Saudi Cultural Missions Theses & Dissertations
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Item 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.1 0Item Restricted Factors influencing healthcare workers’ adherence to infection prevention and control in Saudi Arabia(Saudi Digital Library, 2025-07-09) Awal, Zainab Abdullah A; Mcfeely, Clare; Kidd, LisaBackground: Infection Prevention and Control (IPC) practices are crucial in reducing healthcare-associated infections. Despite their importance, adherence among healthcare workers (HCWs) remains suboptimal. In Saudi Arabia, IPC research has increased especially post-COVID-19. However, research on understanding factors influencing adherence, particularly in Intensive Care Units (ICUs) and medical wards, is limited. Objective: This study aimed to explore factors affecting adherence to IPC practices among HCWs in ICUs and medical wards in Saudi Arabia. Methods: A multi-method qualitative approach was employed across three phases in two Saudi hospitals: • Phase 1: Conducted a qualitative systematic review to identify factors influencing IPC adherence among HCWs in Middle Eastern countries. • Phase 2: Held focus groups with infection control team members (n=8) to gather insights on IPC practices and adherence challenges. • Phase 3: Performed semi-structured interviews with HCWs (n=20) from ICUs and medical wards to explore barriers and facilitators of IPC adherence. Findings: The study identified both individual and organizational factors impacting IPC adherence: • Individual Factors: Moral principles, ethical beliefs, cultural habits, knowledge, and awareness of HCWs influenced IPC adherence. • Organisational Factors: Challenges included leadership deficits, training gaps, environmental constraints, organisational culture, and department-specific issues related to patient acuity. Conclusion: Enhancing IPC adherence requires organisational support, effective monitoring strategies, and culturally sensitive IPC policies. Engaging families in IPC practices, fostering a supportive work environment, and addressing staffing and environmental issues are important. Future research should focus on culturally tailored IPC interventions, family involvement in IPC education, and comparative studies across various healthcare settings and disciplines to improve overall IPC adherence.3 0Item Restricted Research on Assessment of Resilience, Mental Toughness, and Confidence Dynamics in Elite Track and Field Athletes in the Kingdom of Saudi Arabia(Saudi Digital Library, 2025-05-01) Moraya, Mohammed; Beattie, StuartAbstract Resilience, mental toughness, and confidence are critical elements for athletes. According to research, resilience entails the ability to withstand or recover quickly from difficulties. Mental toughness, on the other hand, involves the ability to remain persistent and optimistic in the midst of challenges despite the pressure the challenges bring. Lastly, confidence entails a feeling of believing in oneself. This study explores the dynamics of resilience, mental toughness, and confidence among elite athletes in Saudi Arabia, focusing on track and field competitors. A quantitative approach was used to analyze the psychological factors influencing performance and mental well-being. The study involved 99 male athletes from various competition levels across Saudi Arabia. Questionnaires assessed mental toughness, resilience, and confidence, utilizing established psychological scales like MTI, BRS, and SSCI. Data collection was conducted via an online survey, and professional validation ensured the accuracy of the translated questionnaires. Key findings revealed a significant decline in athletes' confidence levels after competition, with resilience (measured by the Connor-Davidson scale) emerging as the strongest predictor of post-performance confidence recovery. While mental toughness predicted pre-match confidence, it had no significant effect on post-match confidence. Only a small percentage of the variance in confidence change was explained by these psychological factors. Cultural factors also played a role, positively correlating self-efficacy with performance outcomes. The research highlights the importance of resilience in helping athletes recover from confidence after poor performance in competitions. This is demonstrated primarily by the Connor-Davidson resilience tool. The same research highlights the role mental toughness plays. As per the findings, it aids in maintaining confidence under pressure. The study advocates incorporating resilience and mental toughness training into athlete development programs to enhance performance and mental health. Future research could explore the long-term impact of these psychological factors and other elements influencing athletic success.3 0Item Restricted Employee-Related Disclosures and Capital Market Reactions: Analysing Human Capital Disclosure, Wellbeing Washing, and CEO Pay Ratios(Saudi Digital Library, 2025) Almubarak, Alhanouf; Marques, Ana; Motoki, FabioThis dissertation includes three empirical studies on the topic of employee-related disclosures. The first study investigates the association between human capital disclosures and firms’ performance (i.e., profitability and value) and examines how a recent U.S. Securities and Exchange Commission (SEC) change in mandated human capital disclosure is associated with these outcomes. I examine the disclosures of Standard & Poor's (S&P) 500 firms from 2012 to 2021 and have three main results. First, human capital disclosure is positively associated with firms' performance. Second, the change in the SEC's required human capital disclosure is associated with an increase in firms' human