Thermoreversible [2 + 2] Photodimers of Monothiomaleimides and Intrinsically Recyclable Covalent Networks Thereof.

The development of intrinsically recyclable cross-linked materials remains challenged by the inherently unfavorable chemical equilibrium that dictates the efficiency of the reversible covalent bonding/debonding chemistry. Rather than having to (externally) manipulate the bonding equilibrium, we here introduce a new reversible chemistry platform based on monosubstituted thiomaleimides that can undergo complete and independent light-activated covalent bonding and on-demand thermal debonding above 120 °C. Specifically, repeated bonding/debonding of a small-molecule thiomaleimide [2 + 2] photodimer is demonstrated over five heat/light cycles with full conversion in both directions, thereby regenerating its initial monothiomaleimide constituents. This motivated the synthesis of multifunctional thiomaleimide reagents as precursors for the design of covalently cross-linked networks that display intrinsic switching between a monomeric and polymeric state. The resulting materials are shown to covalently dissociate and depolymerize upon heating both in solution and in bulk, thus transforming the densely photo-cross-linked material back into a viscous liquid. Temperature-regulated photorheology evidenced the intrinsic recyclability of the thiomaleimide-based thermosets during multiple cycles of UV cross-linking and thermal de-cross-linking. The thermally reversible photodimerization of thiomaleimides presents a new addition to the designer playground of dynamic polymer networks, providing interesting opportunities for the reprocessing and closed-loop recycling of covalently cross-linked materials.

Healthcare Providers' Experience with Saudi Arabia's 937 Virtual Medical Call Centers and Telehealth.

Introduction: This cross-sectional descriptive study evaluates the experiences and perceptions of healthcare providers (HCPs) regarding the 937 medical call center in Saudi Arabia, a key telemedicine initiative. Aim:  To assess HCP satisfaction, identify challenges, and provide recommendations for improvement. Methods: Conducted from November 20th to December 15th, 2022, the study surveyed 454 HCPs, achieving a 90.5% response rate. Results: A majority (86.8%) of respondents were satisfied with the call center, valuing its ease of use and effectiveness in healthcare delivery. However, challenges such as the accuracy of remote medical assessments, the need for clearer telehealth regulations, and concerns over management support and consultation overlaps were identified. The study also highlights the importance of ongoing support and updates, comprehensive telehealth regulations, integration of more medical specialties, and improvements in system integration and data confidentiality. Conclusion: The study underscores the need for strategic enhancements to the 937 call center to further improve healthcare accessibility and efficiency in Saudi Arabia. These enhancements are vital for aligning telehealth services with Saudi Arabia's healthcare objectives under Saudi Vision 2030.

Prevalence of Red Blood Cell Alloimmunization Among Pediatric Patients With Sickle Cell Disease in Saudi Arabia.

OBJECTIVE: Sickle cell disease (SCD) is a common hereditary hemoglobin disorder worldwide. One of the main treatments for patients with SCD is the requirement for blood transfusions. Posttransfusion alloimmunization with red blood cell (RBC) antigens continues to be a major risk factor for SCD. The objective of this study was to determine the rate, nature, and risk factors of red cell alloimmunization among pediatric patients with SCD in our center and compare our results with published reports from Saudia Arabia SA, regional countries, and some international countries. MATERIALS AND METHODS: A retrospective chart review of patients with SCD at King Abdulaziz Medical City-Jeddah, between 2008 and 2019 was performed. Demographic characteristics and transfusion histories were recorded. Blood samples were analyzed for alloimmunization using immunohematologic techniques. RESULTS: In total, 121 patients were analyzed. Alloantibodies were detected in 21 patients (17.4%) and were mostly single in 15 patients (71.4%), anti-K (23.7%), anti-E (19.0%), and anti-S (9.5%). The other 6 patients (28.6%) had multiple alloantibodies, especially the combination of anti-C and anti-K (9.5%) and the combination of anti-C and anti-E (9.5%). Alloantibody levels were significantly higher in patients with frequent hospital admissions (>5 times annually), those who had an exchange blood transfusion, those younger than 3 years old, and those who received a larger number of blood units ( P ≤0.05). CONCLUSION: The rate of RBC alloimmunization is determined and considered relatively low compared with that in other nations. Matching for extended RBC antigens to include ABO, RH (D, C, c, E, e), K, Fy a , Fy b , Jk a , and Jk b antigens in the screening panel for donors and recipients is highly recommended to ensure better transfusion practices and avoid transfusion-related complications.

