A Physical-Layer Security Cooperative Framework for Mitigating Interference and Eavesdropping Attacks in Internet of Things Environments.

Intentional electromagnetic interference attacks (e.g., jamming) against wireless connected devices such as the Internet of Things (IoT) remain a serious challenge, especially as such attacks evolve in complexity. Similarly, eavesdropping on wireless communication channels persists as an inherent vulnerability that is often exploited by adversaries. This article investigates a novel approach to enhancing information security for IoT systems via collaborative strategies that can effectively mitigate attacks targeting availability via interference and confidentiality via eavesdropping. We examine the proposed approach for two use cases. First, we consider an IoT device that experiences an interference attack, causing wireless channel outages and hindering access to transmitted IoT data. A physical-layer-based security (PLS) transmission strategy is proposed in this article to maintain target levels of information availability for devices targeted by adversarial interference. In the proposed strategy, select IoT devices leverage a cooperative transmission approach to mitigate the IoT signal outages under active interference attacks. Second, we consider the case of information confidentiality for IoT devices as they communicate over wireless channels with possible eavesdroppers. In this case, we propose a collaborative transmission strategy where IoT devices create a signal outage for the eavesdropper, preventing it from decoding the signal of the targeted devices. The analytical and numerical results of this article illustrate the effectiveness of the proposed transmission strategy in achieving desired IoT security levels with respect to availability and confidentiality for both use cases.

Feasibility of using simulated patients for onsite structured practice feedback in Jordanian community pharmacy settings.

Simulated patient (SP) visits followed with structured feedback is useful to outline training needs as well as preference for continuing professional education in community pharmacy settings. This study aimed to investigate community pharmacists' management of an over-the-counter (OTC) product request and feasibility of immediate SP feedback in Jordan. Four trained SP visited a sample of pharmacies in three main urban cities in Jordan requesting an antacid. Information request and professional behavior as well as content of information were evaluated. The SP provided structured immediate feedback. The pharmacy staff views on the visit and usefulness of the feedback were collected. A total of 57 visits were conducted. The average duration of SP visits was 1.55 min. The average score (±SD) for information seeking behavior was 16% (±7) and for professional behavior was 56% (±15). The average score for information provision provided spontaneously was 17.1% (±12). Upon demand by the SP; the average score for information improved to 47.6 (±18). Non-pharmacological advice was not offered often; only 6 (10.5%) visits. Written information was provided in 10 (17.5%) visits. Immediate feedback was accepted by all visited pharmacies. Participants expressed positive views about the SP visit and usefulness of the feedback. Community pharmacists supplied OTC drug without carful screening of symptoms and essential information. The SP approach with immediate feedback was shown feasible and well accepted. Further potential for use of SP with feedback formally in practice and professional development should be explored in future studies.

Costs of hospital services in Jordan.

BACKGROUND: Policy makers are on quest for estimates of health costs to achieve maximum efficiency and sustainability. In Jordan, there is a scarcity of information on hospital service costs. AIM: The purpose of this study was to estimate the direct cost of hospital services in one of the biggest public hospitals in Amman, Jordan. METHODS: A retrospective analysis forms a 400-bed public urban hospital. Costs were estimated in Jordanian dinars (JD) (exchange rate was US$1.41). RESULTS: Inpatient costs contributed to 50% of all costs whilst outpatient clinics consumed 17%. Average cost per admission was JD 481.6 (US$674.2), JD 106.7 (US$149.3) per inpatient day and JD 63.1 (US$88.3) per bed day. The average cost per visit to emergency room was JD 14.1 s (US$19.7). Cost per visit to ambulatory care services ranged between JD 37.3 and 473 (US$52.6-662.2). The average cost per surgery was JD 322.1 (US$454.2). CONCLUSIONS: With high health costs, areas for improvements in efficiency and cost savings must be identified and discussed with managers and policy makers. A larger-scale study is advocated to understand the costs of various health providers such as military, teaching and private hospitals.

The Use of Economic Evidence to Inform Drug Pricing Decisions in Jordan.

