Nurses in the kingdom of Saudi Arabia work in a significantly challenging work environment. This research explored difficulties experienced by psychiatric nursing in mental health hospitals and clinics and their relationship to performance improvement. The study followed the correlation, the descriptive design, the study sample was randomly selected (201) participants from the psychiatric hospitals in Saudi Arabia – Hafar Al –Batan. The researcher used two questionnaires to answer the study questions and achieve their objectives. The first one is the Nurses Work Functioning Questionnaire (NWFQ) it consists of fifty items self-reported survey it contains seven subscale to measure the obstacle arises in work due to common mental illness. The other questionnaire is to measure difficulties and problems it consists of nine items and the scoring system is a five-scale point. Data were analyzed using SPSS 26 version. Results showed that 56% were males while 44% were females. The large percentage according to age was 47.8% to the range age group from 20-29. Then the age group from 30–39 with total number 42 and percentage 20.2%. regarding study sample years of experience, the high percentage was from 5 years- 7 years with 57%. Also , showed that nurses faced a lot of difficulties such as depression, stress and anxiety during their work shift. These symptoms can adversely affect work performance and care quality. But in the current research in general, the results indicate that there is no statistically significant relationship between the overall degree of the mental health scale and the professional performance scale.

Background: The instance of a patient already in hospital wishing to leave against clinician’s advice is referred to as self-discharge or discharge against medical advice. DAMA is a relatively common problem in health care systems. Because lengths of stay (LOS) are commonly several days, these patients often remain acutely ill at the time of self-discharge, and they may remain exposed to the risk of inappropriately treated medical problem, resulting in the need for readmission. It is not surprising that DAMA poses a major problem for many clinicians who treat inpatients, particularly those with cardiac problems because incomplete therapy in conditions such as ischemic heart disease may exert a negative impact on health outcome. Additionally, consequent care will be probably associated with more challenges and higher overall costs over time. Avoiding DAMA is, thus, likely to be beneficial for both patients and health systems. Methods: Study Design -Non-experimental, cross-sectional research design which will identify the reasons influencing DAMA among inpatients with cardiac problems is CCH. The study will describe the reasons by using a quantitative method. Setting of the study - The research will be conducted in Cardiac Center Hail, Ha’il Region, Kingdom of Saudi Arabia, and will focus on inpatient departments. Sample - In order to get accurate result of study, all discharged patients will be asked to participate in this study optionally. Data collection procedures - After getting approval from ethical committee in CCH and Hail Health Cluster, the questionnaires will be kept in nursing station, and explanation of a purpose of study will be demonstrated to all participants. Then, a collection box of questionnaires will be provided in the nursing office. Thereafter, data will be stored within one week from distribution to be ready for analysis. Data analysis - The ‘Patient Satisfaction Survey - DAMA form’ was designed on the basis of the reasons cited by patients in the past for self-discharge and the potential reasons are provided in this form. Demographic information was comprised of such biological characteristics as age, gender, and nationality. Finally, the prospectively collected data were analysed. The data are presented as n = % for the quantitative variables and are summarized by absolute frequencies and percentages for the categorical variables. Results: For approximately 45-day period, there were 102 discharges, of which 19 (18.63%) were cases of DAMA. Analysis was conducted in 17 patients after the exclusion of 2 patients due to missing data. Modes of admission were the emergency department, hospital transfer, and routine or elective admissions. The most prevalent reason cited by the study was feeling well (88.24%), followed by the desire to be transferred to other hospital (5.88%) and financial problems (5.88%). The baseline characteristics of the DAMA cases, for male and female separately, are depicted in Table 1. The range age of study population is above 18 to over 60 years with a male to female ratio of 16:1. Nearly one third of the study patients were in the age group of 51-60 years. The most common age group was 51-60 years in the men and over 60 years in the women. Conclusion: The most frequent self-reported reasons for DAMA in inpatient cardiac patients included feeling well, desire to be transferred to another hospital and financial problems respectively. We believe that explaining the importance of proper medical treatment and benefits versus risks of medication compliance may lessen impulsive decision of DAMA. Providing strategies for decreasing the rate of DAMA by analysing the current circumstances and developing effective interventions may benefit both patients (improving their health) and health care systems (decreasing unnecessary readmissions). There will be a continuous monitoring of the patient satisfaction survey both in regular and monthly basis by the Nursing Service Department. Proper coordination with social health workers, medical and nursing staff will be done. Multidisciplinary collaboration through regular committee meetings shall be implemented.

