The Prevalence and Burden of Psychiatric Disorders in Primary Health Care Visits in Asir Region Saudi Arabia.

BACKGROUND: Psychiatric disorders encompass a wide range of conditions that affect an individual's mental health and well-being. These disorders can manifest in various ways. The recognition, diagnosis, treatment, and referral of psychological conditions heavily rely on general practitioners, who handle consultations that involve a psychological aspect in at least one third of cases. OBJECTIVES: To assess the prevalence and burden of common psychiatric disorders at primary health care centers (PHCs) using the Kessler Psychological Distress Scale (K6) in the general population, aged 18-65, and examine their symptom patterns and comorbidity. METHODOLOGY: A descriptive online cross-sectional survey was conducted over a one-month period, spanning from September to October 2023. The survey targeted the population living in the Asir region. To fulfill the objectives, the K6 scale was used. Data analysis was carried out using the Statistical Package for the Social Sciences (SPSS) version 25. P values were considered statistically significant when they were ≤0.05. RESULTS: The survey included a total of 1,595 participants. Of these, 21.3% of respondents were male, while 78.7% were female. The majority of respondents fall within the 18-25 age group, accounting for 50.5% of the total. A significant portion of the population experiences some form of psychological distress, with 4.6% reporting low psychological distress, 36.1% reporting mild psychological distress, and a substantial 59.2% reporting severe psychological distress. Age (p-value=0.024), gender (p-value=0.001), educational level (p-value=0.001), occupation (p-value=0.008), and monthly income (p-value=0.001) had significant associations with the psychological distress score of psychiatric disorders. CONCLUSION: The prevalence and burden of psychiatric disorders in primary health care visits in Saudi Arabia is a significant public health concern. Our findings showed that the majority of participants reported having severe to mild psychological distress.

Insight into Current Practices of Community Pharmacists in Topical Corticosteroid Prescribing and Counseling: Cross-Sectional Survey Study from Saudi Arabia.

BACKGROUND: Topical corticosteroids are commonly used to treat several skin conditions, most notably atopic dermatitis. Many studies have found that patients lack knowledge about the safety, potency, and appropriate use of topical corticosteroids. This can be due to ineffective education by pharmacists and other healthcare providers. This study aims to evaluate the appropriateness of dispensing and counseling practices of community pharmacists towards topical corticosteroids in Saudi Arabia. METHODS: A cross-sectional survey study was conducted in Saudi Arabia among 418 community pharmacists from different regions of Saudi Arabia. Data were collected using a validated questionnaire that covered community pharmacists' sociodemographic information, their perceptions of patient knowledge about topical corticosteroid use, and their dispensing and their counseling practices, in addition to their perceived barriers to counseling. RESULTS: The majority of the participating community pharmacists were Saudi (57.4%), female (66.7%), holding a bachelor's degree (63.4%), and full-time workers (91.1%). Most of the time, community pharmacists counseled patients on the frequency of application per day and the duration of treatment (75.8% and 74.8%, respectively). The median counseling practice score was 17, with an IQR of 14-21. The main barrier to counseling was lack of time (33.7%). Only 15% of community pharmacists accurately identified all scenarios that necessitate medical referrals. Dry skin, itchiness, and irritation were the most common side effects reported by community pharmacists for patients to complain about (69.4%). Most pharmacists agreed that misuse is the most likely cause of topical corticosteroid adverse drug events (53.7%), followed by medication overuse, such as patient self-treatment (48%). CONCLUSION: Community pharmacists counseling practices to their patients about the use of topical corticosteroids require improvement. Continuing education and hands-on training are needed for community pharmacists regarding counseling about topical corticosteroids use.

Environmental Pollutants PM2.5, PM10, Nitrogen Dioxide (NO2), and Ozone (O3) Association with the Incidence of Monkeypox Cases in European Countries.

