Search results for: non-linear measure

Authors: I. Witbooi, J. De Smidt, A. Oelofse

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Negative emotions that are common in depression are coupled with the activation of the corrugator supercilli and procerus muscles in the glabellar region of the face. This research investigated the impact of OnabotulinumtoxinA (BOTOX) in the improvement of emotional states in depressed subjects by relaxing the mentioned muscles. The aim of the study was to investigate the effectiveness of BOTOX treatment for glabellar frown lines as an adjunctive therapy for Major Depressive Disorder (MDD) and to improve the quality of life and self-esteem of the subjects. It is hypothesized that BOTOX treatment for glabellar frown lines reduces depressive symptoms significantly and therefore augment conventional antidepressant medication. Forty-five (45) subjects diagnosed with MDD were assigned to a treatment (n = 15), placebo (n = 15), and control (n = 15) group. The treatment group received BOTOX injection, while the placebo group received saline injection into the Procerus and Corrugator supercilli muscles with follow-up visits every 3 weeks (weeks 3, 6 and 12 respectively). The control group received neither BOTOX nor saline injections and were only interviewed again on the 12th week. To evaluate the effect of BOTOX treatment in the glabellar region on depressive symptoms, the Montgomery-Asberg Depression Rating (MADRS) scale and the Beck Depression Inventory (BDI) were used. The Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF) and Rosenberg Self-Esteem Scale (RSES) were used in the assessment of self-esteem and quality of life. Participants were followed up for a 12 week period. The expected primary outcome measure is the response to treatment, and it is defined as a ≥ 50% reduction in MADRS score from baseline. Other outcome measures include a clinically significant decrease in BDI scores and the increase in quality of life and self-esteem respectively. Initial results show a clear trend towards such differences. Results showed trends towards expected differences. Patients in the Botox group had a mean MADRS score of 14.0 at 3 weeks compared to 20.3 of the placebo group. This trend was still visible at 6 weeks with the Botox and placebo group scoring an average of 10 vs. 18 respectively. The mean difference in MDRS scores from baseline to 3 weeks were 9.3 and 2.0 for the Botox and placebo group respectively. Similarly, the BDI scores were lower in the Botox group (17.25) compared to the placebo group (19.43). The two self-esteem questionnaires showed expected results at this stage with the RSES 19.1 in the Botox group compared to 18.6 in the placebo group. Similarly, the Botox patients had a higher score for the Q-LES-Q-SF of 49.2 compared to 46.1 for the placebo group. Conclusions: Initial results clearly demonstrated that the use of Botox had positive effects on both scores of depressions and that of self-esteem when compared to a placebo group.

Keywords: adjunctive therapy, depression, glabellar area, OnabotulinumtoxinA

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Authors: Charles Mazhazhate

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This study interrogates and analyses the intricate kin- and- kith network patterns of corruption and mismanagement of resources prevalent in public sector supply chains bedeviling the developing economies of Sub-Saharan Africa with particular reference to Zimbabwe. This is forcing governments to resort to harsh fiscal policies that see their citizens paying high taxes against a backdrop of incomes below the poverty datum line, and this negatively affects their quality of life. The corporate world is also affected by the various tax-regime instituted. Mismanagement of resources and corrupt practices are rampant in state-owned enterprises to the extent that institutional policies, procedures, and practices are often flouted for the benefit of a clique of individuals. This interwoven in kith and kin blood human relations in organizations where appointments to critical positions are based on ascribed status. People no longer place value in their systems to make them work thereby violating corporate governance principles. Greediness and ‘unholy friendship connections’ are instrumental in fueling the employment of people who know each other from their discrete backgrounds. Such employments or socio-metric unions are meant to protect those at the top by giving them intelligent information through spying on what other subordinates are doing inside and outside the organization. This practice has led to the underperforming of organizations as those employees with connections and their upper echelons favorites connive to abuse resources for their own benefit. Even if culprits are known, no draconian measures are employed as a deterrence measure. Public value along public sector supply chains is lost. The study used a descriptive case study research design on fifty organizations in Zimbabwe mainly state-owned enterprises. Both qualitative and quantitative instrumentations were used. Both Snowball and random sampling techniques were used. The study found out that in all the fifty SOEs, there were employees in key positions related to top management, with tentacles feeding into the law enforcement agents, judiciary, security systems, and the executive. Such employees in public seem not to know each other with but would be involved in dirty scams and then share the proceeds with top people behind the scenes. The study also established that the same employees do not have the necessary competencies, qualifications, abilities, and capabilities to be in those positions. This culture is now strong that it is difficult to bust. The study recommends recruitment of all employees through an independent employment bureau to ensure strategic fit.

Keywords: corruption, state owned enterprises, strategic fit, public sector supply chains, efficiency

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Authors: Mariana L. de Araújo, Pedro P. M. Menezes

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Research on strategic human resource management (SHRM) has made progress in the last few decades, showing a relationship between policies and practices of human resource management (HRM) and improving organizational results. That's because demonstrating the effectiveness of any HRM or other organizational practice, which means the extent that this can operate as a tool to achieve organizational performance, is a complex and arduous task to execute. Even today, there isn't consensus about "effectiveness," and the tools to measure the effectiveness are disconnected and not convincing. It is not different from the performance management system (PMS) effectiveness. A disproportionate focus on specific criteria adopted and an accumulation of studies that don't relate to the others, which damages the development of the field. Therefore, it aimed to evaluate the effectiveness of the PMS through models, dimensions, criteria, and measures. The objective of this study is to propose a theoretical-integrative model for evaluating PMS based on the literature in the PMS field. So, the PRISMA protocol was applied to carry out a systematic review, resulting in 57 studies. After performing the content analysis, we identified six dimensions: learning, societal impact, reaction, financial results, operational results and transfer, and 22 categories. In this way, a theoretical-integrative model for assessing the effectiveness of PMS was proposed based on the findings of this study, in which it was possible to confirm that the effectiveness construct is somewhat complex when viewing that most of the reviewed studies considered multiple dimensions in their assessment. In addition, we identified that the most immediate and proximal results of PMS are the most adopted by the studies; conversely, the studies adopted less distal outcomes to assess the effectiveness of PMS. Another finding of this research is that the reviewed studies predominantly analyze from the individual or psychological perspective, even when it comes to criteria whose phenomena are at an organizational level. Therefore, this study converges with a trend recently identified when referring to a process of "psychologization" in which GP studies, in general, have demonstrated macro results of the GP system from an individual perspective. Therefore, given the identification of a methodological pattern, the predominant influence of individual and psychological aspects in studies on HRM in administration is highlighted, demonstrated by the reflection on the practically absolute way of measuring the effectiveness of PMS from perceptual and subjective measures. Therefore, based on the recognition of the patterns identified, the model proposed to promote studies on the subject more broadly and profoundly to broaden and deepen the perspective of the field of management's interests so that the evaluation of the effectiveness of PMS can promote inputs on the impact of the PMS system in organizational performance. Finally, the findings encourage reflections on assessing the effectiveness of PMS through the theoretical-integrative model developed so that the field can promote new theoretical and practical perspectives.

Keywords: performance management, strategic human resource management, effectiveness, organizational performance

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Authors: Dhouha Laribi Galalou, Najla Allani Bouhoula, Atef Hammouda

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This research delves into the fundamental question of the morphological restitution of built archaeology in order to place it in its paradigmatic context and to seek answers to it. Indeed, the understanding of the object of the study, its analysis, and the methodology of solving the morphological problem posed, are manageable aspects only by means of a thoughtful strategy that draws on well-defined epistemological scaffolding. In this stream, the crisis of natural reasoning in archaeology has generated multiple changes in this field, ranging from the use of new tools to the integration of an archaeological information system where urbanization involves the interplay of several disciplines. The built archaeological topic is also an architectural and morphological object. It is also a set of articulated elementary data, the understanding of which is about to be approached from a logicist point of view. Morphological restitution is no exception to the rule, and the inter-exchange between the different disciplines uses the capacity of each to frame the reflection on the incomplete elements of a given architecture or on its different phases and multiple states of existence. The logicist sequence is furnished by the set of scattered or destroyed elements found, but also by what can be called a rule base which contains the set of rules for the architectural construction of the object. The knowledge base built from the archaeological literature also provides a reference that enters into the game of searching for forms and articulations. The choice of the Roman Forum in North Africa is justified by the great urban and architectural characteristics of this entity. The research on the forum involves both a fairly large knowledge base but also provides the researcher with material to study - from a morphological and architectural point of view - starting from the scale of the city down to the architectural detail. The experimentation of the knowledge deduced on the paradigmatic level, as well as the deduction of an analysis model, is then carried out on the basis of a well-defined context which contextualises the experimentation from the elaboration of the morphological information container attached to the rule base and the knowledge base. The use of logicist analysis and artificial intelligence has allowed us to first question the aspects already known in order to measure the credibility of our system, which remains above all a decision support tool for the morphological restitution of Roman Fora in North Africa. This paper presents a first experimentation of the model elaborated during this research, a model framed by a paradigmatic discussion and thus trying to position the research in relation to the existing paradigmatic and experimental knowledge on the issue.

