Search results for: major bleeding event

Authors: Puntarikorn Rungrattanakasin

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Objectives: To develop the trigger tool to warn about the risk of bleeding as an adverse event from warfarin drug usage during admission in Medical Wards of Chumphae Hospital. Methods: A retrospective study was performed by reviewing the medical records for the patients admitted between June 1st,2020- May 31st, 2021. ADEs were evaluated by Naranjo’s algorithm. The international normalized ratio (INR) and events of bleeding during admissions were collected. Statistical analyses, including Chi-square test and Reciever Operating Characteristic (ROC) curve for optimal INR threshold, were used for the study. Results: Among the 139 admissions, the INR range was found to vary between 0.86-14.91, there was a total of 15 bleeding events, out of which 9 were mild, and 6 were severe. The occurrence of bleeding started whenever the INR was greater than 2.5 and reached the statistical significance (p <0.05), which was in concordance with the ROC curve and yielded 100 % sensitivity and 60% specificity in the detection of a bleeding event. In this regard, the INR greater than 2.5 was considered to be an optimal threshold to alert promptly for bleeding tendency. Conclusions: The INR value of greater than 2.5 (>2.5) would be an appropriate trigger tool to warn of the risk of bleeding for patients taking warfarin in Chumphae Hospital.

Keywords: trigger tool, warfarin, risk of bleeding, medical wards

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Authors: Kyoung Hoon Kim

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This work presents an exergetical performance analysis of regenerative organic Rankine cycle (ORC) using turbine bleeding based on the second law of thermodynamics for recovery of finite thermal energy. Effects of system parameters such as turbine bleeding pressure and turbine bleeding fraction are theoretically investigated on the exergy destructions (anergies) at various components of the system as well as the exergy and the second-law efficiencies. Under the conditions of the critical fraction of turbine bleeding, the simulation results show that the exergy efficiency decreases monotonically with respect to the bleeding pressure, however, the second-law efficiency has a peak with respect to the turbine bleeding pressure.

Keywords: organic Rankine cycle, ORC, regeneration, turbine bleeding, exergy, second-law efficiency

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Authors: Arne Koschel

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This article discusses event monitoring options for heterogeneous event sources as they are given in nowadays heterogeneous distributed information systems. It follows the central assumption, that a fully generic event monitoring solution cannot provide complete support for event monitoring; instead, event source specific semantics such as certain event types or support for certain event monitoring techniques have to be taken into account. Following from this, the core result of the work presented here is the extension of a configurable event monitoring (Web) service for a variety of event sources. A service approach allows us to trade genericity for the exploitation of source specific characteristics. It thus delivers results for the areas of SOA, Web services, CEP and EDA.

Keywords: event monitoring, ECA, CEP, SOA, web services

Procedia PDF Downloads 746

Authors: Macie Matta, Ahmad Jabri, Stephanie Jackson

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Introduction: In the absence of hypotension, pulmonary embolism (PE) causing right ventricular dysfunction or strain, whether confirmed by imaging or cardiac biomarkers, is deemed to be an intermediate-risk category. Urgent treatment of intermediate-risk PE can prevent progression to hemodynamic instability and death. Management options include thrombolysis, thrombectomy, or systemic anticoagulation. We aim to evaluate the short-term outcomes of a half-dose tissue plasminogen activator (tPA) for the management of intermediate-risk PE. Methods: We retrospectively identified adult patients diagnosed with intermediate-risk PE between the years 2000 and 2021. Demographic data, lab values, imaging, treatment choice, and outcomes were all obtained through chart review. Primary outcomes measured include major bleeding events and in-hospital mortality. Patients on standard systemic anticoagulation without receiving thrombolysis or thrombectomy served as controls. Patient data were analyzed using SAS®️ Software (version 9.4; Cary, NC) to compare individuals that received half-dose tPA with controls, and statistical significance was set at a p-value of 0.05. Results: We included 57 patients in our final analysis, with 19 receiving tPA. Patient characteristics and comorbidities were comparable between both groups. There was a significant difference between PE location, presence of acute deep vein thrombosis, and peak troponin level between both groups. The thrombolytic cohort was more likely to demonstrate a 60/60 sign and thrombus in transit finding on echocardiography than controls. The thrombolytic group was more likely to have major bleeding (17% vs 7.9%, p= 0.4) and in-hospital mortality (5.3% vs 0%, p=0.3); however, this was not statistically significant. Patients who received half-dose tPA had non-significantly higher rates of major bleeding and in-hospital mortality. Larger scale, randomized control trials are needed to establish the benefit and safety of thrombolytics in patients with intermediate-risk PE.

