Search results for: airway segmentation
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 515

Search results for: airway segmentation

95 Commercial Automobile Insurance: A Practical Approach of the Generalized Additive Model

Authors: Nicolas Plamondon, Stuart Atkinson, Shuzi Zhou

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The insurance industry is usually not the first topic one has in mind when thinking about applications of data science. However, the use of data science in the finance and insurance industry is growing quickly for several reasons, including an abundance of reliable customer data, ferocious competition requiring more accurate pricing, etc. Among the top use cases of data science, we find pricing optimization, customer segmentation, customer risk assessment, fraud detection, marketing, and triage analytics. The objective of this paper is to present an application of the generalized additive model (GAM) on a commercial automobile insurance product: an individually rated commercial automobile. These are vehicles used for commercial purposes, but for which there is not enough volume to apply pricing to several vehicles at the same time. The GAM model was selected as an improvement over GLM for its ease of use and its wide range of applications. The model was trained using the largest split of the data to determine model parameters. The remaining part of the data was used as testing data to verify the quality of the modeling activity. We used the Gini coefficient to evaluate the performance of the model. For long-term monitoring, commonly used metrics such as RMSE and MAE will be used. Another topic of interest in the insurance industry is to process of producing the model. We will discuss at a high level the interactions between the different teams with an insurance company that needs to work together to produce a model and then monitor the performance of the model over time. Moreover, we will discuss the regulations in place in the insurance industry. Finally, we will discuss the maintenance of the model and the fact that new data does not come constantly and that some metrics can take a long time to become meaningful.

Keywords: insurance, data science, modeling, monitoring, regulation, processes

Procedia PDF Downloads 56
94 Recognising and Managing Haematoma Following Thyroid Surgery: Simulation Teaching is Effective

Authors: Emily Moore, Dora Amos, Tracy Ellimah, Natasha Parrott

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Postoperative haematoma is a well-recognised complication of thyroid surgery with an incidence of 1-5%. Haematoma formation causes progressive airway obstruction, necessitating emergency bedside haematoma evacuation in up to ¼ of patients. ENT UK, BAETS and DAS have developed consensus guidelines to improve perioperative care, recommending that all healthcare staff interacting with patients undergoing thyroid surgery should be trained in managing post-thyroidectomy haematoma. The aim was to assess the effectiveness of a hybrid simulation model in improving clinician’s confidence in dealing with this surgical emergency. A hybrid simulation was designed, consisting of a standardised patient wearing a part-task trainer to mimic a post-thyroidectomy haematoma in a real patient. The part-task trainer was an adapted C-spine collar with layers of silicone representing the skin and strap muscles and thickened jelly representing the haematoma. Both the skin and strap muscle layers had to be opened in order to evacuate the haematoma. Boxes have been implemented into the appropriate post operative areas (recovery and surgical wards), which contain a printed algorithm designed to assist in remembering a sequence of steps for haematoma evacuation using the ‘SCOOP’ method (skin exposure, cut sutures, open skin, open muscles, pack wound) along with all the necessary equipment to open the front of the neck. Small-group teaching sessions were delivered by ENT and anaesthetic trainees to members of the multidisciplinary team normally involved in perioperative patient care, which included ENT surgeons, anaesthetists, recovery nurses, HCAs and ODPs. The DESATS acronym of signs and symptoms to recognise (difficulty swallowing, EWS score, swelling, anxiety, tachycardia, stridor) was highlighted. Then participants took part in the hybrid simulation in order to practice this ‘SCOOP’ method of haematoma evacuation. Participants were surveyed using a Likert scale to assess their level of confidence pre- and post teaching session. 30 clinicians took part. Confidence (agreed/strongly agreed) in recognition of post thyroidectomy haematoma improved from 58.6% to 96.5%. Confidence in management improved from 27.5% to 89.7%. All participants successfully decompressed the haematoma. All participants agreed/strongly agreed, that the sessions were useful for their learning. Multidisciplinary team simulation teaching is effective at significantly improving confidence in both the recognition and management of postoperative haematoma. Hybrid simulation sessions are useful and should be incorporated into training for clinicians.

Keywords: thyroid surgery, haematoma, teaching, hybrid simulation

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93 Study of Growth Patterns of the Built-Up Area in Tourism Destinations in Relation to Sustainable Development

Authors: Tagore Sai Priya Nunna, Ankhi Banerjee

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The rapid growth of the tourism industry in India in the last few years after the economic crisis in 2009 has been one of the significant causes that led to the Land Use Land Cover change (LULC) of most tourism destinations. The tourist regions are subjected to significant increase in built-up due to increased construction activities for developing accommodation facilities further boosting tourism demand. This research attempts to analyse the changing LULC and the growth pattern of the built-up area within tourist destinations. Four popular tourist destinations, which promises various types of tourism activity and which are significantly dependent on tourism for economic growth, are selected for the study. The study uses remotely sensed data for analysis of land use change through supervised segmentation into five broad classes. Further, the landuse map is reclassified into binary classes to extract the built-up area. The growth patterns of the built-up are analysed in terms of size, shape, direction and form of growth, through a set of spatial metrics. Additionally, a detailed analysis of the existing development pattern corresponding to planned development zones was performed to identify unplanned growth spots in the study regions. The findings of the study provide insights into how tourism has contributed to significant changes in LULC around tourist sites. Also, the study highlights the growth pattern of built-up areas with respect to the type of tourism activity and geographical characteristics. The research attempts to address the need of integrating spatial metrics for the development of sustainable tourism plans as part of the goals of sustainable development.

Keywords: built-up, growth, patterns, tourism, sustainable

Procedia PDF Downloads 85
92 Hypoglossal Nerve Stimulation (Baseline vs. 12 months) for Obstructive Sleep Apnea: A Meta-Analysis

Authors: Yasmeen Jamal Alabdallat, Almutazballlah Bassam Qablan, Hamza Al-Salhi, Salameh Alarood, Ibraheem Alkhawaldeh, Obada Abunar, Adam Abdallah

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Obstructive sleep apnea (OSA) is a disorder caused by the repeated collapse of the upper airway during sleep. It is the most common cause of sleep-related breathing disorder, as OSA can cause loud snoring, daytime fatigue, or more severe problems such as high blood pressure, cardiovascular disease, coronary artery disease, insulin-resistant diabetes, and depression. The hypoglossal nerve stimulator (HNS) is an implantable medical device that reduces the occurrence of obstructive sleep apnea by electrically stimulating the hypoglossal nerve in rhythm with the patient's breathing, causing the tongue to move. This stimulation helps keep the patient's airways clear while they sleep. This systematic review and meta-analysis aimed to assess the clinical outcome of hypoglossal nerve stimulation as a treatment of obstructive sleep apnea. A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted from inception until August 2022. Studies assessing the following clinical outcomes (Apnea-Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), Oxygen Desaturation Indices (ODI), (Oxygen Saturation (SaO2)) were pooled in the meta-analysis using Review Manager Software. We assessed the quality of studies according to the Cochrane risk-of-bias tool for randomized trials (RoB2), Risk of Bias In Non-randomized Studies - of Interventions (ROBINS-I), and a modified version of NOS for the non-comparative cohort studies.13 Studies (Six Clinical Trials and Seven prospective cohort studies) with a total of 817 patients were included in the meta-analysis. The results of AHI were reported in 11 studies examining OSA 696 patients. We found that there was a significant improvement in the AHI after 12 months of HNS (MD = 18.2 with 95% CI, (16.7 to 19.7; I2 = 0%); P < 0.00001). Further, 12 studies reported the results of ESS after 12 months of intervention with a significant improvement in the range of sleepiness among the examined 757 OSA patients (MD = 5.3 with 95% CI, (4.75 to 5.86; I2 = 65%); P < 0.0001). Moreover, nine studies involving 699 participants reported the results of FOSQ after 12 months of HNS with a significant reported improvement (MD = -3.09 with 95% CI, (-3.41 to 2.77; I2 = 0%); P < 0.00001). In addition, ten studies reported the results of ODI with a significant improvement after 12 months of HNS among the 817 examined patients (MD = 14.8 with 95% CI, (13.25 to 16.32; I2 = 0%); P < 000001). The Hypoglossal Nerve Stimulation showed a significant positive impact on obstructive sleep apnea patients after 12 months of therapy in terms of apnea-hypopnea index, oxygen desaturation indices, manifestations of the behavioral morbidity associated with obstructive sleep apnea, and functional status resulting from sleepiness.

