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The adoption of laparoscopic surgery has significantly transformed surgical practice. However, mastering these techniques requires specialized training. In Saudi Arabia, the level of proficiency in laparoscopic skills among General Surgery (GS) trainees is not well-documented. This study aims to assess GS residents' satisfaction with their laparoscopic training, self-appraise their proficiency, and objectively evaluate their skills using the Fundamentals of Laparoscopic Surgery (FLS) test. This cross-sectional study, approved by the Institutional Review Board and funded by Alfaisal University, took place between October 2021 and May 2023. It involved a two-part approach: an online survey and objective FLS testing. The survey, distributed to GS residents in seven government hospitals in Riyadh, captured self-reported satisfaction and subjective proficiency data. Subsequently, residents who volunteered for FLS testing were objectively assessed using standardized criteria. Of 195 residents, 70 (36%) responded to the survey. Satisfaction with academic teaching and hands-on training in laparoscopic surgery was low (24% and 44%, respectively), while 62% were satisfied with case volume. Self-assessed proficiency was higher for basic skills than for advanced skills like extra-corporeal and intracorporeal knotting. Only a third had been exposed to laparoscopic trainers, and 14.3% had FLS certification prior. Fourteen residents participated in FLS testing, revealing a 36% failure rate in task completion. Prior simulation practice or laparoscopic training certification significantly improved performance (p<0.001), reflected by achieving higher scores and passing FLS proficiency scores. Despite satisfaction with exposure to laparoscopic surgeries, the study highlights a considerable gap in satisfaction and proficiency among GS residents in Saudi Arabia, particularly in advanced laparoscopic skills. The positive impact of simulation-based practice and laparoscopic training certification underscores the need for structured training programs. Addressing these gaps, through integrating comprehensive simulation-based programs and promoting laparoscopic skill certification, is crucial for enhancing surgical education and training outcomes.

Purpose The purpose of this paper is to offer insights into the development of eLearning systems and the perceptions of key players in the management of eLearning systems in three large universities in Saudi Arabia. It establishes the relative importance of different factors and compares these findings with studies conducted elsewhere in the world. Design/methodology/approach Desk research was conducted to gather a profile of the eLearning initiatives in the participating universities. Structured interviews were conducted with senior managers with responsibility for implementing and promoting eLearning in their universities. The interview protocol prompted discussion of the importance of the following sets of factors in the success and acceptance of eLearning: student characteristics, instructor characteristics, learning environment, instructional design, and support. Interviews were transcribed and analysed using thematic analysis. Findings Supported by the Saudi Government, the three universities in this study have been developing their eLearning services. The two most important groups of critical success factors in this process were regarded as those related to student and instructor characteristics. Further analysis within each group of factors suggested that participants regarded instructor knowledge with learning technologies and student knowledge of computer systems, and technical infrastructure as important facilitators of success. Amongst instructional design factors, clarity of learning objectives and content quality were regarded as important. Insights are offered as to the reasons for these selections. Originality/value This study furthers earlier research on eLearning managers’ views and contributes to understanding of eLearning and its management in the Middle East.

The aim of this study is to examine, for the first time, the mental health literacy of the Saudi general population. Additionally, we aim to identify demographic factors associated with elevated mental health literacy scores. A cross-sectional study using a phone interview survey with quota sampling was conducted for equal distribution of sexes, age and administrative regions. Mental health literacy was assessed by the previously validated mental health literacy scale (MHLS). The MHLS ranges from 35 to 160, and a higher score indicates greater level of mental health literacy. In this study, 4,547 (70.2%) agreed to complete the interview. The sample was equally distributed across Saudi Arabia's 13 administrative regions with 50.1% female and mean age 35.9 (SD: ±12.8). In terms of education, 55.1% have a bachelor's degree or above. The nationally weighted score on the original MHLS was 110.75. the MHLS Saudi validation score was influenced by various variables including: marital status, healthcare-related job, sex, education level, and proximity to individuals with mental health issues. The study offers data for the first time on Saudi Arabian mental health literacy status. The high MHLS score reflects good societal awareness and understanding of mental health related concepts and issues in the Saudi population. The results of this study set the baseline for mental health literacy in Saudi Arabia. Future research may focus on utilizing the validated MHLS and the method used in this study to explore the effect of other social and individual factors on mental health literacy.

