SACM - United Kingdom
Permanent URI for this collectionhttps://drepo.sdl.edu.sa/handle/20.500.14154/9667
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Item Restricted What effect do electronic health record (EHR) on medication adherence when treating chronic disease (Hypertension and Diabetes)?(Saudi Digital Library, 2026) Aljuwayr, Meshari; Jenkins, JudyMedication adherence is essential for effective chronic disease management but remains suboptimal among patients with conditions such as hypertension and diabetes. This study examines the impact of Electronic Health Records (EHRs) on medication adherence through a structured literature review of recent peer-reviewed studies (2020–2025). The findings suggest that EHR use, particularly through features such as automated reminders, refill alerts, and patient portals, is associated with improved adherence and better clinical outcomes. Patient satisfaction also plays an important role in sustaining engagement with EHR systems. However, gaps remain in terms of methodological consistency and long-term evidence. Overall, EHRs demonstrate strong potential to enhance medication adherence, although further research is needed to better understand their long-term effectiveness and behavioural impact.6 0Item Restricted Conversational Metaphorical Speech Acts in Saudi Arabic(Saudi Digital Library, 2026) Alshahrani, Nada Nasser; May, MelanieThis study explores how metaphor functions in informal Saudi Arabic conversations, focusing on its role in everyday spoken and written interactions. While previous research has emphasised metaphor in public discourse, this study highlights its use in casual, culturally embedded contexts to manage interaction, express emotion, and perform social actions. To describe metaphorical expressions that enact communicative functions, the study introduces the term Conversational Metaphorical Speech Acts (CMSA). The analysis applies a multidimensional framework integrating structural, contextual, conceptual, and functional aspects. Data were collected from natural social visits, celebratory gatherings, and WhatsApp chats involving Saudi women aged 20 to 80. A total of 173 metaphorical expressions were identified, including 148 verbal and 25 multimodal metaphors (emojis and stickers). Findings show metaphors occurred in bursts, clusters, and at key turn positions, shaping interaction. A generational tendency emerged: younger speakers used modern, humorous metaphors; older participants favoured traditional, proverb-based expressions. Conceptual mappings linked concrete source domains (such as body parts) to abstract targets (such as emotions), with directionality and reversibility. Functionally, metaphors most often enacted expressive acts, followed by representative, directive, and less commonly, commissive acts. Visual metaphors (emojis and stickers) enhanced meaning in digital interactions. This study contributes a culturally grounded model of metaphor as pragmatic, interactive, and multimodal communication.5 0Item Restricted A GWAS Summary Statistics Library for Cross-Trait Analyses(Saudi Digital Library, 2025) Altuwaijri, Yara Abdullah; Nick, Dand; Simpson, MichaelGenome-wide association studies (GWAS) have generated vast amounts of genetic data, yet inconsistent formats and fragmented metadata continue to limit large-scale reuse. This project directly addresses that gap by contributing to the foundation of a standardized GWAS summary statistics library, optimized for high-performance computing (HPC) environments. The overarching aim is to enable systematic, scalable access to GWAS data, allowing researchers to perform a range of common analyses without manual intervention. More sophisticated methods can still be applied separately, but this work ensures the data is gathered and formatted in a consistent, usable way. To achieve this, an automated harmonization pipeline was developed to resolve formatting and structural differences in publicly available GWAS files. An initial audit revealed substantial heterogeneity in file formats, with only 42% of datasets following the most common structure; the remainder required extensive correction. Post-harmonization, all files were standardized with 100% consistency, supporting automation of downstream analyses. Benchmarking of storage requirements and query speed across various summary statistic file formats showed that VCF-based formats—especially compressed and indexed VCF—offered the best performance for common queries, while uncompressed VCF outperformed others for large, multi-variant extractions. These findings inform practical format choices for efficient data integration at scale. A pilot colocalisation analysis targeting the ALDH2 locus confirmed the infrastructure’s utility, revealing strong evidence of pleiotropy across skin diseases. Together, these results demonstrate a scalable framework for the systematic collation and retrieval of GWAS summary statistic data and their use in cross-trait genetic discovery.5 0Item Restricted Neuroplasticity and multisensory training invirtual reality: a multimodal MRI investigationacross healthy and hemianopic populations(Saudi Digital Library, 