Keywords: apnea, meta-analysis, hypoglossal, stimulation

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91 How Digital Empowerment Affects Dissolution of Segmentation Effect and Construction of Opinion Leaders in Isolated Communities: Ethnographic Investigation of Leprosy Rehabilitation Groups

Authors: Lin Zhang

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The fear of leprosy has been longstanding throughout the human history. In an era where isolation is practiced as a means of epidemic prevention, the leprosy rehabilitation group has itself become an isolated community with an entrenched metaphor. In the process of new mediatization of the leprosy isolation community, what are the relations among media literacy, the leprosy internalized stigma and social support? To address the question, the “portrait” of leprosy rehabilitation group is re-delineated through two field studies in the “post-leprosy age” in 2012 and 2020, respectively. Taking an isolation community on Si’an Leprosy Island in Dongguan City, Guangdong Province, China as the study object, it is found that new media promotes the dissolution of segregation effect of the leprosy isolation community and the cultivation of opinion leaders by breaking spatial, psychological and social segregation and by building a community of village affairs and public space in the following way: the cured patients with high new media literacy, especially those who use WeChat and other applications and largely rely on new media for information, have a low level of leprosy internalized stigma and a high level of social support, and they are often the opinion leaders inside their community; on the contrary, the cured patients with low new media literacy, a high level of leprosy internalized stigma and a low level of social support are often the followers inside their community. Such effects of dissolution and construction are reflected not only in the vertical differentiation of the same individual at different times, but also in the horizontal differentiation between different individuals at the same time.

Keywords: segregation, the leprosy rehabilitation group, new mediatization, digital empowerment, opinion leaders

Procedia PDF Downloads 153
90 Count of Trees in East Africa with Deep Learning

Authors: Nubwimana Rachel, Mugabowindekwe Maurice

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Trees play a crucial role in maintaining biodiversity and providing various ecological services. Traditional methods of counting trees are time-consuming, and there is a need for more efficient techniques. However, deep learning makes it feasible to identify the multi-scale elements hidden in aerial imagery. This research focuses on the application of deep learning techniques for tree detection and counting in both forest and non-forest areas through the exploration of the deep learning application for automated tree detection and counting using satellite imagery. The objective is to identify the most effective model for automated tree counting. We used different deep learning models such as YOLOV7, SSD, and UNET, along with Generative Adversarial Networks to generate synthetic samples for training and other augmentation techniques, including Random Resized Crop, AutoAugment, and Linear Contrast Enhancement. These models were trained and fine-tuned using satellite imagery to identify and count trees. The performance of the models was assessed through multiple trials; after training and fine-tuning the models, UNET demonstrated the best performance with a validation loss of 0.1211, validation accuracy of 0.9509, and validation precision of 0.9799. This research showcases the success of deep learning in accurate tree counting through remote sensing, particularly with the UNET model. It represents a significant contribution to the field by offering an efficient and precise alternative to conventional tree-counting methods.

Keywords: remote sensing, deep learning, tree counting, image segmentation, object detection, visualization

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89 The Automatic Transliteration Model of Images of the Book Hamong Tani Using Statistical Approach

Authors: Agustinus Rudatyo Himamunanto, Anastasia Rita Widiarti

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Transliteration using Javanese manuscripts is one of methods to preserve and legate the wealth of literature in the past for the present generation in Indonesia. The transliteration manual process commonly requires philologists and takes a relatively long time. The automatic transliteration process is expected to shorten the time so as to help the works of philologists. The preprocessing and segmentation stage firstly done is used to manage the document images, thus obtaining image script units that will compile input document images free from noise and have the similarity in properties in the thickness, size, and slope. The next stage of characteristic extraction is used to find unique characteristics that will distinguish each Javanese script image. One of characteristics that is used in this research is the number of black pixels in each image units. Each image of Java scripts contained in the data training will undergo the same process similar to the input characters. The system testing was performed with the data of the book Hamong Tani. The book Hamong Tani was selected due to its content, age and number of pages. Those were considered sufficient as a model experimental input. Based on the results of random page automatic transliteration process testing, it was determined that the maximum percentage correctness obtained was 81.53%. The percentage of success was obtained in 32x32 pixel input image size with the 5x5 image window. With regard to the results, it can be concluded that the automatic transliteration model offered is relatively good.

Keywords: Javanese script, character recognition, statistical, automatic transliteration

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88 Characterization of Main Phenolic Compounds in Eleusine indica L. (Poaceae) by HPLC-DAD and 1H NMR

Authors: E. M. Condori-Peñaloza, S. S. Costa

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Eleusine indica L, known as goose-grass, is considered a troublesome weed that can cause important economic losses in the agriculture worldwide. However, this grass is used as a medicinal plant in some regions of Brazil to treat influenza and pneumonia. In Africa and Asia, it is used to treat malaria and as diuretic, anti-helminthic, among other uses. Despite its therapeutic potential, little is known about the chemical composition and bioactive compounds of E. indica. Hitherto, two major flavonoids, schaftoside and vitexin, were isolated from aerial part of the species and showed inhibitory activity on lung neutrophil influxes in mice, suggesting a beneficial effect on airway inflammation. Therefore, the aim of this study was to analyze the chemical profile of aqueous extracts from aerial parts of Eleusine indica specimens using high performance liquid chromatography (HPLC-DAD) and 1H nuclear magnetic resonance spectroscopy (NMR), with emphasis on phenolic compounds. Specimens of E. indica were collected in Minas Gerais state, Brazil. Aerial parts of fresh plants were extracted by decoction (10% p/v). After spontaneous precipitation of the aqueous extract at 10-12°C for 24 hours, the supernatant obtained was frozen and lyophilized. After that, 1 g of the extract was dissolved into 25 mL of water and fractionated on a reverse phase chromatography column (RP-2), eluted with a gradient of H2O/EtOH. Five fractions were obtained. The extract and fractions had their chemical profile analyzed by using HPLC-DAD (C-18 column: 20 μL, 256 -365 nm; gradient water 0.01% phosphoric acid/ acetonitrile. The extract was also analyzed by NMR (1H, 500 MHz, D2O) in order to access its global chemical composition. HPLC-DAD analyses of crude extract allowed the identification of ten phenolic compounds. Fraction 1, eluted with 100% water, was poor in phenolic compounds and no major peak was detected. In fraction 2, eluted with 100% water, it was possible to observe one major peak at retention time (RT) of 23.75 minutes compatible with flavonoid; fraction 3, also eluted with 100% water, showed four peaks at RT= 21.47, 23.52, 24.33 and 25.84 minutes, all of them compatible with flavonoid. In fraction 4, eluted with 50%/ethanol/50% water, it was possible to observe 3 peaks compatible with flavonoids at RT=24.65, 26.81, 27.49 minutes, and one peak (28.83 min) compatible with a phenolic acid derivative. Finally, in fraction 5, eluted with 100% ethanol, no phenolic substance was detected. The UV spectra of all flavonoids detected were compatible with the flavone subclass (λ= 320-345 nm). The 1H NMR spectra of aerial parts extract showed signals in three regions: δ 0.8-3.0 ppm (aliphatic compounds), δ 3.0-5.5 ppm corresponding to carbohydrates (signals most abundant and overlapped), and δ 6.0-8.5 ppm (aromatic compounds). Signals compatible with flavonoids (rings A and B) could also be detected in the crude extract spectra. These results suggest the presence of several flavonoids in E. indica, which reinforces their therapeutic potential. The pharmacological activities of Eleusine indica extracts and fractions will be further evaluated.