BACKGROUND: Drug pricing is an example of a priority setting in a developing country with official requirements for the use of cost-effectiveness (CE) evidence. OBJECTIVE: To describe the role of economic evidence in drug pricing decisions in Jordan. METHODS: A prospective review of all applications submitted between November 2013 and May 2015 to the Jordan Food and Drug Association's drug pricing committee was carried out. All applications that involved requests for CE evidence were reviewed. Details on the type of study, the extent, and whether the evidence submitted was part of the formal deliberations were extracted and summarized. RESULTS: The committee reviewed a total of 1608 drug pricing applications over the period of the study. CE evidence was requested in only 11 applications. The submitted evidence was of limited use to the committee due to concerns about quality, relevance of studies, and lack of pharmacoeconomic expertise. There were also no clear rules describing how CE would inform pricing decisions. CONCLUSIONS: Limited local data and health economic experience were the main barriers to the use of economic evidence in drug pricing decisions in Jordan. In addition, there are no official rules describing the elements and process by which the CE evidence would inform drug pricing decisions. This study summarized accumulated observations for the current use of economic evaluations and evidence-based decision making in Jordan. Recommendations have been proposed to applicants and key decision makers to enhance the role of economic evidence in influencing health policies and evidence-based decision making across priority settings.

Active educational intervention as a tool to improve safe and appropriate use of antibiotics.

Misconception about antibiotics use among the public has been widely outlined to be a main reason for inappropriate use of antibiotics including failure to complete treatment, skipping of doses, re-use of leftover medicines and overuse of antibiotics. The study was devised to evaluate whether education might be a potential strategy to promote safer use of antibiotics and reducing self-medication. Two hundred seventy one adults were asked to complete two questionnaires; a pre and posteducation. The questionnaires comprised of three parts consisting of 17 statements assessing the knowledge on: appropriate use, safe use and resistance of antibiotics. Knowledge score was estimated by calculating the percentage of correct responses. The mean (SD) knowledge score pre-education was 59.4% (20.3). However, posteducation the score was 65.9% (17.9), p < 0.001(t-test). Knowledge scores were classified as poor, adequate and good. Posteducation, participants within poor and adequate knowledge categories were significantly shifted to the good category describing better knowledge, McNemar-χ2 = 28.7, df = 3, p < 0.001. It is concluded that using tailored education material targeting antibiotic need and use with a major aim of improving the public knowledge about antibiotics can be an effective and feasible strategy. This pilot study could be considered as the starting point for a wider scale public educational intervention study and national antibiotic campaign. However, the improvement in participant's knowledge might not reflect an actual change in antibiotics-seeking behaviour or future retention of knowledge. Future research should seek to assess the impact of education on participant's behaviour.

Adherence to UK national guidance for discharge information: an audit in primary care.

AIMS: Poor communication of clinical information between healthcare settings is associated with patient harm. In 2008, the UK National Prescribing Centre (NPC) issued guidance regarding the minimum information to be communicated upon hospital discharge. This study evaluates the extent of adherence to this guidance and identifies predictors of adherence. METHODS: This was an audit of discharge summaries received by medical practices in one UK primary care trust of patients hospitalized for 24 h or longer. Each discharge summary was scored against the applicable NPC criteria which were organized into: 'patient, admission and discharge', 'medicine' and 'therapy change' information. RESULTS: Of 3444 discharge summaries audited, 2421 (70.3%) were from two teaching hospitals and 906 (26.3%) from three district hospitals. Unplanned admissions accounted for 2168 (63.0%) of the audit sample and 74.6% (2570) of discharge summaries were electronic. Mean (95% CI) adherence to the total NPC minimum dataset was 71.7% [70.2, 73.2]. Adherence to patient, admission and discharge information was 77.3% (95% CI 77.0, 77.7), 67.2% (95% CI 66.3, 68.2) for medicine information and 48.9% (95% CI 47.5, 50.3) for therapy change information. Allergy status, co-morbidities, medication history and rationale for therapy change were the most frequent omissions. Predictors of adherence included quality of the discharge template, electronic discharge summaries and smaller numbers of prescribed medicines. CONCLUSIONS: Despite clear guidance regarding the content of discharge information, omissions are frequent. Adherence to the NPC minimum dataset might be improved by using comprehensive electronic discharge templates and implementation of effective medicines reconciliation at both sides of the health interface.

Enhanced Cr(VI) removal via CPBr-modified MIL-88A@amine-functionalized GO: synthesis, performance, and mechanism.

