Alarm fatigue and perceived stress among critical care nurses in the intensive care units: Palestinian perspectives.

OBJECTIVE: The frequency of alarms generated by monitors and other electro-medical devices is undeniably valuable but can simultaneously escalate the workload for healthcare professionals, potentially subjecting intensive care unit nurses to alarm fatigue. The aim of this study is to investigate alarm fatigue and stress levels among critical care nursing personnel. Additionally, the study aims to assess predictors for both alarm fatigue and perceived stress. METHODOLOGY: A descriptive cross-sectional study recruited 187 Intensive Care Unit (ICU) nurses from hospitals located in the northern and central regions of the West Bank, Palestine. Data were gathered through online surveys due to logistic concerns using the Alarm Fatigue Scale and the Perceived Stress Scale. The research was conducted between November 2023 and January 2024. RESULTS: The mean overall alarm fatigue score was 23.36 (SD = 5.57) out of 44. The study showed that 62.6% of the participating ICU nurses experience average to high degree of alarm fatigue, while 69.5% experience average to high levels of perceived stress. A significant positive Pearson correlation was found between stress and alarm fatigue (0.40, P < 0.01). Important predictors of alarm fatigue include perceived stress, nurse-to-patient ratio, gender, and years of experience, while important predictors of perceived stress include alarm fatigue, type of working shift and hospital unit. CONCLUSION: Alarm fatigue can compromise the timely intervention required to prevent adverse outcomes by causing delayed responses or missed critical alarm, which can have major ramifications for patient safety. Addressing stress is crucial for mitigating alarm fatigue and fostering a supportive work environment to ensure optimal patient care. Consequently, exploring strategies to alleviate the negative impacts of alarm fatigue on critical care nurses' stress merits further investigation in future research studies.

Evaluation of performance and estimation of genetic parameters for milk yield and reproductive traits in Awassi and Asaf sheep breeds and crosses in the Palestinian territory.

This study aimed to estimate genetic parameters, including heritability and repeatability, for milk yield and prolificacy in sheep. It included 3682 records from 1837 ewes across various breeds: Awassi, Assaf, and Awassi x Assaf crosses, two Awassi lines: Improved Awassi, AFEC Awassi. The study measured total milk yield (TMY), yield up to 120 days (TMY120), and yield up to 150 days (TMY150), alongside reproductive traits: litter size (LS), number of lambs born alive (NLBA), and lambing interval (LI). The analysis utilized a mixed model and the REML procedure to estimate genetic parameters. Results indicated that litter size (LS) had no significant impact on milk traits, whereas breed, location, ewe parity, and lambing season showed significant effects. Lactation length also significantly influenced TMY. For reproductive traits, treatment was significant for NLBA, with location associated with breed, parity, and season affecting all traits. Heritability estimates for TMY ranged from 0.00 in Awassi x Assaf crosses to 0.11 in Awassi, and for TMY120 and TMY150, from 0.00 in Awassi x Assaf crosses to 0.16 in Awassi. Estimates for LS and NLBA varied similarly. The heritability for LI was 0.03 in Awassi and zero in other breeds and crosses. The findings suggest that in the northern West Bank regions of Nablus and Jenin, Assaf or Awassi x Assaf breeds are preferable. The study underscores the importance of comprehensive performance and pedigree recording for effective sheep farm management.

Delirium in Intensive Care Units: Perceptions of Physicians and Nurses.

Delirium is an indicator of morbidity and mortality in intensive care unit (ICU) patients. It can lead to negative outcomes and longer hospital stays, thus increasing hospital costs. Despite national recommendations for daily assessment of delirium, it remains underdiagnosed. Many studies point to a lack of knowledge among health care professionals to accurately detect and manage ICU delirium. The aim of our study was to assess the knowledge, attitudes, and practices of Palestinian health care professionals regarding ICU delirium. The results of a cross-section observational study revealed that delirium appears to be often underrecognized or misdiagnosed in ICUs in Palestine. Therefore, it is critical to further educate the medical and nursing teams and to promote the use of validated tools that can aid in the assessment of this condition. In this way, the length of hospital stays and related health care costs can be reduced.

Static and Fatigue Loading of Veneered Implant-Supported Fixed Dental Prostheses.

