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This study aims toinvestigate the most important determinants of capital structure in non-financial Saudi Arabian firms listed in Saudi Stock Exchange (TADAWUL) from 2010-2021, using a fixed effect with robust standard regression. Theories of capital structure have different views and conclusions as well as the empirical works. Thus, determining the factors affecting the capital structure in a different context like Saudi Arabia that has a unique feature such as the absence of corporate tax, undeveloped and illiquid bond market, will add to the existing literature. The study finds a positive relationship between each size, asset tangibility, and market- to book with firm leverage On the other hand, there is a negative relationship is found between profitability and sales growth. Some of the findings are consistent with the trade-off theory such as firm size while some of the findings support the picking order theory. Empirical findings should help corporate managers understand the nature of the market and make optimal capital structure decisions.

In this paper, we investigate the demonic transitive closure of fuzzy re- lations in the sense of demonic operators, we focus on the demonic order refinement of fuzzy relations specially transitive closure of fuzzy relations . In order to carry out this task, we adopt existing algorithms and reformulate them in the means of demonic operators.

Background: Neck pain is a significant disabling condition. Prevalence of neck pain is still not clearly stated in the literature due to the variation of its definition. It has a unique number of risk factors like history of neck pain, trauma, and certain sports injuries. In this study we measured the point prevalence of neck pain and the factors associated with it. Materials and Methods: This cross-sectional observational study included a total of 461 participants. The collected data comprised participant characteristics: demographic, socioeconomical status, and nature of work. The Arabic Neck Disability Index was used to assess neck pain. Specific questions about possible associated factors were asked, such as duration of using electronics, type of posture, duration of reading. Results: The neck pain was stated by 64.6% of the study participants. The results demonstrated that participants who reported neck pain were mostly females (70.5%), single (56.6%), or had high educational level (70.2%). Slight infrequent headaches were the most significant Neck Disability Index indicator in 39.5% of the study participants. Conclusion: The prevalence of neck pain was 64.6%, of which, mostly were females. Body postures, reading hours, work-type, and self-rated use of cellphones and PCs were all significantly associated with neck pain. Moreover, headache, concentration, and working habits were the top most significant indicators of the NDI. However, headache was the most significant.

Objectives: Neck pain is the fourth leading cause of disability. The most common validated tool assessing its effect on the participant’s functional status is the neck disability index (NDI). We aimed to investigate the factorial structure of the Arabic NDI (NDI-Ar) using exploratory and confirmatory factor analysis (CFA) in a multioccupational sample. Methods: A cross-sectional study conducted in Saudi Arabia. A total of 641 participants completed the NDI-Ar. The Cronbach’s alpha test was used to test the reliability of the questionnaire. Exploratory factor analysis (EFA) was used to assess the existing factor structure within the 10-indicator NDI questionnaire. Parallel analysis (PA) and scree plot with the unidimensional congruence test, mean of item residual absolute loadings test, and explained common variance test were used to assess the number of the extractable factors and their unidimensionality. CFA was also carried out. Results: EFA of the NDI-Ar suggested the presence of two-factor solutions. However, the analysis with the tests of closeness to unidimensionality, PA tests, and the more rigorous CFA indicated that the two-factor solutions were not tenable, and a single latent factor solution is a better fit with the observed data measured on Middle Eastern people. Conclusion: The present study explored the factorial structure of the NDI-Ar. The two-factor solutions were not tenable and a single latent factor solution might be a better fit.

Background/Aim: The worldwide prevalence of obesity has increased dramatically over the past years. In the Arab region, 66%–75% of adults and 25%–40% of children are either overweight or obese. Bariatric surgery has become the most effective approach for managing obesity and its co-morbidities. An expected outcome of bariatric surgery is cholelithiasis, which is one of the established risk factors of rapid weight loss. The aim of this study is to detect the incidence of symptomatic cholelithiasis among bariatric patients. Patients and Methods: A retrospective cohort study on 711 patients aged between 18 and 60 who underwent laparoscopic sleeve gastrectomy (LSG) was conducted at King Saud University Medical City from January 2016 to January 2018. Results: The postoperative incidence of symptomatic cholelithiasis was 3.5%. The mean duration of symptom development was 12.4 months. The rates of weight loss at 6 and 12 months for patients with symptomatic cholelithiasis were 28.94 ± 4.89% and 38.51 ± 6.84%, respectively (P = 0.002), which were significantly higher than in patients without symptomatic cholelithiasis during the same follow-up period (24.41 ± 6.6% and 32.29 ± 10.28%), respectively; (P = 0.012). Conclusion: We found a 3.5% incidence of symptomatic cholelithiasis among post-LSG patients in a period of 2 years. Rapid weight loss was the only risk factor that contributed to the development of post-LSG gallbladder disease. Statistical Analysis Used: Results were expressed as absolute numbers and percentages for categorical variables and as mean and standard deviation for continuous variables. A paired sample t-test was performed to determine significant differences between means at different time stamps. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 23.0.

