Search results for: remote decentralized clinical trials

Authors: A. Cilek, S. Berberoglu, A. Akin Tanriover, C. Donmez

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Wetlands are the areas which have important effects and functions on protecting human life, adjust to nature, and biological variety, besides being potential exploitation sources. Observing the changes in these sensitive areas is important to study for data collecting and correct planning for the future. Remote sensing and Geographic Information System are being increasingly used for environmental studies such as biotope mapping and habitat monitoring. Akyatan Lagoon, one of the most important wetlands in Turkey, has been facing serious threats from agricultural applications in recent years. In this study, seasonal and temporal monitoring in wetlands system are determined by using remotely sensed data and Geographic Information Systems (GIS) between 1985 and 2015. The research method is based on classifying and mapping biotopes in the study area. The natural biotope types were determined as coastal sand dunes, salt marshes, river beds, coastal woods, lakes, lagoons.

Keywords: biotope mapping, GIS, remote sensing, wetlands

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Authors: Syeda Sahra, Abdullah Jahangir, Rachelle Hamadi, Ahmad Jahangir, Allison Glaser

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Background: Antimicrobial resistance is on the rise. The use of redundant and inappropriate antibiotics is contributing to recurrent infections and resistance. Newer antibiotics with more robust coverage for gram-negative bacteria are in great demand for complicated urinary tract infections (cUTIs), complicated intra-abdominal infections (cIAIs), hospital-acquired bacterial pneumonia (H.A.B.P.), and ventilator-associated bacterial pneumonia (V.A.B.P.). Objective: We performed this meta-analysis to evaluate the efficacy and safety profile of a new antibiotic, Imipenem/cilastatin/relebactam, compared to other broad-spectrum antibiotics for complicated infections. Search Strategy: We conducted a systemic review search on PubMed, Embase, and Central Cochrane Registry. Selection Criteria: We included randomized clinical trials (R.C.T.s) with the standard of care as comparator arm with Imipenem/cilastatin/relebactam as intervention arm. Analysis: For continuous variables, the mean difference was used. For discrete variables, we used the odds ratio. For effect sizes, we used a confidence interval of 95%. A p-value of less than 0.05 was used for statistical significance. Analysis was done using a random-effects model irrespective of heterogeneity. Heterogeneity was evaluated using the I2 statistic. Results: The authors observed similar efficacy at clinical and microbiologic response levels on early follow-up and late follow-up compared to the established standard of care. The incidence of drug-related adverse events, serious adverse events, and drug discontinuation due to adverse events were comparable across both groups. Conclusion: Imipenem/cilastatin/relebactam has a non-inferior safety and efficacy profile compared to peer antibiotics to treat severe bacterial infections (cUTIs, cIAIs, H.A.B.P., V.A.B.P.).

Keywords: bacterial pneumonia, complicated intra-abdominal infections, complicated urinary tract infection, Imipenem, cilastatin, relebactam

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Authors: Neha P. Amin, Maliha Zainib, Sean Parker, Malcolm Mattes

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Purpose/Objectives: Combination immunotherapy (IT) and radiation therapy (RT) is an actively growing field of clinical investigation due to promising findings of synergistic effects from immune-mediated mechanisms observed in preclinical studies and clinical data from case reports of abscopal effects. While there are many ongoing trials of combined IT-RT, there are still limited data on toxicity and outcome optimization regarding RT dose, fractionation, and sequencing of RT with IT. Nivolumab (NIVO), an anti-PD-1 monoclonal antibody, has been rapidly adopted in the clinic over the past 2 years, resulting in more patients being considered for concurrent RT-NIVO. Knowledge about the toxicity profile of combined RT-NIVO is important for both the patient and physician when making educated treatment decisions. The acute toxicity profile of concurrent RT-NIVO was analyzed in this study. Materials/Methods: A retrospective review of all consecutive patients who received NIVO from 1/2015 to 5/2017 at 4 separate centers within two separate institutions was performed. Those patients who completed a course of RT from 1 day prior to initial NIVO infusion through 1 month after last NIVO infusion were considered to have received concurrent therapy and included in the subsequent analysis. Descriptive statistics are reported for patient/tumor/treatment characteristics and observed acute toxicities within 3 months of RT completion. Results: Among 261 patients who received NIVO, 46 (17.6%) received concurrent RT to 67 different sites. The median f/u was 3.3 (.1-19.8) months, and 11/46 (24%) were still alive at last analysis. The most common histology, RT prescription, and treatment site included non-small cell lung cancer (23/46, 50%), 30 Gy in 10 fractions (16/67, 24%), and central thorax/abdomen (26/67, 39%), respectively. 79% (53/67) of irradiated sites were treated with 3D-conformal technique and palliative dose-fractionation. Grade 3, 4, and 5 toxicities were experienced by 11, 1, and 2 patients, respectively. However all grade 4 and 5 toxicities were outside of the irradiated area and attributed to the NIVO alone, and only 4/11 (36%) of the grade 3 toxicities were attributed to the RT-NIVO. The irradiated site in these cases included the brain [2/10 (20%)] and central thorax/abdomen [2/19 (10.5%)], including one unexpected grade 3 pancreatitides following stereotactic body RT to the left adrenal gland. Conclusions: Concurrent RT-NIVO is generally well tolerated, though with potentially increased rates of severe toxicity when irradiating the lung, abdomen, or brain. Pending more definitive data, we recommend counseling patients on the potentially increased rates of side effects from combined immunotherapy and radiotherapy to these locations. Future prospective trials assessing fractionation and sequencing of RT with IT will help inform combined therapy recommendations.