Water contamination by heavy metals, especially chromium (VI), poses a critical environmental issue due to its carcinogenic nature and persistence in the environment. Addressing this, the current study develops an efficient adsorbent, CPBr-MIL-88A@AmGO, which utilizes the synergistic capabilities of Cetylpyridinium bromide-modified MIL-88A and amine-functionalized graphene oxide to enhance Cr(VI) removal from aqueous solutions. The obtained results indicate that CPBr-MIL-88A@AmGO achieves its highest removal efficacy at pH 2, where the interaction of CPBr and AmGO's positively charged centers significantly contributes to the adsorption processes. According to the Langmuir isotherm model, the composite's adsorption capacity reached a maximum of 306.75 mg/g. The adsorption kinetics adhered to a pseudo-second-order model along with the endothermic nature of the process. Although the presence of SO42- ions significantly reduces adsorption capacity, other interfering ions including Na+, K+, Ca2+, Cl-, and NO3- only slightly affect it. Remarkably, the composite maintains high removal efficiency, over 82%, even after 7 recycling tests, underscoring its potential for practical applications in water treatment systems. The proposed mechanism involves the contribution of electrostatic attractions, ion exchange, complexation, and the reduction of Cr(VI) to Cr(III) in the removal process. This study not only offers a potent solution for Cr(VI) remediation but also contributes to sustainable water resource management.

Incidence, predictors, clinical outcomes, and economic burden of recurrent acute kidney injury: a retrospective cohort study.

OBJECTIVE: This study aimed to assess the incidence, predictors, mortality, and economic outcomes of recurrent Acute kidney injury (AKI) in Jordan. METHODS: This was a retrospective cohort study that included adult patients who were admitted with AKI to university hospitals in the country from 2010-2019. Recurrent episodes of AKI, laboratory data, baseline medication list, and death dates were retrieved from patient's medical records. The incidence rate of recurrent AKI was estimated. Predictors of recurrent AKI and mortality during the five years post-discharge was evaluated. Total admission charges were described and evaluated in total and by service provided. RESULTS: Among 1162 AKI patients, 57 patients (4.9%) died during the index admission (first admission during the study period), and among the survivors, 220 patients were re-hospitalized with a recurrent AKI during five years of follow-up. Patients with higher discharge serum creatinine level (SCr) at index admission had higher odds of AKI recurrence (OR = 1.001). Patients who were on respiratory, antineoplastic, or anticoagulant medications were also more susceptible to recurrence; ORs were 1.69, 2.77, and 4.16, respectively. Patients who were elderly, with recurrent AKI episodes, or with a more extended hospital stay at index admission were more likely to die during the five years post discharge. The median charge of recurrent admissions was higher than the median charge of the index admissions; 1519.17 JOD ($2142.7) versus 1362.85 JOD ($1922.2), respectively. CONCLUSIONS: Recurrent AKI is associated with increased mortality and health expenditures. Higher discharge SCr levels at index admission, and chronic comorbidities are associated with a higher likelihood of AKI recurrence.

Biophysical, histological, and bioaccumulation properties of Tilapia muscle affected by water pollution with heavy elements and microbes at the El-Rahawy drain in Egypt.

The leakage of sewage and agricultural drains has led to the contamination of freshwater branches with toxic heavy elements. This raises concerns about their toxic effects on aquatic ecosystems, especially on fish. Tilapia is regarded as an important protein source in Egypt and many other countries. The biophysical, nutritional, and histological aspects of water pollution in the El-Rahawy and Al-Qatta locations of the Nile on Nilotic tilapia muscle were evaluated by assessing the level of contamination of Nilotic tilapia fish. The current study showed that water of the Rosetta branch water was polluted with a very high level at El-Rahawy Drain discharge (RD) location, and with a high level at Al-Qatta (Q) location, while El-Rahawy (R) location was polluted with a lower level. The study traced the pollution effects on Tilapia (Nilotic) muscles in the previous locations. Bioaccumulation factor (BAF) showed a high value of all heavy metals in Tilapia muscle at the Q and R locations. Contrary to what was expected, discharge (RD) location contamination caused BAF increment of heavy metals in Tilapia muscles at upstream R location. All these results were compared with measured dielectric parameters of Tilapia muscle samples in the frequency range (0.02-1000) kHz. There was an increase in conductivity (σac), dielectric constant (ε'), dielectric loss (ε″), penetration depth (dp), and dissipated power (PD) values of Tilapia muscle, with increasing pollution level. The values of permittivity at low and high frequencies (ε's & ε'∞) for Tilapia muscle decreased by increasing pollution. Finally, the variation of these parameters, based on that proportionality relationship, can be considered as a physical indicator for fish contamination affected by their environment pollution, although these parameters need further studies in a controlled (qualitatively and quantitatively) polluted media.

