Search results for: criteria of similarity

Authors: Irina Canco, Amela Malaj

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It is evident that there exists a relationship between supply chain management and business performance. Surveys have showed that in many cases the manager's beliefs and expectations on supply chain management do not match the reality of the business. In this context, the study of supply chain issues is of particular importance and interest considering specifically the current period. The economic problems of this period, are present in Albania as well. The complexity of the supply chain focuses on order fulfilment. Therefore, in this paper, attention will be paid to the impact of supply chain management on business performance. The objective of the paper is to find a relationship between the good supply chain management and business performance. This research is based on the results of surveys referring to the experience of successful businesses on issues related to sustainable supply chain management and its synchronization with the provision of products and services required by the final customers. This study clearly evidenced the impact of the speed of meeting customer requirements on AMAZONA performance. This was also confirmed mathematically through one of the decision criteria in conditions of uncertainty—Laplace criterion.

Keywords: supply chain management, AMAZONA, business performance, Laplace criteria

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Authors: Yah-Ling Hung

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eHealth is undoubtedly emerging as a promising vehicle to provide information for individual self-care management. However, the accessing ability, reading strategies and navigating behavior between higher literacy users and lower literacy users are significantly different. Yet, ways to tailor audiences’ health literacy and develop appropriate eHealth to feed their need become a big challenge. The purpose of this study is to compare the educational effectiveness of eHealth to deliver health knowledge between higher literacy users and lower literacy users, thus establishing useful design strategies of eHealth for users with different level of health literacy. The study was implemented in four stages, the first of which developed a website as the testing media to introduce health care knowledge relating to children’s allergy. Secondly, a reliability and validity test was conducted to make sure that all of the questions in the questionnaire were good indicators. Thirdly, a pre-post knowledge test was conducted with 66 participants, 33 users with higher literacy and 33 users with lower literacy respectively. Finally, a usability evaluation survey was undertaken to explore the criteria used by users with different levels of health literacy to evaluate eHealth. The results demonstrated that the eHealth Intervention in both groups had a positive outcome. There was no significant difference between the effectiveness of eHealth intervention between users with higher literacy and users with lower literacy. However, the average mean of lower literacy group was marginally higher than the average mean of higher literacy group. The findings also showed that the criteria used to evaluate eHealth could be analyzed in terms of the quality of information, appearance, appeal and interaction, but the users with lower literacy have different evaluation criteria from those with higher literacy. This is an interdisciplinary research which proposes the sequential key steps that incorporate the planning, developing and accessing issues that need to be considered when designing eHealth for patients with varying degrees of health literacy.

Keywords: eHealth, health intervention, health literacy, usability evaluation

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Authors: Marzouk Benali, Jawad Jeaidi, Behrang Mansoornejad, Olumoye Ajao, Banafsheh Gilani, Nima Ghavidel Mehr

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Canadian forest industry is seeking to identify and implement transformational strategies for enhanced financial performance through the emerging bioeconomy or more specifically through the concept of the biorefinery. For example, processing forest residues or surplus of biomass available on the mill sites for the production of biofuels, biochemicals and/or biomaterials is one of the attractive strategies along with traditional wood and paper products and cogenerated energy. There are many possible process-product biorefinery pathways, each associated with specific product portfolios with different levels of risk. Thus, it is not obvious which unique strategy forest industry should select and implement. Therefore, there is a need for analytical and design tools that enable evaluating biorefinery strategies based on a set of criteria considering a perspective of sustainability over the short and long terms, while selecting the existing core products as well as selecting the new product portfolio. In addition, it is critical to assess the manufacturing flexibility to internalize the risk from market price volatility of each targeted bio-based product in the product portfolio, prior to invest heavily in any biorefinery strategy. The proposed paper will focus on introducing a systematic methodology for designing integrated biorefineries using process systems engineering tools as well as a multi-criteria decision making framework to put forward the most effective biorefinery strategies that fulfill the needs of the forest industry. Topics to be covered will include market analysis, techno-economic assessment, cost accounting, energy integration analysis, life cycle assessment and supply chain analysis. This will be followed by describing the vision as well as the key features and functionalities of the I-BIOREF software platform, developed by CanmetENERGY of Natural Resources Canada. Two industrial case studies will be presented to support the robustness and flexibility of I-BIOREF software platform: i) An integrated Canadian Kraft pulp mill with lignin recovery process (namely, LignoBoost™); ii) A standalone biorefinery based on ethanol-organosolv process.

