Saudi Cultural Missions Theses & Dissertations
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Item Restricted The Relationship Between Work Schedule Flexibility, Nurses' Perceptions of Core Work Dimensions, and Absenteeism in Saudi Arabia(Saudi Digital Library, 2025-05-26) Alkowikby, Maysa Kaseb; Ebrahim, EmanBackground: Nurse absenteeism is a critical issue impacting healthcare efficiency and patient outcomes. Factors such as rigid work schedules, high workload, and limited job autonomy contribute to absenteeism, particularly in high-stress environments like hospitals in Saudi Arabia. Aim: To examine the relationship between work schedule flexibility, core work dimensions, and absenteeism among nurses in Saudi Arabia. Methods: A descriptive cross-sectional correlational study was conducted with 144 nurses from three major hospitals. Data were collected via the Work Schedule Flexibility Survey (WSFS), Job Diagnostic Survey (JDS), and an absenteeism questionnaire. Statistical tests included ANOVA, Pearson correlation, and multiple linear regression. Results: There was a significant positive relationship between job dimensions and absenteeism (r = 0.51, p < 0.01). Regression analysis revealed that job diagnostics explained 32% of absenteeism variance, with task identity as the strongest predictor (β = 0.38, p < 0.01). Conclusion: Enhancing job design and flexible scheduling could reduce nurse absenteeism and improve workforce stability and patient care outcomes.13 0Item Restricted PULSE LASER ABLATED TITANIA-HAEMATITE NANOCOMPOSITES FOR THE REMOVAL OF LEAD AND ARSENIC FROM WASTEWATER(Saudi Digital Library, 2025) ALSHAMMARI TEFLAH KHULAIF K; BAKHTIAR, HAZRI BINWater contamination by toxic heavy metals, particularly lead (Pb²⁺) and arsenic (As³⁺), poses a severe environmental and public health risks due to their persistence, bioaccumulation, and high level of toxicity. Conventional wastewater treatment methods, such as chemical precipitation and membrane filtration often suffer from high costs, energy demands, and secondary pollution. Therefore, there is a critical need for efficient, cost-effective, and sustainable materials for heavy metal removal. Nanocomposites, particularly those based on titania (TiO₂) and haematite (α-Fe₂O₃) offer promising adsorption and photocatalytic properties. The primary objective of this study is to synthesize titania (TiO₂)- haematite (α-Fe₂O₃) nanocomposites via pulsed laser ablation in liquid (PLAL) and evaluate their efficiency in removing Pb²⁺ and As³⁺ from wastewater. The nanocomposites were analyzed using X-ray diffraction (XRD), scanning electron microscopy (SEM), high resolution transmission electron microscopy (HRTEM), Fourier transform infrared (FTIR) spectroscopy and UV-Vis spectroscopy to determine their structural, morphological, and optical properties. The adsorption efficiency of Pb²⁺ and As³⁺ was evaluated under varying parameters such as laser fluence, solvent pH, contact time, and initial metal concentration. The results indicated that the TiO2-(α-Fe2O₃) nanocomposites exhibited high adsorption capacity due to their large surface area, synergistic photocatalytic effects, and strong metal affinity. The observation of improved heavy metals removal efficiency of the proposed nanocomposites was ascribed to the synergy between TiO2 nanoparticles and α-Fe2O3 nanoparticles, indicating their wastewater treatment potential. The removal efficiency exceeded 90% for both metals under optimized conditions, demonstrating the potential of these nanocomposites as an eco-friendly and effective material for wastewater treatment. These findings affirmed the unique effectiveness of nanocomposites for water treatment implementation. This research contributes to sustainable water treatment technologies by introducing an environmentally friendly solution for heavy metal removal.5 0Item Embargo An Adaptable and Distributed Access Control Approach Based on Machine Learning Techniques in a BYOD Environment(Saudi Digital Library, 2028-07-10) Turkea, ALjuaid; Wahid, Ainuddin; Yamani, MohdTraditional access control systems, such as role-based access control (RBAC), attribute-based access control (ABAC), or relationship-based access control (ReBAC), may limit policy decision points due to the potential for status changes in response to minor changes in user and resource properties. Additionally, system administrators must rely on solutions that require complex rules with multiple conditions and permissions for decision control, which