Keywords: flavonoids, HPLC, NMR, phenolic compounds

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87 Implementation of Modern Information Technologies in Business to Customer Marketing Activity and the Implementation of Pro-Environmental Goals of Enterprises

Authors: M. Łęgowik-Małolepsza

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The article discusses the problem related to the use of modern information technologies to achieve pro-environmental marketing goals in business-to-customer (B2C) relationships. The topic is important and topical due to the strong social need to implement the concept of sustainable development. The aim of the article is to understand and evaluate the possibilities of implementing modern information technologies, such as Customer Relationship Management platforms (CRM), in the area of implementing marketing activities of companies operating in the Business to Customer model. In B2C relations, marketing departments struggle with problems resulting from the need for quick customer segmentation and the fragmentation of data existing in many systems, which significantly hinders the achievement of the assumed marketing goals. Therefore, the article proposes the use of modern information technology solutions in the area of marketing activities of enterprises, taking into account their pro-environmental goals. The most important results of the research carried out include an in-depth understanding of the possibilities of implementing modern information technologies to achieve marketing goals in B2C relationships. Moreover, a better understanding of the coexistence of opportunities and threats related to the implementation of marketing activities, taking into account pro-environmental goals and modern technologies, allows for more effective implementation of sustainable development management in enterprises. The methods used to achieve the goal are literature studies, descriptive analysis, and case studies. The study contributes to the discussion on the scope of application of modern information technologies in the area of B2C marketing activity, taking into account the implementation of pro-environmental goals of enterprises.

Keywords: B2C marketing activity, implementation of technologies, modern information technologies, pro-environmental activities

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86 IoT and Deep Learning approach for Growth Stage Segregation and Harvest Time Prediction of Aquaponic and Vermiponic Swiss Chards

Authors: Praveen Chandramenon, Andrew Gascoyne, Fideline Tchuenbou-Magaia

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Aquaponics offers a simple conclusive solution to the food and environmental crisis of the world. This approach combines the idea of Aquaculture (growing fish) to Hydroponics (growing vegetables and plants in a soilless method). Smart Aquaponics explores the use of smart technology including artificial intelligence and IoT, to assist farmers with better decision making and online monitoring and control of the system. Identification of different growth stages of Swiss Chard plants and predicting its harvest time is found to be important in Aquaponic yield management. This paper brings out the comparative analysis of a standard Aquaponics with a Vermiponics (Aquaponics with worms), which was grown in the controlled environment, by implementing IoT and deep learning-based growth stage segregation and harvest time prediction of Swiss Chards before and after applying an optimal freshwater replenishment. Data collection, Growth stage classification and Harvest Time prediction has been performed with and without water replenishment. The paper discusses the experimental design, IoT and sensor communication with architecture, data collection process, image segmentation, various regression and classification models and error estimation used in the project. The paper concludes with the results comparison, including best models that performs growth stage segregation and harvest time prediction of the Aquaponic and Vermiponic testbed with and without freshwater replenishment.

Keywords: aquaponics, deep learning, internet of things, vermiponics

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85 House Facades and Emotions: Exploring the Psychological Impact of Architectural Features

Authors: Nour Tawil, Sandra Weber, Kirsten K. Roessler, Martin Mau, Simone Kuhn

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The link between “quality” residential environments and human health and well-being has long been proposed. While the physical properties of a sound environment have been fairly defined, little focus has been given to the psychological impact of architectural elements. Recently, studies have investigated the response to architectural parameters, using measures of physiology, brain activity, and emotion. Results showed different aspects of interest: detailed and open versus blank and closed facades, patterns in perceiving different elements, and a visual bias for capturing faces in buildings. However, in the absence of a consensus on methodologies, the available studies remain unsystematic and face many limitations regarding the underpinning psychological mechanisms. To bridge some of these gaps, an online study was launched to investigate design features that influence the aesthetic judgement and emotional evaluation of house facades, using a well-controlled stimulus set of Canadian houses. A methodical modelling of design features will be performed to extract both high and low level image properties, in addition to segmentation of layout-related features. 300 participants from Canada, Denmark, and Germany will rate the images on twelve psychological dimensions representing appealing aspects of a house. Subjective ratings are expected to correlate with specific architectural elements while controlling for typicality and familiarity, and other individual differences. With the lack of relevant studies, this research aims to identify architectural elements of beneficial qualities that can inform design strategies for optimized residential spaces.

Keywords: architectural elements, emotions, psychological response, residential facades.

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84 Women's Employment Issues in Georgia and Solutions Based on European Experience

Authors: N. Damenia, E. Kharaishvili, N. Sagareishvili, M. Saghareishvili

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Women's Employment is one of the most important issues in the global economy. The article discusses the stated topic in Georgia, through historical content, Soviet experience, and modern perspectives. The paper discusses segmentation insa terms of employment and related problems. Based on statistical analysis, women's unemployment rate and its factors are analyzed. The level of employment of women in Transcaucasia (Georgia, Armenia, and Azerbaijan) is discussed and is compared with Baltic countries (Lithuania, Latvia, and Estonia). The study analyzes women’s level of development, according to the average age of marriage and migration level. The focus is on Georgia's Association Agreement with the EU in 2014, which includes economic, social, trade and political issues. One part of it is gender equality at workplaces. According to the research, the average monthly remuneration of women managers in the financial and insurance sector equaled to 1044.6 Georgian Lari, while in overall business sector average monthly remuneration equaled to 961.1 GEL. Average salaries are increasing; however, the employment rate remains problematic. For example, in 2017, 74.6% of men and 50.8% of women were employed from a total workforce. It is also interesting that the proportion of men and women at managerial positions is 29% (women) to 71% (men). Based on the results, the main recommendation for government and civil society is to consider women as a part of the country’s economic development. In this aspect, the experience of developed countries should be considered. It is important to create additional jobs in urban or rural areas and help migrant women return and use their working resources properly.