Keywords: biorefinery strategies, bioproducts, co-production, multi-criteria decision making, tool

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Authors: Fatemeh Rezaei, Mohammad H. Yarmohammadian, Masoud Ferdosi, Abbas Haghshnas

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Background: Failure Modes and Effect Analysis is now having known as the main methods of risk assessment and the accreditation requirements for many organizations. The Risk Priority Number (RPN) approach is generally preferred, especially for its easiness of use. Indeed it does not require statistical data, but it is based on subjective evaluations given by the experts about the Occurrence (O i), the Severity (Si) and the Detectability (D i) of each cause of failure. Methods: This study is a quantitative – qualitative research. In terms of qualitative dimension, method of focus groups with inductive approach is used. To evaluate the results of the qualitative study, quantitative assessment was conducted to calculate RPN score. Results; We have studied patient’s journey process in surgery ward and the most important phase of the process determined Transport of the patient from the holding area to the operating room. Failures of the phase with the highest priority determined by defining inclusion criteria included severity (clinical effect, claim consequence, waste of time and financial loss), occurrence (time- unit occurrence and degree of exposure to risk) and preventability (degree of preventability and defensive barriers) and quantifying risks priority criteria in the context of RPN index. Ability of improved RPN reassess by root cause (RCA) analysis showed some variations. Conclusions: Finally, It could be concluded that understandable criteria should have been developed according to personnel specialized language and communication field. Therefore, participation of both technical and clinical groups is necessary to modify and apply these models.

Keywords: failure mode, effects analysis, risk priority number(RPN), health system, risk assessment

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Authors: B. J. Mahen, N. E. Lloyd-Gale, S. Johnson, W. P. Rakowicz, M. J. Harris, A. D. Miller

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Background: Migraine is a leading cause of disability in the world. Calcitonin gene-related peptide (CGRP) receptor antagonists offer an approach to migraine prophylaxis by inhibiting the inflammatory and vasodilatory effects of CGRP. In recent years, NICE licensed the use of three CGRP-receptor antagonists: Fremanezumab, Galcanezumab, and Erenumab. Here, we present the outcomes of CGRP-antagonist treatment in a cohort of patients who suffer from episodic or chronic migraine and have failed at least three oral prophylactic therapies. Methods: We offered CGRP antagonists to 86 patients who met the NICE criteria to start therapy. We recorded the number of headache days per month (HDPM) at 0 weeks, 3 months, and 12 months. Of those, 26 patients were switched to an alternative treatment due to poor response or side effects. Of the 112 total cases, 9 cases did not sufficiently maintain their headache diary, and 5 cases were not followed up at 3 months. We have therefore included 98 sets of data in our analysis. Results: Fremanezumab achieved a reduction in HDPM by 51.7% at 3 months (p<0.0001), with 63.7% of patients meeting NICE criteria to continue therapy. Patients trialed on Galcanezumab attained a reduction in HDPM by 47.0% (p=0.0019), with 51.6% of patients meeting NICE criteria to continue therapy. Erenumab, however, only achieved a reduction in HDPM by 17.0% (p=0.29), and this was not statistically significant. Furthermore, 34.4%, 9.7%, and 4.9% of patients taking Fremanezumab, Galcanezumab, and Erenumab, respectively, continued therapy beyond 12 months. Of those who attempted drug holidays following 12 months of treatment, migraine symptoms relapsed in 100% of cases. Conclusion: We observed a significant improvement in HDPM amongst episodic and chronic migraine patients following treatment with Fremanezumab or Galcanezumab.

Keywords: migraine, CGRP, fremanezumab, galcanezumab, erenumab

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Authors: Dominic McGann

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Applying Kuhn’s model of paradigm shifts in science to cases of doctrinal change in religion has been a common area of study in recent years. Few authors, however, have sought an explanation for the ease with which this model of theory change in science can be applied to cases of religious change. In order to provide such an explanation of this analytic phenomenon, this paper aims to answer one central question: Why is it that a theory that was intended to be used in an analysis of the history of science can be applied to something as disparate as the doctrinal history of religion with little to no modification? By way of answering this question, this paper begins with an explanation of Kuhn’s model and its applications in the field of religious studies. Following this, Massa’s recently proposed explanation for this phenomenon, and its notable flaws will be explained by way of framing the central proposal of this article, that the operative parts of scientific and religious changes function on the same fundamental concept of changes in understanding. Focusing its argument on this key concept, this paper seeks to illustrate its operation in cases of religious conversion and in Kuhn’s notion of the incommensurability of different scientific paradigms. The conjecture of this paper is that just as a Pagan-turned-Christian ceases to hear Thor’s hammer when they hear a clap of thunder, so too does a Ptolemaic-turned-Copernican-astronomer cease to see the Sun orbiting the Earth when they view a sunrise. In both cases, the agent in question has undergone a similar change in universal understanding, which provides us with a fundamental connection between changes in religion and changes in science. Following an exploration of this connection, this paper will consider the implications that such a connection has for the concept of the division between religion and science. This will, in turn, lead to the conclusion that religion and science are more alike than they are opposed with regards to the fundamental notion of understanding, thereby providing an answer to our central question. The major finding of this paper is that Kuhn’s model can be applied to religious cases so easily because changes in science and changes in religion operate on the same type of change in understanding. Therefore, in summary, science and religion share a crucial similarity and are not as disparate as they first appear.