Introduction An optimal hip implant is biocompatible, durable, and resistant to chemical and mechanical wear. This analysis aimed to compare failure (revision) and complication rates between ceramic-on-ceramic (CoC) and ceramic-on-highly-crosslinked-polyethylene (CoHXLPE) implants. Methods This review comprised of scientific literature published between 1995 and 2019. We included randomized controlled trials in adults (>18 years) that presented results of CoC and CoHXLPE total hip arthroplasty (THA) with more than two years of mean follow-up and drafted in English. The primary outcomes for this analysis were complications, revision rates, and loosening rates. Results Eight studies (1,689 hips) were included in this systematic review. There was no significant differences between COC and CoHXLPE for the risk of post-surgical complications (relative risk [RR]: 1.98, 95% confidence interval [CI]: 0.83-4.69, P = 0.12). Revision rates (RR: 1.25, 95% CI: 0.71-2.20, P = 0.43] and loosening rates between the two implants were not significantly different (RR: 1.17, 95% CI: 0.30-4.52, P = 0.82). Conclusion We report no significant differences between CoHXLPE and CoC in adults undergoing primary THA. Although introduced relatively recently, CoHXLPE is a cost-effective bearing that can be used for younger patients with no risk of increased complications in comparison to CoC. Further studies with longer follow-up periods are recommended to confirm the findings of this meta-analysis.

COVID-19 has emerged as the world's biggest challenge that has not only threatened human lives but also had an immense impact on the economy, safety and religious practices. The situation has worsened due to the lack of proper guidelines for fighting the sudden unexpected outbreaks. The world was not prepared for this situation. Muslims make up the largest religious group in the world, and Saudi Arabia is the center of religious life for Muslims. The eye of the Muslim world is turned toward the measures and reforms that the Saudi state is implementing during this pandemic, including strict curfews and quarantines with heavy fines and punishments for violations. This review highlights some important steps the Saudi government is taking and their impact on controlling the COVID-19 outbreak.

Background Mental health disorders are common in Saudi Arabia with a 34% lifetime prevalence. Cognitive behavioral therapy (CBT), a type of psychotherapy, is an evidence-based intervention for the majority of mental disorders. Although the demand for CBT is increasing, unfortunately, there are few therapists available to meet this demand and the therapy is expensive. Computerized cognitive behavioral therapy (cCBT) is a new modality that can help fill this gap. Objective We aimed to measure the knowledge of cCBT among mental health care professionals in Saudi Arabia, and to evaluate their attitudes and preferences toward cCBT. Methods This quantitative observational cross-sectional study used a convenience sample, selecting mental health care professionals working in the tertiary hospitals of Saudi Arabia. The participants received a self-administered electronic questionnaire through data collectors measuring their demographics, knowledge, and attitudes about cCBT, and their beliefs about the efficacy of using computers in therapy. Results Among the 121 participating mental health care professionals, the mean age was 36.55 years and 60.3% were women. Most of the participants expressed uncertainty and demonstrated a lack of knowledge regarding cCBT. However, the majority of participants indicated a positive attitude toward using computers in therapy. Participants agreed with the principles of cCBT, believed in its efficacy, and were generally confident in using computers. Among the notable results, participants having a clinical license and with cCBT experience had more knowledge of cCBT. The overall attitude toward cCBT was not affected by demographic or work-related factors. Conclusions Mental health care professionals in Saudi Arabia need more education and training regarding cCBT; however, their attitude toward its use and their comfort in using computers in general show great promise. Further research is needed to assess the acceptance of cCBT by patients in Saudi Arabia, in addition to clinical trials measuring its effectiveness in the Saudi population.

COVID-19 has emerged as the world's biggest challenge that has not only threatened human lives but also had an immense impact on the economy, safety and religious practices. The situation has worsened due to the lack of proper guidelines for fighting the sudden unexpected outbreaks. The world was not prepared for this situation. This review highlights some important steps the Middle East countries is taking and their impact on controlling the COVID-19 outbreak. We also discuss some hypothetical predictions for the coming months.