Saudi Cultural Missions Theses & Dissertations
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Item Restricted Fire Performance Of Façade Materials In Saudi High-Rise Buildings: Implications For Civil Defence And Code Compliance.(Saudi Digital Library, 2025) Alzahrani, Rakan Rezgallah; Nadjai, AliAluminium Composite Panel (ACP) façade materials have been implicated in several catastrophic building fires worldwide, raising urgent concerns about their fire performance. The rapid vertical spread of fire, high heat release, and toxic smoke generation associated with certain ACP systems have led to significant casualties and property loss, prompting global scrutiny and regulatory reforms. These developments are particularly relevant for Saudi Arabia due to the intensive solar radiation and high temperatures experienced in the country. In that regard, this study aimed to comprehensively assess the fire performance of cladding materials used in high-rise buildings in Saudi Arabia (particularly Aluminium Composite Panels ACPs) through code compliance checks, experimental testing, and simulation analysis, to enhance building safety and Civil Defence preparedness. Three samples of composite materials were collected from different regions in Saudi Arabia. Bomb Calorimetry, Thermogravimetric Analysis (TGA), and Fourier Transform Infrared Spectroscopy (FTIR), together with Computational Fluid Dynamics (CFD) simulations using Fire Dynamics Simulator (FDS) and the Ozone model were utilised to gain insights into fire behaviour, thermal characteristics and fire performance of the composite materials. The results showed that while composite materials in Saudi Arabia could potentially meet the EN13501 -1 for class A1 and A2, there are specific risk factors within the ACP components that might enhance fire growth and smoke production levels. One sample in particularly was found to be high risk, having weak retardant properties and an exceptionally high mass loss percentage of 76% for the core. In view of such finding, there is a need to reassess façade composite materials and perform full scale tests.12 0Item Restricted BOTTOM-UP VALUE CREATION AND COLLABRATIVE STRATEGY FORMATION THROUGH PROJECT FRONT-ENDING: ENABLING ORGANISATIONAL TRANSFORMATION IN COMPLEX ENVIRONMENT(Saudi Digital Library, 2025) ALHARMAL, AMAL; BELL, GARYThis dissertation investigates how front-ending practices and design thinking shape projects to enable bottom-up value creation in complex organisational transformations. Drawing on Soft Systems Methodology, emergent strategy theory, and value co-creation concepts, the research examines mechanisms transforming project front-ends from planning phases into collaborative innovation spaces. The study analyses Saudi Ministry of Health's Vision 2030 transformation (2015-2025), which engaged 60,000+ citizens through surveys, 2,450+ healthcare professionals through workshops, and 28 stakeholder groups across the healthcare ecosystem. Through analysis of transformation documents and interviews with 5 key ministry officials, the research documents how extended front-ending practices enabled integration of top-down strategic direction with bottom-up innovation. Four mechanisms emerged from the analysis. First, front-ending functioned as value creation space where diverse stakeholders collaboratively explored problems rather than implementing predetermined solutions. Second, project shaping occurred through hybrid governance that balanced national strategic imperatives with frontline innovations via structured coordination mechanisms including 20 semi-autonomous healthcare clusters. Third, distributed value creation emerged through stakeholder networks systematically connecting citizen needs, professional expertise, and policy development processes. Fourth, collaborative strategy formation occurred as bottom-up innovations gained organisational legitimacy through demonstrable success and integration into national healthcare policy. The transformation generated 150+ bottom-up projects, digital platforms serving 24+ million users, and systemic innovations spreading across the healthcare system. These outcomes demonstrate that projects can function as adaptive systems enabling collaborative value creation when appropriate governance structures and stakeholder engagement mechanisms are employed. The findings provide initial evidence and practical insights for managing mega project transformations requiring both strategic coherence and local innovation, offering tested approaches for front-end structuring and stakeholder engagement applicable to similar large-scale public sector initiatives.9 0Item Restricted Fair Pricing of Insurance for Women Drivers in Saudi Arabia(Saudi Digital Library, 2025) Alyafie, Asrar; Constantinescu-Loeffen, Corina; Yslas Altamirano, JorgeThis thesis examines fair automobile insurance pricing in Saudi Arabia, with a focus on the Bonus-Malus System (BMS) and its adaptation for newly licensed women drivers following the 2017 driving policy reform. The research identifies inefficiencies in the current system and proposes methodological improvements to enhance pricing fairness and adaptability. The first part evaluates Saudi Arabia’s existing no-claim discount system by modelling it as a six-class Bonus-Malus