Keywords: Thomas Kuhn, science and religion, paradigm shifts, incommensurability, insight and understanding, philosophy of science, philosophy of religion

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Authors: Ellen Bautista, Rebecca M. Flueckiger, Easter Dasmarinas, Rajeev Colaco, Fulbert Alec R. Gillego, Alma M. Lozada, Cristina Bisson

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Lactational Amenorrhea Method (LAM) for family planning is at least 98% effective at preventing pregnancy when all criteria are met; (1) the mother is exclusively or nearly exclusively breastfeeding, (2) the mother is amenorrheic (not menstruating), and (3) the baby is six months old or younger. LAM is particularly suited for women interested in family planning accepted by religious authorities. As a majority catholic nation, LAM is a common and accepted form of family planning in the Philippines. The USAID funded, LuzonHealth project conducted a prospective evaluation in Legazpi City to inform the enhancement of guidelines aimed at increasing LAM compliance and encouraging a second form of contraceptive once LAM protection expires. LAM compliance, reasons for non-compliance, family planning referral and uptake of secondary modern family planning methods were tracked over a nine-month period among 521 postpartum women. The evaluation found that at three months postpartum, 97% of women either met LAM criteria or had shifted to a non-LAM modern family planning method. In month six 87% of women no longer met LAM criteria and of these only 35% had shifted to an alternative modern family planning method. This means that at six-months postpartum 65% of the women in this evaluation were not protected against pregnancy through modern family planning methods. By postpartum month nine, 70% of the women had been referred to family planning counseling, yet of those referred only 34% reported using modern family planning methods. This evaluation clearly indicates scale-up of non-LAM modern family planning does not sufficiently complement the scale-down of LAM compliance. There is a need to increase client knowledge and understanding of LAM as a temporary family planning method with a strong focus on preparing to shift to another form of modern family planning once LAM protection expires. Additionally, there is great need to restructure the referral mechanism to ensure efficacy and quality of care.

Keywords: Philippines, family planning, lactational amenorrhea method, contraceptives

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Authors: Sa’adu Mafara Abubakar, Muhammad Nuraddeen Danjuma, Adewole Tomiwa Adetunji, Richard Mundembe, Salisu Mohammed, Francis Bayo Lewu, Joseph I. Kiok

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Pearl millet is the most drought tolerant of all domesticated cereals, is cultivated extensively to feed millions of people who mainly live in hash agroclimatic zones. It serves as a major source of food for more than 40 million smallholder farmers living in the marginal agricultural lands of Northern Nigeria. Pearl millet grain is more nutritious than other cereals like maize, is also a principal source of energy, protein, vitamins, and minerals for millions of poorest people in the regions where it is cultivated. Pearl millet has recorded relatively little research attention compared with other crops and no sufficient work has analyzed its genetic diversity in north-western Nigeria. Therefore, this study was undertaken with the objectives to analyze the genetic diversity of pearl millet accessions using SSR marker and to analyze the extent of evolutionary relationship among pearl millet accessions at the molecular level. The result of the present study confirmed diversity among accessions of pearl millet in the study area. Simple Sequence Repeats (SSR) markers were used for genetic analysis and evolutionary relationship of the accessions of pearl millet. To analyze the level of genetic diversity, 8 polymorphic SSR markers were used to screen 69 accessions collected based on three maturity periods. SSR markers result reveal relationships among the accessions in terms of genetic similarities, evolutionary and ancestral origin, it also reveals a total of 53 alleles recorded with 8 microsatellites and an average of 6.875 per microsatellite, the range was from 3 to 9 alleles in PSMP2248 and PSMP2080 respectively. Moreover, both the factorial analysis and the dendrogram of phylogeny tree grouping patterns and cluster analysis were almost in agreement with each other that diversity is not clustering according to geographical patterns but, according to similarity, the result showed maximum similarity among clusters with few numbers of accessions. It has been recommended that other molecular markers should be tested in the same study area.