Keywords: classical reasoning, logicist reasoning, archaeology, architecture, roman forum, morphology, calculation

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Authors: Habib Alshuwaikhat, Nahid Hossain

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Residential sector consumes more than half of the produced electricity in Saudi Arabia, and fossil fuel is the main source of energy to meet growing household electricity demand in the Kingdom. Several studies forecasted and expressed concern that unless the domestic energy demand growth is controlled, it will reduce Saudi Arabia’s crude oil export capacity within a decade and the Kingdom is likely to be incapable of exporting crude oil within next three decades. Though the Saudi government has initiated to address the domestic energy demand growth issue, the demand side energy management policies and programs are focused on industrial and commercial sectors. It is apparent that there is an urgent need to develop a comprehensive energy efficiency strategy for addressing efficient energy use in residential sector in the Kingdom. Then again as Saudi Arabia is at its primary stage in addressing energy efficiency issues in its residential sector, there is a scope for the Kingdom to learn from global energy efficiency practices and design its own energy efficiency policies and programs. However, in order to do that sustainable, it is essential to address local contexts of energy efficiency. It is also necessary to find out the policies and programs that will fit to the local contexts. Thus the objective of this study was set to identify globally best practice energy efficiency policies and programs in residential sector that have replication potential in Saudi Arabia. In this regard two sets of multi-criteria decision analysis matrices were developed to evaluate the energy efficiency policies and programs. The first matrix was used to evaluate the global energy efficiency policies and programs, and the second matrix was used to evaluate the replication potential of global best practice energy efficiency policies and programs for Saudi Arabia. Wuppertal Institute’s guidelines for energy efficiency policy evaluation were used to develop the matrices, and the different attributes of the matrices were set through available literature review. The study reveals that the best practice energy efficiency policies and programs with good replication potential for Saudi Arabia are those which have multiple components to address energy efficiency and are diversified in their characteristics. The study also indicates the more diversified components are included in a policy and program, the more replication potential it has for the Kingdom. This finding is consistent with other studies, where it is observed that in order to be successful in energy efficiency practices, it is required to introduce multiple policy components in a cluster rather than concentrate on a single policy measure. The developed multi-criteria decision analysis matrices for energy efficiency policy and program evaluation could be utilized to assess the replication potential of other globally best practice energy efficiency policies and programs for the residential sector of the Kingdom. In addition it has potential to guide Saudi policy makers to adopt and formulate its own energy efficiency policies and programs for Saudi Arabia.

Keywords: Saudi Arabia, residential sector, energy efficiency, policy evaluation

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Authors: Jesus Salmeron, Carmen De Vega, Maria Soledad Vicente, Mireia Olabarria, Olaia Martinez

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Dysphagia or difficulty in swallowing affects mostly elder people: 56-78% of the institutionalized and 44% of the hospitalized. Liquid food thickening is a necessary measure in this situation because it reduces the risk of penetration-aspiration. Until now, and as proposed by the American Dietetic Association in 2002, possible consistencies have been categorized in three groups attending to their viscosity: nectar (50-350 mPa•s), honey (350-1750 mPa•s) and pudding (>1750 mPa•s). The adequate viscosity level should be identified for every patient, according to her/his impairment. Nevertheless, a systematic review on dysphagia diet performed recently indicated that there is no evidence to suggest that there is any transition of clinical relevance between the three levels proposed. It was also stated that other physical properties of the bolus (slipperiness, density or cohesiveness, among others) could influence swallowing in affected patients and could contribute to the amount of remaining residue. Texture parameters need to be evaluated as possible alternative to viscosity. The aim of this study was to evaluate the instrumental extrusion-compression test as a possible tool to characterize changes along time in water thickened with various products and in the three theoretical consistencies. Six commercial thickeners were used: NM® (NM), Multi-thick® (M), Nutilis Powder® (Nut), Resource® (R), Thick&Easy® (TE) and Vegenat® (V). All of them with a modified starch base. Only one of them, Nut, also had a 6,4% of gum (guar, tara and xanthan). They were prepared as indicated in the instructions of each product and dispensing the correspondent amount for nectar, honey and pudding consistencies in 300 mL of tap water at 18ºC-20ºC. The mixture was stirred for about 30 s. Once it was homogeneously spread, it was dispensed in 30 mL plastic glasses; always to the same height. Each of these glasses was used as a measuring point. Viscosity was measured using a rotational viscometer (ST-2001, Selecta, Barcelona). Extrusion-compression test was performed using a TA.XT2i texture analyzer (Stable Micro Systems, UK) with a 25 mm diameter cylindrical probe (SMSP/25). Penetration distance was set at 10 mm and a speed of 3 mm/s. Measurements were made at 1, 5, 10, 20, 30, 40, 50 and 60 minutes from the moment samples were mixed. From the force (g)–time (s) curves obtained in the instrumental assays, maximum force peak (F) was chosen a reference parameter. Viscosity (mPa•s) and F (g) showed to be highly correlated and had similar development along time, following time-dependent quadratic models. It was possible to predict viscosity using F as an independent variable, as they were linearly correlated. In conclusion, compression-extrusion test could be an alternative and a useful tool to assess physical characteristics of thickened liquids.

Keywords: compression-extrusion test, dysphagia, texture analyzer, thickener

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Authors: Hooriya Sadr Dadras, Shiva Seyed Erfani

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Speaking skills merit meticulous attention both on the side of the learners and the teachers. In particular, accuracy is a critical component to guarantee the messages to be conveyed through conversation because a wrongful change may adversely alter the content and purpose of the talk. Different types of tasks have served teachers to meet numerous educational objectives. Besides, negotiation of meaning and the use of different strategies have been areas of concern in socio-cultural theories of SLA. Negotiation of meaning is among the conversational processes which have a crucial role in facilitating the understanding and expression of meaning in a given second language. Conversational strategies are used during interaction when there is a breakdown in communication that leads to the interlocutor attempting to remedy the gap through talk. Therefore, this study was an attempt to investigate if there was any significant difference between the effect of reasoning gap tasks and information gap tasks on the frequency of conversational strategies used in negotiation of meaning in classrooms on one hand, and on the accuracy in speaking of Iranian intermediate EFL learners on the other. After a pilot study to check the practicality of the treatments, at the outset of the main study, the Preliminary English Test was administered to ensure the homogeneity of 87 out of 107 participants who attended the intact classes of a 15 session term in one control and two experimental groups. Also, speaking sections of PET were used as pretest and posttest to examine their speaking accuracy. The tests were recorded and transcribed to estimate the percentage of the number of the clauses with no grammatical errors in the total produced clauses to measure the speaking accuracy. In all groups, the grammatical points of accuracy were instructed and the use of conversational strategies was practiced. Then, different kinds of reasoning gap tasks (matchmaking, deciding on the course of action, and working out a time table) and information gap tasks (restoring an incomplete chart, spot the differences, arranging sentences into stories, and guessing game) were manipulated in experimental groups during treatment sessions, and the students were required to practice conversational strategies when doing speaking tasks. The conversations throughout the terms were recorded and transcribed to count the frequency of the conversational strategies used in all groups. The results of statistical analysis demonstrated that applying both the reasoning gap tasks and information gap tasks significantly affected the frequency of conversational strategies through negotiation. In the face of the improvements, the reasoning gap tasks had a more significant impact on encouraging the negotiation of meaning and increasing the number of conversational frequencies every session. The findings also indicated both task types could help learners significantly improve their speaking accuracy. Here, applying the reasoning gap tasks was more effective than the information gap tasks in improving the level of learners’ speaking accuracy.