PURPOSE: This study aimed to compare the load to failure and the probability of survival of porcelain fused to zirconia (PFZ) three-unit, implant-supported, fixed dental prostheses (FDPs) to those of indirect composites veneered to either zirconia (CVZ) or milled fiber-reinforced composite (FRC) frameworks under static and fatigue loading. MATERIALS AND METHODS: One-hundred and twenty posterior three-unit FDP (second premolar pontic) frameworks were fabricated via milling from a single Standard Tessellation Language (STL) file. The FDPs were divided into three groups. Each group (n = 40) was subjected to static (n = 20) and fatigue (n = 20) loading tests, as follows: (1) PFZ: zirconia framework layered with porcelain veneer; (2) CVZ: zirconia framework veneered with indirect composite resin; and (3) FRC: FRC framework veneered with indirect composite resin. After porcelain veneering onto sintered zirconia frameworks, or resin composite veneering onto zirconia or FRC frameworks, FDPs were cemented on their abutments using self-adhesive resin cement. After thermal cycling, half of the FDPs were subjected to an accelerated fatigue test. The other half of the FDPs were subjected to single load-to-failure (SLF) testing at a crosshead speed (1 mm/min). Lifetime analysis was conducted to determine the probability of survival, and fractographic analysis was performed. RESULTS: Significant differences were observed among the studied groups for SLF with the highest characteristic strength values observed for PFZ (2154 N), followed by 1905.47 N for CVZ and 1679.56 N for FRC. The probability of survival for 100,000 cycles at 500 N was the highest for FRC (98%) and CVZ (100%) and was significantly lower for PFZ (88%). Different fracture patterns were observed in the fractography. CONCLUSIONS: In fatigue testing, which simulates masticatory function better than static tests, a higher probability of survival was observed for FRC and CVZ than for PFZ. Framework fractures were not observed only for the FRC group, indicating that chairside repair with the addition of indirect composite could be performed for continued function.

Use of narrow-diameter implants in the posterior jaw: a systematic review.

STATEMENT OF PROBLEM: Evidence is limited on the efficacy of narrow-diameter implants (NDIs) in the posterior jaw. PURPOSE: The purpose of this systematic review was to assess the survival of NDIs and provide guidelines for their safe use. MATERIALS AND METHODS: Electronic search of the English-language literature enriched by hand search to identify suitable publications was made. Only peer-reviewed clinical studies published from January 1990 through March 2014 were included. RESULTS: Seventeen studies with a total of 1644 implants met the inclusion criteria, with an observation period from 1 up to 12 years. The mean survival rate of 98.6% was reported. Technical and other complications were observed. CONCLUSION: Short-term clinical data suggest that NDIs may serve in the posterior jaw as an alternative to standard-diameter implants. However, certain clinical conditions must be observed to assure long-term success.

Evaluation of Clinical Competence and Job Satisfaction and Their Related Factors Among Emergency Nurses in Palestinian Hospitals.

Introduction: Nurses are responsible for providing primary care to millions of patients, and emergency nurses serve on the frontline in providing care for mildly to severely critically ill patients. Objectives: This study aims to assess and evaluate the clinical competence and its related factors among emergency nurses in Palestinian hospitals. Methods: A cross-sectional study was conducted among 170 nurses working in the emergency units of hospitals in the West Bank, Palestine. Data collection utilized the Nurse Competence Scale, and the Job Satisfaction Scale. Results: The results showed that only 33(19.4%) of the participants exhibited a good level of clinical competence, with none reaching the very good level. Among them, the highest proportion of good level 60 (35.3%) was in the helping role, while the lowest 38 (22.4%) was in ensuring quality. About 35% of nurses reported very low or low job satisfaction, while 58% had high or very high job satisfaction. Additionally, the results revealed a statistically significant relationship between clinical competence and job satisfaction (P < 0.05). Both clinical competence and job satisfaction were positively correlated with age and experience. Conclusion: The study found a significant relationship between demographic characteristics (e.g., education, experience, and marital status) and clinical competency among emergency nurses. Notably, less than half of the participants demonstrated good clinical competency, with none reaching a very good level. The highest scores were observed in the helping role domain, while the lowest were in the ensuring quality domain. Furthermore, clinical competence was found to be significantly associated with job satisfaction. Consequently, enhancing nurses' clinical competency will lead to an improvement in the quality of patient care.