Background: During triage in the emergency room, observations of vital signs and identification of organ failure are increasingly frequently employed to diagnose systemic inflammatory response syndrome (SIRS) and sepsis. However, there is less emphasis on early detection technologies of systemic inflammatory response syndrome (SIRS) in the critical care unit. Method: This is A prospective research design study, A convenience sample technique utilized consists of (45) nurses working in the intensive care unit at King Khalid general hospital, KSA. Participants completed the electronic questionnaire sheet to assist knowledge of nursing staff about Systemic Inflammatory Response Syndrome by pre, immediate, and post educational program consisting of twenty questions. Results: The findings show a highly statistically significant increase in the mean score in a knowledge level of knowledge before and immediately after the educational program, then it slightly decreases one month after the educational program. There was no statistically significant relationship between the total knowledge of studied nurses and their Sociodemographic Characteristics. Conclusion: Criteria for systemic inflammatory response syndrome (SIRS) are very important to know and, unfortunately, they are not well used in ICU. It is recommended that educational programs be provided for intensive care nurses to help them with the detection of sepsis in the early stages.

Easter, 1916 is a classic work of Irish poet Yeats, describing four leaders in Irish raising and expressing Yeats’ complicated attitudes toward the rebellion. Being different from the traditional view of history, the study interprets the poem by analyzing its clauses from the perspective of functional grammar. It is concluded that a large amount of material process are used to represent the experiences of the characters, which realizes the narrative function of a poem. Relational process, the identifying one particularly, highlights the beliefs of revolutionaries and Yeats’ suspicion of their sacrifice. But finally, the mental, verbal and behavioural processes rebuild his support for the uprising and the nationalism represented by it.

“O Captain! My Captain!”, written by Walt Whitman, one of the most talented poets in American history, is an elegy on the death of Pres. Abraham Lincoln. It portrays Lincoln as the captain of a sea-worn ship, which implies the Union triumphant after the American Civil War. By drawing on multimodal discourse analysis and its theoretical framework of Halliday’s systemic functional grammar, this paper seeks to explore its meaning from both literary and non-literary aspects. The ideational function of the poem presents readers largely material processes, which post a whole dynamic scene. Whitman calls the captain “captain”, “my captain” and “father”. The change indicates that the author’s mourning seems to transcend the sorrow of a citizen for the assassination of a leader to become more like that of a son for his father. Cohesive markers of conjunction glue everything together and make the poem ship-like. To connect literature with linguistics and multimodal discourse analysis provides a new way to interpret Whitman’s poem and helps to understand the poem better.

This paper treats the influence of surface tension on Kelvin-Helmholtz instability arising at the interface separating two superposed, viscous, electrically conducting fluids through a porous medium in the presence of a uniform vertical magnetic field. The stability motion was also assumed to be uniform, and vertical. By applying the normal mode technique to the linearized perturbation equations, the dispersion relation was derived. The stability analysis was carried out for fluids of high kinematic viscosities. It was found that viscosity, surface tension and porosity suppressed the stability, while streaming motion and magnetic field had a destabilizing influence.

Background: A few studies have demonstrated the medicinal benefits of Bio-Clean II herbal remedy. The aim of this study is to determine the phytochemical screening, proximate analysis and microbiological quality of Bio-Clean II. Materials and Methods: Samples of the herbal remedy were procured from the manufacturer and were analyzed using standard procedure of analysis including sterility test, Spectrophotometry, Atomic Absorption spectroscopy, and gravimetric method. All the batches of Bio-Clean II examined pass sterility test. Physicochemical characterization of the herbal remedy was as follows: pH (6.86), temperature (25oC), relative density (1.08), conductivity (272 uS/cm) and total dissolved solid (163 mg/L). Phytochemical screening of the herbal remedy revealed the presence of the following bioactive secondary metabolites in varied quantity: resin (+), Flavonoids (+++), Saponins (+), Anthraquinones (+++), Tannin (++), Alkaloids (++) and Cardiac Glycoside (++); except for Steroids which was absent (-). Trace elements analysis revealed the presence of the following in varied quantity: Iron (2.526 mg/L), Zinc (0.033 mg/L) and Iodine (0.025 mg/L), except for Copper and Cobalt which were absent. The results of the proximate analysis were as follows: % Moisture (54.25), % Carbohydrate (11.23), % Crude Protein (12.41), % Crude Fat (9.25), % Crude Fibre (10.65) and % Ash Content (2.21). The outcome of the study shows that all the samples of Bio-Clean II examined were of high microbiological quality and therefore poses no microbial threat to the safety of potential consumers; while the presence of appreciable quantities of some important phytochemical compounds and trace elements in the herbal remedy further underscores its medicinal benefits as earlier reported.