Keywords: pulmonary embolism, half dose thrombolysis, tissue plasminogen activator, cardiac biomarkers, echocardiographic findings, major bleeding event

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Authors: Samindi Samarakoon, Ørjan Sletbakk Vie, Remi Kleiven Fjelldal

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White concrete facade elements are widely used in construction industry. It is challenging to achieve the desired workability in casting of white concrete elements. Particle Matrix model was used for proportioning the self-compacting white concrete (SCWC) to control segregation and bleeding and to improve workability. The paper presents how to reach the target slump flow while controlling bleeding and segregation in SCWC. The amount of aggregates, binders and mixing water, as well as type and dosage of superplasticizer (SP) to be used are the major factors influencing the properties of SCWC. Slump flow and compressive strength tests were carried out to examine the performance of SCWC, and the results indicate that the particle matrix model could produce successfully SCWC controlling segregation and bleeding.

Keywords: white concrete, particle matrix model, mix design, construction industry

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Authors: Dewi Tristantini, Jason Jonathan

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Coronary Artery Disease (CAD) is one of the deathliest diseases which is caused by atherosclerosis. Atherosclerosis is a disease that plaque builds up inside the arteries. Plaque is made up of fat, cholesterol, calcium, platelet, and other substances found in blood. The current treatment of atherosclerosis is to provide antiplatelet therapy treatment, but such treatments often cause gastrointestinal irritation, muscle pain and hormonal imbalance. Mimusops elengi L.’s leaves can be utilized as a natural and cheap antiplatelet’s source because it contains flavonoids such as quertecin. Antiplatelet aggregation effect of Mimusops elengi L.’s leaves’ wet extract was measured by bleeding time on DDY strain mice with the test substances were given orally during the period of 8 days. The bleeding time was measured on first day and 9th day. Empirically, the dose which is used for humans is 8.5 g of leaves in 600 ml of water. This dose is equivalent to 2.1 g of leaves in 350 ml of water for mice. The extract was divided into 3 doses for mice: 0.05 ml/day; 0.1 ml/day; 0.2 ml/day. After getting the percentage of the increase in bleeding time, data were analyzed by analysis of variance test (Anova), followed by individual comparison within the groups by LSD test. The test substances above respectively increased bleeding time 21%, 62%, and 128%. As the conclusion, the 0.02 ml/day dose of Mimusops elengi L.’s leaves’ wet extract could increase bleeding time better than clopidogrel as positive controls with 110% increase in bleeding time.

Keywords: antiplatelets, atheroschlerosis, bleeding time, Mimusops elengi

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Authors: Mekha Mathew, Varun P Gopi

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Wireless Capsule Endoscopy (WCE) has become a great device in Gastrointestinal (GI) tract diagnosis, which can examine the entire GI tract, especially the small intestine without invasiveness and sedation. Bleeding in the digestive tract is a symptom of a disease rather than a disease itself. Hence the detection of bleeding is important in diagnosing many diseases. In this paper we proposes a novel method for distinguishing bleeding regions from normal regions based on Contourlet transform and Local Binary Pattern (LBP). Experiments show that this method provides a high accuracy rate of 96.38% in CIE XYZ colour space for k-Nearest Neighbour (k-NN) classifier.

Keywords: Wireless Capsule Endoscopy, local binary pattern, k-NN classifier, contourlet transform

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Authors: Yi-De Liu

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Destination branding is a popular practice adopted by many cities in the context of intensified tourism competition. However, branding for major event is a relatively new domain in the studies of destination marketing. Based on a case study of Liverpool as the 2008 European Capital of Culture, the aim of this paper is to explore the effectiveness of the key branding campaign - the ‘Look of the City’ programme. This study looks at quantitative data collected from on-street face-to-face survey. 611 questionnaires were distributed to and collected from local residents, visitors from the immediate hinterland, domestic tourists and overseas visitors. The analysis is done, first by investigating respondents’ impression on the Liverpool 08 brand and the branding campaign, and then by exploring the effects of campaign. The positioning of Liverpool compared with other similar cities is addressed in the end. The final section extracts lessons from this empirical investigation.

