Causes of gastrointestinal bleeding in children based on endoscopic evaluation at a tertiary care center in Bahrain

BACKGROUND Gastrointestinal bleeding(GIB)is a serious health problem worldwide,particularly during childhood.This can be an alarming sign of an underlying disease.Gastrointestinal endoscopy(GIE)is a safe method for the diagnosis and treatment of GIB in most cases.AIM To determine the incidence,clinical presentation,and outcomes of GIB in children in Bahrain over the last two decades.METHODS This was a retrospective cohort review of the medical records of children with GIB who underwent endoscopic procedures in the Pediatric Department at Salmaniya Medical Complex,Bahrain,between 1995 and 2022.Demographic data,clinical presentation,endoscopic findings,and clinical outcomes were recorded.GIB was classified into upper(UGIB)and lower(LGIB)GIB according to the site of bleeding.These were compared with respect to patients’sex,age,and nationality using the Fisher’s exact,Pearson’sχ2,or the Mann-Whitney U tests.RESULTS A total of 250 patients were included in this study.The median incidence was 2.6/100000 per year(interquartile range,1.4-3.7)with a significantly increasing trend over the last two decades (P < 0.0001). Most patients were males (n = 144, 57.6%). Themedian age at diagnosis was 9 years (5-11). Ninety-eight (39.2%) patients required upper GIEalone, 41 (16.4%) required colonoscopy alone, and 111 (44.4%) required both. LGIB was morefrequent (n = 151, 60.4%) than UGIB (n = 119, 47.6%). There were no significant differences in sex (P = 0.710), age (P = 0.185), or nationality (P = 0.525) between the two groups. Abnormalendoscopic findings were detected in 226 (90.4%) patients. The common cause of LGIB was inflammatorybowel disease (IBD) (n = 77, 30.8%). The common cause of UGIB was gastritis (n = 70, 28%).IBD and undetermined cause for bleeding were higher in the 10-18 years group (P = 0.026 and P =0.017, respectively). Intestinal nodular lymphoid hyperplasia, foreign body ingestion, andesophageal varices were more common in the 0-4 years group (P = 0.034, P < 0.0001, and P = 0.029,respectively). Ten (4%) patients underwent one or more therapeutic interventions. The medianfollow-up period was two years (0.5-3). No mortality was reported in this study.CONCLUSIONGIB in children is an alarming condition, whose significance is increasing. LGIB, commonly due toIBD, was more common than UGIB, commonly due to gastritis.

Accidental ingestion of foreign bodies/harmful materials in children from Bahrain:A retrospective cohort study

