SACM - Canada
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Item Restricted Understanding Parental Caregiving for Children with Cerebral Palsy in Saudi Arabia: A Multi-Method Study Combining Insights from a Scoping Review and Qualitative Data(Saudi Digital Library, 2025) Alqahtani, Ashwaq Amer; Afolasade, FakoladeCerebral palsy (CP) is the most common motor disability in childhood, affecting approximately 2-3 per 1,000 live births worldwide. The lifelong nature of CP places significant caregiving responsibilities on families, particularly parents. Understanding parents' experiences and support needs is critical to informing effective interventions and advancing disability research. While CP caregiving has been widely studied, research involving Arab parents of children with CP, particularly in Saudi Arabia, remains scarce. The overarching goal of this thesis was to explore the caregiving experiences of Saudi parents of children with CP and characterize their support needs through a social-ecological lens. This thesis includes two studies, starting with a scoping review that examined existing research on CP caregiving in the Arab contexts, identified gaps in knowledge, and offered recommendations for future studies. Then, a qualitative exploratory descriptive interview study involving 12 Saudi parents from Qassim, Saudi Arabia, aimed to explore their caregiving experiences and characterize their support needs. The scoping review revealed that mothers are predominantly the primary caregivers in Arab contexts, and that caregiver burden is a major concern. However, the qualitative study in Saudi Arabia showed that caregiving responsibilities are shared between both parents, with roles shaped by traditional gender norms. Parents faced significant emotional, physical, material, and informational challenges, with financial strain being particularly pronounced. Barriers to accessing education and health care services further contributed to caregiver stress. However, Islamic spiritual values played a pivotal role in fostering collectivism and community involvement, serving as vital sources of resilience and social support for parents navigating caregiving responsibilities. Overall, the integrated findings showed that effectively supporting Saudi and Arab parents of children with CP depends on understanding their unique experiences and cultural context. To achieve this understanding, families, communities, support organizations, and the government must work together. Future research and program development should consider these contexts to support and effectively address the needs of parents of children with CP in Saudi Arabia.5 0Item Restricted Diagnostic Evaluation of Patients with Epileptic Spasms in the era of next-Generation Sequencing(Saudi Digital Library, 2024-10-11) Alqahtani, Mohammed Azib M; Costain, GregoryObjective: Epileptic spasms (ES) can be caused by a variety of etiologies. However, in almost half of cases, the etiology is unidentified. With the advent of next-generation sequencing (NGS), the recognition of genetic etiologies has increased. Methods: We retrospectively reviewed the medical records of patients with ES who were evaluated in the comprehensive epilepsy program at King Fahad Specialist Hospital Dammam between 2009 and 2022. Results: Our data show that in 57.7% of patients with ES, the etiology was unidentified after a standard clinical evaluation and neuroimaging. Of these patients, n = 25 (35.2%) received a genetic diagnosis after some form of genetic testing, and 3.1% of patients from specialized metabolic work indicated the need for genetic testing to confirm the diagnosis. Karyotyping led to a diagnosis in 3.6% of patients, and chromosomal microarray led to a diagnosis in 7.1%. An NGS epilepsy gene panel (EP) was done for 45 patients, leading to a diagnosis in 24.4% (n = 11). Exome sequencing was done for 27 patients, including n = 14 with non-diagnostic panel testing; it led to a diagnosis in 37.3% (n = 10). Exome sequencing led to a diagnosis in 61.5% of patients without a previous panel test and in only two patients who had previously had a negative panel testing. Significance: In this article, we present the diagnostic evaluations of ES for a cohort of 123 patients and discuss the yield and priority of NGS for evaluating ES. Our findings suggest that exome sequencing has a higher diagnostic yield for determining the etiology of ES in patients for whom the etiology is still unclear after an appropriate clinical assessment and a brain MRI.3 0Item Restricted Three Essays in Mental Health Economics: Education and Labor Market Outcomes(Saudi Digital Library, 2025-06) Alarabim, Hosam; Koreshkova, TatyanaThis dissertation explores how mental and physical health influence key economic outcomes over the life course, focusing on education, occupational outcomes, and workplace productivity. Using longitudinal data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), the study employs advanced modeling techniques, including Generalized Structural Equation Modeling (GSEM) and mixed-effects