Factors Influencing Medical Students' Choice of Anesthesiology as a Future Specialty in Saudi Arabia.

Background According to the American Society of Anesthesiologists (ASA), anesthesiologists are experts in administering anesthesia, pain management, and critical care medicine. In addition, they provide general perioperative care. Personal interests, career stability, reputation, income, and clinical rotation experience influence medical students' career choices. Studies show that anesthesiology remains one of the least popular specialties among Saudi medical students. Our study aims to determine the preference for anesthesiology among Saudi medical students and the factors influencing their career choice options. Methodology This cross-sectional study was implemented by distributing a self-administered verified survey. Results Our study included 532 medical students, predominantly female (n=344, 64.7%), aged 18-24 years (n=424, 79.7%), and Saudi nationals (n=508, 95.5%). Most were single (n=500, 94%) without children (n=522, 98.1%). A majority were not interested in anesthesiology as a future specialty (n=297, 55.8%), with some uncertainty (n=148, 27.8%) and a smaller interested group (n=87, 16.4%). Controllable lifestyle (n=294, 55.3%) and financial income (n=213, 40%) were critical factors for choosing anesthesiology as a specialty. Interest in another specialty (n=342, 64.3%) and stress (n=286, 53.8%) were significant opposing factors. Academic year significantly affected consideration (p<0.001), with second-year students showing the highest interest (61.8%) and sixth-year the lowest (24.8%). Other factors showed no significant association. Conclusion Our study reveals low interest in anesthesiology among Saudi medical students. A controllable lifestyle and financial income are key attractions. Interest declines significantly by the sixth year due to their interest in other specialties, lifestyle concerns, and stress.

Characterizing Defects Inside Hexagonal Boron Nitride Using Random Telegraph Signals in van der Waals 2D Transistors.

Single-crystal hexagonal boron nitride (hBN) is used extensively in many two-dimensional electronic and quantum devices, where defects significantly impact performance. Therefore, characterizing and engineering hBN defects are crucial for advancing these technologies. Here, we examine the capture and emission dynamics of defects in hBN by utilizing low-frequency noise (LFN) spectroscopy in hBN-encapsulated and graphene-contacted MoS2 field-effect transistors (FETs). The low disorder of this heterostructure allows the detection of random telegraph signals (RTS) in large device dimensions of 100 µm2 at cryogenic temperatures. Analysis of gate bias- and temperature-dependent LFN data indicates that RTS originates from a single trap species within hBN. By performing multispace density functional theory (MS-DFT) calculations on a gated defective hBN/MoS2 heterostructure model, we assign substitutional carbon atoms in boron sites as the atomistic origin of RTS. This study demonstrates the utility of LFN spectroscopy combined with MS-DFT analysis on a low-disorder all-vdW FET as a powerful means for characterizing the atomistic defects in single-crystal hBN.

Satisfaction-Behavior Paradox in Lifestyle Choices: A Cross-Sectional Study of Health Behaviors and Satisfaction Levels in Jazan, Saudi Arabia.

BACKGROUND: Lifestyle choices significantly affect health outcomes in Saudi Arabia, but the relationship between health behaviors and satisfaction is unclear. This study aimed to assess lifestyle choices and associated satisfaction levels among residents in the Jazan region of Saudi Arabia. METHODS: A cross-sectional study was conducted in Jazan, Saudi Arabia, with 3411 participants. Sociodemographic, lifestyle, and satisfaction data were collected using a questionnaire that was completed during interviews. Logistic regression analyses were implemented to examine the relationships between the study variables and factors related to weight, physical activity, and eating satisfaction. RESULTS: The study found that 38.3% of participants were inactive and 77% rarely ate fruits and vegetables. A total of 47.6% were overweight or obese. Weight (71.12%) and eating (71.59%) satisfaction were high despite these health concerns. The satisfaction-behavior paradox was especially evident in diet. Higher income, physical activity, and healthy eating habits were significantly associated with higher satisfaction (OR = 1.49, 95% CI: 1.15-1.93, p = 0.003 for weight satisfaction, OR = 34.74, 95% CI: 25.42-48.35, p < 0.001 for physical activity satisfaction, and OR = 2.08, 95% CI: 1.67-2.61, p < 0.001 for fruit and vegetable consumption). CONCLUSIONS: Lifestyle behaviors and satisfaction in Jazan, Saudi Arabia, are complex. The satisfaction-behavior paradox, especially in diet, reveals a major gap between perceived and actual health. These findings highlight the need for targeted, culturally sensitive interventions that address behavioral change and perception alignment to improve regional public health.

