Evaluating competency-based medical education: a systematized review of current practices.

BACKGROUND: Few published articles provide a comprehensive overview of the available evidence on the topic of evaluating competency-based medical education (CBME) curricula. The purpose of this review is therefore to synthesize the available evidence on the evaluation practices for competency-based curricula employed in schools and programs for undergraduate and postgraduate health professionals. METHOD: This systematized review was conducted following the systematic reviews approach with minor modifications to synthesize the findings of published studies that examined the evaluation of CBME undergraduate and postgraduate programs for health professionals. RESULTS: Thirty-eight articles met the inclusion criteria and reported evaluation practices in CBME curricula from various countries and regions worldwide, such as Canada, China, Turkey, and West Africa. 57% of the evaluated programs were at the postgraduate level, and 71% were in the field of medicine. The results revealed variation in reporting evaluation practices, with numerous studies failing to clarify evaluations' objectives, approaches, tools, and standards as well as how evaluations were reported and communicated. It was noted that questionnaires were the primary tool employed for evaluating programs, often combined with interviews or focus groups. Furthermore, the utilized evaluation standards considered the well-known competencies framework, specialized association guidelines, and accreditation criteria. CONCLUSION: This review calls attention to the importance of ensuring that reports of evaluation experiences include certain essential elements of evaluation to better inform theory and practice.

Mechanical properties of hydrated electrospun polycaprolactone (PCL) nanofibers.

Polycaprolactone (PCL) nanofibers are a promising material for biomedical applications due to their biocompatibility, slow degradation rate, and thermal stability. We electrospun PCL fibers onto a striated substrate with 12 µm wide ridges and grooves and determined their mechanical properties in an aqueous solution with a combined atomic force/inverted optical microscopy technique. Fiber diameters, D, ranged from 27 to 280 nm. The hydrated PCL fibers had an extensibility (breaking strain), εmax, of 137%. The Young's modulus, E, and tensile strength, σT, showed a strong dependence on fiber diameter, D; decreasing steeply with increasing diameter, following empirical equations E(D)=(4.3∙103∙e-D51nm+1.1∙102) MPa and σT(D)=(2.6∙103∙e-D55nm+0.6∙102) MPa. Incremental stress-strain measurements were employed to investigate the viscoelastic behavior of these fibers. The fibers exhibited stress relaxation with a fast and slow relaxation time of 3.7 ± 1.2 s and 23 ± 8 s and these experiments also allowed the determination of the elastic and viscous moduli. Cyclic stress-strain curves were used to determine that the elastic limit of the fibers, εelastic, is between 19% and 36%. These curves were also used to determine that these fibers showed small energy losses (<20%) at small strains (ε < 10%), and over 50% energy loss at large strains (ε > 50%), asymptotically approaching 61%, as Eloss=61%·(1-e-0.04*ε). Our work is the first mechanical characterization of hydrated electrospun PCL nanofibers; all previous experiments were performed on dry PCL fibers, to which we will compare our data.

Dementia Knowledge Among Primary Healthcare Physicians in Riyadh, Saudi Arabia.

INTRODUCTION: Dementia poses a significant healthcare challenge globally, and healthcare providers must have adequate knowledge about its diagnosis, management, and support services. By assessing the knowledge level of primary care physicians in Riyadh, we can identify potential gaps and areas for improvement in dementia care, ultimately enhancing patient outcomes and quality of life. This study holds promise in shedding light on the current state of dementia knowledge among primary healthcare physicians in Riyadh and offering insights into strategies to enhance dementia care in this region. METHODS: This cross-sectional questionnaire-based study was conducted from the first of June 2023 to the end of December 2023 in Riyadh, Saudi Arabia. A validated questionnaire was used to assess physicians' knowledge, attitude, and practice toward dementia. RESULTS: A total of 151 physicians completed the questionnaires. The majority were male (55%), below 30 years of age (88.1%), and family medicine residents (84.8%). Most (74.8%) recognized old age as the most significant risk factor; an overwhelming majority of participants (98.7%) could not identify the minimum course of treatment to judge a medication's effectiveness. The average score of correct responses (7.74 ∓ 4.11) was equivalent to 38.7%. Furthermore, the average correct responses were significantly different among the different job levels of the participants. CONCLUSIONS: The findings of this study highlight a lack of knowledge among primary care physicians regarding dementia, emphasizing the crucial importance of physician education in this area. Additionally, the results strongly indicate the need for emphasis on dementia education within the undergraduate medical curriculum, family medicine curriculum, and physician training programs. By addressing these educational gaps, we can better equip physicians to provide optimal care and support for individuals with dementia, ultimately improving patient care and quality of life.

