniques. The experimental results show that KCO within project and cross project predictions especially consistently achieve higher performance of F-score results.

Knowledge, Awareness, and Practice of Safety and Emergency Response Among Scuba Divers in Malaysia: Questionnaire Development and Validation.

INTRODUCTION: Safety has become paramount to ensure that scuba diving continues to expand into new markets, with minimal risks, and that scuba diving translates into a safe and relaxed adventure in response to growing market demands. Research focusing on assessing the knowledge, awareness, and practices (KAP) regarding safety and emergency response among scuba divers has been limited, and there is a need for validated assessment tools in this area. METHODS: This study involved 555 scuba divers in Malaysia, and the questionnaire underwent a thorough development and validation process, including content and face validity assessments, as well as exploratory factor analysis. The validation of the knowledge domain was conducted using Item Response Theory (IRT) analysis, while awareness and practice were validated through exploratory and confirmatory factor analyses (EFA and CFA). RESULTS: The content validity of the instrument was confirmed, with all items scoring over 80% for Item Content Validity Index (I-CVI), Scale Content Validity Index (S-CVI), and Scale Content Validity Index/Average (S-CVI/AVE). The initial draft comprises three domains: knowledge, awareness, and practice. Knowledge items were analyzed using IRT and demonstrated acceptable difficulty and discrimination levels. For the awareness and practice domains, EFA showed a Kaiser-Meyer-Olkin measure (KMO) of 0.83 and 0.79, respectively, with a significant Bartlett's test of Sphericity (P < 0.001). EFA yielded three factors for both awareness and practice domains with a total of 12 items for awareness and 13 items for practice, with satisfactory factor loadings (≥0.3). The final model of CFA showed good fits for both awareness and practice domains in terms of absolute, parsimonious, and comparative measures. The composite reliability of awareness was acceptable with Raykov's rho of 0.71, whereas the practice domain fell slightly below the acceptable threshold at 0.55. This was attributed to low factor loading and a limited number of items within each factor. The final questionnaire now consists of 20 items for knowledge, 10 items for awareness, and 12 items for the practice domain. CONCLUSION: The results of this validation and reliability study indicate that the newly developed questionnaire possesses favorable psychometric properties for assessing KAP related to safety and emergency response in the scuba diving context. This research is essential for harmonizing the perspectives of crucial stakeholders within the recreational scuba diving industry.

Prioritizing patients for hip fracture surgery: the role of frailty and cardiac risk.

Introduction: The number of patients with hip fractures continues to rise as the average age of the population increases. Optimizing outcomes in this cohort is predicated on timely operative repair. The aim of this study was to determine if patients with hip fractures who are frail or have a higher cardiac risk suffer from an increased risk of in-hospital mortality when surgery is postponed >24 h. Methods: All patients registered in the 2013-2021 TQIP dataset who were ≥65 years old and underwent surgical fixation of an isolated hip fracture caused by a ground-level fall were included. Adjustment for confounding was performed using inverse probability weighting (IPW) while stratifying for frailty with the Orthopedic Frailty Score (OFS) and cardiac risk using the Revised Cardiac Risk Index (RCRI). The outcome was presented as the absolute risk difference in in-hospital mortality. Results: A total of 254,400 patients were included. After IPW, all confounders were balanced. A delay in surgery was associated with an increased risk of in-hospital mortality across all strata, and, as the degree of frailty and cardiac risk increased, so too did the risk of mortality. In patients with OFS ≥4, delaying surgery >24 h was associated with a 2.33 percentage point increase in the absolute mortality rate (95% CI: 0.57-4.09, p = 0.010), resulting in a number needed to harm (NNH) of 43. Furthermore, the absolute risk of mortality increased by 4.65 percentage points in patients with RCRI ≥4 who had their surgery delayed >24 h (95% CI: 0.90-8.40, p = 0.015), resulting in a NNH of 22. For patients with OFS 0 and RCRI 0, the corresponding NNHs when delaying surgery >24 h were 345 and 333, respectively. Conclusion: Delaying surgery beyond 24 h from admission increases the risk of mortality for all geriatric hip fracture patients. The magnitude of the negative impact increases with the patient's level of cardiac risk and frailty. Operative intervention should not be delayed based on frailty or cardiac risk.

