Search results for: audit and feedback

Authors: Mahmoud Tarek, Alaa Obeida, Mai Magdy, Khalid Hussein, Aly Shalaby

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Background: More doctors are complaining of burnout than before, Burnout is a state of physical and mental exhaustion caused by the doctor’s lifestyle, unfortunately, Medical errors are also more likely in those suffering from burnout and these may result in malpractice suits. Methodology: It is a retrospective audit of burnout response on all neonatologists over a 9 months period. We gathered data using burnout questionnaire, it was obtained from 23 physicians, the physicians divided into 5 categories according to the final score of the 28 questions in the questionnaire. Category 1 with score from 28-38 with almost no work stress, category 2 with score (38-50) who express a low amount of job related stress, category 3 with score (51-70) with moderate amount of stress, category 4 with score (71-90) those express a high amount of job stress and begun to burnout, category 5 with score (91 and above) who are under a dangerous amount of stress and advanced stage of burnout. Results: 33 neonatologists have received the questionnaire, 23 responses were sent back with a response rate of 69.6%. The results showed that 61% of physicians fall in category 4, 31% of the physician in category 5, while 8% of physicians equally distributed between category 2 and 3 (4% each of them). On the other hand, there is no physician present in category 1. Conclusion: Burnout is prevalent in SNICUs, So interventions to minimize burnout prevalence may be of greater importance as this may be reflected indirectly on medical conditions of the patients and physicians, efforts should be done to decrease this high rate of burnout.

Keywords: Cairo, work overload, exhaustion, surgery, neonatal ICU

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Authors: Xinyu Wang

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In the context of the rapid development of Internet technology and the increasing prevalence of online social media, this study investigates the impact of digital communication on social learning. Through three behavioral experiments, we explore both affective and cognitive social learning in online environments. Experiment 1 manipulates the content of experimental materials and two forms of feedback, emotional valence, sociability, and repetition, to verify whether individuals can achieve online emotional social learning through reinforcement using two social learning strategies. Results reveal that both social learning strategies can assist individuals in affective, social learning through reinforcement, with feedback-based learning strategies outperforming frequency-dependent strategies. Experiment 2 similarly manipulates the content of experimental materials and two forms of feedback to verify whether individuals can achieve online knowledge social learning through reinforcement using two social learning strategies. Results show that similar to online affective social learning, individuals adopt both social learning strategies to achieve cognitive social learning through reinforcement, with feedback-based learning strategies outperforming frequency-dependent strategies. Experiment 3 simultaneously observes online affective and cognitive social learning by manipulating the content of experimental materials and feedback at different levels of social pressure. Results indicate that online affective social learning exhibits different learning effects under different levels of social pressure, whereas online cognitive social learning remains unaffected by social pressure, demonstrating more stable learning effects. Additionally, to explore the sustained effects of online social learning and differences in duration among different types of online social learning, all three experiments incorporate two test time points. Results reveal significant differences in pre-post-test scores for online social learning in Experiments 2 and 3, whereas differences are less apparent in Experiment 1. To accurately measure the sustained effects of online social learning, the researchers conducted a mini-meta-analysis of all effect sizes of online social learning duration. Results indicate that although the overall effect size is small, the effect of online social learning weakens over time.

Keywords: online social learning, affective social learning, cognitive social learning, social learning strategies, social reinforcement, social pressure, duration

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Authors: Prashant Neupane, Sumitra Kafle, Asmi Pandey, Laura Mitchell

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Pain following caesarean section can influence recovery, patient satisfaction, breast feeding success and mother-child bonding. Since the introduction of enhanced recovery protocols, mothers are often discharged 24 hours later. We identified concerns within our hospital with mothers tolerating poorly controlled pain in order to achieve earlier discharge and subsequently suffering significant pain at home with inadequate analgesia. Methods: We conducted a prospective audit of analgesic prescribing and post-operative pain scores after caesarean section. Mothers were seen on post-operative day one, their pain score recorded on a verbal analogue score from 0-10, and their prescription chart reviewed. A follow-up phone call was then made on post-operative day 3-7 to enquire about pain scores and analgesia use at home. Following this, a standardized proforma for prescribing after the caesarean section was introduced, including the addition of dihydrocodeine that patients can take home following discharge. There were educational update sessions for anesthetists and midwifes, and then a re-audit was conducted months later. Results: Data was collected from 50 women before and after the introduction of the change. Initial audit showed that there was considerable variation in prescribing, with four women prescribed no regular analgesia at all and inconsistency in the dose of oral morphine prescribed. Women were not given any form of analgesia to take home after discharge and were advised to take regular paracetamol and ibuprofen. However, 31/50 (62%) reported that they needed additional analgesia and eight women (16%) even sought prescription for additional analgesia from elsewhere. After the introduction of the change, prescribing was more consistent with all patients prescribed regular analgesia. 46/50 patients were given dihydrocodeine on discharge. Mean pain scores on post-operative day one improved from 5.16 to 3.9, and at home improved from 6.18 to 2.58. Use of dihydrocodeine at home significantly improved patients reporting of severe pain at home from 24% to zero. Discussion: Lack of strong analgesia out of the hospital and the increased demands on activity levels means that women are frequently in more pain at home after discharge. Introduction of a standardized prescription proforma, including the use of to-take-out dihydrocodeine, was successful in improving patient pain scores and the requirement for additional analgesia, both in hospital and at home.

