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Aberrant responding poses a significant challenge in measurement and validity, often distorting well-established relationships between psychological and educational constructs. This study examines how aberrant response patterns influence the relationship between student–teacher relations and students’ perceptions of school safety. Using data from 6617 students from the Saudi Arabia Kingdom from the 2022 Programme for International Student Assessment (PISA), we employed the cusp catastrophe model to evaluate the nonlinear dynamics introduced by aberrant responses, as measured by the U3 person-fit index and the number of Guttman errors. Theoretical and empirical support for the cusp model suggests that aberrance functions as a bifurcation parameter, shifting the relationship between student–teacher relations and perceived school safety from predictable linearity to chaotic instability when exceeding a critical threshold in aberrant responding. Results indicate that both the U3 index and the number of Guttman errors significantly contribute to response distortions, confirming the cusp model’s superiority over traditional linear and logistic alternatives. These findings suggest that ignoring aberrant responding risks misinterpreting data structures, while properly accounting for it through catastrophe models provides a more nuanced understanding of nonlinear system behavior in educational assessment. The study highlights the importance of person-fit statistics in psychometric evaluations and reinforces the predictive utility of nonlinear models in handling response distortions in large-scale assessments.

The present study predicts teacher burnout from previous experiences, efficacious beliefs, student achievement, and parental engagement. Data came from the Trends in International Mathematics and Science study (TIMSS 2019) and utilized a random sample of n = 2000 from the Kingdom of Saudi Arabia. It was hypothesized that parental engagement and involvement in school may represent a salient factor in understanding teacher burnout in that if parental disengagement is high, necessary supports and resources available to the teacher are withdrawn. This thesis was tested using the cusp catastrophe with linear negative predictors of teacher burnout being teacher satisfaction, years of experience, teacher efficacy, and student achievement. The role of parental disengagement was verified with critically low levels of parental engagement being associated with abrupt and unpredictable levels of teacher burnout. It is concluded that parental engagement and involvement in schools may provide critical supports that are necessary for teachers to successfully manage their workload.

The purpose of the present study was to evaluate the factorial structure of the bullying scale on the Trends in International Mathematics and Science (TIMSS 2019) for eighth graders and evaluate the instrument’s invariance across gender so that tests of level between males and females can be conducted. Data came from the 2019 cohort of TIMSS in Saudi Arabia. The 14-item scale was evaluated using three competing models: (a) a unidimensional structure, (b) the International Association for the Evaluation of Educational Achievement (IEA) online, non-online two-factor model, and (c) the Wang et al. (2012) 4-domain bullying taxonomy. Participants were 5567 eighth graders who participated in the 2019 TIMSS study. There were 2856 females and 2711 males. The mean age was 13.9 years. Data were analyzed using Confirmatory Factor Analysis (CFA) and Mplus 8.9. Results indicated that a 4-domain structure including verbal, physical, relational, and online bullying represented the most optimal factor structure of the 14-item bullying measure. Tests of exact measurement invariance for gender originally failed but were then satisfied using the newly recommended “alignment” methodology. Latent mean differences were salient and significant suggesting that levels of bullying across all domains were elevated in males compared to females, contrasting earlier views that different types of bullying are linked to males versus females. Results are discussed in relation to educational policy interventions.

The purpose of the present study was to profile bullying behaviors in elementary schools in Saudi Arabia. A secondary purpose was to examine differences in bullying behaviors across gender. Participants were 3867 fourth graders who completed surveys during the TIMSS 2019 survey. An 11-item bullying experience scale was utilized with good internal consistency reliability. Data were analyzed using latent class analysis with Mplus 8.9 to identify profiles of bullying experiences. The results indicated the presence of five profiles with levels of low, medium, and high bullying experiences, as well as two profiles with no cyberbullying experiences and medium high and medium low physical and verbal instances of bullying. Gender effects were highly pronounced, with most maladaptive bullying profiles being predominantly male. It is concluded that physical bullying is mainly occupied by males and the levels of cyberbullying are generally low in the elementary school grades. Implications for educational policy can clearly direct the development of support groups and expert counseling for both bullies and victims, staff training for identification and course of action, and the development of standardized school policies when such incidences occur.