Age-Related Trends of Thyroidectomies in Saudi Arabia: A Multicenter Retrospective Study.

Background: Understanding the relationship between aging and postoperative complications is critical because it may influence how the condition is managed. The safety of thyroidectomy in the older age group is debated in literature. All previous studies were conducted outside of the Middle East, and there is a scarcity of data in the literature describing the relationship between age and postoperative outcomes after thyroidectomy. This study aimed to compare the clinical trends of patients undergoing thyroidectomy between younger and older age groups. Methodology: A multicenter retrospective study was conducted at 3 tertiary care centers in Jeddah, Saudi Arabia. Our inclusion criteria consisted of patients of all ages of both sexes who underwent thyroidectomy. Patients were divided into 2 age groups, <60 years and ≥60 years. Chi-square test and independent t test were used to evaluate the differences between qualitative and continuous variables. Logistic regression analysis was performed with postoperative complications and length of hospitalization as the dependent variables. Results: A total of 798 patients were included in this study. The <60 years age group was comprised of 81% female patients and 19% male patients, compared to 63.4% female patients and 36.6% male patients in the ≥60 years age group (P < .001). The ≥60 years age group had a statistically significant longer mean postoperative length of hospitalization (5.37 ± 7.21 days) compared to the <60 age group (3.33 ± 4.24 days; P = .003). A total of 14.4% of the patients in the <60 years age group developed at least one postoperative complication compared to 17.9% of the patients in the ≥60 years age group (P = .385). Seroma and recurrent laryngeal nerve injury occurred more commonly in the ≥60 years age group compared to the <60 years age group with a statistically significant difference (P = .003 and P < .001, respectively). In contrast, hypocalcemia occurred more commonly in patients of the <60 years age group with a statistically significant difference (P = .044). These findings were further verified by multivariate logistic regression after adjustment for gender, type of procedure, and type of diagnosis. Conclusion: In our region, the overall risk of developing postoperative complications was not different between the younger and older age groups. However, certain complications were more likely to develop in the older age group which requires vigilance from surgeons performing thyroidectomy. Likewise, the length of hospitalization was significantly longer in the older population. Awareness of complications and challenges of thyroidectomy in the older age group is crucial to improve care.

Factors Associated With Patient Failure To Attend Dental Appointments: A Retrospective Analysis.

Nonattendance at scheduled dental appointments has a significant impact on healthcare systems worldwide. This study examines the factors associated with missed appointments at the Dental Center in the Department of Oral and Dental Health in Riyadh, Saudi Arabia, through a retrospective secondary data analysis. Existing medical records from January 1, 2024, to May 1, 2024 were analyzed to identify patterns or factors contributing to nonattendance. Data were collected using a standardized sheet and analyzed with statistical methods, including correlation analysis, ANOVA, and chi-square tests, to determine significant associations and factors affecting nonattendance. The results indicated that the majority of nonattendees were single (56.2%), with a higher proportion of females (60.7%) compared to males (39.3%). Only 3.8% of those who missed their appointments were over 55 years old. Tuesdays had the highest incidence of nonattendance (331 cases). No significant association was found between age groups and the time (F = 0.224, p = 0.925) or date (F = 0.840, p = 0.500) of appointments. Patients were less likely to attend morning appointments compared to evening ones. The high rate of missed appointments reduces the effectiveness and efficiency of the Dental Center's resources. The identified patterns and factors can guide managers and policymakers in developing strategies to reduce missed appointments and improve overall appointment adherence.

Selection of data analytic techniques by using fuzzy AHP TOPSIS from a healthcare perspective.