Intraluminal thrombus (ILT) of the cervical arteries is an uncommon finding that can lead to acute or recurrent ischemic stroke. Currently, antithrombotic therapy in the form of antiplatelet and/or anticoagulation is considered the mainstay of treatment, but evidence of which one has a better outcome is lacking. A retrospective cohort study included 28 patients diagnosed with acute stroke or transient ischemic attack with ILT of the extracranial arteries from 2013 to 2022. The primary efficacy outcome was assessed as recurrent stroke, and the primary safety outcome was assessed as hemorrhagic complications. Secondary outcomes were assessed as the resolution of thrombi by CT angiography (CTA) and clinical improvement by the Modified Rankin Scale (mRS) and NIH Stroke Scale (NIHSS). Out of 28 patients, more than half (57.1%; n = 16) were males with a mean age of 57.8 ± 9.5 years and an average BMI of 26.9 ± 4.5 kg/m2. As initial treatment, twenty-four patients received anticoagulation and four received antiplatelet agents. Recurrent strokes were found in four patients (14.29%), and all were initially treated with anticoagulation. One patient in the anticoagulation group had a significant retroperitoneal hemorrhage. None of the patients in the antiplatelets group had a recurrent stroke or bleeding event. Initial treatment with antiplatelet agents significantly improved the NIHSS on day 7 (P = 0.017). A significant improvement in NIHSS on day 90 was observed in the anticoagulant group (P = 0.011). In the follow-up CTA performed on 24 patients, 18 (75%) showed complete resolution (3 out of 3 (100%) in the antiplatelet group and 15 out of 21 (71.43%) in the anticoagulant group). Initial treatment with anticoagulants improves neurologic outcomes in patients with ILT-induced acute ischemic stroke but carries the risk of recurrent stroke and bleeding. However, initial treatment with dual antiplatelet agents appears to have comparable efficacy without sequelae, particularly in atherosclerosis-induced ILT.

To assess the efficacy and safety of Dipeptidyl Peptidase IV (DPP-4) inhibitors in patients with Type-2 Diabetes Mellitus (T2DM) and chronic kidney disease (CKD) using level 1 evidence. The Cochrane and PubMed databases were searched from inception until January 1, 2022. RCTs that studied the efficacy and safety of DPP-4 inhibitors in diabetic patients with CKD were included. The primary efficacy outcome was assessed as the mean difference between HbA1c at the beginning and the end of each study for each arm, and the primary safety outcome was assessed as the incidence of adverse events and severe adverse events in each study. Twenty-one studies satisfied the pre-defined eligibility criteria. In assessing the efficacy of DPP-4 inhibitors in the treatment of T2DM and CKD, a total of 2917 patients under the DPP-4 inhibitors group and 2377 patients under the control group were included; The mean difference between the HbA1c of DPP-4 Inhibitor and the control group was -0.5295 with a 95% CI of -0.5337 to -0.5252. The included studies had high heterogeneity p < 0.00001 and I = 99%. In assessing the safety outcome and tolerability of DPP-4 inhibitors, a total of 8138 patients under the DPP-4 inhibitors group and 7517 patients under the control group were included; the odds ratio of adverse events between both groups was 0.9967 with a 95% CI of 0.9967 to 1.1047. The included studies had low heterogeneity p = 0.25 and I = 15%. The overall effect, Z = 0.06 (p = 0.95), was insignificant. Patients suffering from both T2DM and CKD exhibited a significantly enhanced glycemic control when treated with DPP-4 inhibitors in comparison to the control group. Furthermore, no significant difference in the incidence of adverse events was observed between the DPP-4 inhibitors and the control group.

This study investigates the impact of outliers on the evolution of clusters in temporal data-sets. Monitoring and tracing cluster transitions of temporal data sets allow us to observe how clusters evolve and change over time. By tracking the movement of data points between clusters, we can gain insights into the underlying patterns, trends, and dynamics of the data. This understanding is essential for making informed decisions and drawing meaningful conclusions from the clustering results. Cluster evolution refers to the changes that occur in the clustering results over time due to the arrival of new data points. The changes in cluster solutions are classified as external and internal transitions. The study employs the survival ratio and history cost function to investigate the effects of outliers on changes experienced by the clusters at successive time points. The results demonstrate that outliers have a significant impact on cluster evolution, and appropriate outlier handling techniques are necessary to obtain reliable clustering results. The findings of this study provide useful insights for practitioners and researchers in the field of stream clustering and can help guide the development of more robust and accurate stream clustering algorithms.