Impact of class II and class III skeletal malocclusion on pharyngeal airway dimensions: A systematic literature review and meta-analysis.

Background: This study is a pioneer systematic review and meta-analysis aimed at comparing the influence of Class II and Class III skeletal malocclusions on pharyngeal airway dimensions. It stands as the inaugural comprehensive assessment to collate and analyze the disparate findings from previously published articles on this topic. The objective of this study was to identify published articles that compare the effects of class II and class III skeletal malocclusion on the pharyngeal airway dimensions. Methods: An all-inclusive search for existing published studies was done to identify peer-reviewed scholarly articles that compared the influence of class II and class III skeletal malocclusion on pharyngeal airway dimensions. The search was done via five electronic databases: Cochrane Library, EMBASE, Scopus, Web of Science, and PubMed. Screening of the articles was done and the eligible studies were critically assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Results: The initial search yielded 476 potential articles of which, nine were finally included in this study for a total of 866 patients. Three studies were of cross-sectional design and six were of retrospective study design. Following a critical analysis and review of the studies, class III skeletal malocclusion had significantly larger volume and area measurements compared to class II skeletal malocclusion. Conclusion: Research in the field of literature has established that variations in skeletal classifications have a discernible effect on the size of the pharyngeal airways. With the advancement of skeletal malocclusions to a class III, there is an observed increase in both the volume and cross-sectional area of the airways.

The relationship between internet addiction and stress, anxiety, and depression in adolescents in Saudi Arabia.

BACKGROUND: There is an increasing rate of Internet addiction among adolescents that may lead to many negative psychological outcomes. This study assessed the relationship between Internet addiction and stress, anxiety, and depression in adolescents in Saudi Arabia. METHODS: A correlational online survey captured data on Internet use and psychological outcomes from 462 adolescents between March and May 2022. Young's Internet Addiction Scale assessed the degree of Internet addiction. The Depression, Anxiety, and Stress Scale (DASS21) assessed the perceived level of stress, anxiety, and depression. Bivariate and multivariate analyses determined the relationship between Internet addiction and depression, anxiety, and stress. RESULTS: Sixty-eight percent of adolescents had mild to severe Internet addiction. Sixty percent of the adolescents perceived mild to extremely severe depression, 58% perceived mild to extremely severe anxiety, and 44% perceived mild to extremely severe stress. Adolescents with more Internet addiction scores perceived more stress, anxiety, and depression (p ≤ 0.05). CONCLUSIONS: The Internet addiction rate is high among adolescents in Saudi Arabia. Adolescents with more Internet addiction scores are prone to perceive higher levels of stress, anxiety, and depression. APPLICATION TO PRACTICE: Interventional multidisciplinary programs are needed to make adolescents, parents, schoolteachers, and school nurses in Saudi Arabia aware of Internet addiction and methods to reduce the dependence of those adolescents on the Internet. School nurses should provide adolescents and parents with means to reduce their Internet dependence.

Revolutionizing tropical fruits preservation: Emerging edible coating technologies.

Tropical fruits, predominantly cultivated in Southeast Asia, are esteemed for their nutritional richness, distinctive taste, aroma, and visual appeal when consumed fresh. However, postharvest challenges have led to substantial global wastage, nearly 50 %. The advent of edible biopolymeric nanoparticles presents a novel solution to preserve the fruits' overall freshness. These nanoparticles, being edible, readily available, biodegradable, antimicrobial, antioxidant, Generally Recognized As Safe (GRAS), and non-toxic, are commonly prepared via ionic gelation owing to the method's physical crosslinking, simplicity, and affordability. The resulting biopolymeric nanoparticles, with or without additives, can be employed in basic formulations or as composite blends with other materials. This study aims to review the capabilities of biopolymeric nanoparticles in enhancing the physical and sensory aspects of tropical fruits, inhibiting microbial growth, and prolonging shelf life. Material selection for formulation is crucial, considering coating materials, the fruit's epidermal properties, internal and external factors. A variety of application techniques are covered such as spraying, and layer-by-layer among others, including their advantages, and disadvantages. Finally, the study addresses safety measures, legislation, current challenges, and industrial perspectives concerning fruit edible coating films.