Keywords: accuracy in speaking, conversational strategies, information gap tasks, reasoning gap tasks

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Authors: Audia Syafa'atur Rahman, Rozali Haron

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The practices of Islamic banking are more attuned to the goals of profit maximization rather than obtaining ethical profit. Ethical profit is obtained from interest-free earnings and to give an impact which benefits to the growth of society and economy. Good corporate governance practices are needed to assure the sustainability of Islamic banks in order to achieve Maqasid Shariah with the main purpose of boosting the well-being of people. The Maqasid Shariah performance measurement is used to measure the duties and responsibilities expected to be performed by Islamic banks. It covers not only unification dimension like financial measurement, but also many dimensions covered to reflect the main purpose of Islamic banks. The implementation of good corporate governance is essential because it covers the interests of the stakeholders and facilitates effective monitoring to encourage Islamic banks to utilize resources more efficiently in order to achieve the Maqasid Shariah. This study aims to provide the empirical evidence on the Maqasid performance of Islamic banks in relation to the Maqasid performance evaluation model, to examine the influence of SSB characteristics and board structures to Islamic Banks performance as measured by Maqasid performance evaluation model. By employing the simple additive weighting method, Maqasid index for all the Islamic Banks in Indonesia within 2012 to 2016 ranged from above 11% to 28%. The Maqasid Syariah performance index where results reached above 20% are obtained by Islamic Banks such as Bank Muamalat Indonesia, Bank Panin Syariah, and Bank BRI Syariah. The consistent achievement above 23% is achieved by BMI. Other Islamic Banks such as Bank Victoria Syariah, Bank Jabar Banten Syariah, Bank BNI Syariah, Bank Mega Syariah, BCA Syariah, and Maybank Syariah Indonesia shows a fluctuating value of the Maqasid performance index every year. The impact of SSB characteristics and board structures are tested using random-effects generalized least square. The findings indicate that SSB characteristics (Shariah Supervisory Board size, Shariah Supervisory Board cross membership, Shariah Supervisory Board Education, and Shariah Supervisory Board reputation) and board structures (Board size and Board independence) have an essential role in improving the performance of Islamic Banks. The findings denote Shariah Supervisory Board with smaller size, higher portion of Shariah Supervisory Board cross membership; lesser Shariah Supervisory Board holds doctorate degree, lesser reputable scholar, more members on board of directors, and less independence non-executive directors will enhance the performance of Islamic Banks.

Keywords: Maqasid Shariah, corporate governance, Islamic banks, Shariah supervisory board

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Authors: Lana Damaj, Vincent Laur, Azar Maalouf, Alexis Chevalier

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Matched termination is an important part of the passive waveguide components. It is typically used at the end of a waveguide transmission line to prevent reflections and improve signal quality. Waveguide terminations (loads) are commonly used in microwave and RF applications. In traditional microwave architectures, usually, waveguide termination consists of a standard rectangular waveguide made by a lossy resistive material, and ended by shorting metallic plate. These types of terminations are used, to dissipate the energy as heat. However, these terminations may increase the size and the weight of the overall system. New alternative solution consists in developing terminations based on 3D-printing of materials. Designing such terminations is very challenging since it should meet the requirements imposed by the system. These requirements include many parameters such as the absorption, the power handling capability in addition to the cost, the size and the weight that have to be minimized. 3D-printing is a shaping process that enables the production of complex geometries. It allows to find best compromise between requirements. In this paper, a comparison study has been made between different existing and new shapes of waveguide terminations. Indeed, 3D printing of absorbers makes it possible to study not only standard shapes (wedge, pyramid, tongue) but also more complex topologies such as exponential ones. These shapes have been designed and simulated using CST MWS®. The loads have been printed using the carbon-filled PolyLactic Acid, conductive PLA from ProtoPasta. Since the terminations has been characterized in the X-band (from 8GHz to 12GHz), the rectangular waveguide standard WR-90 has been selected. The classical wedge shape has been used as a reference. First, all loads have been simulated with the same length and two parameters have been compared: the absorption level (level of |S11|) and the dissipated power density. This study shows that the concave exponential pyramidal shape has the better absorption level and the convex exponential pyramidal shape has the better dissipated power density level. These two loads have been printed in order to measure their properties. A good agreement between the simulated and measured reflection coefficient has been obtained. Furthermore, a study of material structuring based on the honeycomb hexagonal structure has been investigated in order to vary the effective properties. In the final paper, the detailed methodology and the simulated and measured results will be presented in order to show how 3D-printing can allow controlling mass, weight, absorption level and power behaviour.

Keywords: additive manufacturing, electromagnetic composite materials, microwave measurements, passive components, power handling capacity (PHC), 3D-printing

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Authors: Marlin Mubarak

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Background: Endometriosis is a complex disabling disease affecting young females in the reproductive period mainly. The aim of this project is to generate a diagnostic model to predict severity and stage of endometriosis prior to Laparoscopic surgery. This will help to improve the pre-operative diagnostic accuracy of stage 3 & 4 endometriosis and as a result, refer relevant women to a specialist centre for complex Laparoscopic surgery. The model is based on the British Society of Gynaecological Endoscopy (BSGE) pain questionnaire, clinical examination and ultrasound scan. Design: This is a prospective, observational, study, in which women completed the BSGE pain questionnaire, a BSGE requirement. Also, as part of the routine preoperative assessment patient had a routine ultrasound scan and when recto-vaginal and deep infiltrating endometriosis was suspected an MRI was performed. Setting: Luton & Dunstable University Hospital. Patients: Symptomatic women (n = 56) scheduled for laparoscopy due to pelvic pain. The age ranged between 17 – 52 years of age (mean 33.8 years, SD 8.7 years). Interventions: None outside the recognised and established endometriosis centre protocol set up by BSGE. Main Outcome Measure(s): Sensitivity and specificity of endometriosis diagnosis predicted by symptoms based on BSGE pain questionnaire, clinical examinations and imaging. Findings: The prevalence of diagnosed endometriosis was calculated to be 76.8% and the prevalence of advanced stage was 55.4%. Deep infiltrating endometriosis in various locations was diagnosed in 32/56 women (57.1%) and some had DIE involving several locations. Logistic regression analysis was performed on 36 clinical variables to create a simple clinical prediction model. After creating the scoring system using variables with P < 0.05, the model was applied to the whole dataset. The sensitivity was 83.87% and specificity 96%. The positive likelihood ratio was 20.97 and the negative likelihood ratio was 0.17, indicating that the model has a good predictive value and could be useful in predicting advanced stage endometriosis. Conclusions: This is a hypothesis-generating project with one operator, but future proposed research would provide validation of the model and establish its usefulness in the general setting. Predictive tools based on such model could help organise the appropriate investigation in clinical practice, reduce risks associated with surgery and improve outcome. It could be of value for future research to standardise the assessment of women presenting with pelvic pain. The model needs further testing in a general setting to assess if the initial results are reproducible.

Keywords: deep endometriosis, endometriosis, minimally invasive, MRI, ultrasound.

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Authors: Chia-Ching Sun, Li-Yin Chien, Chun-Ting Hsiao

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Background: Appropriate gestation weight gain benefits pregnant women and their children; however, excessive weight gain could raise the risk of adverse health outcomes and chronicle diseases. Nevertheless, there is currently limited evidence on the effect of physical activities on pregnant women’s gestational weight gain. Purpose: This study aimed to explore the correlation between the level of physical activity and gestation weight gain during the second and third trimester of pregnancy. Methods: This longitudinal study enrolled 800 healthy pregnant women aged over 20 from six hospitals in northern Taiwan. Structured questionnaires were used to collect data twice for each participant during 14-27 and 28-40 weeks of gestation. Variables included demographic data, maternal health history, and lifestyle. The International Physical Activity Questionnaire-short form was used to measure the level of physical activity from walking and of moderate-intensity and vigorous-intensity before and during pregnancy. Weight recorded at prenatal checkups were used to calculate average weight gain in each trimester of pregnancy. T-tests, ANOVA, chi-squared tests, and multivariable logistic regression models were applied to determine the predicting factors for weight gain during the second and third trimester. Result: Participants who had achieved recommended physical activity level (150 minutes of moderate physical activity or 75 minutes of vigorous physical activity a week) before pregnancy (aOR=1.85, 95% CI=1.27-2.67) or who achieved recommended walking level (150 minutes a week) during the second trimester of pregnancy (aOR=1.43, 95% CI= 1.00-2.04) gained significantly more weight during the second trimester. Compared with those who did not reach recommended level of moderate-intensity physical activity (150 minutes a week), women who had reached that during the second trimester were more likely to be in the less than recommended weight gain group than in the recommended weight gain group (aOR=2.06, CI=1.06-4.00). However, there was no significant correlation between physical activity level and weight gain in the third trimester. Other predicting factors of excessive weight gain included education level which showed a negative correlation (aOR=0.38, CI=0.17-0.88), whereas overweight and obesity before pregnancy showed a positive correlation (OR=3.97, CI=1.23-12.78). Conclusions/implications for practice: Participants who had achieved recommended physical activity level before pregnancy significantly reduced exercise during pregnancy and gained excessive weight during the second trimester. However, women who engaged in the practice of physical activity as recommended could effectively control weight gain in the third trimester. Healthcare professionals could suggest that pregnant women who exercise maintain their pre-pregnancy level of physical activity, given activities requiring physical contact or causing falls are avoided. For those who do not exercise, health professionals should encourage them to gradually increase the level of physical activity. Health promotion strategies related to weight control and physical activity level achievement should be given to women before pregnancy.