Early perception, behavior, knowledge, and preventive practices related to COVID-19 among Palestinians.

It is necessary to understand early perception, behavior, and knowledge of coronavirus disease 2019 (COVID-19) and preventive practices in relation to suggested policies and information accessible to the Palestinian population during the early stages of the pandemic. The aim of this research is to contribute to this understanding for the purpose of affecting future practical preventive policies that can be implemented and adapted in Palestine in order to shape a new reflective practices model to face any future epidemic crisis of any type. A cross-sectional design was used to conduct the study over 3 weeks in April 2020 and an online survey was disseminated in all areas of Palestine. A total of 1040 responses were collected from persons who were over 18 years of age. A high level of knowledge related to COVID-19 was found, including symptoms and characteristics of the virus, prevention practices, and at-risk groups. Respondents believe that they are more susceptible to influenza than COVID-19 and more likely to be infected by the influenza virus than the COVID-19 virus but expect that infection of influenza would be less severe than infection of COVID-19. Respondents were more inclined to find COVID-19 worrying and stressful than they were to find it fear-inducing. Around two-thirds of respondents believe that different types of COVID-19-related conspiracy theories are true to some degree. Going forward, it is crucial and essential to provide basic awareness among large populations around diseases, which can contribute to positively influencing people's knowledge and attitudes and their perception toward such diseases and combat conspiracy theories.

Knowledge, Perceptions, and Prevention Practices among Palestinian University Students during the COVID-19 Pandemic: A Questionnaire-Based Survey.

The purpose of this study is to offer a timely understanding of university students' knowledge, perception, and preventative practices related to COVID-19 in Palestine and to determine affecting factors (gender, region, and type of locality). A cross-sectional design was used and data was collected over 2 weeks in April 2020 through an online survey. A total of 484 surveys were collected from students from different Palestinian universities. Participants showed high levels of knowledge across multiple topics (symptoms and characteristics of COVID-19, prevention practices, and at-risk groups), although respondents were less likely to indicate mask wearing as an effective prevention practice compared to other practices, and almost one-third reported incorrectly that taking antibiotics is effective in preventing COVID-19 infection. Respondents reported the most trust in the Ministry of Health as a source of information, and the least trust in social media. A generally high level of acceptance of government regulations related to the COVID-19 pandemic was found. Given the current global situation and the second wave of infections in Palestine, plans should be in place to disseminate correct information and combat newly-emerging rumors and misinformation through channels that are trusted by the university student population.

Case-Control Study of Risk Factors and Self-Care Behaviors of Foot Ulceration in Diabetic Patients Attending Primary Healthcare Services in Palestine.

The purpose of this study is to identify certain sociodemographic, lifestyle, self-care, and foot examination factors that predict the development of diabetic foot ulcers in Palestine. A case-control study was performed in Palestine in 2019. The control group consisted of diabetic patients without foot ulceration (NFU). The case group included diabetic patients who had foot ulcers (DFU) with a size not less than 0.5 cm2. The sample of patients was taken from primary healthcare diabetic clinics in Palestine. Findings of the study showed several independent risk factors for developing DFUs, which were smoking, sensory loss to vibration, sensory loss to monofilament, loss of pedal pulse, presence of calluses, nephropathy, retinopathy, and neuropathy. Also, this study has shown that illiteracy and low income were significantly associated with DFU development. Moreover, the current study demonstrated that poor self-care behaviors were associated with DFU. The information gained from the study will contribute to raising awareness and improving health education for diabetic patients and their families with the aim of reducing the complications of diabetes.

Clinical and socio-demographic parameters contributing to treatment incompliance in Palestinian patients with diabetes.

