Live GPU Forensics: The Process of Recovering Video Frames from NVIDIA GPU

The purpose of this research is to apply a graphics processing unit (GPU) forensics method to recover video artifacts from NVIDIA GPU. The tested video specs are 512 x 512 in resolution for video 1 and 800 x 600 in resolution for video 2. Both videos are mpeg4 video codec. A VLC player was used in the experiment. A special program has been developed using OpenCL to recover 1) patterns that are frames consist of pixel values and 2) dump data from the GPU global memory. The dump data that represent the video frame were located using simple steps. The recovery process was successful. For 512 x 512 resolution video, the frames were partially recovered but it shows enough information for the forensics investigator to determine what was viewed last. The research indicates that it is harder, but not impossible, to obtain a viewable frame from higher-resolution vide

Development, implementation, and evaluation of medication therapy management in Saudi Arabia

Background: Despite global evolution of the role of pharmacists, community pharmacy (CP) practice in the Kingdom of Saudi Arabia (KSA) is still in infancy and in need of substantial upgrades. Under the Vision 2030, the Saudi healthcare system is undergoing a significant transition. In this regard, the CP sector has benefited from ongoing initiatives that aim to introduce a new approach to healthcare. This PhD work aims to develop, implement and evaluate of CP-based medication review service in KSA. Methods: This thesis was conducted using multiple methodologies. First, a systematic review and meta-analysis were conducted to evaluate the effectiveness of community-pharmacist-led medication review services with a wide range of targeted outcomes. Second, a mixed-methods study using an embedded design was conducted to assess the impact of a CP-based medication therapy management (MTM) service on patients’ outcomes. The embedded design consisted of two components, a pilot randomised control trial (RCT) and a qualitative descriptive study. The data were collected sequentially and independently. Glycated haemoglobin (HbA1c) was the primary outcome. Secondary outcomes included: clinical parameters, drug-related problems, health services utilisation, medication adherence, distress and satisfaction. Participants’ experience and views about the service was evaluated using face-to-face, semi-structured qualitative interviews. The final stage involved the process evaluation, quantitative and qualitative methods were utilised to understand the processes and conditions surrounding MTM service development and implementation. Results: Forty RCTs were included in the systematic review and twelve in the meta-analysis. Compared to the control, a significant improvement was noted in the community-pharmacist-based medication review group for the following outcomes: blood pressure (BP) in patients with diabetes (mean difference (MD) in systolic blood pressure (SBP): -6.8 [95% CI -11.3, -2.3]; MD in diastolic blood pressure (DBP): -2.1 [95% CI -3.4, -0.9]) and in the hypertension patients (MD in SBP: -6.2 [95% CI -13.3, 0.9]; MD in DBP: -2.1 [95% CI -6.5, 2.3]), HbA1c in patients with diabetes (MD -0.6; 95% CI -0.9, -0.3), and total cholesterol (TC) in patients with hyperlipidaemia (MD -0.2; 95% CI -0.3, -0.1). One hundred sixty patients with a mean age of 50 years (standard deviation (SD) ±11.9) took part in the RCT study. One hundred twenty-nine patients completed the RCT. Compared to standard care group, improvement was noted in MTM service group for all outcome measures. For the primary outcome, the mean HbA1c level was 0.21% (p=0.503) lower in the intervention arm at six-month. Additionally, the MTM service reduces the odds of healthcare utilisation by 93.1% (p=0.7) at six-month. Participants in the intervention group were 8 times more likely to be adherent compared to the participants in the standard group (p=0.0001). Finally, the MTM service group had a significantly higher median satisfaction score 4 [IQR 4, 4] than the standard care group 1.4 [IQR 1.3, 1.9]. For second phase, sixteen patients participated in the interview. Patients’ responses were classified into three broad themes: perceived benefits from the service, factors contributing to positive patient experiences and barriers and suggestions. Finally, the findings of the process evaluation concluded that the service delivery was achieved as initially planned in the study protocol. Although most of the MTM service components achieved high fidelity, there were challenges in implementing the personal medication record (PMR), monthly follow-up and referral. A number of facilitating factors for service implementation were explored such as: availability of qualified and enthusiastic pharmacists to run MTM clinic, choice of the pharmacy location and utilisation of collaborative agreement. On other hand, barriers to implementation included: lack of manpower and interprofessional setup. Conclusions: CP-based MTM service was deemed to be a ‘pioneer’ and serve the patient considerably, connected all health practitioners with all specialties in one clinic. The service is a potentially successful opportunity in the Saudi CP setting. The MTM service can improve clinical and patient-health outcomes. The findings from this thesis have useful clinical implications that could guide future research and clinical practice