The healthcare industry has been put to test the need to manage enormous amounts of data provided by various sources, which are renowned for providing enormous quantities of heterogeneous information. The data are collected and analyzed with different Data Analytic (DA) and machine learning algorithm approaches. Researchers, scientists, and industrialists must manage or select the best approach associated with DA in healthcare. This scientific study is based on decision analysis between the DA factors and alternatives. The information affects the whole system in a rational manner. This information is very important in healthcare sector for appropriate prediction and analysis. The evaluation discusses its benefits and presents an analytic framework. The Fuzzy Analytic Hierarchy Process (Fuzzy AHP) approach is used to address the weight of the factors. The Fuzzy Techniques for Order Preference by Similarity to Ideal Solution (Fuzzy TOPSIS) address the rank of the data analytic alternatives used in healthcare sector. The models used in the article briefly discuss the challenges of DA and approaches to address those challenges. The assorted factors of DA are capture, cleaning, storage, security, stewardship, reporting, visualization, updating, sharing, and querying. The DA alternatives include descriptive, diagnostic, predictive, prescriptive, discovery, regression, cohort and inferential analyses. The most influential factors of the DA and the most suitable approach for the DA are evaluated. The 'cleaning' factor has the highest weight, and 'updating' is achieved at least by the Fuzzy-AHP approach. The regression approach of data analysis had the highest rank, and the diagnostic analysis had the lowest rank. Decision analyses are necessary for data scientists and medical providers to predict diseases appropriately in the healthcare domain. This analysis also revealed the cost benefits to hospitals.

Acceptance of electronic referrals across the Kingdom of Saudi Arabia: results from a national e-health database.

Introduction: An effective referral system is necessary to ensure quality and an optimum continuum of care. In the Kingdom of Saudi Arabia, an e-referral system known as the Saudi Medical Appointments and Referrals Centre (SMARC), has been fully functioning since 2019. This study aims to explore the rate of medical e-referral request acceptance in the KSA, and to study the factors associated with acceptance. Methods: This period cross-sectional study utilised secondary collected data from the SMARC e-referral system. The data spans both 2020 and 2021 and covers the entirety of the KSA. Bivariate analyses and binary logistic regression analyses were performed to compute adjusted Odds Ratios (aORs) and 95% confidence intervals. Results: Of the total 632,763 referral requests across the 2 years, 469,073 requests (74.13%) were accepted. Absence of available machinery was a significant predictor for referral acceptance compared to other reasons. Acceptance was highest for children under 14 with 28,956 (75.48%) and 63,979 (75.48%) accepted referrals, respectively. Patients requiring critical care from all age groups also had the highest acceptance including 6,237 referrals for paediatric intensive care unit (83.54%) and 34,126 referrals for intensive care unit (79.65%). All lifesaving referrals, 42,087 referrals, were accepted (100.00%). Psychiatric patients were observed to have the highest proportion for accepted referrals with 8,170 requests (82.50%) followed by organ transplantations with 1,005 requests (80.92%). Sex was seen to be a significant predictor for referrals, where the odds of acceptances for females increased by 2% compared to their male counterparts (95% CI = 1.01-1.04). Also, proportion of acceptance was highest for the Eastern business unit compared to all other units. External referrals were 32% less likely to be accepted than internal referrals (95% CI = 0.67-0.69). Conclusion: The current findings indicate that the e-referral system is mostly able to cater to the health services of the most vulnerable of patients. However, there remains areas for health policy improvement, especially in terms of resource allocation.

Changes in Nutritional Habits and Lifestyles Associated With COVID-19 in Jazan, Saudi Arabia: A 2022 Cross-Sectional Survey.