structure. Comparative analysis with different international systems using actuarial tools and a principal component analysis-derived toughness index reveals key weaknesses: slow convergence, financial imbalance, and excessive penalties for new drivers. Real-world data from Allied Cooperative Insurance Group confirms these limitations, particularly for novice women drivers. On the other hand, the second part introduces a goal programming (GP) optimisation approach to design optimal premium scales. Implemented in R and Excel, the GP model balances competing objectives, including fairness, financial equilibrium, and premium stability, while improving actuarial performance measures. This methodology provides a flexible framework for adapting BMS structures to changing market and regulatory conditions. The final part investigates modifications to key BMS components using Saudi market data. Analysis of transition rules based on claim frequency and severity shows that severity-based penalties enhance risk classification, especially when modelling dependencies between claim frequency and severity. The study demonstrates that increasing BMS levels improves risk segmentation but requires balancing practical implementation constraints. In general, this research contributes practical and generalisable methods for modernising BMS design in evolving insurance markets, benefiting insurers, regulators, and policyholders through improved risk assessment and fairer premium structures.13 0Item Restricted Simulation and measurement of particle therapy beams with a silicon-based detection system(Saudi Digital Library, 2025) Alqahtani, Fajer; Taylor, JonIn 2022, the World Health Organisation estimated that cancer is responsible for 9.7 million deaths worldwide per year [1]. Advances in recent years have continued to improve the understanding and treatment of cancer, making more cancers treatable and increasing treatment efficacy and survival rates [2]. Among current modalities, radiotherapy continues to plays a key role alongside chemotherapy and surgery where it is used to apply high doses of radiation to cancerous cells to kill or shrink tumours [3]. Particle therapy, particularly proton and carbon ion therapy, has gained increasing clinical adoption in recent decades, due to its superior dose conformity and the Bragg peak, which allow precise dose delivery to tumours while minimising irradiation of surrounding healthy tissue [4]. However, these advantages require precise dose delivery and accurate range verification to ensure that patients receive the correct dose at the correct location while protecting surrounding healthy tissues as much as possible. This work concentrates on the development of a water phantom tracking system using silicon pixel detectors for beam monitoring and range verification in particle therapy. Monte Carlo simulations have been used to predict the response of the tracking system, investigate the contributions of the dose deposition of primary and secondary radiation fields, and to calculate dose-depth profiles for both proton and carbon ion beams. These studies allowed a detailed characterisation of the Bragg peak at different energies and offered insights into the energy contributions and detector response under different conditions. Complementary simulations were performed using Allpix2 to understand the charge deposition and charge sharing effect of the HVTrack pixel detector. Experimental measurements with FE-I4b and Timepix3 pixel detectors integrated into the water phantom, were conducted using clinical proton beams at the Rutherford Cancer Centres, UK. Measurements of beam profiles and Bragg peaks were compared to simulation results, demonstrating a reasonable agreement and confirming the silicon pixel detectors’ capability for range verification and beam monitoring. The findings of this thesis contribute to the ongoing development of detection systems for quality assurance in particle therapy. The combination of Monte Carlo simulation tools and experimental measurements creates a robust framework to improve beam monitoring accuracy and enhance the clinical translation of silicon pixel detector technologies in radio- therapy.5 0Item Restricted Evaluation of an Early-Stage Prototype of a Virtual Reality-Based Physiotherapy Toolkit for Individuals with Chronic Knee Pain(Saudi Digital Library, 2025) Almutairi, Alhanouf; Button, Kate; Alamri, MohammadAbstract Background: Chronic knee pain (CKP) affects quality of life and poses significant challenges for healthcare delivery, with low treatment adherence outside clinical settings. Therapeutic exercise remains a cornerstone intervention for managing CKP, with evidence supporting its effectiveness in improving function and reducing pain. Virtual reality (VR) has emerged as a promising tool for delivering therapeutic exercises in a more engaging and motivating format. However, there remains a paucity of evidence regarding the biomechanical challenges and usability of VR applications for home-based knee rehabilitation. This thesis aimed to evaluate an early-stage prototype of a VR-based physiotherapy toolkit designed for people with CKP with the aim of facilitating therapeutic exercises within a home setting. Method and findings: A total of 40 participants with CKP (52.5% male, 