Keywords: analgesia, caesarean section, post-operative pain, standardised

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Authors: Saeed Asiri

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The Novel Automated System (NAS) has the control system of the level of chlorine and acid (i.e. pH level) through a feedback in three forms of synchronous alerts. The feedback is in the form of an alert voice, a visible color, and a message on a digital screen. In addition, NAS contains a slide-in container in which chemicals are used to treat the problems of chlorine and acid levels independently. Moreover, NAS has a net in front of it to clean the pool on the surface of the water from leaves and wastes and so on which is controlled through a remote control. The material used is a lightweight aluminum with mechanical and electric parts integrated with each other. In fact, NAS is qualified to serve as an assistant security guard for swimming pools because it has the characteristics that make it unique and smart.

Keywords: novel automated system, pool safety, maintenance, pH level, digital screen

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Authors: Kamal Kaushik, Trisha, Dandapni, Sambit Nanda, A. Mukherjee, S. Pradhan

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INTRODUCTION: As complexity in radiotherapy practice and processes are increasing, there is a need to assure quality control to a greater extent. At present, no international literature available with regards to the optimal quality control indicators for radiotherapy; moreover, few clinical audits have been conducted in the field of radiotherapy. The primary aim is to improve the processes that directly impact clinical outcomes for patients in terms of patient safety and quality of care. PROCEDURE: A team of an Oncologist, a Medical Physicist and a Radiation Therapist was formed for weekly clinical audits of patient’s undergoing radiotherapy audits The stages for audits include Pre planning audits, Simulation, Planning, Daily QA, Implementation and Execution (with image guidance). Errors in all the parts of the chain were evaluated and recorded for the development of further departmental protocols for radiotherapy. EVALUATION: The errors at various stages of radiotherapy chain were evaluated and recorded for comparison before starting the clinical audits in the department of radiotherapy and after starting the audits. It was also evaluated to find the stage in which maximum errors were recorded. The clinical audits were used to structure standard protocols (in the form of checklist) in department of Radiotherapy, which may lead to further reduce the occurrences of clinical errors in the chain of radiotherapy. RESULTS: The aim of this study is to perform a comparison between number of errors in different part of RT chain in two groups (A- Before Audit and B-After Audit). Group A: 94 pts. (48 males,46 female), Total no. of errors in RT chain:19 (9 needed Resimulation) Group B: 94 pts. (61 males,33 females), Total no. of errors in RT chain: 8 (4 needed Resimulation) CONCLUSION: After systematic periodic clinical audits percentage of error in radiotherapy process reduced more than 50% within 2 months. There is a great need in improving quality control in radiotherapy, and the role of clinical audits can only grow. Although clinical audits are time-consuming and complex undertakings, the potential benefits in terms of identifying and rectifying errors in quality control procedures are potentially enormous. Radiotherapy being a chain of various process. There is always a probability of occurrence of error in any part of the chain which may further propagate in the chain till execution of treatment. Structuring departmental protocols and policies helps in reducing, if not completely eradicating occurrence of such incidents.

Keywords: audit, clinical, radiotherapy, improving functionality

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Authors: Akinnubi Rufus Temidayo

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Coastal West Africa is highly sensitive to climate variability, driven by complex ocean-atmosphere interactions that shape temperature, precipitation, and extreme weather. Radiative feedback mechanisms—such as water vapor feedback, cloud-radiation interactions, and surface albedo—play a critical role in modulating these patterns. Yet, limited research addresses these feedbacks in climate models specific to West Africa’s coastal zones, creating challenges for accurate climate projections and adaptive planning. This study aims to evaluate the influence of radiative feedbacks on the coastal climate of West Africa by quantifying the effects of water vapor, cloud cover, and sea surface temperature (SST) on the region’s radiative balance. The study uses a regional climate model (RCM) to simulate feedbacks over a 20-year period (2005-2025) with high-resolution data from CORDEX and satellite observations. Key mechanisms investigated include (1) Water Vapor Feedback—the amplifying effect of humidity on warming, (2) Cloud-Radiation Interactions—the impact of cloud cover on radiation balance, especially during the West African Monsoon, and (3) Surface Albedo and Land-Use Changes—effects of urbanization and vegetation on the radiation budget. Preliminary results indicate that radiative feedbacks strongly influence seasonal climate variability in coastal West Africa. Water vapor feedback amplifies dry-season warming, cloud-radiation interactions moderate surface temperatures during monsoon seasons, and SST variations in the Atlantic affect the frequency and intensity of extreme rainfall events. The findings suggest that incorporating these feedbacks into climate planning can strengthen resilience to climate impacts in West African coastal communities. Further research should refine regional models to capture anthropogenic influences like greenhouse gas emissions, guiding sustainable urban and resource planning to mitigate climate risks.

Keywords: west africa, radiative, climate, resilence, anthropogenic

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Authors: Beata Jackowska-Zduniak

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We formulate and analyze a mathematical model describing dynamics of the hypothalamus-pituitary-thyroid homoeostatic mechanism in endocrine system. We introduce to this system two types of couplings and delay. In our model, feedback controls the secretion of thyroid hormones and delay reflects time lags required for transportation of the hormones. The influence of delayed feedback on the stability behaviour of the system is discussed. Analytical results are illustrated by numerical examples of the model dynamics. This system of equations describes normal activity of the thyroid and also a couple of types of malfunctions (e.g. hyperthyroidism).