Keywords: pregnant woman, physical activity, gestation weight gain, obesity, overweight

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Authors: Mehdi Janbaz

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The global financial crisis and the credit crunch that followed magnified the importance of credit risk management and its crucial role in the stability of all financial sectors and the whole of the system. Many believe that risks faced by the sovereign sector are highly interconnected with banking risks and most likely to trigger and reinforce each other. This study aims to examine (1) the impact of banking and interbank risk factors on the sovereign credit risk of Eurozone, and (2) how the EU Credit Default Swaps spreads dynamics are affected by the Crude Oil price fluctuations. The hypothesizes are tested by employing fitting risk measures and through a four-staged linear modeling approach. The sovereign senior 5-year Credit Default Swap spreads are used as a core measure of the credit risk. The monthly time-series data of the variables used in the study are gathered from the DataStream database for a period of 2008-2019. First, a linear model test the impact of regional macroeconomic and market-based factors (STOXX, VSTOXX, Oil, Sovereign Debt, and Slope) on the CDS spreads dynamics. Second, the bank-specific factors, including LIBOR-OIS spread (the difference between the Euro 3-month LIBOR rate and Euro 3-month overnight index swap rates) and Euribor, are added to the most significant factors of the previous model. Third, the global financial factors including EURO to USD Foreign Exchange Volatility, TED spread (the difference between 3-month T-bill and the 3-month LIBOR rate based in US dollars), and Chicago Board Options Exchange (CBOE) Crude Oil Volatility Index are added to the major significant factors of the first two models. Finally, a model is generated by a combination of the major factor of each variable set in addition to the crisis dummy. The findings show that (1) the explanatory power of LIBOR-OIS on the sovereign CDS spread of Eurozone is very significant, and (2) there is a meaningful adverse co-movement between the Crude Oil price and CDS price of Eurozone. Surprisingly, adding TED spread (the difference between the three-month Treasury bill and the three-month LIBOR based in US dollars.) to the analysis and beside the LIBOR-OIS spread (the difference between the Euro 3M LIBOR and Euro 3M OIS) in third and fourth models has been increased the predicting power of LIBOR-OIS. Based on the results, LIBOR-OIS, Stoxx, TED spread, Slope, Oil price, OVX, FX volatility, and Euribor are the determinants of CDS spreads dynamics in Eurozone. Moreover, the positive impact of the crisis period on the creditworthiness of the Eurozone is meaningful.

Keywords: CDS, crude oil, interbank risk, LIBOR-OIS, OVX, sovereign credit risk, TED

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Authors: Michelle Rippy

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Medicolegal death investigation historically is a field that does not receive much research attention or advancement, as all of the subjects are deceased. Public health threats, drug epidemics and contagious diseases are typically recognized in decedents first, with thorough and accurate death investigations able to assist in epidemiology research and prevention programs. One vital component of medicolegal death investigation is determining the decedent’s time of death. An accurate time of death can assist in corroborating alibies, determining sequence of death in multiple casualty circumstances and provide vital facts in civil situations. Popular television portrays an unrealistic forensic ability to provide the exact time of death to the minute for someone found deceased with no witnesses present. The actuality of unattended decedent time of death determination can generally only be narrowed to a 4-6 hour window. In the mid- to late-20th century, liver temperatures were an invasive action taken by death investigators to determine the decedent’s core temperature. The core temperature was programmed into an equation to determine an approximate time of death. Due to many inconsistencies with the placement of the thermometer and other variables, the accuracy of the liver temperatures was dispelled and this once common place action lost scientific support. Currently, medicolegal death investigators utilize three major after death or post-mortem changes at a death scene. Many factors are considered in the subjective determination as to the time of death, including the cooling of the decedent, stiffness of the muscles, release of blood internally, clothing, ambient temperature, disease and recent exercise. Current research is utilizing non-invasive hospital grade tympanic thermometers to measure the temperature in the each of the decedent’s ears. This tool can be used at the scene and in conjunction with scene indicators may provide a more accurate time of death. The research is significant and important to investigations and can provide an area of accuracy to a historically inaccurate area, considerably improving criminal and civil death investigations. The goal of the research is to provide a scientific basis to unwitnessed deaths, instead of the art that the determination currently is. The research is currently in progress with expected termination in December 2018. There are currently 15 completed case studies with vital information including the ambient temperature, decedent height/weight/sex/age, layers of clothing, found position, if medical intervention occurred and if the death was witnessed. This data will be analyzed with the multiple variables studied and available for presentation in January 2019.

Keywords: algor mortis, forensic pathology, investigations, medicolegal, time of death, tympanic

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Authors: Mareen Brosterhaus, Antje Hammer, Steffen Kalina, Stefan Grau, Anjali A. Roeth, Hany Ashmawy, Thomas Gross, Marcel Binnebosel, Wolfram T. Knoefel, Tanja Manser

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Background: The identification of critical incidents in hospitals is an essential component of improving patient safety. To date, various methods have been used to measure and characterize such critical incidents. These methods are often viewed by physicians and nurses as external quality assurance, and this creates obstacles to the reporting events and the implementation of recommendations in practice. One way to overcome this problem is to use tools that directly involve staff in measuring indicators of quality and safety of care in the department. One such instrument is the global trigger tool (GTT), which helps physicians and nurses identify adverse events by systematically reviewing randomly selected patient records. Based on so-called ‘triggers’ (warning signals), indications of adverse events can be given. While the tool is already used internationally, its implementation in German hospitals has been very limited. Objectives: This study aimed to assess the feasibility and potential of the global trigger tool for identifying adverse events in German hospitals. Methods: A total of 120 patient records were randomly selected from two surgical, and one neurosurgery, departments of three university hospitals in Germany over a period of two months per department between January and July, 2017. The records were reviewed using an adaptation of the German version of the Institute for Healthcare Improvement Global Trigger Tool to identify triggers and adverse event rates per 1000 patient days and per 100 admissions. The severity of adverse events was classified using the National Coordinating Council for Medication Error Reporting and Prevention. Results: A total of 53 adverse events were detected in the three departments. This corresponded to adverse event rates of 25.5-72.1 per 1000 patient-days and from 25.0 to 60.0 per 100 admissions across the three departments. 98.1% of identified adverse events were associated with non-permanent harm without (Category E–71.7%) or with (Category F–26.4%) the need for prolonged hospitalization. One adverse event (1.9%) was associated with potentially permanent harm to the patient. We also identified practical challenges in the implementation of the tool, such as the need for adaptation of the global trigger tool to the respective department. Conclusions: The global trigger tool is feasible and an effective instrument for quality measurement when adapted to the departmental specifics. Based on our experience, we recommend a continuous use of the tool thereby directly involving clinicians in quality improvement.

Keywords: adverse events, global trigger tool, patient safety, record review

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Authors: Dorit Alt, Nirit Raichel

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Educational practice is continually subjected to renewal needs, due mainly to the growing proportion of information communication technology, globalization of education, and the pursuit of quality. These types of renewal needs require developing updated instructional and assessment practices that put a premium on adaptability to the emerging requirements of present society. However, university instruction is criticized for not coping with these new challenges while continuing to exemplify the traditional instruction. In order to overcome this critical inadequacy between current educational goals and instructional methods, the LLAF consortium (including 16 members from 8 countries) is collaborating to create a curricular reform for lifelong learning (LLL) in teachers' education, health care and other applied fields. This project aims to achieve its objectives by developing, and piloting models for training students in LLL and promoting meaningful learning activities that could integrate knowledge with the personal transferable skills. LLAF has created a practical guide for teachers containing updated pedagogical strategies and assessment tools based on the constructivist approach for learning. This presentation will be limited to teachers' education only and to the contribution of a pre-pilot research aimed at providing a scale designed to measure constructivist activities in higher education learning environments. A mix-method approach was implemented in two phases to construct the scale: The first phase included a qualitative content analysis involving both deductive and inductive category applications of students' observations. The results foregrounded eight categories: knowledge construction, authenticity, multiple perspectives, prior knowledge, in-depth learning, teacher- student interaction, social interaction and cooperative dialogue. The students' descriptions of their classes were formulated as 36 items. The second phase employed structural equation modeling (SEM). The scale was submitted to 597 undergraduate students. The goodness of fit of the data to the structural model yielded sufficient fit results. This research elaborates the body of literature by adding a category of in-depth learning which emerged from the content analysis. Moreover, the theoretical category of social activity has been extended to include two distinctive factors: cooperative dialogue and social interaction. Implications of these findings for the LLAF project are discussed.