BACKGROUND: The COVID-19 pandemic impacted dietary habits and physical activity patterns, with some long-term consequences. This study evaluated the effects of the pandemic on adults' dietary habits and physical activity in Jazan and compared them to pre-pandemic. METHODS: An analytical cross-sectional survey was conducted among conveniently selected 559 individuals in Jazan, Saudi Arabia, in February 2022 using a validated online questionnaire. Data was collected to assess changes in eating habits, food intake, and weight before and 21 months after lifting of COVID-19 curfew restrictions in the region. Chi-square and McNemar's tests were used for analysis. RESULTS: The proportion of individuals consuming homemade meals decreased from 50.6% (n=283) before the pandemic to 46.5% (n=260) during the pandemic, while the proportion of participants consuming less than three meals per day increased from 42.2% (n=236) to 45.4% (n=254), and breakfast consumption decreased significantly from 58.1% (n=325) to 53.5% (n=299) (p = 0.033). There was an increase in the consumption of fast food from 10.7% (n=60) to 12.0% (n=67) and dining at restaurants from 18.4% (n=103) to 19.3% (n=108); however, these increases were not statistically significant compared to pre-pandemic rates. During the pre-COVID-19 period, 46.9% (n=262) reported engaging in physical activity one to three times a week, whereas this frequency decreased to 41.3% (n=231) during the pandemic (p = 0.017). In contrast, a significant increase was observed in the duration of computer usage as prior to the pandemic, 20.2% (n=113) reported spending more than five hours per day on the computer, while this proportion increased to 31.8% (n=178) during the pandemic (p < 0.001). Furthermore, a considerable proportion of both males and females, constituting over one-third (n=189) of the total sample, reported an increase in body weight. CONCLUSION: The findings suggest that the adult population in the Jazan region of Saudi Arabia experienced significant lifestyle changes during the COVID-19 pandemic, including altered dietary patterns and a significant decline in physical activity. To mitigate potential adverse effects on future well-being, it is crucial to implement enduring initiatives promoting healthy lifestyles.

Stroke Knowledge and Response Among the General Population in Saudi Arabia: A Population-Based Survey.

INTRODUCTION: Stroke, a condition that disrupts brain function and can result in long-lasting clinical symptoms or death, remains a substantial global health concern. General awareness of stroke leads to a proper response to stroke, pursuit of medical treatment, and a better outcome. Our study aims to explore how the general Saudi Arabian population responds to stroke, investigate the relationship between stroke knowledge and appropriate actions, and identify the most relied upon medical information source about stroke among the public. By highlighting these aspects, we aspire to contribute to the development of effective stroke prevention and management strategies in Saudi Arabia. METHODOLOGY: This descriptive, cross-sectional, web-based study was carried out across multiple regions in Saudi Arabia. Data collection involved a validated online questionnaire (STAT) in Arabic, targeting adults aged 18 and older. Data analysis was performed using SPSS software. RESULTS: The study included 390 participants. Notable findings emerged regarding the recognition of stroke symptoms and the factors influencing this recognition. A substantial proportion of respondents correctly identified visual disturbances (55.9%), motor impairment (39.5%), cardiac symptoms (56.2%), sensory symptoms (32.8%), chest pain (62.6%), and arm weakness (36.7%) as indicators requiring immediate medical attention. However, there were lower correct response rates for symptoms such as sudden dizziness (22.8%), confusion (16.9%), difficulty understanding (27.9%), and urinary symptoms (26.9%). Older individuals and retirees generally scored higher in correctly identifying these symptoms. CONCLUSION: Our study highlights a commendable level of awareness of certain stroke symptoms, such as visual disturbances and chest pain, among the general population of Saudi Arabia. Nonetheless, notable gaps remain in recognizing other symptoms, such as sudden dizziness and confusion. This identification gap presents a clear opportunity for targeted educational initiatives that are essential to improving public recognition of these symptoms. By addressing these gaps, we aim to enhance the response to stroke incidents, potentially improving outcomes and reducing morbidity rates.

Showcasing the Saudi e-referral system experience: the epidemiology and pattern of referrals utilising nationwide secondary data.

Introduction: Referrals are an integral part of any healthcare system. In the Kingdom of Saudi Arabia (KSA) an electronic referral (e-referral) system known as the Saudi Medical Appointments and Referrals Centre (SMARC) began formally functioning in 2019. This study aims to showcase the Saudi experience of the e-referral system and explore the epidemiology of referrals nationally. Methods: This retrospective descriptive study utilised secondary collected data between 2020 and 2021 from the SMARC system. Cross tabulations with significance testing and colour-coded maps were used to highlight the patterns across all regions. Results: The study analysed over 600,000 referral requests. The mean age of patients was 40.70 ± 24.66 years. Males had a higher number of referrals (55.43%). Referrals in 2021 were higher than those in 2020 (56.21%). Both the Autumn and Winter seasons had the highest number of referrals (27.09% and 27.43%, respectively). The Surgical specialty followed by Medicine had the highest referrals (26.07% and 22.27%, respectively). Life-saving referrals in the Central region were more than double those in other regions (14.56%). Emergency referrals were also highest in the Southern regions (44.06%). The Central and Eastern regions had higher referrals due to unavailable sub-speciality (68.86% and 67.93%, respectively). The Southern regions had higher referrals due to both unavailable machine and unavailable beds (18.44% and 6.24%, respectively). Conclusion: This study shows a unique system in which referrals are between secondary, tertiary, and specialised care. It also highlights areas of improvement for equitable resource allocation and specialised care in slightly problematic areas as well as the use of population density in future planning.

