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This research explores the causes behind increasing defaults among Small and Medium Enterprises (SMEs) in Kuwait by focusing on the impact of the crisis and the role of the Kuwait National Fund for SME Development. The central crisis examined in this study is the COVID-19 pandemic, which acted as a catalyst that intensified pre-existing financial and operational challenges within the SME sector. Other systemic vulnerabilities such as limited financial literacy, weak risk management, and policy gaps are also considered within this broader crisis context. By employing a mixed method approach, the study draws on 15 interviews with owners of defaulted SMEs and a questionnaire involving 64 defaulted SMEs. This dual method framework qualitative (thematic analysis) and quantitative (survey based statistics) provides both depth and generalizability in understanding default risks. Thematic analysis revealed that crises such as COVID-19 related operational delays, changes in customer behaviour, and increased financial obligations were the main contributing factors. The quantitative findings align with these themes, with 89% acknowledging that the pandemic affected their ability to repay loans. This research contributes to existing literature by empirically linking crisis induced pressures to SME loan defaults in a Gulf context, with Kuwait as the focus. Policy implications include strengthening the Kuwait National Fund’s role in flexible financial support, risk management programs, and enhancing SME access to alternative funding channels. The study proposes that the Kuwait National Fund for SME Development could implement sustainability policies and practices such as flexible financial support, capacity building, risk management, and facilitating connections with alternative funding sources to address these issues. These proposed strategies provide SMEs with more resources and skills to handle challenges, which may reduce default rates and contribute to a more resilient SME sector in Kuwait.

The surgery-first approach has gained popularity in recent years due to its ability to bypass the presurgical orthodontic phase and significantly reduce treatment duration. However, its broader impact on quality of life and psychosocial outcomes in patients with skeletal class III malocclusion has not been systematically evaluated. This systematic review aimed to assess the effects of the surgery-first approach on quality of life, psychosocial outcomes, and treatment duration in this patient population. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A comprehensive search of PubMed, Cochrane Library, Scopus, Web of Science, and Embase databases identified studies evaluating the surgery-first approach in skeletal class III patients. Studies addressing the impact of this approach on quality of life, psychosocial outcomes, and treatment duration were included, and the quality of evidence was assessed using the Newcastle-Ottawa Scale. Due to heterogeneity in study designs and outcomes, a narrative synthesis of the data was performed. A total of eight studies, conducted between 2015 and 2022, with 252 participants, met the inclusion criteria. The surgery-first approach demonstrated significant improvements in quality of life, particularly in the early postoperative stages, while avoiding the decline typically observed during the presurgical phase of the conventional orthodontics-first approach. Psychosocial benefits, such as reduced anxiety and enhanced self-esteem, were consistently reported. Treatment duration for the surgery-first approach ranged from 7 to 15 months, significantly shorter than the conventional approach. However, the strength of the evidence was limited by small sample sizes and a lack of randomization in most studies. The surgery-first approach offers distinct advantages for skeletal class III patients, including improved quality of life, enhanced psychosocial outcomes, and shorter treatment duration compared to the conventional orthodontics-first protocol. Nevertheless, further high-quality randomized clinical studies with longer follow-up periods are needed to evaluate long-term outcomes and ensure treatment stability.

Purpose The purpose of this study is to understand the public value of the government of Kuwait using blockchain technology to develop the capabilities of smart cities. Design/methodology/approach Research was conducted in Kuwait, where the increased use of blockchain technology has been evidenced in both the private and public sectors. A total of seven IT managers were interviewed to gauge their responses to blockchain and its use in Kuwait ministries. Findings Blockchain technology offers many benefits for the development of smart cities in Kuwait. This is a statement that received almost mutual agreement amongst all the IT managers interviewed. However, as regards wider acceptance, the majority mentioned that a framework is necessary to better articulate the public value of using blockchain in smart cities in Kuwait. Originality/value This paper develops research hypotheses and a framework for articulating the public value of blockchain technology for smart cities in Kuwait.

High frequency trading (HFT) requires a detailed analysis of the quote structure of the continuous limit order book in order to correctly de- rive viable arbitrage strategies. Traders can manipulate order books by submitting and retracting ‘spoof’ orders at various levels of the order book by introducing, quote volume at or above (below) the best ask(bid). However, the limit order book data for heavily traded finan- cial instruments presents an almost unique problem to the econome- trician interested in constructing high frequency measures of liquidity impact over and above the inside spread. A single month of data for an individual maturity of an activity traded futures contract, in our example light crude, can easily exceed 10 Billion bytes of data, even when stored using the single precision floating point format. In this thesis we conduct a large scale analysis of the West Texas Inter- mediate (WTI) futures contract across the 120 simultaneously traded maturities for five levels of the order book from 2008 to 2016 sample at the continuous limit. Using this very-large data-set we estimate a new form of realized vector autoregression and derive the impulse re- sponse functions useful in building a HFT strategy. we show that for WTI futures a speed of execution of the order of 100s of milliseconds is needed to fully exploit a false quoting strategy designed to system- atically unbalance the order flow. Furthermore, we demonstrate that viable strategies can be built by spoofing up to three levels above the inside spread. A second part of the thesis involves creating new bootstrap routines to extract meaningful composition data to generate factor pricing mod- els from high frequency data. The key element of this analysis is in understanding the eigendecomposition and subsequent principal com- ponent analysis to extract factors from the data. our bootstrap is new and we provide an analysis of power and consistency in correct- ing bias in the estimation of the eigenstructure and hence evaluating the optimal number of principal components within the data.