Keywords: constructivist learning, higher education, mix-methodology, lifelong learning

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Authors: Scott Snyder

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Grading approaches in higher education have not changed meaningfully in over 100 years. While there is variation in the types of grades assigned across countries, most use approaches based on simple ordinal scales (e.g, letter grades). While grades are generally viewed as an indication of a student's performance, challenges arise regarding the clarity, validity, and reliability of letter grades. Research about grading in higher education has primarily focused on grade inflation, student attitudes toward grading, impacts of grades, and benefits of plus-minus letter grade systems. Little research is available about alternative approaches to grading, varying approaches used by faculty within and across colleges, and faculty attitudes toward grades and alternative approaches to grading. To begin to address these gaps, a survey was conducted of faculty in a sample of departments at three diverse colleges in a southeastern state in the US. The survey focused on faculty experiences with and attitudes toward grading, the degree to which faculty innovate in teaching and grading practices, and faculty interest in alternatives to the point system approach to grading. Responses were received from 104 instructors (21% response rate). The majority reported that teaching accounted for 50% or more of their academic duties. Almost all (92%) of respondents reported using point and percentage systems for their grading. While all respondents agreed that grades should reflect the degree to which objectives were mastered, half indicated that grades should also reflect effort or improvement. Over 60% felt that grades should be predictive of success in subsequent courses or real life applications. Most respondents disagreed that grades should compare students to other students. About 42% worried about their own grade inflation and grade inflation in their college. Only 17% disagreed that grades mean different things based on the instructor while 75% thought it would be good if there was agreement. Less than 50% of respondents felt that grades were directly useful for identifying students who should/should not continue, identify strengths/weaknesses, predict which students will be most successful, or contribute to program monitoring of student progress. Instructors were less willing to modify assessment than they were to modify instruction and curriculum. Most respondents (76%) were interested in learning about alternative approaches to grading (e.g., specifications grading). The factors that were most associated with willingness to adopt a new grading approach were clarity to students and simplicity of adoption of the approach. Follow-up studies are underway to investigate implementations of alternative grading approaches, expand the study to universities and departments not involved in the initial study, examine student attitudes about alternative approaches, and refine the measure of attitude toward adoption of alternative grading practices within the survey. Workshops about challenges of using percentage and point systems for determining grades and workshops regarding alternative approaches to grading are being offered.

Keywords: alternative approaches to grading, grades, higher education, letter grades

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Authors: Shagufta Riaz, Ayesha Younus, Munir Ashraf, Tanveer Hussain

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Aesthetic and performance are two most important considerations along with quality, durability, comfort and cost that affect the garment credibility. Fabric drape is perhaps the most important clothing characteristics that distinguishes fabric from the sheet, paper, steel or other film materials. It enables the fabric to mold itself under its own weight into desired and required shape when only part of it is directly sustained. The fabric has the ability to be crumpled charmingly in bent folds of single or double curvature due to its drapeability to produce a smooth flowing i.e. ‘the sinusoidal-type folds of a curtain or skirt’. Drape and seam strength are two parameters that are considered for aesthetic and performance of fabric for both apparel and home textiles. Until recently, no such study have been conducted in which effect of weave designs on drape and seam strength of fabric and garment is inspected. Therefore, the aim of this study was to measure seam strength and drape of fabric and garment objectively by changing weave designs and quality of the fabric. Also, the comparison of 2-D drape and 3-D drape was done to find whether a fabric behaves in same manner or differently when sewn and worn on the body. Four different cotton weave designs were developed and pr-treatment was done. 2-D Drape of the fabric was measured by drapemeter attached with digital camera and a supporting disc to hang the specimen on it. Drape coefficient value (DC %) has negative relation with drape. It is the ratio of draped sample’s projected shadow area to the area of undraped (flat) sample expressed as percentage. Similarly, 3-D drape was measured by hanging the A-line skirts for developed weave designs. BS 3356 standard test method was followed for bending length examination. It is related to the angle that the fabric makes with its horizontal axis. Seam strength was determined by following ASTM test standard. For sewn fabric, stitch density of seam was found by magnifying glass according to standard ASTM test method. In this research study, from the experimentation and evaluation it was investigated that drape and seam strength were significantly affected by change of weave design and quality of fabric (PPI & yarn count). Drapeability increased as the number of interlacement or contact point deceased between warp and weft yarns. As the weight of fabric, bending length, and density of fabric had indirect relationship with drapeability. We had concluded that 2-D drape was higher than 3-D drape even though the garment was made of the same fabric construction. Seam breakage strength decreased with decrease in picks density and yarn count.

Keywords: drape coefficient, fabric, seam strength, weave

Procedia PDF Downloads 264

Authors: Crystal Hoole

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Employee well-being has become an area of concern for top executives and organizations worldwide. In developing countries such as South Africa, and especially in the educational sector, employees have to deal with anxiety, stress, fear, student protests, political and economic turmoil and excessive work demands on a daily basis. Research has shown that workplaces with higher resilience and better well-being strategies also report higher productivity, increased innovation, better employee retention and better employee engagement. Many organisations offer standard employee assistance programs and once-off short interventions. However, most of these well-being initiatives are perceived as ineffective. Some of the criticism centers around a lack of holistic well-being approaches, no proof of the success of well-being initiatives, not being part of the organization’s strategies and a lack of genuine leadership support. This study attempts to illustrate how a holistic well-being intervention, over a period of 100 days, is far more effective in impacting organizational outcomes. A quasi-experimental design, with a pre-test and pro-test design with a randomization strategy, will be used. Measurements of organizational outcomes are taken at three-time points throughout the study, before, middle and after. The constructs that will be measured are employee engagement, psychological well-being, organizational culture and trust, and perceived stress. The well-being is imitative follows a salutogenesis approach and is aimed at building resilience through focusing on six focal areas, namely sleep, mindful eating, exercise, love, gratitude and appreciation, breath work and mindfulness, and finally, purpose. Certain organizational constructs, including employee engagement, psychological well-being, organizational culture and trust and perceived stress, will be measured at three-time points during the study, namely before, middle and after. A quasi-experimental, pre-test and post-test design will be applied, also using a randomization strategy to limit potential bias. Repeated measure ANCOVA will be used to determine whether any change occurred over the period of 100 days. The study will take place in a Higher Education institution in South Africa. The sample will consist of academic and administrative staff. Participants will be assigned to a test and control group. All participants will complete a survey measuring employee engagement, psychological well-being, organizational culture and trust, and perceived stress. Only the test group will undergo the well-being intervention. The study envisages contributing on several levels: Firstly, the study hopes to find a positive increase in the various well-being indicators of the participants who participated in the study and secondly to illustrate that a longer more holistic approach is successful in improving organisational success (as measured in the various organizational outcomes).

Keywords: wellbeing, resilience, organizational success, intervention

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Authors: Khadija Al-Hosni, Moon Fai Chan, Mohammed Al-Azri

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Background: Several studies suggest that most school-age adolescents are poorly informed on cancer warning signs and risk factors. Providing adolescents with sufficient knowledge would increase their awareness in adulthood and improve seeking behaviors later. Significant: The results will provide a clear vision in assisting key decision-makers in formulating policies on the students' awareness programs towards cancer. So, the likelihood of avoiding cancer in the future will be increased or even promote early diagnosis. Objectives: to evaluate the effectiveness of an education program designed to increase awareness of cancer signs and symptoms risk factors, improve the behavior of seeking help among school students in Oman, and address the barriers to obtaining medical help. Methods: A randomized controlled trial with two groups was conducted in Oman. A total of 1716 students (n=886/control, n= 830/education), aged 15-17 years, at 10th and 11th grade from 12 governmental schools 3 in governorates from 20-February-2022 to 12-May-2022. Basic demographic data were collected, and the Cancer Awareness Measure (CAM) was used as the primary outcome. Data were collected at baseline (T0) and 4 weeks after (T1). The intervention group received an education program about cancer's cause and its signs and symptoms. In contrast, the control group did not receive any education related to this issue during the study period. Non-parametric tests were used to compare the outcomes between groups. Results: At T0, the lamp was the most recognized cancer warning sign in control (55.0%) and intervention (55.2%) groups. However, there were no significant changes at T1 for all signs in the control group. In contrast, all sign outcomes were improved significantly (p<0.001) in the intervention group, the highest response was unexplained pain (93.3%). Smoking was the most recognized risk factor in both groups: (82.8% for control; 84.1% for intervention) at T0. However, there was no significant change in T1 for the control group, but there was for the intervention group (p<0.001), the highest identification was smoking cigarettes (96.5%). Too scared was the largest barrier to seeking medical help by students in the control group at T0 (63.0%) and T1 (62.8%). However, there were no significant changes in all barriers in this group. Otherwise, being too embarrassed (60.2%) was the largest barrier to seeking medical help for students in the intervention group at T0 and too scared (58.6%) at T1. Although there were reductions in all barriers, significant differences were found in six of ten only (p<0.001). Conclusion: The intervention was effective in improving students' awareness of cancer symptoms, warning signs (p<0.001), and risk factors (p<0.001 reduced the most addressed barriers to seeking medical help (p<0.001) in comparison to the control group. The Ministry of Education in Oman could integrate awareness of cancer within the curriculum, and more interventions are needed on the sociological part to overcome the barriers that interfere with seeking medical help.