capital disclosure. Third, from the year when the SEC initiated discussions about the amendment (2016) to 2019, there was a noticeable increase in the association between disclosure and firm profitability. However, this association disappears after the implementation of the mandated changes (2020 and 2021). The second study investigates wellbeing washing, where firms claim to prioritise the wellbeing of their employees but fail to implement measures to put this into practice. I focus on wellbeing disclosures in Environmental, Social, and Governance (ESG) reports, particularly those of S&P 100 firms from 2018 to 2022. I examine the association between firms' disclosures regarding employee wellbeing and the ratings of employees on the Glassdoor website. I find that, overall, wellbeing disclosures in ESG reports are negatively associated with contemporaneous Glassdoor ratings of current employees. Additionally, I find firms that disclose a high level of wellbeing information, regardless of their actual employee satisfaction, have a significantly higher market value. The third study investigates the association between CEO-to-median employee pay ratios and firm-level risk, using a sample from the S&P 100 from 2018 to 2022. I find a positive association between the CEO pay ratio and firm-level risk. However, this association does not exist in socially responsible firms, as I find no association between CEO pay ratios and firm-level risk.4 0Item Restricted Targeted Sanctions in International Law(Saudi Digital Library, 2024-10-14) Almughamis, Mohammed Rashed; Antonio, CocoTargeted non-forcible measures have been the favorite tool of enforcement to the Security Council when it comes to non-forcible measures since the late nineties but that desire is accompanied with obsession of effectiveness extent of this type non-forcible measures. This research examines the foundations bases of non-forcible measures, the clearest types of non forcible meauseres, and testes the effectiveness of UN targeted non-forcible measures using Cortright and Lopez criteria.It provides evaluation of the teste result followed by analysis.13 0Item Embargo Impact of Culinary Destination and Service Performance: Expectation Confirmations, Satisfaction, Trust, and Consumer Revisit Intention(Saudi Digital Library, 2025-07-08) Almasoud, Abdullah Mohammed Abdullah; Joung, David (Chair); Choi, Eun Kyong; Berezina, Katerina; Balkin, RichardPurpose- The dissertation addresses a critical gap in understanding post-dining consumer behavior within a culinary tourism destination at the BLVD RUH CITY destination. It explores how visitors' perceptions of food consumption value, specifically price, taste/quality, interaction, prestige, emotional, and epistemic, influence their perception of the culinary destination's image and their evaluations of restaurant service performance in the culinary destination. The study further examines how these evaluations affect expectation confirmation, influencing key post-dining outcomes, including satisfaction, trust, and revisit intention. Design/Methodology- The study employs an empirical research design supported by a causal-explanatory framework. Data were collected via an online survey and analyzed using a two-step covariance-based structural equation modeling (CB-SEM) approach. The first phase involved confirmatory factor analysis (CFA) to validate the measurement model, followed by CB-SEM to test the hypothesized structural relationships. The research model is grounded in the Theory of Consumption Values (TCV), Expectation Confirmation Theory (ECT), and the trust component of Commitment-Trust Theory (CTT). Demographic variables were included as control variables to obtain more nuanced insights into visitor behavior. Findings- The study revealed that epistemic value and taste/quality value positively influenced the image of a culinary tourism destination, while emotional, interaction, price, and prestige values did not significantly affect image formation. However, price, taste/quality value, epistemic, and emotional influences had a positive impact on evaluations of service performance. The image of a culinary tourism destination and service performance significantly affected expectation confirmation, which subsequently influenced satisfaction and trust. Ultimately, satisfaction and trust were recognized as crucial predictors of the intention to revisit, confirming the interconnected roles of these concepts in shaping post-dining loyalty in culinary tourism. Practical Implications- The findings offer targeted guidance for restaurant managers, destination marketers, and tourism planners by identifying the food-related values that influence visitor perceptions, service evaluations of restaurants, and behavioral outcomes. Emphasizing taste/quality, as well as epistemic value, can effectively shape a strong destination image, while taste/quality, price, epistemic value, and emotional value can enhance perceptions of restaurant service. Aligning the actual dining experience with visitors’ expectations encourages expectation confirmation, satisfaction, trust, and loyalty. The study’s model provides a framework for improving culinary tourism experiences through better service design, enhanced expectation confirmation, and consistent quality delivery across touchpoints in the destination. Originality/Value- This study is among the first to synthesize three established theories (TCV, ECT, and CTT) into a single, empirically tested model, offering a novel conceptual contribution to marketing, consumer behavior, tourism, and hospitality. It enhances the theoretical literature's understanding of how food-related consumption values, the image