47.5% female, age range 18–56+ years) underwent a single laboratory session during which both kinematic performance and system usability were assessed. The study design was informed by the Medical Research Council (MRC) framework for developing complex interventions and was structured across three parts: part 1 comprised an umbrella review of eight systematic reviews examining the applications of VR-based physiotherapy. This part aimed to identify, synthesise and critically evaluate existing evidence on the application of VR in therapeutic interventions. The findings suggested that while VR demonstrates potential to improve physical function, significant gaps persist in understanding its biomechanics and its usability for home-based physiotherapy settings. The methodological quality of the reviewed research was low, highlighting the need for rigorous and high-quality research in this area. Part 2 evaluated whether an in-house VR-based physiotherapy toolkit can accurately replicate therapeutic movements and provide appropriate challenges across different difficulty levels. Participants performed five VR-based physiotherapy exercise scenarios, during which joint range of motion (ROM) and key muscles’ activity were recorded concurrently. The results demonstrated that progressive increases in exercise difficulty led to enhanced movement demands while preserving symmetrical lower-limb muscle activation. These findings indicate that the system can deliver individualised exercise interventions that adapt to personal movement characteristics following physiotherapy best practices. Part 3 focused on evaluating the usability and acceptability of the VR-based physiotherapy prototype among participants with CKP. Usability was quantitatively established using the System Usability Scale (SUS), yielding a mean score of 76, which is indicative of good overall usability. Qualitative feedback was also collected and exposed to content analysis, which revealed a positive user experience: 389 positive codes were recorded, compared to 62 negative codes. However, specific areas for improvement were identified, including frequent technical challenges (307 codes) and the need for clearer instructional guidance (84 codes). Conclusion: This research demonstrates that VR can offer a promising, engaging, and biomechanically relevant system to deliver therapeutic exercises. However, challenges related to technical reliability and clarity of instructional content require further development to ensure successful long-term implementation. This research contributes to a growing body of evidence supporting the integration of VR into musculoskeletal physiotherapy and provides valuable insights to inform future development and successful implementation in both home and clinical settings.5 0Item Restricted Characterizing the two-component regulatory system (TCS) LytSR in Group B Streptococcus(Saudi Digital Library, 2025) Mashwal, Fahad; Khandaker, ShadiaAbstract Streptococcus agalactiae or Group B Streptococcus (GBS) is a commensal bacterium of the female urogenital tract and the leading cause of neonatal meningitis worldwide. GBS has two-component systems (TCSs) that detect and respond to environmental changes during colonization or invasive disease contributing to bacterial survival and virulence. In this thesis, I investigated the role of the LytST two-component system in GBS pathogenesis, with a specific focus on the sensory component lytS, using in vitro and in vivo approaches along with the host transcriptomics analysis. An isogenic lytS deletion mutant (ΔlytS) was generated in a hypervirulent serotype III, CC17 GBS strain. ΔlytS and wild-type (WT) strains were compared in vitro for growth dynamics in different conditions, autolysis (Triton X-100 induced and natural), biofilm formation, β-hemolysin/cytolysin activity, and morphology via scanning electron microscope. Adhesion and invasion assays in human brain microvascular endothelial cells (hCMEC/D3) were also performed to evaluate the role of lytS and the contribution of extracellular DNA (eDNA) to these phenotypic properties. Blood-brain barrier (BBB) transmigration and trans-endothelial electrical resistance (TEER) were evaluated using a Transwell model. Time-kill assays with penicillin assessed antibiotic susceptibility. A murine intravenous infection model was used to measure survival, bacterial loads, cytokine responses, and BBB integrity. A vaginal colonization model examined the role of lytS in bacterial persistence and the contribution of eDNA to maintaining carriage. Finally, RNA sequencing of hCMEC/D3 cells at 3 h and 6 h post-infection was performed to characterize host transcriptional responses to WT and ΔlytS infection. ΔlytS exhibited increased autolysis, elevated eDNA release, and enhanced biofilm formation. Scanning electron microscope revealed dense clumping in ΔlytS compared to WT. ΔlytS showed greater adhesion but reduced invasion and transmigration across the BBB, DNase treatment abolished the adhesion difference highlighting the influence of eDNA in adhesion by the ΔlytS. Hemolytic activity was lower in ΔlytS and the mutant strain was more susceptible to penicillin at most of the time points tested. In the in vivo experiments, mice infected with ΔlytS showed better survival, reduced brain