BACKGROUND Children like to discover their environment by putting substances in their mouths.This behavior puts them at risk of accidentally ingesting foreign bodies(FBs)or harmful materials,which can cause serious morbidities.AIM To study the clinical characteristics,diagnosis,complications,management,and outcomes of accidental ingestion of FBs,caustics,and medications in children.METHODS We conducted a retrospective cohort study of all children admitted for accidental ingestion to the Department of Pediatrics,Salmaniya Medical Complex,Bahrain,between 2011 and 2021.Demographic data,type of FB/harmful material ingested,and investigations used for diagnosis and management were recorded.The patients were divided into three groups based on the type of ingested material(FBs,caustics,and medications).The three groups were compared based on patient demographics,socioeconomic status(SES),symptoms,ingestion scenario,endoscopic and surgical complications,management,and outcomes.The FB anatomical location was categorized as the esophagus,stomach,and bowel and compared with respect to symptoms.The Fisher’s exact,Pearson’s χ^(2),Mann-Whitney U,and Kruskal-Wallis tests were used for comparison.RESULTS A total of 161 accidental ingestion episodes were documented in 153 children.Most children were boys(n=85,55.6%),with a median age of 2.8(interquartile range:1.8-4.4)years.Most participants ingested FBs(n=108,70.6%),31(20.3%)ingested caustics,and the remaining 14(9.2%)ingested medications.Patients with caustic ingestion were younger at the time of presentation(P<0.001)and were more symptomatic(n=26/31,89.7%)than those who ingested medications(n=8/14,57.1%)or FBs(n=52/108,48.6%)(P<0.001).The caustic group had more vomiting(P<0.001)and coughing(P=0.029)than the other groups.Most FB ingestions were asymptomatic(n=55/108,51.4%).In terms of FB location,most esophageal FBs were symptomatic(n=14/16,87.5%),whereas most gastric(n=34/56,60.7%)and intestinal FBs(n=19/32,59.4%)were asymptomatic(P=0.002).Battery ingestion was the most common(n=49,32%).Unsafe toys were the main source of batteries(n=22/43,51.2%).Most episodes occurred while playing(n=49/131,37.4%)or when they were unwitnessed(n=78,57.4%).FBs were ingested more while playing(P<0.001),caustic ingestion was mainly due to unsafe storage(P<0.001),and medication ingestion was mostly due to a missing object(P<0.001).Girls ingested more jewelry items than boys(P=0.006).The stomach was the common location of FB lodgment,both radiologically(n=54/123,43.9%)and endoscopically(n=31/91,34%).Of 107/108(99.1%)patients with FB ingestion,spontaneous passage was noted in 54(35.5%),endoscopic removal in 46(30.3%),laparotomy in 5(3.3%)after magnet ingestion,and direct laryngoscopy in 2(1.3%).Pharmacological therapy was required for 105(70.9%)patients;79/105(75.2%)in the FB group,22/29(75.9%)in the caustic group,and 4/14(28.8%)in the medication group(P=0.001).Omeprazole was the commonly used(n=58;37.9%)and was used more in the caustic group(n=19/28,67.9%)than in the other groups(P=0.001).Endoscopic and surgical complications were detected in 39/148(26.4%)patients.The caustic group had more complications than the other groups(P=0.036).Gastrointestinal perforation developed in the FB group only(n=5,3.4%)and was more with magnet ingestion(n=4)than with other FBs(P<0.001).In patients with FB ingestion,patients aged<1 year(P=0.042),those with middle or low SES(P=0.028),and those with more symptoms at presentation(P=0.027)had more complications.Patients with complications had longer hospital stays(P<0.001)than those without.CONCLUSION Accidental ingestion in children is a serious condition.Symptomatic infants from middle or low SES families have the highest morbidity.Prevention through parental education and government legislation is crucial.

Causative bacteria of ventilator-associated pneumonia in intensive care unit in Bahrain:Prevalence and antibiotics susceptibility pattern

BACKGROUND Ventilator-associated pneumonia(VAP)is defined as pneumonia that occurs two calendar days following endotracheal intubation or after that.It is the most common infection encountered among intubated patients.VAP incidence showed wide variability between countries.AIM To define the VAP incidence in the intensive care unit(ICU)in the central gove-rnment hospital in Bahrain and review the risk factors and the predominant bacterial pathogens with their antimicrobial susceptibility pattern.METHODS The research was a prospective cross-sectional observational study over six months from November 2019 to June 2020.It included adult and adolescent patients(>14 years old)admitted to the ICU and required intubation and mechanical ventilation.VAP was diagnosed when it occurred after 48 h after endotracheal intubation using the clinical pulmonary infection score,which considers the clinical,laboratory,microbiological,and radiographic evidence.RESULTS The total number of adult patients admitted to the ICU who required intubation and mechanical ventilation during the study period was 155.Forty-six patients developed VAP during their ICU stay(29.7%).The calculated VAP rate was 22.14 events per 1000 ventilator days during the study period,with a mean age of 52 years±20.Most VAP cases had late-onset VAP with a mean number of ICU days before the development of VAP of 9.96±6.55.Gram-negative contributed to most VAP cases in our unit,with multidrug-resistant Acinetobacter being the most identified pathogen.CONCLUSION The reported VAP rate in our ICU was relatively high compared to the international benchmark,which should trigger a vital action plan for reinforcing the implementation of the VAP prevention bundle.