Keywords: employment of women, segregation in terms of employment, women's employment level in Transcaucasia, migration level

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83 Low-Cost Parking Lot Mapping and Localization for Home Zone Parking Pilot

Authors: Hongbo Zhang, Xinlu Tang, Jiangwei Li, Chi Yan

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Home zone parking pilot (HPP) is a fast-growing segment in low-speed autonomous driving applications. It requires the car automatically cruise around a parking lot and park itself in a range of up to 100 meters inside a recurrent home/office parking lot, which requires precise parking lot mapping and localization solution. Although Lidar is ideal for SLAM, the car OEMs favor a low-cost fish-eye camera based visual SLAM approach. Recent approaches have employed segmentation models to extract semantic features and improve mapping accuracy, but these AI models are memory unfriendly and computationally expensive, making deploying on embedded ADAS systems difficult. To address this issue, we proposed a new method that utilizes object detection models to extract robust and accurate parking lot features. The proposed method could reduce computational costs while maintaining high accuracy. Once combined with vehicles’ wheel-pulse information, the system could construct maps and locate the vehicle in real-time. This article will discuss in detail (1) the fish-eye based Around View Monitoring (AVM) with transparent chassis images as the inputs, (2) an Object Detection (OD) based feature point extraction algorithm to generate point cloud, (3) a low computational parking lot mapping algorithm and (4) the real-time localization algorithm. At last, we will demonstrate the experiment results with an embedded ADAS system installed on a real car in the underground parking lot.

Keywords: ADAS, home zone parking pilot, object detection, visual SLAM

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82 Subcutan Isosulfan Blue Administration May Interfere with Pulse Oximetry

Authors: Esra Yuksel, Dilek Duman, Levent Yeniay, Sezgin Ulukaya

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Sentinel lymph node biopsy (SLNB) is a minimal invasive technique with lower morbidity in axillary staging of breast cancer. Isosulfan blue stain is frequently used in SLNB and regarded as safe. The present case report aimed to report severe decrement in SpO2 following isosulfan blue administration, as well as skin and urine signs and inconsistency with clinical picture in a 67-year-old ,77 kg, ASA II female case that underwent SLNB under general anesthesia. Ten minutes after subcutaneous administration of 10 ml 1% isosulfan blue by the surgeons into the patient, who were hemodynamically stable, SpO2 first reduced to 87% from 99%, and then to 75% in minutes despite 100% oxygen support. Meanwhile, blood pressure and EtCO2 monitoring was unremarkable. After specifying that anesthesia device worked normally, airway pressure did not increase and the endotracheal tube has been placed accurately, the blood sample was taken from the patient for arterial gas analysis. A severe increase was thought in MetHb concentration since SpO2 persisted to be 75% although the concentration of inspired oxygen was 100%, and solution of 2500 mg ascorbic acid in 500 ml 5% Dextrose was given to the patient via intravenous route until the results of arterial blood gas were obtained. However, arterial blood gas results were as follows: pH: 7.54, PaCO2: 23.3 mmHg, PaO2: 281 mmHg, SaO2: %99, and MetHb: %2.7. Biochemical analysis revealed a blood MetHb concentration of 2%.However, since arterial blood gas parameters were good, hemodynamics of the patient was stable and methemoglobin concentration was not so high, the patient was extubated after surgery when she was relaxed, cooperated and had adequate respiration. Despite the absence of respiratory or neurological distress, SpO2 value was increased only up to 85% within 2 hours with 5 L/min oxygen support via face mask in the surgery room as the patient was extubated. At that time, the skin of particularly the upper part of her body has turned into blue, more remarkable on the face. The color of plasma of the blood taken from the patient for biochemical analysis was blue. The color of urine coming throughout the urinary catheter placed in intensive care unit was also blue. Twelve hours after 5 L/min. oxygen inhalation via a mask, the SpO2 reached to 90%. During monitoring in intensive care unit on the postoperative 1st day, facial color and urine color of the patient was still blue, SpO2 was 92%, and arterial blood gas levels were as follows: pH: 7.44, PaO2: 76.1 mmHg, PaCO2: 38.2 mmHg, SaO2: 99%, and MetHb 1%. During monitoring in clinic on the postoperative 2nd day, SpO2 was 95% without oxygen support and her facial and urine color turned into normal. The patient was discharged on the 3rd day without any problem.In conclusion, SLNB is a less invasive alternative to axillary dissection. However, false pulse oximeter reading due to pigment interference is a rare complication of this procedure. Arterial blood gas analysis should be used to confirm any fall in SpO2 reading during monitoring.

Keywords: isosulfan blue, pulse oximetry, SLNB, methemoglobinemia

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81 The Impact of Culture on Tourists’ Evaluation of Hotel Service Experiences

Authors: Eid Alotaibi

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The purpose of this study is to investigate the impact of tourists’ culture on perception and evaluation of hotel service experience and behavioral intentions. Drawing on Hofested’s cultural dimensions, this study seeks to further contribute towards understanding the effect of culture on perception and evaluation of hotels’ services, and whether there are differences between Saudi and European tourists’ perceptions of hotel services evaluation. A descriptive cross-sectional design was used in this study. Data were collected from tourists staying in five-star hotels in Saudi Arabia using the self-completion technique. The findings show that evaluations of hotel services differ from one culture to another. T-test results reveal that Saudis were more tolerant and reported significantly higher levels of satisfaction, were more likely to return and recommend the hotel, and perceived the price for the hotel stay as being good value for money as compared to their European counterparts. The sample was relatively small and specific to only five-star hotel evaluations. As a result, findings cannot be generalized to the wider tourist population. The results of this research have important implications for management within the Saudi hospitality industry. The study contributes to the tourist cultural theory by emphasizing the relative importance of cultural dimensions in-service evaluation. The author argues that no studies could be identified that compare Saudis and Europeans in their evaluations of their experiences staying at hotels. Therefore, the current study would enhance understanding of the effects of cultural factors on service evaluations and provide valuable input for international market segmentation and resource allocation in the Saudi hotel industry.

Keywords: culture, tourist, service experience, hotel industry, Hofested’s cultural dimensions

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80 Perception of Public Transport Quality of Service among Regular Private Vehicle Users in Five European Cities

Authors: Juan de Ona, Esperanza Estevez, Rocío de Ona

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Urban traffic levels can be reduced by drawing travelers away from private vehicles over to using public transport. This modal change can be achieved by either introducing restrictions on private vehicles or by introducing measures which increase people’s satisfaction with public transport. For public transport users, quality of service affects customer satisfaction, which, in turn, influences the behavioral intentions towards the service. This paper intends to identify the main attributes which influence the perception private vehicle users have about the public transport services provided in five European cities: Berlin, Lisbon, London, Madrid and Rome. Ordinal logit models have been applied to an online panel survey with a sample size of 2,500 regular private vehicle users (approximately 500 inhabitants per city). To achieve a comprehensive analysis and to deal with heterogeneity in perceptions, 15 models have been developed for the entire sample and 14 user segments. The results show differences between the cities and among the segments. Madrid was taken as reference city and results indicate that the inhabitants are satisfied with public transport in Madrid and that the most important public transport service attributes for private vehicle users are frequency, speed and intermodality. Frequency is an important attribute for all the segments, while speed and intermodality are important for most of the segments. An analysis by segments has identified attributes which, although not important in most cases, are relevant for specific segments. This study also points out important differences between the five cities. Findings from this study can be used to develop policies and recommendations for persuading.

