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This study delves into the complex prioritization process for Autism Spectrum Disorder (ASD), focusing on triaged patients at three urgency levels. Establishing a dynamic prioritization solution is challenging for resolving conflicts or trade-offs among ASD criteria. This research employs fuzzy multi-criteria decision making (MCDM) theory across four methodological phases. In the first phase, the study identifies a triaged ASD dataset, considering 19 critical medical and sociodemographic criteria for the three ASD levels. The second phase introduces a new Decision Matrix (DM) designed to manage the prioritization process effectively. The third phase focuses on the new extension of Fuzzy-Weighted Zero-Inconsistency (FWZIC) to construct the criteria weights using Single-Valued Neutrosophic 2-tuple Linguistic (SVN2TL). The fourth phase formulates the Multi-Attributive Border Approximation Area Comparison (MABAC) method to rank patients within each urgency level. Results from the SVN2TL-FWZIC weights offer significant insights, including the higher criteria values \"C12 = Laughing for no reason\" and \"C16 = Notice the sound of the bell\" with 0.097358 and 0.083832, indicating their significance in identifying potential ASD symptoms. The SVN2TL-FWZIC weights offer the base for prioritizing the three triage levels using MABAC, encompassing medical and behavioral dimensions. The methodology undergoes rigorous evaluation through sensitivity analysis scenarios, confirming the consistency of the prioritization results with critical analysis points. The methodology compares with three benchmark studies, using four distinct points, and achieves a remarkable 100% congruence with these prior investigations. The implications of this study are far-reaching, offering a valuable guide for clinical psychologists in prioritizing complex cases of ASD patients.

The study aimed to investigate the effect of job satisfaction on the productivity of paramedics working for the Saudi Red Crescent Authority in the Makkah region. To achieve the study's objectives, a descriptive-analytical method was employed. The study population consisted of all employees of the Saudi Red Crescent Authority in the Makkah region, and the sample included 310 employees. A questionnaire was used as the primary tool for data collection. The study revealed several key findings, most notably: The productivity variable demonstrated a high level of commitment among respondents, with an average score of 4.33 and a standard deviation of 0.54. The statement \"I am committed to following the policies and procedures adopted by the Saudi Red Crescent Authority\" ranked first with a mean of 4.52, reflecting a strong adherence to organizational guidelines. Conversely, the statement \"I am always ready to work outside of regular hours when needed\" received the lowest score (mean = 3.32), suggesting a lower willingness to work beyond regular hours, possibly due to concerns related to work-life balance. The independent variable (job satisfaction) accounted for 7.7% of the variance in the dependent variable (level of productivity), as indicated by the adjusted coefficient of determination (Adj. R² = 0.077). The overall effect of the independent variable (job satisfaction) on the dependent variable (level of productivity) was statistically significant (F = 26.895, Sig. = 0.000). Furthermore, the analysis showed that job satisfaction had a significant impact on productivity (ß = 0.225, t-value = 5.186, Sig. = 0.000). Based on these findings, the null hypothesis was rejected, and the alternative hypothesis was accepted, confirming that there is a statistically significant relationship between job satisfaction and productivity among paramedics in the Saudi Red Crescent Authority in the Makkah region. The study recommends the following: The Saudi Red Crescent Authority should increase the availability of scientific courses, workshops, and conferences to address the need for ongoing professional development. This will help paramedics feel more engaged and valued, potentially enhancing job satisfaction and productivity. Review and adjust working hours to better align with paramedics' needs for work-life balance. Implementing flexible scheduling or additional rest periods could reduce fatigue and improve overall job satisfaction. Reevaluate the current salary and allowance structures, particularly the infection allowance, to ensure they are competitive and reflective of the risks and responsibilities associated with the job. Consider implementing additional financial incentives or bonuses for paramedics who consistently demonstrate high productivity or work in high-risk environments.

Recent reconnaissance geochemical investigations have unveiled Cryogenian magmatism linked to the compressional accretionary phase, contributing to the growth of the Afif Terrane in the eastern Arabian Shield. The Cryogenian Suwaj intrusive suite, within the Afif Terrane, displays a compositional range from gabbro-diorite to tonalite-granodiorite. The uniform compositional variation is primarily due to magmatic differentiation within parental magma across multiple pulses. The I-type calc-alkaline Suwaj granitoids represent arc-related juvenile materials resulting from the partial melting of a metabasaltic source. The geochemical characteristics of the Suwaj granitoids suggest typical adakite formation resulting from the melting of the basaltic portion of the young, hot oceanic slab. The age correlation between the Halaban ophiolite and the Suwaj Suite aligns with adakite formation in convergent margins. Tectonically, the Suwaj suite’s origin is attributed to the subduction of the Paleo-Ad-Dawadmi oceanic slab during microplate amalgamation, reflecting an integral part of the Arabian-Nubian Shield’s evolution, underscoring crustal thickening after arc collision.