Keywords: mathematical modeling, ordinary differential equations, endocrine system, delay differential equation

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Authors: Martha E. Ndeley

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Operation management is the key element within the manufacturing process. However, during this process, there are a number of unforeseen disruptions that causes the process to a standstill which are, machine breakdown, employees absenteeism, improper scheduling. When this happens, it forces the shop flow to a rescheduling process and these strategy reschedules only a limited part of the initial schedule to match up with the pre-schedule at some point with the objective to create a new schedule that is reliable which in the long run gets disrupted. In this work, we have developed feedback control system that minimizes any form of disruption before the impact becomes severe, the model was tested in a paper manufacturing industries and the results revealed that, if the disruption is minimized at the initial state, the impact becomes unnoticeable.

Keywords: disruption, machine, absenteeism, scheduling

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Authors: Karolina Wieczorek, Zofia Przypaśniak

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Climate change is a rapidly growing threat to global health, and part of the responsibility to combat it lies within the healthcare sector itself, including adequate education of future medical professionals. To mitigate the consequences, the General Medical Council (GMC) has equipped medical schools with a list of outcomes regarding sustainability teaching. Students are expected to analyze the impact of the healthcare sector’s emissions on climate change. The delivery of the related teaching content is, however, often inadequate and insufficient time is devoted for exploration of the topics. Teaching curricula lack in-depth exploration of the learning objectives. This study aims to assess the extent and characteristics of climate change and sustainability subjects teaching in the curriculum of a chosen UK medical school (Barts and The London School of Medicine and Dentistry). It compares the data to the national average scores from the Climate Change and Sustainability Teaching (C.A.S.T.) in Medical Education Audit to draw conclusions about teaching on a regional level. This is a single-center audit of the timetabled sessions of teaching in the medical course. The study looked at the academic year 2020/2021 which included a review of all non-elective, core curriculum teaching materials including tutorials, lectures, written resources, and assignments in all five years of the undergraduate and graduate degrees, focusing only on mandatory teaching attended by all students (excluding elective modules). The topics covered were crosschecked with GMC Outcomes for graduates: “Educating for Sustainable Healthcare – Priority Learning Outcomes” as gold standard to look for coverage of the outcomes and gaps in teaching. Quantitative data was collected in form of time allocated for teaching as proxy of time spent per individual outcomes. The data was collected independently by two students (KW and ZP) who have received prior training and assessed two separate data sets to increase interrater reliability. In terms of coverage of learning outcomes, 12 out of 13 were taught (with the national average being 9.7). The school ranked sixth in the UK for time spent per topic and second in terms of overall coverage, meaning the school has a broad range of topics taught with some being explored in more detail than others. For the first outcome 4 out of 4 objectives covered (average 3.5) with 47 minutes spent per outcome (average 84 min), for the second objective 5 out of 5 covered (average 3.5) with 46 minutes spent (average 20), for the third 3 out of 4 (average 2.5) with 10 mins pent (average 19 min). A disproportionately large amount of time is spent delivering teaching regarding air pollution (respiratory illnesses), which resulted in the topic of sustainability in other specialties being excluded from teaching (musculoskeletal, ophthalmology, pediatrics, renal). Conclusions: Currently, there is no coherent strategy on national teaching of climate change topics and as a result an unstandardized amount of time spent on teaching and coverage of objectives can be observed.

Keywords: audit, climate change, sustainability, education

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Authors: Shuofen Hsu, Ya-Yi Chao, Chao-Wei Li

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This paper investigates the factors of whether firms’ quarterly consolidated financial statements to be voluntary reviewed by auditor. To promote the information transparency, the Financial Supervisory Commission of Executive Yuan in Taiwan ruled the Taiwanese listed companies should announce the first and third quarterly consolidated financial statements since 2008 to 2012, while the Commission didn’t require the consolidated financial statements should be reviewed by auditors. This is a very special practice in emerging market, especially in Taiwan. The valuable data of this period is suitable for us to research the determinants of firms’ voluntary review decision in emerging markets. We collected the auditors' report of each company and each year of Taiwanese listed companies since 2008 to 2012 for our research samples. We use probit model to test and analyze the determinants of voluntary review decision of the first and third quarterly consolidated financial statements. Our empirical result shows that the firms whose first and third quarterly consolidated financial statements are voluntary to be reviewed by auditors have better ranking of information transparency, higher audit quality, and better corporate governance, suggesting that voluntary review is a good signal to firms’ better information and corporate governance quality.

Keywords: voluntary review, information transparency, audit quality, quarterly consolidated financial statements

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Authors: Manoj M. Sarode, Sharad P. Jadhav, Mukesh D. Patil, Pushparaj S. Suryawanshi

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Even though the PID controller is widely used in industrial process, tuning of PID parameters are not easy. It is a time consuming and requires expert people. Another drawback of PID controller is that process dynamics might change over time. This can happen due to variation of the process load, normal wear and tear etc. To compensate for process behavior change over time, expert users are required to recalibrate the PID gains. Implementation of model based controllers usually needs a process model. Identification of process model is time consuming job and no guaranty of model accuracy. If the identified model is not accurate, performance of the controller may degrade. Model based controllers are quite expensive and the whole procedure for the implementation is sometimes tedious. To eliminate such issues Autotuning PID controller becomes vital element. Software based Relay Feedback Autotuning Controller proves to be efficient, upgradable and maintenance free controller. In Relay Feedback Autotune controller PID parameters can be achieved with a very short span of time. This paper presents the real time implementation of LabVIEW based Relay Feedback Autotuning PID controller. It is successfully developed and implemented to control level of a laboratory setup. Its performance is analyzed for different setpoints and found satisfactorily.

