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Global market competitiveness and standards are pushing the manufacturing supply chain to adopt sustainable approaches to enhance quality, reduce waste, improve environmental practices, and optimize product costs. Blockchain technology has emerged as a promising tool for improving supply chain transparency and manufacturing sustainability. However, various challenges to the mainstream use of blockchain must be identified and addressed. In this regard, the study aims to identify and comprehend the challenges of adopting blockchain technology in the manufacturing sector to improve sustainable standards. To bridge this gap, the study used a three-step procedure. First, through a comprehensive literature review, 19 potential challenges were identified. Then, with the experts' discussion, a total of 18 challenges were finalized. In the second phase, data was collected from 15 professionals with industrial backgrounds. Lastly, the collected data was analyzed using Combined Compromise Solution methodologies and the Fuzzy-Decision-Making Trial and Evaluation Laboratory (fuzzy DEMATEL). This hybrid methodology prioritizes the challenges in blockchain adoption and categorizes them into causal groups. This improves the decision-making process by evaluating how the mutual impact of challenges in blockchain adoption affects achieving sustainability in the manufacturing supply chain. The outcomes of the presented work are validated through a sensitivity analysis of the outranked dimensions of blockchain adoption challenges. Results show that 'High Initial Investment Cost' and 'Lack of Digital Skills' are the top challenges in its adoption. The findings of this work provide a roadmap to make the manufacturing supply chain sustainable and accomplish sustainability., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

In the era of Industry 4.0 (I4.0), automation and data analysis have undergone significant advancements, greatly impacting production management and operations management. Technologies such as the Internet of Things (IoT), robotics, cloud computing (CC), and big data, have played a crucial role in shaping Logistics 4.0 (L4.0) and improving the efficiency of the manufacturing supply chain (SC), ultimately contributing to sustainability goals. The present research investigates the role of I4.0 technologies within the framework of the extended theory of planned behavior (ETPB). The research explores various variables including subjective norms, attitude, perceived behavior control, leading to word-of-mouth, and purchase intention. By modeling these variables, the study aims to understand the influence of I4.0 technologies on L4.0 to establish a sustainable manufacturing SC. A questionnaire was administered to gather input from small and medium-sized firms (SMEs) in the manufacturing industry. An empirical study along with partial least squares structural equation modeling (SEM), was conducted to analyze the data. The findings indicate that the use of I4.0 technology in L4.0 influences subjective norms, which subsequently influence attitudes and personal behavior control. This, in turn, leads to word-of-mouth and purchase intention. The results provide valuable insights for shippers and logistics service providers empowering them to enhance their performance and contribute to achieving sustainability objectives. Consequently, this study contributes to promoting sustainability in the manufacturing SC by stimulating the adoption of I4.0 technologies in L4.0., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Antibiotic resistance is a global public health concern, and understanding the knowledge, attitudes, and practices (KAP) of the general population is essential for effective prevention and management. This cross-sectional study aimed to assess the KAP of antibiotic resistance among adults in Saudi Arabia., Materials and Methods: Between August 2023 and October 2023, 1000 participants aged 16-65 years from various regions in Saudi Arabia were surveyed using an online questionnaire. Data were analyzed using Excel and IBM SPSS Statistics version 27.0.0 (Armonk, NY: IBM Corp.). The sociodemographic characteristics of the participants were examined, and KAP variables towards antibiotic resistance were explored through a range of statistical methods, including frequencies, percentages, means, and standard deviations. Significance was defined as a p-value of ≤0.05., Results: The majority of participants were Saudi natives (98.1%) with ages between 16 and 25 years (38%), and over half were female (55.7%). More than half held a university degree (54.7%), mainly in non-medical fields (73.3%), and a significant portion reported a monthly income above 10,000 Saudi Riyals (49.7%). Regarding knowledge, 76.5% were aware of antibiotic resistance, but only 24.2% correctly identified its causes. Attitude assessments showed that 50.8% never used antibiotics as a preventive measure, and 47.3% always followed medical prescriptions. Practices revealed that 50.5% rarely used antibiotics, and 68.8% obtained antibiotic prescriptions from doctors. Additionally, 68.9% stopped taking antibiotics only after completing the course., Conclusion: It is important to implement health education campaigns aimed at the public, emphasize the role of health care providers in health education for the general public, and enforce stringent regulations to control the non-prescription dispensing of antibiotics. However, further studies are needed on this subject in the future., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alkhuraisi et al.)