Keywords: destination branding, major event, European capital of culture, Liverpool

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Authors: Yi-De Liu

Abstract:

Cultural tourism is one of the largest and fastest growing global tourism markets and the cultures are increasingly being used to promote cities and to increase their competitiveness and attractiveness. One of the major forms of cultural tourism development undertaken throughout Europe has been the staging of a growing number of cultural events. The event of European Capitals of Culture (ECOC) is probably the best example of the new trends of cultural tourism in Europe, which is therefore used in this article to demonstrate some of the key issues surrounding the event-led strategy for cultural tourism development. Based on the experience of the 2008 ECOC Liverpool, UK, the study’s findings point to a number of ways in which the ECOC constitutes a boost for the development of cultural tourism in terms of realising experience economy, enhancing city image, facilitating urban regeneration, promoting cultural production and consumption, as well as establishing partnerships. This study is concluded by drawing some critical factors that event and tourism organisers should consider.

Keywords: cultural tourism, event tourism, cultural event, European capital of culture, Liverpool

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Authors: Kwan Hee Han, Jun Woo Lee, Sung Moon Bae, Twae Kyung Park

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ECA (Event-Condition-Action) languages are largely adopted for event processing since they are an intuitive and powerful paradigm for programming reactive systems. However, there are some limitations about ECA rules for processing of complex events such as coupling of event producer and consumer. The objective of this paper is to propose an ECA rule pattern to improve the current limitations of ECA rule, and to develop a prototype system. In this paper, conventional ECA rule is separated into 3 parts and each part is extended to meet the requirements of CEP. Finally, event processing logic is established by combining the relevant elements of 3 parts. The usability of proposed extended ECA rule is validated by a test scenario in this study.

Keywords: complex event processing, ECA rule, Event processing system, event-driven architecture, internet of things

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Authors: Muhammad Mansoor Majeed, Imtiaz Ahmed

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For centuries, honey has been used for the management and cure of different diseases for the treatment of wound, ulcers, burns, cough, and sore throat, etc. It has also been proved to decrease inflammation, edema, and exudates in different body tissues. This study is performed to find out the effectiveness of honey in the treatment and prevention of gingivitis, gingival bleeding, and accumulation of plaque. Randomized control trial was performed on two subject groups. Honey provided to one subject group to apply on their gums and tooth and then gargle with water and drink. Frequency of the procedure is thrice a day for a month. Another group was given a placebo. Before and after, readings were taken according to Loe and Silness Plaque and Gingival Index. Initially, the mean plaque index, Gingival index and the percentage of sites which were bleeding in the honey group was 0.910, 0.800 and 58.71% respectively which has reduced to 0.313, 0.296 and 27.6% in 30 ± 3 days whereas the control group did not show signs of improvement. Visible changed has observed in the honey group from 0.910 to 0.313 in mean plaque index, 0.800 to 0.296 in Gingival Index, and the percentage of bleeding sited decreased from 58.71% to 27.6%. No significant changes observed in another group. We can conclude that honey reduces the formation/accumulation of plaque and decreases gingival bleeding as well as it has therapeutic effects.

Keywords: honey, gingivitis, Pakistan, bleeding gums

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Authors: Anam Alam, Rahim Jamaluddin Kanji

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With the rapid growth of event in everywhere, event extraction has now become an important matter to retrieve the information from the unstructured data. One of the challenging problems is to extract the event from it. An event is an observable occurrence of interaction among entities. The paper investigates the effectiveness of event extraction capabilities of three software tools that are Wandora, Nitro and SPSS. We performed standard text mining techniques of these tools on the data sets of (i) Afghan War Diaries (AWD collection), (ii) MUC4 and (iii) WebKB. Information retrieval measures such as precision and recall which are computed under extensive set of experiments for Event Extraction. The experimental study analyzes the difference between events extracted by the software and human. This approach helps to construct an algorithm that will be applied for different machine learning methods.