As the first and basic level of formal education for children, elementary school has the aim of providing basic abilities to students to develop their lives personally, community members, citizens, and members of humanity and prepare students for secondary education. . Lack of mastery of social skills can lead to potential problems, on the contrary by having social skills students can achieve success in school and society. So it is necessary to develop a measuring tool for the social skills scale. This study aims to develop social skills test kits based on the concept of social skills that have been identified in initial observations and validate the social skills test kits that have been developed, to produce a social skills measurement instrument in the form of a scale. The results can be used by educators as feedback in coaching. The results of the validity of the Expert Judgment on the social skills scale instrument conducted by six experts using the Aiken V formula were declared valid with conditions > 0.78 with 18 items valid from 21 items. While the KMO test of 0.58> 0.50 means that the instrument is considered valid as a measuring tool for the social skills scale of elementary school students. Then the reliability test was carried out with Cronbach's Alpha test. Based on the results of field data processed with the SPSS application, it was found that the reliability of Cronbach's Alpha was 0.87> 0.50, meaning that the social skills scale was considered reliable as a means of measuring social skills in elementary school students.

Different systems of criminal policy including governmental and social have followed various restorative justice models such as "abolitionist or pure-minded", "separatist or autonomous" and "reformist or maximalist", based on their prevailing political, doctrinal, and ideological values and discourses, and in this regard have focused on various restorative programs such as arbitration councils, mediation, family sessions, as well as healing and sentencing circles. Iranian criminal justice system, unlike other systems, has adopted a different approach to restorative justice, due to its special legal and political structure. This paper analyzes the structure of this system from the perspective of restorative justice models and processes. It explains the prevailing and common model of restorative justice in this system and its limitations and challenges.

Background: Molar pregnancies represent a significant burden of disease on the spectrum of gestational trophoblastic diseases. Molar pregnancy is one of the causes of maternal morbidity and mortality among women in the reproductive age group. However the magnitude, clinical features and risk factors are not well documented in our country .This study was conducted to describe these aspects of the disease entity in one tertiary level hospital. Objective: to determine the frequency and evaluate the current clinical characteristics of patients with molar pregnancy in Bangladesh. Study design: this was a cross sectional observational study. Study place and period: Department of Obstetrics and Gynaecology in BSMMU, Dhaka. Study period from January 2015 to June 2015. Study population: Patients with molar pregnancy admitted in the department of Obstetrics and Gynaecology in BSMMU during the study period. Outcome variables: Varieties of clinical presentation, diagnosis and treatment modalities. Results: The incidence of molar pregnancy was 7.3 per thousand pregnancies in BSMMU hospital during the study period. The age of the patient ranged from 18-47 years, with maximum 65% between 21-40 years age group. Only 5% patients were above the age of 40. Majority 65% of patients were multigravida while 35% were primigravida. Maximum 85% of all were from low socio-economic group. In 40% patient's blood group was B+ve and A+ve in 25% patients. Abnormal vaginal bleeding was the commonest presenting symptoms in 60% patients. Other than that 15% patients came with vaginal bleeding and passage of vesicles, 12.5% with lower abdominal pain, 7.5% patients had no symptom except amenorrhea diagnosed incidentally and other 5% had amenorrhea with exaggerated sign symptom of pregnancy. More than two third (80%) of the patients had uterus more than the period of gestation. USG, serum ß-hCG and CBC was done in all the cases. Chest X- ray was done in 60% cases. Serum ß- hCG level was found above the level of 50000 in 80% cases. Different modalities of treatment such as suction evacuation, D&C and hysterectomy were used for the patients with molar pregnancy. Suction evacuation was the first line treatment in 87.5% patients of molar pregnancy & follow up should be done at least for 6 months. Conclusion: Molar pregnancy is the disease of women in their reproductive years. It was commonly found in young multipara women of below average income group. Most common clinical manifestation was vaginal bleeding. Diagnosis was confirmed by ultrasonography and serum ß-hCG. Patients with molar pregnancy have the risks of developing persistent gestational trophoblastic disease (GTD) and should be followed up. It is now indispensible to set up a nationwide accepted protocol for the early detection and management of patient with molar pregnancy as well as to initiate a structured follow up programme to observe the prognosis of the disease.