Exploring the Relationship Between Bakhour Use and Respiratory Health: A Cross-Sectional Study in the Jazan Region, Saudi Arabia.

Background: Despite deep cultural traditions, incense burning significantly impacts respiratory health. Effects of Arabian bakhour remain unknown in Saudi Arabia's Jazan region with prevalent use. This cross-sectional study addresses this gap by investigating bakhour exposure and respiratory diseases. Methods: This was descriptive cross-sectional study conducted in Jazan area, Saudi Arabia, from October 2023 to March 2024. A total of 1612 participants age more than 18 years, both gender and resident of Jazan Area were included. Those aged less than 18 years were excluded. SPSS v 26 was used for data analysis. Results: The sample (n=1612) had a mean age of 29±11 years and was 63% female. Bakhour use was nearly universal (98%), especially using coal (73%). Higher bakhour frequency significantly associated with increased cough (p<0.01) and dyspnea (p<0.01). Certain bakhour types linked to greater allergic rhinitis prevalence (p<0.01). Regression analysis revealed cough during bakhour use worsened respiratory health (increased respiratory score) by 3.89 times (95% CI 1.13-6.64; p=0.006) while dyspnea increased the score by 7.48 times (95% CI 4.70-10.25; p<0.001). Conclusion: This study provides valuable insights into the association between Bakhour use and respiratory health in the Jazan region. The findings emphasize the need for further research and public health interventions to mitigate potential respiratory risks associated with Bakhour use.

Satisfaction Paradoxes in Health Behaviors: Contrasting Patterns across Weight, Physical Activity and Dietary Habits.

(1) Background: Obesity, a poor diet, and inactivity are major health issues among Saudi youth. However, satisfaction with unhealthy lifestyles could impede change. This study assessed lifestyle factors and related satisfaction among Saudi university students. (2) Methods: In this cross-sectional study, 1957 students at Jazan University completed surveys on demographics, physical activity, dietary habits, and 10-point satisfaction scales for weight, activity, and diet. Chi-squared tests and logistic regression were used to analyze the associations between behaviors and satisfaction. (3) Results: Overweight/obesity prevalence was 25.45%, and only 26.67% of the subjects met activity guidelines. Many of them exhibited poor dietary habits. Despite unhealthy behaviors, some expressed high satisfaction, especially regarding their diets. Subjects with a normal BMI had the highest weight satisfaction. Activity satisfaction increased with higher activity levels. Dietary satisfaction was minimally impacted by healthfulness. Males and higher incomes were correlated with greater satisfaction. (4) Conclusions: A concerning paradox exists between unhealthy lifestyles and satisfaction among Saudi university students, particularly regarding their diets. Multicomponent interventions informed by behavior change theories and employing motivational techniques are urgently needed to address this disconnect and facilitate positive behavior change.

Evaluating the public's readiness to combat vector-borne disease threats in Jazan, Saudi Arabia: A cross-sectional survey.