Keywords: adolescents, awareness, cancer, education, intervention, student

Procedia PDF Downloads 87

Authors: Ramesh Chinnasamy, Srishti Semalty, Vishnu S. Nair, Thirumurugan Vedagiri, Mahesh Ganeshan, Gautam Talukdar, Karthy Sivapushanam, Abhijit Das

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Snakes form an integral component of ecological systems. Human population explosion and associated acceleration of habitat destruction and degradation, has led to a rapid increase in human-snake encounters. The study aims at understanding the level of awareness, knowledge, and attitude of the people towards human-snake negative interaction and role of awareness programmes in the Moyar river valley, Tamil Nadu. The study area is part of the Mudumalai and the Sathyamangalam Tiger Reserves, which are significant wildlife corridors between the Western Ghats and the Eastern Ghats in the Nilgiri Biosphere Reserve. The data was collected using questionnaire covering 644 respondents spread across 18 villages between 2018 and 2019. The study revealed that 86.5% of respondents had strong negative perceptions towards snakes which were propelled by fear, superstitions, and threat of snakebite which was common and did not vary among different villages (F=4.48; p = <0.05) and age groups (X2 = 1.946; p = 0.962). Cobra 27.8% (n = 294) and rat snake 21.3% (n = 225) were the most sighted species and most snake encounter occurred during the monsoon season i.e., July 35.6 (n = 218), June 19.1% (n = 117) and August 18.4% (n = 113). At least 1 out of 5 respondents was reportedly bitten by snakes during their lifetime. The most common species of snakes that were the cause of snakebite were Saw scaled viper (32.6%, n = 42) followed by Cobra 17.1% (n = 22). About 21.3% (n = 137) people reported livestock loss due to pythons and other snakes 21.3% (n = 137). Most people, preferred medical treatment for snakebite (87.3%), whereas 12.7%, still believed in traditional methods. The majority (82.3%) used precautionary measure by keeping traditional items such as garlic, kerosene, and snake plant to avoid snakes. About 30% of the respondents expressed need for technical and monetary support from the forest department that could aid in reducing the human-snake conflict. It is concluded that the general perception in the study area is driven by fear and negative attitude towards snakes. Though snakes such as Cobra were widely worshiped in the region, there are still widespread myths and misconceptions that have led to the irrational killing of snakes. Awareness and innovative education programs rooted in the local context and language should be integrated at the village level, to minimize risk and the associated threat of snakebite among the people. Results from this study shall help policy makers to devise appropriate conservation measures to reduce human-snake conflicts in India.

Keywords: Envenomation, Health-Education, Human-Wildlife Conflict, Neglected Tropical Disease, Snakebite Mitigation, Traditional Practitioners

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Authors: J. Fox, J. Randhawa, M. Chan, L. Campbell, A. Weakely, D. J. Harvey, S. Tomaszewski Farias

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Early identification of individuals at risk for conversion to dementia provides an opportunity for preventative treatment. Many older adults (30-60%) report specific subjective cognitive decline (SCD); however, previous research is inconsistent in terms of what types of complaints predict future cognitive decline. The purpose of this study is to identify which specific complaints from the Everyday Cognition Scales (ECog) scales, a measure of self-reported concerns for everyday abilities across six cognitive domains, are associated with: 1) conversion from a clinical diagnosis of normal to either MCI or dementia (categorical variable) and 2) progressive cognitive decline in memory and executive function (continuous variables). 415 cognitively normal older adults were monitored annually for an average of 5 years. Cox proportional hazards models were used to assess associations between self-reported ECog items and progression to impairment (MCI or dementia). A total of 114 individuals progressed to impairment; the mean time to progression was 4.9 years (SD=3.4 years, range=0.8-13.8). Follow-up models were run controlling for depression. A subset of individuals (n=352) underwent repeat cognitive assessments for an average of 5.3 years. For those individuals, mixed effects models with random intercepts and slopes were used to assess associations between ECog items and change in neuropsychological measures of episodic memory or executive function. Prior to controlling for depression, subjective concerns on five of the eight Everyday Memory items, three of the nine Everyday Language items, one of the seven Everyday Visuospatial items, two of the five Everyday Planning items, and one of the six Everyday Organization items were associated with subsequent diagnostic conversion (HR=1.25 to 1.59, p=0.003 to 0.03). However, after controlling for depression, only two specific complaints of remembering appointments, meetings, and engagements and understanding spoken directions and instructions were associated with subsequent diagnostic conversion. Episodic memory in individuals reporting no concern on ECog items did not significantly change over time (p>0.4). More complaints on seven of the eight Everyday Memory items, three of the nine Everyday Language items, and three of the seven Everyday Visuospatial items were associated with a decline in episodic memory (Interaction estimate=-0.055 to 0.001, p=0.003 to 0.04). Executive function in those reporting no concern on ECog items declined slightly (p <0.001 to 0.06). More complaints on three of the eight Everyday Memory items and three of the nine Everyday Language items were associated with a decline in executive function (Interaction estimate=-0.021 to -0.012, p=0.002 to 0.04). These findings suggest that specific complaints across several cognitive domains are associated with diagnostic conversion. Specific complaints in the domains of Everyday Memory and Language are associated with a decline in both episodic memory and executive function. Increased monitoring and treatment of individuals with these specific SCD may be warranted.

Keywords: alzheimer’s disease, dementia, memory complaints, mild cognitive impairment, risk factors, subjective cognitive decline

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Authors: Dercan Gencbas, Hatice Bebis, Sue Moorhead

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In the nursing process, many of the nursing classification systems were created to be used in international. From these, NANDA-I, Nursing Outcomes Classification (NOC) and Nursing Interventions Classification (NIC). In this direction, the main objective of this study is to establish a model for caregivers in hospitals and communities in Turkey and to ensure that nursing outputs are assessed by NOC-based measures. There are many scales to measure Urinary Incontinence (UI), which is very common in children, in old age, vaginal birth, NOC scales are ideal for use in the nursing process for comprehensive and holistic assessment, with surveys available. For this reason, the purpose of this study is to evaluate the validity of the NOC outputs and indicators used for UI NANDA-I. This research is a methodological study. In addition to the validity of scale indicators in the study, how much they will contribute to recovery after the nursing intervention was assessed by experts. Scope validations have been applied and calculated according to Fehring 1987 work model. According to this, nursing inclusion criteria and scores were determined. For example, if experts have at least four years of clinical experience, their score was 4 points or have at least one year of the nursing classification system, their score was 1 point. The experts were a publication experience about nursing classification, their score was 1 point, or have a doctoral degree in nursing, their score was 2 points. If the expert has a master degree, their score was 1 point. Total of 55 experts rated Fehring as a “senior degree” with a score of 90 according to the expert scoring. The nursing interventions to be applied were asked to what extent these indicators would contribute to recovery. For coverage validity tailored to Fehring's model, each NOC and NOC indicator from specialists was asked to score between 1-5. Score for the significance of indicators was from 1=no precaution to 5=very important. After the expert opinion, these weighted scores obtained for each NOC and NOC indicator were classified as 0.8 critical, 0.8 > 0.5 complements, > 0.5 are excluded. In the NANDA-I / NOC / NIC system (guideline), 5 NOCs proposed for nursing diagnoses for UI were proposed. These outputs are; Urinary Continence, Urinary Elimination, Tissue Integrity, Self CareToileting, Medication Response. After the scales are translated into Turkish, the weighted average of the scores obtained from specialists for the coverage of all 5 NOCs and the contribution of nursing initiatives exceeded 0.8. After the opinions of the experts, 79 of the 82 indicators were calculated as critical, 3 of the indicators were calculated as supplemental. Because of 0.5 > was not obtained, no substance was removed. All NOC outputs were identified as valid and usable scales in Turkey. In this study, five NOC outcomes were verified for the evaluation of the output of individuals who have received nursing knowledge of UI and variant types. Nurses in Turkey can benefit from the outputs of the NOC scale to perform the care of the elderly incontinence.

Keywords: nursing outcomes, content validity, nursing diagnosis, urinary incontinence

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Authors: Sylvie Michel, Sylvie Gerbaix, Marc Bidan

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The COVID-19 pandemic has been a major and global disruption that has affected all supply chains on a worldwide scale. Consequently, the question posed by this communication is to understand how - in the face of such disruptions - supply chains, including their actors, management tools, and processes, react, survive, adapt, and even improve. To do so, the concepts of resilience and antifragility applied to a supply chain have been leveraged. This article proposes to perceive resilience as a step to surpass in moving towards antifragility. The research objective is to propose an analytical framework to measure and compare resilience and antifragility, with antifragility seen as a property of a system that improves when subjected to disruptions rather than merely resisting these disruptions, as is the case with resilience. A unique case study was studied - MSF logistics (France) - using a qualitative methodology. Semi-structured interviews were conducted in person and remotely in multiple phases: during and immediately after the COVID crisis (8 interviews from March 2020 to April 2021), followed by a new round from September to November 2023. A Delphi method was employed. The interviews were analyzed using coding and a thematic framework. One of the theoretical contributions is consolidating the field of supply chain resilience research by precisely characterizing the dimensions of resilience for a humanitarian supply chain (Reorganization, Collaboration mediated by IS, Humanitarian culture). In this regard, a managerial contribution of this study is providing a guide for managers to identify the four dimensions and sub-dimensions of supply chain resilience. This enables managers to focus their decisions and actions on dimensions that will enhance resilience. Most importantly, another contribution is comparing the concepts of resilience and antifragility and proposing an analytical framework for antifragility—namely, the mechanisms on which MSF logistics relied to capitalize on uncertainties, contingencies, and shocks rather than simply enduring them. For MSF Logistics, antifragility manifested through the ability to identify opportunities hidden behind the uncertainties and shocks of COVID-19, reducing vulnerability, and fostering a culture that encourages innovation and the testing of new ideas. Logistics, particularly in the humanitarian domain, must be able to adapt to environmental disruptions. In this sense, this study identifies and characterizes the dimensions of resilience implemented by humanitarian logistics. Moreover, this research goes beyond the concept of resilience to propose an analytical framework for the concept of antifragility. The organization studied emerged stronger from the COVID-19 crisis due to the mechanisms we identified, allowing us to characterize antifragility. Finally, the results show that the information system plays a key role in antifragility.