Keywords: service quality, satisfaction, public transportation, private vehicle users, car users, segmentation, ordered logit

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79 Biomechanical Performance of the Synovial Capsule of the Glenohumeral Joint with a BANKART Lesion through Finite Element Analysis

Authors: Duvert A. Puentes T., Javier A. Maldonado E., Ivan Quintero., Diego F. Villegas

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Mechanical Computation is a great tool to study the performance of complex models. An example of it is the study of the human body structure. This paper took advantage of different types of software to make a 3D model of the glenohumeral joint and apply a finite element analysis. The main objective was to study the change in the biomechanical properties of the joint when it presents an injury. Specifically, a BANKART lesion, which consists in the detachment of the anteroinferior labrum from the glenoid. Stress and strain distribution of the soft tissues were the focus of this study. First, a 3D model was made of a joint without any pathology, as a control sample, using segmentation software for the bones with the support of medical imagery and a cadaveric model to represent the soft tissue. The joint was built to simulate a compression and external rotation test using CAD to prepare the model in the adequate position. When the healthy model was finished, it was submitted to a finite element analysis and the results were validated with experimental model data. With the validated model, it was sensitized to obtain the best mesh measurement. Finally, the geometry of the 3D model was changed to imitate a BANKART lesion. Then, the contact zone of the glenoid with the labrum was slightly separated simulating a tissue detachment. With this new geometry, the finite element analysis was applied again, and the results were compared with the control sample created initially. With the data gathered, this study can be used to improve understanding of the labrum tears. Nevertheless, it is important to remember that the computational analysis are approximations and the initial data was taken from an in vitro assay.

Keywords: biomechanics, computational model, finite elements, glenohumeral joint, bankart lesion, labrum

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78 Defect Correlation of Computed Tomography and Serial Sectioning in Additively Manufactured Ti-6Al-4V

Authors: Bryce R. Jolley, Michael Uchic

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This study presents initial results toward the correlative characterization of inherent defects of Ti-6Al-4V additive manufacture (AM). X-Ray Computed Tomography (CT) defect data are compared and correlated with microscopic photographs obtained via automated serial sectioning. The metal AM specimen was manufactured out of Ti-6Al-4V virgin powder to specified dimensions. A post-contour was applied during the fabrication process with a speed of 1050 mm/s, power of 260 W, and a width of 140 µm. The specimen was stress relief heat-treated at 16°F for 3 hours. Microfocus CT imaging was accomplished on the specimen within a predetermined region of the build. Microfocus CT imaging was conducted with parameters optimized for Ti-6Al-4V additive manufacture. After CT imaging, a modified RoboMet. 3D version 2 was employed for serial sectioning and optical microscopy characterization of the same predetermined region. Automated montage capture with sub-micron resolution, bright-field reflection, 12-bit monochrome optical images were performed in an automated fashion. These optical images were post-processed to produce 2D and 3D data sets. This processing included thresholding and segmentation to improve visualization of defect features. The defects observed from optical imaging were compared and correlated with the defects observed from CT imaging over the same predetermined region of the specimen. Quantitative results of area fraction and equivalent pore diameters obtained via each method are presented for this correlation. It is shown that Microfocus CT imaging does not capture all inherent defects within this Ti-6Al-4V AM sample. Best practices for this correlative effort are also presented as well as the future direction of research resultant from this current study.

Keywords: additive manufacture, automated serial sectioning, computed tomography, nondestructive evaluation

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77 Neural Network Approach For Clustering Host Community: Based on Perceptions Toward Tourism, Their Satisfaction Level and Demographic Attributes in Iran (Lahijan)

Authors: Nasibeh Mohammadpour, Ali Rajabzadeh, Adel Azar, Hamid Zargham Borujeni,

Abstract:

Generally, various industries development depends on their stakeholders and beneficiaries supports. One of the most important stakeholders in tourism industry ( which has become one of the most important lucrative and employment-generating activities at the international level these days) are host communities in tourist destination which are affected and effect on this industry development. Recognizing host community and its segmentations can be important to get their support for future decisions and policy making. In order to identify these segments, in this study, clustering of the residents has been done by using some tools that are designed to encounter human complexities and have ability to model and generalize complex systems without any needs for the initial clusters’ seeds like classic methods. Neural networks can help to meet these expectations. The research have been planned to design neural networks-based mathematical model for clustering the host community effectively according to multi criteria, and identifies differences among segments. In order to achieve this goal, the residents’ segmentation has been done by demographic characteristics, their attitude towards the tourism development, the level of satisfaction and the type of their support in this field. The applied method is self-organized neural networks and the results have compared with K-means. As the results show, the use of Self- Organized Map (SOM) method provides much better results by considering the Cophenetic correlation and between clusters variance coefficients. Based on these criteria, the host community is divided into five sections with unique and distinctive features, which are in the best condition (in comparison other modes) according to Cophenetic correlation coefficient of 0.8769 and between clusters variance of 0.1412.

Keywords: Artificial Nural Network, Clustering , Resident, SOM, Tourism

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76 Monitoring of Cannabis Cultivation with High-Resolution Images

Authors: Levent Basayigit, Sinan Demir, Burhan Kara, Yusuf Ucar

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Cannabis is mostly used for drug production. In some countries, an excessive amount of illegal cannabis is cultivated and sold. Most of the illegal cannabis cultivation occurs on the lands far from settlements. In farmlands, it is cultivated with other crops. In this method, cannabis is surrounded by tall plants like corn and sunflower. It is also cultivated with tall crops as the mixed culture. The common method of the determination of the illegal cultivation areas is to investigate the information obtained from people. This method is not sufficient for the determination of illegal cultivation in remote areas. For this reason, more effective methods are needed for the determination of illegal cultivation. Remote Sensing is one of the most important technologies to monitor the plant growth on the land. The aim of this study is to monitor cannabis cultivation area using satellite imagery. The main purpose of this study was to develop an applicable method for monitoring the cannabis cultivation. For this purpose, cannabis was grown as single or surrounded by the corn and sunflower in plots. The morphological characteristics of cannabis were recorded two times per month during the vegetation period. The spectral signature library was created with the spectroradiometer. The parcels were monitored with high-resolution satellite imagery. With the processing of satellite imagery, the cultivation areas of cannabis were classified. To separate the Cannabis plots from the other plants, the multiresolution segmentation algorithm was found to be the most successful for classification. WorldView Improved Vegetative Index (WV-VI) classification was the most accurate method for monitoring the plant density. As a result, an object-based classification method and vegetation indices were sufficient for monitoring the cannabis cultivation in multi-temporal Earthwiev images.