Vector-borne diseases (VBDs) pose a significant public health challenge in Saudi Arabia, particularly in the Jazan region. This study aimed to assess the knowledge, attitudes, and practices regarding VBDs among the population of Jazan and to identify factors associated with these variables. A cross-sectional survey was conducted among 642 adult residents of Jazan using a convenience random sampling technique. The survey tool consisted of 6 domains: demographics, knowledge of VBDs, preventive practices, care-seeking behavior, knowledge of specific VBDs, and attitudes towards VBDs. Data were analyzed using descriptive statistics, chi-square tests, t tests, ANOVA, and multivariable logistic regression. The majority of participants (60.0%) had high knowledge scores, while (75.5%) and (77.7%) had high attitude and practice scores, respectively. However, knowledge gaps were identified in specific areas, such as the transmission of leishmaniasis and Rift Valley fever. Gender was a significant predictor of both knowledge and practice scores, with males having higher knowledge and females demonstrating higher levels of preventive practices. Age, education, income, and working status were also associated with knowledge scores. The findings highlight the need for targeted interventions and educational campaigns to address the identified gaps in knowledge, attitudes, and practices. Future research should focus on exploring the effectiveness of different intervention strategies and investigating the integration of VBD prevention and control measures into existing healthcare systems. By employing a multi-disciplinary approach, evidence-based strategies can be developed to prevent and control VBDs, ultimately improving public health outcomes in Jazan and other endemic regions worldwide.

Tuberculosis research advances and future trends: A bibliometric knowledge mapping approach.

The Gulf Cooperation Council (GCC) countries are more vulnerable to many transmissible diseases, including tuberculosis (TB). This study is to identify the scientific publications related to TB in the GCC countries using topic modeling and co-word analysis. A bibliometric analytic study. The R-package, VOSviewer software, IBM SPPS, and Scopus Analytics were used to analyze performance, hotspots, knowledge structure, thematic evolution, trend topics, and inter-gulf and international cooperation on TB in the past 30 years (1993-2022). A total of 1999 publications associated with research on GCC-TB were published. The annual growth rate of documents was 7.76%. Saudi Arabia is the most highly published, followed by the United Arab Emirates, Kuwait, Qatar, Oman, and Bahrain. The most-cited GC country is Kingdom Saudi Arabia, followed by Kuwait. One hundred sixty research institutions contributed to the dissemination of TB-related knowledge in the GCC, where the highest publishing organizations were King Saud University (Kingdom Saudi Arabia; n = 518). The number of publications related to TB is high in GCC Countries. The current tendencies indicated that GCC scholars are increasingly focused on deep learning, chest X-ray, molecular docking, comorbid covid-19, risk factors, and Mycobacterium bovis.

Awareness and Knowledge of the Physical Activity Guidelines and Their Association with Physical Activity Levels.

BACKGROUND: Physical activity guidelines recommend that adults engage in aerobic exercise and activities that preserve or increase muscle mass. The primary aim of this study was to assess the awareness and knowledge of these guidelines among adults in the Jazan region of Saudi Arabia. A secondary objective was to examine the role of awareness and knowledge in the adherence to physical activity guidelines. METHODS: In this cross-sectional observational study, 1018 participants were recruited through a self-administered online survey. Participants' awareness and knowledge about physical activity guidelines were assessed using a prompted questionnaire. Physical activity levels and weekly energy expenditures were evaluated using the International Physical Activity Questionnaire. RESULTS: The proportion of the participants who reported being aware of the guidelines was approximately 48%, whereas the proportion of the participants who correctly identified the guidelines for moderate-intensity physical activity was 38%. However, only 23% correctly identified the muscle strength guidelines. Those who were aware of the guidelines were most likely to meet the physical activity recommendations (OR = 2.03; 95% CI = 1.55-2.65). Participants who reported being aware of the guidelines exhibited a significantly higher energy expenditure, measured in MET minutes per week (p < 0.01). Similarly, participants who correctly identified the guidelines had greater energy expenditure (p = 0.03). CONCLUSIONS: We found that adults in Jazan have a moderate level of awareness and knowledge of PA guidelines and that awareness is a predictor of adherence to these guidelines. Individuals who are aware of PA guidelines or have knowledge of them tend to have higher levels of physical activity. These findings suggest that public health campaigns that promote awareness and knowledge of the physical activity guidelines may accelerate the progress in engaging the Saudi population with these guidelines.

A hierarchical optimization approach to maximize hosting capacity for electric vehicles and renewable energy sources through demand response and transmission expansion planning.