Bronchogenic cysts are considered rare airway anomalies that can have a significant impact on the well-being of infants. In this case report, we present a rare presentation of bronchogenic cyst presenting with early neonatal respiratory distress due to airway and vascular compression. Surgical excision was curative with an excellent prognosis.

Background Truncus arteriosus (TA) is characterised by failure of septation of the outflow tract into aortic and pulmonary trunks and is associated with high morbidity and mortality. Although ranked among the least common congenital heart defects, TA provides an excellent model for the role of individual genes in cardiac morphogenesis as exemplified by TBX1 deficiency caused by point mutations or, more commonly, hemizygosity as part of the 22q11.2 deletion syndrome. The latter genetic lesion, however, is only observed in a proportion of patients with TA, which suggests the presence of additional disease genes. Objective To identify novel genes that cause Mendelian forms of TA. Methods and results We exploited the occurrence of monogenic forms of TA in the Saudi population, which is characterised by high consanguinity, a feature conducive to the occurrence of Mendelian phenocopies of complex phenotypes as we and others have shown. Indeed, we demonstrate in two multiplex consanguineous families that we are able to map TA to regions of autozygosity in which whole-exome sequencing revealed homozygous truncating mutations in PRKD1 (encoding a kinase derepressor of MAF2) and NRP1 (encoding a coreceptor of vascular endothelial growth factor (VEGFA)). Previous work has demonstrated that Prkd1−/− is embryonic lethal and that its tissue-specific deletion results in abnormal heart remodelling, whereas Nrp1−/− develops TA. Surprisingly, molecular karyotyping to exclude 22q11.2 deletion syndrome in the replication cohort of 17 simplex TA cases revealed a de novo hemizygous deletion that encompasses PRDM1, deficiency of which also results in TA phenotype in mouse. Conclusions Our results expand the repertoire of molecular lesions in chromatin remodelling and transcription factors that are implicated in the pathogenesis of congenital heart disease in humans and attest to the power of monogenic forms of congenital heart diseases as a complementary approach to dissect the genetics of these complex phenotypes.

Fungal endocarditis (FE) accounts for ~50% of the mortality rate associated with predisposing host conditions. Despite optimal therapeutic strategies, the survival rate remains low. FE is mostly caused by Candida albicans and Aspergillus fumigatus. Previous valvular surgery is the most essential risk factor for Aspergillus endocarditis, which observed in 40–50% of cases. However, native valve FE caused by Aspergillus is uncommon, with only a few reported cases. We hereby report a case of native valve FE caused by A. fumigatus with complications following Wegener’s disease and prostate cancer. The patient survived after successful management with the combination of surgical and medical therapy. Aspergillus endocarditis is a rare and fatal fungal infection. Despite difficulties in diagnosis and treatment, medical intervention with antifungal therapy and immediate surgical intervention are essential to achieve desirable outcomes.