Keywords: Cannabis, drug, remote sensing, object-based classification

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75 A Radiomics Approach to Predict the Evolution of Prostate Imaging Reporting and Data System Score 3/5 Prostate Areas in Multiparametric Magnetic Resonance

Authors: Natascha C. D'Amico, Enzo Grossi, Giovanni Valbusa, Ala Malasevschi, Gianpiero Cardone, Sergio Papa

Abstract:

Purpose: To characterize, through a radiomic approach, the nature of areas classified PI-RADS (Prostate Imaging Reporting and Data System) 3/5, recognized in multiparametric prostate magnetic resonance with T2-weighted (T2w), diffusion and perfusion sequences with paramagnetic contrast. Methods and Materials: 24 cases undergoing multiparametric prostate MR and biopsy were admitted to this pilot study. Clinical outcome of the PI-RADS 3/5 was found through biopsy, finding 8 malignant tumours. The analysed images were acquired with a Philips achieva 1.5T machine with a CE- T2-weighted sequence in the axial plane. Semi-automatic tumour segmentation was carried out on MR images using 3DSlicer image analysis software. 45 shape-based, intensity-based and texture-based features were extracted and represented the input for preprocessing. An evolutionary algorithm (a TWIST system based on KNN algorithm) was used to subdivide the dataset into training and testing set and select features yielding the maximal amount of information. After this pre-processing 20 input variables were selected and different machine learning systems were used to develop a predictive model based on a training testing crossover procedure. Results: The best machine learning system (three-layers feed-forward neural network) obtained a global accuracy of 90% ( 80 % sensitivity and 100% specificity ) with a ROC of 0.82. Conclusion: Machine learning systems coupled with radiomics show a promising potential in distinguishing benign from malign tumours in PI-RADS 3/5 areas.

Keywords: machine learning, MR prostate, PI-Rads 3, radiomics

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74 Immature Palm Tree Detection Using Morphological Filter for Palm Counting with High Resolution Satellite Image

Authors: Nur Nadhirah Rusyda Rosnan, Nursuhaili Najwa Masrol, Nurul Fatiha MD Nor, Mohammad Zafrullah Mohammad Salim, Sim Choon Cheak

Abstract:

Accurate inventories of oil palm planted areas are crucial for plantation management as this would impact the overall economy and production of oil. One of the technological advancements in the oil palm industry is semi-automated palm counting, which is replacing conventional manual palm counting via digitizing aerial imagery. Most of the semi-automated palm counting method that has been developed was limited to mature palms due to their ideal canopy size represented by satellite image. Therefore, immature palms were often left out since the size of the canopy is barely visible from satellite images. In this paper, an approach using a morphological filter and high-resolution satellite image is proposed to detect immature palm trees. This approach makes it possible to count the number of immature oil palm trees. The method begins with an erosion filter with an appropriate window size of 3m onto the high-resolution satellite image. The eroded image was further segmented using watershed segmentation to delineate immature palm tree regions. Then, local minimum detection was used because it is hypothesized that immature oil palm trees are located at the local minimum within an oil palm field setting in a grayscale image. The detection points generated from the local minimum are displaced to the center of the immature oil palm region and thinned. Only one detection point is left that represents a tree. The performance of the proposed method was evaluated on three subsets with slopes ranging from 0 to 20° and different planting designs, i.e., straight and terrace. The proposed method was able to achieve up to more than 90% accuracy when compared with the ground truth, with an overall F-measure score of up to 0.91.

Keywords: immature palm count, oil palm, precision agriculture, remote sensing

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73 Comparison of Nutritional Status of Asthmatic vs Non-Asthmatic Adults

Authors: Ayesha Mushtaq

Abstract:

Asthma is a pulmonary disease in which blockade of the airway takes place due to inflammation as a response to certain allergens. Breathing troubles, cough, and dyspnea are one of the few symptoms. Several studies have indicated a significant effect on asthma due to changes in dietary routines. Certain food items, such as oily foods and other materials, are known to cause an increase in the symptoms of asthma. Low dietary intake of fruits and vegetables may be important in relation to asthma prevalence. The objective of this study is to assess and compare the nutritional status of asthmatic and non-asthmatic patients. The significance of this study lies in the factor that it will help nutritionists to arrange a feasible dietary routine for asthmatic patients. This research was conducted at the Pulmonology Department of the Pakistan Institute of Medical Science Islamabad. About thirty hundred thirty-four million people are affected by asthma worldwide. Pakistan is on the verge of being an uplifted urban population and asthma cases are increasingly high these days. Several studies suggest an increase in the Asthmatic patient population due to improper diet. This is a cross-sectional study aimed at assessing the nutritious standing of Asthmatic and non-asthmatic patients. This research took place at the Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan. The research included asthmatic and non-asthmatic patients coming to the pulmonology department clinic at the Pakistan Institute of Medical Sciences (PIMS). These patients were aged between 20-60 years. A questionnaire was developed for these patients to estimate their dietary plans in these patients. The methodology included four sections. The first section was the Socio-Demographic profile, which included age, gender, monthly income and occupation. The next section was anthropometric measurements which included the weight, height and body mass index (BMI) of an individual. The next section, section three, was about the biochemical attributes, such as for biochemical profiling, pulmonary function testing (PFT) was performed. In the next section, Dietary habits were assessed by a food frequency questionnaire (FFQ) through food habits and consumption pattern was assessed. The next section life style data, in which the person's level of physical activity, sleep and smoking habits were assessed. The next section was statistical analysis. All the data obtained from the study were statistically analyzed and assessed. Most of the asthma Patients were females, with weight more than normal or even obese. Body Mass Index (BMI) was higher in asthma Patients than those in non-Asthmatic ones. When the nutritional Values were assessed, we came to know that these patients were low on certain nutrients and their diet included more junk and oily food than healthy vegetables and fruits. Beverages intake was also included in the same assessment. It is evident from this study that nutritional status has a contributory effect on asthma. So, patients on the verge of developing asthma or those who have developed asthma should focus on their diet, maintain good eating habits and take healthy diets, including fruits and vegetables rather than oily foods. Proper sleep may also contribute to the control of asthma.

Keywords: BMI, nutrition, PAL, diet

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72 Developmental Difficulties Prevalence and Management Capacities among Children Including Genetic Disease in a North Coastal District of Andhra Pradesh, India: A Cross-sectional Study

Authors: Koteswara Rao Pagolu, Raghava Rao Tamanam

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The present study was aimed to find out the prevalence of DD's in Visakhapatnam, one of the north coastal districts of Andhra Pradesh, India during a span of five years. A cross-sectional investigation was held at District early intervention center (DEIC), Visakhapatnam from 2016 to 2020. To identify the pattern and trend of different DD's including seasonal variations, a retrospective analysis of the health center's inpatient database for the past 5 years was done. Male and female children aged 2 months-18 years are included in the study with the prior permission of the concerned medical officer. The screening tool developed by the Ministry of health and family welfare, India, was used for the study. Among 26,423 cases, children with birth defects are 962, 2229 with deficiencies, 7516 with diseases, and 15716 with disabilities were admitted during the study period. From birth defects, congenital deafness occurred in large numbers with 22.66%, and neural tube defect observed in a small number of cases with 0.83% during the period. From the side of deficiencies, severe acute malnutrition has mostly occurred (66.80 %) and a small number of children were affected with goiter (1.70%). Among the diseases, dental carriers (67.97%) are mostly found and these cases were at peak during the years 2016 and 2019. From disabilities, children with vision impairment (20.55%) have mostly approached the center. Over the past 5 years, the admission rate of down's syndrome and congenital deafness cases showed a rising trend up to 2019 and then declined. Hearing impairment, motor delay, and learning disorder showed a steep rise and gradual decline trend, whereas severe anemia, vitamin-D deficiency, otitis media, reactive airway disease, and attention deficit hyperactivity disorder showed a declining trend. However, congenital heart diseases, dental caries, and vision impairment admission rates showed a zigzag pattern over the past 5 years. This center had inadequate diagnostic facilities related to genetic disease management. For advanced confirmation, the cases are referred to a district government hospital or private diagnostic laboratories in the city for genetic tests. Information regarding the overall burden and pattern of admissions in the health center is obtained by the review of DEIC records. Through this study, it is observed that the incidence of birth defects, as well as genetic disease burden, is high in the Visakhapatnam district. Hence there is a need for strengthening of management services for these diseases in this region.