Foodborne botulism outbreak with potential new management options.

OBJECTIVES: To shed some light on a potential therapeutic modality that may facilitate resolution of botulism symptoms, namely 3,4-diaminopyridine (3,4-DAP). METHODS: In Riyadh, Saudi Arabia, we recently encountered a foodborne botulism outbreak that, luckily, was discovered early. In Prince Sultan Military Medical city, we admitted, during a period of approximately 3 weeks, 15 probable cases, 2 of which were excluded due to more likely alternative diagnoses. We report in this case series 13 highly suspected cases of botulism that we encountered during the outbreak. RESULTS: A total of 12 out of 13 patients required intensive care unit (ICU) admission, one of which required intubation. Symptoms included cranial nerve palsies, gastrointestinal symptoms, limb and respiratory muscle weakness. Patients showed clinical improvement when received botulinum antitoxin and 3,4-DAP if given early in the course of the disease. CONCLUSION: Early admisntration of 3,4-DAP may facilitate recovery and prevent disease progression. Larger prospective trials should be carried out to confirm that.

Exploring clinical specialists' perspectives on the future role of AI: evaluating replacement perceptions, benefits, and drawbacks.

BACKGROUND OF STUDY: Over the past few decades, the utilization of Artificial Intelligence (AI) has surged in popularity, and its application in the medical field is witnessing a global increase. Nevertheless, the implementation of AI-based healthcare solutions has been slow in developing nations like Pakistan. This unique study aims to assess the opinion of clinical specialists on the future replacement of AI, its associated benefits, and its drawbacks in form southern region of Pakistan. MATERIAL AND METHODS: A cross-sectional selective study was conducted from 140 clinical specialists (Surgery = 24, Pathology = 31, Radiology = 35, Gynecology = 35, Pediatric = 17) from the neglected southern Punjab region of Pakistan. The study was analyzed using χ2 - the test of association and the nexus between different factors was examined by multinomial logistic regression. RESULTS: Out of 140 respondents, 34 (24.3%) believed hospitals were ready for AI, while 81 (57.9%) disagreed. Additionally, 42(30.0%) were concerned about privacy violations, and 70(50%) feared AI could lead to unemployment. Specialists with less than 6 years of experience are more likely to embrace AI (p = 0.0327, OR = 3.184, 95% C.I; 0.262, 3.556) and those who firmly believe that AI knowledge will not replace their future tasks exhibit a lower likelihood of accepting AI (p = 0.015, OR = 0.235, 95% C.I: (0.073, 0.758). Clinical specialists who perceive AI as a technology that encompasses both drawbacks and benefits demonstrated a higher likelihood of accepting its adoption (p = 0.084, OR = 2.969, 95% C.I; 0.865, 5.187). CONCLUSION: Clinical specialists have embraced AI as the future of the medical field while acknowledging concerns about privacy and unemployment.

Patients and Health Professionals' Perceptions of Primary Health Care Services in Saudi Arabia: A Scoping Review.