Assessing content and factors influencing responses to information requests in community pharmacies in Jordan: A simulated patients study.

OBJECTIVES: To assess the management of requests for information about a prescription only medicine (simvastatin for treatment of dyslipidemia) by pharmacy staff in community settings and explore the factors influencing the information content. METHODS: A cross sectional study conducted using the stimulated patient (SP) method between November 2018 and May 2019. The SP conveyed the request at the beginning of the encounter in a standardized way based on predetermined plots and was instructed to ask the pharmacy staff directly if information was not discussed spontaneously. After the visit, the SP provided written feedback including information about the scenario and a copy of individualized feedback. The study was reported according to the checklist for reporting research using simulated patient methodology (CRiSP). Factors influencing information content with or without information demand were investigated. RESULTS: A total of 55 visits were analyzed. The average content score for the information discussed spontaneously was 16.2% with the standard deviation (SD) equal to15.6. The score improved significantly after information was demanded by the SP; the average total information content score became 34.4% (SD = 16) with p < 0.001. The score of information discussed spontaneously was higher for male pharmacy staff, older age, more experience, and a Pharm D degree. When the SP prompted or demanded for information, older pharmacy staff with more experience and with a college degree scored higher. Independent pharmacies, longer visit durations, and less distraction were associated significantly with higher information scores Pharmacy staff aged 35-39 and those with 6-10 years of experience were significant contributors to spontaneous discussion of information with p values = 0.003 and 0.013, respectively. After the SP demanded information, pharmacy staff with less than 5 years of experience and greater confidence as well as longer visits were positively predicting higher information scores with p values of 0.049, 0.04, and 0.04, respectively. CONCLUSIONS: Information provided by community pharmacists responding to information requests about prescription only medications was found to be suboptimal. Patient requests for information were found to be a positive driver for better information content. Further research of mixed methodologies is required to clarify the factors and motivators enabling information exchange in community settings and to outline true training needs.

Environmental Impacts of Ecofriendly Iron Oxide Nanoparticles on Dyes Removal and Antibacterial Activity.

Biosynthesized nanoparticles have a promising future since they are a more environmentally friendly, cost-effective, repeatable, and energy-efficient technique than physical or chemical synthesis. In this work, Purpureocillium lilacinum was used to synthesize iron oxide nanoparticles (Fe2O3-NPs). Characterization of mycosynthesized Fe2O3-NPs was done by using UV-vis spectroscopy, transmission electron microscope (TEM), dynamic light scattering (DLS), and X-ray diffraction (XRD) analysis. UV-vis gave characteristic surface plasmon resonance (SPR) peak for Fe2O3-NPs at 380 nm. TEM image reveals that the morphology of biosynthesized Fe2O3-NPs was hexagonal, and their size range between 13.13 and 24.93 nm. From the XRD analysis, it was confirmed the crystalline nature of Fe2O3 with average size 57.9 nm. Further comparative study of photocatalytic decolorization of navy blue (NB) and safranin (S) using Fe2O3-NPs was done. Fe2O3-NPs exhibited potential catalytic activity with a reduction of 49.3% and 66% of navy blue and safranin, respectively. Further, the antimicrobial activity of Fe2O3-NPs was analyzed against pathogenic bacteria (Pseudomonas aeruginosa, Escherichia coli, Bacillus subtilis, and Staphylococcus aureus). The Fe2O3-NPs were clearly more effective on gram-positive bacteria (S. aureus and B. subtilis) than gram-negative bacteria (E. coli and P. aeruginosa). Thus, the mycosynthesized Fe2O3-NPs exhibited an ecofriendly, sustainable, and effective route for decolorization of navy blue and safranin dyes and antibacterial activity.