Keywords: child health screening, developmental delays, district early intervention center, genetic disease management, infrastructural facility, Visakhapatnam district

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71 The Axonal Connectivity of Motor and Premotor Areas as Revealed through Fiber Dissections: Shedding Light on the Structural Correlates of Complex Motor Behavior

Authors: Spyridon Komaitis, Christos Koutsarnakis, Evangelos Drosos, Aristotelis Kalyvas

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This study opts to investigate the intrinsic architecture, morphology, and spatial relationship of the subcortical pathways implicated in the connectivity of the motor/premotor cortex and SMA/pre-SMA complex. Twenty normal, adult, formalin-fixed cerebral hemispheres were explored through the fiber micro-dissection technique. Lateral to medial and medial to lateral dissections focused on the area of interest were performed in a tandem manner and under the surgical microscope. We traced the subcortical architecture, spatial relationships, and axonal connectivity of four major pathways: a) the dorsal component of the SLF (SLF-I) was found to reside in the medial aspect of the hemisphere and seen to connect the precuneus with the SMA and pre-SMA complex, b) the frontal longitudinal system (FLS) was consistently encountered as the natural anterior continuation of the SLF-II and SLF-III and connected the premotor and prefrontal cortices c) the fronto-caudate tract (FCT), a fan-shaped tract, was documented to participate in connectivity of the prefrontal and premotor cortices to the head and body of the caudate nucleus and d) the cortico-tegmental tract(CTT) was invariably recorded to subserve the connectivity of the tegmental area with the fronto-parietal cortex. No hemispheric asymmetries were recorded for any of the implicated pathways. Sub-segmentation systems were also proposed for each of the aforementioned tracts. The structural connectivity and functional specialization of motor and premotor areas in the human brain remain vague to this day as most of the available evidence derives either from animal or tractographic studies. By using the fiber-microdissection technique as our main method of investigation, we provide sound structural evidence on the delicate anatomy of the related white matter pathways.

Keywords: neuroanatomy, premotor, motor, connectivity

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70 Is Fashion Consumption Ageless? A Study of Differences in Fashion Consumption Behavior of Generation X, Y, and Z Females

Authors: Vaishali Joshi, Pallav Joshi

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The main objective of this study is to examine the fashion consumption behavior of females with respect to their age group. Differences were studied in the pre-purchase, purchase and post-purchase behavior of females belonging to three age cohorts such as Generation X, Generation Y, and Generation Z. Quantitative approach was used to conduct this research. Data was collected through structured questionnaire. The questionnaire consisted of three sections. Section one included a question of the source of information of purchasing fashion apparels which measure the pre-purchase behavior. Section two measures purchase behavior which included two questions: i. motivations for purchasing fashion apparel and ii. important attributes considered for purchasing fashion apparel. The last section included a question regarding disposal of fashion apparel which measures the post-purchase behavior. Hundred females were selected as the respondents for this study through convenience sampling in the fashion streets. They were categorized into three age groups and then the results were analyzed. Four hypotheses were developed after reviewing the existing literature. Regression analysis was conducted for testing the hypothesis. Hypothesis one was accepted which stated that ‘social influence’ as a source of information for purchasing fashion apparels decreases with age. Hypothesis two was accepted which suggested that motivation of ‘Attention seeking’ for purchasing fashion apparel decreases with age. Hypothesis three and four also accepted which suggested that the importance of ‘Quality’ and ‘Price’ increases with age but hypothesis five was rejected which suggested that the importance of ‘Fit’ increases with age and last but not the least hypothesis six was accepted which suggested that the ‘duration’ of using fashion apparel increases with age. Limitation of the study deals with the sample of only female respondents. Implication can be made from this research in the field of Fashion apparel industry with respect to consumer segmentation and better marketing approaches can be implemented by the marketers form this study. Further research can be concluded by including male respondents also.

Keywords: fashion, consumption behavior, age cohorts, motivation

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69 A Relationship Model That Illustrates the Effect of Humorous Packaging Designs on Brand Awareness and Brand Attitude

Authors: Shu-Yuan Lin, Tung-Chin Chou

Abstract:

As products become increasingly similar in competitive markets, achieving product segmentation and differentiation through packaging design has become the primary task when designing retail product packaging. When the main focus of brand marketing is no longer the product itself, emotional marketing, such as the use of humorous packaging designs, may be employed to successfully promote the brand. Such efforts will capture the hearts of consumers, generate discussions, and allow the brand to leave a deep impression in consumers. In this study, snack packaging was used to develop a relationship model that illustrated the effect of humorous packaging designs on brand awareness and brand attitude. The study was divided into three stages: In the first stage, in-depth interviews and focus group interviews were conducted with experts to construct 24 indicators for assessing humorous packaging designs. In the second stage, survey questionnaires were distributed to a young consumer group; the results showed that the group had a high and low product involvement with chocolate and dried shredded squid, respectively. Humorous packaging designs were subsequently created for two snack types to produce a study sample of 12 different packaging. In the third stage, packaging designs were evaluated by obtaining scores for the consumers’ brand awareness, brand attitude, and perceived effects of the packaging designs. Finally, a relationship model was developed to show the effect of humorous packaging designs on brand awareness and brand attitude, confirming that two perceived effects of humorous packaging designs (i.e., ‘pleasant and emotionally healing’ and ‘connected to people’s daily life’) exhibited a significant and positive effect on ‘perceived brand value,’ where the effect of ‘pleasant and emotionally healing’ was the most significant. In addition, ‘pleasant and emotionally healing’ exerted a significant and positive effect on ‘brand purchase intention.’ Furthermore, packaging designs with humorous elements helped foster brand awareness.