Keywords: pearl millet, genetic diversity, simple sequence repeat (SSR)

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Authors: Gianni Jacucci

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Epistemology traditionally finds its place within human research philosophies and methodologies. Artificial intelligence methods pose challenges, particularly given the unresolved relationship between AI and pivotal concepts in social arenas such as hermeneutics and accountability. We begin by examining the essential criteria governing scientific rigor in the human sciences. We revisit the three foundational philosophies underpinning qualitative research methods: empiricism, hermeneutics, and phenomenology. We elucidate the distinct attributes, merits, and vulnerabilities inherent in the methodologies they inspire. The integration of AI, e.g., deep learning algorithms, sparks an interest in evaluating these criteria against the diverse forms of AI architectures. For instance, Interpreted AI could be viewed as a hermeneutic approach, relying on a priori interpretations, while straight AI may be perceived as a descriptive phenomenological approach, processing original and uncontaminated data. This paper serves as groundwork for such explorations, offering preliminary reflections to lay the foundation and outline the initial landscape.

Keywords: artificial intelligence, deep learning, epistemology, qualitative research, methodology, hermeneutics, accountability

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Authors: Sayuri Inoue, Naohiro Nakamura, Tsubasa Hamada

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The seismic design method of buildings is classified into two types: static design and dynamic design. The static design is a design method that exerts static force as seismic force and is a relatively simple design method created based on the experience of seismic motion in the past 100 years. At present, static design is used for most of the Japanese buildings. Dynamic design mainly refers to the time history response analysis. It is a comparatively difficult design method that input the earthquake motion assumed in the building model and examine the response. Currently, it is only used for skyscrapers and specific buildings. In the present design standard in Japan, it is good to use either the design method of the static design and the dynamic design in the medium and high-rise buildings. However, when actually designing middle and high-rise buildings by two kinds of design methods, the relatively simple static design method satisfies the criteria, but in the case of a little difficult dynamic design method, the criterion isn't often satisfied. This is because the dynamic design method was built with the intention of designing super high-rise buildings. In short, higher safety is required as compared with general buildings, and criteria become stricter. The authors consider applying the dynamic design method to general buildings designed by the static design method so far. The reason is that application of the dynamic design method is reasonable for buildings that are out of the conventional standard structural form such as emphasizing design. For the purpose, it is important to compare the design results when the criteria of both design methods are arranged side by side. In this study, we performed time history response analysis to medium-rise buildings that were actually designed with allowable stress method. Quantitative comparison between static design and dynamic design was conducted, and characteristics of both design methods were examined.

Keywords: buildings, seismic design, allowable stress design, time history response analysis, Japanese seismic code

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Authors: Osman Turkoglu, Alvin Estilo, Ritu Gupta, Liliam Pineda-Salgado, Rajesh Pandey

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Background: Hepatotoxicity can be linked to a variety of clinical symptoms and histopathological signs, posing a great challenge in the surveillance of suspected drug-induced liver injury (DILI) cases in the safety database. Additionally, the majority of such cases are rare, idiosyncratic, highly unpredictable, and tend to demonstrate unique individual susceptibility; these qualities, in turn, lend to a pharmacovigilance monitoring process that is often tedious and time-consuming. Objective: Develop a multifactorial algorithm to assist pharmacovigilance physicians in identifying high-risk hepatotoxicity cases associated with DILI from the sponsor’s safety database (Argus). Methods: Multifactorial selection criteria were established using Structured Query Language (SQL) and the TIBCO Spotfire® visualization tool, via a combination of word fragments, wildcard strings, and mathematical constructs, based on Hy’s law criteria and pattern of injury (R-value). These criteria excluded non-eligible cases from monthly line listings mined from the Argus safety database. The capabilities and limitations of these criteria were verified by comparing a manual review of all monthly cases with system-generated monthly listings over six months. Results: On an average, over a period of six months, the algorithm accurately identified 92% of DILI cases meeting established criteria. The automated process easily compared liver enzyme elevations with baseline values, reducing the screening time to under 15 minutes as opposed to multiple hours exhausted using a cognitively laborious, manual process. Limitations of the algorithm include its inability to identify cases associated with non-standard laboratory tests, naming conventions, and/or incomplete/incorrectly entered laboratory values. Conclusions: The newly developed multifactorial algorithm proved to be extremely useful in detecting potential DILI cases, while heightening the vigilance of the drug safety department. Additionally, the application of this algorithm may be useful in identifying a potential signal for DILI in drugs not yet known to cause liver injury (e.g., drugs in the initial phases of development). This algorithm also carries the potential for universal application, due to its product-agnostic data and keyword mining features. Plans for the tool include improving it into a fully automated application, thereby completely eliminating a manual screening process.