Background: Monkeypox, also known as monkeypox disease, is caused by the monkeypox virus (MPXV), which is a zoonotic infection. The swift spread of human monkeypox cases has caused an alarming situation worldwide. This novel study aimed to investigate the association of particulate matter air pollutants PM2.5, PM10, Nitrogen dioxide (NO2), and Ozone (O3) on the incidence of monkeypox cases from May 1, 2022, to July 15, 2022. Methods: The data on air pollutants PM2.5, PM10, NO2, and O3 and monkeypox cases were recorded from the date of occurrence of the first case of monkeypox in the United Kingdom, Spain, France, Germany, Italy, the Netherlands, Switzerland, and Portugal from May 1, 2022, to July 15, 2022. The daily concentrations of PM2.5, PM10, NO2, and O3 were recorded from the metrological website "Air Quality Index-AQI," and daily human monkeypox cases were recorded from the official website of "Our World in Data." The mean values along with simple, multiple, and Spearman Rho correlations were performed to investigate the relationship and strength of association between the concentrations of air pollutants and cases of monkeypox. Results: The environmental pollutants PM2.5, PM10, NO2, and O3 were positively associated with monkeypox cases in the United Kingdom, Spain, France, Germany, Italy, the Netherlands, Switzerland, and Portugal. The analysis further revealed that for each 10-unit increase in PM2.5, PM10, and NO2, levels, the number of monkeypox cases was significantly augmented by 29.6%, 9.7%, 13%, and 80.6%, respectively. Conclusions: Environmental pollutants PM2.5, PM10, NO2, and O3 have been positively linked to the number of daily monkeypox cases in European countries. Environmental pollution is a risk factor for the increasing incidence of monkeypox daily cases. The regional and international authorities must implement policies to curtail air pollution to combat the cases of monkeypox in European countries and worldwide.

Post-COVID-19 syndrome: nature of symptoms and associated factors.

Aim: Post-COVID-19 syndrome is defined as continuous symptoms related to SARS-CoV-2 infection, which can persist for several weeks or months. Previous studies identified risk factors associated with post-COVID-19 syndrome, including female sex, hypertension, and allergic respiratory diseases. This study aims to investigate the frequency of this syndrome among Arabic patients. Subject and methods: A cross-sectional study was conducted from March to August 2022. The study included 520 Arabic patients with confirmed COVID-19 diagnosis, who were asked about possible symptoms persisting for ≥28 days. Results: Twenty-five percent (25%) of the included patients developed post-COVID-19 syndrome. The most common recorded symptoms were cough (32%), anosmia (32%), fatigue (28%), headache (19%), muscle pain (19%), and shortness of breath (17%). It was found that female sex, hospitalization due to initial COVID-19 infection, and the presence of chronic diseases were significant risk factors for developing post-COVID-19 syndrome. Conclusion: The study recorded post-COVID-19 syndrome among 25% of Arabic participants. Initial COVID-19 hospitalization, initial symptomatic COVID-19, and female sex were significant risk factors for developing post-COVID-19 syndrome. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-022-01802-3.

Demographic Characteristics and Status of Vaccinated Individuals with a History of COVID-19 Infection Pre- or Post-Vaccination: A Descriptive Study of a Nationally Representative Sample in Saudi Arabia.

BACKGROUND: Saudi Arabia expedited the approval of some COVID-19 vaccines and launched mass vaccination campaigns. The aim of this study was to describe the demographics of vaccinated COVID-19 cases and compare the mortality rates of COVID-19 cases who were infected post-vaccination in Saudi Arabia. METHODS: This was a retrospective cohort study. We retrieved data for COVID-19 cases who were infected pre- or post-vaccination and had received at least one injection of the Oxford-AstraZeneca or Pfizer-BioNTech vaccine from 4 December 2020 to 15 October 2021. RESULTS: The number of patients who were infected and had received at least one dose of a COVID-19 vaccine was 281,744. Approximately 45% of subjects were infected post-vaccination, and 75% of subjects had received the Pfizer-BioNTech vaccine. Only 0.342% of the patients who were infected post-vaccination died, and 447 patients were admitted to ICUs. Most of the patients who were infected with COVID-19 post-vaccination and were admitted to ICUs (69.84%) had received only one dose of the vaccine (p < 0.0001). The mean time to infection for patients who had received one and two doses of the Oxford-AstraZeneca vaccine were 27 and 8 days longer than their counterparts who had received one and two doses of Pfizer-BioNTech vaccine, respectively. No difference in the odds of mortality between the Pfizer-BioNTech and Oxford-AstraZeneca vaccines was found (OR = 1.121, 95% CI = [0.907-1.386], p-value = 0.291). Patients who had received two doses of the vaccine had significantly lower odds of mortality compared to those who had received one dose (p < 0.0001). CONCLUSIONS: Vaccines are vital in combating the COVID-19 pandemic. The results of this study show no difference between the Pfizer-BioNTech and Oxford-AstraZeneca vaccines in the rate of mortality. However, the number of vaccine doses was significantly associated with a lower risk of mortality. Future studies should examine the effectiveness of different COVID-19 vaccines using real-world data and more robust designs.