Keywords: event extraction, Wandora, nitro, SPSS, event analysis, extraction method, AFG, Afghan War Diaries, MUC4, 4 universities, dataset, algorithm, precision, recall, evaluation

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Authors: Nisa Mohan

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Adverse drug event (ADE) related hospital admissions are common among older people. The first step in prevention is accurately estimating the prevalence of ADE admissions. Clinical coding is an efficient method to estimate the prevalence of ADE admissions. The objective of the study is to estimate the rate of under-coding of ADE admissions in older people in New Zealand and to explore how clinical coders decide whether or not to code an admission as an ADE. There has not been any research in New Zealand to explore these areas. This study is done using a mixed-methods approach. Two common and serious ADEs in older people, namely bleeding and hypoglycaemia were selected for the study. In study 1, eight hundred medical records of people aged 65 years and above who are admitted to hospital due to bleeding and hypoglycemia during the years 2015 – 2016 were selected for quantitative retrospective medical records review. This selection was made to estimate the proportion of ADE-related bleeding and hypoglycemia admissions that are not coded as ADEs. These files were reviewed and recorded as to whether the admission was caused by an ADE. The hospital discharge data were reviewed to check whether all the ADE admissions identified in the records review were coded as ADEs, and the proportion of under-coding of ADE admissions was estimated. In study 2, thirteen clinical coders were selected to conduct qualitative semi-structured interviews using a general inductive approach. Participants were selected purposively based on their experience in clinical coding. Interview questions were designed in a way to investigate the reasons for the under-coding of ADE admissions. The records review study showed that 35% (Cl 28% - 44%) of the ADE-related bleeding admissions and 22% of the ADE-related hypoglycemia admissions were not coded as ADEs. Although the quality of clinical coding is high across New Zealand, a substantial proportion of ADE admissions were under-coded. This shows that clinical coding might under-estimate the actual prevalence of ADE related hospital admissions in New Zealand. The interviews with the clinical coders added that lack of time for searching for information to confirm an ADE admission, inadequate communication with clinicians, along with coders’ belief that an ADE is a small thing might be the potential reasons for the under-coding of the ADE admissions. This study urges the coding policymakers, auditors, and trainers to engage with the unconscious cognitive biases and short-cuts of the clinical coders. These results highlight that further work is needed on interventions to improve the clinical coding of ADE admissions, such as providing education to coders about the importance of ADEs, education to clinicians about the importance of clear and confirmed medical records entries, availing pharmacist service to improve the detection and clear documentation of ADE admissions and including a mandatory field in the discharge summary about external causes of diseases.

Keywords: adverse drug events, bleeding, clinical coders, clinical coding, hypoglycemia

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Authors: Seyed Abbas Tabatabaei, Fereydoon Moghadas Nejad, Mohammad Saed

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The bleeding prediction of the asphalt is one of the most complex subjects in the pavement engineering. In this paper, an Adaptive Neuro Fuzzy Inference System (ANFIS) is used for modeling the effect of important parameters on bleeding is trained and tested with the experimental results. bleeding index based on the asphalt film thickness differential as target parameter,asphalt content, temperature depth of two centemeter, heavy traffic, dust to effective binder, Marshall strength, passing 3/4 sieves, passing 3/8 sieves,passing 3/16 sieves, passing NO8, passing NO50, passing NO100, passing NO200 as input parameters. Then, we randomly divided empirical data into train and test sections in order to accomplish modeling. We instructed ANFIS network by 72 percent of empirical data. 28 percent of primary data which had been considered for testing the approprativity of the modeling were entered into ANFIS model. Results were compared by two statistical criterions (R2, RMSE) with empirical ones. Considering the results, it is obvious that our proposed modeling by ANFIS is efficient and valid and it can also be promoted to more general states.

Keywords: bleeding, asphalt film thickness differential, Anfis Modeling

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Authors: Fedili Benamar, Belloulou Mohamed Lamine, Ouahes Hassane, Ghattas Samir