regression, to construct latent health measures and quantify their economic consequences. The first chapter examines the impact of adolescent mental health on academic achievement, particularly high school completion and college enrollment. It addresses the limitations of using narrow diagnostic proxies for mental health by applying a factor-analytic approach to create latent constructs. The findings reveal that better mental health significantly improves educational attainment, with a stronger effect on college entry than on high school completion. The second chapter investigates how health status shapes occupational sorting across two major classifications: white-collar and full-time employment. It finds that individuals with poor mental health are disproportionately concentrated in low skill, physically demanding, blue-collar jobs, while those with better health are more likely to enter cognitively intensive, white-collar occupations. Physical health also influences job type, reinforcing disparities in labor market access and long-term mobility. The third chapter evaluates the effect of mental health on workplace productivity. By constructing a composite latent productivity score, based on job satisfaction, hours worked, and income, the study estimates the long-term effects of lagged health status. A one standard deviation increase in mental health is associated with a 0.0251 rise in latent productivity and a 0.0201 increase in wage measure of productivity, confirming the strong and persistent influence of psychological well-being. Together, these chapters show that mental health is a critical determinant of economic opportunity, shaping individual outcomes from adolescence through adulthood.5 0Item Restricted The effect of corticosteroids on sinus microbiota in chronic rhinosinusitis patients with nasal polyposis(McGill University, 2019) Alammar, Yousif; Rousseau, Simon; Tewfik, Marc; Rousseau, Simon; Tewfik, MarcBackground: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a multifactorial disease with no known single cause, but it is thought that bacteria play a role in the disease process. The short-term response of bacterial communities to corticosteroid therapy has been found to be unpredictable. As a result, this pilot study aims to assess the long-term effect of corticosteroid therapy on sinus microbiota in chronic rhinosinusitis patients with nasal polyposis (CRSwNP). Methods: A longitudinal prospective case-control study was done on patients with CRSwNP and on healthy subjects. Patients with CRSwNP were randomly allocated to a maximal medical therapy (corticosteroids and antibiotics) treatment group or a corticosteroid-only treatment group. Data was collected at 3 time points (before treatment, 1 and 3 months after treatment): A guarded sinus swab was collected from the middle meatus; the SNOT-22 questionnaire was used to assess clinical symptoms. Specimens were cultured and Matrix-assisted laser desorption ionization–time of flight (MALDI-TOF) mass spectrometry (MS) was used as a bacterial detection method. The raw data produced was analyzed to characterize the sample and to assess the response to each medical treatment. Results: Data from 29 patients with CRSwNP (16 maximal medical therapy; 13 corticosteroids only) was compared to 15 healthy subjects. Patients reported significant symptoms improvement initially (1- month), but not on the long-term (3-months). This result was found as a response to both treatment groups, whether or not antibiotics was used. There was no significant difference in the sinus microbiota prevalence between CRSwNP patients and normal subjects. After three months from treatment, Corynebacterium genera tended to increase in the maximal medical therapy group, while Staphylococcus and gram-negative genera (Pseudomonas) tended to increase after corticosteroid treatment. Smoking, aspirin sensitivity and previous endoscopic sinus surgery were found to be co-factors significantly associated with the response to systemic corticosteroid therapy. Conclusion: In this pilot study both treatment options were effective on the short-term, but not on the long-term with no clear sinus microbiota response linked. As a result, this study agrees with previous reports that discourage the use of systemic antibiotics without evidence of active infection.21 0Item Restricted Exploring Physiologic Markers for the Identification of Vasovagal Syncope(University of Calgary, 2024) Robert S Sheldon, Mohammed Alsaleh; Sheldon, Robert SBackground: Vasovagal Syncope (VVS) is a common cardiovascular disorder, with at least 40% of individuals experiencing at least one episode in their life and about 20% of adults experiencing recurrent episodes. Traditional diagnostic methods such as the Head-Up Tilt (HUT) test and Implantable Cardiac Monitors (ICM) have significant limitations, including limited availability, high costs, and intensive resource requirements. A novel wearable, beat-to-beat blood pressure (BP) monitor is being developed to address these issues. This device, worn on the ear, samples BP at 50 Hz, stores