Objective: This scoping review aims to identify and summarize existing evidence concerning the quality and capacity of PHC services in the Kingdom of Saudi Arabia (KSA) with a focus on the patients and healthcare professionals' perceptions of PHC. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The digital library, PubMed, and the search engine Google Scholar were searched to broaden our results for primary research involving patient and/or health professionals' perspectives on Primary Healthcare in KSA. Results: A total of 38 publications were selected for the scoping review. Several studies examined patients' overall satisfaction with PHC services (n=14) while others focused their investigation on specific services provided by PHC (n=3). Several studies assessed the perceptions of certain groups of patients (n=5). Several studies examined health professionals' perceptions of the use of electronic health records (n=3), the safety culture (n=2), communicable disease management (n=1), emergency services (n=1), laboratory services (n=1), cost-effectiveness (n=1), and leadership (n=1). This review also included studies that assessed the health professionals' job satisfaction and burnout (n=6). Conclusion: Patients were satisfied with some aspects of PHC services while recognizing that improvements in some areas were needed. These included waiting time, physician-patient communication, access to the services in rural areas, patient involvement in disease management, and oral health. Health workers were positive about certain quality aspects and services provided by PHC such as EHRs, safety culture, communicable disease management, emergency services, and laboratory services. Health workers demonstrated a low level of job satisfaction due to several reasons, including, working conditions, financial incentives, and burnout.

Economic expansion and innovation: A comprehensive analysis of Pakistan's path to technological excellence.

To encourage technological and industrial innovation, nations worldwide implement "re-industrialization" and "manufacturing return." This study investigates the relationship between GDP growth, expenditure on research and development, and medium- to high-tech as a percentage of manufactured exports on technological innovation in Pakistan. We evaluated long-run and short-run causal relationships using the ARDL, bound-F test, and ECM regression. The study found a positive relationship between GDP growth and technological innovation in the short and long run. In the short run, with a one-year lag, the analysis reveals a positive and statistically significant relationship between technological innovation, medium-high-tech exports, and GDP growth. In the long run, R&D is positive and significant, while economic growth and technological innovation are positive but not statistically significant. There is a 0.38 percent chance that exogenous shocks will eventually lead to equilibrium in the long run. Based on the findings of this study, it is recommended to allocate resources to research and development, promoting collaborative initiatives, ensuring intellectual property rights, and developing a skilled workforce.

Ethical Awareness and Practices Among Emergency Department Personnel in Riyadh's Tertiary Hospitals: A Cross-Sectional Analysis.

Introduction: Ethical dilemmas in healthcare, particularly in emergency medical services (EMS), present significant challenges for healthcare workers (HCWs), necessitating a profound understanding of ethics and decision-making. This study assesses the ethical awareness and practices among HCWs in emergency departments of tertiary hospitals in Saudi Arabia, aiming to identify areas of strength and opportunities for improvement. Methods: A cross-sectional survey was conducted among 256 HCWs, including physicians, nurses, and administrative staff, in emergency departments across tertiary hospitals in Riyadh, Saudi Arabia. The questionnaire evaluated participants' knowledge of healthcare ethics, their experiences with ethical dilemmas, and the sources from which they derived their ethical understanding. Results: The majority of participants exhibited a commendable level of ethical knowledge and practice, with frequent encounters of ethical or legal issues highlighting the pervasive nature of ethical challenges in emergency healthcare settings. Key sources of ethical knowledge included experiential learning and academic lectures, with a notable emphasis on practical experience. Despite the satisfactory level of ethical awareness, areas requiring further educational focus were identified, emphasizing the need for enhanced ethics training tailored to the emergency medical context. Discussion: The findings underline the critical importance of incorporating ethics into the core of healthcare education and ongoing professional development for HCWs. Establishing a culture of continuous ethical dialogue and learning is essential for fostering patient-centered care and making informed ethical decisions in the fast-paced environment of emergency services. The study advocates for revising current ethics training programs to ensure they are comprehensive, relevant, and accessible, preparing HCWs to effectively address both current and future ethical challenges.

The evolving role of social media in enhancing quality of life: a global perspective across 10 countries.