Using integrated Interferometric Synthetic Aperture Radar (InSAR) datasets (Envisat: 2003–2009; Sentinel-1: 2014–2018), local gravity surveys, and passive seismic data, we investigated the environmental hazards associated with the rise of the Miocene Jazan salt diapir (JZD; ~ 2 km2) within Jazan city, Saudi Arabia, and identified areas at risk in its immediate surroundings. Our findings include (1) the JZD outcrop and its northern, southern and western bordering areas have been undergoing substantial uplift (up to 4.7 mm/yr), whereas the sabkhas to the east are witnessing subsidence (up to − 7.5 mm/yr); (2) a low Bouguer anomaly (7.5 mGal) was observed over the JZD relative to its surroundings (8.5–12 mGal) with the steepest gradient along its eastern side; (3) strong and clear horizontal/vertical (H/V) spectral ratio peak and high frequency (5–10 Hz) over the JZD outcrop and areas proximal to its western margin, but areas to the east have a weak H/V peak and low frequency (1.5-3 Hz); (4) drilling confirmed presence of a shallow (4 m) salt bedrock layer west of the JZD and the absence of this layer to its east (up to depths of 60 m); (5) uplift patterns along the diapir margins are indicative of near-vertical contact along the JZD eastern margin and less steep contacts along the remaining margins; and (6) additional near-surface diapirs could potentially be identified in the vicinity of the JZD using our integrated approach.

Cervical facet dislocation is a serious injury that carries risks of short- and long-term morbidity. The optimal management of these injuries remains controversial with the ongoing debate regarding indications and requirements for closed reduction, timing, type of surgical approach and method of fixation. This review gives an update on the relevant anatomy, classification systems for sub-axial cervical facet dislocation and an overview of the current concepts regarding their management, including surgical approaches and the choice of implants.

Background and objectiveFractures of the proximal interphalangeal joint (PIPJ) of the hand have always been difficult to treat, often leading to less than satisfactory outcomes. The use of dynamic external fixator devices to treat these fractures is well established and it is based on the philosophy of minimal soft tissue injury and early joint mobilization. There has been a wide variety in their designs, surgical technique, and reported outcomes. This study aimed to report the long-term outcome following the use of the Ligamentotaxor® device (Ligamentotaxor1, ArexTM, Palaiseau, France) in treating fractures of the PIPJ of the hand.MethodsBetween 2009 and 2018, 33 patients treated in our institution with Ligamentotaxor® for fractures of the PIPJ were followed up for a minimum period of 12 months. Radiographs and clinical records were reviewed for clinical and functional outcomes including finger range of motion (ROM), union, Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) score, and any complications.ResultsA total of 33 patients completed a minimum follow-up of 12 months (mean: 27.5 months). All fractures showed radiological union at a mean of 33 days. Surgery was performed within a mean of 8.9 days and surgical operating time averaged 23.7 minutes. Devices were removed at a mean of 33 days. At the end of the follow-up, the mean range of flexion was 66 degrees and the mean extension lag was six degrees. The mean QuickDASH score was 8.72. Of note, 85% of the patients experienced no limitations in their daily activities, while 35% reported pain on exertion. One patient had a pin tract infection. Four patients had cold intolerance and persistent swelling.ConclusionThe results of the use of Ligamentotaxor® in this series are comparable to those of other dynamic external fixator devices reported in the literature. Thanks to its quick and easy surgical technique, the device provides an appealing option for the management of PIPJ fractures.

BackgroundHealthcare systems can never work without nurses being the cornerstone of it, and they are the front line to face the horses to confront with complex ethical dilemmas. Ethical standards standing is integral to nursing practice due to the patient’s own character preservation, commitment to the patient’s autonomy, and equitable access to genuine care. This study investigates the role that nurses have in maintaining ethical practice, the challenges they encounter in ethical practice in healthcare settings, and the ways of improving ethical practice.MethodsThis was a mixed-method study that involved a literature review and qualitative interviews with 25 practicing nurses. These were analyzed using thematic analysis to identify recurring ethical responsibilities, challenges, and strategies.ResultsThe core ethical responsibilities of respect for autonomy (92%), confidentiality (89%), and patient advocacy (85%) all played a central part in relation to role practices. High prevalence of resource constraints, where 72% of partakers agreed because 57% acknowledge the existence of barriers and 34% agree to the presence of resource constraints; organizational pressures, where 68% of partakers agreed because 51% acknowledge barriers and 46% agree to the presence of organizational pressures; cultural conflicts where 60% of partakers agreed because 45% acknowledge barriers and 35% agree on the presence of cultural conflicts were prevalent. Effective communication, continuous ethics education, and organizational support were some of these strategies.ConclusionThe ethical challenge of maintaining ethical standards in healthcare is played by nurses. Being able to address barriers through education and systemic support can also help nurses navigate ethical dilemmas and, ultimately, better patient outcomes and the framework and professional integrity of the nurse.

