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Antibiotic resistance is a worldwide public health emergency. Nonprescription antibiotic use is a chief cause of antibiotic resistance. The Saudi Government, as a consequence, imposed in 2018 executive regulations to prevent the distribution of antibiotics without a prescription. Herein, we aimed to investigate the prevalence of and risk factors for nonprescription antibiotic use among individuals presenting to one hospital in Saudi Arabia after enacting these regulations. This cross-sectional study was conducted on people, aged ≥18 years, who presented to the primary healthcare clinics of King Khalid University Hospital in Riyadh during the period between 1/1/2019 and 28/2/2019. Participants were asked to fill out a self-administrated questionnaire assessing their nonprescription antibiotic use during the past year in addition to sociodemographic information. Then, logistic regression analyses were performed to calculate the odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for age, sex, education, and nationality of any nonprescription antibiotic use compared with no use within the past year. Out of 463 participants, 62.9% were females, 67.4% were <40 years, and 93.7% were Saudi citizens. Overall, 30.5% of participants reported nonprescription antibiotic use during the past year (19.7% one to two times and 10.8% more than two times). Male and non-Saudi participants were more likely to report any nonprescription antibiotic use, with HRs (95% CIs) of 1.99 (1.30, 3.04) and 3.81 (1.73, 8.35), respectively. The main reasons behind nonprescription antibiotic use were having previous experience with a health condition (69.2%), inaccessibility of healthcare (26.6%), and recommendation from a relative or a friend (16.1%). A major limitation of this study was that it included individuals attending one hospital. Individuals who seek medical consultation could be dissimilar to those who do not see doctors regarding nonprescription antibiotic use.

Research article published in MDPI Nanomaterials (Nanomaterials 2020, 10, 1184; http://dx.doi.org/10.3390/nano10061184). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). ; This study was funded partly by the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No. 675063 (Laser4Fun project, www.laser4fun.eu) and under the FET Open grant agreement No. 862016 (BioCombs4Nanofibers, www.jku.at/biocombs4nanofibers).

The absence of scope of practice guidelines may lead to role ambiguity and legal consequences in nursing practice. This study measures the scope of practice of nurses in Saudi Arabia. The study utilized a descriptive cross-sectional design using an electronic version of the Arabic Actual Scope of Nursing Practice (A-ASCOP) questionnaire among 928 nurses. Descriptive analysis was followed by a t-test and an analysis of variance (ANOVA). Significance was assured through the Bonferroni test; the effect size was measured through partial η2 when appropriate. The A-ASCOP mean score of each dimension ranged from 4.29 to 4.72 (overall mean = 4.59). Significant overall ASCOP score variations were evident, with higher ASCOP among expatriate nurses, females, Hospital Operation Program (HOP) nurses, and nurses with postgraduate qualifications. Partial η2 showed a small effect of <0.016. Low-complexity nursing tasks showed insignificant differences no matter the nurse's position, but were less practiced by Bachelor of Science in Nursing (BSN) and advanced-degree nurses than by those with a diploma education. High complexity of ASCOP was practiced significantly more often by postgraduate-prepared nurses than by diploma-educated nurses. The study showed that there is a range of variation in nursing practice, but that the lack of internal regulations (nursing scope of practice) has no effect on nursing duties. In a country such as Saudi Arabia, where massive national improvement initiatives are frequent, clearly defining the scope of practice for nurses is essential and needs to be done through government mandates. Further studies are essential to define what the scope of practice should include.

The absence of scope of practice guidelines may lead to role ambiguity and legal consequences in nursing practice. This study measures the scope of practice of nurses in Saudi Arabia. The study utilized a descriptive cross-sectional design using an electronic version of the Arabic Actual Scope of Nursing Practice (A-ASCOP) questionnaire among 928 nurses. Descriptive analysis was followed by a t-test and an analysis of variance (ANOVA). Significance was assured through the Bonferroni test; the effect size was measured through partial η2 when appropriate. The A-ASCOP mean score of each dimension ranged from 4.29 to 4.72 (overall mean = 4.59). Significant overall ASCOP score variations were evident, with higher ASCOP among expatriate nurses, females, Hospital Operation Program (HOP) nurses, and nurses with postgraduate qualifications. Partial η2 showed a small effect of <0.016. Low-complexity nursing tasks showed insignificant differences no matter the nurse's position, but were less practiced by Bachelor of Science in Nursing (BSN) and advanced-degree nurses than by those with a diploma education. High complexity of ASCOP was practiced significantly more often by postgraduate-prepared nurses than by diploma-educated nurses. The study showed that there is a range of variation in nursing practice, but that the lack of internal regulations (nursing scope of practice) has no effect on nursing duties. In a country such as Saudi Arabia, where massive national improvement initiatives are frequent, clearly defining the scope of practice for nurses is essential and needs to be done through government mandates. Further studies are essential to define what the scope of practice should include.