Effect of environmental pollutants PM2.5, CO, O3 and NO2, on the incidence and mortality of SARS-COV-2 in largest metropolitan cities, Delhi, Mumbai and Kolkata, India.

OBJECTIVES: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has developed a challenging situation worldwide. In India, the SARS-CoV-2 cases and deaths have markedly increased. This study aims to evaluate the impact of environmental pollutants "particulate matter (PM 2.5 µm), carbon monoxide (CO), Ozone (O3), and Nitrogen Dioxide (NO2) on daily cases and deaths due to SARS-CoV-2 infection" in Delhi, Mumbai, and Kolkata, India. METHODS: The day-to-day air pollutants PM2.5, CO, O3, and NO2 were recorded from the metrological web "Real-time Air Quality Index (AQI)." SARS-COV-2 everyday cases and deaths were obtained from the "Coronavirus outbreak in India Web". The PM 2.5, CO, O3, NO2, and daily cases, deaths were documented for more than one year, from March 2, 2020, to March 15, 2021. RESULTS: Environmental pollutants CO, O3, and NO2, were positively related to SARS-COV-2 cases and deaths. The findings further described that for each one-unit increase in CO, O3, and NO2 levels, the number of cases was significantly augmented by 0.77%, 0.45%, and 4.33%. CONCLUSIONS: Environmental pollution is a risk factor to SARS-CoV-2 daily cases and deaths. The regional and international authorities must implement the policies to reduce air pollution and the COVID-19 pandemic. The findings can inform health policymakers' verdicts about battling the COVID-19 pandemic in India and globally by minimizing environmental pollution.

Frequency of Epidermal Growth Factor Receptor and T790M Mutations Among Patients With Non-Small Cell Lung Carcinoma: A Hospital-Based Study in the King Khalid University Hospital (KKUH) Since 2009-2017.

Objectives To estimate the proportion of positive epidermal growth factor receptor (EGFR) mutations among patients diagnosed with non-small cell lung carcinoma (NSCLC) and T790M at the King Khalid University Hospital (KKUH). Methods A retrospective cohort study that included all patients that were diagnosed with NSCLC from 2009 to 2017 at KKUH. Data obtained from both electronic and paper medical records and the following information were studied: age, gender, smoking, region, subtype of NSCLC, EGFR mutation test result, treatment, T790M mutation test (if required), comorbidities, metastasis. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS, version 21.0; SPSS Inc., Chicago, IL, USA). Results Among 71 patients with NSCLC 18 cases were identified for EGFR positive mutation and only one case for T790M. Deletion mutation in exon 19 represented 50% of total cases. Moreover, it showed that it is more frequent in males and non-smokers with 61.1% (11) and 66.7% (12), respectively. Majority of the cases were above the age of 60 years by 61.1% (11). The mutations reported highest in those living in Najd with a 44.4% (8) and all the mutated cases were adenocarcinoma. There was no statistical significance in the association between EGFR mutation and disease variables. Conclusion Ultimately, we found that the frequency of EGFR and T790M mutations among NSCLC patients at KKUH from 2009 to 2017 was 25.4% and 1.4%, respectively. Moreover, this result was conspicuous among non-smokers.

The prevalence of Factor V Leiden (Arg506Gln) mutation in King Khalid University Hospital patients, 2017-2019.