2026) Alharshan, Fahad; Meyer, Georg; Rowe, FionaThis thesis investigates behavioural, structural, and functional plasticity induced byvisuomotor and audiovisual (AV) training in healthy adults and stroke survivors withhomonymous hemianopia (HH). A multimodal neuroimaging framework was applied,combining Diffusion Kurtosis Imaging (DKI), Diffusion Tensor Imaging (DTI), task-basedfunctional MRI (fMRI), and functional connectivity (FC) analyses to characterise training-related brain adaptation.In healthy adults, 6 weeks of voluntary eye-movement training produced reliablemicrostructural changes. DKI revealed significant reductions in kurtosis and diffusivitywithin early visual cortices, particularly the cuneus, with greater sensitivity than DTI inregions such as the pericalcarine cortex. Systematic differences in Bland–Altman analysisconfirmed training-related effects localised to the trained visual field. Using the same cohort,task-based FC analyses showed strengthened coupling between the frontal eye field (FEF)and posterior occipital cortex, and between the cuneus and cerebellum. These increasesscaled with individual improvements in reaction time, demonstrating taskspecific networkreorganisation aligned with behavioural learning.In stroke survivors with HH, 6 weeks of immersive VR-based AV training yielded significantbehavioural improvements across trained and untrained tasks. DTI indicated plasticity inpreserved occipital, thalamic, and temporal regions, reflected in increases in fractionalanisotropy (FA) and reductions in axial diffusivity (AD). FC analyses identified strengthenedconnectivity between medial visual cortex and occipital and auditory regions, with structuraland functional changes overlapping spatially, suggesting convergent compensatorymechanisms. Exploratory fMRI contrasts revealed spatially restricted activation changesconsistent with practice-related efficiency rather than large-scale restoration of damagedpathways. Lesion volume was negatively associated with responsiveness across behaviouraland imaging measures.Together, these studies demonstrate that both visuomotor and AV training induce rapidstructural and functional plasticity, with early visual cortices and the cerebellum emerging asshared hubs of adaptation. In HH, additional recruitment of multisensory pathways reflectscompensatory reorganisation of spared networks. These findings highlight the potential ofimmersive VR and multisensory methods for enhancing neurorehabilitation in chronic visualfield loss.3 0Item Restricted Application of Vibration-Based Machine Learning Model for Fault Diagnosis in Rotating Machines(Saudi Digital Library, 2026) Almutairi, Khalid Makhlad; Jyoti, SinhaReliable operation of rotating machinery is essential for industrial process efficiency. While vibration-based condition monitoring (VCM) is the standard for fault detection, it typically requires specialist knowledge and manual interpretation that can vary between analysts. This thesis addresses this limitation by developing an automated, robust vibration-based machine learning (VML) framework capable of diagnosing both rotor and bearing faults with minimal intervention. The research first extends an artificial neural network (ANN) model using optimised time- and frequency-domain vibration parameters to classify rotor faults (misalignment, shaft cracks, rub) and anti-friction bearing defects. Experimental validation was conducted on a multi-rotor test rig across three distinct operating speeds: 450 RPM (below the first critical speed), 900 RPM (between critical speeds), and 1350 RPM (above the second critical speed). The model demonstrated 100% classification accuracy for all fault types under these varying dynamic conditions. To facilitate industrial application, a hierarchical three-step diagnostic methodology is developed. Using a unified ANN configuration and feature set, the system sequentially performs: (1) Fault Detection (classifying machine state as healthy or faulty), (2) Fault Diagnosis (identifying the specific defect type), and (3) Fault Location (pinpointing the defect's position). This structured approach streamlines maintenance decision-making and is validated with 100% accuracy in detection, diagnosis, and location across all tested speeds. Furthermore, the study integrates the poly-coherent composite spectrum (pCCS) technique to fuse multi-sensor vibration data. This approach preserves amplitude and phase information while reducing noise, allowing for a significant reduction of input features: specifically, from 24 parameters across four sensors to a compact set of eight standardised parameters. Finally, the methodology's generalisability is proven on a second, mechanically distinct test rig featuring a split roller bearing. The standardised parameters and identical ANN model successfully transferred to this new configuration, accurately identifying healthy, misalignment, unbalance, and inner-race bearing fault conditions with 100% accuracy at speeds of 12 Hz and 18 Hz, and 96.7% accuracy for unbalance detection at 6 Hz. This confirms the framework's robustness and its potential as a universal diagnostic tool for diverse rotating