Saudi Cultural Missions Theses & Dissertations
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Item Restricted Developing a pharmaceutical care screening tool for use by acute mental health clinical pharmacy services(Saudi Digital Library, 2025) Alshaikhmubarak, Fatima Qais; Lewis, Penny J; Keers, Richard NBackground: Mental health inpatient pharmacy teams in the UK are under pressure to deliver optimal care despite limited resources and staff shortages. Prioritising clinical pharmacy services is an innovative approach that aims to optimise the use of pharmacy expertise and reduce the incidence of Drug Related Problems (DRPs). Patient prioritisation tools have been developed and shown to be effective in improving patient outcomes and service delivery in acute care. Such approaches are much needed in mental health hospitals where medications are the main therapeutic intervention and patients are highly vulnerable to DRPs due to factors such as cognitive impairment. Research aim: The aim of this research programme was to develop a pharmaceutical care screening tool for use by acute mental health clinical pharmacy services. Methods: A systematic review was undertaken to identify risk factors for DRPs in hospital based mental health units. This was followed by a multi-method study where all mental health NHS trusts and boards in the UK were surveyed to identify organisations using pharmaceutical patient prioritisation approaches. Identified organisations were invited for follow up interviews and to provide their prioritisation documents for analysis. The third step towards the tool development was two sequential Delphi questionnaires, informed by the systematic review and the multi-method study, aiming to reach agreement on the content and design of the tool. Lastly, iterative acceptability testing was undertaken where mental health pharmacy team members from five NHS organisations tested the developed tool and provided feedback through reflection sheets and focus group discussions. Qualitative data was analysed thematically using NVivo software and quantitative data was summarised using Microsoft Excel. Results: A total of 22 studies were included in the systematic review. Identified risk factors included increased number of prescribed medications, advanced age and length of hospitalisation. The multi-method study identified 21 (n=21/55, 38.2%) organisations using patient prioritisation systems. A total of 15 interviews were conducted and 11 prioritisation documents were received. Identified systems varied greatly in their development, use, and complexity. A total of 36 experts completed the first round of Delphi study one (agreement reached on inclusion of 43.1% (47/109) of the risk indicators) and 29 completed the second round (agreement reached on inclusion of 66.7% (82/123) of the risk indicators). Experts agreed on using the traffic light system (red, amber, and green) to classify patients into risk groups. For Delphi study two, 32 experts completed the first round (agreement reached on inclusion of 41.3% of statements) and 30 completed the second round (agreement reached on inclusion of 44.8% of statements). The developed tool was generally acceptable by pharmacy professionals from five NHS organisations and participants’ feedback helped refine it further. Conclusion: This PhD programme developed an evidence- and consensus- based patient prioritisation tool accompanied by a manual and training material for mental health pharmacy teams. This tool may enhance clinical decision-making and help achieve the shared objectives of the mental health outcomes strategy “No Health Without Mental Health”. Future work may help further explore the tool’s feasibility and effectiveness and assist in determining its usability and future potential across diverse contexts.5 0Item Restricted Effect of Different Plaque Removal Methods on the Surface Characteristics and Color Stability of Composite Resins(Saudi Digital Library, 2025) Alkheledan, Lamya; Rizvi, NaureenAir polishing is a commonly employed technique for professional mechanical plaque removal in dental patients. Although effective, evidence suggests it can increase surface roughness of composite restorations, which may in turn increase their susceptibility to staining. There remains, however, a lack of studies directly investigating the effects of different air polishing powders on the colour stability of composite resins. The purpose of this study was to evaluate the effect of air polishing with sodium bicarbonate and erythritol powder on surface characteristics and colour stability of nanohybrid composite resins, compared with no polishing and traditional pumice paste. The aim was to help inform clinical recommendations for professional mechanical plaque removal and polishing in patients who have composite restorations in aesthetic zones. Materials and methods: Sixty disc-shaped specimens of G-ænial Anterior composite (GC Corp., Tokyo, Japan) were prepared and allocated to 4 groups (n=15): control (no polishing), sodium bicarbonate air polishing, erythritol air polishing, and traditional pumice polishing. All specimens underwent immersion in tea at 37 °C for 24 hours and colour measurements were recorded at four stages, (baseline, post-staining, post-polishing, final staining) using the eLab digital colour analysis system (eLAB Prime, GmbH, Germany). Separately, one specimen was