Keywords: antifragility, humanitarian supply chain, information systems, qualitative research, resilience.

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Authors: Prashant Neupane, Asmi Pandey, Mumna Ehsan, Katie Davies, Richard Lowsby

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Introduction/Background & aims: Safe and effective prescribing in hospitals, directly and indirectly, impacts the health of the patients. Even though digital prescribing in the National Health Service (NHS), UK has been used in lots of tertiary centers along with district general hospitals, a significant number of NHS trusts are still using paper prescribing. We came across lots of irregularities in our daily clinical practice when we are doing paper prescribing. The main aim of the study was to assess how safely and effectively are we prescribing at our hospital where there is no access to digital prescribing. Method/Summary of work: We conducted a prospective audit in the critical care department at Mid Cheshire Hopsitals NHS Foundation Trust in which 20 prescription charts from different patients were randomly selected over a period of 1 month. We assessed 16 multiple categories from each prescription chart and compared them to the standard trust guidelines on prescription. Results/Discussion: We collected data from 20 different prescription charts. 16 categories were evaluated within each prescription chart. The results showed there was an urgent need for improvement in 8 different sections. In 85% of the prescription chart, all the prescribers who prescribed the medications were not identified. Name, GMC number and signature were absent in the required prescriber identification section of the prescription chart. In 70% of prescription charts, either indication or review date of the antimicrobials was absent. Units of medication were not documented correctly in 65% and the allergic status of the patient was absent in 30% of the charts. The start date of medications was missing and alternations of the medications were not done properly in 35%of charts. The patient's name was not recorded in all desired sections of the chart in 50% of cases and cancellations of the medication were not done properly in 45% of the prescription charts. Conclusion(s): From the audit and data analysis, we assessed the areas in which we needed improvement in prescription writing in the Critical care department. However, during the meetings and conversations with the experts from the pharmacy department, we realized this audit is just a representation of the specialized department of the hospital where access to prescribing is limited to a certain number of prescribers. But if we consider bigger departments of the hospital where patient turnover is much more, the results could be much worse. The findings were discussed in the Critical care MDT meeting where suggestions regarding digital/electronic prescribing were discussed. A poster and presentation regarding safe and effective prescribing were done, awareness poster was prepared and attached alongside every bedside in critical care where it is visible to prescribers. We consider this as a temporary measure to improve the quality of prescribing, however, we strongly believe digital prescribing will help to a greater extent to control weak areas which are seen in paper prescribing.

Keywords: safe prescribing, NHS, digital prescribing, prescription chart

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Authors: Keiko Tamura, Munenari Inoguchi, Michiyo Tsuji

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When disasters occur, in order to raise the speed of each decision making and response, it is common that delegation of authority is carried out. This tendency is particularly evident when the department or branch of the organization are separated by the physical distance from the main body; however, there are some issues to think about. If the department or branch is too dependent on the head office in the usual condition, they might feel lost in the disaster response operation when they are face to the situation. Avoiding this problem, an organization should decide how to delegate the authority and also who accept the responsibility for what before the disaster. This paper will discuss about the method which presents an approach for executing the delegation of authority process, implementing authorities, management by objectives, and preparedness plans and agreement. The paper will introduce the examples of efforts for the three research centers of Niigata University, Japan to arrange organizations capable of taking necessary actions for disaster response. Each center has a quality all its own. One is the center for carrying out the research in order to conserve the crested ibis (or Toki birds in Japanese), the endangered species. The another is the marine biological laboratory. The third one is very unique because of the old growth forests maintained as the experimental field. Those research centers are in the Sado Island, located off the coast of Niigata Prefecture, is Japan's second largest island after Okinawa and is known for possessing a rich history and culture. It takes 65 minutes jetfoil (high-speed ferry) ride to get to Sado Island from the mainland. The three centers are expected to be easily isolated at the time of a disaster. A sense of urgency encourages 3 centers in the process of organizational restructuring for enhancing resilience. The research team from the risk management headquarters offer those procedures; Step 1: Offer the hazard scenario based on the scientific evidence, Step 2: Design a risk management organization for disaster response function, Step 3: Conduct the participatory approach to make consensus about the overarching objectives, Step 4: Construct the unified operational action plan for 3 centers, Step 5: Simulate how to respond in each phase based on the understanding the various phases of the timeline of a disaster. Step 6: Document results to measure performance and facilitate corrective action. This paper shows the result of verifying the output and effects.

Keywords: delegation of authority, disaster response, risk management, unified command

Procedia PDF Downloads 126

Authors: Man-Yu Wong, Siyu Zhou, Zhiqiang Cao

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In quality of life, health service utilization is an important determinant of medical resource expenditures on Colorectal cancer (CRC) care, a better understanding of the increased utilization of health services is essential for optimizing the allocation of healthcare resources to services and thus for enhancing the service quality, especially for high expenditure on CRC care like Hong Kong region. In assessing the association between the health-related quality of life (HRQOL) and health service utilization in patients with colorectal neoplasm, count data models can be used, which account for over dispersion or extra zero counts. In our data, the HRQOL evaluation is a self-reported measure obtained from a questionnaire completed by the patients, misreports and variations in the data are inevitable. Besides, there are more zero counts from the observed number of clinical consultations (observed frequency of zero counts = 206) than those from a Poisson distribution with mean equal to 1.33 (expected frequency of zero counts = 156). This suggests that excess of zero counts may exist. Therefore, we study tests for detecting zero-inflation in models with measurement error in covariates. Method: Under classical measurement error model, the approximate likelihood function for zero-inflation Poisson regression model can be obtained, then Approximate Maximum Likelihood Estimation(AMLE) can be derived accordingly, which is consistent and asymptotically normally distributed. By calculating score function and Fisher information based on AMLE, a score test is proposed to detect zero-inflation effect in ZIP model with measurement error. The proposed test follows asymptotically standard normal distribution under H0, and it is consistent with the test proposed for zero-inflation effect when there is no measurement error. Results: Simulation results show that empirical power of our proposed test is the highest among existing tests for zero-inflation in ZIP model with measurement error. In real data analysis, with or without considering measurement error in covariates, existing tests, and our proposed test all imply H0 should be rejected with P-value less than 0.001, i.e., zero-inflation effect is very significant, ZIP model is superior to Poisson model for analyzing this data. However, if measurement error in covariates is not considered, only one covariate is significant; if measurement error in covariates is considered, only another covariate is significant. Moreover, the direction of coefficient estimations for these two covariates is different in ZIP regression model with or without considering measurement error. Conclusion: In our study, compared to Poisson model, ZIP model should be chosen when assessing the association between condition-specific HRQOL and health service utilization in patients with colorectal neoplasm. and models taking measurement error into account will result in statistically more reliable and precise information.

Keywords: count data, measurement error, score test, zero inflation

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Authors: Saman Ahani, Aboozar Dehghan, Roham Vali, Hamid Salehian, Amin Ebrahimi

Abstract:

Pulsed-wave (PW) doppler ultrasonography is a non-invasive, relatively accurate imaging technique that can measure blood speed. The imaging could be obtained via the common carotid artery, as one of the main vessels supplying the blood of vital organs. In horses, factors such as susceptibility to depression of the cardiovascular system and their large muscular mass have rendered them vulnerable to changes in blood speed. One of the most important factors causing blood velocity changes is the administration of anesthetic drugs, including Ketamine and Acepromazine. Thus, in this study, the Pulsed-wave doppler technique was performed to assess the highest blood velocity in the common carotid artery following administration of Ketamine and Acepromazine. Six male and six female healthy Kurdish horses weighing 351 ± 46 kg (mean ± SD) and aged 9.2 ± 1.7 years (mean ± SD) were housed under animal welfare guidelines. After fasting for six hours, the normal blood flow velocity in the common carotid artery was measured using a Pulsed-wave doppler ultrasonography machine (BK Medical, Denmark), and a high-frequency linear transducer (12 MHz) without applying any sedative drugs as a control group. The same procedure was repeated after each individual received the following medications: 1.1, 2.2 mg/kg Ketamine (Pfizer, USA), and 0.5, 1 mg/kg Acepromizine (RACEHORSE MEDS, Ukraine), with an interval of 21 days between the administration of each dose and/or drug. The ultrasonographic study was done five (T5) and fifteen (T15) minutes after injecting each dose intravenously. Lastly, the statistical analysis was performed using SPSS software version 22 for Windows and a P value less than 0.05 was considered to be statistically significant. Five minutes after administration of Ketamine (1.1, 2.2 mg/kg) in both male and female horses, the blood velocity decreased to 38.44, 34.53 cm/s in males, and 39.06, 34.10 cm/s in females in comparison to the control group (39.59 and 40.39 cm/s in males and females respectively) while administration of 0.5 mg/kg Acepromazine led to a significant rise (73.15 and 55.80 cm/s in males and females respectively) (p<0.05). It means that the most drastic change in blood velocity, regardless of gender, refers to the latter dose/drug. In both medications and both genders, the increase in doses led to a decrease in blood velocity compared to the lower dose of the same drug. In all experiments in this study, the blood velocity approached its normal value at T15. In another study comparing the blood velocity changes affected by Ketamine and Acepromazine through femoral arteries, the most drastic changes were attributed to Ketamine; however, in this experiment, the maximum blood velocity was observed following administration of Acepromazine via the common carotid artery. Therefore, further experiments using the same medications are suggested using Pulsed-wave doppler measuring the blood velocity changes in both femoral and common carotid arteries simultaneously.

Keywords: Acepromazine, common carotid artery, horse, ketamine, pulsed-wave doppler ultrasonography

Procedia PDF Downloads 128

Authors: Junior Akunzi

Abstract:

In the matter of patient treatment planning quality assurance in 3D conformational therapy (3D-CRT) and volumetric arc therapy (VMAT or RapidArc), the independent monitor unit verification calculation (MUVC) is an indispensable part of the process. Concerning 3D-CRT treatment planning, the MUVC can be performed manually applying the standard ESTRO formalism. However, due to the complex shape and the amount of beams in advanced treatment planning technic such as RapidArc, the manual independent MUVC is inadequate. Therefore, commercially available software such as RadCalc can be used to perform the MUVC in complex treatment planning been. Indeed, RadCalc (version 6.3 LifeLine Inc.) uses a simplified Clarkson algorithm to compute the dose contribution for individual RapidArc fields to the isocenter. The purpose of this project is the validation of RadCalc in 3D-CRT and RapidArc for treatment planning dosimetry quality assurance at Antoine Lacassagne center (Nice, France). Firstly, the interfaces between RadCalc and our treatment planning systems (TPS) Isogray (version 4.2) and Eclipse (version13.6) were checked for data transfer accuracy. Secondly, we created test plans in both Isogray and Eclipse featuring open fields, wedges fields, and irregular MLC fields. These test plans were transferred from TPSs according to the radiotherapy protocol of DICOM RT to RadCalc and the linac via Mosaiq (version 2.5). Measurements were performed in water phantom using a PTW cylindrical semiflex ionisation chamber (0.3 cm³, 31010) and compared with the TPSs and RadCalc calculation. Finally, 30 3D-CRT plans and 40 RapidArc plans created with patients CT scan were recalculated using the CT scan of a solid PMMA water equivalent phantom for 3D-CRT and the Octavius II phantom (PTW) CT scan for RapidArc. Next, we measure the doses delivered into these phantoms for each plan with a 0.3 cm³ PTW 31010 cylindrical semiflex ionisation chamber (3D-CRT) and 0.015 cm³ PTW PinPoint ionisation chamber (Rapidarc). For our test plans, good agreements were found between calculation (RadCalc and TPSs) and measurement (mean: 1.3%; standard deviation: ± 0.8%). Regarding the patient plans, the measured doses were compared to the calculation in RadCalc and in our TPSs. Moreover, RadCalc calculations were compared to Isogray and Eclispse ones. Agreements better than (2.8%; ± 1.2%) were found between RadCalc and TPSs. As for the comparison between calculation and measurement the agreement for all of our plans was better than (2.3%; ± 1.1%). The independent MU verification calculation software RadCal has been validated for clinical use and for both 3D-CRT and RapidArc techniques. The perspective of this project includes the validation of RadCal for the Tomotherapy machine installed at centre Antoine Lacassagne.

Keywords: 3D conformational radiotherapy, intensity modulated radiotherapy, monitor unit calculation, dosimetry quality assurance

Procedia PDF Downloads 216

Authors: Jie Liu, Jinqu Cheng, Qiyuan Peng, Yong Yin

Abstract:

Urban rail transit (URT) plays a significant role in dealing with traffic congestion and environmental problems in cities. However, equipment failure and obstruction of links often lead to URT links’ capacities loss in daily operation. It affects the reliability and transport service quality of URT network seriously. In order to measure the influence of links’ capacities loss on reliability and transport service quality of URT network, passengers are divided into three categories in case of links’ capacities loss. Passengers in category 1 are less affected by the loss of links’ capacities. Their travel is reliable since their travel quality is not significantly reduced. Passengers in category 2 are affected by the loss of links’ capacities heavily. Their travel is not reliable since their travel quality is reduced seriously. However, passengers in category 2 still can travel on URT. Passengers in category 3 can not travel on URT because their travel paths’ passenger flow exceeds capacities. Their travel is not reliable. Thus, the proportion of passengers in category 1 whose travel is reliable is defined as reliability indicator of URT network. The transport service quality of URT network is related to passengers’ travel time, passengers’ transfer times and whether seats are available to passengers. The generalized travel cost is a comprehensive reflection of travel time, transfer times and travel comfort. Therefore, passengers’ average generalized travel cost is used as transport service quality indicator of URT network. The impact of links’ capacities loss on transport service quality of URT network is measured with passengers’ relative average generalized travel cost with and without links’ capacities loss. The proportion of the passengers affected by links and betweenness of links are used to determine the important links in URT network. The stochastic user equilibrium distribution model based on the improved logit model is used to determine passengers’ categories and calculate passengers’ generalized travel cost in case of links’ capacities loss, which is solved with method of successive weighted averages algorithm. The reliability and transport service quality indicators of URT network are calculated with the solution result. Taking Wuhan Metro as a case, the reliability and transport service quality of Wuhan metro network is measured with indicators and method proposed in this paper. The result shows that using the proportion of the passengers affected by links can identify important links effectively which have great influence on reliability and transport service quality of URT network; The important links are mostly connected to transfer stations and the passenger flow of important links is high; With the increase of number of failure links and the proportion of capacity loss, the reliability of the network keeps decreasing, the proportion of passengers in category 3 keeps increasing and the proportion of passengers in category 2 increases at first and then decreases; When the number of failure links and the proportion of capacity loss increased to a certain level, the decline of transport service quality is weakened.

Keywords: urban rail transit network, reliability, transport service quality, links’ capacities loss, important links

Procedia PDF Downloads 128

Authors: Cindy Sithole, Didier Nyembwe, Peter Olubambi

Abstract:

The sand casting process involves pattern making, mould making, metal pouring and shake out. Every step in the sand moulding process is very critical for production of good quality castings. However, waste generated during the sand moulding operation and lack of quality are matters that influences performance inefficiencies and lack of competitiveness in South African foundries. Defects produced from the sand moulding process are only visible in the final product (casting) which results in increased number of scrap, reduced sales and increases cost in the foundry. The purpose of this Research is to propose six sigma technique (DMAIC, Define, Measure, Analyze, Improve and Control) intervention in sand moulding foundries and to reduce variation caused by deficiencies in the sand moulding process in South African foundries. Its objective is to create sustainability and enhance productivity in the South African foundry industry. Six sigma is a data driven method to process improvement that aims to eliminate variation in business processes using statistical control methods .Six sigma focuses on business performance improvement through quality initiative using the seven basic tools of quality by Ishikawa. The objectives of six sigma are to eliminate features that affects productivity, profit and meeting customers’ demands. Six sigma has become one of the most important tools/techniques for attaining competitive advantage. Competitive advantage for sand casting foundries in South Africa means improved plant maintenance processes, improved product quality and proper utilization of resources especially scarce resources. Defects such as sand inclusion, Flashes and sand burn on were some of the defects that were identified as resulting from the sand moulding process inefficiencies using six sigma technique. The courses were we found to be wrong design of the mould due to the pattern used and poor ramming of the moulding sand in a foundry. Six sigma tools such as the voice of customer, the Fishbone, the voice of the process and process mapping were used to define the problem in the foundry and to outline the critical to quality elements. The SIPOC (Supplier Input Process Output Customer) Diagram was also employed to ensure that the material and process parameters were achieved to ensure quality improvement in a foundry. The process capability of the sand moulding process was measured to understand the current performance to enable improvement. The Expected results of this research are; reduced sand moulding process variation, increased productivity and competitive advantage.

Keywords: defects, foundries, quality improvement, sand moulding, six sigma (DMAIC)

Procedia PDF Downloads 195