Exploring Enablers and Barriers to Municipal Solid Waste (MSW) Management Technologies Adoption in the Kingdom of Bahrain

Municipal Solid Waste (MSW) becomes a point of focus globally due to its harmful effects on the environment and human health if it is not managed properly. MSW was proved globally to be used as a resource, and it has a major opportunity in the realm of conversion technologies. Accordingly, this study aims to explore the enablers and barriers to six different MSW management (MSWM) technologies adopted in the Kingdom of Bahrain, in order to ensure the successful adoption of these technologies that are Anaerobic Digestion (AD), Incineration, Pyrolysis, Gasification, Composting and Refused Derived Fuel (RDF). This study provides sufficient information to the decision and policy-makers for the processes of selection and adoption of the MSWM technologies in Bahrain, using a qualitative approach “mainly semi-structured interviews” with experts and then Thematic Analysis using nvivo12 software. The results show that the main themes that enablers and barriers fall under are: political (e.g. national waste management strategy), technical (e.g. segregation at source), managerial (e.g. capacity building), social (e.g. public awareness), economic (e.g. incentives to investment) and environmental (e.g. air quality). This study concluded that in order to succeed in the MSWM technologies adoption, the resulted barriers should be overcome. Furthermore, Incineration was recommended as the best solution to manage MSW which has the least barriers and most enablers in Bahrain as per the experts.

Effects of Multi-Stage Flash and Reverse Osmosis Desalinations on Benthic Assemblages in Bahrain,Arabian Gulf

Marine environment of the Arabian Gulf is naturally stressed due to marked fluctuations in sea temperatures and high salinities. Anthropogenically induced stresses including waste water discharges from desalination plants could pose additional threats to the coastal and marine ecosystems in the Arabian Gulf. Macrobenthic assemblages in the proximity of two major desalination plants that use Multi-Stage Flash (MSF) and brackish water Reverse Osmosis (RO) technologies in Bahrain were investigated. Reduced levels of biodiversity and abundance were recorded in sampling stations adjacent to the outlet of MSF reflecting severe impacts on macrobenthic assemblages caused by brine effluents that associated with high temperatures, salinities, and a range of chemical and heavy metal pollutants. Although localized severe impacts on macrobenthic assemblages were detected, collective discharges of desalination effluents, may synergistically contribute to the degradation of the naturally stressed marine ecosystems and natural resources in the Arabian Gulf.

Bacterial co-infection in patients with SARS-CoV-2 in the Kingdom of Bahrain

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic presents a significant challenge to the medical profession,increasing in the presence of microbial coinfection.Bacterial and Fungal co-infections increase the risk of morbidity and mortality in patients with COVID-19.AIM To study the bacterial profile in patients with COVID-19 who needed admission to receive treatment in the main centres concerned with managing COVID-19 disease in the Kingdom of Bahrain.METHODS The study was a retrospective observational analysis of the bacterial profile and the bacterial resistance in patients with confirmed COVID-19 disease who needed admission to receive treatment in the main centres assigned to manage patients with COVID-19 disease in the Kingdom of Bahrain from February to October 2020.We used the electronic patients’records and the microbiology laboratory data to identify patients’demographics,clinical data,microbial profile,hospital or community-acquired,and the outcomes.RESULTS The study included 1380 patients admitted with confirmed COVID-19 disease during the study period.51%were admitted from February to June,and 49%were admitted from July to October 2020,with a recurrence rate was 0.36%.There was a significant increase in bacterial and fungal co-infection in the second period compared to the first period.The most common isolated organisms were the gram-negative bacteria(mainly Klebsiella pneumoniae,Pseudomonas aeruginosa,multi-drug resistant Acinetobacter baumannii,and Escherichia coli),the grampositive bacteria(mainly coagulase negative Staphylococci,Enterococcus faecium,Enterococcus faecalis,Staphylococcus aureus)and fungaemia(Candida galabrata,Candida tropicalis,Candida albicans,Aspergillus fumigatus,Candida parapsilosis,Aspergillus niger).The hospital-acquired infection formed 73.8%,61.6%,100%gram-negative,gram-positive and fungaemia.Most of the hospital-acquired infection occurred in the second period with a higher death rate than communityacquired infections.CONCLUSION Bacterial and fungal co-infections in patients admitted with confirmed COVID-19 disease pose higher morbidity and mortality risks than those without coinfections.We should perform every effort to minimize these risks.