Keywords: autotuning, PID, liquid level control, recalibrate, labview, controller

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Authors: Ammar Nimer Natsheh

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Chaos control is used to design a controller that is able to eliminate the chaotic behaviour of nonlinear dynamic systems that experience such phenomena. The paper describes the control of the bifurcation behaviour of a parallel-connected DC-DC buck-boost converter used to provide an interface between energy storage batteries and photovoltaic (PV) arrays as renewable energy sources. The paper presents a delayed feedback control scheme in a module converter comprises two identical buck-boost circuits and operates in the continuous-current conduction mode (CCM). MATLAB/SIMULINK simulation results show the effectiveness and robustness of the scheme.

Keywords: chaos, bifurcation, DC-DC Buck-Boost Converter, Delayed Feedback Control

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Authors: Mawloud Mosbah, Bachir Boucheham

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We present here the results for a comparative study of some techniques, available in the literature, related to the relevance feedback mechanism in the case of a short-term learning. Only one method among those considered here is belonging to the data mining field which is the K-Nearest Neighbours Algorithm (KNN) while the rest of the methods is related purely to the information retrieval field and they fall under the purview of the following three major axes: Shifting query, Feature Weighting and the optimization of the parameters of similarity metric. As a contribution, and in addition to the comparative purpose, we propose a new version of the KNN algorithm referred to as an incremental KNN which is distinct from the original version in the sense that besides the influence of the seeds, the rate of the actual target image is influenced also by the images already rated. The results presented here have been obtained after experiments conducted on the Wang database for one iteration and utilizing colour moments on the RGB space. This compact descriptor, Colour Moments, is adequate for the efficiency purposes needed in the case of interactive systems. The results obtained allow us to claim that the proposed algorithm proves good results; it even outperforms a wide range of techniques available in the literature.

Keywords: CBIR, category search, relevance feedback, query point movement, standard Rocchio’s formula, adaptive shifting query, feature weighting, original KNN, incremental KNN

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Authors: Saeed Nazari, Masoom Nazari, Ali Hejazi, Siamak Sanoobari Ghazi Jahani, Mohammad Dehghani, Javad Vakili

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More than ever, digitization is an imperative for businesses to keep their competitive advantages, foster innovation and reduce paperwork. To design and successfully implement digital transformation initiatives within process safety management system, employees need to be equipped with the right tool, frameworks, and best practices. we developed a unique full stack application so-called SHEQTool which is entirely dynamic based on our extensive expertise, experience, and client feedback to help business processes particularly operations safety management. We use our best knowledge and scientific methodologies published by CCPS and OSHA Guidelines to streamline operations and integrated them into task management within Petrochemical Companies. We digitalize their main process safety management system elements and their sub elements such as hazard identification and risk management, training and communication, inspection and audit, critical changes management, contractor management, permit to work, pre-start-up safety review, incident reporting and investigation, emergency response plan, personal protective equipment, occupational health, and action management in a fully customizable manner with no programming needs for users. We review the feedback from main actors within petrochemical plant which highlights improving their business performance and productivity as well as keep tracking their functions’ key performance indicators (KPIs) because it; 1) saves time, resources, and costs of all paperwork on our businesses (by Digitalization); 2) reduces errors and improve performance within management system by covering most of daily software needs of the organization and reduce complexity and associated costs of numerous tools and their required training (One Tool Approach); 3) focuses on management systems and integrate functions and put them into traceable task management (RASCI and Flowcharting); 4) helps the entire enterprise be resilient to any change of your processes, technologies, assets with minimum costs (through Organizational Resilience); 5) reduces significantly incidents and errors via world class safety management programs and elements (by Simplification); 6) gives the companies a systematic, traceable, risk based, process based, and science based integrated management system (via proper Methodologies); 7) helps business processes complies with ISO 9001, ISO 14001, ISO 45001, ISO 31000, best practices as well as legal regulations by PDCA approach (Compliance).

Keywords: process, safety, digitalization, management, risk, incident, SHEQTool, OSHA, CCPS

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Authors: Hsin-Yi Lo, Huang-Ju Jiun, Yu-Chiao Chu

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Hemodynamic monitoring is an important in the intensive care unit. Advances in medical technology in recent years, more diversification of intensive care equipment, there are many kinds of instruments available for monitoring of hemodynamics, Edwards Lifesciences Hemodynamic Monitoring (FloTrac) is one of them. The recent medical safety incidents in parameters were changed, nurses have not to notify doctor in time, therefore, it is hoped to analyze the current problems and find effective improvement strategies. In August 2021, the survey found that only 74.0% of FloTrac correctness of operation, reasons include lack of education, the operation manual is difficulty read, lack of audit mechanism, nurse doesn't know those numerical changes need to notify doctor, work busy omission, unfamiliar with operation and have many nursing records then omissions. Improvement methods include planning professional nurse education, formulate the secret arts of FloTrac, enacting an audit mechanism, establish FloTrac action learning, make「follow the sun」care map, hold simulated training and establish monitoring data automatically upload nursing records. After improvement, FloTrac correctness of operation increased to 98.8%. The results are good, implement to the ICU of the hospital.