Introduction Demand for urgent care is increasing, and the pressure on emergency departments (EDs) is of significant concern. Demand growth is to some extent due to the over-utilization of EDs by patients who seek care for non-urgent problems. It has been estimated that up to one-third of all ED visits are non-emergent. In EDs, patients with non-urgent problems are blamed for increased demand, even though most of the patients' reasons for attending EDs are not well studied. The aim of this study is primarily to determine the factors that influence the decision of patients to visit EDs instead of their primary care physician for non-urgent problems. Secondary aim of this study is to assess the level of ED knowledge among the participants.  Methods This is a descriptive, cross-sectional study following a convenient sampling technique conducted through an online questionnaire distributed to the population in Saudi Arabia (SA). The data, which includes sociodemographic data, ER knowledge, the correct definition of ED, cases that ED deals with, and reasons for visiting an ED over a primary health care center (PHC), were collected during August and September 2021. Results Of the 915 respondents, the most common age group was 25 years old or less (34.4%) and the majority were females (68.3%). It was observed that slightly more respondents preferred to visit a PHC (50.4%) while 49.6% preferred to visit EDs when having a medical condition. The proportion of respondents who would visit a PHC was 90.9%, and 36.6% indicated having good experiences there. The overall mean knowledge score was 4.63 (standard deviation [SD] 1.51) out of 6 points, with low, moderate, and high knowledge classified among 12.9%, 22.4%, and 64.7% of respondents, respectively. The five most reported reasons for choosing the ER as the preferred clinic over a PHC were: (1) ED provided quick medical care, (2) easy access to emergency care, (3) unavailability of appointments at a PHC center on the same day, (4) lack of full investigation at the PHC center, (5) lack of primary care providers at the PHC. The least reported reason was advice from another person to visit the emergency department. It was found that a significantly low knowledge was demonstrated by the over 45-years age group (p <0.001) and those who were unemployed (p = 0.018). Conclusion This study showed that 49.6% would prefer to visit the ED. It demonstrated the reasons for choosing the ED over a PHC, with the most reported reason being that the ED provides quick medical service, while the least reported reason was advice from another person to visit the ED. For the correct utilization of EDs, it is recommended to increase the knowledge and awareness level of the general population through public campaigns and awareness videos on social media applications.

Introduction Despite the overwhelming amount of evidence against the use of aspirin for primary prophylaxis of cardiovascular disease (CVD), the arguably unwarranted use of aspirin has increased over the years, which may or may not be based on any specific medical advice, and merely self-prescribed. Aim This study aimed to determine the prevalence of unwarranted aspirin use among moderate-risk individuals for the primary prevention of adverse vascular events in Saudi Arabia. Patient and method A cross-sectional study was conducted among 100 patients who presented to the emergency room (ER) due to suspected cardiac diseases. The data were collected from the patients who visited ER in King Fahad Hospital, Al-Hofuf, Saudi Arabia. Participants were asked about their socio-demographic characteristics, aspirin use habits, and their comorbidities. Results Of the 100 patients, 35% were aged more than 60 years old. The overall use of aspirin was 78%. The prevalence of aspirin use was significantly more common among the older age group (53.8%), those with associated chronic diseases, such as diabetes (59%) and hypertension (75.6%) and those with a previous history of hospitalization due to stroke or a cardiac event (66.7%). Conclusion The use of aspirin among patients who are at moderate risk of cardiovascular events was widely prevalent, but their unwarranted use was low. Older patients with chronic diseases who believed in its great benefit and tended to ignore its complications are the most common users of aspirin. More research is recommended to determine the prevalence and the factors associated with unwarranted use of aspirin in patients with CVD in our region.

Background In patients with transposition of the great arteries (TGA), commissural malalignment (CM) between semilunar valves may be associated with abnormal coronary (CA) pattern. We intend to assess the degree of CM with incidence of unusual CA anatomy. Methods We proposed a ratio to measure the distance of both ends of the anterior facing sinuses of the pulmonary valve from the facing commissure of the aortic valve. We labeled it as D1 and D2 distance. A ratio (C ratio) of the smaller distance (either D1 or D2 whichever is shorter) over the sum of both D1 and D2 was taken (D1 or D2 whichever is shorter / D1 + D2). We related this ratio with the incidence of the unusual CA anatomy in D-TGA patients. Results We had a total of 158 patients. We defined the point beyond which the C-Ratio becomes significantly associated with abnormal coronary artery pattern, this represents the median effective level (EL50). The EL50 of the C-Ratio was found to be equal to 31% (0.31). The prediction revealed that the CA pattern would most probably be usual when there is a minor commissural malalignment (C-Ratio less than the EL50) and most probably be unusual when there is a major malalignment (C-Ratio is greater than the EL50). The sensitivity was 71% and the specificity 88% ( p -value < 0.0001). Conclusions The C-Ratio helps to categorize the degree of CM as minor (less than 0.31) or major (more than 0.31). A higher C-Ratio predicts a higher incidence of unusual CA pattern.