Development of intelligent buildings in Bahrain

There is a growing demand for high building performance,providing better energy efficiency as well as high standard living and workplace. Intelligent Buildings (IBs) will meet the needs of sustainable development in built environment. The Kingdom of Bahrain's construction industry has grown significantly in past years to support economic growth,other business sectors,and the aim to be one of the world's major financial centres. This paper aims at investigating current issues regarding intelligent buildings in the Kingdom of Bahrain. Case studies of three buildings,which are Bahrain Financial Harbour (BFH),Bahrain World Trade Centre (BWTC) Project and the Bahrain City Centre (BCC) Shopping Mall,have been carried out via structured observation,interview and questionnaire survey in Bahrain in 2007. Through this study,we conclude that the pace of construction in Bahrain and the Middle East is such that there are lots of scopes for IBs to develop further,both from the perspective of the number of IBs being built and also the sophistication of their specifications.

High prevalence of bla_(CTX-M) in Enterobactcriaceac isolates from the Kingdom of Bahrain

Objective:To determine the molecular epidemiology of extended-spectrumβ-lactamase （ESRL） by testing a cohort of clinical ESBL-producing bacterial isolates that were isolated in the Kingdom of Bahrain.Methods:ESBL producing Enterabacleriaceae isolates（based on phenotypie tests） were collected from Microbiology Laboratory ot the Salmaniya Medical Complex,Bahrain between January-June 2006.Antibiotic susceptibility to a panel of antibiotics was performed and blaCTX-M genes were detected by multiplex PCR.Results:A total of 230 isolates（Escherichia coli.n=180:Klebsiella pneumoniae,n=50） were studied.98%were CTX-M type.For Escherichia coli isolates.65（36.1%） harbored CTXM+TF.M combination and 68（37.8%） had CTX-M alone.In contrast,for Klebsiella pneumoniae isolates only 5（10.0%） harbored the CTX-M combination,and none had CTX-M only.The blaCTX-M gene was found predominantly in urine isolates（n=145/230;63.0%）.Sensitivity to imipenem and nitrofurantoin was 100%and 60%.respectively.CTX-M carriage was associated with the resistance lo fluoroquinolones, trimethoprim-sulfamethoxazole and aminoglycosides.Conclusions:Our study documentes high prevalence of CTX-M ESBL type among Escherichia call and Klebsiella from the Kingdom of Bahrain.The apparent dissemination of CTX-M producers could represent a substantial barrier in the treatment of community-acquired infections.The use of extended-Spectrum cephalosporins. quinolones,and aminoglycosides is compromised,leaving carbapenems as the therapeutic option for severe infections caused by ESBL producers.

Energy consumption,emissions and economic growth in Bahrain

This study examines the Granger causality relationships between economic growth,energy consumption and emissions,from 1980 to 2007 in Bahrain,controlling for capital and urban population using Toda and Yamamoto's approach.It was found that there is unilateral causality which runs from urban population,economic growth,capital and energy consumption to environment.Further,we found strong support for causality running from economic growth to energy consumption,emissions and capital.The existence of these linkages suggests that the government of Bahrain may pursue energy efficiency strategies and carbon emissions reduction policy in the long run without impeding economic growth.Additionally,the long run pursuit of high economic growth given sustained increases in energy efficiency may also reduce CO_2 emissions intensity per unit of her GDP.