Arg506Gln mutation is responsible for one of the procoagulant factors and most common inherited thrombophilia in the Factor V Leiden (FVL) family. The replacement of the missense mutation for Arg506Gln / R506Q is at 1691st position from Guanine to Adenine with the modification of the amino acid from arginine to glutamine. The aim of this study was to investigate the current prevalence of the G1691A mutation in the FVL gene in the capital city's King Khalid University Hospitals (KKUH). Since 2017-2019 we have recruited 482 patients in these cross-sectional studies to test the G1691A mutation in KKUH's FVL gene. DNA was extracted using 2mL of the EDTA blood and genotyping was performed with polymerase chain reaction and the data was analyzed using Sanger sequencing. In this study, 4.4% of the G1691A mutation was found to be positive (combined heterozygous-GA and homozygous-AA variants) and 95.6% of them with negative, i.e., homozygous normal-GG genotypes. Our study concludes that with the advances in genetic testing and their recent availability, early mutation detection could approve the genotype risks for many patients and this mutation is not as rare as previously believed in the Saudi region as our study has established with a 4.4 percent prevalence.

Patients, Prescribers, and Institutional Factors Associated with Inappropriate Use of Acid Suppressive Therapy in Medical Wards: An Experience of a Single-Center in Saudi Arabia.

PURPOSE: To identify factors associated with inappropriate acid-suppressive therapy (AST) use in hospitalized medical ward patients. PATIENTS AND METHODS: This was a combined retrospective cohort study reviewing the electronic medical records of medical ward in a secondary university hospital between January 2018 and July 2019, in addition to prescriber surveys about AST knowledge. We included adult patients (≥18 years old) admitted to the medical ward who received at least one dose of AST during their hospitalization. Statistical analyses included descriptive statistics and logistic regression. RESULTS: A total of 335 patients were included. Most of the patients were female (66.6%), with a mean age of 42.37 ± 17.72 years; 76% (n=256) of the study subjects were prescribed AST for an inappropriate indication. Patients who were not receiving any home medications associated with high bleeding risk had higher odds of being prescribed AST inappropriately (OR, 4.06; 95% CI, 1.09-13.8). A total of 27 physicians completed the prescriber survey, and the average prescriber's knowledge score was 46.8 ± 15.6%. This score did not differ by the prescriber's position. CONCLUSION: This study demonstrated the overuse of AST in the medical ward. Therefore, improving providers' awareness about AST and implementing an AST stewardship program in institutions is necessary to limit this long-lasting issue.

Face Masks Use and Its Role in Restraining the Spread of COVID-19 Pandemic in Saudi Arabia: Knowledge, Attitude, and Practices Based Cross-Sectional Study.

Face masks (FM) play a role in limiting the spread of viral infections; despite this, their role is influenced by the population's adherence to wearing the FM. However, the impact on the effectiveness of the FM is variable in various communities. This study aimed to investigate the knowledge, attitude, and practices toward FM use during COVID-19 in Saudi Arabia. This observational "cross-sectional questionnaire-based study was conducted in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia." The data was collected using an online questionnaire survey from September 8-21, 2021, during the COVID-19 pandemic. The questionnaire was distributed via social media platforms to assess knowledge, attitude, and practices using single choice questions and a five-point Likert scale. Among 1,356, respondents' the rate was 678 (50%), 207 (30.5%) were males and 471 (69.5%) females. Among the participants, Saudi citizens were (649; 95.7%), with University education (502; 74%) and were mostly (368; 54.3%) between 16 and 24 years of age. The participants (384; 56.6%, p < 0.001) had good knowledge about face masks, and more than half of the respondents, 531 (78.3%) (p < 0.001), showed a positive attitude. Most of the respondents (477, 70.2%) believed that everyone could use the face mask to minimize the spread of the disease; however (111; 16.4%) reported that they would not wear a face mask if the government did not recommend wearing it in public places during the COVID-19 pandemic. Saudi citizens have above-average knowledge and optimistic attitudes toward using face masks during the COVID-19 pandemic. The community is convinced about the face masks and believes that face masks play a predominant role in limiting the spread of SARS-CoV-2.

Association of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Blockers With Severity of COVID-19: A Multicenter, Prospective Study.