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Introduction: Perioperative blood loss is a frequent cause of complications in total hip replacement (THR). The present prospective study assessed the efficacy of tranexamic acid (Exacyl(®)) in reducing blood loss in primary THR. Hypothesis: Tranexamic acid reduces blood loss in THR. Material and method: -This is a prospective randomized study on the effectiveness of Exacyl (tranexamic acid) in total hip replacement surgery performed on a standardized technique between 2019 and September 2022. -It involved 154 patients, of which 84 received a single injection of Exacyl (group 1) at a dosage of 10 mg/kg over 20 minutes during the perioperative period. -All patients received postoperative thromboprophylaxis with enoxaparin 0.4 ml subcutaneously. -All patients were admitted to the post-interventional intensive care unit for a duration of 24 hours for monitoring and pain management as per the service protocol. Results: 154 patients, of which 84 received a single injection of Exacyl (group 1) and 70 patients patients who did not receive Exacyl perioperatively : (Group 2 ) The average age is 57 +/- 15 years The distribution by gender was nearly equal with 56% male and 44% female; "The distribution according to the ASA score was as follows: 20.2% ASA1, 82.3% ASA2, and 17.5% ASA3. "There was a significant difference in the average volume of intraoperative and postoperative bleeding during the 48 hours." The average bleeding volume for group 1 (received Exacyl) was 614 ml +/- 228, while the average bleeding volume for group 2 was 729 +/- 300, with a chi-square test of 6.35 and a p-value < 0.01, which is highly significant. The ANOVA test showed an F-statistic of 7.11 and a p-value of 0.008. A Bartlett test revealed a chi-square of 6.35 and a p-value < 0.01." "In Group 1 (patients who received Exacyl), 73% had bleeding less than 750 ml (Group A), and 26% had bleeding exceeding 750 ml (Group B). In Group 2 (patients who did not receive Exacyl perioperatively), 52% had bleeding less than 750 ml (Group A), and 47% had bleeding exceeding 750 ml (Group B). "Thus, the use of Exacyl reduced perioperative bleeding and specifically decreased the risk of severe bleeding exceeding 750 ml by 43% with a relative risk (RR) of 1.37 and a p-value < 0.01. The transfusion rate was 1.19% in the population of Group 1 (Exacyl), whereas it was 10% in the population of Group 2 (no Exacyl). It can be stated that the use of Exacyl resulted in a reduction in perioperative blood transfusion with an RR of 0.1 and a p-value of 0.02. Conclusions: The use of Exacyl significantly reduced perioperative bleeding in this type of surgery.

Keywords: acid tranexamic, blood loss, anesthesia, total hip replacement, surgery

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Authors: Bahareh Khakifirooz, Arian Shojaei, Amirhossein Hajialigol, Bahare Abdolahi

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Laceration of the inner layer of the myometrium can cause massive bleeding during and after childbirth, which can lead to the death of the mother if it is not diagnosed in time. We studied a rare case of massive intrapartum bleeding following myometrial laceration that was diagnosed correctly, and the patient survived with in-time treatments. The patient was a 26 years-old woman who was under observation for term pregnancy and complaint of rupture of membranes (ROM) and vaginal bleeding. Following the spontaneous course of labor and without receiving oxytocin, during the normal course of labor, she had an estimated total blood loss of 750 mL bleeding, which, despite the normal fetal heart rate and with the mother's indication for cesarean section, was transferred to the operating room and underwent cesarean section. During the cesarean section, the amniotic fluid was clear; after the removal of the placenta, severe and clear bleeding was flowing from the posterior wall of the uterus, which was caused by the laceration of the inner layer of the myometrium in the posterior wall of the lower segment of the uterus. The myometrial laceration was repaired with absorbable continuous locked sutures, and hemostasis was established, then, the patient used uterotonic drugs, and after monitoring, the patient was discharged from the hospital in good condition.

Keywords: intrapartum hemorrhage, inner myometrial laceration, labor, Increased intrauterine pressure

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Authors: Tadesse Melaku Abegaz, Akshaya Srikanth Bahagavathula, Abdulla Shehab Sheab, Asim Hassen

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Objectives: Non-adherence and discontinuation of anticoagulant therapy lead to increased ischemic stroke risk and contributes to suboptimal outcomes of the anticoagulant treatment. This systematic review and meta-analysis were aimed to investigate the adherence to NOACs and adverse events in patients with AF. Methods: Original research articles conducted on patients with AF and using any NOACs (dabigatran, rivoraxaban and apixaban) reporting adherence for at least 35 days were included. Scientific databases including PubMed, Web of Science, and Google Scholar were searched using MeSH keywords to obtaining literature researched between 2008 to till June, 2016. Study characteristics, patient’s sociodemographic and clinical characteristics, medication adherence levels and bleeding events reported were recorded. Results: The overall sample size of the six studies is 1,640,157, with CHADS2 scores < 2 in 551 patients, CHADS2-VASc ≥ 2 in 62,232 AF patients. Three-forth [75.6% (95%CI= 66.5-84.8), p < 0.001] are adherent to NOACs. However, a higher rate [72.7% (62.5-82.9), p < 0.001] of adherence was observed with Dabigatran than Apixaban [59.9% (3.2-123.1), p=0.063] and Rivaroxaban [59.3% (38.7-80.0), p<0.001]. Sub-group analysis revealed that nearly 57% of the AF patients on NOACs have CHADS2 scores < 2 and 20% of these patients were non-adherent to NOACs. Overall bleeding events rate associated with NOACs non-adherent AF patients was found to be 7.5% (0.2-14.8), p=0.045. However, nearly 11.2% of AF patients experienced bleeding events were non-adherent to NOAC medications. A higher proportion of bleeding events were noticed with Dabigatran (14.7%). Conclusions: Adherence rates, while uniformly suboptimal, nevertheless varied considerably, lowest at 59.3% for rivaroxaban and 59.9% for apixaban, followed by dabigatran (75.6%). Overall bleeding events associated with NOACs rates were 7.5%. However, lower adherence to NOACs was associated with worse outcomes among patients with greater stroke risk.