Keywords: automation, drug-induced liver injury, pharmacovigilance, post-marketing

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Authors: Yong Bum Shin

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This case focuses on Weighted additive difference, Conjunctive, Disjunctive, and Elimination by aspects methodologies in consumer decision-making models and the Simple additive weighting (SAW) approach in the multi-criteria decision-making (MCDM) area. Most decision-making models illustrate that the rank reversal phenomenon is unpreventable. This paper presents that rank reversal occurs in popular managerial methods such as Weighted Additive Difference (WAD), Conjunctive Method, Disjunctive Method, Elimination by Aspects (EBA) and MCDM methods as well as such as the Simple Additive Weighting (SAW) and finally Unified Commensurate Multiple (UCM) models which successfully addresses these rank reversal problems in most popular MCDM methods in decision-making area.

Keywords: multiple criteria decision making, rank inconsistency, unified commensurate multiple, analytic hierarchy process

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Authors: Stephen Wagman

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This paper identifies three common structures in English sentences that are important for understanding academic texts, regardless of the characteristics or background of the readers or whether they are reading English as a second or a foreign language. Adapting a model from the Humanities, the explication of texts used in literary studies, the paper analyses sample sentences to reveal structures that enable the reader not only to decide which words are necessary for understanding the main ideas but to make the decision without knowing the meaning of the words. By their very syntax noun structures point to the key word for understanding them. As a rule, the key noun is followed by easily identifiable prepositions, relative pronouns, or verbs and preceded by single adjectives. With few exceptions, the modifiers are unnecessary for understanding the idea of the sentence. In addition, sentences are often structured by lists in which the items frequently consist of parallel groups of words. The principle of a list is that all the items are similar in meaning and it is not necessary to understand all of the items to understand the point of the list. This principle is especially important when the items are long or there is more than one list in the same sentence. The similarity in meaning of these items enables readers to reduce sentences that are hard to grasp to an understandable core without excessive use of a dictionary. Finally, the idea of subordination and the identification of the subordinate parts of sentences through connecting words makes it possible for readers to focus on main ideas without having to sift through the less important and more numerous secondary structures. Sometimes a main idea requires a subordinate one to complete its meaning, but usually, subordinate ideas are unnecessary for understanding the main point of the sentence and its part in the development of the argument from sentence to sentence. Moreover, the connecting words themselves indicate the functions of the subordinate structures. These most frequently show similarity and difference or reasons and results. Recognition of all of these structures can not only enable students to read more efficiently but to focus their attention on the development of the argument and this rather than a multitude of unknown vocabulary items, the repetition in lists, or the subordination in sentences are the one necessary element for comprehension of academic articles.

Keywords: development of the argument, lists, noun structures, subordination

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Authors: Deliou Adel, Saadalah Younes, Belkaid Khmissi, Dehbi Meriem

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Composite materials, in the most common sense of the term, are a set of synthetic materials designed and used mainly for structural applications; the mechanical function is dominant. The mechanical behaviors of the composite, as well as the degradation mechanisms leading to its rupture, depend on the nature of the constituents and on the architecture of the fiber preform. The profile is required because it guides the engineer in designing structures with precise properties in relation to the needs. This work is about studying the mechanical behavior of unidirectional composite laminates according to different failure criteria. Varying strength parameter values make it possible to compare the ultimate mechanical characteristics obtained by the criteria of Tsai-Hill, Fisher and maximum stress. The laminate is subjected to uniaxial tensile membrane forces. Estimates of their ultimate strengths and the plotting of the failure envelope constitute the principal axis of this study. Using the theory of maximum stress, we can determine the various modes of damage of the composite. The different components of the deformation are presented for different orientations of fibers.

Keywords: unidirectional kevlar/epoxy composite, failure criterion, membrane stress, deformations, failure envelope

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Authors: Seyed Reza Aghili, Tahereh Shokohi, Shirin Sadat Hashemi Fesharaki, Mohammad Ali Boroumand, Bahar Salmanian