BACKGROUND: Speculations whether treatment with angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin II receptor blockers (ARB) predisposes to severe coronavirus disease 2019 (COVID-19) or worsens its outcomes. This study assessed the association of ACE-I/ARB therapy with the development of severe COVID-19. METHODS: This multi-center, prospective study enrolled patients hospitalized for COVID-19 and receiving one or more antihypertensive agents to manage either hypertension or cardiovascular disease. ACE-I/ARB therapy associations with severe COVID-19 on the day of hospitalization, intensive care unit (ICU) admission, mechanical ventilation and in-hospital death on follow-up were tested using a multivariate logistic regression model adjusted for age, obesity, and chronic illnesses. The composite outcome of mechanical ventilation and death was examined using the adjusted Cox multivariate regression model. RESULTS: Of 338 enrolled patients, 245 (72.4%) were using ACE-I/ARB on the day of hospital admission, and 197 continued ACE-I/ARB therapy during hospitalization. Ninety-eight (29%) patients had a severe COVID-19, which was not significantly associated with the use of ACE-I/ARB (OR 1.17, 95% CI 0.66-2.09; P = .57). Prehospitalization ACE-I/ARB therapy was not associated with ICU admission, mechanical ventilation, or in-hospital death. Continuing ACE-I/ARB therapy during hospitalization was associated with decreased mortality (OR 0.22, 95% CI 0.073-0.67; P = .008). ACE-I/ARB use was not associated with developing the composite outcome of mechanical ventilation and in-hospital death (HR 0.95, 95% CI 0.51-1.78; P = .87) versus not using ACE-I/ARB. CONCLUSION: Patients with hypertension or cardiovascular diseases receiving ACE-I/ARB therapy are not at increased risk for severe COVID-19 on admission to the hospital. ICU admission, mechanical ventilation, and mortality are not associated with ACE-I/ARB therapy. Maintaining ACE-I/ARB therapy during hospitalization for COVID-19 lowers the likelihood of death. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT4357535.

Using the Health Belief Model to Predict the Uptake of Mammographic Screening Among Saudi Women.

Background Breast cancer (BC) is known to be the second leading cause of cancer deaths after lung cancer in Saudi Arabia. Early detection using screening methods can improve disease outcomes. In Saudi Arabia, the rates of BC screening are very low although it is a country that provides free healthcare services. This discrepancy between the availability of free healthcare services and women not utilizing these services necessitates an in-depth understanding of the health-related beliefs and barriers towards BC screening among Saudi women.  Objective We aimed to use the Health Belief Model (HBM) to predict the uptake of mammographic screening among Saudi women. The secondary objective was to determine the knowledge, attitudes, and practices related to BC and mammography screening. Research methodology  This was an analytical cross-sectional study using a self-administered questionnaire, which consisted of sociodemographic data, family history of BC, general information about BC, and the Champion's Health Belief Model Scale (CHBMS). The study was conducted among Saudi women visiting the King Khalid University Hospital in Riyadh from September 2018 to February 2019. The data were analyzed using SPSS Statistics software version 26.00 (IBM, Armonk, NY). Results A total of 401 females participated in the study; the median age of the subjects was 49 years [interquartile range (IQR): 43-53 years]. Among them, 69.6% were married and 21.1% had a family history of BC. There was a statistically significant association of younger age, marital status, and a positive family history of BC with women undergoing mammographic screening (p<0.05). Of the participants, 61.6% knew about the warning signs of BC, while only 59.9% were aware of the risk factors associated with it. The binary logistic regression did not show any significant association between CHBMS and mammogram screening. We concluded that the CHBMS components cannot be used in isolation to predict the risk of not undergoing mammogram screening. However, barriers and motivation components along with the knowledge and other factors can be used to predict mammogram screening. Conclusion Among our cohort of Saudi women, 62.1% had general awareness about BC, and younger age, marital status, and positive family history of BC were significantly associated with women undergoing mammography screening. The CHBMS components cannot be used in isolation to predict the risk of not undergoing mammogram screening, while barriers and motivation components along with the knowledge and other factors can be used to predict mammogram screening.

Prevalence of biopsy-proven nonalcoholic fatty liver among patients with gallstone disease.