Health promotions among the adolescent population have a significant role in achieving the 2030 sustainable development goals of the World Health Organization. The COVID-19 pandemic has led to several devastating impacts on the health, economic, social, and healthcare systems, and adolescents' health promotions are no exception. We assessed health promotion behaviors and associated factors among the adolescent population of northern Saudi Arabia (KSA). We used the Arabic version of the adolescent health promotion scale (AHPS-40) among the 400-adolescent population. The AHPS-40 assessed six domains of adolescent health behavior: nutrition, social support, health responsibility, life appreciation, exercise, and stress management. We applied the Chi-square test to identify the associated factors of adolescent health promotion activities and the logistic regression test to find the predictors for overall health promotion categories. Of the studied participants, the mean ± SD of the total AHPS-40 was 103.31 ± 18.78. The nutrition domain of the AHPS-40 was significantly associated with the age group (  = 0.002), and the social support domain was significantly related to fathers' (  = 0.022) and mothers' education (  = 0.006). The exercise domain of AHPS-40 was significantly associated with age group (  = 0.018) and school level (  = 0.026). Gender was significantly associated with most of the six domains. Furthermore, more than half (52.7%) of them had a low health promotion behavior, which was significantly associated with gender (adjusted odds ratio = 1.59, 95% CI of AOR = 1.04 -2.45,  = 0.032). Our study results suggest improving health promotion behaviors by instituting awareness-raising and health promotion intervention programs for adolescent groups. Furthermore, we recommend a focused, exploratory, mixed-method survey among the adolescents of other regions of KSA to identify the region-specific adolescent's health promotion behaviors.

Background and Aims Pemphigus vulgaris is an autoimmune vesiculobullous mucocutaneous disorder with life‐threatening consequences. Early detection and adequate care are crucial for a good prognosis. This study aimed to determine the demographic data, clinical features, and the prognosis of patients with oral pemphigus vulgaris. Materials and Methods From 2001 to 2021, all diagnosed oral pemphigus vulgaris cases were extracted. Each patient's demographic and clinical data were gathered. Patients were called via phone to assess the prognosis, treatment type, and specialty of the physician who provided the diagnosis and therapy. Results The majority of the patients had only oral lesions with higher prevalence in female who also expressed severe pain than male. Only 14 of 29 patients responded phone calls. Except for one, all patients were in active disease. More than half of those respondents said pemphigus negatively affects social behavior and food intake. Correct diagnosis and treatment were decided by dermatology, oral medicine, and maxillofacial surgery specialists. Conclusion Oral pemphigus vulgaris was prevalent in females. Severe pain was common in females and older people. Even with effective therapy, the prognosis was poor. Medical and dental professionals had little knowledge of pemphigus vulgaris. Patients frequently report poor quality of life.

Parents are an essential element of family intervention for all children, including those with autism spectrum disorders (ASDs). We can better understand and address parents’ knowledge gaps about ASD through in-depth research and inquiry into parents’ current level of understanding, attitude, and perception. We aimed to assess the knowledge, attitude, and perception of ASD and influencing factors towards ASD among a group of parents with and without a child diagnosed with ASD in Sakaka, Al-Jouf Region, Saudi Arabia. Using the cross-sectional study design, information from the parents was gathered using a pretested questionnaire that included validated scales for measuring knowledge, attitudes, and perceptions related to ASD. The required number of participants was selected using the convenience sampling method. We used Spearman’s correlation test to determine the strength and direction of correlation between each domain. As a last step, we analyzed the influencing factors using binomial logistic regression. Among the 400 participants, 41.2% had high knowledge, 69.1% had a positive attitude, and 60.3% had a high perception of ASD. We found that knowledge was significantly higher among the parents with autistic individuals in the family (p = 038). The high and positive attitude was significantly greater among females (p = 0.010) and parents with high income (p = 0.007), and the perception was significantly associated with females (p = 0.037) and highly educated participants (p = 0.046). Furthermore, we found a positive correlation between knowledge, attitude, and perception. Overall, only less than half of the participants had a high knowledge of ASD. Hence, we recommend awareness-raising programs for the parents in this region. Furthermore, a prospective study involving parents from all provinces of Saudi Arabia is recommended.