can lead to access control issues such as policy conflicts, decision-making bottlenecks, poor performance, and trust and privacy issues related to policy management. This thesis presents three security access control mechanisms to overcome these limitations. Firstly, it proposes a method of enforcing access decisions that is adaptable and dynamic, based on a multi-layer deep learning hybrid model (TabularDNN). The technique converts all input attributes from an access request into an allow or deny decision using multiple layers to ensure accurate and efficient access control. Furthermore, the proposed solution was evaluated using the Kaggle-Amazon access control policy dataset; the results indicated a 94\% accuracy rate, demonstrating enhanced access decision implementation by considering various resource and user attributes. Additionally, it ensures privacy through indirect communication with the Policy Administration Point (PAP). This mechanism improves flexibility and provides dynamic and adaptable access control, demonstrating the proposed method's efficiency and reliability. Secondly, this dissertation presents an access decision-making algorithm for access control-based supervised learning, enhancing policy decision points (PDPs) by converting the PDP problem into a binary classification for access requests. The research describes a vector decision classifier that uses machine learning methods, specifically implementing the random forest algorithm, to make accurate access decisions and enable dynamic, distributed PDPs. Performance was evaluated using the Kaggle-Amazon access control policy dataset, comparing the proposed mechanism to previous research benchmarks for performance, time, and flexibility. The method ensures privacy for access control policies by preventing direct communication between the PDP and PAP. The study showed that PDP-based machine learning could navigate multiple policies and large access requests with 95\% accuracy, a 0.15-second response time, and no policy conflicts. This method improves security by implementing a distributed access control system that is dynamic, adaptable, and flexible. Finally, it presents an adaptive policy adjustment based on anomaly detection methods using machine learning algorithms. This method conducts risk monitoring and anomaly detection and features an adaptive policy mechanism that dynamically adjusts policies based on detected anomalies. The UNSW-NB15 dataset was used to evaluate the solution's performance. The results highlighted a detection accuracy of 95\% with a response time of approximately 0.5 seconds. The adaptive policy adjustment achieves a 97\% accuracy rate. The mechanism improves insider threat detection and access control simultaneously while optimizing and simplifying the process of managing policies. This method effectively addresses the critical trust and privacy challenges associated with policy management in corporate environments.15 0Item Restricted UNVEILING THE ANTI-VEGF LANDSCAPE: AN INTEGRATIVE STUDY OF COMPARATIVE EFFECTIVENESS, COST-UTILITY, AND PHARMACOVIGILANCE(Saudi Digital Library, 2025-04-04) Baljoon, Ahmead; Matthew DuttonBackground: Intravitreal anti-angiogenic medications have recently grabbed the attention of researchers to control the pathology of neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME). This thesis aims to assess the differences in efficacy and safety between faricimab and aflibercept in patients with nAMD and DME through a comparative effectiveness analysis, specifically utilizing a meta-analysis approach. Additionally, it seeks to compare the cost-effectiveness of faricimab and aflibercept in nAMD patients from the payer's perspective in the United States. Furthermore, a pharmacovigilance study conducted to assess the real-world safety profile of faricimab in comparison to other anti-VEGF agents. Methods: A systematic review and meta-analysis were conducted by searching four academic databases, focusing on two efficacy outcomes, changes in best-corrected visual acuity (BCVA) and central subfield thickness (CST), as well as three safety outcomes: conjunctival hemorrhage, serious adverse events (SAEs), and all-cause mortality. Standardized mean differences (SMDs) and relative risks were used to summarize the results, providing a comprehensive evaluation of faricimab and aflibercept in managing nAMD and DME. A Markov model was developed to compare faricimab (flexible dosing) and aflibercept over a five-year period, incorporating transition