Overconfidence, Time-on-Task, and Medical Errors: Is There a Relationship?

Background: Literature suggest that physicians' high level of confidence has a negative impact on medical decisions, and this may lead to medical errors. Experimental research is lacking; however, this study investigated the effects of high confidence on diagnostic accuracy. Methods: Forty internal medicine residents from different hospitals in Saudi Arabia were divided randomly into two groups: A high-confidence group as an experimental and a low-confidence group acting as a control. Both groups solved each of eight written complex clinical vignettes. Before diagnosing these cases, the high-confidence group was led to believe that the task was easy, while the low-confidence group was presented with information from which it could deduce that the diagnostic task was difficult. Level of confidence, response time, and diagnostic accuracy were recorded. Results: The participants in the high-confidence group had a significantly higher confidence level than those in the control group: 0.75 compared to 0.61 (maximum 1.00). However, neither time on task nor diagnostic accuracy significantly differed between the two groups. Conclusion: In the literature, high confidence as one of common cognitive biases has a strong association with medical error. Even though the high-confidence group spent somewhat less time on the cases, suggesting potential premature decision-making, we failed to find differences in diagnostic accuracy. It is suggested that overconfidence should be studied as a personality trait rather than as a malleable characteristic.

The consumption of dietary supplements in Saudi Arabia during the COVID-19 pandemic: A cross-sectional study.

Background and Objectives: People frequently utilize dietary supplements (DS), notably during the COVID-19 epidemic, despite the lack of data supporting their usefulness and safety in enhancing general health. This study aimed to measure the consumption of DS in Saudi Arabia during COVID-19. Previous studies focused on using dietary supplements for preventing or reducing mental health. Materials and Methods: A cross-sectional study was conducted with 1572 participants aged 18-65, from all-over Saudi Arabia who were invited to complete a self-administered questionnaire to measure the consumption of supplements during the pandemic lockdown period. Also, it investigates the factor that effect supplements consumption. Results: Around 63% of the participants did not change their consumption patterns during the pandemic, while 16% consumed more and 21.4% consumed fewer supplements during the pandemic. The most commonly used supplements were iron; calcium, especially among pregnant women; omega-3, especially in people older than 65 years; and vitamin D. Females (81%; P < 0.002); age (94.7%; P < 0.002); married people (84%; P < 0.001); those with a higher educational level (83.9%; P = 0.02); those with a higher monthly income (86.1%; P = 0.006); and pregnant women (100%; P < 0.007) reported the highest rates of consumption. Conclusion: Dietary supplements have recently become popular in Saudi Arabia, but large differences remain between Saudis in their consumption of supplements. Additional research should be conducted to examine the level of knowledge of dietary supplements among Saudi population.

Effect of total fasting hours on the overall quality of recovery after surgery: An observational study.