Investigations of a Possible Chemical Effect of Salvadora persica

Salvadora persica is commonly used chewing sticks in many parts of the world as an oral hygiene tool. This study measured the amount of benzyl isothiocyanate (BITC) released into the mouth and assessed its retention time in saliva. The study also tested if the released amount of BITC could potentially be antibacterial or cytotoxic. Twelve subjects brushed their teeth with fresh Miswak once, twice, and four times. The amount of BITC in the saliva and in the used brushes was quantified using gas chromatography-mass spectrometry. The antibacterial effect of BITC and Miswak essential oil (MEO) was tested against Haemophilus influenzae, Aggregatibacter actinomycetemcomitans, and Porphyromonas gingivalis. The cytotoxic effect on gingival fibroblasts and keratinocytes was tested using MTT. The highest amount of the active compounds was detected in saliva after using the Miswak tip for once and immediately. It significantly decreased when the Miswak tip was used more than once and thus after 10 min. The growth of the tested bacteria was inhibited by MEO and BITC in a dose dependent manner, P. gingivalis being the most sensitive. MTT assay showed that BITC and MEO were cytotoxic towards gingival fibroblasts while oral keratinocytes showed resistance. This study suggests that the Miswak tip should be cut before each use to ensure the maximum effect

Translation, cultural adaptation and validation of Patient Satisfaction with Pharmacist Services Questionnaire (PSPSQ) 2.0 into the Arabic language among people with diabetes

Background: Understanding patient satisfaction is key to advancing pharmacy services and improving health outcomes. There is a lack of a translated and psychometrically validated tool in the Arabic language to measure patient satisfaction with pharmacy services. Objective: To translate the English version of the PSPSQ 2.0 into Arabic language, culturally adapt, and verify its reliability and validity. Setting: A community pharmacy in Riyadh, Saudi Arabia. Method: A cross-sectional study was conducted between April 2021 and June 2022 among patients with diabetes attending a community pharmacy. The International Society for Pharmacoeconomics and Outcomes Research good practice guidelines for linguistic translation and cultural adaptation were used to translate and culturally adapt the English version of PSPSQ 2.0 into Arabic. The Arabic version of PSPSQ 2.0 was subjected to factor analysis using principal component analysis with varimax rotation to evaluate its validity and Cronbach’s alpha was used to assess the reliability of PSPSQ 2.0. Results: A total of 129 (68.2% male, and mean age 50 (SD: 11.9) years) patients with diabetes participated in the study. The analysis was undertaken for the items in each of the three domains of PSPSQ 2.0: quality of care, interprofessional relationship and overall care. Exploratory factor analysis revealed validity of 92.7%, 80.5% and 96.2%, respectively. The Arabic version of PSPSQ 2.0 had high internal consistency with Cronbach’s alpha scores 0.99, 0.95 and 0.98 for the three measured domains, respectively. The sample adequacy was 0.924. Conclusion: The PSPSQ 2.0 was successfully translated and culturally adapted into the Arabic language and had acceptable validity and reliability to measure patient satisfaction with services provided by pharmacists in community pharmacies

Impact of a community pharmacy-based medication therapy management program on clinical and humanistic outcomes in patients with uncontrolled diabetes:a randomised controlled trial

This study was aimed to evaluate the impact of community pharmacy (CP)-based medication therapy management (MTM) program on clinical and humanistic outcomes in patients with uncontrolled diabetes. An open label, parallel-group randomised controlled trial was undertaken at a community pharmacy in Riyadh city, Kingdom of Saudi Arabia. Patients with a diagnosis of uncontrolled diabetes (HbA1c of ≥ 8%) meeting the eligibility criteria were randomised to receive either the MTM programme provided by pharmacists or standard care. The primary outcome was change in HbA1c over 6 months. Secondary outcomes included: changes in clinical parameters (blood pressure (BP), lipid profile, serum creatinine (SCr) and albumin-to- creatinine ratio (ACR)), types of drug-related problems (DRPs), health service utilization (HSU), adherence, diabetes distress and overall patient satisfaction with the service at 6-month. A sufficiently powered sample of 160 participants with a mean age was 50 years (SD ± 11.9) was recruited. The majority of the patients (68.1%) were male and had diabetes for more than eight years [IQR 3, 14]. After adjusting for baseline HbA1c, compared to the control group, the mean HbA1c level was 0.02% (p = 0.929) and 0.2% (p = 0.47) lower in the intervention arm at 3-month and 6-month respectively. However, these differences were not statistically significant. Nonetheless, within each arm, there was a significant improvement in HbA1c from baseline. Furthermore, the intervention arm demonstrated improvement in BP control (SBP lowered by 3.2 mmHg (p = 0.05) and DBP lowered by 3.8 mmHg (p = 0.008)). During the study period, none of the participants in the intervention group reported hospitalization or ER visits compared to 14 patients in the control group [OR 0.069 (95% CI 0.004, 1.3)]. Patient satisfaction as measured by Patient Satisfaction with Pharmacist Services Questionnaire 2.0 (PSPSQ 2.0) was significantly higher among MTM program participants compared to standard care (p = 0.00001). Patients in the MTM program were eight times more likely to be adherent compared to the patients in the standard care [OR 7.89 (95% CI 3.6, 17.4)]. MTM program metrics showed that per patient, the pharmacists spent a median of 35 [IQR 30, 44.5] minutes at the initial visit and 20 [IQR 10, 25] minutes during the 6-month visit. The number of DRPs had significantly dropped in the intervention arm at 3 and 6-month (p = 0.0001). In conclusion, CP-based MTM program can improve health outcomes and prevent hospitalisations in patients with diabetes. These findings support the implementation of CP-based MTM services for patients with diabetes in the Kingdom of Saudi Arabia