Characterization of the Outfall Area of a Multi-Stage-Flash Desalination Plant in Bahrain

In Bahrain, like the other Gulf Cooperation Council (GCC) countries, desalination is inevitable to meet the escalating municipal water demands. However, desalination is associated with many environmental effects, which need to be minimized to their lowest possible limits. One of the major environmental concerns of desalination in the Arabian Gulf region is the local and regional effects of the outfall areas on the marine environment. In this study, the outfall area of a government-owned MSF desalination plant is characterized in terms of temperature and salinity. The spatial extent of the plume of the desalination plant’s effluent is mapped by a field survey conducted during the winter season around the plant’s outfall area at 25 cm and 1 m below the water surface and at low and high tide. The results of the characterization indicated that the temperature of the brine discharged to the outfall was 37°C, higher than the ambient seawater temperature by 16.5°C at high tide and 17.5°C at low tide, and that the extent of the mixing zone area was found at about 260 m and 1 km from the outfall point at high tide and low tide, respectively. The results also showed that brine thermal discharge is not in compliance with the standard limits (<3°C from ambient within 100 m of shoreline) both at high and low tides with differences reaching more than 10°C. In terms of salinity, the brine discharged salinity was 56.2 parts per trillion (ppt) compared to an ambient seawater salinity of 43.2 ppt. The maximum salinity measured near the outfall point was 56 ppt at low tide and 51 ppt at high tide, both at 1 m below the surface water column. It is found that the current design structure consisting of two jetties to isolate the desalination plant outfall area from its surroundings is not environmentally sound, as the current surface/inter-tidal outfall location is susceptible to significant increases in salinity and temperature around the outfall area due to the limited flushing it experiences. Therefore, the current design of the outfall area needs to be reviewed to ensure meeting brine discharge regulations and mitigate its impact on the surrounding marine area. The spatial extent of the brine plume can be minimized by building a discharge area further offshore at a sub-tidal location where turbulent flow exists to minimize the spatial extent and intensity of the brine plume. It is recommended that this characterization be extended to all desalination plants in Bahrain, and a regular monitoring program, which should also include selected biological communities and organisms of ecological relevance, be established around the desalination plants outfall areas.

Measuring the Public Awareness toward Household Waste Management in Muharraq Governorate-Kingdom of Bahrain

Municipal Solid Waste (MSW) generation is growing rapidly as compared to the rate of urbanization. Household waste management is considered a highly challenging task for Bahrain’s policy-makers, urban planners and municipalities due to rising population, burgeoning growth rate of waste generation, limited availability of land and scarce waste disposal sites. Public awareness represents a key enabler in order to succeed any sustainable waste management practice in the country. The survey aimed at gauging public awareness about household waste management in Muharraq Governorate and explored if there are any correlations between educational level, gender, occupation and age and area of living with the level of public awareness as well as its three components: knowledge, attitude and behaviour of the people in Muharraq Governorate. The results indicated the total awareness is significantly different across different age levels and nationality. Moreover, it shows a high public awareness toward household waste management among people in Muharraq Governorate, which indicated that the society is aware and has the basics to build on in terms of sustainable waste management practices and technologies adoption, which may help overcome the possible social barrier represented by low public awareness.

Evaluation of the Environmental Impact Assessment System in Bahrain

Environmental Impact Assessment (EIA) was formally adopted as a measure to protect the environment in Bahrain in 1998. A decade after its implementation, this paper evaluates the current EIA system in Bahrain using a set of criteria. The evaluation was based on review of literature, investigation of legislative and administrative framework and interviews with EIA practitioners. Several measures are required to further strengthen the EIA system in Bahrain including amending EIA laws to include whole aspects of EIA process, developing comprehensive guidelines on procedural EIA, increasing public participation, improving capacity building and integrating environmental concerns to higher-level policy making through existing national environmental strategies. Findings of this study could contribute to wider international experience of EIA performance in developing countries.