This article explores the changes in the Emirati school system from Arabic to bilingual curriculum (English and Arabic) as well as the influence of English in Emirati Arabic: English loanwords and verbs in Emirati Arabic; as well as their occurrences in light of age and gender, two important social variables related to linguistic behavior. To do so, we administered questionnaires and recorded Emirati high school students (aged 17-18), Emirati alumni from 38 to 50 years old, as well as elderly Emiratis aged 64 to 66, which means a generation gap of over 40 years from the youngest to the eldest group. We will analyze which English loanwords and verbs are present in Emirati Arabic due to historical reasons and the most recent incorporations due to modernization factors.

Background: Diabetes remains a global public health concern in the world. Much is known about the burden of type 2 diabetes as opposed to type 1 diabetes mellitus (T1DM) hence underdiagnosis is evident. Diabetes type 1 is often associated with multiple symptoms and patients with type 1 diabetes are left with regular insulin injection as remedy despite odds of the fact that it is sprout by multiple challenges ranging from hypoglycemia, expensive nature and inconveniences. The use of probiotic bacteria appears today as one of safer alternative to alleviate diabetes and symptoms. Aim of the study: This study aims at characterizing potential hypoglycemic probiotic lactic acid bacterium from fermented cow milk and to evaluate its effects on anthropometric parameters of type-1 diabetes mellitus (T1DM) in an alloxan-induced mice model. Methods: The lactic acid bacteria were isolated from samples of Fulani cow milk using pour plating technique on de Man Rogosa and Sharpe (MRS) agar. The isolates were then further characterized phenotypically and molecularly using the 16s rRNA gene sequencing. Type-1 diabetes mellitus was induced in Balb-c mice by administration of 150mg/Kg B.w of alloxan intraperitoneally, twice consecutively. Animals were randomly divided into 6 groups after induction with 150mg/kg of alloxan per body weight except Group I (normal control). Animals were treated with different probiotic doses of concentration: 9x108 CFU/mL, 1.8x109 CFU/mL and 2.7x109CFU/mL respectively and insulin as positive control. MDA, NO levels as well as anti-oxidant levels (SOD, CAT, GSH) were measured from pancreatic homogenate. Results: One isolate (PRI 29) was selected based on its functional properties like resistance to simulated gastro-intestinal stress environment (acid and bile salt tolerance) and absence of hemolytic activity. This probiotic isolate was identified as a strain of Lactobacillus fermentum. The isolate was sensitive to 10 tested antibiotics including vancomycin, Imipenem and Ciprofloxacin. The isolate resisted acid and bile salts since there was no significant difference (p >0.05) between viable count before and after incubation pH 2.5 and bile salts concentration of 0.3 and 0.6%. Administration of probiotic LAB significantly (p<0.001) ameliorated polydipsia and polyphagia. The glucose and oral glucose tolerance levels were ameliorated in probiotics treated groups p<0.05 as compared to the untreated group. Administration of Lactobacillus fermentum strain was capable of significantly ameliorating oxidative stress in LAB treated mice compared to untreated group (p<0.001) demonstrated by decrease in pro-oxidant NO and MDA. The administration of probiotics led to increase in anti-oxidants (SOD, GSH & CAT) to scavenge oxidative stress biomarkers within the mice treated group (p<0.05). Conclusion: The selected Probiotic lactic acid bacterium isolated from cow milk possess antidiabetic and anti -oxidant properties.

ABO blood group system was the 1st human blood group system to be discovered. Blood group is an integral part of clinical diagnosis using various hematological techniques to understand hematological disorders. Blood type is a classification of blood based on the presence and absence of antibodies and inherited antigenic substance on the surface of red blood cells. It is important to have clear information on blood groups in case of blood transfusion and related matters. It is also mandatory to have complete history of patient including the blood grouping and for the establishment and maintenance of blood banks.The present study was carried out among the students of Govt.Degree College Doda, Jammu and Kashmir from 10th of May to 20th of June 2022 in which 950 students participated .The collected data was statistically analysed in the form of Pie charts and bar diagrams by using Microsoft Excel software.