Keywords: atrial fibrillation, bleeding events, meta-analysis, novel oral anticoagulants

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Authors: Duhania O. Mahara, Santi W. Purnami, Aulia N. Fitria, Merissa N. Z. Wirontono, Revina Musfiroh, Shofi Andari, Sagiran Sagiran, Estiana Khoirunnisa, Wahyudi Widada

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For assessing interventions in numerous disease areas, the use of multiple time-to-event outcomes is common. An individual might experience two different events called bivariate time-to-event data, the events may be correlated because it come from the same subject and also influenced by individual characteristics. The bivariate time-to-event case can be applied by copula-based bivariate Cox survival model, using the Clayton and Frank copulas to analyze the dependence structure of each event and also the covariates effect. By applying this method to modeling the recurrent event infection of hemodialysis insertion on chronic kidney disease (CKD) patients, from the AIC and BIC values we find that the Clayton copula model was the best model with Kendall’s Tau is (τ=0,02).

Keywords: bivariate cox, bivariate event, copula function, survival copula

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Authors: Yi-De Liu

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For many European cities, a key motivation in developing event strategies is to use event as a catalyst for urban regeneration. One type of event that is particularly used as a means of urban development is the European Capital of Culture (ECOC) initiative. Based on a case study of the 2008 ECOC Liverpool, this paper aims at conceptualising the significance of major event for a city’s economic, cultural and social regenerations. In terms of economic regeneration, the role of the ECOC is central in creating Liverpool’s visitor economy and reshaping city image. Liverpool planned different themes for eight consecutive years as a way to ensure economic sustainability. As far as cultural regeneration is concerned, the ECOC contributed to the cultural regeneration of Liverpool by stimulating cultural participation and interest from the demand side, as well as improving cultural provision and collaboration within the cultural sector from the supply side. So as to social regeneration, Liverpool treated access development as a policy guideline and considered the ECOC as an opportunity to enhance the sense of place. The most significant lesson learned from Liverpool is its long-term planning and efforts made to integrate the ECOC into the overall urban development strategy. As a result, a more balanced and long-term effect on urban regeneration could be achieved.

Keywords: cultural event, urban regeneration, european capital of culture, Liverpool

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Authors: Kalyan Koganti

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Background: In India, platelet transfusions are given to large no. of patients suffering from dengue due to the fear of bleeding especially when the platelet counts are low. Though many patients do not bleed when the platelet count falls to less than 20,000, certain patients bleed even if the platelet counts are more than 20,000 without any comorbid condition (like gastrointestinal ulcer) in the past. This fear has led to huge amounts of unnecessary platelet transfusions which cause significant economic burden to low and middle-income countries like India and also sometimes these transfusions end with transfusion-related adverse reactions. Objective: To identify the role of Activated Partial Thromboplastin Time (APTT) in comparison with thrombocytoenia as an indicator to assess the real need of platelet transfusions. Method: A prospective study was conducted at a hospital in South India which included 176 admitted cases of dengue confirmed by immunochromatography. APTT was performed in all these patients along with platelet count. Cut off values of > 60 seconds for APTT and < 20,000 for platelet count were considered to assess the bleeding manifestations. Results: Among the total 176 patients, 56 patients had bleeding manifestations like malena, hematuria, bleeding gums etc. APTT > 60 seconds had a sensitivity and specificity of 93% and 90% respectively in identifying bleeding manifestations where as platelet count of < 20,000 had a sensitivity and specificity of 64% and 73% respectively. Conclusion: Elevated APTT levels can be considered as an indicator to assess the need of platelet transfusion in dengue. As there is a significant variation among patients who bleed with respect to platelet count, APTT can be considered to avoid unnecessary transfusions.