Context: Preoperative fasting is one of the pre-requisite for patients undergoing a surgery. Despite clear instructions, patients frequently fast for extended periods before elective surgeries. Longer periods of fasting may cause discomfort, thirst, hunger, and other physiological problems. Aims: To assess the quality of postoperative recovery among adult patients having different preoperative fasting hours by using the postoperative Quality of Recovery40 (QoR40) score. Settings and Design: This was an observational study that was conducted for adult patients undergoing elective surgery during four weeks between 19th September and 13th October 2022 at Security Forces Hospital Riyadh, Kingdom of Saudi Arabia. Methods and Material: We excluded pediatric patients, patients undergoing spine or neurosurgery, emergency cases, or local anesthesia cases. Non-probability convenient sampling technique was used in this study. The postoperative quality of recovery-40 (QoR-40) questionnaire was distributed among 200 patients. Statistical Analysis Used: All analyses were performed with Statistical Package for the Social Sciences software (SPSS) v25. Descriptive statistics (frequency, percentage, median, and IQR) were used for the questionnaire's variables. The difference between the variables was analyzed using Kruskal-Wallis, and a P value <0.05 was considered statistically significant. Results: Out of 200 patients, 172 patients responded but 16 responses were excluded. A total of 156 adult patients' responses were included in this study. The majority were female (53%), 31% were older than 45 years. More than 50% of patients reported fasting for more than 6 hours for drinking and more than 8 hours for eating. On the positive scale, the comfort score was significantly affected by the fasting hours for drinking (P value = 0.045). On the negative scale of the questionnaire, the emotions were significantly affected by fasting hours for both drinking (P value = 0.027) and eating (P value = 0.043). Conclusions: The study results showed better comfort for patients with lesser fasting hours for drinking. Moreover, the results strongly suggest the need of following the fasting guidelines without prolonging the fasting duration. However, further studies with larger sample sizes are recommended.

The effect of bariatric surgery on dietary Behaviour, dietary recommendation Adherence, and micronutrient deficiencies one year after surgery.

Bariatric surgery (BS) is associated with vitamin and mineral deficiencies, which might be augmented by low adherence to dietary guidelines and inappropriate dietary behaviours. The aim of this study was to determine the influence of BS on eating behaviour, prevalence of nutrient deficiency, level of commitment to diet, and lifestyle recommendations one-year post-BS. A cross-sectional study was conducted among adult patients who underwent BS in 2019 and had follow-up for a year. Age, gender, and clinical data were collected from the hospital system and other information was obtained from questionnaires during phone interviews. A total of 160 patients participated in the study. At 12 months, a significant increase from the baseline values in plasma levels of vitamin B12, folate, vitamin D, iron, corrected calcium, albumin, CRP, and MCV, as well as a significant decrease in BMI was observed. Adherence to dietary and lifestyle recommendations was moderate to high. Emotional, and restrained eating behaviours were moderate with 64.4%, and 77.5%, respectively. External eating was low at 58.1%. The study concluded that pre-and post-bariatric surgery nutrients should be closely monitored.

Comparing the Effectiveness of Role-Play Simulation versus Real Patient Transferal Skills Training in Occupational Therapy Students in Saudi-Arabia- A Quasi-Experimental Study.

Purpose: To compare the effectiveness of using role-play simulation as a possible alternative to real-patient training to teach transferal skills to occupational therapy students. Patients and Methods: Seventy-one occupational therapy students (including those in their second, third and fourth years) participated in a quasi-experimental study. The students were randomly divided into two groups. One group received role-play simulation at the university. The other received training on real patients with mild to moderate stroke and spinal cord injury (one session/week for six weeks) in clinical (inpatient) settings in Jeddah to learn patient transferring skills. Student performance was taken as a measure of teaching method effectiveness, and was evaluated by using a validated OSCE-type assessment tool developed at the end of training. The tool showed good reliability (Cronbach's α was > 0.7) and inter-reliability (Kappa < 0.001). Results: A total number of 71 students participated in the study. The majority of the students were female (66.2%, N=47) and 33.8% (N=24) were male. About 33.8% (N=24) of students were in the second year, 29.6% (N=21) were in the third year and 36.6% (N=26) were in the fourth year. There were 36 (49.3%) students in the simulation group The mean age of the students was 20.70 (SD=1.2). There was no significant difference in the students' performance in both groups with a P-value of 0.139. Conclusion: Role-play simulation can effectively be used for students' training as there was no difference in the outcome of the students' performance in patient transferring skills in both groups. This finding can help in designing and implementing training through simulation, especially in situations where training on severely ill patients may be a safety risk.

A Cytological Study of Oral Human Papillomavirus (HPV) Infection Among Electronic Cigarette Smokers in Al-Madinah Al-Munawara.