probabilities derived from x pooled estimates of data from two clinical trials and direct medical costs. Sensitivity analyses assessed the impact of key model parameters on cost-effectiveness. Additionally, a pharmacovigilance study evaluated the ocular safety profiles of faricimab, aflibercept, and ranibizumab using adverse event reports from the US FDA Adverse Event Reporting System (FAERS) from Q4/2003 to Q2/2024. The analysis, performed with OpenVigil 2.1, identified potential safety signals using MedDRA classification for AEs. Results: Four RCTs included 3220 patients. Faricimab had a significant lower mean change in CST than aflibercept (SMD = -0.24, 95%CI, -0.39 to -0.10, p = 0.001). BCVA did not differ. Conjunctival hemorrhage, SAEs, and all-cause mortality were similar across treatment arms. Base-case analysis demonstrated that faricimab is a cost-effective option, with a lower total cost ($51,913) and higher effectiveness (3.39 quality-adjusted life years (QALYs)) than aflibercept, which had higher costs ($61,210) and lower QALYs (3.29). Faricimab’s incremental cost-effectiveness ratio (ICER) dominated aflibercept ( $91,787.78 per QALY), reflecting better cost-effectiveness, mainly due to reduced injection frequency and related costs. The study also reports the AEs significantly linked to faricimab, aflibercept, and ranibizumab for the treatment of nAMD and DME. The findings include several novel AEs linked to faricimab, including Idiopathic orbital inflammation, hypopyon, and ocular vasculitis. xi Conclusion: Faricimab and aflibercept offer similar therapeutic benefits in treating retinal vascular diseases. However, further trials are necessary to confirm the significant reduction in central CST with faricimab in the treatment of in nAMD and DME. Faricimab offers superior economic value in treating nAMD in the USA, delivering comparable clinical benefits at lower costs than aflibercept. Its cost-effectiveness and reduced treatment burden support its potential as a preferred option for nAMD management from a payer’s perspective, suggesting benefits for healthcare systems by reducing costs and injection frequency. Faricimab-associated AEs are primarily linked to active inflammatory ocular disorders, while ranibizumab and aflibercept are more often associated with structural eye changes, lens disorders, ocular infections, or surgical effects. However, faricimab's safety profile remains incomplete due to limited post-marketing data.4 0Item Restricted NF-κB-Mediated Oxidative Stress Drives Cigarette Smoke-Induced EMT in Human Bronchial Cells(Saudi Digital Library, 2025-05-09) Alqithami, Sarah; Orren, DavidCigarette smoke is a complex mixture of over 7,000 chemicals, many of which are known carcinogens and pro-inflammatory agents that contribute to chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD) and lung cancer. This study aimed to investigate the cellular and molecular responses of human bronchial epithelial cells (HBECs) to cigarette smoke condensate (CSC), focusing on oxidative stress and the NF-κB signaling pathway. Three HBEC lines (HBEC3KT, HBEC14, and HBEC2) were exposed to CSC (20 µg/mL) for 48 hours, a dose shown to induce morphological changes consistent with an epithelial-to-mesenchymal transition (EMT) phenotype without causing overt cytotoxicity. RNA sequencing revealed significant differential gene expression in all three cell lines upon CSC exposure. Principal component analysis (PCA) and hierarchical clustering demonstrated clear transcriptomic shifts, particularly in genes related to oxidative stress (e.g., NQO1, GCLM, HMOX1), inflammatory responses (e.g., IL6, CXCL8, TNFAIP3), hypoxia (e.g., CA9, VEGFA, HIF1A), and metabolic regulation. Enrichment analyses further confirmed activation of the NRF2 antioxidant pathway, pro-inflammatory NF-κB and IL-17 signaling, and hypoxia-inducible factor (HIF) pathways, indicating a coordinated stress response to CSC. Western blot and immunofluorescence analyses supported transcriptomic findings by demonstrating increased protein expression of phosphorylated NF-κB p65 in CSC-treated cells, particularly in HBEC3KT, confirming its activation in response to smoke-induced EMT. Scratch wound healing assays showed that CSC treatment enhanced the migratory ability of HBEC3KT cells, resulting in faster wound closure. These findings suggest that CSC may positively influence cell migration and tissue repair. Additionally, a decrease in the expression of E-cadherin (CDH1) and an increase in