BACKGROUND: This research study investigates the degree of medication-related satisfaction experienced by Palestinian patients with diabetes. In addition, this study further assesses the association between certain clinical and socio-demographic factors and the degree of satisfaction among the patients. METHODS: This cross-sectional, descriptive study design consisted of 415 randomly selected patients from the Palestine Medical Complex (PMC), the Palestinian Ministry of Health Clinics, and from the Palestinian Diabetes Institute (also known as: Al-Bireh Medical Center). The Diabetes Medication Satisfaction (DiabMedSat) questionnaire measured patients' satisfaction levels regarding their medications. RESULTS: Odds ratios from binomial logistic analysis and the analysis of variance determined statistically significant correlations. The analysis has displayed the presence of significant associations between clinical and socio-demographic factors and treatment satisfaction. Significance was determined at p values < 0.05 and p values < 0.01. CONCLUSION: This research identified statistically significant associations between certain clinical and socio-demographic factors and diabetic patients' satisfaction regarding their treatment. Addressing the concerns and difficulties experienced by the patients may impede treatment incompliance and hinder the development of complications, or at least postpone them.

Linkage disequilibrium interval mapping of quantitative trait loci.

BACKGROUND: For many years gene mapping studies have been performed through linkage analyses based on pedigree data. Recently, linkage disequilibrium methods based on unrelated individuals have been advocated as powerful tools to refine estimates of gene location. Many strategies have been proposed to deal with simply inherited disease traits. However, locating quantitative trait loci is statistically more challenging and considerable research is needed to provide robust and computationally efficient methods. RESULTS: Under a three-locus Wright-Fisher model, we derived approximate expressions for the expected haplotype frequencies in a population. We considered haplotypes comprising one trait locus and two flanking markers. Using these theoretical expressions, we built a likelihood-maximization method, called HAPim, for estimating the location of a quantitative trait locus. For each postulated position, the method only requires information from the two flanking markers. Over a wide range of simulation scenarios it was found to be more accurate than a two-marker composite likelihood method. It also performed as well as identity by descent methods, whilst being valuable in a wider range of populations. CONCLUSION: Our method makes efficient use of marker information, and can be valuable for fine mapping purposes. Its performance is increased if multiallelic markers are available. Several improvements can be developed to account for more complex evolution scenarios or provide robust confidence intervals for the location estimates.

Avaliação técnica do dispositivo de fechamento vascular Exoseal-Cordis / Technical evaluation of Exoseal-Cordis vascular closure device

Contexto: Os dispositivos de oclusão vascular (DOV) permitem rápida remoção da bainha introdutora de um acesso arterial, reduzindo o tempo de hemostasia, a restrição do paciente ao leito e as complicações no sítio de punção. Objetivos: Avaliar a eficácia e possíveis complicações do uso de dispositivo de oclusão arterial comparado com a compressão manual. Métodos: Estudo longitudinal prospectivo randomizado com 20 pacientes no período de dezembro de 2014 a julho de 2015 em Maringá (PR). Foram divididos em dois grupos: aqueles que utilizaram DOV (grupo DOV) e aqueles submetido apenas a compressão manual (grupo CM). Realizaram-se exames de ultrassom Doppler para avaliar a espessura pele-artéria pré e pós-procedimento e verificou-se o tempo de compressão e de deambulação. Os dados foram analisados pelo Programa Statistical Analysis Software. Resultados: Um total de 60% dos pacientes eram do sexo masculino e a média de idade de ambos os grupos foi de aproximadamente 60 anos. Não houve diferença na espessura pele-artéria entre os grupos. O tempo de compressão no grupo DOV foi de 2 minutos e no grupo CM foi de 21±2,11 minutos (p = 0,0005), e o tempo para retorno de movimentos no membro inferior puncionado foi de 2,35±0,75 horas no grupo DOV e de 6 horas no grupo CM (p = 0,0005). Não houve complicações. Conclusões: Neste estudo a hemostasia por compressão manual foi tão efetiva quanto o uso de DOV, embora o tempo de compressão e o tempo para retorno às atividades sejam menores nos pacientes submetidos ao uso do dispositivo