Keywords: hemodynamic monitoring, edwards lifesciences hemodynamic monitoring, multiple strategies, intensive care

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Authors: Ayami Umemura

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The purpose of this paper is to examine the meaning of verbalization in clinical practice using the keywords silence and singularity. A patient's experience of illness and treatment is singular, irreplaceable, and irreproducible and ultimately cannot be compared with that of others. In his book Difference and Repetition, Gilles Deleuze positioned irreplaceable singularity as the opposite concept of particularity as a generalizable and substitutable property and matched the former with universality. He also said that singularity could not be represented because of its irreplaceable nature. Representation or verbalization is a procedure that converts an irreplaceable, idiosyncratic reality into something that can be substituted. Considering the act of verbalizing medical diagnosis based on this, it can be said that diagnosis is the practice of decontextualizing and generalizing the suffering embedded in the patient's irreplaceable life history as a disease. This paper examines the above with the key concept of the practice of "non-verbalization" in traditional medical practices in Sri Lanka. In the practice of Sri Lankan traditional medicine and the inheritance of medical knowledge and care techniques, there is a tendency to avoid verbalizing specific matters or stating them aloud. Specifically, the following should be avoided. The healer informs the patient of the name of the disease, mentions the name of the herb used in front of the patient, explains the patient's condition to the healer, and referring the names of poisonous animals, such as poisonous snakes that have been damaged. And so on. Furthermore, when passing on medical knowledge and skills, it is also possible to avoid verbalizing knowledge of medicinal herbs and medical treatment methods and explaining them verbally. In addition to the local belief that the soul of language in Sri Lanka is deeply involved in this background, Sri Lankan traditional medicine has a unique view of the human body and personality that is rooted in the singularity that appears in the relationship with the movement of celestial bodies and the supernatural realm. It can be pointed out that it is premised on the view. In other words, the “silence” in Sri Lankan indigenous medicine is the reason for emphasizing specificity. Furthermore, we can say that "non-verbalization" is a practice aimed at healing. Based on these discussions, this paper will focus on the unique relationships between practitioners and patients that become invisible due to verbalization, which is overlooked by clinical medicine, where informed consent, ensuring transparency, and audit culture is dominant. We will examine the experience of treatment and aim to relativize clinical medicine, which is based on audit cultures.

Keywords: audit cultures, indigenous medicine, singularity, verbalization

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Authors: Zara L. Sheady

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Fluidic oscillators are being utilised in an increasing number of applications in a wide variety of areas; these include on-board vehicle cleaning systems, flow separation control on aircraft and in fluidic circuitry. With this increased use, there is a further understanding required for the mechanics of the fluidics of the fluidic oscillator and why they work in the manner that they do. ANSYS CFX has been utilized to visualise the pressure and velocity within a microfluidic feedback oscillator. The images demonstrate how the pressure vortices build within the oscillator at the points where the velocity is diverted from linear motion through the oscillator. With an enhanced understanding of the pressure and velocity distributions within a fluidic oscillator, it will enable users of microfluidics to more greatly tailor fluidic nozzles to their specification.

Keywords: ANSYS CFX, control, fluidic oscillators, mechanics, pressure, relationship, velocity

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Authors: Shreya Saxena

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Background: Choledocholithiasis is a common complication of gallstone disease. Risk scoring systems exist to guide the need for further imaging or endoscopy in managing choledocholithiasis. We completed an audit to review the American Society for Gastrointestinal Endoscopy (ASGE) scoring system for prediction and management of choledocholithiasis against the current practice at a tertiary hospital to assess its utility in resource optimisation. We have now conducted a cost focused sub-analysis on patients categorized high-risk for choledocholithiasis according to the guidelines to determine any associated cost benefits. Method: Data collection from our prior audit was used to retrospectively identify thirteen patients considered high-risk for choledocholithiasis. Their ongoing management was mapped against the guidelines. Individual costs for the key investigations were obtained from our hospital financial data. Total cost for the different management pathways identified in clinical practice were calculated and compared against predicted costs associated with recommendations in the guidelines. We excluded the cost of laparoscopic cholecystectomy and considered a set figure for per day hospital admission related expenses. Results: Based on our previous audit data, we identified a77% positive predictive value for the ASGE risk stratification tool to determine patients at high-risk of choledocholithiasis. 47% (6/13) had an magnetic resonance cholangiopancreatography (MRCP) prior to endoscopic retrograde cholangiopancreatography (ERCP), whilst 53% (7/13) went straight for ERCP. The average length of stay in the hospital was 7 days, with an additional day and cost of £328.00 (£117 for ERCP) for patients awaiting an MRCP prior to ERCP. Per day hospital admission was valued at £838.69. When calculating total cost, we assumed all patients had admission bloods and ultrasound done as the gold standard. In doing an MRCP prior to ERCP, there was a 130% increase in cost incurred (£580.04 vs £252.04) per patient. When also considering hospital admission and the average length of stay, it was an additional £1166.69 per patient. We then calculated the exact costs incurred by the department, over a three-month period, for all patients, for key investigations or procedures done in the management of choledocholithiasis. This was compared to an estimate cost derived from the recommended pathways in the ASGE guidelines. Overall, 81% (£2048.45) saving was associated with following the guidelines compared to clinical practice. Conclusion: MRCP is the most expensive test associated with the diagnosis and management of choledocholithiasis. The ASGE guidelines recommend endoscopy without an MRCP in patients stratified as high-risk for choledocholithiasis. Our audit that focused on assessing the utility of the ASGE risk scoring system showed it to be relatively reliable for identifying high-risk patients. Our cost analysis has shown significant cost savings per patient and when considering the average length of stay associated with direct endoscopy rather than an additional MRCP. Part of this is also because of an increased average length of stay associated with waiting for an MRCP. The above data supports the ASGE guidelines for the management of high-risk for choledocholithiasis patients from a cost perspective. The only caveat is our small data set that may impact the validity of our average length of hospital stay figures and hence total cost calculations.