BACKGROUND: Health workforce planning is critical for health systems to safeguard the ability to afford, train, recruit, and retain the appropriate number and mix of health workers. This balance is especially important when macroeconomic structures are also reforming. The Kingdom of Saudi Arabia is moving toward greater diversification, privatization, and resiliency; health sectorreform is a key pillar of this transition. METHODS: We used the Ministry of Health Yearbook data on the number of workers and health expenditures from 2007 to 2018 and projected health labor market supply and demand of workers through 2030, evaluated the potential shortages and surpluses, and simulated different policy scenarios to identify relevant interventions. We further focused on projections for health workers who are Saudi nationals and health worker demand within the public sector (versus the private sector) to inform national objectives of reducing dependency on foreign workers and better deploying public sector resources. RESULTS: We projected the overall health labor market to demand 9.07 physicians and nurses per 1,000 population (356,514) in 2030; the public sector will account for approximately 67% of this overall demand. Compared to a projected supply of 10.16 physicians and nurses per 1,000 population (399,354), we estimated an overall modest surplus of about 42,840 physicians and nurses in 2030. However, only about 17% of these workers are estimated to be Saudi nationals, for whom there will be a demand shortage of 287,895 workers. Among policy scenarios considered, increasing work hours had the largest effect on reducing shortages of Saudi workers, followed by bridge programs for training more nurses. Government resources can also be redirected to supporting more Saudi nurses while still ensuring adequate numbers of physicians to meet service delivery goals in 2030. CONCLUSION: Despite projected overall balance in the labor market for health workers in 2030, without policy interventions, severe gaps in the Saudi ...

BackgroundHealth workforce planning is critical for health systems to safeguard the ability to afford, train, recruit, and retain the appropriate number and mix of health workers. This balance is especially important when macroeconomic structures are also reforming. The Kingdom of Saudi Arabia is moving toward greater diversification, privatization, and resiliency; health sectorreform is a key pillar of this transition.MethodsWe used the Ministry of Health Yearbook data on the number of workers and health expenditures from 2007 to 2018 and projected health labor market supply and demand of workers through 2030, evaluated the potential shortages and surpluses, and simulated different policy scenarios to identify relevant interventions. We further focused on projections for health workers who are Saudi nationals and health worker demand within the public sector (versus the private sector) to inform national objectives of reducing dependency on foreign workers and better deploying public sector resources.ResultsWe projected the overall health labor market to demand 9.07 physicians and nurses per 1,000 population (356,514) in 2030; the public sector will account for approximately 67% of this overall demand. Compared to a projected supply of 10.16 physicians and nurses per 1,000 population (399,354), we estimated an overall modest surplus of about 42,840 physicians and nurses in 2030. However, only about 17% of these workers are estimated to be Saudi nationals, for whom there will be a demand shortage of 287,895 workers. Among policy scenarios considered, increasing work hours had the largest effect on reducing shortages of Saudi workers, followed by bridge programs for training more nurses. Government resources can also be redirected to supporting more Saudi nurses while still ensuring adequate numbers of physicians to meet service delivery goals in 2030.ConclusionDespite projected overall balance in the labor market for health workers in 2030, without policy interventions, severe gaps in the Saudi workforce will ...

Ice accretion on external aircraft surfaces due to the impact of supercooled water droplets can negatively affect the aerodynamic performance and reduce the operational capability and, therefore, must be prevented. Icephobic coatings capable of reducing the adhesion strength of ice to a surface represent a promising technology to support thermal or mechanical ice protection systems. Icephobicity is similar to hydrophobicity in several aspects and superhydrophobic surfaces embody a straightforward solution to the ice adhesion problem. Short/ultrashort pulsed laser surface treatments are proposed as a viable technology to generate superhydrophobic properties on metallic surfaces. However, it has not yet been verified whether such surfaces are generally icephobic under representative icing conditions. This study investigates the ice adhesion strength on Ti6Al4V, an alloy commonly used for aerospace components, textured by means of direct laser writing, direct laser interference patterning, and laser-induced periodic surface structures laser sources with pulse durations ranging from nano- to femtosecond regimes. A clear relation between the spatial period, the surface microstructure depth, and the ice adhesion strength under different icing conditions is investigated. From these observations, a set of design rules can be defined for superhydrophobic surfaces that are icephobic, too.