BACKGROUND: Excessive or inappropriate use of social media has been linked to disruptions in regular work, well-being, mental health, and overall reduction of quality of life. However, a limited number of studies documenting the impact of social media on health-related quality of life (HRQoL) are available globally. AIM: This study aimed to explore the perceived social media needs and their impact on the quality of life among the adult population of various selected countries. METHODOLOGY: A cross-sectional, quantitative design and analytical study utilized an online survey disseminated from November to December 2021. RESULTS: A total of 6689 respondents from ten countries participated in the study. The largest number of respondents was from Malaysia (23.9%), followed by Bangladesh (15.5%), Georgia (14.8%), and Turkey (12.2%). The prevalence of social media users was over 90% in Austria, Georgia, Myanmar, Nigeria, and the Philippines. The majority of social media users were from the 18-24 age group. Multiple regression analysis showed that higher education level was positively correlated with all four domains of WHOQoL. In addition, the psychological health domain of quality of life was positively associated in all countries. Predictors among Social Media Needs, Affective Needs (ß = -0.07), and Social Integrative Needs (ß = 0.09) were significantly associated with psychological health. CONCLUSION: The study illuminates the positive correlation between higher education levels and improved life quality among social media users, highlighting an opportunity for policymakers to craft education-focused initiatives that enhance well-being. The findings call for strategic interventions to safeguard the mental health of the global social media populace, particularly those at educational and health disadvantages.

The Translation and Validation of Patient-Centered Outcomes Questionnaire Into Arabic: A Chronic Periodontitis Patient-Based Study.

Background The patient-centered outcomes questionnaire (PCOQ) is a self-report questionnaire that aims to assess four fundamental domains (pain, fatigue, distress, and interference) on an 11-point numerical rating scale from 0 to 10 in chronic diseases. The implementation of this tool will help assess chronic diseases; hence, this study aimed to translate the PCOQ to a sample of periodontitis patients. Methodology This study went through the content validity index. Arabic PCOQ used Cronbach's alpha for reliability with 300 participants. From July to August 2023, patients with periodontitis visiting an outpatient dental center in Riyadh were invited to participate in the study. The language, content, and structure of the questionnaire were appropriate, and with forward and backward translation, external entity translation was implemented. Results Regarding the participants' gender, the number of males was higher at 61%. Regarding age distribution, 50.7% of the participants were between 30 and 50 years old. A clarity score of 95.2% and a representativeness score of 97.3% were reported in the content validity analysis. The Cronbach's alpha of the Arabic PCOQ questionnaire was 0.85, and the subscales ranged between 0.68 and 0.93. Conclusions The translated version of the Arabic PCOQ is a valid tool to be used in Arab countries. Nonetheless, this instrument can provide insights for healthcare professionals, policymakers, and managers to improve patient satisfaction and healthcare system delivery.

Correction: The impact of COVID-19 pandemic on key performance indicators in three Saudi hospitals.

[This corrects the article DOI: 10.1371/journal.pone.0285616.].

Sustaining the Earth: Unraveling the Synergy of Workplace Spirituality, Responsible Leadership, and Pro-Environmental Behavior in Pakistan's SMEs.

Purpose: The purpose of this research is to investigate the synergistic impact of workplace spirituality (WPS), responsible leadership (RL), and pro-environmental behavior (PEB) within the context of Pakistan's Small and Medium Enterprises (SMEs) along with the mediating mechanism of Affective commitment (AC). Methods: Our study utilizes structural equation modeling (SEM) to analyze survey data collected from 390 employees within Pakistani SMEs. We develop a single unified framework to test the hypothesized relationships between RL, PEB, and AC as a mediator. Results: Our results unveil significant positive relationships between WPS, RL, and PEB. Our findings endorse both the direct connections between WPS, RL, and PEB, as well as the mediating mechanisms through AC. This study offers novel insights into the influence of PEB in the context of Pakistan's SMEs. Conclusion: The research significantly contributes to the existing literature by examining WPS, RL, PEB, and AC in the context of Pakistan's SMEs. The study's conclusions emphasize the potential benefits of integrating WPS and RL into business practices to encourage PEB. Additionally, we discuss the limitations of our research and suggest future avenues for further exploration in this vital area of sustainable business management.

A bibliometric approach to understanding the recent development of self-sufficient fish feed production utilizing agri-food wastes and by-products towards sustainable aquaculture.