Objective This study aims to determine how electronic cigarette (e-cigarette) use contributes to the spread of the human papillomavirus (HPV) and to assess the potential cellular proliferative activity it may produce. Methodology In Madinah, a case-control study was conducted between October 2022 and March 2023. Two oral cytologic smear samples were collected from each of the 500 volunteers; 250 consumers of electronic cigarettes and 250 non-smokers each provided two samples. To detect cytological changes and HPV infection, these samples were stained using Papanicolaou and immunocytochemical techniques. Results Twelve (4.8%) of the electronic cigarettes exhibited cytological atypia, while only one (0.4%) of the nonsmokers' group did. Infection with the human papillomavirus (HPV) was detected in eight (3.2%) of the e-cigarette users, but it was only found in two (0.8%) of the nonsmokers (P ≤ 0.05). Conclusion Electronic cigarette smoking increases the likelihood of contracting HPV and developing cytological atypia, both of which, if left untreated, can contribute to the development of precancerous and cancerous lesions in the mouth.

An Evidence Theory Based Embedding Model for the Management of Smart Water Environments.

Having access to safe water and using it properly is crucial for human well-being, sustainable development, and environmental conservation. Nonetheless, the increasing disparity between human demands and natural freshwater resources is causing water scarcity, negatively impacting agricultural and industrial efficiency, and giving rise to numerous social and economic issues. Understanding and managing the causes of water scarcity and water quality degradation are essential steps toward more sustainable water management and use. In this context, continuous Internet of Things (IoT)-based water measurements are becoming increasingly crucial in environmental monitoring. However, these measurements are plagued by uncertainty issues that, if not handled correctly, can introduce bias and inaccuracy into our analysis, decision-making processes, and results. To cope with uncertainty issues related to sensed water data, we propose combining network representation learning with uncertainty handling methods to ensure rigorous and efficient modeling management of water resources. The proposed approach involves accounting for uncertainties in the water information system by leveraging probabilistic techniques and network representation learning. It creates a probabilistic embedding of the network, enabling the classification of uncertain representations of water information entities, and applies evidence theory to enable decision making that is aware of uncertainties, ultimately choosing appropriate management strategies for affected water areas.

Legal and Bioethical Educational Module in Saudi Board of Emergency Medicine: A Qualitative Need Assessment".

Purpose: Medical malpractice is a leading cause of morbidity and mortality worldwide, negatively affecting healthcare systems, communities, and providers. Although physicians value legal knowledge, their understanding of medical law is limited. Integrating medical law and ethics into medical school curriculums can develop a practitioner's decision-making skills, critical thinking abilities, and ethical judgment. The Saudi Board of Emergency Medicine (SBEM) is a residency training program governed by the Saudi Commission for Health Specialties (SCFHS), which aims to improve healthcare quality and patient safety in Saudi Arabia. This study explored stakeholders' perceptions regarding implementing a legal and bioethical education module in the SBEM curriculum. Methods: Nineteen participants (seven program directors and 12 trainees) from the different training centers around the kingdom (from Riyadh, Jeddah, and eastern province) have been included in the study. Thirty minutes to one-hour face-to-face and virtual (zoom-based) structured interviews have been done. Each interview was audio-recorded and transcribed verbatim. Then, data have been analyzed using a grounded theory constant comparative approach to develop categories, central themes, and a descriptive model. Results: Four themes have emerged from the data, including planning and executing the current bioethical and legal educational activities in the SBEM, the current teaching methods and guiding resources for the bioethical and legal subjects, the assessment methods used to evaluate the trainees' comprehension of bioethical and legal topics and the opinions regarding integrating bioethical and legal education module with the current curriculum of the SBEM. Conclusion: The study found that the current educational initiatives for legal and bioethical topics in SBEM are insufficient. There are no clear learning objectives, study guides, or combined practices for trainees to develop safe approaches when faced with ethical and legal challenges. A comprehensive protocol with required competencies and dedicated educators may help trainees understand Islamic ethics and jurisprudence principles for delivering culturally sensitive and patient-centered care. Further studies and needs assessments are recommended.

Knowledge, perception, and beliefs of Saudi physicians at King Abdulaziz Medical City, Riyadh related to medical cannabis: Literature review and a cross-sectional survey.

