Model checking web applications

The modelling of web-based applications can assist in capturing and understanding their behaviour. The development of such applications requires the use of sound methodologies to ensure that the intended and actual behaviour are the same. As a verification technique, model checking can assist in finding design flaws and simplifying the design of a web application, and as a result the design and the security of the web application can be improved. Model checking has the advantage of using an exhaustive search of the state space of a system to determine if the specifications are true or not in a given model. In this thesis we present novel approaches in modelling and verifying web applications' properties to ensure their design correctness and security. Since the actions in web applications rely on both the user input and the server status; we propose an approach for modelling and verifying dynamic navigation properties. The Spin model checker has been used successfully in verifying communication protocols. However, the current version of Spin does not support modelling time. We integrate discrete time in the Spin model to allow the modelling of realistic properties that rely on time constraints and to analyse the sequence of actions and time. Examining the sequence of actions in web applications assists in understanding their behaviour in different scenarios such as navigation errors and in the presence of an intruder. The model checker Uppaal is presented in the literature as an alternative to Spin when modelling real-time systems. We develop models with real time constraints in Uppaal in order to validate the results from the Spin models and to compare the differences between modelling with real time and with discrete time as in Spin. We also compare the complexity and expressiveness of each model checker in verifying web applications' properties. The web application models in our research are developed gradually to ensure their correctness and to manage the complexities of specifying the security and navigation properties. We analyse the compromised model to compare the differences in the sequence of actions and time with the secure model to assist in improving early detections of malicious behaviour in web applications

ASSOCIATION BETWEEN LOCUS OF CONTROL OF HEALTH, RELIGIOUS ATTITUDE, AND SPIRITUALITY IN OLDER ADULTS IN PSYCHIATRIC HOSPITALS OF JEDDAH

Background: A common perception in Muslim society is there that, in old age people see God (Allah) to close as well as they spend most of their time in worshiping and other religious as well spiritual based activities. While role of health and locus of health control is also playing such religious and spiritual practices. Aim of Study: To check the correlation between health locus of control, religious attitude, and spirituality among older Saudi Arabians adults Method: A cross-sectional descriptive research design was used on the 109 older adults, who were selected through online questionnaire by using convenient purposive sampling technique. As we used three questionnaire such as health locus of control, religious attitude scale and spirituality index. Findings & Results: It was found that older adults have a high level of religious attitude as 71.2% and spirituality as 80.1%. The correlation of the sub-domain of health locus of control in its powerful others dimension has a low but statistically significant correlation with religious attitude (r = .278, p < .01) and does not have a correlation with spirituality, thus, a level high religious attitude makes it more likely that older adults have a locus of control over health powerful others at a high level (odds = 3.11, 2.21 – 7.22).  Conclusion: There is higher level of religious attitude in Saudi older Adults. While health locus of control has a significant impact in practicing religious activities as well as showing spirituality

The Study of Learning Styles among Medical Students at Majmaah University, Saudi Arabia

The main objectives of this research were to detect types of learning styles (LS), time spending in studying, to know the relation with GPA, and to determine which LS is suitable with teaching style used in the College of Medicine at Majmaah University. The study was cross-sectional self-survey conducted among male and female medical students at College of Medicine at Majmaah city over 6 months. Cluster sampling was used and total participants were 194 students from College of Medicine (males & females). The data was collected using a designed questionnaire and analysis of data was performed by SPSS (V26).This study showed that majority of participants preferred the Visual learning (VL) style (27.79%), the second most used type was Kinesthetic (24.79%), and the least used type was Auditory (24.53%). It also showed that students who prefer VL style score more than students who prefer other learning styles. It was observed that the student who prefers kinesthetic style spent more time in the studying the more use of this type. In Conclusion, The study concluded that the majority of participants were preferred the VL style. It is also showed that student who prefers visual learning style score more than students who prefer other learning styles. It is important to increase awareness of students regarding types of their learning styles and teaching strategies in college during admission