vimentin (VIM) and indicated partial epithelial-mesenchymal transition (EMT). These findings were corroborated by gene expression patterns and validated through protein-level analyses. Cell viability assays demonstrated moderate cytotoxicity following 48-hour CSC treatment, with HBEC2 being the most sensitive. These results suggest a potential state of chronic cellular stress, inflammation, and hypoxia, along with indications of impaired epithelial restitution, although these effects have not yet been directly demonstrated in lung tissue, all of which are hallmark features of early airway remodeling in smoke-related lung pathologies. In summary, this study comprehensively elucidates the transcriptional and functional responses of bronchial epithelial cells to cigarette smoke condensate. The integration of transcriptomic, proteomic, and functional data highlights the central roles of oxidative stress, inflammation, and epithelial dysfunction in smoke-induced airway injury. These findings provide mechanistic insights into early events driving airway remodeling and inflammation in smokers and may inform future therapeutic strategies targeting airway epithelial resilience.12 0Item Restricted PERCEPTION OF OBSTRUCTIVE SLEEP APNEA AMONG RESPIRATORY THERAPISTS AND ORTHODONTISTS IN SAUDI ARABIA(Saudi Digital Library, 2025-04-02) Alharbi, Ghaida AtyyatAllah; Ralph “Chip” Zimmerman, PhD, RRT, RRT-NPS, FAARCBackground: Obstructive sleep apnea (OSA) is a common sleep disorder that significantly impacts health, leading to cognitive impairment, daytime fatigue, and cardiovascular complications. Respiratory therapists (RTs) and orthodontists play vital roles in its management through diagnosis and treatment. However, gaps in knowledge and limited awareness about OSA remain prevalent. Understanding the perceptions of RTs and orthodontists is crucial to addressing these challenges, improving patient care, and fostering interdisciplinary collaboration in OSA management. Purpose: This research aims to assess the perceptions of obstructive sleep apnea (OSA) and identify differences in understanding, confidence, and management approaches among respiratory therapists and orthodontists in Saudi Arabia (SA). Methods: A qualitative study was conducted to explore the perceptions of obstructive sleep apnea (OSA) among respiratory therapists and orthodontists. Data was collected through Webex video interviews using a semi-structured format with 10 open-ended questions, including socio-demographic information and perspectives on OSA management and confidence in addressing cases. Face validity was established through a review by three respiratory therapy educators from Georgia State University (GSU) and one orthodontist. Results: A total of 11 participants completed the interviews, including 6 respiratory therapists (RTs) and 5 orthodontists. The study findings revealed the emergence of 23 themes, refined into 9 sub-superordinate themes and 8 overarching superordinate themes. Among RTs, a notable proportion demonstrated a high understanding of OSA (n=6) and comprehensive treatment knowledge (n=5). However, 6 RTs showed varying levels of knowledge regarding OSA symptoms, with some displaying only general or limited knowledge. Diagnostic engagement varied, with 6 RTs identifying as somewhat engaged in diagnosis. Additionally, 5 RTs highlighted systemic and institutional barriers, including insufficient staff and poor healthcare facilities. Confidence in managing OSA was reported as high by 6 RTs. Among orthodontists, 5 participants demonstrated moderate understanding of OSA, with detailed knowledge of clinical features reported by the same number. All orthodontists were somewhat engaged in diagnosis and exhibited comprehensive treatment knowledge (n=5). However, confidence in managing OSA remained low to moderate across the group. Additionally, 2 orthodontists emphasized institutional challenges, particularly low awareness among healthcare staff. Awareness of OSA consequences varied, with 5 orthodontists reporting limited to strong awareness. Misconstrued perceptions of OSA prevalence were evident among some orthodontists. Conclusion: Findings underscore the differences in perceptions between the two professions, with RTs showing greater confidence and diagnostic involvement, while orthodontists displayed deeper knowledge of clinical 8 features and treatment options. Addressing the identified gaps through targeted education and interdisciplinary collaboration may enhance OSA management