Hospital unit costs in Jordan: insights from a country facing competing health demands and striving for universal health coverage.

BACKGROUND: Public providers in Jordan are facing increasing health demands due to human crises. This study aimed to benchmark the unit costs of hospital services in public providers in Jordan to provide insights into the outlook for public health care costs. METHODS: The unit costs of hospital services per admission, inpatient days, outpatient visits, emergency visits and surgical operations were estimated using the standard average costing method (top-down) for the fiscal year 2018-2019. The unit costs per inpatient day were estimated for nine specialities and staff in Jordanian dinars (exchange rate JOD 1 = USD 1.41). RESULTS: The average unit cost per admission in Jordan was JOD 782.300 (USD 1101.80), the per inpatient day cost was JOD 236.600 (USD 333.20), the per bed day cost was JOD 172.900 (USD 244.90), the per outpatient visit cost was JOD 58.400 (USD 82.30), the per operation cost was JOD 449.600 (USD 633.20) and the per emergency room visit cost was JOD 31.800 (USD 44.80). The specialities of ICU/CCU and OB/GYN presented the highest unit costs per inpatient day across providers: JOD 377.800 (USD 532.90) and JOD 362.600 (USD 510.70), respectively. The average salaried unit cost of staff depended mainly on year of employment. Nonetheless, the unit costs varied depending on the service utilization, type of service and organizational outlet. CONCLUSIONS: Knowledge of how unit costs vary across public providers in Jordan is essential to outline cost control strategies and inform future research. Institutionalization of the cost information system and high-level governmental support are necessary to generate a routine practice of collecting and sharing cost information.

Capacity Building for Health Technology Assessment in Jordan: Institutionalization and Its Use in Pricing and Reimbursement Decisions.

OBJECTIVES: This study aimed to describe the process of the institutionalization of health technology assessment (HTA) in Jordan. In particular, this study presents local policy perspectives on capacity building for HTA and the progress made toward its use in pricing and reimbursement decisions. HTA CAPACITY BUILDING: University-based education and professional development training in pharmacoeconomics and pharmaceutical policy have been the starting points to create a receptive environment, necessary expertise, and local tools across many settings in Jordan. International collaboration with HTA supporting bodies helped to build connections and informed policy development on local levels through projects, meetings, and discussions. HTA INSTITUTIONALIZATION AND ITS USE IN PRICING AND REIMBURSEMENT DECISIONS: Institutionalizing HTA in the King Hussein Cancer Center and the Royal Medical Services was the driving factor for HTA implementation and practice advancement; nevertheless, process transparency and experience sharing through reports and publications are still limited. The Jordan Food and Drug Administration's pricing and formulary decisions require pharmacoeconomic consultation in selected cases according to the Jordanian Drug Law. Nevertheless, there is a lack of local methodological guidelines for conducting HTA. In addition, HTA practitioners and the regulatory scope of future HTA activities in Jordan cannot be determined yet. RECOMMENDATIONS AND FUTURE DIRECTIONS: Over the past 2 decades, Jordan has crossed a number of milestones and advanced further to implement HTA as a tool for evaluating health interventions. As a next step, legislation is needed to mandate the use of HTA and to enhance transparency in decision-making processes.

Perceived Public Stress Among Jordanians During the COVID-19 Outbreak.

OBJECTIVES: Outbreaks and containment measures implemented to control them can increase stress in affected populations. The impact of the coronavirus disease 2019 (COVID-19) outbreak on perceived stress levels in the Jordanian population is unknown. The aim of the study was to determine the perceived stress level and factors associated with it in the Jordanian population during the COVID-19 outbreak. METHODS: Required data, such as those from the Perceived Stress Scale (PSS-10) and possible predictors of perceived stress, were collected through a Web-based survey. Statistical analysis was conducted through SPSS. RESULTS: The mean (SD) of perceived stress score was 19.8 (6.7). Regression analysis revealed that stress was increased in females, young adults, usually being stressed more than others by a health problem, increased perceived severity of the disease, increased overall worry score, and student's worry regarding their studies/graduation. Perceived stress was decreased if participants' self-rated health status score increased. CONCLUSIONS: In the context of increasing public health preparedness, the results of this study can be used in designing interventions to alleviate stress in susceptible segments of the Jordanian community.