of a culinary tourism destination, perceived restaurant service performance, expectation confirmation, satisfaction, and trust interact to shape revisit intention. Furthermore, it enhances empirical research in the underexplored Middle Eastern context by validating this research model in Riyadh, Saudi Arabia, at the BLVD RUH City destination, thereby strengthening the cross-cultural applicability of consumer behavior frameworks.18 0Item Restricted Game Theory Application to Strategic Decision Making in Space Debris Management(Saudi Digital Library, 2025) Al Suwaidan, Mohammad; Rosengren, Aaron JThis dissertation addresses the pressing challenges of space debris that pose a significant threat to the sustainability of space operations, endangering both existing satellites and future space missions. Space debris, comprising defunct satellites, spent rocket stages, and collision fragments, creates significant risks for operational spacecraft and future missions. As debris density increases, so does the likelihood of cascading collision events, a phenomenon known as Kessler syndrome, which could render entire orbital regions unusable and severely impact essential space-based services. Despite growing awareness of this challenge, current management approaches remain fragmented and inadequate. Existing models typically address either physical dynamics or economic aspects in isolation, failing to capture the critical interactions between human decision making and debris evolution. This research gap is particularly concerning as the space industry transitions from state dominated activities to a commercial ecosystem characterized by rapid innovation and complex competition. To address these challenges, this study develops a com prehensive framework that combines game-theoretic approaches with detailed mathematical modeling to analyze space debris management strategies. Chapter 2 of the dissertation applies evolutionary game theory and population dynamics to evaluate how different management strategies evolve over time under various scenarios. Through the development of both standard and advanced models, this study demonstrates how different management strategies evolve over time. Adopting complementary models that incorporate the NASA Standard Breakup Model, collision probability calculations, and realistic economic payoff structures, this research demonstrates that market forces alone are insufficient to prevent orbital environmental degradation. The analysis of five distinct scenarios provides a holistic view of the long-term consequences of different policy approaches. Chapter 3 draws on classical game theory to analyze strategic interactions in managing space debris, emphasizing the importance of collaboration among stakeholders in avoiding the tragedy of the commons in space. This analysis highlights the risks associated with unregulated exploitation, as well as the benefits of promoting cooperation through economic incentives. The results reveal critical insights into the long-term consequences of different management approaches. This dissertation contributes to the ongoing dialogue on sustainable space utilization and offers a quantitative framework for informed decision-making in space policy and sustainability14 0Item Restricted SEVERITY GRADING AND EARLY DETECTION OF ALZHEIMER’S DISEASE THROUGH TRANSFER LEARNING(Saudi Digital Library, 2025) Alqahtani, Saeed; Zohdy, MohamedAlzheimer’s disease (AD) is a neurological disorder that predominantly affects individuals aged 65 and older. It is one of the primary causes of dementia, and it contributes significantly and progressively to impairing and destroying brain cells. Recently, efforts to mitigate the impact of AD have focused with particular emphasis on early detection through computer aided diagnosis (CAD) tools. This study aims to develop deep learning models for the early detection and classification of AD cases into four categories: non-demented, moderate-demented, mild-demented, and very mild demented. Using Transfer Learning technique (TL), several models were implemented including AlexNet, ResNet-50, GoogleNet (InceptionV3), and SqueezeNet, by leveraging magnetic resonance images (MRI) and applying image augmentation techniques. A total of 12,800 images across the four classifications that were preprocessed to ensure balance and meet the specific requirements of each model. The dataset was split into 80% for training and 20% for testing. AlexNet achieved an average accuracy of 98.05%, GoogleNet (InceptionV3) reached 97.80%, ResNet-50 attained 91.11%, and SqueezeNet 86.37%. The use of transfer learning method addresses data limitations, allowing effective model training without the need for building from scratch, thereby enhancing the potential for early and accurate diagnosis of Alzheimer’s disease [1].12 0Item Restricted The Impact of Educational Context on the Academic and Social Outcomes of Students with Intellectual Disabilities Who Moved from Inclusive to Segregated Classrooms in Saudi Arabia(Saudi Digital Library, 2025-06-10) Althiab, Mshael D; Ryndak, DianeThis study explores the academic and social outcomes of female students with mild intellectual disabilities (ID) in Saudi Arabia (SA) who transitioned from elementary comprehensive inclusive classrooms (ECICs) to middle self-contained classrooms (MSCCs). Framed within Bronfenbrenner’s Ecological Systems Theory and the Social Model of Disability, the research investigates how educational context, family involvement, and systemic expectations influence the experiences and development of students with ID. Drawing on six emergent themes organized into two overarching categories, the findings highlight that ECICs provided