and patient outcomes8 0Item Restricted Involvement of Transient Receptor Potential Ankyrin 1 (TRPA1) in Inflammatory Dental Pulp Pain(Saudi Digital Library, 2025-04-17) BaHammam, Anas; Michot, Benoit; Gibbs, JenniferTRPA1 is a cation channel involved in pain detection and inflammatory signaling in multiple cell types within the dental pulp. However, its role in pulpitis remains unclear. This study investigates the contribution of TRPA1 to dental pain and pain-like behaviors in a mouse model. Wild-type (WT) and TRPA1 knockout (KO) mice underwent pulp exposure, followed by multiple applications of either LPS or saline forming four experimental groups. Then pulp cap material placed. Pain-like behaviors were assessed on days 1, 3, and 7 post-op using the Nesting Test, Mouse Grimace Scale (MGS), and Von Frey Filament Test (VFF). Additionally, c-Fos expression in the trigeminal nucleus of the brainstem was quantified to assess neural activation. LPS administration in wild-type (WT) mice resulted in a significant increase in pain-like behaviors compared to TRPA1 knockout (KO) mice (p < 0.05), underscoring the role of TRPA1 in inflammatory pain responses. The most pronounced differences were observed between WT and KO groups under both LPS and saline treatment. However, differences between LPS and saline treatments within each genotype were minimal, and the absence of TRPA1 more substantially attenuated behavioral responses. Consistent with the behavioral data, c-Fos expression was significantly elevated in WT mice but markedly reduced in KO-LPS mice, indicating decreased neuronal activation in the trigeminal nucleus in the absence of TRPA1. These findings demonstrate that TRPA1 plays a critical role in activating the nociceptive dental pain and triggering pain like behaviors in mice. Further investigations are needed to explore the therapeutic potential of TRPA1 inhibition and its clinical applications for managing dental pain.9 0Item Restricted The Implementation of Deferred Prosecution Agreements Within the Saudi Legal System for Corporate Crime Resolution(ProQuest, 2025) Alhumaidhi, Faiz Abdullah; Sundquist, Cristian PowellThis study examines the possibility of effectively adopting a Deferred Prosecution Agreement (DPA) as an alternative to traditional corporate criminal prosecution within the Saudi legal system. The aim of proposing the implementation of the DPA in Saudi Arabia is to leverage its advantages for corporations, governments, and society in addressing complex corporate crimes. Additionally, the proposed law would contribute to the evolution of the Saudi legal framework, particularly concerning corporate activities, aligning with the country’s vision for economic development. While the United States has utilized the DPA for decades, the United Kingdom has recently implemented it to facilitate the investigation of complex corporate cases. The DPA application also extended to other countries, such as France and Canada. However, this study primarily focuses on the United States and United Kingdom DPA models to take advantage of their experience in the analysis, as they widely recognize and utilize the law. Thus, after evaluating the necessity, effectiveness, and compatibility of the DPA within the Saudi legal system, the study provides recommendations for the Saudi DPA model.5 0Item Restricted NURSING INFORMATICS COMPETENCY AND EFFECTIVE CLINICAL DECISION-MAKING AMONG NURSES IN SAUDI ARABIA(Saudi Digital Library, 2025) ALRUWAILI, SABIRIN; Al Osta, MohammadABSTRACT Introduction: Clinical Decision-Making (CDM) is among the essential skills in the nursing profession that affect the outcomes of provided care. Nurses utilize various resources to achieve optimal care outcomes, including nursing informatics tools and skills, where nurses’ competencies play a vital role. Aim: To examine the relationship between nursing informatics competency and the levels of clinical decision-making skills among nurses in Saudi Arabia. Methods: A descriptive correlational design with convenience sampling methods was used to conduct the current study. A self-report questionnaire that consists of questions about demographic characteristics, the Nursing Informatics Competency Assessment Tool (NICAT), and the Clinical Decision-Making in Nursing Scale (CDMNS). Data were collected between May and July 2024 using online Google Forms from registered nurses at three governmental hospitals in Saudi Arabia. Results: 160 registered nurses participated in the study. The results show