Within the scope of sustainable development, integrating electric vehicles (EVs) and renewable energy sources (RESs) into power grids offers a number of benefits. These include reducing greenhouse gas emissions, diversifying energy sources, and promoting the use of green energy. Although the literature on hosting capacity (HC) models has grown, there is still a noticeable gap in the discussion of models that successfully handle transmission expansion planning (TEP), demand response (DR), and HC objectives simultaneously. Combining TEP, DR, and HC objectives in one model optimizes resource use, enhances grid stability, supports renewable and EV integration, and aligns with regulatory and market demands, resulting in a more efficient, reliable, and sustainable power system. This research presents an innovative two-layer HC model, including considerations for TEP and DR. The model determines the highest degree of load shifting appropriate for incorporation into power networks in the first layer. Meanwhile, the second layer focuses on augmenting the RES and EVs' hosting capability and modernizing the network infrastructure. System operators can choose the best scenario to increase the penetration level of EVs and RESs with the aid of the proposed model. The proposed model, which is formulated as a multi-objective mixed-integer nonlinear optimization problem, uses a hierarchical optimization technique to identify effective solutions by combining the particle swarm optimization algorithm and the crayfish optimizer. When compared to traditional methods, the results obtained from implementing the proposed hierarchical optimization algorithm on the Garver network and the IEEE 24-bus system indicated how effective it is at solving the presented HC model. The case studies demonstrated that integrating DR into the HC problem reduced peak load by 10.4-23.25%. The findings also highlighted that DR did not impact the total energy consumed by EVs throughout the day, but it did reshape the timing of EV charging, creating more opportunities for integration during periods of high demand. Implementing DR reduced the number of projects needed and, in some cases, led to cost savings of up to 12.3%.

A Study of Awareness, Knowledge, Attitudes, and Practices Regarding Antibiotic Resistance.

Background Antibiotic resistance is a critical global health concern, intensified by public misconceptions and inconsistent antibiotic use. Misunderstandings about antibiotics and their improper use contribute to the acceleration of resistance, making it harder to treat infections effectively. Previous research has identified knowledge gaps in the public, yet there is limited understanding of how these gaps translate into attitudes and practices across different demographic groups. This study aimed to assess the levels of knowledge, attitudes, and practices regarding antibiotic resistance among various demographic groups and to determine the influence of demographic factors on these variables. Methods A descriptive study was conducted using a structured online questionnaire distributed through social media and health forums. The questionnaire targeted adults aged 18 years and older from diverse socioeconomic backgrounds. Data were analyzed using SPSS version 26 (Armonk, NY: IBM Corp.) for descriptive statistics, chi-square tests, and logistic regression analysis. Results The study included responses from 1,561 participants, revealing that 75.72% had knowledge of antibiotic resistance, but only 68.23% understood its public health implications. Attitudes toward antibiotic use were generally positive, with 90.14% recognizing the importance of completing antibiotic courses. However, 32.16% admitted they would stop taking antibiotics once feeling better, even if the course was not finished, highlighting a significant gap between knowledge and practice. Regression analysis identified awareness of prevention measures (coefficient=2.06) and knowledge of antibiotic resistance (coefficient=1.38) as strong predictors of awareness. The chi-square test showed a significant association between gender and awareness of prevention measures (chi-square value=15.19, p-value=0.000097). Conclusions Despite a high level of knowledge about antibiotic resistance, gaps in attitudes and practices persist. These findings underscore the necessity for tailored educational campaigns that not only inform but also engage and alter behaviors across all demographic groups to combat antibiotic resistance effectively.

Maxillofacial Bone Fractures in Children and Adolescents in Saudi Arabia: A Systematic Review.