prepared for each group solely for SEM analysis to qualitatively assess surface morphology before and after polishing. Results: Significant differences in colour change (ΔE₀₀) were observed across groups (p < 0.001). Sodium bicarbonate showed the highest initial staining (T1: 13.51 ± 2.41), followed by erythritol + CHX (10.67 ± 2.34), pumice (9.77 ± 1.03), and control (7.26 ± 0.97). For stain removal (T2), sodium bicarbonate exhibited the greatest change (7.76 ± 3.53), indicating stronger abrasive action, while erythritol + CHX (5.15 ± 1.52) and pumice (5.08 ± 1.10) showed comparable effects. Cumulative colour change (T3) was highest in the erythritol + CHX group (10.57 ± 1.69), followed by the control (10.34 ± 1.10), with lower values in sodium bicarbonate (8.58 ± 0.74) and pumice (7.90 ± 1.89). SEM imaging showed smoother, more uniform surfaces with pumice, and greater surface disruption in specimens exposed to sodium bicarbonate and erythritol + CHX. Conclusions: Rubber cup polishing with pumice effectively removed stains while maintaining the lowest overall colour change out of the three polishing methods tested. Sodium bicarbonate produced the highest initial discolouration and demonstrated the greatest stain removal capacity. Erythritol resulted in the highest colour change after repeated polishing and staining. Specimens in the unpolished control group also accumulated stains over time. While changes to composite surface characteristics were observed with all polishing methods, further studies are needed to quantify these changes. Clinicians should be aware that commonly used polishing methods can affect both colour stability and surface characteristics of composite restorations.13 0Item Restricted Inter- and Intra-rater Reliability of a New Wearable Accelerometer in Measuring Hip Flexion Peak Velocity, Mean Velocity, Maximum Range of Motion, and Mean Range of Motion during the Askling H-Test Among Asymptomatic Healthy Adults(Saudi Digital Library, 2025) AlHazmi, Dhuha Saeed S; Willett, MatthewBackground: The Askling H-test is recognised as a valid and reliable test to assess hamstring performance during high velocity movement and to guide the return to sport (RTS) decision after hamstring strain injuries (HIS). Key parameters obtained from this test, such as hip flexion angular velocity, along with range of motion, provide critical insights into hamstring eccentric control, flexibility, and potential risk of reinjury. However, evidence on the use of wearable IMUs to capture these parameters remains limited, particularly in sport medicine and rehabilitation settings. Purpose: To evaluate the inter-rater and intra-rater reliability of the Output Sports accelerometer in measuring hip flexion Peak Velocity (Vpeak), Mean Velocity (Vmean), Maximum and Mean Range of Motions (ROMmax, ROMmean) during the Askling H-test among asymptomatic healthy adults under two bracing conditions. Study Design: Cross-sectional Reliability Study. Methods: Four raters utilised the Output Sports accelerometer to capture Vpeak, Vmean, ROMmax, and ROMmean during the Askling H-test on asymptomatic, healthy young males and females under two bracing conditions. Inter- and intra-rater reliability were evaluated using Intraclass correlation coefficients (ICCs) with 95% confidence intervals (CI). Visual estimation of agreement was performed using Bland-Altman Plots. SEM and MDC were calculated to estimate error/change. Results: A total of sixty-eight participants (40 males, 28 females) with a mean age of 24.52±3.86 years were included. A moderate to good inter-rater reliability was observed across both sexes and bracing conditions (ICC=0.69-0.88 males, ICC=0.65-0.89 females), with moderate to good intra-rater reliability for females (ICC=0.59-0.86) and poor to good in males (ICC=0.48-0.74). Conclusion: The Output Sports accelerometer is a reliable device for assessing hip flexion velocities and ROM during the Askling H-test. Bracing further enhanced its measurement consistency, supporting its use in clinical and sports settings. Level of Evidence: Level 3. Key Terms: Askling H-test, Accelerometer, Hamstring Strain Injury, Output Sports, Reliability.4 0Item Restricted The Impact of Localisation on the Humanitarian Response to the 2023 Türkiye–Syria Earthquake(Saudi Digital Library, 2025) Alshahrani, Ahmed.Mobark; Dias, NuwanThe Turkey-Syria earthquake occurred on February 6, 2023, with a magnitude of 7.8 at 4 AM. It affected northern Syria and central and southern Türkiye. This study investigates the role of localisation in the humanitarian response to the 2023 Türkiye–Syria earthquake. Guided by a five-dimensional analytical framework—effectiveness, agency, collaboration, constraints, and enablers—the study synthesizes 26 secondary sources including humanitarian reports, evaluations, and academic literature. Findings reveal that Syrian NGOs played a central role in delivering timely and culturally appropriate shelter solutions, leveraging proximity, trust networks, and contextual knowledge. However, systemic barriers—limited access to decision-making, unequal partnerships, and insufficient direct funding—undermined their contributions. The study concludes that localisation in shelter response remains constrained by structural inequities within international humanitarian governance. Achieving its full potential requires transformative shifts in funding