Keywords: cost-analysis, choledocholithiasis, risk stratification tool, general surgery

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Authors: M. A. Sohaly, M. A. Elfouly

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Parkinson's disease (PD) is a heterogeneous movement disorder that often appears in the elderly. PD is induced by a loss of dopamine secretion. Some drugs increase the secretion of dopamine. In this paper, we will simply study the stability of PD models as a nonlinear delay differential equation. After a period of taking drugs, these act as positive feedback and increase the tremors of patients, and then, the differential equation has positive coefficients and the system is unstable under these conditions. We will present a set of suggested modifications to make the system more compatible with the biodynamic system. When giving a set of numerical examples, this research paper is concerned with the mathematical analysis, and no clinical data have been used.

Keywords: Parkinson's disease, stability, simulation, two delay differential equation

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Authors: Mirza Mohibulla Baig, Imil Hamda Imran, Tri Bagus Susilo, Sami El Ferik

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The paper deals with system identification and control a nonlinear model of semi-autonomous underwater vehicle (UUV). The input-output data is first generated using the experimental values of the model parameters and then this data is used to compute the estimated parameter values. In this study, we use the semi-autonomous UUV LAURS model, which is developed by the Sensors and Actuators Laboratory in University of Sao Paolo. We applied three methods to identify the parameters: integral method, which is a classical least square method, recursive least square, and weighted recursive least square. In this paper, we also apply three different inputs (step input, sine wave input and random input) to each identification method. After the identification stage, we investigate the control performance of yaw motion of nonlinear semi-autonomous Unmanned Underwater Vehicle (UUV) using feedback linearization-based controller. In addition, we compare the performance of the control with an integral and a non-integral part along with state feedback. Finally, disturbance rejection and resilience of the controller is tested. The results demonstrate the ability of the system to recover from such fault.

Keywords: system identification, underwater vehicle, integral method, recursive least square, weighted recursive least square, feedback linearization, integral error

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Authors: Jade Martínez-Llinàs, Pere Colet

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By exploring the possible dynamical regimes in a prototypical model for mutually delay-coupled OEOs, here it is shown that two mutually coupled non-identical OEOs, besides in- and out-of-phase square-waves, can generate stable square-wave pulses synchronized at a quarter of the period (T/4) in a broad parameter region. The key point to obtain T/4 solutions is that the two OEO operate with mixed feedback, namely with negative feedback in one and positive in the other. Furthermore, the coexistence of multiple solutions provides a large degree of flexibility for tuning the frequency in the GHz range without changing any parameter. As a result the two coupled OEOs system is good candidate to be implemented for information encoding as a high-capacity memory device.

Keywords: nonlinear optics, optoelectronic oscillators, square waves, synchronization

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Authors: Ramya P, Lino Abraham Varghese, S. Bose

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By cloud storage services, the data can be stored in the cloud, and can be shared across multiple users. Due to the unexpected hardware/software failures and human errors, which make the data stored in the cloud be lost or corrupted easily it affected the integrity of data in cloud. Some mechanisms have been designed to allow both data owners and public verifiers to efficiently audit cloud data integrity without retrieving the entire data from the cloud server. But public auditing on the integrity of shared data with the existing mechanisms will unavoidably reveal confidential information such as identity of the person, to public verifiers. Here a privacy-preserving mechanism is proposed to support public auditing on shared data stored in the cloud. It uses group signatures to compute verification metadata needed to audit the correctness of shared data. The identity of the signer on each block in shared data is kept confidential from public verifiers, who are easily verifying shared data integrity without retrieving the entire file. But on demand, the signer of the each block is reveal to the owner alone. Group private key is generated once by the owner in the static group, where as in the dynamic group, the group private key is change when the users revoke from the group. When the users leave from the group the already signed blocks are resigned by cloud service provider instead of owner is efficiently handled by efficient proxy re-signature scheme.