Facial injuries, including maxillofacial trauma (MFT), are common in children and adolescents due to their age and bone maturation stage. Children's injuries are less common than adults' due to parental supervision and the flexibility of the facial bone. Causes of maxillofacial bone fractures (MFBF) vary based on socioeconomic, cultural, and environmental factors. Management of MFBF in children and adolescents should consider their growth and development stage. A systematic review is needed to understand the prevalence, pattern, and distribution of MFBF in Saudi Arabia. This systematic review aimed to identify papers on MFBF in children and adolescents in Saudi Arabia using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The search strategy involved searching electronic databases like PubMed/Medline, Web of Science, and Ebsco. The review included full-text original research papers, with inclusion criteria including English publications, human studies, and no restrictions on sample size, gender, date, or language. The selection process involved screening titles and abstracts, evaluating full texts, and identifying relevant studies. Data extraction involved two authors individually assessing selected studies. The PRISMA flow diagram of the literature search revealed that 26 papers were identified, of which 15 remained after excluding duplicates. After screening titles and abstracts, 10 articles were removed, and five papers were assessed for eligibility. Four papers met the inclusion criteria for the systematic review. The studies examined 1447 patients for the presence of MFBF in different regions. The majority of MFBF were caused by falls and road traffic accidents (RTAs) in children and adolescents. Mandibular fractures were the most common, followed by maxillary fractures. The majority of patients had tooth/teeth avulsions, followed by tooth luxation and crown fractures. Only one study described investigation methods for MFBF diagnosis. The systematic review reveals a high prevalence of MFBF among children and adolescents in Saudi Arabia, primarily due to falls and RTAs. The mandible is the most frequently fractured bone, and many children have concomitant teeth involvement. To reduce MFBF, effective initiatives and parental awareness strategies are recommended.

Golden Hour Intravenous Thrombolysis for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.

OBJECTIVES: The benefits of intravenous thrombolysis are time-dependent, with maximum efficacy when administered within the first "golden" hour after onset. Nevertheless, the impact of golden hour thrombolysis has not been well quantified. METHODS: Medline, Embase, and Web of Science databases were systematically searched from inception to August 27, 2023. We included studies that reported safety and efficacy outcomes of ischemic stroke patients treated with intravenous thrombolysis in the golden hour versus later treatment window. The primary outcome was an excellent functional outcome, defined as a modified Rankin Scale score of 0-1 at 90 days. The secondary efficacy outcome was a good functional outcome (defined as modified Rankin Scale score of 0-2). The main safety outcome was symptomatic intracerebral hemorrhage. RESULTS: Seven studies involving 78,826 patients met the selection criteria. Golden hour thrombolysis was associated with higher odds of 90-day excellent functional outcomes (OR 1.40, 95% CI 1.16-1.67) and 90-day good functional outcomes (OR 1.38, 95% CI 1.13-1.69) compared with thrombolysis outside the golden hour. The number needed to treat to benefit for golden hour thrombolysis to reduce disability by at least 1 level on the modified Rankin Scale per patient was 2.6. Rates of symptomatic intracerebral hemorrhage and mortality were similar between groups. INTERPRETATION: Golden hour thrombolysis significantly improved acute ischemic stroke outcomes. The findings provide rationale for intensive efforts aimed at expediting thrombolytic therapy within the golden hour window following the onset of acute ischemic stroke. ANN NEUROL 2024;96:582-590.

The utility of serum glucose potassium ratio as a predictive factor for haemorrhagic transformation, stroke recurrence, and mortality among ischemic stroke patients.

Background and Objective: Glucose-Potassium Ratio (GPR) has emerged as a biomarker in several pathophysiological conditions. However, the association between GPR and long-term outcomes in stroke patients has not been investigated. Our study evaluated the applicability of baseline GPR as a predictive prognostic tool for clinical outcomes in ischemic stroke patients. Methods: The multicenter retrospective cohort study included acute-subacute adult ischemic stroke patients who had their baseline serum GPR levels measured. Eligible patients were categorized into two sub-cohorts based on the baseline GPR levels (<1.67 vs. ≥ 1.67). The primary outcome was the incidence of 30-day hemorrhagic transformation, while stroke recurrence, and all-cause mortality within twelve months, were considered secondary. Results: Among 4083 patients screened, 1047 were included in the current study. In comparison with GPR < 1.67 group, patients with ≥ 1.67 GPR had a significantly higher ratio of all-cause mortality within twelve months (aHR 2.07 [95 % CI 1.21-3.75] p = 0.01), and higher ratio of 30-day hemorrhagic transformation but failed to reach the statistical significance (aHR 1.60 [95 % CI 0.95-2.79], p = 0.08). Conclusion: Overall, baseline GPR serum is an independent predictor of all-cause mortality within twelve months in patients with acute and subacute ischemic stroke. Further clinical studies are necessary to validate these findings.