machinery.4 0Item Restricted Comparative Study of the United States and China’s Security Investments in the Arabian Gulf during 2020-2025: Case Studies of Saudi Arabia, the United Arab Emirates, and Qatar(Saudi Digital Library, 2025) Bakolka, Mashail; Jennifer, CassidyThis research explores the motivations and strategies of the United States (US) and China in the Gulf region with a particular emphasis on Saudi Arabia (KSA), the United Arab Emirates (UAE), and Qatar. Guided by the theoretical framework of offensive realism, the findings are based on the assumption that state actors in an inherently chaotic international system will always seek to maximise their power and competitive advantage in order to safeguard their stability and interests. This thesis is equally applicable to powerful international players like the United States and China as well as the three selected case study countries in the Gulf. The analysis reveals that the United States has remained the predominant security guarantor in the region as it can pre-emptively contain regional threats or aggressive actors such as Iran through its direct presence and leverage, in addition to its commitment to maintaining the security of its Gulf Arab partners. As such, it has continuously invested in arms deals, military bases, joint operations, and training programmes with each of the three chosen Gulf states, and its strongest base and presence remains on the territory of Qatar. In comparison, China has proven cautious in encroaching upon these bilateral ties, instead framing its collaboration with the three countries as an economic one under its global Belt and Road Initiative. In some instances, however, cooperation and deals have extended to the realm of security with secretive arms deals or dual-use technological and infrastructure investments that could be construed as posing a threat to US regional goals. So far, Saudi Arabia, the United Arab Emirates, and Qatar have tried to sustain a balancing or hedging strategy which would not endanger their beneficial relationship with and reliance upon the US for the sake of their own security, but at the same time they have attempted to diversify their options with China proving an eager though limited partner.3 0Item Restricted An investigation into the factors influencing decision making regarding the management of carious primary teeth under general anaesthetic(Saudi Digital Library., 2026) Almohammed, Bushra Abdulaziz; Barber, Sophy; Balmer, RichardCaries in primary teeth remains a common reason for Paediatric Dental General Anaesthesia (PDGA) in the United Kingdom (UK). Different treatment options are available for carious primary teeth under general anaesthesia (GA), ranging from restorative treatments to extraction. Variation in treatment planning has been observed in practice, but the reasons underlying these decisions are not well understood. Aim: To explore the factors that influence paediatric dentists’ decision-making, when planning treatment for children with carious primary teeth under GA in the UK. Method: A qualitative cross-sectional study, informed by an interpretivist- constructivist approach. using focus groups was conducted with paediatric speciality trainees, specialists and consultants within the UK, who were all recruited through the British Society of Paediatric Dentistry (BSPD). Focus groups were conducted online and recorded, then transcribed. Data were analysed using reflexive thematic analysis to explore clinicians’ reported views and experiences of treatment planning carious primary teeth under GA. Results: Nineteen participants took part in three focus groups. Participants described variation in treatment planning under GA, which they related to different treatment philosophies, training backgrounds and organisational arrangements. Modified Hall technique, was the treatment of choice, when aiming to preserve teeth. Participants described reluctance to provide vital pulp therapy (VPT) under GA, despite supportive evidence-based guidelines, because of predictability concerns and risk of repeat GA. Decision making was reported to be influenced by experience, workplace hierarchy and service pressures, including waiting lists, workforce limitations and the type of GA list available. Participants also emphasised the importance of parental expectations, shared decision-making and perception of families’ ability to maintain oral health. Conclusion: Treatment planning for carious primary teeth under GA was described to be influenced by interactions between clinical, family and service-related factors. The findings provide insights into how UK paediatric dentists explain their decision-making and highlight the importance of aligning treatment planning with current evidence, supporting shared decision-making and address organisational barriers to comprehensive care.13 0Item Restricted The Legal Framework for Public-Private Partnerships (PPPs) as an economic, social, and environmental Sustainability Transition in Saudi Arabia(Saudi Digital Library, 2026) Alluhidan, Nouf Ahmed; Chimia, Annamaria; Trepte, PeterThis research examines the legal framework for public–private partnerships (PPPs) in the Kingdom of Saudi Arabia as a sustainable transition mechanism across three levels: social, economic, and environmental, by analysing all national regulations applicable to PPPs. The private sector could play a significant role in societal prosperity through its direct and indirect effects, making PPPs a crucial component in building sustainable infrastructures in countries. This has led the United Nations to recognise the need for all parties, including governments and the private sector, to cooperate in an international partnership to achieve the Sustainable Development Goals (SDGs). However, PPPs cannot effectively contribute to the SDGs unless governments implement internal legal reforms and enhance the legal environment. Therefore, the purpose of this research is to examine the current legal framework for PPPs under Saudi law and assess the extent to which it supports the Kingdom’s Vision 2030 and the SDGs. Numerous PPPs have recently been adopted in the country for the first time, with many more in the tendering process at various stages. In this regard, due to the recent adoption of PPPs, there was a strong need to conduct interviews to investigate their application across different sectors in the country. Semi-structured interviews were conducted with government procurement officials, policymakers, and other experts in the field to determine the extent to which PPPs can serve as effective instruments for achieving sustainability in Saudi Arabia. PPPs clearly offer various advantages, including leveraging private sector expertise and funding, enhancing quality, fostering innovation and local content, and enabling risk sharing. However, challenges remain, such as unstable environmental and social regulations, a lack of environmental and social requirements in contracts, negative impacts on public employees, and a wide number of applicants in the short term. In conclusion, the legal framework governing PPPs is critical to ensuring Saudi Arabia’s efforts to achieve its Vision 2030 objectives, some of which align with international standards, while others require serious consideration and reform.62 0Item Restricted The Role of the NLRP3 Inflammasome in PCOS: A Possible Novel Association(Saudi Digital Library, 2026) Alenezi, Salih Atalah R; Amer, SaadAbstract Background: Polycystic ovary syndrome (PCOS) is a common endocrine–metabolic disorder of women of reproductive age, characterised by ovulatory dysfunction, hyperandrogenism, and frequently accompanied by obesity and insulin resistance. Increasing evidence suggests an association between PCOS and chronic low-grade inflammation. The NLRP3 inflammasome is a cytosolic protein complex of the innate immune system that activates inflammatory cytokines (notably IL-1β and IL-18) in response to metabolic stress. As NLRP3-driven inflammation has been implicated in obesity, diabetes and related disorders, this thesis explored the hypothesis that NLRP3 inflammasome activity contributes to the pathophysiology of PCOS. The aim was to evaluate this potential association through systematic reviews, meta-analyses and experimental studies. Methods: Three systematic reviews with meta-analyses were conducted. The first examined NLRP3 and its components (Caspase-1 (CASP-1), ASC, IL-1β) in adipose tissue or blood from obese versus non-obese individuals, and in women or animal models with PCOS. The second assessed the impact of diet-induced weight loss in PCOS on circulating inflammatory markers (CRP, IL-6, IL-1β, TNF-α) and reproductive hormones (testosterone, androstenedione, LH, SHBG). The third evaluated the impact of elevated body mass index (BMI) on pregnancy outcomes and complications in women with PCOS undergoing in vitro fertilisation (IVF). Standard systematic search methodology and quality appraisal tools (Cochrane/NOS) were applied, and pooled analyses were performed using RevMan software where appropriate. Original laboratory studies were also undertaken to investigate inflammasome activity in adipose tissue. Gene expression of NLRP3, IL-1β, CASP-1, and ASC was measured using qPCR and protein expression of NLRP3 by Western blotting in visceral and subcutaneous adipose tissue from PCOS and non-PCOS women. In addition, circulating IL-1β and IL-18 were assessed by ELISA. Key Findings: NLRP3 in Obesity and PCOS (Systematic Review, Chapter 2): Meta-analysis demonstrated that the expression of NLRP3 inflammasome components in adipose tissue was significantly higher in obese individuals compared with non-obese controls. Specifically, NLRP3, ASC and IL-1β were elevated in obese adipose tissue. Although the number of human studies was limited, most studies of women with PCOS and rodent PCOS models also reported upregulation of NLRP3 and its associated components, supporting a potential link between obesity, PCOS and inflammasome activation. Weight Loss, Inflammation and Hyperandrogenism (Systematic Review, Chapter 3): Analysis of nine studies (n=286) evaluating dietary weight loss in PCOS showed that modest weight reduction significantly improved inflammatory and hormonal profiles. Circulating CRP, IL-6 and TNF-α levels decreased post-intervention. Additionally, androstenedione