BACKGROUND/AIM: Gallstone disease (GD) and nonalcoholic fatty liver disease (NAFLD) are associated with metabolic syndrome. Despite the benign nature of NAFLD, 10% of patients may develop advanced fibrosis and cirrhosis. We aimed to identify the prevalence and factors associated with NAFLD among GD patients in the Saudi population. PATIENTS AND METHODS: This is a single-center, observational cohort study that included patients seen in general surgery clinics at our institution from 2011 to 2017. All liver biopsies were taken at the same time as the cholecystectomy. Demographical and clinical data were prospectively collected from the study population. RESULTS: Of the 301 GD patients in the study, 15% had a normal body mass index (BMI), 29% were overweight, and 56% were obese. There were 143 (47.8%) patients with NAFLD, of which 125 (41.8%) showed steatosis and 18 (6%) had nonalcoholic steatohepatitis. There was a significant positive correlation between NAFLD and age (r = 0.243; P < 0.0001), and BMI (r = 0.242; P < 0.0001). Obese patients with BMI 30-40 kg/m[2] were 2.403 (P = 0.039) more likely to have NAFLD compared with normal BMI patients, and this value increased to 6.145 (P = 0.002) in patients with BMI >40 kg/m[2]. Additionally, patients with T2DM were 2.839 times (P = 0.015) more likely to have NAFLD compared with those who did not. CONCLUSIONS: The prevalence of NAFLD among GD patients is high. High BMI and diabetes are independent factors associated with NAFLD in GD patients. The results suggest that there may be a need for routine liver biopsy in selected patients during cholecystectomy.

Knowledge of patients on safe medication use in relation to nonsteroidal anti-inflammatory drugs.

INTRODUCTION: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed and used medications that are used as analgesic, antipyretic, or anti-inflammatory agents, but have a high risk of adverse effects. OBJECTIVE: The main purpose of this study is to evaluate the knowledge of patients toward the risks and safe usage of NSAIDs. METHODS: A descriptive cross-sectional study was conducted among patients who attended orthopedic clinics at King Khalid University Hospital in Riyadh, Saudi Arabia, during December 2017 to February 2018. A self-administered questionnaire comprising three sections [sociodemographic information, patients' knowledge of NSAIDs, and the attitude toward receiving information about NSAIDs' adverse drug reactions (ADRs)] was used. The attitude was measured with a 5-point Likert scale. RESULTS: The mean duration of NSAIDs usage was 7.3 ± 6.9 years. Only 45% of the respondents used NSAIDs daily, while 38% said they only used NSAIDs as needed. Nearly one-quarter of patients (25.5%) were counseled by a healthcare provider on the risks of NSAIDs. Almost 94% and 90.5% of the study subjects agreed that physicians and pharmacists, respectively, should play an essential role in providing information regarding ADRs to their patients. More than half of the respondents claimed that information about ADRs might lead them to discontinue their medicines. More than one-third of respondents stated that their healthcare setting provided them with insufficient knowledge of ADRs. CONCLUSION: Counseling of patients may diminish potentially inappropriate use and increase risk awareness. Healthcare providers can improve their role in identifying and counseling patients on NSAIDs.

Organizational Commitment and Nurses' Characteristics as Predictors of Job Involvement.

OBJECTIVE: To predict nurses' job involvement on the basis of their organizational commitment and personal characteristics at a large tertiary hospital in Saudi Arabia. DATA SOURCES: Data were collected in 2015 from a convenience sample of 558 nurses working at a large tertiary hospital in Riyadh, Saudi Arabia. STUDY DESIGN: A cross-sectional correlational design was used in this study. Data were collected using a structured questionnaire. PRINCIPAL FINDINGS: All commitment scales had significant relationships. Multiple linear regression analysis revealed that the model predicted a sizeable proportion of variance in nurses' job involvement (p < 0.001). CONCLUSIONS: High organizational commitment enhances job involvement, which may lead to more organizational stability and effectiveness.

Bias-dependence of luminescent coupling efficiency in multijunction solar cells.

In this work, we demonstrate an improved method to simulate the characteristics of multijunction solar cell by introducing a bias-dependent luminescent coupling efficiency. The standard two-diode equivalent-circuit model with constant luminescent coupling efficiency has limited accuracy because it does not include the recombination current from photogenerated carriers. Therefore, we propose an alternative analytical method with bias-dependent luminescent coupling efficiency to model multijunction cell behavior. We show that there is a noticeable difference in the J-V characteristics and cell performance generated by simulations with a constant vs. bias-dependent coupling efficiency. The results indicate that introducing a bias-dependent coupling efficiency produces more accurate modeling of multijunction cell behavior under real operating conditions.