Cannabis is an herbaceous flowering plant, originally an indigenous plant in Eastern Asia, which later spread globally due to widespread agricultural practices. Cannabis was used medicinally until the early twentieth century, but subsequently prohibited due to the psychoactive effects. Aims: To explore the medical cannabis-related level of knowledge of physicians at King Abdulaziz Medical City, including patient needs, perceptions of therapeutic effects, potential harm, and the willingness to prescribe if legalized in future. Methodology: The study was a cross-sectional questionnaire-based survey. It was conducted at King Abdulaziz Medical City in Riyadh from February 2020 to February 2021. All physicians from the different specialties, who consented to participate, were included in this study. Statistical Analysis: Descriptive statistics are presented as mean and standard deviation and proportions. An ANOVA test was applied to measure the association of the beliefs regarding the right to prescribe with overall knowledge. All tests were considered significant at P < 0.05. Results: A total of 249 physicians participated with the majority (70%) male. The sample was similar regardless of the physician's position in the medical hierarchy, with a mean work experience of 8 years. Almost half of the participants indicated that they do not have good knowledge regarding the effects of MC products and more than half that they are unaware of the different MC products and formulations currently available. Conclusion: The majority of the sample lacked knowledge about the medicinal use of cannabis for specific indications and felt uncomfortable to discuss the medicinal use of cannabis with their patients.

Evaluation of learning environment of different family medicine programs, Jeddah-KSA, 2021.

Background: A supportive educational climate in which learners are educated and monitored is a significant determinant of the medical trainees' performance and progress and eventually contributes to better patient care. Therefore, residents' training programs need to be assessed and incorporated according to the views and expectations of the candidates. The objectives of this research are to compare and evaluate the learning environment of Family Medicine (FM) programs in Jeddah and make practical recommendations for improvement of the learning environment. Methods: A descriptive causal-comparative study was designed at FM programs in Jeddah, Saudi Arabia during January, and February 2021, including all residents from R1 to R4. A Postgraduate Hospital Educational Environment Measure (PHEEM) questionnaire was used in this study. The overall score and the three domains were calculated. Results: Two hundred and eighty-three questionnaires were distributed, and 262 were completed and collected, making a response rate of 92.6%. Females represented were 150 (57.3%), and males were 112 (42.7%). The study shows that 78 (29.8%) of the residents reported that the learning environment was excellent, and 154 (58.8%) described it as a more positive than the negative environment, whereas 29 (11.1%) described it as having a lot of problems. Out of 160 maximum scores, the highest total score (127) was observed among residents at the National Guard program, whereas the lowest score (108) was in the FM joint program, P < 0.001. Conclusion: Evaluation of the training programs is an essential component of quality assurance procedures. The satisfaction of the FM residents at different programs in Jeddah, Saudi Arabia, is better than reported previously, but however, further improvement is warranted. Juniors and residents of the National Guard program were more satisfied than their peers. We recommend low score items should have special consideration from high authorities and ongoing evaluation of the FM training program for further improvement of the learning environment.

The Mechanical Properties of Blended Fibrinogen:Polycaprolactone (PCL) Nanofibers.

Electrospinning is a process to produce versatile nanoscale fibers. In this process, synthetic and natural polymers can be combined to produce novel, blended materials with a range of physical, chemical, and biological properties. We electrospun biocompatible, blended fibrinogen:polycaprolactone (PCL) nanofibers with diameters ranging from 40 nm to 600 nm, at 25:75 and 75:25 blend ratios and determined their mechanical properties using a combined atomic force/optical microscopy technique. Fiber extensibility (breaking strain), elastic limit, and stress relaxation times depended on blend ratios but not fiber diameter. As the fibrinogen:PCL ratio increased from 25:75 to 75:25, extensibility decreased from 120% to 63% and elastic limit decreased from a range between 18% and 40% to a range between 12% and 27%. Stiffness-related properties, including the Young's modulus, rupture stress, and the total and relaxed, elastic moduli (Kelvin model), strongly depended on fiber diameter. For diameters less than 150 nm, these stiffness-related quantities varied approximately as D-2; above 300 nm the diameter dependence leveled off. 50 nm fibers were five-ten times stiffer than 300 nm fibers. These findings indicate that fiber diameter, in addition to fiber material, critically affects nanofiber properties. Drawing on previously published data, a summary of the mechanical properties for fibrinogen:PCL nanofibers with ratios of 100:0, 75:25, 50:50, 25:75 and 0:100 is provided.