students with meaningful access to age/grade level general education (GE) academic content, opportunities for peer collaboration, opportunities to develop strong social relationships, and high expectations and inclusive teaching practices that led to positive outcomes. In contrast, the shift to MSCCs was associated with curtailed access to age/grade level GE curriculum, lower instructional quality, fewer social interactions with age/grade level peers, diminished expectations, and limited support structures. Family engagement and geographical context further influenced students’ educational experiences, with families in suburban areas experiencing more barriers to advocacy and inclusion. The study underscores the positive impact of inclusive practices in elementary GE classrooms and the importance of sustaining those inclusive practices throughout educational experiences. It also calls for alignment between policy, pedagogy, services, community awareness, and family advocacy. Recommendations are offered for improving inclusive education in SA, with a focus on enhancing teacher training, family-school collaboration, and equitable access to inclusive GE for all students.6 0Item Restricted Evaluation of DNA Repair Biomarkers in Epithelial Ovarian and Breast Cancers(Saudi Digital Library, 2025-01-02) (Shoqafi, Ahmed); Madhusudan, SrinivasanDNA damage signalling and repair pathways play a crucial role in the regulation of genomic stability. Impaired DNA repair promotes genomic instability, a key route to the development of cancers. Cells have developed signalling pathways that are activated in response to DNA damage to detect and repair the damage that has occurred. Ataxia-Telangiectasia Mutated (ATM) and Ataxia-Telangiectasia and Rad3-related (ATR) kinases are activated in the presence of DNA damage and initiate a series of phosphorylation events that lead to the activation of downstream effectors. Some of these effectors include p53 and BRCA1, which regulate cell cycle, DNA repair, and apoptosis. The major DNA repair pathways are nucleotide excision repair (NER), which removes bulky DNA adducts; base excision repair (BER), which is involved in repairing small, non-helix-distorting base lesions; mismatch repair (MMR), which corrects replication errors and double-strand break repair which include homologous recombination (HR) and non-homologous end joining (NHEJ). All these pathways are regulated in a manner that is specific to the type of damage that needs to be repaired so that repair is as accurate as possible. Since conventional therapies for advanced epithelial ovarian cancer (EOC) and breast cancers have been found to be less effective, there has been a shift to search for new therapeutic approaches that aim at targeting the DNA repair pathways. The host laboratory, using whole-exome sequencing in platinum-sensitive (PEO1, A2780) and platinum-resistant (PEO4, A2780cis) ovarian cancer cell lines, identified TP73 and POLE as potential predictors of platinum resistance. In the current study, I have investigated the role of TP73 and POLE in EOC and breast cancers in detail. TP73 is a member of the TP53 family of transcription factors that are involved in DNA repair, cell growth, migration, and death. In 331 EOC samples, I observed that high protein expression of TP73 was associated with higher tumour grade, late-stage disease and shorter progression free survival (PFS). In the large publicly available clinical cohort (n=522) and the cancer genome atlas (TCGA) ovarian cohort (n=182), TP73 transcript was upregulated in tumours compared to normal tissues and associated with shorter PFS. Preclinically, I have shown that overexpression of TP73 in A2780 platinum-sensitive ovarian cancer cells enhanced cell proliferation, invasion and increased DNA repair capacity. In clinical breast cancers, analysis of TP73 expression in 1,369 invasive breast cancers and 317 DCIS cases revealed that high cytoplasmic TP73 expression is significantly associated with aggressive disease features, including high tumour grade, ER negativity, triple-negative phenotype, and poor breast cancer-specific survival, particularly in the TP53 mutant subgroup. These findings highlight the prognostic and predictive significance of TP73 in EOC and breast cancers. POLE has roles during DNA replication and repair pathways. I have investigated POLE expression in EOC and breast cancers. Immunohistochemical analysis of 331 EOC samples revealed that 75% exhibited low nuclear POLE expression, while 25% showed high expression. High POLE levels were significantly associated with higher tumour grade, poor progression free survival (PFS) and overall survival (OS). The transcriptomic levels of POLE were analysed in patients with EOC, revealing that high POLE mRNA expression was significantly associated with poor progression free survival (PFS) and overall survival (OS) (All p=<0,05). Functional studies in platinum-resistant OVCAR 4 cells demonstrated that POLE knockdown increased cisplatin sensitivity, which was associated with double-strand break (DSB) accumulation, S-phase cell cycle arrest and increased apoptosis. The data supports the role of POLE in predicting response to platinum chemotherapy in EOC. The study of 1,480 invasive breast cancer cases revealed that exhibited low nuclear POLE expression, which was associated with aggressive tumour features, poorer breast cancer specific survival (BCSS), and reduced response to endocrine therapy in ER+ and luminal subtypes. These findings suggest that POLE may be a predictive factor in ER+ breast cancers. Taken together, the data provides evidence for the role of TP73 and POLE as potential biomarkers in EOC and breast cancers.37 0