and streams data, and features a rechargeable battery lasting up to 30 hours. This innovative solution will offer a cost-effective, user-friendly alternative for VVS management, potentially improving diagnostic accuracy and patient outcomes. Aims: We aimed to investigate the potential of a wearable beat-to-beat BP monitor in diagnosing vasovagal syncope. The thesis is structured around the following objectives: Objective 1: Provide a detailed narrative review of vasovagal syncope physiology, the BezoldJarisch reflex, and the need for a wearable beat-to-beat BP monitor. Objective 2: Validate the short-term blood pressure fluctuations during scripted physiological changes with a wearable beat-to-beat BP monitor. Methods: The narrative review explores physiological mechanisms underlying VVS, highlighting serotonin's role. For Objective 2 data were collected from 14 participants during activities such as rhythmic breathing and hand grips to validate the ear BP monitor. Spectral and coherence analyses assessed synchronization between the ear monitor and the Modelflow system, with non-parametric methods evaluating statistical differences. ii Results: The narrative review identified key markers for monitoring VVS. The narrative review identified key markers for monitoring vasovagal syncope (VVS), which guided the validation of the ear BP monitor. Data was successfully collected from 14 out of 20 participants, comprising 47% male and 53% female subjects, with an average age of 24.29 ± 5.61 years. The device demonstrated high coherence values (>0.95) across all activities, indicating strong synchronization with the Modelflow system. No significant differences were observed in systolic BP measurements, with p-values of 0.37 for low-frequency components and 0.18 for high-frequency components, confirming the ear BP monitor's ability to capture BP fluctuations during dynamic physiological changes accurately. Further analysis identified the fundamental heartbeat frequency as 1.4 Hz, with harmonics at 2.8 Hz, 4.2 Hz, and beyond. The coherence of these harmonics highlighted the consistency of the heartbeat-induced waveform shapes, indicating that the arterial blood pressure measurements from the Modelflow and EarBP devices were stable and reliable. Coherence across frequencies revealed comparable signal synchronization between the two devices, with significant coherence observed at the fundamental frequency and its harmonics. Coherence values were tightly clustered near the median across all conditions, with the Valsalva maneuver showing slightly more significant variability due to lower coherence values in some participants. These results collectively validate the ear BP monitor as a reliable tool for arterial pressure measurement and synchronized waveform analysis. Conclusion: This thesis advances the understanding of vasovagal syncope (VVS) physiology and validates using a novel ear-based blood pressure monitor. The narrative review identified key physiological markers and mechanisms, including the Bezold-Jarisch reflex and serotonin signaling, central to VVS episodes. The validation study demonstrated high accuracy and synchronization of the ear BP monitor with established standards, offering a non-invasive, iii wearable alternative for real-time blood pressure monitoring. While promising, further research is required to expand its validation across diverse populations and address potential limitations such as motion artifacts. These findings support the use of an ear BP monitor as an innovative tool with the potential to diagnose vasovagal syncope2 0Item Restricted THE NEUROPHYSIOLGY OF SELECTIVE ATTENTION IN HUMAN SUBCORTICAL MOTOR NUCLEI(University of Toronto, 2025) Alanazi, Frhan; William, HutchisonSelective attention and working memory are fundamental cognitive processes traditionally attributed to cortical regions. Emerging evidence suggests that subcortical motor nuclei, such as the thalamus and basal ganglia, also play crucial roles in these functions, but the mechanism is still unclear. This thesis aimed to examine the neurophysiological mechanisms of selective attention and working memory in subcortical motor nuclei through intraoperative single-unit and local field potential (LFP) recordings in humans. In the first study, neuronal activity was recorded from the ventral intermediate nucleus (Vim) and ventral oral anterior/posterior nuclei of the motor thalamus in 25 patients with parkinsonian and non-parkinsonian tremors during an auditory oddball task. Results showed a significant decrease in neuronal firing rates and in beta-band (13–35 Hz) oscillations to the deviant tones, indicating the involvement of Vim in auditory selective attention. Parkinson’s disease (PD) patients off medication exhibited increased beta power but reduced modulation to attended tones, suggesting dopamine's role in modulating thalamic beta oscillations for selective attention. The second study focused on the centromedian nucleus (CM) of the thalamus in 11 epilepsy patients performing a similar auditory attention task. CM neurons demonstrated