Endometrioid Adenocarcinoma within an Endometriotic Cyst in the Mesosalpinx: A Case Report and Review of the Literature.

Endometriosis-related neoplasms may arise within endometriotic cysts of organs of the female genital tract or other organ systems. Herein, we present a case of endometrioid adenocarcinoma arising within an endometriotic cyst in the mesosalpinx. A 27-year-old single female presented to the clinic with a history of right hypochondrial pain. Pelvic MRI revealed a bulky uterus with three intramural uterine fibroids and a complex cyst in the mesosalpinx. The excised cyst showed predominantly confluent growth of relatively well-defined glands resembling proliferative-phase endometrium in a background of endometriosis. The tumor was diagnosed as endometrioid adenocarcinoma within an endometriotic cyst, pathologic stage pT1a. She was referred to the oncology team, where a positron emission tomography scan showed unremarkable results. Although these neoplasms have been reported in various locations within the female genital tract, endometrioid adenocarcinoma arising from endometriosis in the mesosalpinx is seldom reported.

Refeeding Syndrome Awareness among Physicians of King Abdullah Medical City in Makkah, Saudi Arabia.

BACKGROUND: Refeeding syndrome (RFS) is a lethal condition of metabolic disturbances that arise from the sudden switch of metabolism from a state of starvation to one of nourishment. Quick recognition would reduce health complications. Physicians who are unaware of the syndrome will not identify and treat it. As nutritional risk is associated with the risk of RFS, physicians should be aware of it. AIM: To determine whether the physicians of King Abdullah Medical City (KAMC) in Makkah know of RFS and, if so, have skills in diagnosis and managing the syndrome. METHODS: One hundred and fifty-nine physicians of KAMC were recruited in a cross-sectional study. They were asked to complete a questionnaire by face-to-face interview. The questionnaire was designed to capture physicians' knowledge and ability to manage RFS based on the awarding of certain scoring points. RESULTS: The level of knowledge among physicians had a significant association between knowledge and age (p = 0.021) and medical specialty (p = 0.010). Additionally, the most knowledgeable physicians were those who work in critical care (21.4%). Around 18% of physicians were not able to manage RFS. CONCLUSIONS: Lacking knowledge of RFS and how to manage it leads to critical life-threatening complications. Physicians need nutritional education to help them diagnose RFS and consult dietitians to avoid its complications.

Media use, dietary intake, and diet quality of adolescents in Saudi Arabia.

BACKGROUND: Excessive media use can affect diet of adolescents, but relevant data in Saudi Arabia are lacking. The present study aimed to explore the association between media use, dietary intake, and diet quality among adolescents. METHODS: This cross-sectional study included data of 631 adolescents (ages 11-18 years) who were randomly recruited from 16 schools located in two main cities in the Western region of Saudi Arabia (Madinah and Jeddah). Envelopes including a questionnaire were sent home to collect sociodemographic data. Students then completed the short-form food frequency questionnaire to assess diet quality. Data on media use, anthropometrics, and 24-h dietary recalls were also collected. RESULTS: A high proportion of adolescents (86.2%) exceeded media use recommendations of ≤2 h per day. Significantly higher proportions of younger adolescents, males, and non-Saudis reported media use within the recommendation compared to their peers. Media use predicted lower diet quality score (B = -0.67 [95% CI: -1.09 to -0.28]) and lower intake of calcium, zinc, vitamin D, and vitamin C (B = -104 [95% CI: -203 to -5.24], B = -2.13 [95% CI: -4.15 to -0.11], B = -23.5 [95% CI: -41.3 to -5.65], B = -24.0 [95% CI: -45.1 to -2.96], respectively). CONCLUSION: Interventions to limit media use are urgently needed for adolescents in Saudi Arabia to improve diet quality and overall nutritional health. IMPACT: Excessive media use can affect diet of adolescents, but relevant data are lacking in Saudi Arabia. The majority of adolescents exceed the recommendations for media use. Media use was negatively associated with diet quality and intake of calcium, zinc, vitamin D, and vitamin C. This study will inform public health entities and policy makers to draw evidence-based, culturally tailored recommendations and develop nutrition interventions to enhance diet quality and nutritional status of adolescents. Findings of this study highlight the urgency to develop intervention programs and policies that aim to limit media use among adolescents.