Keywords: combined immunotherapy and radiation, immunotherapy, Nivolumab, toxicity of concurrent immunotherapy and radiation

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Authors: A. Bouzekri, H. Benmassaud

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Aurès region is one of the arid and semi-arid areas that have suffered climate crises and overexploitation of natural resources they have led to significant land degradation. The use of remote sensing data allowed us to analyze the land and its spatiotemporal changes in the Aurès between 1987 and 2013, for this work, we adopted a method of analysis based on the exploitation of the images satellite Landsat TM 1987 and Landsat OLI 2013, from the supervised classification likelihood coupled with field surveys of the mission of May and September of 2013. Using ENVI EX software by the superposition of the ground cover maps from 1987 and 2013, one can extract a spatial map change of different land cover units. The results show that between 1987 and 2013 vegetation has suffered negative changes are the significant degradation of forests and steppe rangelands, and sandy soils and bare land recorded a considerable increase. The spatial change map land cover units between 1987 and 2013 allows us to understand the extensive or regressive orientation of vegetation and soil, this map shows that dense forests give his place to clear forests and steppe vegetation develops from a degraded forest vegetation and bare, sandy soils earn big steppe surfaces that explain its remarkable extension. The analysis of remote sensing data highlights the profound changes in our environment over time and quantitative monitoring of the risk of desertification.

Keywords: remote sensing, spatiotemporal, land use, Aurès

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Authors: Seshi Reddy Kasu, Florian Misoc

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The use of hydroelectric pump-storage system at large scale, MW-size systems, is already widespread around the world. Designed for large scale applications, pump-storage station can be scaled-down for small, remote residential applications. Given the cost and complexity associated with installing a substation further than 100 miles from the main transmission lines, a remote, independent and self-sufficient system is by far the most feasible solution. This article is aiming at the design of wind and solar power generating system, by means of pumped-storage to replace the wind and/or solar power systems with a battery bank energy storage. Wind and solar pumped-storage power generating system can reduce the cost of power generation system, according to the user's electricity load and resource condition and also can ensure system reliability of power supply. Wind and solar pumped-storage power generation system is well suited for remote residential applications with intermittent wind and/or solar energy. This type of power systems, installed in these locations, could be a very good alternative, with economic benefits and positive social effects. The advantage of pumped storage power system, where wind power regulation is calculated, shows that a significant smoothing of the produced power is obtained, resulting in a power-on-demand system’s capability, concomitant to extra economic benefits.

Keywords: battery bank, photo-voltaic, pump-storage, wind energy

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Authors: Bin Liu

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As one of the most important tasks in protein sequence analysis, protein remote homology detection has been studied for decades. Currently, the profile-based methods show state-of-the-art performance. Position-Specific Frequency Matrix (PSFM) is widely used profile. However, there exists noise information in the profiles introduced by the amino acids with low frequencies. In this study, we propose a method to remove the noise information in the PSFM by removing the amino acids with low frequencies called Top frequency profile (TFP). Three new matrix transformation methods, including Autocross covariance (ACC) transformation, Tri-gram, and K-separated bigram (KSB), are performed on these profiles to convert them into fixed length feature vectors. Combined with Support Vector Machines (SVMs), the predictors are constructed. Evaluated on two benchmark datasets, and experimental results show that these proposed methods outperform other state-of-the-art predictors.

Keywords: protein remote homology detection, protein fold recognition, top frequency profile, support vector machines

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Authors: B. Hossen, Y. Helmut

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Soil salinity is a major problem for the coastal region of Bangladesh, which has been increasing for the last four decades. Determination of soil salinity is essential for proper land use planning for agricultural crop production. The aim of the research is to estimate and monitor the soil salinity in the study area. Remote sensing can be an effective tool for detecting soil salinity in data-scarce conditions. In the research, Landsat 8 is used, which required atmospheric and radiometric correction, and nine soil salinity indices are applied to develop a soil salinity map. Ground soil salinity data, i.e., EC value, is collected as a printed map which is then scanned and digitized to develop a point shapefile. Linear regression is made between satellite-based generated map and ground soil salinity data, i.e., EC value. The results show that maximum R² value is found for salinity index SI 7 = G*R/B representing 0.022. This minimal R² value refers that there is a negligible relationship between ground EC value and salinity index generated value. Hence, these indices are not appropriate to assess soil salinity though many studies used those soil salinity indices successfully. Therefore, further research is necessary to formulate a model for determining the soil salinity in the coastal of Bangladesh.

Keywords: soil salinity, EC, Landsat 8, salinity indices, linear regression, remote sensing

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Authors: Arafat A. A. Shabaneh

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Harsh environments demand a developed detection of an optical communication system to ensure a high level of security and safety. Fiber Bragg gratings (FBG) are emerging sensing instruments that respond to variations in strain and temperature via varying wavelengths. In this paper, cascaded uniform FBG as a strain sensor for 6 km length at 1550 nm wavelength with 30 oC is designed with analyzing of dynamic strain and wavelength shifts. FBG is placed in a small segment of optical fiber, which reflects light of a specific wavelength and passes the remaining wavelengths. This makes a periodic alteration in the refractive index within the fiber core. The alteration in the modal index of fiber produced due to strain consequences in a Bragg wavelength. When the developed sensor exposure to a strain of cascaded uniform FBG by 0.01, the wavelength is shifted to 0.0000144383 μm. The sensing accuracy of the developed sensor is 0.0012. Simulation results show reliable and effective strain monitoring sensors for remote sensing applications.

Keywords: Cascaded fiber Bragg gratings, Strain sensor, Remote sensing, Wavelength shift

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Authors: Annop Jaewisorn

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This study explores the relationship between natural disasters and inequalities -both income and expenditure inequality- at a micro-level of Thailand as the first study of this nature for this country. The analysis uses a unique panel and remote-sensing dataset constructed for the purpose of this research. It contains provincial inequality measures and other economic and social indicators based on the Thailand Household Survey during the period between 1992 and 2019. Meanwhile, the data on natural disasters, which are remote-sensing data, are received from several official geophysical or meteorological databases. Employing a panel fixed effects, the results show that natural disasters significantly reduce household income and expenditure inequality as measured by the Gini index, implying that rich people in Thailand bear a higher cost of natural disasters when compared to poor people. The effect on income inequality is mainly driven by droughts, while the effect on expenditure inequality is mainly driven by flood events. The results are robust across heterogeneity of the samples, lagged effects, outliers, and an alternative inequality measure.