Keywords: data integrity, dynamic group, group signature, public auditing

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Authors: Adrian Craig, Jonathan Easaw, Rose Jordan, Ben Hall

Abstract:

The prescription of intravenous fluids is a fundamental component of inpatient management, but it is one which usually lacks thought. Fluids are a drug, which like any other can cause harm when prescribed inappropriately or wrongly. However, it is well recognised that it is poorly done, especially in the acute portals. The National Institute for Health and Care Excellence (NICE) recommends 1mmol/kg of potassium, sodium, and chloride per day. With various options of fluids, clinicians tend to face difficulty in choosing the most appropriate maintenance fluid, and there is a reluctance to prescribe potassium as part of an intravenous maintenance fluid regime. The aim was to prospectively audit the prescription of the first bag of intravenous maintenance fluids, the use of urea and electrolytes results to guide the choice of fluid and the use of fluid prescription charts, in a busy emergency department of a major trauma centre in Stoke-on-Trent, United Kingdom. This was undertaken over a week in early November 2016. Of those prescribed maintenance fluid only 8.9% were prescribed a fluid which was most appropriate for their daily electrolyte requirements. This audit has helped to highlight further the issues that are faced in busy Emergency Departments within hospitals that are stretched and lack capacity for prompt transfer to a ward. It has supported the findings of NICE, that emergency admission portals such as Emergency Departments poorly prescribed intravenous fluid therapy. The findings have enabled simple steps to be taken to educate clinicians about their fluid of choice. This has included: posters to remind clinicians to consider the urea and electrolyte values before prescription, suggesting the inclusion of a suggested intravenous fluid of choice in the prescription chart of the trust and the inclusion of a session within the introduction programme revising intravenous fluid therapy and daily electrolyte requirements. Moving forward, once the interventions have been implemented then, the data will be reaudited in six months to note any improvement in maintenance fluid choice. Alongside this, an audit of the rate of intravenous maintenance fluid therapy would be proposed to further increase patient safety by avoiding unintentional fluid overload which may cause unnecessary harm to patients within the hospital. In conclusion, prescription of maintenance fluid therapy was poor within the Emergency Department, and there is a great deal of opportunity for improvement. Therefore, the measures listed above will be implemented and the data reaudited.

Keywords: chloride, electrolyte, emergency department, emergency medicine, fluid, fluid therapy, intravenous, maintenance, major trauma, potassium, sodium, trauma

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Authors: Cindy Wang-Cowham, Judy Ningyu Tang

Abstract:

The paper contributes towards the development of scarce literature on HR knowledge management. Drawing literature from knowledge management, the authors define the meaning of HR knowledge and propose that there are social mechanisms in organizations that facilitate the management and sharing of HR knowledge. Instead of investigating the subject in large multinational corporations, the present paper examines it in a large Chinese privately owned enterprise, which has an international standing. The main finding of the case analysis is that communication and feedback plays a pivotal role when managing HR knowledge. Social mechanisms can stimulate the communication and feedback between employees, thus facilitate knowledge exchange.

Keywords: HR knowledge, knowledge management, large privately owned enterprises, China

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Authors: Mohammed Fakehy, Mohammed Haggag

Abstract:

The problem of test anxiety considered as one of the most important and most complex psychological problems faced by students of King Saud University, where university students in a need to bring their reassurance and psychological comfort, relieves feeling pain and difficulties of the study. Recently, there are programs and science that help human to change, including the science Linguistic Programming this neural science stems from not just the tips of the need to make the effort or continue to work, but provides the keys in which one can be controlled in the internal environment. Even human potential energy is extracted seeking to achieve success and happiness and excellence. Through the work of the researchers as members of the teaching staff at King Saud University and specialists in the field of psychology noticed the suffering of some students of King Saud University, test anxiety. In an attempt by the researchers to mitigate as much as possible of the unity of this concern, students will have a training program in Neuro Linguistic Programming. The main Question of this study is What is the effectiveness of the impact of a training program using NLP to reduce test anxiety by using a biological feedback. Therefore, the results of this study might serve as a good announcement about the usefulness of NLP programs which influence future research to significant effect of NLP on test anxiety.

Keywords: neuro linguistic programming, test anxiety, biological feedback, king saud

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Authors: Nureni O. Adeboye, Dawud A. Agunbiade

Abstract:

This research attempts to investigate the effects of heteroscedasticity and periodicity in a Panel Data Regression Model (PDRM) by extending previous works on balanced panel data estimation within the context of fitting PDRM for Banks audit fee. The estimation of such model was achieved through the derivation of Joint Lagrange Multiplier (LM) test for homoscedasticity and zero-serial correlation, a conditional LM test for zero serial correlation given heteroscedasticity of varying degrees as well as conditional LM test for homoscedasticity given first order positive serial correlation via a two-way error component model. Monte Carlo simulations were carried out for 81 different variations, of which its design assumed a uniform distribution under a linear heteroscedasticity function. Each of the variation was iterated 1000 times and the assessment of the three estimators considered are based on Variance, Absolute bias (ABIAS), Mean square error (MSE) and the Root Mean Square (RMSE) of parameters estimates. Eighteen different models at different specified conditions were fitted, and the best-fitted model is that of within estimator when heteroscedasticity is severe at either zero or positive serial correlation value. LM test results showed that the tests have good size and power as all the three tests are significant at 5% for the specified linear form of heteroscedasticity function which established the facts that Banks operations are severely heteroscedastic in nature with little or no periodicity effects.