architecture, power distribution, and coordination practices. Practical recommendations are provided to enhance agency, inclusion, and local capacity in future crisis responses.12 0Item Restricted Use of PolyEtherEtherKetone (PEEK) containing the antifungal agent nonanoic acid as a denture base material to inhibit Candida albicans colonisation(Saudi Digital Library, 2022) Mujayridi, Mazen; Murdoch, Craig; Barker, EmiliaIntroduction: Complete denture is one of the treatment modalities in treating edentulous patients. However, denture stomatitis is one of the critical complications of wearing a complete denture. Yet, the current materials used in fabricating denture bases are unsatisfactory due to mechanical drawbacks and their association with increased risk of denture stomatitis. Objective: To investigate the modification of the newly arising denture base material polyetheretherketone (PEEK) by sulfuric acid etching to act as a scaffold that retains the antifungal agent nonanoic acid in an attempt to inhibit the growth of the C. albicans and compare it to well- known miconazole antifungal drug. Moreover, to evaluate the surface property of acid-modified PEEK. Material and methods: Disc-shaped samples were prepared from PEEK. Sixteen samples were randomly selected for both plain (n=8) and etched (n=8) samples and surface property analysis performed. Fifteen etched discs allocated into five groups in triplicate experiments as follows: (PBS) as a negative control, miconazole as a positive control, and three different concentrations of nonanoic acid to perform a disc diffusion test to measure the ability of these antifungals in the inhibition of candida growth. Also, the XTT assay was used to measure the biofilm viability of C. albicans in the absence or presence of nonanoic acid. Results: Surface roughness was significantly higher on the etched PEEK compared to plain samples (P<0.0001), and the microhardness value of the etched PEEK was significantly lower than the plain disc (P<0.0001). The disc diffusion test significantly demonstrated a higher area of inhibition zone of the nonanoic acid with 0.2M compared to the other groups. Also, a dose- response relationship of nonanoic acid was found in killing candida. The XTT viability assay validates the antifungal effectiveness of nonanoic acid on the inhibition of the growth of the candida than does the miconazole group. Conclusions: Within the limitations of this study, the data suggest that nonanoic acid is an attractive alternative in inhibiting the growth of C. albicans compared to the well-known antifungal drug (miconazole). Moreover, the data demonstrate the dose-response relationship of nonanoic acid in inhibiting candida growth. Further studies are indispensable before utilizing the modified PEEK as a denture base material.6 0Item Restricted ARTIFICIAL INTELLIGENCE AND FRAUD PREVENTION IN FINANCIAL SERVICES: LEGAL AND REGULATORY PERSPECTIVES ON AI’S ROLE IN DETECTING FINANCIAL CRIME(Saudi Digital Library., 2025) Alheih, Shahad; Keller, AnatArtificial intelligence (AI) is transforming financial services by enhancing fraud detection, improving regulatory compliance, and enabling real-time monitoring of financial activities. This dissertation examines the legal and regulatory frameworks governing AI-driven fraud prevention tools, with a focus on the United Kingdom and the European Union. It explores the potential of AI to strengthen financial integrity while identifying key challenges related to transparency, accountability, and data protection. The research argues that while AI offers significant benefits in detecting and preventing financial crime, robust governance mechanisms are required to mitigate associated risks. Through doctrinal legal analysis, the study evaluates existing laws, regulatory guidance, and emerging AI-specific legislation to determine whether current frameworks adequately address the complexities of AI-based fraud prevention. The dissertation concludes that although significant progress has been made, regulatory gaps persist, particularly in relation to algorithmic bias, explainability, and cross-border data governance. Strengthening these areas is essential to ensure that AI technologies support—not undermine—the principles of fairness, legality, and financial stability.6 0Item Restricted Barriers Shaping the Attitude–Behaviour Gap in Sustainable Purchasing: Evidence from Saudi Arabia(Saudi Digital Library, 2025) Aljohani, Eshraq; Arunachalam, DeepakThis dissertation investigates the persistence of the attitude–behaviour gap in sustainable purchasing among Saudi consumers, a context where environmental awareness has grown but outcomes remain unsustainable. The research explores structural and supply-chain obstacles preventing people from turning pro-sustainability attitudes into actual purchasing actions. Guided by an interpretivist philosophy, it adopts a qualitative design using thirteen semi-structured interviews conducted in Arabic with Saudi consumers. Thematic analysis identified key patterns. Findings reveal five obstacles: high costs that frame sustainable products as luxury goods; limited availability in mainstream retail channels; weak transparency that fuels scepticism; negative product experiences prioritising convenience and quality; and inadequate end-of-life systems leaving consumers disempowered. The research shows that the gap stems from fundamental