Recent developments in alginate-based adsorbents for removing phosphate ions from wastewater: a review.

The huge development of the industrial sector has resulted in the release of large quantities of phosphate anions which adversely affect the environment, human health, and aquatic ecosystems. Naturally occurring biopolymers have attracted considerable attention as efficient adsorbents for phosphate anions due to their biocompatibility, biodegradability, environmentally-friendly nature, low-cost production, availability in nature, and ease of modification. Amongst them, alginate-based adsorbents are considered one of the most effective adsorbents for removing various types of pollutants from industrial wastewater. The presence of active COOH and OH- groups along the alginate backbone facilitate its physical and chemical modifications and participate in various possible adsorption mechanisms of phosphate anions. Herein, we focus our attention on presenting a comprehensive overview of recent advances in phosphate removal by alginate-based adsorbents. Modification of alginate by various materials, including clays, magnetic materials, layered double hydroxides, carbon materials, and multivalent metals, is addressed. The adsorption potentials of these modified forms for removing phosphate anions, in addition to their adsorption mechanisms are clearly discussed. It is concluded that ion exchange, complexation, precipitation, Lewis acid-base interaction and electrostatic interaction are the most common adsorption mechanisms of phosphate removal by alginate-based adsorbents. Pseudo-2nd order and Freundlich isotherms were figured out to be the major kinetic and isotherm models for the removal process of phosphate. The research findings revealed that some issues, including the high cost of production, leaching, and low efficiency of recyclability of alginate-based adsorbents still need to be resolved. Future trends that could inspire further studies to find the best solutions for removing phosphate anions from aquatic systems are also elaborated, such as the synthesis of magnetic-based alginate and various-shaped alginate nanocomposites that are capable of preventing the leaching of the active materials.

Cost-effectiveness of pharmacist-led care versus usual care in type 2 diabetic Jordanians: a Markov modeling of cardiovascular diseases prevention.

BACKGROUND: Cardiovascular diseases (CVDs) are responsible for one third of global deaths and the main cause of death among Jordanians. Pharmacist-led care was outlined previously as a cost-effective approach in the management of chronic illness; however, this is not well studied in low to middle-income countries. AIM AND OBJECTIVES: To assess the cost-effectiveness of pharmacist-led care versus usual care in preventing CVDs in Type 2 Diabetes Mellitus (T2DM). METHOD: A Markov model of one-year cycle length and 10-year time horizon was constructed to simulate 10-year CVD events, mortality, and costs for two hypothetical cohorts; usual care and pharmacist-led care, respectively, of Jordanian patients suffering from T2DM. Public health provider perspective was adopted. Outcomes examined were incremental costs, LYGs, and incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analysis (PSA) assessed the robustness of the results. RESULT: The pharmacist-led care generated an additional 0.3 LYG/patient at an additional cost of JD1,238.78 (US$1,747.24) comparing to the usual care in the 10-year base-case analysis. Deterministic and PSA supported the robustness of base-case findings, indicating that pharmacist-led care is cost-effective. CONCLUSION: The findings outline long-term clinical and economic benefits of expanding clinical pharmacist's roles in direct patient care services.

Direct medical costs of breast cancer in Jordan: cost drivers and predictors.

Introduction: Breast cancer is the most common cancer amongst females in Jordan. The study aimed to estimate the total direct medical cost of breast cancer from a healthcare provider's perspective.Methods: A retrospective cohort study was done to include all Jordanian females who were diagnosed with breast cancer at two leading public providers of cancer care in Jordan, Bashir Hospital and the University of Jordan Hospital. Data were extracted from the Jordan Cancer Registry (JCR) from 2011 to 2014 including demographic, clinical, and economic data of the patient.Results: A total of 877 and 665 patients were included in the first and second year after diagnosis, respectively. Costs increased in the advanced stages; costs for stages 0, I, II, III, and IV were Jordanian dinars)JD(6,749.94 ($9,517.42), JD 5,960.46 ($8,404.25), JD 8,003.58 ($11,285.05), JD 9,390.59 ($13,240.73), and JD 9,587.44 ($13,518.29), respectively. Treatment costs were the main cost driver across all stages.Conclusions: This analysis offers insight into costs, cost drivers, and resources utilization incurred by breast cancer patients in Jordan. Two major hospitals in Jordan can play a key informative role in future cost-effectiveness of breast cancer screening and therapeutic treatments in the different stages of cancer.