that nurses in Saudi Arabia were “proficient” in their nursing informatics competencies with total scale average (M=110.5, SD ±24.3), and have a perceived “medium” level in their effective clinical decision-making with total average score (148.6, SD ±32.0). Moreover, there was a statistically significant strong linear relationship between nursing informatics competency and perceived levels of clinical decision-making (r=.734, p<.001). However, nursing informatics competency was the sole statistically significant predictor (β=0.7, p<.001) of their perceived level of clinical decision-making. Conclusion and Implications: The study presented the critical role of nursing informatics competency in clinical decision-making among nurses. The results highlight to the healthcare stakeholders and nursing management the importance of investing in targeted informatics training and the integration of nursing informatics clinical decision support tools into the clinical nursing practice. Moreover, the findings encourage researchers to explore additional factors influencing clinical decision-making through longitudinal and qualitative research methods to gain a deeper understanding of this complex process.10 0Item Restricted Prevalence of Prediabetes and Type 2 Diabetes Among Undiagnosed Schoolteachers in Riyadh, Saudi Arabia(Saudi Digital Library, 2025) Aldekhayel, Ghassan; Farragher, Tracey; Verma, Arpana; Greenhalgh, Christine; Azmi, ShazliBackground: Diabetes Mellitus (DM) is an important public health issue in the Middle East region because of its high prevalence. In Saudi Arabia, the prevalence of type 2 DM among adults is 23.1%, and is one of the top ten causes of mortality. Patients with type 2 DM may remain undiagnosed for many years, due to its asymptomatic nature especially in the early stages. It is estimated that nearly half of adults with type 2 DM in Saudi Arabia are undiagnosed, which indicates the importance of early detection to understand the true burden of the disease. In addition, early detection and management of type 2 DM prevents complications related to diabetes. Also, identifying prediabetes cases helps prevent or delay the onset of type 2 DM. Methods: This study included both observational cross-sectional and longitudinal study designs. Schoolteachers in Riyadh were randomly selected from the Ministry of Education database and invited to complete the Saudi diabetes risk score questionnaire. Those identified as high risk underwent diabetes diagnostic tests, such as fasting plasma glucose and glycated haemoglobin (HbA1c), at collaborating primary healthcare centres. Participants diagnosed with type 2 DM or prediabetes were followed up after 3 months to assess risk factors associated with changes in HbA1c. Additionally, participants completed health-related quality of life (HRQoL) questionnaires at baseline, 3 months, and 6 months, to assess the quality of life of participants over time and compare HRQoL outcomes between low and high risk participants. Results: Among 945 recruited participants, 387 (41%) were female, the mean age was 42.5 years (SD ± 7.1), and 372 (39.4%) were classified as high risk. Out of 109 high risk participants who attended diabetes diagnostic testing, 7 (6.4%) were diagnosed with type 2 DM, and 19 (17.4%) were diagnosed with prediabetes. Population weighted estimates indicated that 1.8% of teachers in Riyadh had undiagnosed type 2 DM or prediabetes (95% CI: 0%, 6.91%). Among participants diagnosed with type 2 DM or prediabetes greater reductions in HbA1c levels at the 3-month follow-up was associated with higher baseline HbA1c levels (Coefficient: -0.63, 95% CI: [-0.79, -0.47]). Additionally, high risk participants reported lower HRQoL scores across physical, psychological, social relationships, and environment domains compared to low risk participants, with statistically significant differences observed in the physical (Coefficient: -5.57, 95% CI: [-8.65, -2.48]) and psychological (Coefficient: -4.40, 95% CI: [-7.47, -1.33]) domains. Conclusion: The study found a high prevalence of teachers at high risk of type 2 DM in Saudi Arabia. Early identification and intervention for participants with higher baseline HbA1c levels were associated with greater HbA1c reductions after 3 months, which may lead to better health outcomes and reduce the burden of diabetes-related complications. These findings highlight the feasibility and potential benefits of systematic prediabetes and type 2 DM case finding programmes in Saudi Arabia.5 0