Background: Ceftolozane-tazobactam is an emerging ‎treatment for severe infections caused by multidrug-resistant (MDR) Pseudomonas ‎aeruginosa. However, limited ‎data support its use in bacteremia treatment. This study aimed to assess the effectiveness of the treatment of MDR P. aeruginosa bacteremia using ceftolozane-‎tazobactam-based or colistin-based regimens. ‎ PATIENTS AND METHODS: This retrospective, cohort, multicentre study included adult patients with ‎MDR P. aeruginosa bacteremia treated with either ceftolozane-tazobactam or ‎colistin, between September 2018 and August 2021, at four hospitals in Saudi ‎Arabia. The primary endpoint was the 30-day risk-adjusted mortality. Secondary endpoints included the 14-day risk of mortality, bacterial eradication, and clinical ‎success. Cox proportional hazards ‎regression and relative risk estimation were used for analysis, as appropriate. ‎ RESULTS: In total, 46 patients were included; 17 patients received ceftolozane-‎tazobactam-based regimen, and 29 received a colistin-based regimen. There was no association with the use of ‎ceftolozane-tazobactam compared to colistin and the 30-day risk-adjusted mortality ‎‎(hazard ratio [HR] ‎0.58, 95% confidence interval [CI] 0.16-2.13, P = 0.42). Also, the ‎‎14-day risk of mortality and bacterial eradication were not different between the ‎ceftolozane-tazobactam and colistin regimens, HR 2.1, 95% CI 0.42-10.48; P = 0.36; and ‎relative risk (RR) 0.65; 95% CI 0.28-1.52; P = 0.30; respectively. On the other hand, ‎ceftolozane-tazobactam use was associated with higher clinical success than colistin ‎‎(RR 1.84, 95% CI 1.11-3.06: P = 0.021).‎ CONCLUSION: The risk of mortality of MDR P.aeruginosa bacteremia was ‎similar when treated with ceftolozane-tazobactam-based or colistin-based antimicrobial regimens. A higher clinical success was observed with the ceftolozane-‎tazobactam-based regimen compared to the colistin-based regimen. ‎., Competing Interests: Conflicts of Interest The authors declare no conflict of interest of any type.‎, (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Importance: Although effective vaccines against COVID-19 have been developed, additional vaccines are still needed., Objective: To evaluate the efficacy and adverse events of 2 inactivated COVID-19 vaccines., Design, Setting, and Participants: Prespecified interim analysis of an ongoing randomized, double-blind, phase 3 trial in the United Arab Emirates and Bahrain among adults 18 years and older without known history of COVID-19. Study enrollment began on July 16, 2020. Data sets used for the interim analysis of efficacy and adverse events were locked on December 20, 2020, and December 31, 2020, respectively., Interventions: Participants were randomized to receive 1 of 2 inactivated vaccines developed from SARS-CoV-2 WIV04 (5 µg/dose; n = 13 459) and HB02 (4 µg/dose; n = 13 465) strains or an aluminum hydroxide (alum)-only control (n = 13 458); they received 2 intramuscular injections 21 days apart., Main Outcomes and Measures: The primary outcome was efficacy against laboratory-confirmed symptomatic COVID-19 14 days following a second vaccine dose among participants who had no virologic evidence of SARS-CoV-2 infection at randomization. The secondary outcome was efficacy against severe COVID-19. Incidence of adverse events and reactions was collected among participants who received at least 1 dose., Results: Among 40 382 participants randomized to receive at least 1 dose of the 2 vaccines or alum-only control (mean age, 36.1 years; 32 261 [84.4%] men), 38 206 (94.6%) who received 2 doses, contributed at least 1 follow-up measure after day 14 following the second dose, and had negative reverse transcriptase-polymerase chain reaction test results at enrollment were included in the primary efficacy analysis. During a median (range) follow-up duration of 77 (1-121) days, symptomatic COVID-19 was identified in 26 participants in the WIV04 group (12.1 [95% CI, 8.3-17.8] per 1000 person-years), 21 in the HB02 group (9.8 [95% CI, 6.4-15.0] per 1000 person-years), and 95 in the alum-only group (44.7 [95% CI, 36.6-54.6] per 1000 person-years), resulting in a vaccine efficacy, compared with alum-only, of 72.8% (95% CI, 58.1%-82.4%) for WIV04 and 78.1% (95% CI, 64.8%-86.3%) for HB02 (P < .001 for both). Two severe cases of COVID-19 occurred in the alum-only group and none occurred in the vaccine groups. Adverse reactions 7 days after each injection occurred in 41.7% to 46.5% of participants in the 3 groups; serious adverse events were rare and similar in the 3 groups (WIV04: 64 [0.5%]; HB02: 59 [0.4%]; alum-only: 78 [0.6%])., Conclusions and Relevance: In this prespecified interim analysis of a randomized clinical trial, treatment of adults with either of 2 inactivated SARS-CoV-2 vaccines significantly reduced the risk of symptomatic COVID-19, and serious adverse events were rare. Data collection for final analysis is pending., Trial Registration: ClinicalTrials.gov Identifier: NCT04510207; Chinese Clinical Trial Registry: ChiCTR2000034780.