bacterial loads, and lower proinflammatory cytokines compared to WT. The mutant also preserved BBB integrity following infection. Vaginal colonization by ΔlytS was prolonged, with significantly higher eDNA levels over time, compared to WT. RNA-seq analysis showed that cells infected with the ΔlytS mutant had impaired activation of key immune pathways, vesicular-transport pathways, and pathways involved in the modulation of neuronal signaling, compared with cells infected with the WT strain. Our data indicates that the two-component system LytST domain, through lytS, plays an important role in regulating GBS phenotypic properties, such as autolysis, biofilm formation, adherence and invasion to brain endothelial cells. It also regulates overall virulence in vivo along with altered host transcriptomic profile. These findings are important for understanding the pathogenesis of GBS-induced meningitis in neonates and may aid in the development of targeted therapeutics and vaccines in future.3 0Item Restricted Moisture migration in Alginate-based Wound Dressings(Saudi Digital Library, 2025) Alzoghaibi, Lama; Williams, DarylPrecise and sensitive quantification of the moisture migration behavior of alginate moist wound dressings within an environment analogous to one of its end use is challenging to simulate, largely due to alginates’ high susceptibility to swelling. This study utilised the gravimetric method, chiefly the dry cup method outlined by the ASTM E 96 standard, to investigate and compare the rate of moisture vapor transmission, %moisture content, and permeability parameters through the moist wound dressings: Algisite M, Cutiderm, Kaltostat and Tegaderm in different simulated environments for accurate characterisation within a simulated environment closely resembling the biological context of their application, at 37 °C and RH% conditions adjusted based on the data to be extracted being diffusion or water sorption.5 0Item Restricted Assessing the Effectiveness of Saudi Environmental Awareness Week: Evaluating Its Impact on Pro-Environmental and Sustainable Behaviour, and Exploring Strategies for Improvement(Saudi Digital Library, 2025) Alsubaie, Mohammed; Dallison, RichardIn Saudi Arabia, the annual Saudi Environmental Awareness Week (SEAW) was established to foster public engagement in sustainability. However, a notable research gap exists concerning the empirical evaluation of such campaigns within this unique socio-cultural context. This study provides the first assessment of SEAW of its kind, aiming to evaluate its impact on environmental knowledge and pro-environmental behaviour, and to identify the key determinants that support or hinder sustainable actions among its participants. Adopting a pragmatic philosophy, this research employs a mixed-methods design, utilising a cross-sectional online survey with a retrospective pre-post self-assessment. The survey, completed by 100 participants of SEAW 2025, included quantitative scales and open-ended questions. Data are analysed using paired-samples t-tests, hierarchical multiple regression, and thematic analysis. SEAW is found to be highly effective in achieving its primary educational goal, with a large and statistically significant increase in self-reported environmental knowledge (p < .001). However, pro-environmental behaviour was not significantly predicted by psychosocial factors but was most strongly associated with the availability of sustainable options (β = .219, p = .053). This highlights a significant ‘intention-infrastructure gap’, where participants' motivation to act is constrained by external, structural barriers. Qualitative analysis further illuminated this gap, revealing forceful participant frustration with infrastructural deficits and economic penalties. Concurrently, the analysis identified potent, culturally specific motivators, such as the alignment of environmentalism with Islamic values (khilāfa), and a clear public desire for future campaigns to be more practical, systemic, and culturally resonant. iv While SEAW successfully builds a cognitive foundation for change, its ultimate impact is blunted by a prohibitive enabling environment. Future environmental initiatives in Saudi Arabia must evolve beyond information dissemination to focus on dismantling structural barriers and leveraging unique cultural and religious frameworks to translate awareness into sustained, meaningful action.6 0Item Restricted FLUORIDE CONTENT OF INFANT FORMULA COMMERCIALLY AVAILABLE IN CENTRAL INDIANA(Saudi Digital Library, 2025) Altamimi, Ayman; Lippert, FrankBACKGROUND Fluorides have a well-established role in dental caries prevention. Fluoride content in infant formula has raised concerns about whether it is within safe levels for the developing teeth. There is a large number of products on the market with likely varying fluoride concentrations, and these products’ fluoride content will differ depending on whether, for example, fluoridated water was used during manufacturing or reconstitution. Several studies have been published on infant formula containing fluoride and the associated risk of developing enamel fluorosis. However, few recent studies in the US have determined whether liquid or powder infant formula fall within safe/recommended levels. Purpose: This study measured the fluoride content of infant formula sold in grocery stores in central Indiana, prepared using three types of water (Purified, Nursery, and Tap) to determine if they fall within safe levels. Alternative hypotheses: There is a significant difference in the concentration of fluoride between different brands of infant formula. Material & Methods: We analyzed twenty different infant formula products sold in grocery stores in the Indianapolis, Indiana area for their fluoride content. Samples were reconstituted with Nursery water (containing approx. 