and LH levels were reduced, whilst SHBG increased. These findings indicate that dietary weight loss seems to ameliorate both chronic inflammation and hyperandrogenism in PCOS. BMI and IVF Outcomes in PCOS (Systematic Review, Chapter 3): Analysis of nineteen studies (n=7680) demonstrated that elevated BMI in women with PCOS undergoing IVF was associated with adverse reproductive outcomes. PCOS women with normal BMI had higher odds of clinical pregnancy and live birth, while high BMI was associated with increased risk of miscarriage, gestational diabetes, and gestational hypertension. These findings highlight the significant impact of metabolic status on clinical reproductive outcomes in PCOS. Adipose Tissue Inflammasome Gene Expression (Chapter 5): Contrary to the initial hypothesis, CASP-1 gene expression was significantly higher in non-PCOS versus PCOS women across all adipose depots (VAT and SAT). On the other hand, expression of NLRP3, IL-1β and ASC did not differ significantly between women with and without PCOS. These findings suggest a more complex role for the NLRP3 inflammasome in PCOS with a more nuanced regulatory pattern than previously assumed. Adipose Tissue Protein Expression (Chapter 6): At the protein level, NLRP3 expression in the combined subcutaneous and visceral adipose tissue, and in visceral adipose tissue alone, was significantly higher in non-PCOS versus PCOS women, again contradicting the original hypothesis. Plasma IL-1β was undetectable and IL-18 was measurable but not significantly different between groups. These data mirrored the transcript findings, raising the possibility of a more complex inflammatory mechanism in PCOS. Conclusions and Implications (Chapter 7): Taken together, this thesis provides novel insights into the association between the NLRP3 inflammasome and PCOS. The systematic reviews demonstrated that obesity and PCOS are generally accompanied by activation of inflammasome pathways, and that weight loss can reduce both inflammation and androgen excess, and that elevated BMI is associated with poorer reproductive outcomes, including those following IVF. However, the original experimental studies revealed unexpected findings, with higher CASP-1 and NLRP3 expression in non-PCOS women, suggesting that inflammasome regulation in PCOS may be more complex than previously assumed. Potential explanations include compensatory downregulation, metabolic influences such as hyperinsulinemia, or the involvement of alternative inflammasome pathways. In conclusion, this work advances understanding of inflammatory mechanisms in PCOS by highlighting a potential but intricate role for the NLRP3 inflammasome. These findings underscore the need for future studies to disentangle the regulatory interactions between metabolism, immunity and reproductive dysfunction in PCOS, and to assess whether targeted metabolic or anti-inflammatory therapies might have clinical utility in managing this syndrome.5 0Item Restricted On the Human Neuromuscular Junction: Anatomical Features and the Effects of Increasing Age.(Saudi Digital Library, 2026) Ramadan, Abdullah; Gillingwater, TomThe neuromuscular junction (NMJ) is a specialised chemical synapse that mediates communication between motor neurons and skeletal muscle fibres, playing a critical role in voluntary motor control. Despite its functional importance, our understanding of human NMJ morphology remains limited, particularly in terms of ageing and nano-structured details. This thesis addresses key gaps in human NMJ research through investigating anatomical characterisation, age-associated structural changes in human upper limb muscles, and applying a new super-resolution (SR) technique to reveal fine structures. In the first part of this study, NMJs were systematically analysed in upper limb muscles obtained from healthy adult donors. Using immunohistochemistry (IHC) staining and confocal microscopy, a baseline morphological profile was established. The second part explored age-related changes of the NMJ, focusing on terminal Schwann cells (TSCs) and voltage-gated sodium channels (NaV1.4) besides the basic presynaptic and postsynaptic elements. Aged NMJs exhibited subtle structural alterations, including changes in TSCs architecture and disruption in NaV1.4 expression, suggesting progressive synaptic decline with preserved overall integrity. These findings indicate that human NMJ ageing changes diverge from the rodent scenario, where the latter reveals a progressive structural denervation in response to ageing. The final part of the thesis introduced and validated Expansion Microscopy (ExM) as a novel technique for NMJs imaging at nanoscale resolution. ExM results are enabled by VIII isotropic tissue expansion, capturing synaptic details in three-dimensional visualisation. As a recent SR technique, the ExM is cost-effective, accessible and applicable. Collectively, these three studies represent the aims of the thesis, provide a comprehensive and novel anatomical account of the human NMJ. They offer critical reference data, reveal patterns of structural ageing, and establish a powerful imaging platform for future research4 0