The development and validation of a multivariable model to predict the bleeding risk score for patients with non-valvular atrial fibrillation using direct oral anticoagulants in the Arab population.

Background Frequently used models, such as the HAS-BLED, ATRIA, ORBIT, and GARFIELD-AF evaluate the risk of bleeding when using an anticoagulant, for example warfarin, in patients with non-valvular atrial fibrillation. Limited studies are available reporting a model with a good discriminative ability to predict the bleeding risk score when using direct oral anticoagulants. Methods Patient data were collected from King Abdulaziz Medical City, King Fahad Cardiac Center, and Prince Sultan Cardiac Center in Riyadh, from outpatients, inpatients, or primary care clinics. In total, 1722 patients with a prescription for a new oral anticoagulant, Dabigatran, Rivaroxaban, or Apixaban, were enrolled. A resampling approach for variable selection was used and a five-fold cross-validation to assess the model fit and misclassification probabilities. The analysis used the receiver operating characteristics curve (ROC) and the concordance (c) statistic to assess the validation models’ discriminative power. The final penalized likelihood parameters were used for the development of the risk prediction tool. The accuracy of a classification and the prediction are reported with the sensitivity, specificity, and Brier score. Results Bleeding occurred in 11.15% of cases, of which 23.08% required a blood transfusion and 51.65% had a reduction in haemoglobin of more than 2 gm. The variable selection model identified 15 predictors associated with major bleeding. The discriminative ability of the model was good (c-statistic 0.75, p = 0.035). The Brier score of the model was 0.095. With a fixed cut-off probability value of 0.12 for the logistic regression equation, the sensitivity was 72.7%, and the specificity 66.3%. Conclusion This model demonstrated a good performance in predicting the bleeding risk in Arab patients treated with novel oral anticoagulants. This easy to use bleeding risk score will allow the clinician to quickly classify patients according to their risk category, supporting close monitoring and follow-up for high-risk patients, without laboratory and radiological monitoring

Assessment of sleep quality, post-traumatic stress disorder, and locus of control in motor vehicle accident survivors

BackgroundHigh incidence of Motor Vehicle Accidents (MVAs) in Saudi Arabia and the established link between MVA and related psychological factors necessitate a survey of the prevalence of MVA and associative factors. AimsTo investigate the relationship between sleep patterns, locus of control, and post-traumatic stress disorder (PTSD) among MVA survivors at King Abdulaziz Medical City (KAMC), Riyadh.MethodsA cross-sectional survey was conducted on 334 patients with MVA admitted cases, and patients who visited outpatient clinics. In addition to basic demographic information and driving history, PTSD severity, sleep quality, and locus of control were assessed using a validated PTSD Checklist – Civilian Version (PCL-C), Rotter’s Locus of Control Scale (LCS), and items taken from the Pittsburg Sleep Quality Index. Association between the variables was analysed using the Chi-Square test.ResultsPrevalence of moderate to severe PTSD was 39.2 per cent. No association between PTSD severity and involvement in an MVA was found. Women had significantly higher scores PTSD lower internal locus of control scores. The majority of the respondents reported fairly good to very good sleep quality, although 18 per cent admitted to having a driving impairment or hindrance in completing other daily activities due to inadequate sleep in the past month. Regarding trouble staying awake while driving, a significant correlation was found with powerful others (p=0.026) and chance (0.019).ConclusionNo correlation was found between PTSD severity, poor sleep, locus of control and MVA in this study, although high rates of PTSD necessitate valid identification and treatment of patients at risk

Central versus Peripheral Postcardiotomy Veno-Arterial Extracorporeal Membrane Oxygenation: Systematic Review and Individual Patient Data Meta-Analysis