The global agri-food industry generates a large volume of waste annually, which causes both environmental and economic problems. Recently, there has been a growing interest in the use of agri-food wastes and by-products to produce self-sufficient fish feed. This study aimed to analyze the intellectual structure of the recent research on the utilization of agri-food wastes and by-products as self-sufficient fish feed materials based on 922 Scopus-indexed core collection documents from 252 journals written by 4420 authors from 73 countries with an annual growth rate of 18.65% over the last four years (2019-2022). This bibliometric study implemented knowledge domain visualization (KDV) using VOSViewer and Biblioshiny in the Bibliometrix R-package to investigate the basic scientometric profile of the selected fields. The results showed that Dawood M.A.O., with PageRanks of 0.0732, 19 total publications, 695 global citations from 2019 to 2022, and closeness values of 0.25, was the most productive author within the field. Subsequently, China was determined to be the most productive country (93 valid documents) and have the strongest collaboration network. Major research hotspots in the field included aquaculture and sustainable aquaculture, fish feed with agri-food waste, rainbow trout species, the development of a circular economy, probiotic applications, and cell signaling cytokines and peptides. This bibliometric study provides comprehensive information on the intellectual domain and research landscape on self-sufficient fish feed and also shows how interest in this research topic and similar ones is growing.

A Comparison of Surgeon Estimated Times and Actual Operative Times in Pediatric Dental Rehabilitation under General Anesthesia. A Retrospective Study.

This retrospective study aimed to compare the accuracy of the pediatric dental surgeon's estimated operative times for dental rehabilitation under general anesthesia (DRGA) in pediatric patients. This study population included 674 pediatric patients who underwent DRGA at the study facility between January 2022 and December 2022, using convenience sampling to select patients who met our inclusion criteria. Data were collected from electronic medical and anesthesia records based on several factors, including patient-related factors such as age and gender, surgeon-related factors such as rank and experience, and anesthesia-related factors such as induction and recovery time (in minutes). This study highlights a significant difference between the surgeon's estimated time (SET) and actual operative time (AOT) for pediatric DRGA procedures, with a mean difference of 19.28 min (SD = 43.17, p < 0.0001), indicating a tendency for surgeons to overestimate surgery time. Surgical procedure time was the strongest predictor of this discrepancy, with an R square value of 0.427 and a significant p-value of 0.000. Experience with surgeons, anesthesia induction, and recovery time were also significant predictors. Meanwhile, age, gender, and rank of surgeons did not significantly predict the difference between SET and AOT. Therefore, the study suggests that surgeons should adjust their estimates for pediatric DRGA procedures, specifically emphasizing a more accurate estimation of surgery time, to ensure adequate resource allocation and patient outcomes.

The effect of voluntary disclosure on financial performance: Empirical study on manufacturing industry in Indonesia.

The manufacturing sector's adherence to managing natural resources from the environment still needs to be improved. This study's objective is to determine how Corporate Social Responsibility (CSR) influences the financial performance of manufacturing firms featured in the LQ45 Index, as measured by Return on Assets (ROA), Return on Equity (ROE), and Net Profit Margin (NPM). All manufacturing companies that are included in the LQ45 Index's population for this study were sampled using the purposive sampling method. This study uses secondary data from the CSRI based on the Global Reporting Initiative (GRI) G4 standard for 2018-2020 and the annual reports of companies in the manufacturing industry sector listed on the LQ45 Index. Moreover, applying a quantitative methodology, descriptive statistical methods, conventional assumption tests, and simple linear regression analysis were applied in this study's data analysis. The results of the study proved that CSR has a significant effect on ROA but does not affect the ROE and NPM of LQ45 manufacturing companies. In accordance with the signaling theory, CSR disclosure sends a favourable message to outsiders, which stakeholders and shareholders will respond to through changes in business earnings. CSR implementation can establish a positive image for the company, but it can also improve the company's image in both the commodity and capital markets. Investors will be more attracted to a company with a positive corporate image since a positive corporate image increases consumer loyalty. As consumer loyalty rises, the company's sales will likewise rise, and its profitability will increase as a result. This paper opens a new research path in corporate social responsibility and financial performance for possible links among variables; a matter that has not been previously explored in Indonesia Manufacturing Public Companies.