AbstractThe study aimed to estimate direct and indirect costs of environmental degradation resulting from not fully reusing treated wastewater. To achieve our objectives, the study relied on probability distributions and economics equations. The study found that the percentage of treated wastewater reused ranged within 0.9%–47.3% at a 95% confidence level and, correspondingly, the amount of unused wastewater ranged within 52.7%–99.1% at a 95% confidence level. The total costs borne by the Saudi economy for treating wastewater were 658.67 million dollars in 2019. Direct costs of environmental degradation account for 75.5% of that total, whereas indirect costs account for the remaining 24.5% of the cost of environmental degradation of 658.67 million dollars in 2019. To reduce such costs, results of this study suggest the need to continue to assess and monitor the quality of treated wastewater and make full use of it for agricultural and industrial purposes.

Musaddique Hussain,1 Shahzada Khurram Syed,2 Mobeen Fatima,1 Saira Shaukat,1 Malik Saadullah,3 Ali M Alqahtani,4 Taha Alqahtani,4 Talha Bin Emran,5 Ali H Alamri,6 Muhammad Qasim Barkat,7 Ximei Wu7 1Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, 63100, Pakistan; 2Department of Basic Medical Sciences, School of Health Sciences, University of Management and Technology Lahore, Lahore, 54000, Pakistan; 3Department of Pharmaceutical Chemistry, Government College University, Faisalabad, 38000, Pakistan; 4Department of Pharmacology, College of Pharmacy, King Khalid University, Abha, 62529, Saudi Arabia; 5Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, 4381, Bangladesh; 6Department of Pharmaceutics, College of Pharmacy, King Khalid University, Abha, 62529, Saudi Arabia; 7Department of Pharmacology, School of Medicine, Zhejiang University, Hangzhou City, 310000, People's Republic of ChinaCorrespondence: Musaddique HussainDepartment of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, 63100, PakistanEmail musaddique.hussain@iub.edu.pkXimei WuDepartment of Pharmacology, School of Medicine, Zhejiang University, Hangzhou City, People's Republic of ChinaEmail xiwu@zju.edu.cnAbstract: Acute respiratory distress syndrome (ARDS) is an overwhelming inflammatory disorder of the lung due to direct and indirect insults to the lungs. ARDS is characterized by increased vascular permeability, protein-rich edema, diffuse alveolar infiltrate, and loss of aerated lung tissue, leading to decreased lung compliance, tachypnea, and severe hypoxemia. COVID-19 is generally associated with ARDS, and it has gained prime importance since it started. The mortality rate is alarmingly high in COVID-19-related ARDS patients regardless of advances in mechanical ventilation. Several pharmacological agents, including corticosteroids, nitric oxide, neuromuscular blocker, anti-TNF, statins, and exogenous surfactant, have been studied and some are under investigation, like ketoconazole, lisofylline, N-acetylcysteine, prostaglandins, prostacyclin, and fish oil. The purpose of this review is to appraise the understanding of the pathophysiology of ARDS, biomarkers, and clinical trials of pharmacological therapies of ARDS and COVID-19-related ARDS.Keywords: acute respiratory distress syndrome, acute lung injury, COVID-19, COVID-19-related ARDS

Objective: Little is known about the impact of Coronavirus (COVID-19) among the health care workers in Saudi Arabia. Therefore, the present study aimed to assess the psychological impact of COVID-19 among the health care workers. Methods: A cross-sectional survey was conducted from May till mid-July among 389 health care workers from government and private hospitals in Saudi Arabia. Data was collected using a pre-structured online questionnaire that measured adverse psychological outcomes, including the Patient Health Questionnaire-9 (PHQ-9) scale and the Generalized Anxiety Disorder 7-item (GAD-7) scale. The Pearson chi-square test was used to assess the distribution of depression and anxiety among health care workers. Results: A high level of anxiety was recorded among the health care workers, and 69.3% of health care workers below the age of 40 were found to have depression. There was a significant increase in depression among staff with chronic health problems (72.1% vs. 61.9%; p = 0.048). High anxiety levels were detected among young staff compared to others (68.7% vs. 43.8%; p = 0.001). Moreover, 82.1% of the female staff were anxious, as compared to 55.6% of the males (p = 0.001). Conclusions: We found increased prevalence of adverse psychological outcomes among the health care workers in Saudi Arabia during the outbreak of COVID-19. Therefore, there is a need for proper screening and development of corresponding preventive measures to decrease the adverse psychological outcomes.