Background: Vascular closure devices (VCD) make it possible to rapidly remove the introducer sheath from an arterial access, thereby reducing the length of time in hemostasis, the time patients are restricted to their beds, and the number of puncture site complications. Objectives: To evaluate the efficacy and possible complications associated with use of an arterial occlusion device compared with manual compression. Methods: This was a prospective, randomized, longitudinal study of 20 patients conducted from December 2014 to July 2015 in Maringá, PR, Brazil. They were divided into two groups: those who were treated using a VCD (VCD group) and those for whom only manual compression was used (MC group). Doppler ultrasound examination was used to determine skin-artery depth before and after the procedure and the length of time compression was maintained and the delay before mobilization were also recorded. Data were analyzed using the program Statistical Analysis Software. Results: A total of 60% of the patients were male and the mean age of both groups was approximately 60 years. There was no difference in skin-artery depth between the groups. The duration of compression in the VCD group was 2 minutes and in the MC group it was 21±2.11 minutes (p = 0.0005), while the delay before return to mobility of the lower limb that had been punctured was 2.35±0.75 hours in the VCD group and 6 hours in the MC group (p = 0.0005). There were no complications. Conclusions: In this study, hemostasis by manual compression exhibited equal efficacy to use of a VCD, but the duration of compression and delay before resumption of activity were shorter in the patients for whom the device was employed

Detecting selection in population trees: the Lewontin and Krakauer test extended.

Detecting genetic signatures of selection is of great interest for many research issues. Common approaches to separate selective from neutral processes focus on the variance of F(ST) across loci, as does the original Lewontin and Krakauer (LK) test. Modern developments aim to minimize the false positive rate and to increase the power, by accounting for complex demographic structures. Another stimulating goal is to develop straightforward parametric and computationally tractable tests to deal with massive SNP data sets. Here, we propose an extension of the original LK statistic (T(LK)), named T(F-LK), that uses a phylogenetic estimation of the population's kinship (F) matrix, thus accounting for historical branching and heterogeneity of genetic drift. Using forward simulations of single-nucleotide polymorphisms (SNPs) data under neutrality and selection, we confirm the relative robustness of the LK statistic (T(LK)) to complex demographic history but we show that T(F-LK) is more powerful in most cases. This new statistic outperforms also a multinomial-Dirichlet-based model [estimation with Markov chain Monte Carlo (MCMC)], when historical branching occurs. Overall, T(F-LK) detects 15-35% more selected SNPs than T(LK) for low type I errors (P < 0.001). Also, simulations show that T(LK) and T(F-LK) follow a chi-square distribution provided the ancestral allele frequencies are not too extreme, suggesting the possible use of the chi-square distribution for evaluating significance. The empirical distribution of T(F-LK) can be derived using simulations conditioned on the estimated F matrix. We apply this new test to pig breeds SNP data and pinpoint outliers using T(F-LK), otherwise undetected using the less powerful T(LK) statistic. This new test represents one solution for compromise between advanced SNP genetic data acquisition and outlier analyses.

Linkage disequilibrium fine mapping of quantitative trait loci: a simulation study.

Recently, the use of linkage disequilibrium (LD) to locate genes which affect quantitative traits (QTL) has received an increasing interest, but the plausibility of fine mapping using linkage disequilibrium techniques for QTL has not been well studied. The main objectives of this work were to (1) measure the extent and pattern of LD between a putative QTL and nearby markers in finite populations and (2) investigate the usefulness of LD in fine mapping QTL in simulated populations using a dense map of multiallelic or biallelic marker loci. The test of association between a marker and QTL and the power of the test were calculated based on single-marker regression analysis. The results show the presence of substantial linkage disequilibrium with closely linked marker loci after 100 to 200 generations of random mating. Although the power to test the association with a frequent QTL of large effect was satisfactory, the power was low for the QTL with a small effect and/or low frequency. More powerful, multi-locus methods may be required to map low frequent QTL with small genetic effects, as well as combining both linkage and linkage disequilibrium information. The results also showed that multiallelic markers are more useful than biallelic markers to detect linkage disequilibrium and association at an equal distance.

A comparison between methods for linkage disequilibrium fine mapping of quantitative trait loci.

We present a maximum likelihood method for mapping quantitative trait loci that uses linkage disequilibrium information from single and multiple markers. We made paired comparisons between analyses using a single marker, two markers and six markers. We also compared the method to single marker regression analysis under several scenarios using simulated data. In general, our method outperformed regression (smaller mean square error and confidence intervals of location estimate) for quantitative trait loci with dominance effects. In addition, the method provides estimates of the frequency and additive and dominance effects of the quantitative trait locus.