Keywords: brand awareness, brand attitude, humorous design, packaging design

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68 Performance of a Lytic Bacteriophage Cocktail against Pseudomonas aeruginosa in Conditions That Simulate the Cystic Fibrosis Lung Environment

Authors: Isaac Martin, Abigail Lark, Sandra Morales, Eric W. Alton, Jane C. Davies

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Objectives: The cystic fibrosis (CF) lung is a unique microbiological niche, wherein harmful bacteria persist for many years despite antibiotic therapy. Pseudomonas aeruginosa (Pa), the major culprit leading to lung decline and increased mortality, thrives in the lungs of patients with CF due to several factors that have been linked with poor antibiotic performance. Our group is investigating alternative therapies including bacteriophage cocktails with which we have previously demonstrated efficacy against planktonic organisms. In this study, we explored the effects of a 4-phage cocktail on Pa grown in two different conditions, intended to mirror the CF lung: a) alongside standard antibiotic treatment in pre-formed biofilms (structures formed by Pa-secreted exopolysaccharides which provide both physical and cell division barriers to antimicrobials and host defenses and b) in an acidic environment postulated to be present in the CF airway due both to the primary defect in bicarbonate secretion and secondary effects of inflammation. Methods: 16 Pa strains from CF patients at the Royal Brompton Hospital were selected based on sensitivity to a) ceftazidime/ tobramycin and b) the phage cocktail in a conventional plaque assay. To assess efficacy of phage in biofilms, 96 well plates with Pa (5x10⁷ CFU/ ml) were incubated in static conditions, allowing adherent bacterial colonies to form for 24 hr. Ceftazidime and tobramycin (both at 2 × MIC) were added, +/- bacteriophage (4x10⁸ PFU/mL) for a further 24 hr. Cell viability and biomass were estimated using fluorescent resazurin and crystal violet assays, respectively. To evaluate the effect of pH, strains were grown planktonically in shaking 96 well plates at pH 6.0, 6.6, 7.0 and 7.5 with tobramycin or phage, at varying concentrations. Cell viability was quantified by fluorescent resazurin assay. Results: For the biofilm assay, treatment groups were compared with untreated controls and expressed as percent reduction in cell viability and biomass. Addition of the 4-phage cocktail resulted in a 1.3-fold reduction in cell viability and 1.7-fold reduction in biomass (p < 0.001) when compared to standard antibiotic treatment alone. Notably, there was a 50 ± 15% reduction in cell viability and 60 ± 12% reduction in biomass (95% CI) for the 4 biofilms demonstrating the most resistance to antibiotic treatment. 83% of strains tested (n=6) showed decreased bacterial killing by tobramycin at acidic pHs (p < 0.01). However, 25% of strains (n=12) showed improved phage killing at acidic pHs (p < 0.05), with none showing the pattern of reduced efficacy at acidic pH demonstrated by tobramycin. Conclusion: The 4-phage anti-Pa cocktail tested against Pa performs well in pre-formed biofilms and in acidic environments; two conditions intended to mimic the CF lung. To our knowledge, these are the first data looking at the effects of subtle pH changes on phage-mediated bacterial killing in the context of Pa infection. These findings contribute to a growing body of evidence supporting the use of nebulised lytic bacteriophage as a treatment in the context of lung infection.

Keywords: biofilm, cystic fibrosis, pH, Pseudomonas aeruginosa, lytic bacteriophage

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67 New Model of Immersive Experiential Branding for International Universities

Authors: Kakhaber Djakeli

Abstract:

For market leadership, iconic brands already start to establish their unique digital avatars into Metaverse and offer Non Fungible Tokens to their fans. Metaverse can be defined as an evolutionary step of Internet development. So if companies and brands use the internet, logically, they can find new solutions for them and their customers in Metaverse. Marketing and Management today must learn how to combine physical world activities with those either entitled as digital, virtual, and immersive. A “Phygital” Solution uniting physical and digital competitive activities of the company covering the questions about how to use virtual worlds for Brand Development and Non Fungible Tokens for more attractiveness soon will be most relevant question for Branding. Thinking comprehensively, we can entitle this type of branding as an Immersive one. As we see, the Immersive Brands give customers more mesmerizing feelings than traditional ones. Accordingly, the Branding can be divided by the company in its own understanding into two models: traditional and immersive. Immersive Branding being more directed to Sensorial challenges of Humans will be big job for International Universities in near future because they target the Generation - Z. To try to help those International Universities opening the door to the mesmerizing, immersive branding, the Marketing Research have been undertaken. The main goal of the study was to establish the model for Immersive Branding at International Universities and answer on many questions what logically arises in university life. The type of Delphi Surveys entitled as an Expert Studies was undertaken for one great mission, to help International Universities to open the opportunities to Phygital activities with reliable knowledge with Model of Immersive Branding. The Questionnaire sent to Experts of Education were covering professional type of questions from education to segmentation of customers, branding, attitude to students, and knowledge to Immersive Marketing. The research results being very interesting and encouraging enough to make author to establish the New Model of Immersive Experiential Branding for International Universities.

Keywords: branding, immersive marketing, students, university

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66 Implementing a Comprehensive Emergency Care and Life Support Course in a Low- and Middle-Income Country Setting: A Survey of Learners in India

Authors: Vijayabhaskar Reddy Kandula, Peter Provost Taillac, Balasubramanya M. A., Ram Krishnan Nair, Gokul Toshnival, Vibhu Dhawan, Vijaya Karanam, Buffy Cramer

Abstract:

Introduction: The lack of Emergency Care Services (ECS) is a cause of extensive and serious public health problems in low- and middle-income countries (LMIC), Many LMIC countries have ambulance services that allow timely transfer of ill patients but due to poor care during the ‘Golden Hour’ many deaths occur which are otherwise preventable. Lack of adequate training as evidenced by a study in India is a major reason for poor care during the ‘Golden Hour’. Adapting developed country models which includes staffing specialty-trained doctors in emergency care, is neither feasible nor guarantees cost-effective ECS. Methods: Based on our assessment and felt needs by first-line doctors providing emergency care in 2014, Rajiv Gandhi Health Sciences University’s JeevaRaksha Trust in partnership with the University of Utah, USA, designed, piloted and successfully implemented a 4-day Comprehensive-Emergency Care and Life Support course (C-ECLS) for allopathic doctors. 1730 doctors completed the 4-day course between June 2014 and December- 2020. Subsequently, we conducted a survey to investigate the utilization rates and usefulness of the training. 1662 were contacted but only 309 completed the survey. The respondents had the following designations: Senior faculty (33%), junior faculty (25), Resident (16%), Private-Practitioners (8%), Medical-Officer (16%) and not-working (11%). 51% were generalists (51%) and the rest were specialists (>30 specialties). Results: 97% (271/280) felt they are better doctors because of C-ECLS. 79% (244/309) reported that training helped to save life- specialists more likely than generalists (91% v/s 68%. P<0.05). 64% agreed that they were confident of managing COVID-19 symptomatic patients better because of C-ECLS. 27% (77) were neutral; 9% (24) disagreed. 66% agreed that training helps to be confident in managing COVID-19 critically ill patients. 26% (72) were neutral; 8% (23) disagreed. Frequency of use of C-ECLS skills: Hemorrhage-control (70%), Airway (67%), circulation skills (62%), Safe-transport and communication (60%), managing critically ill patients (58%), cardiac arrest (51%), Trauma (49%), poisoning/animal bites/stings (44%), neonatal-resuscitation (39%), breathing (36%), post-partum-hemorrhage and eclampsia (35%). Among those who used the skills, the majority (ranging from (88%-94%) reported that they were able to apply the skill more effectively because of ECLS training. Conclusion: JeevaRaksha’s C-ECLS is the world’s first comprehensive training. It improves the confidence of front-line doctors and enables them to provide quality care during the ‘Golden Hour’ of emergency. It also prepares doctors to manage unknown emergencies (e.g., COVID-19). C-ECLS was piloted in Morocco, and Uzbekistan and implemented countrywide in Bhutan. C-ECLS is relevant to most settings and offers a replicable model across LMIC.

Keywords: comprehensive emergency care and life support, training, capacity building, low- and middle-income countries, developing countries

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