selective, multiphasic firing and beta/low gamma (13–45 Hz) modulations to deviant tones in 81% of neurons tested. These findings highlight the CM's participation in cognitive function, supporting its role under top-down control and implicating beta and gamma oscillatory activities in cognitive processing. The third study investigated neuronal activity in the subthalamic nucleus (STN) and Vim during a visual 1-back task in 16 patients with PD or essential tremor. Both nuclei exhibited selective firing rate changes and beta desynchronization in response to target stimuli. Vim beta desynchronization occurred earlier than in the STN, even preceding the stimulus, suggesting a role in stimulus prediction. Collectively, these studies provide evidence that subcortical motor nuclei are actively involved in selective attention and working memory and have significant implications for understanding the neural circuitry underlying cognitive functions and the pathophysiology of neurological disorders like Parkinson’s disease and epilepsy. Furthermore, they offer potential insights for developing deep brain stimulation therapies targeting cognitive symptoms associated with these conditions.14 0Item Restricted A Security Risk Assessment Framework for IoT Systems(University of Regina, 2024-08) Waqdan, Mofareh Abdullah; MouhoubThe emergence and growth of the Internet of Things (IoT) have changed how we live and interact with technology. The seamless integration of connected devices, from household to industrial equipment, has brought about a new era of interconnectedness. However, this rapid expansion of the IoT also introduces new security concerns that need to be assessed. Assessing the security risks associated with deploying and using this technology is crucial. Consequently, organizations need a risk assessment framework that helps identify, evaluate, and manage the risks of IoT, including data privacy and confidentiality, system integrity, availability, and performance. The state-of-the-art has been given significant attention to security risk assessment in traditional cybersecurity with powerful computer systems, but the challenges of deploying IoT devices and their associated vulnerabilities have been overlooked. In this thesis, we first present a novel IoT security risk assessment framework for the healthcare environment, in which we have improved upon existing methodologies. The proposed framework dynamically calculates the risk score for different device profiles, considering their population and other parameters, such as network protocols, device heterogeneity, device security updates, device physical security status, device history status, layer history status, and device criticality. Second, we present a customizable framework for assessing the security risk of deploying and utilizing IoT devices in various environments. We dynamically calculate risk scores for different devices, considering their importance to the system and their vulnerabilities, among other parameters. The customizable framework considers the important parameters of the devices, their vulnerabilities, and how they impact the overall risk assessment. The importance of these devices and the severity of vulnerabilities are incorporated in the framework using the well-known Multi-Attribute Decision Making (MADM) methods, namely, Simple Additive Weighting (SAW) and Weighting Product (WP). Finally, the risk is assessed on a setup comprised of IoT devices widely deployed in healthcare systems, such as emergency rooms.13 0Item Restricted Modulation of Aryl Hydrocarbon Receptor-Regulated Genes by Methylmercury(University of Alberta, 2024) Alqahtani, Mohammed Ali; Ayman, ElKadiEnvironmental pollution poses a significant threat to public health, with various contaminants contributing to a wide range of adverse health effects. Among these contaminants, ؤ (MeHg) and the aryl hydrocarbon receptor (AHR) ligand 2,3,7,8-tetrachlorodibenzodioxin (TCDD) are particularly concerning due to their persistence in the environment and potent biological activities. Both compounds have been extensively studied for their individual effects, but the potential health risks associated with their combined exposure are less understood. The primary objective of this work was to investigate the individual and combined effects of MeHg and TCDD on AHR-regulated enzymes. This investigation was conducted using the murine hepatoma Hepa-1c1c7 cell line and extended to mouse hepatic and extrahepatic tissues. The effects of MeHg on Ahr-regulated gene expression were examined in the absence and presence of TCDD, along with evaluations of protein expression and enzymatic catalytic activity. In hepatic tissue, both MeHg and Hg2+ inhibited the TCDD-mediated induction of Cyp1a1/1a2 mRNA levels. However, only Hg2+ inhibited the TCDD-mediated induction of CYP1A1/1A2 protein and catalytic activity at posttranscriptional levels, indicating differential modulation by Hg2+ and MeHg. Additionally, the inhibitory role of HO-1 (heme oxygenase-1) on CYP1A activity induced by TCDD was investigated in vitro using