1.0 ppm fluoride), Tap water (approx. 0.7 ppm fluoride) and Purified water (negligible fluoride content). A sample for the tests was taken from each preparation and the concentrations of fluoride of all samples was determined using the fluoride microdiffusion method. The statistical analysis of results was carried out using two-way ANOVA. Results: When comparing the mean (SD) fluoride concentration among the three types of infant formula reconstitution with water, tap water had significantly higher fluoride concentration mean than both Nursery water and purified water (P <.001 at α=.050 level). Nursery water also had significantly higher fluoride concentration mean than purified water (P <.001 at α=.050 level). When the three types of water were used for reconstitution of the 20 infant formula brands, the overall highest fluoride concentration mean was seen when tap water was used for reconstitution (0.950) followed by nursery water (0.789) while the least fluoride concentration was in purified water (0.102). Conclusion: Within the study's limitations, it can be concluded that apart from one formula none of the tested infant formulas sold in central Indiana grocery stores when reconstituted with purified water were found to decrease the chance of infants exceeding UL levels for both age groups but were found to increases the chance exceeding the AI levels for infants aged 0–6 months. All tested infant formulas reconstituted with nursery and tap water were found to increase the chance of infants exceeding the UL, and the AI levels for both groups resulted in increasing the chance of fluoride concentrations exceeding the recommended/safe levels. Thus, the type of water used for reconstitution rather than the type of formula appears to be the determining factor for the levels of fluoride intake associated with infant formula. Clinical Significance: With the recent increase in the utilization of infant formula, different brands with varying fluoride concentrations and the different modes of reconstitution must be evaluated to determine if their fluoride concentrations will fall within safe/recommended levels and thus increase the risk of enamel fluorosis development.28 0Item Restricted Factors Associated with Inhaled Corticosteroids (ICS) and Long-Term Oxygen Therapy (LTOT) in Chronic Obstructive Pulmonary Disease (COPD)(Saudi Digital Library, 2025) ALANAZI, MANSOUR SHADAD; Damery, Sarah; Ellis, PaulAbstract Background: Chronic obstructive pulmonary disease (COPD) affects millions globally, with inhaled corticosteroids (ICS) and long-term oxygen therapy (LTOT) representing cornerstone interventions. However, their prescription patterns and impact on survival in large real-world cohorts remain underexplored, with significant gaps between clinical trial evidence and routine clinical practice. Methods: This retrospective secondary analysis examined data from the COPD Cohorts Collaborative International Assessment (3CIA), comprising 17,843 COPD patients from 22 international cohorts across seven countries (2008-2014). Three objectives were addressed: describing baseline characteristics stratified by LTOT and ICS use; investigating associations between treatments and GOLD stage classification using ordinal logistic regression; and assessing treatment associations with all-cause mortality using binary logistic regression. Complete case analysis was employed, with statistical significance set at p<0.05. Results: LTOT data were available for 3,987 patients (22.4%) and ICS data for 8,987 patients (50.4%). Both treatment groups demonstrated significantly higher baseline mortality rates (LTOT: 33.4% vs 11.2%, p<0.001; ICS: 21.9% vs 9.5%, p<0.001) and distinct clinical profiles, with former smokers predominating in treated groups. Paradoxically, both treatments were associated with decreased odds of higher GOLD stages (LTOT: OR=0.283, p<0.001; ICS: OR=0.392, p<0.001). In multivariable mortality analysis, neither LTOT (OR=0.725, p=0.398) nor ICS (OR=0.925, p=0.799) showed significant associations with all-cause mortality. The Charlson comorbidity index emerged as the strongest mortality predictor (OR=1.355 per point increase, p<0.001), while current smoking nearly tripled mortality risk (OR=2.442, p=0.016). Conclusions: Despite higher baseline mortality in treatment users, neither ICS nor LTOT demonstrated mortality benefits in adjusted analyses, reflecting confounding by indication where treatment prescription serves as a disease severity marker. Comorbidity burden and smoking status were stronger mortality predictors than respiratory treatments. These findings emphasize the importance of comprehensive patient assessment, appropriate treatment selection, and smoking cessation in COPD management.4 0