Keywords: inequality, natural disasters, remote-sensing data, Thailand

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Authors: Prem K. Mony, Bharadwaj Amrutur, Prashanth Thankachan, Swarnarekha Bhat, Suman Rao, Maryann Washington, Annamma Thomas, N. Sheela, Hiteshwar Rao, Sumi Antony

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The disease burden among mothers and newborns is caused mostly by a handful of avoidable conditions occurring around the time of childbirth and within the first month following delivery. Real-time monitoring of vital parameters of mothers and neonates offers a potential opportunity to impact access as well as the quality of care in vulnerable populations. We describe the design, development and testing of an innovative wearable device for remote biomonitoring (RBM) of body temperatures in mothers and neonates in a hospital in southern India. The architecture consists of: [1] a low-cost, wearable sensor tag; [2] a gateway device for ‘real-time’ communication link; [3] piggy-backing on a commercial GSM communication network; and [4] an algorithm-based data analytics system. Requirements for the device were: long battery-life upto 28 days (with sampling frequency 5/hr); robustness; IP 68 hermetic sealing; and human-centric design. We undertook pre-clinical laboratory testing followed by clinical trial phases I & IIa for evaluation of safety and efficacy in the following sequence: seven healthy adult volunteers; 18 healthy mothers; and three sets of babies – 3 healthy babies; 10 stable babies in the Neonatal Intensive Care Unit (NICU) and 1 baby with hypoxic ischaemic encephalopathy (HIE). The 3-coin thickness, pebble-design sensor weighing about 8 gms was secured onto the abdomen for the baby and over the upper arm for adults. In the laboratory setting, the response-time of the sensor device to attain thermal equilibrium with the surroundings was 4 minutes vis-a-vis 3 minutes observed with a precision-grade digital thermometer used as a reference standard. The accuracy was ±0.1°C of the reference standard within the temperature range of 25-40°C. The adult volunteers, aged 20 to 45 years, contributed a total of 345 hours of readings over a 7-day period and the postnatal mothers provided a total of 403 paired readings. The mean skin temperatures measured in the adults by the sensor were about 2°C lower than the axillary temperature readings (sensor =34.1 vs digital = 36.1); this difference was statistically significant (t-test=13.8; p<0.001). The healthy neonates provided a total of 39 paired readings; the mean difference in temperature was 0.13°C (sensor =36.9 vs digital = 36.7; p=0.2). The neonates in the NICU provided a total of 130 paired readings. Their mean skin temperature measured by the sensor was 0.6°C lower than that measured by the radiant warmer probe (sensor =35.9 vs warmer probe = 36.5; p < 0.001). The neonate with HIE provided a total of 25 paired readings with the mean sensor reading being not different from the radian warmer probe reading (sensor =33.5 vs warmer probe = 33.5; p=0.8). No major adverse events were noted in both the adults and neonates; four adult volunteers reported mild sweating under the device/arm band and one volunteer developed mild skin allergy. This proof-of-concept study shows that real-time monitoring of temperatures is technically feasible and that this innovation appears to be promising in terms of both safety and accuracy (with appropriate calibration) for improved maternal and neonatal health.

Keywords: public health, remote biomonitoring, temperature surveillance, wearable sensors, mothers and newborns

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Authors: Mahdi Farajzadeh Ajirlou

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The detailed serious adverse effects raised the stresses around the safety of individuals who have gotten COVID-19 vaccines. Numerous verification referrers that disease with COV-19 causes neurological dysfunction in a significant proportion of influenced patients, where these side effects show up seriously amid the disease, and still less is known approximately the potential long-term results for the brain, where the loss of olfaction could be a neurological sign and simple indications of COVID-19. Since publishing effective clinical trial results of mRNA coronavirus disease 2019 (COVID-19) and injecting it to the volunteers in 2020, numerous reports have emerged approximately about cardiovascular complications followed by the mRNA vaccination. Vaccination-associated adenopathy could be a constant imaging finding after the organization of COVID-19 antibodies that will lead to a symptomatic problem in patients with shown or suspected cancer, in whom it may be vague from dangerous nodal inclusion. In spite of all the benefits and viability of the coronavirus infection 2019 (COVID-19) antibodies specified in later clinical trials, a few other post-vaccination side impacts, such as lymphadenopathy (LAP), were observed. Also, numerous variables, including financial conditions, have played a critical part in expanding the number of people with COVID-19 infection and also much more side effects in that country. Amid the Coronavirus widespread, Iran has been experiencing extreme sanctions, which has faced this nation with an extreme financial crisis. Additionally, with COVID-19 widespread, there was a developing concern around the abuse of imaging exams extraordinarily within the pediatric populace, which highlights the issues pointed out by this review.

Keywords: radiology, vaccines, COVID-19, side effect

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Authors: Shuen-Tai Wang, Hsi-Ya Chang

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Cloud computing is becoming more and more matured over the last few years and consequently the demands for better cloud services is increasing rapidly. One of the research topics to improve cloud services is the desktop computing in virtualized environment. This paper aims at the development of an adaptive virtual desktop service in cloud computing platform based on our previous research on the virtualization technology. We implement cloud virtual desktop and application software streaming technology that make it possible for providing Virtual Desktop as a Service (VDaaS). Given the development of remote desktop virtualization, it allows shifting the user’s desktop from the traditional PC environment to the cloud-enabled environment, which is stored on a remote virtual machine rather than locally. This proposed effort has the potential to positively provide an efficient, resilience and elastic environment for online cloud service. Users no longer need to burden the platform maintenances and drastically reduces the overall cost of hardware and software licenses. Moreover, this flexible remote desktop service represents the next significant step to the mobile workplace, and it lets users access their desktop environments from virtually anywhere.