market and supply chain obstacles surpassing environmental awareness. Market transformation is presented as the solution to bridge this gap through affordable prices, accessible products, transparent information, consistent quality, and circular infrastructure. It contributes to theory by challenging the sufficiency of the Theory of Planned Behaviour and highlights practical implications for managers and policymakers.17 0Item Restricted THE IMPACT OF ESG PERFORMANCE ON SYNDICATED LOAN TERMS: AN EMPIRICAL ANALYSIS(Mashael Shamakhi, 2025) Zhao, Binru; Zhang, Hanxiong; Khoo, Shee Yee; Gepp, Adrian; Shamakhi, Mashael EssaThis research provides an integrated examination of four critical areas in modern finance: the impact of Environmental, Social, and Governance (ESG) performance on syndicated loan terms, the influence of behavioural factors on investment decisions, the effectiveness of Credit Rating Agencies (CRAs) in assessing financial risk, and analytical models used to detect financial statement fraud. The ESG analysis shows no statistically significant effect on loan pricing, maturity, or covenant strictness, despite minor economic tendencies. The behavioural finance review highlights how social interactions, media sentiment, and AI-based tools amplify investor biases and market volatility. The evaluation of CRAs identifies persistent challenges related to rating accuracy, conflicts of interest, and delayed downgrades, even after post-crisis regulatory reforms. Finally, the fraud analytics component assesses models such as the Beneish M-Score, the Dechow F-Score, and machine learning methods like RUSBoost, demonstrating the limitations of traditional scoring models under extreme class imbalance. Collectively, the study underscores the interconnected roles of human behaviour, information quality, and quantitative analytics in shaping financial market outcomes and emphasizes the need for transparent methodologies, robust regulatory frameworks, and advanced analytical tools to enhance financial stability.10 0Item Restricted The Market and Economic Impact of Public Investment Fund’s (PIF) Acquisition of Telecommunication Towers Company Limited (TAWAL) from STC Group(Saudi Digital Library, 2025) Altamimi, Razan; Imperial, Business SchoolThis report examines the market, financial, and strategic implications of the Public Investment Fund’s (PIF) acquisition of a 51% stake in the Telecommunications Towers Company (TAWAL) from the Saudi Telecom Company (STC), followed by its planned merger with the Golden Lattice Investment Company (GLIC). Drawing on industry data, valuation models, and financial forecasts, the study evaluates how the consolidation of tower assets, forming the region’s largest telecom infrastructure entity that supports Saudi Arabia’s digital transformation and Vision 2030 objectives. The analysis employs discounted cash flow (DCF) valuation for both STC and PIF, revealing enhanced enterprise value driven by stable free cash flows, strong margins, and significant terminal value contributions. The findings show that the deal strengthens STC’s reinvestment capacity, positions PIF as a dominant regional infrastructure investor, and underscores the economic benefits of telecom infrastructure consolidation. Overall, the acquisition and merger are expected to generate long-term strategic and financial gains for both entities and the Saudi economy.7 0Item Restricted A Multi-Perspective Narrative Review of the Impact of Drug Recalls on Pharmaceutical Companies & Mitigation Strategies(Saudi Digital Library, 2025) Alshehri, Areej; Catena, RodolfoIntroduction: Drug recalls, though essential for public health protection, they trigger financial and reputational impacts on pharmaceutical companies. Aims: This narrative review study aim is to identify the financial and reputational impacts of drug recalls on major pharmaceutical companies, effective post-recall response strategies, and best practices for recall prevention. Methodology: A search was conducted using various electronic databases, including PubMed, Web of Science, Google Scholar, websites related to pharmaceutical companies, and news articles. Keywords related to recalls in pharmaceutical industry were used. This search was limited to literature published between 2014 and 2025. This review included original research articles, review articles, and case studies. Results: The review identified significant financial and reputational impacts resulting from drug recalls, including litigation costs, operational losses, and diminished brand trust. Identified effective recall strategies included regulatory compliance, transparent communication, contingency planning, delegated authority, recall simulations, insurance coverage (including Directors and Officers D&O), strong documentation, closed-loop recall systems, and diverse board leadership. Moreover, compliance with manufacturing standards, ongoing quality control, Quality by Design (QbD) adoption, system integration, and global recall databases, may prevent recalls. Conclusion: This review underscores the importance of strategic recall management, legal preparedness, and preventive quality measures. The ranitidine example illustrates how outcomes can vary based on company response, emphasising the need for proactive planning, effective management, and integrated systems to minimise harm and preserve corporate reputation.2 0