The present paper focuses on the business value or more specifically return on investment of adoption of Building Information Modeling (BIM) in the construction industry in developing countries. The research area forms a gap in the knowledge of the research as well as practicing communities. Hence, there is a genuine need to fill the missing knowledge. It is a valid question why such concern about the ROI of adoption has not been raised as far as other tools which represented a paradigm shift in the construction industry such as AutoCAD, by which a complete and rapid switch from manual drawing to digital drawing, still in 2D format but with attributes. Such attributes have been used for material take-off and vendor lists among others. However, BIM was introduced as a revolutionary technology at least thirty years ago, the concern or doubts regarding its overall business value still hanging over, and not a single research paper or report out of the voluminous corpus of literature, has managed to resolve this issue. If we add the element of most studies talk about developed countries, while the situation and numbers are completely different in developing countries which are still struggling with the awareness or adoption of BIM in the construction industry. Among the factors commonly mentioned to adversely affect the diffusion of BIM in developing countries, lack of government support, and more closely related to the present study, concern over the business value of BIM adoption. Research methodology in the present paper has been set after reviewing the voluminous corpus of literature and finding that there exist a large number of questionnaires and/or workshops dealing with the same question in different approaches. Such existent studies processed respondents’ answers to reach some conclusions depicted statistically or graphically. Based on this, the author has decided to review such extant studies rather than perform an independent questionnaire which at the end of the day will add to questions rather than to answers. The main finding of the study is no quantitative formulation of ROI can be adopted and the only way to deal with such a question is to rely on qualitative studies asserting there exists a high potential of adopting BIM to generate direct as well as indirect revenues. All attempts found in the literature to quantify the ROI of BIM cannot be generalized due to disputed involved assumptions.

Introduction: The placenta is an organ that is attached to the uterine wall and connects the fetus with the mother through the umbilical cord. The placenta is said to be retained when it is not expelled out even half an hour after the birth of the baby. The study aimed to evaluate the retention of the placenta. Methods: This was a cross-sectional study was conducted at the Department of Obstetrics & Gynecology , Faridpur Medical College Hospital, Faridpur from June 2016 to November 2016. The sample was taken purposively and the sample size was 110. Patients were diagnosed with a case of 'retained placenta' through proper history, and clinical examination. Written informed consent was taken from every patient or their relatives. The information was collected in a preformed data collection sheet. Observation and results of the study and statistical analysis were presented in tables. Data were analyzed by using the computer-based program Statistical Package for Social Science (SPSS) software for windows. Result: Out of 110 study subjects about 58.18% were found in the age group of 21-30 years and 20% were found in the age group of 20 years. The age of the patients ranges from 18 to 40 years. Among 110 study subjects, 64.55% were from lower socioeconomic status, 27.27% were from middle socioeconomic status and only 8.18% belonged to affluent socioeconomic status. The majority (74.54%) of cases were delivered at home and 25.46% of cases were delivered at different levels of hospitals (among them 1.82% of cases occurred in the institute where the study was done). Among them 20% were para- 1, 54.54% were para-2-4 and 25.46% of respondents were para ≥ 5. The majority (60%) of study subjects were admitted between 3 to 8 hours after developing retained placenta, followed by 18.19% who came within 2 hours. Regarding the clinical presentation, 69.09% of study subjects presented with anemia of varying degrees, 24.53% presented with shock, 5.45% presented with sepsis, and only 0.93% (one patient) presented with acute renal failure. Concerning predisposing factors of retained placenta, 25.46% of study subjects were grand multipara, 11.82% had H/O MR or D & C, 10.90% with prolonged labor, 10.90% respondents had IUD, 10% with past H/O retained placenta, 8.20% had preterm labor, 2.72% had H/O LUCS/ other uterine surgery and 20% were without any predisposing factors. Among the respondents, 27.27% of study subjects presented with genital tract trauma, 5.45% with sepsis, 5.45% with acute renal failure, 0.91% with DIC, 0.91% with uterine prolapse 64.55% with no associated conditions/complications. Among the total study population, 58.18% of retained placenta cases required manual removal under G/A, and 41.82% were managed by manual removal of the placenta under deep sedation. Out of 110 respondents, 21.82% of cases of retained placenta did not require any blood transfusion, 58.18% received 1-2 units and 20% received 3 or more units of blood transfusion. During management, 13.63% of study subjects developed uterine atony, 0.91% developed uterine inversion, 2.73% were complicated by uterine perforation, 0.91% were complicated by anesthetic hazard; 81.82% had no complication during management. Out of 110, 18.18% of study subjects experienced various complications. Among them 9.10% were managed by intrauterine balloon tamponade,2.73% required hysterectomy, and 6.37% were managed by other measures. 70% of respondents stayed in the hospital for 1-3 days, 26.36% for 4 to 7 days, and 3.64% stayed more than 7 days before discharge. Regarding the outcome of retained placenta among study subjects, 80.91% improved and discharged, 10% had severe anemia and required subsequent blood transfusion, 6.36% developed an infection, 0.91% developed acute renal failure and 2 patients died (one due to DIC and another patient due to irreversible shock). Conclusion: The retained placenta is an obstetric emergency. Rapid recognition and treatments are essential because heavy blood loss with coagulation problems remains the lethal factor in this disease. Rapid control of hemorrhage should be the first initiative. Active management of the third stage of labor lowers the danger by a significant percentage.