Keywords: audit fee lagrange multiplier test, heteroscedasticity, lagrange multiplier test, Monte-Carlo scheme, periodicity

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Authors: Waqas Ahmad, Eisha Tahir, Shahper Aqeel, Imran Khalid Niazi, Amjad Iqbal

Abstract:

Background: Breast conservation surgery applies a number of techniques for accurate localization of lesions. Wire localization remains the method of choice in non-palpable breast cancers post-neoadjuvant chemotherapy. Objective: The aim of our study was to determine the accuracy of wire localization procedures in our department and compare it with internationally set protocols as per the Royal College of Radiologists. Post wire mammography, as well as the margin status of the postoperative specimen, assessed the accuracy of the procedure. Methods: We retrospectively reviewed the data of 225 patients who presented to our department from May 2014 to June 2015 post neoadjuvant chemotherapy with non-palpable cancers. These patients are candidates for wire localized lumpectomies either under ultrasound or stereotactic guidance. Metallic marker was placed in all the patients at the time of biopsy. Post wire mammogram was performed in all the patients and the distance of the wire tip from the marker was calculated. The presence or absence of the metallic clip in the postoperative specimen, as well as the marginal status of the postoperative specimen, was noted. Results: 157 sonographic and 68 stereotactic wire localization procedures were performed. 95% of the wire tips were within 1 cm of the metallic marker. Marginal status was negative in 94% of the patients in histopathological specimen. Conclusion: Our audit report declares more than 95% accuracy of image guided wire localization in successful excision of non-palpable breast lesions.

Keywords: breast, cancer, non-palpable, wire localization

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Authors: Paul B Stone, Subhashini Ganapathy, Mary E. Fendley, Layla Akilan

Abstract:

As notifications become more common through mobile devices, it is important to understand the impact of wearable devices on the improved user experience of man-machine interfaces. This study examined the use of a wearable device for a real-time system using a computer-simulated petrochemical system. The key research question was to determine how using the information provided by the wearable device can improve human performance through measures of situational awareness and decision making. Results indicate that there was a reduction in response time when using the watch, and there was no difference in situational awareness. Perception of using the watch was positive, with 83% of users finding value in using the watch and receiving haptic feedback.

Keywords: computer applications, haptic feedback, petrochemical systems, situational awareness, wearable technology

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Authors: Y. Jin, N. Zhang, X. Luo, W. Zhang

Abstract:

China with annual increasing 0.5-0.6 billion squares city residence has brought in enormous energy consumption by HVAC facilities and other appliances. In this regard, governments and researchers are encouraging renewable energy like solar energy, geothermal energy using in houses. However, high cost of equipment and low energy conversion result in a very low acceptable to residents. So what’s the equilibrium point of eco-feedback to reach economic benefit and thermal comfort? That is the main question should be answered. In this paper, the objective is an on-site solar PV and heater house, which has been evaluated as a low energy building. Since HVAC system is considered as main energy consumption equipment, the residence with 24-hour monitoring system set to measure temperature, wind velocity and energy in-out value with no HVAC system for one month of summer and winter. Thermal comfort time period will be analyzed and confirmed; then the air-conditioner will be started within thermal discomfort time for the following one summer and winter month. The same data will be recorded to calculate the average energy consumption monthly for a purpose of whole day thermal comfort. Finally, two analysis work will be done: 1) Original building thermal simulation by computer at design stage with actual measured temperature after construction will be contrastive analyzed; 2) The cost of renewable energy facilities and power consumption converted to cost efficient rate to assess the feasibility of renewable energy input for residence. The results of the experiment showed that a certain deviation exists between actual measured data and simulated one for human thermal comfort, especially in summer period. Moreover, the cost-effectiveness is high for a house in targeting city Guilin now with at least 11 years of cost-covering. The conclusion proves that an eco-feedback of a low energy residence is never only consideration of its energy net value, but also the cost efficiency that is the critical factor to push renewable energy acceptable by the public.

Keywords: cost efficiency, eco-feedback, low energy residence, thermal comfort

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Authors: Tawfiq Chekifi, Brahim Dennai, Rachid Khelfaoui

Abstract:

Over the last few decades, modeling immiscible fluids such as oil and water have been a classical research topic. Droplet-based microfluidics presents a unique platform for mixing, reaction, separation, dispersion of drops, and numerous other functions. For this purpose, several devices were studied, as well as microfluidic oscillator. The latter was obtained from wall attachment microfluidic amplifiers using a feedback loop from the outputs to the control inputs, nevertheless this device have not well used for microdrops applications. In this paper, we suggest a numerical CFD study of a microfluidic oscillator with two different lengths of feedback loop. In order to produce simultaneous microdrops of gasoil on water, a typical geometry that includes double T-junction is connected to the fluidic oscillator. The generation of microdrops is computed by volume-of-fluid method (VOF). Flow oscillations of microdrops were triggered by the Coanda effect of jet flow. The aim of work is to obtain a high oscillation frequency in output of this passive device, the influence of hydrodynamics and physics parameters on the microdrops frequency in the output of our microsystem is also analyzed, The computational results show that, the length of feedback loop, applied pressure on T-junction and interfacial tension have a significant effect on the dispersion of microdrops and its oscillation frequency. Across the range of low Reynold number, the microdrops generation and its dynamics have been accurately controlled by adjusting applying pressure ratio of two phases.

Keywords: fluidic oscillator, microdrops manipulation, VOF (volume of fluid method), microfluidic oscillator

Procedia PDF Downloads 397