Enhancing Psychological Resilience: Examining the Impact of Managerial Support on Mental Health Outcomes for Saudi Ambulance Personnel.

Ambulance personnel are among the groups with high mental health risks. This study aims to investigate the role of managerial support in determining the mental well-being of ambulance personnel, a group at high risk for mental health issues. A descriptive, cross-sectional survey design was conducted in Riyadh, Saudi Arabia, in February 2022, involving a convenience sample of 354 ambulance personnel. An online survey was distributed via social media platforms. Manager behavior and mental well-being were assessed using the Manager Behavior Questionnaire (MBQ) and the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). The participants represented nearly equal-sized groups from different agencies, with 50.3% residing in the Riyadh Region and 67.5% aged between 25 and 34. The mean score for manager behavior was 2.92 ± 1.124, while the mental well-being scale's mean score was 3.398 ± 0.8219. Variance analyses revealed statistically significant differences in manager behavior concerning gender, age, residence, and years of experience (p < 0.05), as well as in the mental well-being of ambulance personnel. Generalized linear regression analysis demonstrated a statistically significant relationship between manager behavior and mental well-being (p < 0.01). Focusing on improving organizational management behaviors is a promising strategy for enhancing mental health interventions among ambulance personnel. Further research is recommended to monitor the mental health of these professionals and develop evidence-based interventions to support their well-being.

The impact of COVID-19 pandemic on key performance indicators in three Saudi hospitals.

OBJECTIVE: The coronavirus disease (COVID-19) disrupted healthcare systems and medical care worldwide. This study attempts to assess the performance of three Saudi hospitals during COVID-19 by comparing waiting times for outpatient appointments and the volume of elective surgeries before and after COVID-19. METHODS: We used ADA'A data collected from three Saudi hospitals for this retrospective cohort study. The outcome variables were "Waiting Time for Appointment" and "Elective OR Utilization". The hospitals included in this study were: a 300-bed maternity and children's hospital; a 643-bed general hospital; and a 1230-bed tertiary hospital. We included all patients who visited the OPD and OR in the time period from September 2019 to December 2021. A two-way ANOVA test was used to examine the differences in the outcome variables by hospital and by the phase of COVID-19. RESULTS: For the elective OR utilization rate, the results showed that both the hospital and the phase of COVID-19 were significantly different (p-value < 0.05). On average, the elective OR utilization rate dipped considerably in the early phase of COVID-19 (33.2% vs 44.9%) and jumped sharply in the later phase (50.3%). The results showed that the waiting time for OPD appointment was significantly different across hospitals and before and after COVID-19 in each hospital (p-value < 0.05). the waiting time dropped during the early phase of COVID-19 for both the general hospital (GEN) (24.6 days vs 34.8 days) and the tertiary hospital (MDC) (40.3 days vs 48.6 days), while the maternity and children's hospital (MCH)'s score deteriorated sharply (24.6 days vs 9.5 days). CONCLUSION: This study indicates that COVID-19 led to a significant impact on elective surgery rates and waiting time for OPD appointments in the early stage of the pandemic when the lockdown strategy was implemented in the country. Although the elective surgery rate had decreased at the designated COVID-hospital, the waiting time for OPD appointment had improved. This is a clear indication that the careful planning and management of resources for essential services during pandemic was effective.

A cross-sectional study factors associated with resilience among medical staff in radiology departments during COVID-19, Riyadh, Kingdom of Saudi Arabia.