the HO-1 competitive inhibitor tin-mesoporphyrin, which partially restored the MeHg-mediated decrease in CYP1A1 activity. In extrahepatic tissues, MeHg exhibited mainly inhibitory effects, particularly decreasing the basal level of Cyp1a1 and Cyp1a2 mRNA and protein, which was more evident at the 24-hour time point in kidneys, followed by hearts. Similarly, when mice were co-exposed, MeHg reduced the TCDD-induced Cyp1a1 and Cyp1a2 expression. However, MeHg potentiated kidney Cyp1b1 mRNA expression, opposing the observed change in its protein level. Exposure to MeHg induces several antioxidant enzymes, including NAD(P)H:quinone oxidoreductase (NQO1), whose expression is regulated by both AHR and nuclear factor erythroid 2-related factor-2 (NRF2). This co-regulation prompted an investigation into which transcription factor primarily orchestrates NQO1 expression upon MeHg exposure. Our findings demonstrate that NQO1 induction by MeHg is, at least in part, mediated by NRF2. In conclusion, the findings of this work reveal an intricate interplay between MeHg and TCDD on AHR-regulated CYP1 enzymes, with notable inhibitory effects that might be significant for procarcinogen metabolism. Varied responses across tissues highlight the potential implications for environmental health.9 0Item Restricted Sociocultural Determinants of Children’s Oral Health Among Immigrants: Developing and Testing a Conceptual Model(university of alberta, 2024) Dahlan, Rana; Amin, MaryamBackground: The Canadian Collaboration for Immigration and Refugee Health highlights oral health diseases among the top 11 health challenges for immigrants and refugees. Foreign-born individuals face higher vulnerability due to migration-related disruptions and limited dental access. Cultural shifts, known as "acculturation," impact immigrants' health, varying in degree. Understanding this requires considering post-migration socio-cultural context. Social connections change post-migration, affecting oral health, well-being, and quality of life. Recognizing these shifts is crucial for stakeholders: dentists, community workers, and researchers. Social support is vital for new immigrants, aiding adaptation, and healthcare access. Both parental acculturation and support shape children's oral health. Their combined impact on oral health remains underexplored in existing literature. Objective: The overarching objective of this research was to construct and assess a conceptual model aimed at predicting oral health behaviors and caries experience of immigrants’ children. The goal was to develop a model that explains the sociocultural factors influencing children’s oral health among immigrants, using Structural Equation Modeling (SEM). Methods: This study unfolded in three phases, beginning with ethics approval from the University of Alberta Research Ethics Board (Protocol # Pro00072345). The first phase encompassed two systematic reviews: one focused on acculturation's impact on oral health among immigrants and ethnic minorities, while the other explored social support's influence on oral health in these groups. The second phase, a cross-sectional study, investigated how parental acculturation and perceived social support affected their children's oral health behaviors and caries experience. Participants included first-generation immigrant parents residing in Canada for two or more years, with children aged 2–12 years. Data collection took place in convenient community settings through multilingual community workers using non-probability snowball sampling. Parents provided demographic, perceived social support, acculturation, and children's oral health behavior data. Trained dentists conducted dental exams and used the DMFT/dmft index to assess caries experience. Oral health behaviors were measured with an eight-item questionnaire. The main independent variables were parents' perceived social support (PSS),measured using the validated Personal Resource Questionnaire (PRQ2000) and parents' acculturation and strategies were evaluated with the Asian American Multidimensional Acculturation Scale (AAMAS). The data collected in the second phase informed the creation of a conceptual model in the third phase, aimed at predicting immigrant children’s oral health behaviors and caries experience through Structural Equation Modeling (SEM), examining parental acculturation and perceived social support's influences. Results: A total of 336 parent/child pairs participated in the study. The average parental acculturation level was 10.46, and the average perceived social support (PSS) score was 63.27. Factors like length of residency, parents' education, and household income significantly predicted acculturation level. Parents with higher Canadian cultural knowledge reported more frequent children's toothbrushing. Parents of children consuming >1 sugary item/day had higher acculturation levels, English language proficiency, and Canadian food adoption. Parents of recent dental visitors reported higher assimilation and lower separation scores, while those visiting due to problems had higher