Keywords: cloud computing, virtualization, virtual desktop, VDaaS

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Authors: Ghanem Al-Ghamdi

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African Horse Sickness causes significant challenges to horse practitioners and owners in Africa and possibly in certain locations in the Arab Pensila. The aim of this work was to observe a hot spot of epidemic in Al-Baha, Southwestern of Saudi Arabia that could be AHS. A five year-old horse farm that had eight horses with no history of clinical problems was visited in late October 2014. In August 2014, horses showed clinical signs of severe pain, congestion of mucus membranes, foam oozing of the nose, recumbency, difficult breath and ultimately death. The course of the disease averaged 2 days. The farm had no previous history of this episode. Other animals including camel, sheep reside the same farm sharing feeding and water sources however no obvious similar clinical problems were noticed among the two species. Five horses showed the clinical disease and all horses were lost. Veterinary help was not available for diagnosis or treatment. A follow up visit to the farm after one year indicated that the three remaining horses were healthy but were relocated to a different facility out the Al-Baha Region. The most likely cause of such clinical problem is African Horse Sickness, however clinical exam and sampling of other horses in the region is absolute must as well as examining arthropods.

Keywords: African horse sickness, horses, Al-Baha, Saudi Arabia

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Authors: Radu Soflau, Lia-Ecaterina Oltean

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Background: Increasing evidence supports the efficacy of psychological interventions for psychosis. However, it is unclear which one of these interventions is most likely to address negative psychotic symptoms and related outcomes. We aimed to determine the relative efficacy of psychological and psychosocial interventions for negative symptoms, overall psychotic symptoms, and related outcomes. Methods: To attain this goal, we conducted a systematic review and network meta-analysis. We searched for potentially eligible trials in PubMed, EMBASE, PsycInfo, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases up until February 08, 2022. We included randomized controlled trials that investigated the efficacy of psychological for adults with psychosis. We excluded interventions for prodromal or “at risk” individuals, as well as patients with serious co-morbid medical or psychiatric conditions (others than depressive and/or anxiety disorders). Two researchers conducted study selection and performed data extraction independently. Analyses were run using STATA network and mvmeta packages, applying a random effect model under a frequentist framework in order to compute standardized mean differences or risk ratio. Findings: We identified 47844 records and screened 29466 records for eligibility. The majority of eligible interventions were delivered in addition to pharmacological treatment. Treatment as usual (TAU) was the most frequent common comparator. Theoretically driven psychological interventions generally outperformed TAU at post-test and follow-up, displaying small and small-to-medium effect sizes. A similar pattern of results emerged in sensitivity analyses focused on studies that employed an inclusion criterion for relevant negative symptom severity. Conclusion: While the efficacy of some psychological interventions is promising, there is a need for more high-quality studies, as well as more trials directly comparing psychological treatments for negative psychotic symptoms.

Keywords: psychosis, network meta-analysis, psychological interventions, efficacy, negative symptoms

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Authors: Jia Zhang, Fengmei Yao, Yanjing Tan

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The accurate estimation of crop yield is of great importance for the food security. In this study, a process-based mechanism model was modified to estimate yield of C4 crop by modifying the carbon metabolic pathway in the photosynthesis sub-module of the RS-P-YEC (Remote-Sensing-Photosynthesis-Yield estimation for Crops) model. The yield was calculated by multiplying net primary productivity (NPP) and the harvest index (HI) derived from the ratio of grain to stalk yield. The modified RS-P-YEC model was used to simulate maize yield in the Northeast China Plain during the period 2002-2011. The statistical data of maize yield from study area was used to validate the simulated results at county-level. The results showed that the Pearson correlation coefficient (R) was 0.827 (P < 0.01) between the simulated yield and the statistical data, and the root mean square error (RMSE) was 712 kg/ha with a relative error (RE) of 9.3%. From 2002-2011, the yield of maize planting zone in the Northeast China Plain was increasing with smaller coefficient of variation (CV). The spatial pattern of simulated maize yield was consistent with the actual distribution in the Northeast China Plain, with an increasing trend from the northeast to the southwest. Hence the results demonstrated that the modified process-based model coupled with remote sensing data was suitable for yield prediction of maize in the Northeast China Plain at the spatial scale.

Keywords: process-based model, C4 crop, maize yield, remote sensing, Northeast China Plain

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Authors: Valerie A. Conrade

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Introduction: A large body of literature suggests patients who complete fecal immunochemical testing (FIT) kits are likely to identify colorectal cancer sooner than those who do not complete FIT kits. Background: Patients who do not participate in preventative measures such as the FIT kit are at a higher risk of colorectal cancer growing unnoticed. The objective was to see if the method the principal investigator (PI) uses to educate clinical staff on the importance of FIT kit administration provides an increased amount of FIT kit dissemination to patients post clinical education. Methodologies: Data collection via manual tallies took place before and after the clinical staff was educated on the importance of FIT kits. Results: The results showed an increase in FIT kit dissemination post clinical staff education. Through enhanced instruction to the clinical staff regarding the importance of FIT kits, expanding their knowledge on preventative measures to detect colorectal cancer positively impacted nurses and, in turn, their patients.

Keywords: colon cancer, education, fecal immunochemical testing, nursing

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Authors: Jacqueline Y. Thompson, Sam Watson, Lee Middleton, Karla Hemming