This study explores the application of blockchain technology within the healthcare sector, emphasizing its potential benefits and barriers in health informatics. By leveraging secondary data from a diverse range of academic publications, industry reports, and case studies, the research provides a comprehensive overview of how blockchain can be a transformative force in healthcare. The findings suggest that blockchain technology offers significant advantages, including enhanced data security, improved interoperability, and increased transparency. These benefits could lead to more efficient healthcare delivery, reduced costs, and better patient outcomes. However, the study also identifies several barriers to widespread blockchain adoption, such as technical complexity, regulatory challenges, scalability issues, and the need for standardized protocols. By addressing these obstacles, stakeholders can unlock the full potential of blockchain technology, ensuring a more secure and efficient future for health informatics. This study serves as a foundational resource for healthcare professionals, policymakers, and technologists aiming to navigate and implement blockchain solutions in the healthcare industry.

Intra-abdominal infections encompass a range of medical conditions categorized by their complexity. Uncomplicated infections involve inflammation or infection limited to a single abdominal organ, such as acute appendicitis or cholecystitis, without extending to the peritoneum, while complicated infections spread to the peritoneal cavity. The key associated microbiological agents include Gram-positive cocci, Gram-negative Enterobacteriaceae, and obligate anaerobes, with common pathogens being Escherichia coli, Klebsiella pneumoniae, Streptococcus species, and Bacteroides fragilis. Treatment options include well-established antibiotics and newer agents like meropenem, metronidazole, and ceftazidime/avibactam. Meropenem, a carbapenem antibiotic, is known for its broad-spectrum efficacy and low toxicity, making it suitable for severe infections. Ceftazidime, a third-generation cephalosporin, is effective against Pseudomonas aeruginosa, especially when paired with avibactam, a β-lactamase inhibitor, enhancing its effectiveness. Metronidazole disrupts bacterial DNA, targeting anaerobic bacteria and protozoa. This systematic review and meta-analysis aimed to evaluate the safety and efficacy of the ceftazidime-avibactam plus metronidazole combination compared to meropenem for intra-abdominal infections. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, a comprehensive search of databases such as PubMed, Web of Science, and the Cochrane Library was conducted. Results showed that the combination therapy had a slightly higher overall adverse event rate (5.57%) compared to meropenem (4.56%), although this difference was not statistically significant [risk ratio (RR): 1.22; 95% confidence interval (CI): 0.78-1.93; p = 0.39]. Meropenem demonstrated a significantly higher clinical response rate in ceftazidime-susceptible infections (89.93% vs. 85.88%; RR: 0.96; 95% CI: 0.93-0.99; p = 0.009). No significant differences were observed in ceftazidime-resistant infections. Overall, the findings suggest that ceftazidime-avibactam combined with metronidazole is a viable alternative to meropenem, highlighting the need for further research to optimize treatment strategies amid rising antibiotic resistance.

Respiratory diseases, such as chronic obstructive pulmonary disease (COPD), asthma, pneumonia, and lung cancer, significantly impact public health globally. Understanding the epidemiology of these diseases involves analyzing various factors, including prevalence, incidence, risk factors, and demographic trends. For instance, smoking, environmental pollutants, and occupational exposures are key contributors to the development and exacerbation of respiratory conditions. Epidemiological studies reveal disparities in disease burden among different populations, particularly among those with limited access to healthcare, highlighting the importance of targeted prevention strategies and public health initiatives. For nurses, the implications of this epidemiological knowledge are profound. It informs critical aspects of nursing care, including patient education, assessment, and intervention strategies tailored to the needs of specific populations at risk. By recognizing the patterns of respiratory diseases, nurses can implement evidence-based practices, such as smoking cessation programs and effective management plans for chronic respiratory conditions. Furthermore, understanding these epidemiological trends aids in advocating for policy changes and improving community health resources, ultimately enhancing patient outcomes and promoting respiratory health.