Epidemiology of women diagnosed with breast cancer in Jordan: A 5-year survival analysis and patients' characteristics from 2 public hospitals.

OBJECTIVES: To evaluate the epidemiology, prognostic factors, and 5-year overall survival (OS) of females with breast cancer (BC) diagnosed between 2011 and 2014 in Jordan. METHODS: A retrospective medical review of females who were diagnosed with BC between 2011 and 2014 at the 2 leading public health providers in Jordan was performed. The endpoint of the study was 2018. Data were extracted from the medical files between 2011 and 2018, including demographic clinical data on the patient level. Survival by age, laterality, grade, stage, and treatments modes were calculated by the Kaplan Meier method. RESULTS: A total of 877 women were included with median age of 51 years and follow-up duration of 2.4 years. Majority of the patients had ductal carcinoma and estrogen receptor (ER) positive type. The 5-year OS for patients with stage I, II, III, and IV, 94%, 86%, and 46% (p<0.001), respectively. The tumor stage and nodal status were the main prognostic variables affecting the overall survival. CONCLUSION: The incidence in Jordan is increasing, yet survival rates are improving with increased diagnosis during early stages. Therefore, strategies for implementing universal screening programs are advocated to improve clinical outcomes and to reduce the disease burden.

Pea peels as a value-added food ingredient for snack crackers and dry soup.

The food industry produces large quantities of waste, which is available in bulk at zero cost. This study aimed to investigate a new method to maximize the protein intake from pea peels and its further utilization as a value-added food ingredient to produce healthy snack crackers and dry soup. Dehydrated green curd of pea peel (DGCPp) with high protein content (35%) was prepared and incorporated into snack cracker and instant soup powder. Wheat flour was substituted with DGCPp to prepare crackers at three substitution levels (5, 10, and 15%) compared to the cracker control sample (100% wheat flour). Increasing the level of this substitution improved the nutritional value of crackers, with highest protein content was in DGCPp crackers (15%). Crackers also had higher contents of mineral and essential amino acids. The physicochemical and sensorial properties of soup samples were significantly influenced by the addition of DGCPp. Higher rehydration value and mineral content (Ca, Mg, Fe, and Zn) were observed in DGCPp soup samples compared to the control sample. Soup samples of all proportions were more acceptable by all the panelists compared with the control sample. With these findings, it can be concluded that DGCPp can be utilized in a variety of food products (such as crackers and soups) with higher nutritive values.

Awareness, knowledge, and attitudes of health professions students toward health economics and pharmacoeconomics education in Jordan.

INTRODUCTION: Health economics education (HEe) and pharmacoeconomics education (PEe) in the Middle East and North Africa area is growing, particularly in pharmacy education. Little is known about the awareness, knowledge, and attitudes of health professions students toward health economics (HE) and pharmacoeconomics (PE) and the extent of education they receive before joining the workforce. METHODS: A self-completed validated questionnaire was distributed to students from medical, dental, pharmacy, and nursing schools in Jordan. The questionnaire assessed awareness, knowledge, and attitudes about HE and PE terminologies, applications, and need for training. Chi-square and Kruskal-Wallis H tests were used to outline the differences between students' responses. RESULTS: A total of 2648 questionnaires were analysed, representing 586 medical, 414 dental, 1080 pharmacy, and 568 nursing students. Approximately 65% of respondents reported they had heard of HE or PE. Supportive views about the necessity for economic education in healthcare professions curricula were reported. Nursing students most often expressed desire to undertake training before graduation while dental students showed the least interest. CONCLUSIONS: Students across health professions groups acquire various extents of HEe and PEe before graduation. Pharmacy schools demonstrated leading interest and progress in providing PEe in Jordan, and medical schools appeared to follow. Both dental and nursing schools were lagging. Regional support from the International Society for Pharmacoeconomics and Outcomes Research Arabic Network, accreditation, and regulatory requirements are leading social and contextual contributors to PEe in Jordan.