Customers Recognition Level of Logos in Kingdom of Bahrain

This study is conducted to measure customer recognition level of business logos in Kingdom of Bahrain in order to identify the best predictor for logo recognition in a local context.A quantitative approach and combination of descriptive and correlational research design is reflected in this study.Customers in Bahraini market whose age range is between 15 and 50 years were deemed to be research population;to form a representative sample,non-probability sampling technique was applied,specifically combination of convenient and judgmental sampling method.While in deciding the size of the sample,ratio sampling was used;total of 384 customers using confidence level of 95%were the research sample.As for data collection,the researcher used structured interview questionnaire as an instrument to extract the raw data and 16 business logos were presented equally to customers,those logos belong to four distinctive industries in Bahrain:food,medical,beauty services,and fashion.As for the demographic profile,most of customers in the sample were female(54.9%)that belonged to the age range between 18-24 years old(33%)with income range between 301 and 600 BD(41.1%)from Capital Governorate(41.9%);in term of education level most of respondents have bachelor’s degree holder(58.1%).The research concluded with significant findings,one of which was that the relationship profile revealed that all of the demographic variables inserted in the research had significant correlation with the customer’s overall logo recognition and in addition to the other aspects associated with recognition,such as logo scope recognition,logo industry recognition,and company name recognition.Moreover,it has been concluded that the scope of all medical logos in the research was mostly moderately by the customer beside many other findings.

Effect of Brine Discharge From Al-Dur RO Desalination Plant on the Infauna Species Composition in the East Coast of Bahrain

The GCC countries have been experiencing an accelerated socio-economic development process since the 1970s,resulting in rapid demographic and urbanization growth and associated with rapidly increasing municipal water demands.To meet these demands’quantity and quality,the GCC countries resorted to desalination.Currently,the GCC countries collectively possess the largest desalination capacity in the world(~45%),and based on the current urbanization trends,it is expected that current rates in desalination capacity growth will continue in the future.However,desalination has a number of environmental externalities on the marine,and their severity will depend on various factors(i.e.,site-specific).The objective of the present study is to investigate the impacts of the brine water discharged by Al-Dur RO desalination plant on the coastal infauna benthic species composition in the east coast of Bahrain.Sediment samples were collected from 10 locations selected at different distances from the discharge outlet.The species composition of infauna was investigated using univariate analysis and multivariate analysis.The results showed an extreme elevation in temperature(>38℃)and hypersaline waters(>55‰)at locations nearby the discharge outlet,and also at bottom waters of depths more than 3 m during the high and low tide cycles in both seasons with exceptional levels in summer.Four main groups of benthic infauna identified are represented by Polychaeta(12 taxa),Bivalves(4 taxa),Gastropod(2 taxa),and Amphipod(3 taxa)including 256 specimens.The univariate analysis indicated spatial variations in infauna species composition where the lower diversity indices were found at locations close to the discharge outlet and at Station 5 where noticeable vertical differences were observed indicating exceptional elevation of hypersaline waters with lesser extent of temperature at bottom layer.However,the highest species diversity indices characterized the most offshore stations.The infauna species composition found to be related to the water quality particularly salinity in the outlet vicinity rather than the bottom texture.Polychaeta could be considered as the most useful bio-indicator to reveal any contamination from desalination brine discharge,due to their sensitivity and their capability to adopt to any environmental alteration.

The Adoption and Use of Social Media and Its Impact on Mainstream Media in Bahrain

The adoption and use of social media has played a major role in the changes in journalists’ work. The use of these new means has become indispensable to the daily tasks and work of journalists in most news organizations. It is no longer possible to bypass these means when it comes to searching for information and news, or in production, publishing, distribution and marketing, or even in interaction with the public. The characteristics of ease, speed, immediacy, interactivity, and being free of charge that characterize them, have made them a useful technological tool, which is influential and necessary not only for the future of the journalist’s career but also for the future of the news organization itself. With the growing number of users of social media around the world, journalists and news organizations have found additional access, more important than previous channels, to access additional sources that help them market and interact with their work in a new dynamic environment completely different from previous communication models, and put audience activity at the forefront. In this study, which is part of the Technology Acceptance Model (TAM), the author tries to understand and analyze the factors of adoption and use of social media as a new technological tool by Bahraini journalists and to identify their new role in the changes in journalism. In addition, the study attempts to examine the implications in relation to the future of the press profession and the economic model of the news organization. The results showed a clear adoption and an increased use of social media by journalists, who consider it a key element in the development of journalism, and an inevitable strategic choice for the future of the news organization. They also expressed their full awareness of the problems surrounding the issue of precision and credibility of news accessed through social media.