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Introduction: The odds ratio (estimated via logistic regression) is a well-established and common approach for estimating covariate-adjusted binary treatment effects when comparing a treatment and control group with dichotomous outcomes. Its popularity is primarily because of its stability and robustness to model misspecification. However, the situation is different for the relative risk and risk difference, which are arguably easier to interpret and better suited to specific designs such as non-inferiority studies. So far, there is no equivalent, widely acceptable approach to estimate an adjusted relative risk and risk difference when conducting clinical trials. This is partly due to the lack of a comprehensive evaluation of available candidate methods. Methods/Approach: A simulation study is designed to evaluate the performance of relevant candidate methods to estimate relative risks to represent conditional and marginal estimation approaches. We consider the log-binomial, generalised linear models (GLM) with iteratively weighted least-squares (IWLS) and model-based standard errors (SE); log-binomial GLM with convex optimisation and model-based SEs; log-binomial GLM with convex optimisation and permutation tests; modified-Poisson GLM IWLS and robust SEs; log-binomial generalised estimation equations (GEE) and robust SEs; marginal standardisation and delta method SEs; and marginal standardisation and permutation test SEs. Independent and identically distributed datasets are simulated from a randomised controlled trial to evaluate these candidate methods. Simulations are replicated 10000 times for each scenario across all possible combinations of sample sizes (200, 1000, and 5000), outcomes (10%, 50%, and 80%), and covariates (ranging from -0.05 to 0.7) representing weak, moderate or strong relationships. Treatment effects (ranging from 0, -0.5, 1; on the log-scale) will consider null (H0) and alternative (H1) hypotheses to evaluate coverage and power in realistic scenarios. Performance measures (bias, mean square error (MSE), relative efficiency, and convergence rates) are evaluated across scenarios covering a range of sample sizes, event rates, covariate prognostic strength, and model misspecifications. Potential Results, Relevance & Impact: There are several methods for estimating unadjusted and adjusted relative risks. However, it is unclear which method(s) is the most efficient, preserves type-I error rate, is robust to model misspecification, or is the most powerful when adjusting for non-prognostic and prognostic covariates. GEE estimations may be biased when the outcome distributions are not from marginal binary data. Also, it seems that marginal standardisation and convex optimisation may perform better than GLM IWLS log-binomial.

Keywords: binary outcomes, statistical methods, clinical trials, simulation study

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Authors: Gianna Zou

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Propensity score matching (PSM), introduced by Paul R. Rosenbaum and Donald Rubin in 1983, is a popular statistical matching technique which tries to estimate the treatment effects by taking into account covariates that could impact the efficacy of study medication in clinical trials. PSM can be used to reduce the bias due to confounding variables. However, PSM assumes that the response values are normally distributed. In some cases, this assumption may not be held. In this paper, a machine learning method - Bayesian Additive Regression Tree (BART), is used as a more robust method of matching. BART can work well when models are misspecified since it can be used to model heterogeneous treatment effects. Moreover, it has the capability to handle non-linear main effects and multiway interactions. In this research, a BART Matching Method (BMM) is proposed to provide a more reliable matching method over PSM. By comparing the analysis results from PSM and BMM, BMM can perform well and has better prediction capability when the response values are not normally distributed.

Keywords: BART, Bayesian, matching, regression

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Authors: Mohammadreza Nematollahi, Bahareh Mosadegh Sedghy, Alireza Tajbakhsh

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The last two decades have witnessed substantial attention to organic and sustainable agricultural supply chains. Motivated by real-world practices, this paper aims to address two main challenges observed in organic product supply chains: decentralized decision-making process between farmers and their retailers, and competition between organic products and their conventional counterparts. To this aim, an agricultural supply chain consisting of two farmers, a conventional farmer and an organic farmer who offers an organic version of the same product, is considered. Both farmers distribute their products through a single retailer, where there exists competition between the organic and the conventional product. The retailer, as the market leader, sets the wholesale price, and afterward, the farmers set their production quantity decisions. This paper first models the demand functions of the conventional and organic products by incorporating the effect of asymmetric brand equity, which captures the fact that consumers usually pay a premium for organic due to positive perceptions regarding their health and environmental benefits. Then, profit functions with consideration of some characteristics of organic farming, including crop yield gap and organic cost factor, are modeled. Our research also considers both economies and diseconomies of scale in farming production as well as the effects of organic subsidy paid by the government to support organic farming. This paper explores the investigated supply chain in three scenarios: decentralized, centralized, and coordinated decision-making structures. In the decentralized scenario, the conventional and organic farmers and the retailer maximize their own profits individually. In this case, the interaction between the farmers is modeled under the Bertrand competition, while analyzing the interaction between the retailer and farmers under the Stackelberg game structure. In the centralized model, the optimal production strategies are obtained from the entire supply chain perspective. Analytical models are developed to derive closed-form optimal solutions. Moreover, analytical sensitivity analyses are conducted to explore the effects of main parameters like the crop yield gap, organic cost factor, organic subsidy, and percent price premium of the organic product on the farmers’ and retailer’s optimal strategies. Afterward, a coordination scenario is proposed to convince the three supply chain members to shift from the decentralized to centralized decision-making structure. The results indicate that the proposed coordination scenario provides a win-win-win situation for all three members compared to the decentralized model. Moreover, our paper demonstrates that the coordinated model respectively increases and decreases the production and price of organic produce, which in turn motivates the consumption of organic products in the market. Moreover, the proposed coordination model helps the organic farmer better handle the challenges of organic farming, including the additional cost and crop yield gap. Last but not least, our results highlight the active role of the organic subsidy paid by the government as a means of promoting sustainable organic product supply chains. Our paper shows that although the amount of organic subsidy plays a significant role in the production and sales price of organic products, the allocation method of subsidy between the organic farmer and retailer is not of that importance.

Keywords: analytical game-theoretic model, product competition, supply chain coordination, sustainable organic supply chain

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Authors: T. Garba, Y. Y. Babanyara, K. G. Ilellah, M. A. Modibbo, T. O. Quddus, M. J. Sani

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After the United Nation Convention on Desertification (UNCD) in 1977 which was preceded by extensive, regional, and local studies, and consultations with numerous scientists, decision-makers, and relevant institutions. Global Plan of Action to Combat Desertification (PACD) was formulated, endorsed by member Countries. The role of implementing PACD was vested with Governments of countries affected by desertification. The Federal Government of Nigeria as a signatory and World Bank funded and implement afforestation project aimed at combating desertification between 1988 and 1999. This research, therefore, applied remote sensing techniques to assess the effectiveness of the project. To achieve that a small portion of about 143,609 hectares was curved out from the project area. Normalized Difference of the Vegetative Index (NDVI) and Land Use Land Cover were derived from Landsat TM 1986, Landsat ETM 1999 and Nigeria Sat 1, 2007 of the project area. The findings show that there was an increase in cultivated area due to the project from 1986 through 1999 and 2007. This is further buttressed by the three NDVI imageries due to their high positive pixel value from 0.04 in 1986 to 0.22 in 1999 and to 0.32 in 2007 These signifies the gradual physical development of Afforestation project in the area. In addition, it was also verified by histograms of changes in vegetation which indicated an increased vegetative cover from 60,192 in 1986, to 102,476 in 1999 and then to 88,343 in 2007. The study concluded that Remote Sensing approach has actually confirmed that the project was indeed successful and effective.