This investigation explored marine fungi from Red Sea sediments, focusing on AMG31. Chemical profiling of the fungal extract by high-performance liquid chromatography and gas chromatography–mass spectrometry revealed diverse bioactive compounds, with hesperetin (80,471.56 μg·g ) and rosmarinic acid (8,396.08 μg·g ) predominating. Additionally, the extract contained substantial phenolics (55.517 mg·g ), flavonoids (28.757 mg·g ), and tannins (18.650 mg·g ). The fungal extract facilitated green synthesis of copper-zinc oxide nanocomposites (CZ nanocomposites), which were thoroughly characterized using fourier transform infrared spectroscopy, transmission electron microscopy, energy-dispersive X-ray spectroscopy, X-ray diffraction, dynamic light scattering, and zeta potential. The physicochemical characterization exhibits the formation of spherical, well-arranged, crystalline structures, with sizes of 12–45 nm. The nanocomposites demonstrated exceptional hemocompatibility (1.7% hemolysis at 1,000 μg·mL ). Antioxidant evaluations showed potent activity in both the extract (2,2-diphenyl-1-picrylhydrazyl [DPPH] IC : 25.66 μg·mL ; 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) [ABTS] IC : 33.36 μg·mL ) and CZ nanocomposite (DPPH IC : 42.71 μg·mL ; ABTS IC : 47.34 μg·mL ), with the nanocomposite exhibiting superior total antioxidant capacity (394.08 AAE μg·mg ) and ferric reducing antioxidant power (362.57 AAE μg·mg ) values. The CZ nanocomposite demonstrated stronger anti-inflammatory activity (COX-1 IC : 22.72 μg·mL ; COX-2 IC : 33.03 μg·mL ) than the extract (COX-1 IC : 205.54 μg·mL ; COX-2 IC : 397.18 μg·mL ). Antimicrobial results revealed that the fungal extract exhibited superior inhibitory zones against (30 mm), (29 mm), (30 mm), and (25 mm), exceeding gentamicin performance, while the CZ nanocomposite showed exceptional activity against (32 mm). For species, the nanocomposite demonstrated superior inhibition against (35 mm, minimum inhibitory concentration [MIC] 7.8 μg·mL ), while the extract showed better activity against (27 mm, MIC 15.62 μg·mL ). This work highlights the potential of Red Sea fungi as sources of bioactive compounds and green synthesis of functional nanomaterials for pharmaceutical applications.

Background: The facial spaces in head and neck are the potential spaces between the various layers of fascia normally filled with loose connective tissue and bounded by anatomical barriers, usually of bone, muscle or facial layers. Objective: To evaluate the level of knowledge and awareness about space infection among pediatric patients and their parents in Riyadh, KSA which can lead to seeking early help. Results: A total of 102 children (56 girls, 46 boys; mean age from 2-12 years) visited Dar al Uloom hospital since January 2019. Most of the patients (51 cases) were children aged 6–9 years. It has been observed that majority of 10- 12 years old children noticed pain first (58.3%) followed by abscess drainage (25%) whereas, large number of 2-5 years old children noticed pain as the first option (66.7%) followed by swelling (26.7%). Further, a greater number of 6-9 years old children noticed pain (80.4%) followed by swelling (7.8%). These results suggest that the association of the first symptom observed by the child with different age groups was found to be significant. Conclusion: In our study, the most common age group of pediatric patient infected with space infection was from 6-9 years, and the most common source of infection was caries. The level of education does not affect the awareness. It was observed that the symptoms of space infection were first noticed by the child, and it was due to the lack of early visits to the dentist. Hence, there is a need of increased awareness of the parents towards space infection and its potential risk. Bangladesh Journal of Medical Science Vol. 22 No. 04 October’23 Page : 773-777

There is increasing evidence suggesting that ABO blood type may play a role in the immunopathogenesis of COVID-19 infection. In addition to ABO blood type, the Rhesus (Rh) factor has also been implicated in various disease processes. Therefore, our study aimed to assess the association between both ABO and Rh blood types in critically ill patients with COVID-19 and their clinical outcomes. A multicenter retrospective cohort study conducted in Saudi Arabia between March 1, 2020, and July 31, 2021, involving adult COVID-19 patients admitted to Intensive Care Units, aimed to explore potential associations between rhesus blood group types (Positive versus Negative) and clinical outcomes. The primary endpoint assessed was the hospital length of stay (LOS). Other endpoints were considered secondary. After propensity score matching (3:1 ratio), 212 patients were included in the final analysis. The hospital length of stay was longer in a negative Rh blood group compared with patients in the Rh-positive group (beta coefficient 0.26 (0.02, 0.51), p = 0.03). However, neither 30-day mortality (HR 0.28; 95% CI 0.47, 1.25, p = 0.28) nor in-hospital mortality (HR 0.74; 95% CI 0.48, 1.14, p = 0.17) reached statistical significance. Additionally, among the different ABO types, the A+ blood group exhibited a higher proportion of thrombosis/infarction and in-hospital mortality (28.1% and 31.2%, respectively). This study highlights the potential impact of blood group type on the prognosis of critically ill patients with COVID-19. It has been observed that patients with a negative Rh blood group type tend to have a longer hospital stay, while their mortality rates and complications during ICU stay are similar to the patients with a Rh-positive group.