Perspectives, practices, and challenges of online teaching during COVID-19 pandemic: A multinational survey

The result of the movement restrictions during the COVID-19 pandemic was an impromptu and abrupt switch from in-person to online teaching. Most focus has been on the perception and experience of students during the process. The aim of this international survey is to assess staffs' perspectives and challenges of online teaching during the COVID-19 lockdown. Cross-sectional research using a validated online survey was carried out in seven countries (Brazil, Saudi Arabia, Jordan, Indonesia, India, the United Kingdom, and Egypt) between the months of December 2021 and August 2022, to explore the status of online teaching among faculty members during the COVID-19 pandemic. Variables and response are presented as percentages while logistic regression was used to assess the factors that predict levels of satisfaction and the challenges associated with online instruction. A total of 721 response were received from mainly male (53%) staffs. Most respondents are from Brazil (59%), hold a Doctorate degree (70%) and have over 10 years of working experience (62%). Although, 67% and 79% have relevant tools and received training for online teaching respectively, 44% report that online teaching required more preparation time than face-to-face. Although 41% of respondents were uncertain about the outcome of online teaching, 49% were satisfied with the process. Also, poor internet bandwidth (51%), inability to track students' engagement (18%) and Lack of technical skills (11.5%) were the three main observed limitations. Having little or no prior experience of online teaching before the COVID-19 pandemic [OR, 1.58 (95% CI, 1.35–1.85)], and not supporting the move to online teaching mode [OR, 0.56 (95% CI,0.48–0.64)] were two main factors independently linked with dissatisfaction with online teaching. While staffs who support the move to online teaching were twice likely to report no barriers [OR, 2.15 (95% CI, 1.61–2.86)]. Although, relevant tools and training were provided to support the move to online teaching during COVID-19 lockdown, barriers such as poor internet bandwidth, inability to track students’ engagement and lack of technical skills were main limitations observed internationally by teaching staffs. Addressing these barriers should be the focus of higher education institution in preparation for future disruptions to traditional teaching modes

Vitamin D serum level predicts stroke clinical severity, functional independence, and disability—A retrospective cohort study

BackgroundStroke is a leading cause of mortality and disability and one of the most common neurological conditions globally. Many studies focused on vitamin D as a stroke risk factor, but only a few focused on its serum level as a predictor of stroke initial clinical severity and recovery with inconsistent results. The purpose of this study was to assess the relationship between serum vitamin D levels and stroke clinical severity at admission and functional independence and disability at discharge in Saudi Arabia.MethodologyA retrospective cohort study of adult ischemic stroke patients who had their vitamin D tested and admitted within 7 days of exhibiting stroke symptoms at King Abdulaziz Medical City (KAMC) Jeddah, Saudi Arabia. Based on vitamin D level, the patients were categorized into normal [25(OH)D serum level ≥ 75 nmol/L], insufficient [25(OH)D serum level is 50–75 nmol/L], and deficient [25(OH)D serum level ≤ 50 nmol/L]. The primary outcome was to assess the vitamin D serum level of ischemic stroke patients’ clinical severity at admission and functional independence at discharge. The National Institute of Health Stroke Scale (NIHSS) was used to assess the clinical severity, whereas the modified Rankin scale (mRS) was used to assess functional independence and disability.ResultsThe study included 294 stroke patients, out of 774, who were selected based on the inclusion and exclusion criteria. The mean age of the participants was 68.2 ± 13.4 years, and 49.3% were male. The patients’ distribution among the three groups based on their vitamin D levels is: normal (n = 35, 11.9%), insufficient (n = 66, 22.5%), and deficient (n = 196, 65.6%). After adjusting for potential covariates, regression analysis found a significant inverse relationship of NIHSS based on 25(OH)D serum level (beta coefficient: −0.04, SE: 0.01, p = 0.003). Patients with deficient serum vitamin D level also had significantly higher odds of worse functional independence in mRS score [OR: 2.41, 95%CI: (1.13–5.16), p = 0.023] when compared to participants with normal vitamin D level.ConclusionLow vitamin D levels were associated with higher severity of stroke at admission and poor functional independence and disability at discharge in patients with acute ischemic stroke. Further randomized clinical and interventional studies are required to confirm our findings

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Epidemiology of Chlamydia trachomatis in the Middle East and north Africa: a systematic review, meta-analysis, and meta-regression.