Keywords: afforestation, desertification, landsat, vegetative index, remote sensing

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Authors: Eric Lee G. Escobedo-Wu, Nidhi Rohatgi, Fouzel Dhebar

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It is challenging for patients to navigate through healthcare systems after-hours. This leads to delays in care, patient/provider dissatisfaction, inappropriate resource utilization, readmissions, and higher costs. It is important to provide patients and providers with effective clinical decision-making tools to allow seamless connectivity and coordinated care. In August 2015, patient-centric Stanford Health Care established Clinical Advice Services (CAS) to provide clinical decision support after-hours. CAS is founded on key Lean principles: Value stream mapping, empathy mapping, waste walk, takt time calculations, standard work, plan-do-check-act cycles, and active daily management. At CAS, Clinical Assistants take the initial call and manage all non-clinical calls (e.g., appointments, directions, general information). If the patient has a clinical symptom, the CAS nurses take the call and utilize standardized clinical algorithms to triage the patient to home, clinic, urgent care, emergency department, or 911. Nurses may also contact the on-call physician based on the clinical algorithm for further direction and consultation. Since August 2015, CAS has managed 228,990 calls from 26 clinical specialties. Reporting is built into the electronic health record for analysis and data collection. 65.3% of the after-hours calls are clinically related. Average clinical algorithm adherence rate has been 92%. An average of 9% of calls was escalated by CAS nurses to the physician on call. An average of 5% of patients was triaged to the Emergency Department by CAS. Key learnings indicate that a seamless connectivity vision, cascading, multidisciplinary ownership of the problem, and synergistic enterprise improvements have contributed to this success while striving for continuous improvement.

Keywords: after hours phone calls, clinical advice services, nurse triage, Stanford Health Care

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Authors: Taleb Odeh, Nizar Abu-Jaber, Nour Khries

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The southern part of Wadi Al Yarmouk catchment area covers north of Jordan. It locates within latitudes 32° 20’ to 32° 45’N and longitudes 35° 42’ to 36° 23’ E and has an area of about 1426 km2. However, it has high relief topography where the elevation varies between 50 to 1100 meter above sea level. The variations in the topography causes different units of landforms, climatic zones, land covers and plant species. As a results of these different landscapes units exists in that region. Spatial planning is a major challenge in such a vital area for Jordan which could not be achieved without determining landscape units. However, an integrated approach of remote sensing and geographic information Systems (GIS) is an optimized tool to investigate and map landscape units of such a complicated area. Remote sensing has the capability to collect different land surface data, of large landscape areas, accurately and in different time periods. GIS has the ability of storage these land surface data, analyzing them spatially and present them in form of professional maps. We generated a geo-land surface data that include land cover, rock units, soil units, plant species and digital elevation model using ASTER image and Google Earth while analyzing geo-data spatially were done by ArcGIS 10.2 software. We found that there are twenty two different landscape units in the study area which they have to be considered for any spatial planning in order to avoid and environmental problems.

Keywords: landscape, spatial planning, GIS, spatial analysis, remote sensing

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Authors: Alba Prats-Bisbe, Jaume López-Carballo, David Leno-Colorado, Alberto García Molina, Alicia Romero Marquez, Elena Hernández Pena, Eloy Opisso Salleras, Raimon Jané Campos

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Neurological disorders are a leading cause of disability and premature mortality worldwide. Neurorehabilitation (NRHB) is a clinical process aimed at reducing functional impairment, promoting societal participation, and improving the quality of life for affected individuals. Virtual reality (VR) technology is emerging as a promising NRHB support tool. Its immersive nature fosters a strong sense of agency and embodiment, motivating patients to engage in meaningful tasks and increasing adherence to therapy. However, the clinical benefits of VR interventions are challenging to determine due to the high heterogeneity among health applications. This study explores a stepwise development approach for creating VR-based tools to assist individuals with neurological disorders in medical practice, aiming to enhance reproducibility, facilitate comparison, and promote the generalization of findings. Building on previous research, the step-by-step methodology encompasses: Needs Identification– conducting cross-disciplinary meetings to brainstorm problems, solutions, and address barriers. Intervention Definition– target population, set goals, and conceptualize the VR system (equipment and environments). Material Selection and Placement– choose appropriate hardware and software, place the device within the hospital setting, and test equipment. Co-design– collaboratively create VR environments, user interfaces, and data management strategies. Prototyping– develop VR prototypes, conduct user testing, and make iterative redesigns. Usability and Feasibility Assessment– design protocols and conduct trials with stakeholders in the hospital setting. Efficacy Assessment– conduct clinical trials to evaluate outcomes and long-term effects. Cost-Effectiveness Validation– assess reproducibility, sustainability, and balance between costs and benefits. NRHB is complex due to the multifaceted needs of patients and the interdisciplinary healthcare architecture. VR has the potential to support various applications, such as motor skill training, cognitive tasks, pain management, unilateral spatial neglect (diagnosis and treatment), mirror therapy, and ecologically valid activities of daily living. Following this methodology was crucial for launching a VR-based system in a real hospital environment. Collaboration with neuropsychologists lead to develop A) a VR-based tool for cognitive rehabilitation in patients with acquired brain injury (ABI). The system comprises a head-mounted display (HTC Vive Pro Eye) and 7 tasks targeting attention, memory, and executive functions. A desktop application facilitates session configuration, while database records in-game variables. The VR tool's usability and feasibility were demonstrated in proof-of-concept trials with 20 patients, and effectiveness is being tested through a clinical protocol with 12 patients completing 24-session treatment. Another case involved collaboration with nurses and paediatric physiatrists to create B) a VR-based distraction tool during invasive techniques. The goal is to alleviate pain and anxiety associated with botulinum toxin (BTX) injections, blood tests, or intravenous placements. An all-in-one headset (HTC Vive Focus 3) deploys 360º videos to improve the experience for paediatric patients and their families. This study presents a framework for developing clinically relevant and technologically feasible VR-based support tools for hospital settings. Despite differences in patient type, intervention purpose, and VR system, the methodology demonstrates usability, viability, reproducibility and preliminary clinical benefits. It highlights the importance approach centred on clinician and patient needs for any aspect of NRHB within a real hospital setting.