Keywords: activated partial thromboplastin time, dengue, platelet transfusion, thrombocytopenia

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Authors: Assem El-Ansary

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This paper illustrates the event-oriented Behavioral Pattern Analysis (BPA) modeling approach using the Healthcare Multi-Agent System. The Event defined in BPA is a real-life conceptual entity that is unrelated to any implementation. The major contributions of this research are: The Behavioral Pattern Analysis (BPA) modeling methodology. The development of an interactive software tool (DECISION), which is based on a combination of the Analytic Hierarchy Process (AHP) and the ELECTRE Multi-Criteria Decision Making (MCDM) methods.

Keywords: analysis, modeling methodology, software modeling, event-oriented, behavioral pattern, use cases, Healthcare Multi-Agent System

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Authors: Assem El-Ansary

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This paper illustrates the event-oriented Behavioral Pattern Analysis (BPA) modeling approach in developing an Intelligent Agent Reservation System (IARS). The Event defined in BPA is a real-life conceptual entity that is unrelated to any implementation. The major contributions of this research are developing the Behavioral Pattern Analysis (BPA) modeling methodology, and developing an interactive software tool (DECISION) which is based on a combination of the Analytic Hierarchy Process (AHP) and the ELECTRE Multi-Criteria Decision Making (MCDM) methods.

Keywords: analysis, intelligent agent, reservation system, modeling methodology, software modeling, event-oriented, behavioral pattern, use cases

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Authors: Mohsin Raza, Arne Bilberg, Thomas Ditlev Brunø, Ann-Louise Andersen, Filip SKärin

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Shifting from a dedicated or flexible manufacturing system to a reconfigurable manufacturing system (RMS) requires a significant amount of time, money, and effort. Therefore, it is vital to verify beforehand that the potential reconfigurable solution will be able to achieve the organizational objectives. Discrete event simulation offers the opportunity of assessing several reconfigurable alternatives against the set objectives. This study signifies the importance of using discrete-event simulation as a tool to verify several reconfiguration options. Two different industrial cases have been presented in the study to elaborate on the role of discrete event simulation in the implementation methodology of RMSs. The study concluded that discrete event simulation is one of the important tools to consider in the RMS implementation methodology.

Keywords: reconfigurable manufacturing system, discrete event simulation, Tecnomatix plant simulation, RMS

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Authors: Asamaporn Puetpaiboon, Sunisa Chatmongkolchart, Nalinee Kovitwanawong, Osaree Akaraborworn

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Traumatic patients with massive bleeding require intensive resuscitation. The actual cost of anesthesia per case has never been clarified, so our study aimed to quantify the direct cost, and cost-to-charge ratio of anesthetic care in traumatic patients with intraoperative massive bleeding. This study was a prospective, observational, cost analysis study, conducted in Prince of Songkla University hospital, Thailand, with traumatic patients, of any mechanisms being recruited. Massive bleeding was defined as estimated blood loss of at least one blood volume in 24 hours, or a half of blood volume in 3 hours. The cost components were identified by the micro-costing method, and valued by the bottom-up approach. The direct cost was divided into 4 categories: the labor cost, the capital cost, the material cost and the cost of drugs. From September 2017 to August 2018, 10 patients with multiple injuries were included. Seven patients had motorcycle accidents, two patients fell from a height and another one was in a minibus accident. Two patients died on the operating table, and another two died within 48 hours. The median Sequential Organ Failure Assessment (SOFA) score was 8. The median intraoperative blood loss was 3,500 ml. The median direct cost, per case, was 250 United States Dollars (2017 exchange rate), and the cost-to-charge ratio was 0.53. In summary, the direct cost was nearly half of the hospital charge, for these traumatic patients with massive bleeding. However, our study did not analyze the indirect cost.

Keywords: cost, cost-to-charge ratio, micro-costing, trauma

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Authors: Rajaa Filali, Mohamed Bouhdadi

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This paper presents an incremental formal development of the Wireless Transaction Protocol (WTP) in Event-B. WTP is part of the Wireless Application Protocol (WAP) architectures and provides a reliable request-response service. To model and verify the protocol, we use the formal technique Event-B which provides an accessible and rigorous development method. This interaction between modelling and proving reduces the complexity and helps to eliminate misunderstandings, inconsistencies, and specification gaps. As result, verification of WTP allows us to find some deficiencies in the current specification.