Background: It is unclear whether peripheral arterial cannulation is superior to central arterial cannulation for postcardiotomy veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Methods: A systematic review was conducted using PubMed, Scopus, and Google Scholar to identify studies on postcardiotomy VA-ECMO for the present individual patient data (IPD) meta-analysis. Analysis was performed according to the intention-to-treat principle. Results: The investigators of 10 studies agreed to participate in the present IPD meta-analysis. Overall, 1269 patients were included in the analysis. Crude rates of in-hospital mortality after central versus peripheral arterial cannulation for VA-ECMO were 70.7% vs. 63.7%, respectively (adjusted OR 1.38, 95% CI 1.08–1.75). Propensity score matching yielded 538 pairs of patients with balanced baseline characteristics and operative variables. Among these matched cohorts, central arterial cannulation VA-ECMO was associated with significantly higher in-hospital mortality compared to peripheral arterial cannulation VA-ECMO (64.5% vs. 70.8%, p = 0.027). These findings were confirmed by aggregate data meta-analysis, which showed that central arterial cannulation was associated with an increased risk of in-hospital mortality compared to peripheral arterial cannulation (OR 1.35, 95% CI 1.04–1.76, I2 21%). Conclusions: Among patients requiring postcardiotomy VA-ECMO, central arterial cannulation was associated with an increased risk of in-hospital mortality compared to peripheral arterial cannulation. This increased risk is of limited magnitude, and further studies are needed to confirm the present findings and to identify the mechanisms underlying the potential beneficial effects of peripheral VA-ECMO

Medication adherence among diabetic and hypertensive patients in Al-Qassim region of Saudi Arabia

Non-adherence to medication is often an unrecognized risk factor that contributes to failure of the therapeutic plan. The purpose of the study was to identify factors related to high, medium and low medication adherence among adult Saudi patients with hypertension and diabetes mellitus. This study is designed as a descriptive cross sectional survey and was conducted in three tertiary care hospitals of Al-Qassim province of Saudi Arabia. The data was collected using the 8-item Morisky Medication Adherence Scale (MMAS-8) and analyzed by SPSS. Three levels of adherence were considered based on the following scores: 0 to <6 (low); 6 to <8 (medium); 8 (high). Of the 396 patients interviewed, 52% reported low adherence to prescribed medication. Multinomial logistic regression analysis was conducted. Gender, age, literacy level, duration of illness and type of chronic disease were negatively associated with medication adherence. The study shows very high proportion of low and medium adherence on long term medication, which may be responsible for the failure of achieving therapeutic outcome. Further investigation is required to evaluate the applicability of MMAS-8 as a tool of measuring medication adherence among Saudi patients with chronic diseases. Adherence enhancing strategies should also be evaluated in separate patients group

Digital Forensics and Security Vulnerabilities in GPU

The purpose of this research is to perform a graphics recovery process on the GPU in line with the principles of computer forensics. The research investigates three different venues in the GPU forensics field. The first venue targets the recovery of images and web-pages. The researchers tested the possibility of recovering artifacts of last visited web pages and last opened images from the GPUs global memory. The tested types of images are JPEG, TIFF, and BMP graphic file formats of 64x64 pixels, 100x100 pixels, 200x200 pixels, 245x256 pixels, 512x512 pixels, and 1024x1024 pixels in size. Other variables, such as the choice of OS, GPU, and GPU driver, were also tested to measure the effectiveness on the proposed method. The research indicates that recovering artifacts from the GPUs global memory is possible using a set of unique pixel patterns. The research highlights three challenges of implementing forensic techniques on GPUs: 1) elusive global memory allocation scheme of GPUs; 2) varying levels of support for different GPU drivers; and 3) the prerequisite of using certain types of OS and applications. The second venue is GPU video forensics which investigates the possibility of recovering video artifacts from NVIDIA GPU. The tested video specs are 512 x 512 in resolution for video 1 and 800 x 600 in resolution for video 2. Both videos are mpeg4 video codec. A VLC and GOM video players were used in the experiment. A special program has been developed using OpenCL to recover 1) patterns that are frames consist of pixel values and 2) dump data from the GPU global memory. The dump data that represent the video frame were located using simple steps. The recovery process was successful. For 512 x 512 resolution video, the frames were partially recovered but it shows enough information for the forensics investigator to determine what was viewed last. The research indicates that it is harder, but not impossible, to obtain a viewable frame from higher-resolution video. The third venue of this research targets the security side of the GPU by reverse engineer a unique family of malware, namely the Win Jelly and the Demon keylogger, that escapes detection by utilizing AMD and NVIDIA Graphics Processing Units (GPUs) as a hideout. Static and dynamic analysis of Win Jelly and Demon were presented to gain a deeper understanding about the behavior of these malware and how they exploit the GPU, two separate techniques were developed using OpenCL and CUDA to completely remove the malware from the GPU and to help avoid future threats. The proposed method and tools successfully removed the malicious files from the GPU without any drawbacks