Featuring key topics within finance, small business management, and entrepreneurship to develop and maintain prosperous business ventures With a comprehensive and organized approach to fundamental financial theories, tools, and management techniques, Entrepreneurial Finance: Fundamentals of Financial Planning and Management for Small Business equips readers with the necessary fundamental knowledge and advanced skills to succeed in small firm and business settings. With a unique combination of topics from finance, small business management, and entrepreneurship, the book prepares readers for the challenges of today's economy. Entrepreneurial Finance: Fundamentals of Financial Planning and Management for Small Business begins with key concepts of small business management and entrepreneurship, including management tools and techniques needed to establish, run, and lead business ventures. The book then delves into how small businesses are operated, managed, and controlled. General finance skills and methods are integrated throughout, and the book also features: * Numerous practical examples and scenarios that provide a real-world perspective on entrepreneurship and small business management * A brief summary, list of key concepts, and ten discussion questions at the end of each chapter to prepare readers for the challenges of today's economy * A practical guide to the complete life of a small business, from establishing a new venture to training and developing young entrepreneurs tasked with maintaining and developing a prosperous economy * An in-depth discussion of the entire process of writing a successful business plan, including the rationale, significance, and requirements * Techniques needed to solidify the free enterprise tradition, develop entrepreneurial strategies, and grow small businesses Entrepreneurial Finance: Fundamentals of Financial Planning and Management for Small Business is an ideal textbook for upper-undergraduate and first-year graduate courses in entrepreneurial finance within business, economics, management science, and public administration departments. The book is also useful for MBA-level courses as well as for business and management PhD majors as a resource in methodology. The book is also an idea reference for entrepreneurs, business managers, market analysts, and decision makers who require information about the theoretical and quantitative aspects of entrepreneurial finance.

Any airconditioned zone must be thermally insulated from its surroundings to maintain the desired temperature. Thermal insulators thus play a significant role in reducing heat transfer between airconditioned areas and their surroundings to save energy. Thermal insulators are usually made from materials with low thermal conductivity, and to reduce the cost of such insulators, this study investigated the use of waste organic materials as thermal insulators. This study is the second part of a project that aims to achieve an optimised insulator from both the thermal and economic perspectives. To achieve this, the heat conductivity of five different samples made from hair, grass, date seed, and date palm fibre were examined. The all samples were made with industrial white glue as a binder. The heat flow method was employed to determine their thermal conductivity, with results that showed that all samples offered thermal resistance to heat transfer in the range 0.0530 to 0.1068 W/mK. The best thermal resistance was provided by the sample made from hair and fibres. The current study supports sustainability by encouraging the use of waste organic materials in thermal insulators.

Bisoprolol and nebivolol are highly selective β 1 -adrenoceptor antagonists, with clinical indications in many countries within the management of heart failure with reduced left ventricular ejection fraction (HFrEF), ischaemic heart disease (IHD), and hypertension. Nebivolol has additional vasodilator actions, related to enhanced release of NO in the vascular wall. In principle, this additional mechanism compared with bisoprolol might lead to more potent vasodilatation, which in turn might influence the effectiveness of nebivolol in the management of HFrEF, IHD and hypertension. In this article, we review the therapeutic properties of bisoprolol and nebivolol, as representatives of “second generation” and “third generation” β-blockers, respectively. Although head-to-head trials are largely lacking, there is no clear indication from published studies of an additional effect of nebivolol on clinical outcomes in patients with HFrEF or the magnitude of reductions of BP in patients with hypertension.

The aim of this study was to show whether blocking the deleterious effects of neurohormonal activation from furosemide by the use of ACEI/ARBs, or the improvement of renal perfusion by using these drugs allows better diuresis and renal function preservation. This is a prospective, randomized study in which patients with chronic heart failure were included. Patients admitted for ACEI/ARBs maintenance with acute decompensated HF were added in the study. The patients were divided into two groups: group 1 had ACEI/ARBs continued during admission and group 2 had stopped taking them. Patients with acute heart failure were provided with angiotensin II receptor blockers. Therefore, the present study aims to differentiate between the uses of ACEI/ARBs blocking the deleterious effects of neurohormonal activation or the improvement of renal perfusion by holding these drugs to allow better diuresis and renal function preservation in a young population. The results showed that the mean age of 32 patients of group 1 was 58±15.3 and for group 2 56±15.6. On day of analysis, BP was 113/65±11.9/6.5 and 108/66.9±14.1/9.8, weight was 68.4±19.8 kg and 73.7±20.2 kg, net volume balance of urine output was 2810.3±1011.8 mL and 3941.7±2849.7 mL, and length of stay was 11.75±6 and 7.9±3.7 days for groups 1 and 2, respectively. There was no significant difference in SBP ( =0.2926), DBP ( =0.7369), weight ( =0.4798), glomerular filtration rate (GFR) ( =0.7), and volume balance ( =0.166). However, there was statistically significant difference in length of hospital stay ( =0.0392). The study concluded that continuing ACEI/ARBs or holding them during IV diuresis had no difference in the effect on kidney function or diuresis. Length of stay appears to be shorter for those who held their ACEI/ARBs.