Keywords: event-B, wireless transaction protocol, proof obligation, refinement, Rodin, ProB

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Authors: Assem I. El-Ansary

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This paper illustrates the event-oriented Behavioral Pattern Analysis (BPA) modeling approach in developing an Multi-Agent Railway Control System (MARCS). The Event defined in BPA is a real-life conceptual entity that is unrelated to any implementation. The major contributions of this research are the Behavioral Pattern Analysis (BPA) modeling methodology, and the development of an interactive software tool (DECISION), which is based on a combination of the Analytic Hierarchy Process (AHP) and the ELECTRE Multi-Criteria Decision Making (MCDM) methods.

Keywords: analysis, multi-agent, railway control, modeling methodology, software modeling, event-oriented, behavioral pattern, use cases

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Authors: Assem El-Ansary

Abstract:

This paper illustrates the event-oriented Behavioral Pattern Analysis (BPA) modeling approach in developing an Multi-Agent TeleRobotic Security Control System (MTSCS). The event defined in BPA is a real-life conceptual entity that is unrelated to any implementation. The major contributions of this research are the Behavioral Pattern Analysis (BPA) modeling methodology, and the development of an interactive software tool (DECISION), which is based on a combination of the Analytic Hierarchy Process (AHP) and the ELECTRE Multi-Criteria Decision Making (MCDM) methods.

Keywords: analysis, multi-agent, TeleRobotics control, security, modeling methodology, software modeling, event-oriented, behavioral pattern, use cases

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Authors: Angelis P. Barlampas

Abstract:

The aim of this work is to denote that during an emergency state, an examination study may not be accomplished by state-of-the-art of imaging and, therefore, cannot obviously reveal all the existing findings. But, such a situation may have disastrous consequences for the patient. When interpreting radiological images, one must try to be as meticulous as possible, especially if the patient has alerting clinical symptoms. A case may be missed because its findings are not so obvious in rapid uncompleted radiological imaging. A thirty-seven years old female patient visited the emergency department because of a headache and hemiparesis of her left leg. Firstly, a CT examination without contrast was done, and mild serpentinous hyperintensities were depicted at the right parietal lobe. In addition to that, there was a linear, mildly hyperattenuating structure resembling a vessel in the nearby middle line. At first, an AVM was suspected, so an MRI examination with i.v. Gd was prescribed. The patient returned a few days later, not having done the MRI and complaining of persisting symptomatology. A new CT examination without and with i.v.c administration was done that showed no hyperintensities but a type-enhancing vessel in the posterior interhemispheric fissure. The latest findings are consistent with a venous malformation with previous bleeding.

Keywords: bleeding, brain, CNS, hemorrhage, CT, venous malformation

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Authors: Rajaa Filali, Mohamed Bouhdadi

Abstract:

This paper presents an incremental development of the Dynamic Host Configuration Protocol (DHCP) in Event-B. DHCP is widely used communication protocol, which provides a standard mechanism to obtain configuration parameters. The specification is performed in a stepwise manner and verified through a series of refinements. The Event-B formal method uses the Rodin platform to modeling and verifying some properties of the protocol such as safety, liveness and deadlock freedom. To model and verify the protocol, we use the formal technique Event-B which provides an accessible and rigorous development method. This interaction between modelling and proving reduces the complexity and helps to eliminate misunderstandings, inconsistencies, and specification gaps.

Keywords: DHCP protocol, Event-B, refinement, proof obligation, Rodin

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Authors: Sabrine Ammar, Mohamed Tahar Bhiri

Abstract:

Automatic planning has a de facto standard language called Planning Domain Definition Language (PDDL) for describing planning problems. It aims to formalize the planning problems described by the concept of state space. PDDL-related dynamic analysis tools, namely planners and validators, are insufficient for verifying and validating PDDL descriptions. Indeed, these tools made it possible to detect errors a posteriori by means of test activity. In this paper, we recommend a formal approach coupling the two languages Event-B and PDDL, for automatic planning. Event-B is used for formal modeling by stepwise refinement with mathematical proofs of planning problems. Thus, this paper proposes a refinement strategy allowing to obtain reliable PDDL descriptions from an ultimate Event-B model correct by construction. The ultimate Event-B model, correct by construction which is supposed to be translatable into PDDL, is automatically translated into PDDL using our MDE Event-B2PDDL tool.

Keywords: code generation, event-b, PDDL, refinement strategy, translation rules

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