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Introduction: Intravenous catheter-associated fungal infection as nosocomial infection continue to be a deep problem among hospitalized patients, decreasing quality of life and adding healthcare costs. The capacity of catheters in the spread of candidemia in heart failure patients is obvious. The aim of this study was to evaluate the prevalence and genetic identification of Candida species in heart disorder patients. Material and Methods: This study was conducted in Tehran Hospital of Cardiology Center (Tehran, Iran, 2014) during 1.5 years on the patients hospitalized for at least 7 days and who had central or peripheral vein catheter. Culture of catheters, blood and skin of the location of catheter insertion were applied for detecting Candida colonies in 223 patients. Identification of Candida species was made on the basis of a combination of various phenotypic methods and confirmed by sequencing the ITS1-5.8S-ITS2 region amplified from the genomic DNA using PCR and the NCBI BLAST. Results: Of the 223 patients samples tested, we identified totally 15 Candida isolates obtained from 9 (4.04%) catheter cultures, 3 (1.35%) blood cultures and 2 (0.90%) skin cultures of the catheter insertion areas. On the base of ITS region sequencing, out of nine Candida isolates from catheter, 5(55.6%) C. albicans, 2(22.2%) C. glabrata, 1(11.1%) C. membranifiaciens and 1 (11.1%) C. tropicalis were identified. Among three Candida isolates from blood culture, C. tropicalis, C. carpophila and C. membranifiaciens were identified. Non-candida yeast isolated from one blood culture was Cryptococcus albidus. One case of C. glabrata and one case of Candida albicans were isolated from skin culture of the catheter insertion areas in patients with positive catheter culture. In these patients, ITS region of rDNA sequence showed a similarity between Candida isolated from the skin and catheter. However, the blood samples of these patients were negative for fungal growth. We report two cases of catheter-related candidemia caused by C. membranifiaciens and C. tropicalis on the base of genetic similarity of species isolated from blood and catheter which were treated successfully with intravenous fluconazole and catheter removal. In phenotypic identification methods, we could only identify C. albicans and C. tropicalis and other yeast isolates were diagnosed as Candida sp. Discussion: Although more than 200 species of Candida have been identified, only a few cause diseases in humans. There is some evidence that non-albicans infections are increasing. Many risk factors, including prior antibiotic therapy, use of a central venous catheter, surgery, and parenteral nutrition are considered to be associated with candidemia in hospitalized heart failure patients. Identifying the route of infection in candidemia is difficult. Non-albicans candida as the cause of candidemia is increasing dramatically. By using conventional method, many non-albicans isolates remain unidentified. So, using more sensitive and specific molecular genetic sequencing to clarify the aspects of epidemiology of the unknown candida species infections is essential. The positive blood and catheter cultures for candida isolates and high percentage of similarity of their ITS region of rDNA sequence in these two patients confirmed the diagnosis of intravenous catheter-associated candidemia.

Keywords: catheter-associated infections, heart failure patient, molecular genetic sequencing, ITS region of rDNA, Candidemia

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Authors: Nasser Almonawer

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Timely reaction to an evolving global business environment and volatile market conditions necessitates system and process flexibility, which in turn demands agile and adaptable architecture and a steady infusion of affordable new technologies. On the contrary, a large number of organizations utilize systems characterized by inflexible and obsolete legacy architectures. To effectively respond to the dynamic contemporary business environments, such architectures must be migrated to robust and modular open architectures. To this end, this paper proposes an integrated decision support system for a seamless migration to open systems. The proposed decision support system (DSS) integrates three well-established quantitative and qualitative decision-making models—namely, the Delphi method, Analytic Hierarchy Process (AHP) and Goal Programming (GP) to (1) assess risks and establish evaluation criteria; (2) formulate migration strategy and rank candidate systems; and (3) allocate resources among the selected systems.

Keywords: decision support systems, open systems architecture, analytic hierarchy process (AHP), goal programming (GP), delphi method

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Authors: Chun-Shien Lu

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Privacy-preserving query has recently received considerable attention in the signal processing and multimedia community. It is also a critical step in wireless sensor network for retrieval of sensitive data. The purposes of privacy-preserving query in both the areas of signal processing and sensor network are the same, but the similarity and difference of the adopted technologies are not fully explored. In this paper, we first review the recently developed methods of privacy-preserving query, and then describe in a comprehensive manner what we can learn from the mutual of both areas.