Objectives: To  determine whether distance from a cochlear implant (CI) center can influences the ages of presentation and intervention for CI, which thus may influence CI outcomes in Saudi Arabia., Methods: This study comprised a retrospective cross-sectional analysis of 221 patients who presented to the CI committee between March 2016 and March 2018 at King Abdullah Ear Specialist Center, Riyadh, Saudi Arabia. Through phone interviews and patients' files, age at suspicion, audiology testing, diagnosis, hearing aid fitting, and CI discussion were recorded for prelingually deaf children; additionally, demographic information were recorded. Patients were divided into 3 groups based on the distance between their place of residence and the nearest CI center (residing within 200 km, 200-500 km, and greater than 500 km)., Results: Patients living within 200 km showed the youngest mean age for all tested checkpoints; however, there were no statistically significant differences among the groups., Conclusion: In Saudi Arabia, distance from CI center does not have a significant effect on age of presentation for CI intervention.

Objective: To introduce the endoscopic acoustic stapedial reflex (EASR) as a technique for assessing stapedial mobility in ears with chronic otitis media (COM)., Methods: This prospective study was performed from February 2008 to February 2009, patients with COM presented to the Otology Clinic, King Abdul-Aziz University Hospital, Riyadh, Kingdom of Saudi Arabia were examined with a rigid ear endoscope to visualize the stapedius tendon and the head of stapes. The reflex is elicited by pulsed sound stimuli. The stapedius muscle contraction and the mobility of the stapes are visualized during exposure ipsilaterally, and contralaterally to sound stimuli., Results: Conventional tympanometry did not detect a stapedial reflex in any of the 10 patients. Acoustic stapedial reflex was detected in all ears. Despite a visible stapedial muscle contraction, one patient did not demonstrate stapes movement, and was confirmed to have stapes fixation at surgery. All patients tolerated the test with no complications, or side effects., Conclusion: The EASR was introduced for the first time. In addition to the well-known value of the stapedial reflex testing, it provides a safe, and reliable method for assessment of stapes mobility.

Objective: To explore the frequency of neutropenia in psychiatric patients., Methods: We conducted this study by retrospectively taking a convenient sample from patients who were admitted to Al-Amal Complex for Mental Health (ACMH), Riyadh, Saudi Arabia from January to December 2004. Fifty-one patients (48 men and 3 women), with a mean age of 34 years (18-52 years) were included., Results: We found that there is a large difference between the rates of neutropenia in the general population (12.8 cases/million persons/year), obtained from international studies, and in psychiatric inpatients included in our study (26400 cases/million psychiatric patients/year)., Conclusion: Psychiatric patients are more vulnerable to develop neutropenia.

The first confirmed Rift Valley fever outbreak outside Africa was reported in September 2000, in the Arabian Peninsula. As of February 2001, a total of 884 hospitalized patients were identified in Saudi Arabia, with 124 deaths. In Yemen, 1,087 cases were estimated to have occurred, with 121 deaths. Laboratory diagnosis of Rift Valley fever virus (RVFV) infections included virus genetic detection and characterization of clinical specimens by reverse transcription-polymerase chain reaction, in addition to serologic tests and virus isolation. Genetic analysis of selected regions of virus S, M, and L RNA genome segments indicated little genetic variation among the viruses associated with disease. The Saudi Arabia and Yemen viruses were almost identical to those associated with earlier RVF epidemics in East Africa. Analysis of S, M, and L RNA genome segment sequence differences showed similar phylogenetic relationships among these viruses, indicating that genetic reassortment did not play an important role in the emergence of this virus in the Arabian Peninsula. These results are consistent with the recent introduction of RVFV into the Arabian Peninsula from East Africa.