marginalization scores. Parental acculturation wasn't significantly linked to children's dental decay (DMFT/dmft). Household income predicted parental PSS (B = -5.69). Children of parents with higher PSS brushed teeth ≥2/day. Parental education predicted social integration and nurturance; income predicted social integration, worth, and assistance. Parents with more intimacy and social integration were more aware of children's oral health. Parental social integration scores were higher when children consumed ≥1 sugary snack/day. All domain scores were higher when children brushed teeth ≥2/day. Structural Equation Modeling (SEM) indicated 77% of DMFT/dmft variance was explained by parental PSS, acculturation, predisposing/enabling factors, and children's oral health (OH) behaviors. Parental PSS had a direct effect on reduced dental caries and sugar consumption. Parental acculturation mediated by positive OH behaviors increased caries risk. Conclusions: The SEM analysis found significant variance in immigrants’ children's caries experience. Findings highlight parental acculturation and PSS levels predicting oral health behaviors and caries. Recognizing sociocultural factors is vital for stakeholders—dentists, community workers, and researchers. Immigrants' vulnerability to oral health issues underscores the need for deeper exploration and expanding the model.2 0Item Restricted Exposure to Allergens and Proinflammatory Mediators Modulate Airway Epithelial Cell Innate Responses, Metabolism, and Physiology(University of Alberta, 2024) Alzahrani, Khadija Rashed; Vliagoftis, HarissiosLungs and airways health and protection depend on the integrity of airway epithelium. Insulin is a growth hormone that through activation of several signaling pathways play a central role to maintain cellular growth and activate metabolism. Airway epithelium is in constant exposure to inhaled agents like pathogens, allergens, pollutants, and particular matters. Airborne allergens like cockroach or house dust mite (HDM) contain proteases that can interact with airway epithelium and initiate immune responses through activation of airway epithelial cells and innate immune cells. Airway epithelium cytokines and innate immune cells promote activation of adaptive immune cells like Th2 lymphocytes that produce proinflammatory mediators like interleukin-4 (IL-4), IL-13, and IL-5. T helper 2 (Th2) cytokines amplify the immune responses and stimulate airway epithelial cells to release CCL chemotactic factors/eotaxins that attract eosinophils to the site of inflammation. Airway epithelium exposure to inhaled irritants and excessive inflammatory responses is known to disrupt epithelium integrity and exacerbate inflammatory responses. Th2 inflammation in asthma is associated with epithelial injury, epithelial remodeling, and metabolic alterations. Increased expression of inflammatory mediators tumor necrosis factor (TNF) and IL-6 in metabolically active tissues have been associated with cellular damage and insulin resistance. Inducible AECs local inflammation was shown to trigger systemic inflammation, insulin resistance, and impaired glucose metabolism, and the severity of inflammation correlated with impaired glucose metabolism. Several studies showed that insulin resistance increased the risk of aeroallergen sensitization and developing asthma-like symptoms. In this project we hypothesized that exposure of airway epithelial cells (AECs) to allergens and proinflammatory mediators may modulate Th2 immune cell responses, induce insulin resistance and metabolic shifts. First, we examined the effect of cockroach and house dust mite on IL-13 and IL-4-induced inflammatory responses. AECs were cultured and stimulated with cockroach or house dust mite, IL-13, IL-4, or a combination of an allergen and IL-13 or IL-4. IL-13 and IL-4 induced effects were measured. Then, we tested the effect of cockroach, house dust mite, TNF or IL-6-induced inflammatory responses on physiological epithelial changes and insulin-induced effects. Epithelial proliferation, resistance, energetic phenotype changes, and insulin induced activation of PI3K/Akt were examined. We showed that serine proteases of cockroach extract prevented IL-13-induced expression of eosinophil chemokine CCL26 from AECs. Depletion of CCL26 was previously shown to delay resolution of airway allergic inflammation which may result in prolonged eosinophilia. Prolonged inflammation was linked to altered metabolism and insulin action in several studies. We showed for the first time that house duct mite and TNF modulated insulin effects in AECs. TNF and HDM changed insulin-induced ATP production in AECs. Additionally, TNF reduced insulin-induced Akt phosphorylation, reduced epithelial barrier function and recovery after injury. Our data suggest that cockroach serine proteases and TNF may interfere with the Th2-mediated proinflammatory effects, regulate AECs energetic phenotype, and induce insulin resistance. These inflammatory and metabolic changes exacerbate the pathogenesis of asthma which may alter immune cell responses.5 0