Keywords: encryption, privacy-preserving, search, security

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Authors: Heeba A. Gurku

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Introduction: Cone Beam CT(CBCT) images play an integral part in proper patient positioning in cancer patients undergoing radiation therapy treatment. But these images are low in quality. The purpose of this study is to generate high-quality synthetic CT images from CBCT using generative models. Material and Methods: This study utilized two datasets from The Cancer Imaging Archive (TCIA) 1) Lung cancer dataset of 20 patients (with full view CBCT images) and 2) Pancreatic cancer dataset of 40 patients (only 27 patients having limited view images were included in the study). Cycle Generative Adversarial Networks (GAN) and its variant Attention Guided Generative Adversarial Networks (AGGAN) models were used to generate the synthetic CTs. Models were evaluated by visual evaluation and on four metrics, Structural Similarity Index Measure (SSIM), Peak Signal Noise Ratio (PSNR) Mean Absolute Error (MAE) and Root Mean Square Error (RMSE), to compare the synthetic CT and original CT images. Results: For pancreatic dataset with limited view CBCT images, our study showed that in Cycle GAN model, MAE, RMSE, PSNR improved from 12.57to 8.49, 20.94 to 15.29 and 21.85 to 24.63, respectively but structural similarity only marginally increased from 0.78 to 0.79. Similar, results were achieved with AGGAN with no improvement over Cycle GAN. However, for lung dataset with full view CBCT images Cycle GAN was able to reduce MAE significantly from 89.44 to 15.11 and AGGAN was able to reduce it to 19.77. Similarly, RMSE was also decreased from 92.68 to 23.50 in Cycle GAN and to 29.02 in AGGAN. SSIM and PSNR also improved significantly from 0.17 to 0.59 and from 8.81 to 21.06 in Cycle GAN respectively while in AGGAN SSIM increased to 0.52 and PSNR increased to 19.31. In both datasets, GAN models were able to reduce artifacts, reduce noise, have better resolution, and better contrast enhancement. Conclusion and Recommendation: Both Cycle GAN and AGGAN were significantly able to reduce MAE, RMSE and PSNR in both datasets. However, full view lung dataset showed more improvement in SSIM and image quality than limited view pancreatic dataset.

Keywords: CT images, CBCT images, cycle GAN, AGGAN

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Authors: Guillaume P. Fernandez

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Individual language use is a matter of choice in particular interactions. The paper proposes a conceptual and theoretical framework with methodological consideration to develop how language produced in dyadic relations is to be considered and situated in the larger social configuration the interaction is embedded within. An integrated and comprehensive view is taken: social interactions are expected to be ruled by a normative context, defined by the chain of interdependences that structures the personal network. In this approach, the determinants of discursive practices are not only constrained by the moment of production and isolated from broader influences. Instead, the position the individual and the dyad have in the personal network influences the discursive practices in a twofold manner: on the one hand, the network limits the access to linguistic resources available within it, and, on the other hand, the structure of the network influences the agency of the individual, by the social control inherent to particular network characteristics. Concretely, we investigate how and to what extent consistent ego is from one interaction to another in his or her use of adverbs. To do so, social network analysis (SNA) methods are mobilized. Participants (N=130) are college students recruited in the french speaking part of Switzerland. The personal network of significant ones of each individual is created using name generators and edge interpreters, with a focus on social support and conflict. For the linguistic parts, respondents were asked to record themselves with five of their close relations. From the recordings, we computed an average similarity score based on the adverb used across interactions. In terms of analyses, two are envisaged: First, OLS regressions including network-level measures, such as density and reciprocity, and individual-level measures, such as centralities, are performed to understand the tenets of linguistic similarity from one interaction to another. The second analysis considers each social tie as nested within ego networks. Multilevel models are performed to investigate how the different types of ties may influence the likelihood to use adverbs, by controlling structural properties of the personal network. Primary results suggest that the more cohesive the network, the less likely is the individual to change his or her manner of speaking, and social support increases the use of adverbs in interactions. While promising results emerge, further research should consider a longitudinal approach to able the claim of causality.

Keywords: personal network, adverbs, interactions, social influence

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Authors: M. A. C. S. Sampath Fernando, James M. Curran, Renate Meyer