BACKGROUND: The epidemiology of Chlamydia trachomatis in the Middle East and north Africa is poorly understood. We aimed to provide a comprehensive epidemiological assessment of C trachomatis infection in the Middle East and north Africa. METHODS: We did a systematic review of C trachomatis infection as well as a meta-analysis and meta-regression of C trachomatis prevalence. We searched PubMed and Embase, as well as regional and national databases up to March 13, 2019, using broad search terms with no language or year restrictions. Any document or report including biological measures for C trachomatis prevalence or incidence was eligible for inclusion. We extracted all measures of current (genital or rectal), recent, and ever infection with C trachomatis. We estimated pooled average prevalence in different populations using random-effects meta-analysis. Factors associated with prevalence and sources of between-study heterogeneity were determined using meta-regression. FINDINGS: We identified a total of 1531 citations, of which 255 reports contributed to 552 C trachomatis prevalence measures from 20 countries. No incidence measures were identified. Pooled prevalence of current genital infection was 3·0% (95% CI 2·3-3·8) in general populations, 2·8% (1·0-5·2) in intermediate-risk populations, 13·2% (7·2-20·7) in female sex workers, 11·3% (9·0-13·7) in infertility clinic attendees, 12·4% (7·9-17·7) in women with miscarriage, 12·4% (9·4-15·7) in symptomatic women, and 17·4% (12·5-22·8) in symptomatic men. Pooled prevalence of current rectal infection was 7·7% (4·2-12·0) in men who have sex with men. Substantial between-study heterogeneity was found. Multivariable meta-regression explained 29·0% of variation. Population type was most strongly associated with prevalence. Additional associations were found with assay type, sample size, country, and sex, but not with sampling methodology or response rate (about 90% of studies used convenience sampling and >75% had unclear response rate). There was no evidence for temporal variation in prevalence between 1982 and 2018. INTERPRETATION: C trachomatis prevalence in the Middle East and north Africa is similar to other regions, but higher than expected given its sexually conservative norms. High prevalence in infertility clinic attendees and in women with miscarriage suggests a potential role for C trachomatis in poor reproductive health outcomes in this region. FUNDING: National Priorities Research Program from the Qatar National Research Fund (a member of Qatar Foundation)

Acquisition strategies : determining the design requirements and managing the procurement process for the next generation of patrol craft for the Saudi Border Guard