The Use of the Internet and the Practice of Journalism in Bahrain

This paper seeks to present the most important results of a field study on the role of using the Internet in enhancing the journalistic assignments in the Kingdom of Bahrain,in accelerating the production and dissemination of news,and in creating new opportunities for communication and interaction with the public.The study also examines Bahraini journalists’perceptions of the changes in their journalistic practice and the positive and negative effects of the Internet on the journalist’s job.In addition,the study examines the possible changes that the Internet makes in relation to the values and ethics of the press.The results showed that the use of the Internet in the press had a positive impact on journalistic practice.Bahraini journalists tend to adopt and use it in their day-to-day work,although they are cautious about the unreliability of news and information on the Internet,their awareness of increased accountability before the public,and their belief in the negative role that the Internet can play in sacrificing accuracy for speed.

Trends of central line-associated bloodstream infections in the intensive care unit in the Kingdom of Bahrain:Four years’experience

BACKGROUND The central venous line is an essential component in monitoring and managing critically ill patients.However,it poses patients with increased risks of severe infections with a higher probability of morbidity and mortality.AIM To define the trends of the rates of central line-associated bloodstream infections(CLABSI)over four years,its predicted risk factors,aetiology,and the antimicrobial susceptibility of the isolated pathogens.METHODS The study was a prospective case-control study,performed according to the guidelines of the Center for Disease Control surveillance methodology for CLABSI in patients admitted to the adult intensive care unit(ICU)and auditing the implementation of its prevention bundle.RESULTS Thirty-four CLABSI identified over the study period,giving an average CLABSI rate of 3.2/1000 central line days.The infection's time trend displayed significant reductions over time concomitantly with the CLABSI prevention bundle's reinforcement from 4.7/1000 central line days at the beginning of 2016 to 1.4/1000 central line days by 2018.The most frequently identified pathogens causing CLABSI in our ICU were gram-negative organisms(59%).The most common offending organisms were Acinetobacter,Enterococcus,and Staphylococcus epidermidis,each of them accounted for 5 cases(15%).Multidrug-resistant organisms contributed to 56%of CLABSI.Its rate was higher when using femoral access and longer hospitalisation duration,especially in the ICU.Insertion of the central line in the non-ICU setting was another identified risk factor.CONCLUSION Implementing the prevention bundles reduced CLABSI significantly in our ICU.Implementing the CLABSI prevention bundle is crucial to maintain a substantial reduction in the CLABSI rate in the ICU setting.

Critical Factors in Promoting Sustainable Innovation in Bahrain

Despite many initiatives to help foster innovation over the last decade,Bahrain has yet to realise its full potential,indicated by low levels of published research,patent registrations,and entrepreneurial activities.The COVID-19 pandemic highlighted the importance of sustainable innovation for economic recovery.This study aimed to identify the critical factors needed to stimulate innovation,as well as any barriers.Using a case study approach,emerging findings from an online survey of participants from a range of private and government organizations were explored through in-depth interviews with selected"innovation influencers".It was found that the economic and cultural environments in Bahrain favor a conservative approach to innovation,with the opening of new market opportunities with existing products the most reported form applied.The need for a sustainable economic recovery post-pandemic has raised awareness of the importance of innovation in all its forms.The environmental factors influencing innovation are charted in an ecosystem model,with effective leadership and a national strategy identified as key components.The Innovation Ecosystem derived from this case study of Bahrain has wider applicability as a benchmarking framework.By mapping the local context against framework elements,identified gaps can usefully inform a sustainable innovation strategy at both a national and organizational level.