Abdominal X-Ray Findings of Patients With Crohn's Disease Presenting With Acute Abdominal Pain.

OBJECTIVES: The primary objective of this study is to describe the most common radiological findings found on abdominal X-rays of patients with Crohn's disease (CD) presenting with acute abdominal pain. METHODS: A cross-sectional study was conducted at a tertiary care hospital in Riyadh. Data from CD patients who presented with acute abdominal pain between December 2016 and December 2021 was analyzed. A total of 144 abdominal X-rays met the inclusion and exclusion criteria and were included in the study. The medical records of patients who had the X-rays were subsequently reviewed for the presence or absence of follow-up imaging studies. RESULTS: Of the 144 abdominal X-ray studies, 54 (37.5%) had positive findings, while 90 (62.5%) were unremarkable. The most common category of findings was small bowel findings (32.6%), acute complications (32.6%), followed by extraintestinal findings (2.7%), and colonic findings (1.35%). About 29.2% of the abdominal X-rays had subsequent follow-up imaging done. The multivariate logistic binary regression analysis demonstrated that males had an odds ratio of 2.25 of undergoing follow-up imaging compared to females (p = 0.049). CONCLUSION:  The non-specific findings found on the majority of the abdominal X-rays may indicate that it is of limited diagnostic value in this patient population. However, they play an integral role in ruling out acute complications in CD patients presenting with abdominal pain and exhibiting disease activity.

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Enhancing Graph Routing Algorithm of Industrial Wireless Sensor Networks Using the Covariance-Matrix Adaptation Evolution Strategy.

The emergence of the Industrial Internet of Things (IIoT) has accelerated the adoption of Industrial Wireless Sensor Networks (IWSNs) for numerous applications. Effective communication in such applications requires reduced end-to-end transmission time, balanced energy consumption and increased communication reliability. Graph routing, the main routing method in IWSNs, has a significant impact on achieving effective communication in terms of satisfying these requirements. Graph routing algorithms involve applying the first-path available approach and using path redundancy to transmit data packets from a source sensor node to the gateway. However, this approach can affect end-to-end transmission time by creating conflicts among transmissions involving a common sensor node and promoting imbalanced energy consumption due to centralised management. The characteristics and requirements of these networks encounter further complications due to the need to find the best path on the basis of the requirements of IWSNs to overcome these challenges rather than using the available first-path. Such a requirement affects the network performance and prolongs the network lifetime. To address this problem, we adopt a Covariance-Matrix Adaptation Evolution Strategy (CMA-ES) to create and select the graph paths. Firstly, this article proposes three best single-objective graph routing paths according to the IWSN requirements that this research focused on. The sensor nodes select best paths based on three objective functions of CMA-ES: the best Path based on Distance (PODis), the best Path based on residual Energy (POEng) and the best Path based on End-to-End transmission time (POE2E). Secondly, to enhance energy consumption balance and achieve a balance among IWSN requirements, we adapt the CMA-ES to select the best path with multiple-objectives, otherwise known as the Best Path of Graph Routing with a CMA-ES (BPGR-ES). A simulation using MATALB with different configurations and parameters is applied to evaluate the enhanced graph routing algorithms. Furthermore, the performance of PODis, POEng, POE2E and BPGR-ES is compared with existing state-of-the-art graph routing algorithms. The simulation results reveal that the BPGR-ES algorithm achieved 87.53% more balanced energy consumption among sensor nodes in the network compared to other algorithms, and the delivery of data packets of BPGR-ES reached 99.86%, indicating more reliable communication.