Keywords: neurological disorders, neurorehabilitation, stepwise development approach, virtual reality

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Authors: Afolabi O.J, Simon-Oke I.A., Oniya M.O., Okaka C.E.

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River blindness is a skin, and an eye disease caused by Onchocerca volvulus and vectored by a female hematophagous blackfly. The study aims to evaluate the distribution of the clinical signs of river blindness and the efficacy of ivermectin in the treatment of river blindness in Idogun. Observational studies in epidemiology that involve the use of a structured questionnaire to obtain useful epidemiological information from the respondents, physical assessment via palpation from head to ankle was used to assess clinical signs from the respondents and skin snip test was used to evaluate the prevalence of the disease. The efficacy of the drug was evaluated and expressed in percentages. One hundred and ninety-two (192) out of the 384 respondents examined, showed various signs of river blindness. However, it was only 108 (28.1%) respondents with the clinical signs that demonstrated Onchocerca volvulus microfilariae in their skin snips. The clinical signs observed among the respondents include skin depigmentation such as dermatitis, leopard skin, papules, pruritus and self-inflicted injury, while ocular symptoms include cataract, ocular lesion and partial blindness. Among these clinical signs, papules, and pruritus were the most dominant in the community. The prevalence of the clinical signs was observed to vary significantly among the age groups and gender (P<0.05). The efficacy of the drug after 6 and 12 months of treatments shows that the drug is more effective at age groups 10-50 years than the age groups 51-90 years. Ivermectin is observed to be efficacious in the treatment of the disease. However, to achieve eradication of the disease, the drug may be administered at 0.15mg/kg twice a year.

Keywords: riverblindness, clinical signs, ivermectin, Idogun

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Authors: Kai Liua, Hongbo Sua, Weimin Wangb, Hong Liangb

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Urban heat island (UHI) has attracted attention around the world since they profoundly affect human life and climatological. Better understanding the effects of landscape pattern on UHI is crucial for improving the ecological security and sustainability of cities. This study aims to investigate how landscape composition and configuration would affect UHI in Shenzhen, China, based on the analysis of land surface temperature (LST) in relation landscape metrics, mainly with the aid of three new satellite sensors launched by China. HJ-1B satellite system was utilized to estimate surface temperature and comprehensively explore the urban thermal spatial pattern. The landscape metrics of the high spatial resolution remote sensing satellites (GF-1 and ZY-3) were compared and analyzed to validate the performance of the new launched satellite sensors. Results show that the mean LST is correlated with main landscape metrics involving class-based metrics and landscape-based metrics, suggesting that the landscape composition and the spatial configuration both influence UHI. These relationships also reveal that urban green has a significant effect in mitigating UHI in Shenzhen due to its homogeneous spatial distribution and large spatial extent. Overall, our study not only confirm the applicability and effectiveness of the HJ-1B, GF-1 and ZY-3 satellite system for studying UHI but also reveal the impacts of the urban spatial structure on UHI, which is meaningful for the planning and management of the urban environment.

Keywords: urban heat island, Shenzhen, new remote sensing sensor, remote sensing satellites

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Authors: Ahmed Yousef A. Al Sultan

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Introduction: The aim of this review is based on clinical research that studies the changes in middle cerebral artery velocity using Transcranial Doppler (TCD) and cerebral oxygen saturation using cerebral oximetry in patients undergoing carotid endarterectomy (CEA) surgery under local anesthesia (LA). Patients with or without neurological symptoms during the surgery are taking a role in this study using triplet method of cerebral oximetry, transcranial doppler and awake test in detecting any cerebral ischemic symptoms. Methods: about one hundred patients took part during their CEA surgeries under local anesthesia, using triple assessment mentioned method, Patients requiring general anesthesia be excluded from analysis. All data were recorded at eight surgery stages separately to serve this study. Results: In total regional cerebral oxygen saturation (rSO2), middle cerebral artery (MCA) velocity, and pulsatility index were significantly decreased during carotid artery clamping step in CEA procedures on the targeted carotid side. With most observed changes in MCA velocity during the study. Discussion: Cerebral oxygen saturation and middle cerebral artery velocity were significantly decreased during clamping step of the procedures on the targeted side. The team with neurological symptoms during the procedures showed higher changes of rSO2 and MCA velocity than the team without neurological symptoms. Cerebral rSO2 and MCA velocity significantly increased directly after de-clamping of the internal carotid artery on the affected side.

Keywords: awake testing, carotid endarterectomy, cerebral oximetry, Tanscranial Doppler

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Authors: Aderonke Oluseun Akinwumi, Olusola A. Komolaf

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This paper gives information about the wide array of challenges facing both the electric utilities and consumers in the distribution system in developing countries, using Obafemi Awolowo University, Ile-Ife Nigeria as a case study. It also proffers cost-effective solution through remote monitoring, diagnostic and operation of distribution networks without compromising the system reliability. As utilities move from manned and unintelligent networks to completely unmanned smart grids, switching activities at substations and feeders will be managed and controlled remotely by dedicated systems hence this design. The Substation Remote Diagnostic and Operation Solution (sRDOs) would remotely monitor the load on Medium Voltage (MV) and Low Voltage (LV) feeders as well as distribution transformers and allow the utility disconnect non-paying customers with absolutely no extra resource deployment and without interrupting supply to paying customers. The aftermath of the implementation of this design improved the lifetime of key distribution infrastructure by automatically isolating feeders during overload conditions and more importantly erring consumers. This increased the ratio of revenue generated on electricity bills to total network load.