PhD ThesisThe Saudi Border Guard (SBG) undertakes a major responsibility for securing more than 800km of the Kingdom borders, which are surrounded by 14 countries; 10 of them with direct land borders, and four which are separated by the Red Sea and Gulf of Arabia. In addition to the location of the most holy Muslim places of Makkah and al Madina. All these factors make the responsibilities of the Saudi Border Guard (SBG) to be difficult tasks, especially with the increasing activities of smuggling, illegal immigration, illegal trade, terrorism and piracy. In addition there is the need to protect the territorial in terms of fishing, and leisure and to provide guidance, help, and rescue of people and ships that may be in distress, in Saudi sea waters and in the adjacent international sea transport lines, in both the Red Sea and the Gulf of Arabia. Obviously the huge number of acts of piracy in recent years, especially off the Somalia coast, must be part of a new era in the Middle East future. Thus for these and other reasons an efficient fleet of SBG vessels must be employed. There are increasing numbers of people who try to cross the Saudi borders illegally in order to find jobs, to visit the holy places, to engage in illegal trade, or for other purposes. This is especially so owing to the poverty of some of the regional and other countries with high populations (for example the SBG stopped 37,000 people attempting to cross the Saudi borders from Yemen, on the first 20 days of Ramadan, 2009, according to the SBG archives), as well as due to regional political conflicts. Thus there is a need for a strong capability not only in terms of quantity but also in quality of the SBG future. In this project a survey has been carried out in the form of questionnaire and interviews to SBG members in order to ascertain the degree of the shortfalls in the recent SBG fleet and to provide inputs to proposed specifications for the SBG future fleet. However this expected result of this survey is not completely effectiveness fitness for purpose but help to provide usefully information to the designer in order to define the proposed requirement. In addition there are considerable navigation difficulties, around the Saudi coasts in both the Red Sea and the Gulf of Arabia. This is especially so along the Red Sea coast, which is considered as being one of the most dangerous of seas for navigation. The Saudi territorial waters along the Red Sea are characterised by extensive coral reefs, which cause considerable difficulties for local navigation, especially for free ranging Coast Guard Vessels. There are no accurate maps for navigation along the coast of the Red Sea, nor of the random spread of the coral reefs. All of these factors must require the SBG to create a comprehensive plan for the determination excellent ship specifications in order to meet with the SBG mission requirement in the future fleet, and in addition to make use of newly developed technology for efficiently searching and monitoring borders. Geographic political forecasts and new developments in technology must be taken into consideration during the first stage of planning to develop and define the suitable specifications of vessels the future fleet for the SBG. Internal studies within the SBG as well as studies within SA as a whole must be concentrated in the official members of the SBG and related government officials, with the task to continuously survey and discuss all aspects not only of teaching, to achieve the required result, in the way to plan for the next 20 to 30 years of the development and operations of the SBG fleet. This study looks at the overall acquisition process for the provision of the new craft that will be necessary for the Saudi Border Guard to be able to accomplish its future missions. This will involve ensuring that the new vessels will be able to effectively and efficiently undertake the many and diverse operational tasks that will face the SBG over the next 20 to 30 years. Given that uncertainties will exist and develop in the foreseeable future, such new vessels must have a degree of flexibility in meeting their operational requirements and be supported by a shore staff organisation that anticipates and responds to technical problems and developments as and when they occur

The Magnitude and Determinants of Tinnitus among Health Science Students at King Khalid University

Background. Tinnitus is a symptom that is defined as a subjective perception of noise in an absence of external sound. It is an indicator of auditory system abnormalities. It can also be present in individuals without any hearing abnormalities. Difficulty to consternate, insomnia, and decreased speech discrimination are the most common symptoms related to tinnitus. Aim. To assess the magnitude and pattern with determinants of tinnitus among health science students at King Khalid University. Methodology. A descriptive cross-sectional survey was conducted targeting all accessible students in health science colleges in King Khalid University which is the main university in the Aseer region, south of Saudi Arabia. Students were included consecutively from different faculties and different grades. Data were collected through a self-administered prestructured questionnaire, which was distributed and recollected the next day. Tinnitus was screened using an adapted form of the National Health and Nutrition Examination Survey (NHANES). Results. A total sample of 400 students have been included with their ages ranging from 18 to 30 years with a mean age of 22 ± 1.8 years), and 28.5% of the students recorded positive findings. Tinnitus was bilateral among 51.8% of students, and 44.7% of tinnitus students hear buzzing sound while 21.1% have hissing sound and 10.5% had pulsating sound. Among 46.5% of students with tinnitus, the heard sound was of moderate loudness and intermittent among 64.9% of them. Conclusions and Recommendations. In conclusion, the study revealed that just more than a quarter of students complained of tinnitus which was bilateral among half of them. Tinnitus frequency was mainly moderate in intensity and intermittent. Having ear problems, loud sounds, and allergy were the most important predictors of having Tinnitus