OBJECTIVES: This study aims to assess the level of resilience of medical workers in radiology departments in Riyadh, Kingdom of Saudi Arabia, during the COVID-19 outbreak and to explore associated factors. SETTING: Medical staff, including nurses, technicians, radiology specialists and physicians, working in radiology departments at government hospitals in Riyadh, Saudi Arabia during the COVID-19 outbreak. DESIGN: A cross-sectional study. PARTICIPANTS: The study was conducted among 375 medical workers in radiology departments in Riyadh, Kingdom of Saudi Arabia. The data collection took place from 15 February 2022 to 31 March 2022. RESULTS: The total resilience score was 29.37±6.760 and the scores of each dimension showed that the higher mean score was observed in the domain of 'flexibility', while the lowest was observed in 'maintaining attention under stress'. Pearson's correlation analysis showed that there was a significant negative correlation between resilience and perceived stress (r=-0.498, p<0.001). Finally, based on multiple linear regression analysis, factors affecting resilience among participants are the availability of psychological hotline (available, B=2.604, p<0.050), knowledge of COVID-19 protective measures (part of understanding, B=-5.283, p<0.001), availability of adequate protective materials (partial shortage, B=-2.237, p<0.050), stress (B=-0.837, p<0.001) and education (postgraduate, B=-1.812, p<0.050). CONCLUSIONS: This study sheds light on the level of resilience and the factors that contribute to resilience in radiology medical staff. Moderate levels of resilience call for health administrators to focus on developing strategies that can effectively help cope with workplace adversities.

Decomposed and composed effects of economic freedom on economic growth in south Asia.

It is frequently asserted that high levels of economic growth are supported by economic freedom. For the period 1995-2021, this study examines the influence of the composed economic freedom index and several subcomponents of economic freedom on the economic growth of four South Asian economies, namely Bangladesh, India, Pakistan, and Sri Lanka. The Ordinary Least Squares, Random Effect Model, and Robust Least Squares approaches are utilized to estimate the composed and decomposed influence of economic freedom on economic growth. Robust Least Squares reflects the robustness of the connection between economic liberty and growth. According to the results of these tests, economic liberty has a strong and favorable stimulus on growth. When the different indicators of economic liberty are evaluated independently, we discovered that the magnitudes of most economic freedom indicators are significant. Conversely, monetary freedom contributes very little to economic expansion. The effects of government spending, public trust, and labor flexibility on economic expansion are hypothetical. The tax load hinders economic expansion in the economies under consideration. Property rights, freedom to do business, trade liberty, investment choice, and financial liberty all have a positive, strong, and sizeable stimulus on economic growth. The decomposed influence of each indicator of economic freedom will help develop policy choices.

Impact of Implementing Key Performance Indicators on Catheter-Associated Urinary Tract Infection (CAUTI) Rates Among Adult ICU Patients in Saudi Arabia.

Background: The prevalence of catheter-associated urinary tract infections (CAUTIs) in hospitals characterizes one of the most significant problems in healthcare. This study aims to assess whether the implementation of impact of key performance indicators (KPIs) checklist reduces the number of CAUTI in adults present in intensive care unit (ICU) with indwelling catheters. Methods: This is a retrospective analytical study conducted in a tertiary hospital in Riyadh, Saudi Arabia, from June 2020 to June 2021. One hundred and thirty-four patients with CAUTIs met the criteria and were included in the study. Socio-demographic data was collected to enable informed analysis based on personal information (age, gender, marital status, monthly income, level of education, and department) and medical history (duration of catheterization, types of organisms, history of chronic illness, and duration of hospitalization). The research also used a prevention of CAUTI checklist containing 26 items. The outcome measures were 1) the rate of CAUTIs measured pre- and post-implementing performance measurement indicators (KPI) of CAUTIs prevention practice and 2) the prevention of catheter-associated urinary tract infection in three areas: general information recording, insertion practices, and maintenance practices. Results: The study found that there was compliance with the prevention of CAUTIs in terms of recording the general patient's information (72%), insertion practices (52%), and maintenance practices (50%). However, most safety practices, including poor hygiene and safety standards, patient handling, and audited protocol programs, were not strictly followed, resulting in increased risk factors for CAUTIs. Conclusion: Compliance with the prevention of CAUTIs in terms of recording the general patient's information, insertion practices, and maintenance practices lies within the range of 50-75%, and the recommended practices are usually followed. A targeted education on CAUTI-prevention practices curtailing the most aggravating risk factors and adopting a safety culture driven by a patient handling and audited protocol program should be explored to reduce hospital CAUTIs.