Keywords: electric utility, consumers, remote monitoring, diagnostic, system reliability, manned and unintelligent networks, unmanned smart grids, switching activities, medium voltage, low voltage, distribution transformer

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Authors: Kiran Datta, Daniella Holland-Hart, Anthony Byrne

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Introduction: Oesophago-gastric (OG) cancers are the fifth commonest in the UK, accounting for over 12,000 deaths each year. Most patients will present at later stages of the disease, with only 21% of patients with stage 4 disease surviving longer than a year. As a result, many patients are unsuitable for curative surgery and instead receive palliative treatment to improve prognosis and symptom burden. However, palliative chemotherapy can result in significant toxicity: almost half of the patients are unable to complete their chemotherapy regimen, with this proportion rising significantly in older and frailer patients. In addition, clinical trials often exclude older and frailer patients due to strict inclusion criteria, meaning there is limited evidence to guide which patients are most likely to benefit from palliative chemotherapy. Inappropriate chemotherapy administration is at odds with the goals of palliative treatment and care, which are to improve quality of life, and this also represents a significant resource expenditure. This literature review aimed to examine and appraise evidence regarding treatment resilience in order to guide clinicians in identifying the most suitable candidates for palliative chemotherapy. Factors influencing treatment resilience were assessed, as measured by completion rates, dose reductions, and toxicities. Methods: This literature review was conducted using rapid review methodology, utilising modified systematic methods. A literature search was performed across the MEDLINE, EMBASE, and Cochrane Library databases, with results limited to papers within the last 15 years and available in English. Key inclusion criteria included: 1) participants with either oesophageal, gastro-oesophageal junction, or gastric cancers; 2) patients treated with palliative chemotherapy; 3) available data evaluating the association between baseline participant characteristics and treatment resilience. Results: Of the 2326 papers returned, 11 reports of 10 studies were included in this review after excluding duplicates and irrelevant papers. Treatment resilience factors that were assessed included: age, performance status, frailty, inflammatory markers, and sarcopenia. Age was generally a poor predictor for how well patients would tolerate chemotherapy, while poor performance status was a better indicator of the need for dose reduction and treatment non-completion. Frailty was assessed across one cohort using multiple screening tools and was an effective marker of the risk of toxicity and the requirement for dose reduction. Inflammatory markers included lymphopenia and the Glasgow Prognostic Score, which assessed inflammation and hypoalbuminaemia. Although quick to obtain and interpret, these findings appeared less reliable due to the inclusion of patients treated with palliative radiotherapy. Sarcopenia and body composition were often associated with chemotherapy toxicity but not the rate of regimen completion. Conclusion: This review demonstrates that there are numerous measures that can estimate the ability of patients with oesophago-gastric cancer to tolerate palliative chemotherapy, and these should be incorporated into clinical assessments to promote personalised decision-making around treatment. Age should not be a barrier to receiving chemotherapy and older and frailer patients should be included in future clinical trials to better represent typical patients with oesophago-gastric cancers. Decisions regarding palliative treatment should be guided by these factors identified as well as patient preference.

Keywords: frailty, oesophago-gastric cancer, palliative chemotherapy, treatment resilience

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Authors: Ying-Hsiang Ho, Hsiao-Tseng Lin

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Mudan Township is a remote mountainous area in Taiwan. In recent years, due to the migration of the population, inconvenient transportation, digital divide, and low production, agricultural products marketing have become a major issue. This research aims to develop the marketing strategy suitable for the agricultural products of the rural areas. The main objective of this work is to conduct in-depth interviews with scholars and experts in the marketing field, combined with the marketing 4P combination, to analyze and summarize the possible marketing strategies for agricultural products for remote districts. The interviews consist of seven experts from industry who have practical experience in producing, marketing, and selling agricultural products and three professors that have experience in teaching marketing management. The in-depth interviews are conducted for about an hour using a pre-drafted interview outline. The results of the interviews are summarized by semantic analysis and presented in a marketing 4P combination. The results indicate that in terms of products, high-quality products with original characteristics can be added through the implementation of production history, organic certification, and cultural packaging. In the place part, we found that the use of emerging communities, the emphasis on cross-industry alliances, the improvement of information application capabilities of rural households, production and marketing group, and contractual farming system are the development priorities. In terms of promotion, it should be an emphasis on the management of internet social media and word-of-mouth marketing. Mudan Township may consider promoting agricultural products through special festivals such as farmer's market, wild ginger flower season and hot spring season. This research also proposes relevant recommendations for the government's public sector and related industry reference for the promotion of agricultural products for remote area.

Keywords: marketing strategy, remote districts, agricultural products, in-depth interviews

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Authors: Abeer Alhazmi

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Introduction: Clinical education is considered a significant part of the learning process for nurses and nursing students. However, recruiting high- caliber individuals to train them to be tomorrow’s educators/teachers has been a recurrent challenge. One of the troubling challenges in this field is the absent of proper training programmes to train educators to be future education professionals and leaders. Aim: To explore the impact of a stage 1 and stage 2 clinical instructor courses on developing leadership skills for nurses as educators.Theoretical Framework: Informed by a symbolic interactionist framework, this research explored the Impact of stage 1 and stage 2 clinical instructor courses on nurses' knowledge, attitudes, and leadership skills. Method: Using Glaserian grounded theory method the data were derived from 3 focus groups and 15 in-depth interviews with nurse educators/clinical instructors and nurses who attended stage 1 and stage 2 clinical instructor courses at King Abdu-Aziz University Hospital (KAUH). Findings: The findings of the research are represented in the core category exploring new identity as educator and its two constituent categories Accepting change, and constructing educator identity. The core and sub- categories were generated through a theoretical exploration of the development of educator’s identity throughout stage 1 and stage 2 clinical instructor courses. Conclusion: The social identity of the nurse educators was developed and changed during and after attending stage 1 and stage 2 clinical instructor courses. In light of an increased understanding of the development process of educators identity and role, the research presents implications and recommendations that may contribute to the development of nursing educators in general and in Saudi Arabia in specific.

Keywords: clinical instructor course, educators, identity work, clinical nursing

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