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Model assessment, in the Bayesian context, involves evaluation of the goodness-of-fit and the comparison of several alternative candidate models for predictive accuracy and improvements. In posterior predictive checks, the data simulated under the fitted model is compared with the actual data. Predictive model accuracy is estimated using information criteria such as the Akaike information criterion (AIC), the Bayesian information criterion (BIC), the Deviance information criterion (DIC), and the Watanabe-Akaike information criterion (WAIC). The goal of an information criterion is to obtain an unbiased measure of out-of-sample prediction error. Since posterior checks use the data twice; once for model estimation and once for testing, a bias correction which penalises the model complexity is incorporated in these criteria. Cross-validation (CV) is another method used for examining out-of-sample prediction accuracy. Leave-one-out cross-validation (LOO-CV) is the most computationally expensive variant among the other CV methods, as it fits as many models as the number of observations. Importance sampling (IS), truncated importance sampling (TIS) and Pareto-smoothed importance sampling (PSIS) are generally used as approximations to the exact LOO-CV and utilise the existing MCMC results avoiding expensive computational issues. The reciprocals of the predictive densities calculated over posterior draws for each observation are treated as the raw importance weights. These are in turn used to calculate the approximate LOO-CV of the observation as a weighted average of posterior densities. In IS-LOO, the raw weights are directly used. In contrast, the larger weights are replaced by their modified truncated weights in calculating TIS-LOO and PSIS-LOO. Although, information criteria and LOO-CV are unable to reflect the goodness-of-fit in absolute sense, the differences can be used to measure the relative performance of the models of interest. However, the use of these measures is only valid under specific circumstances. This study has developed 11 models using normal, log-normal, gamma, and student’s t distributions to improve the PCR stutter prediction with forensic data. These models are comprised of four with profile-wide variances, four with locus specific variances, and three which are two-component mixture models. The mean stutter ratio in each model is modeled as a locus specific simple linear regression against a feature of the alleles under study known as the longest uninterrupted sequence (LUS). The use of AIC, BIC, DIC, and WAIC in model comparison has some practical limitations. Even though, IS-LOO, TIS-LOO, and PSIS-LOO are considered to be approximations of the exact LOO-CV, the study observed some drastic deviations in the results. However, there are some interesting relationships among the logarithms of pointwise predictive densities (lppd) calculated under WAIC and the LOO approximation methods. The estimated overall lppd is a relative measure that reflects the overall goodness-of-fit of the model. Parallel log-likelihood profiles for the models conditional on equal posterior variances in lppds were observed. This study illustrates the limitations of the information criteria in practical model comparison problems. In addition, the relationships among LOO-CV approximation methods and WAIC with their limitations are discussed. Finally, useful recommendations that may help in practical model comparisons with these methods are provided.

Keywords: cross-validation, importance sampling, information criteria, predictive accuracy

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Authors: Sushmita Roy Chowdhury, Steve Holding, Sujoy Khan

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The immunogenic responses of the lung towards the fungus Aspergillus fumigatus may range from invasive aspergillosis in the immunocompromised, fungal ball or infection within a cavity in the lung in those with structural lung lesions, or allergic bronchopulmonary aspergillosis (ABPA). Patients with asthma or cystic fibrosis are particularly predisposed to ABPA. There are consensus guidelines that have established criteria for diagnosis of ABPA, but uncertainty remains on the serologic cut-off values that would increase the diagnostic specificity of ABPA. We retrospectively analyzed 80 patients with severe asthma and evidence of peripheral blood eosinophilia ( > 500) over the last 3 years who underwent all serologic tests to exclude ABPA. Total IgE, specific IgE and specific IgG levels against Aspergillus fumigatus were measured using ImmunoCAP Phadia-100 (Thermo Fisher Scientific, Sweden). The Modified ISHAM working group 2013 criteria (obligate criteria: asthma or cystic fibrosis, total IgE > 1000 IU/ml or > 417 kU/L and positive specific IgE Aspergillus fumigatus or skin test positivity; with ≥ 2 of peripheral eosinophilia, positive specific IgG Aspergillus fumigatus and consistent radiographic opacities) was used in the clinical workup for the final diagnosis of ABPA. Patients were divided into 3 groups - definite, possible, and no evidence of ABPA. Specific IgG Aspergillus fumigatus levels were not used to assign the patients into any of the groups. Of 80 patients (males 48, females 32; mean age 53.9 years ± SD 15.8) selected for the analysis, there were 30 patients who had positive specific IgE against Aspergillus fumigatus (37.5%). 13 patients fulfilled the Modified ISHAM working group 2013 criteria of ABPA (‘definite’), while 15 patients were ‘possible’ ABPA and 52 did not fulfill the criteria (not ABPA). As IgE levels were not normally distributed, median levels were used in the analysis. Median total IgE levels of patients with definite and possible ABPA were 2144 kU/L and 2597 kU/L respectively (non-significant), while median specific IgE Aspergillus fumigatus at 4.35 kUA/L and 1.47 kUA/L respectively were significantly different (comparison of standard deviations F-statistic 3.2267, significance level p=0.040). Mean levels of IgG anti-Aspergillus fumigatus in the three groups (definite, possible and no evidence of ABPA) were compared using ANOVA (Statgraphics Centurion Professional XV, Statpoint Inc). Mean levels of IgG anti-Aspergillus fumigatus (Gm3) in definite ABPA was 125.17 mgA/L ( ± SD 54.84, with 95%CI 92.03-158.32), while mean Gm3 levels in possible and no ABPA were 18.61 mgA/L and 30.05 mgA/L respectively. ANOVA showed a significant difference between the definite group and the other groups (p < 0.001). This was confirmed using multiple range tests (Fisher's least significant difference procedure). There was no significant difference between the possible ABPA and not ABPA groups (p > 0.05). The study showed that a sizeable proportion of patients with asthma are sensitized to Aspergillus fumigatus in this part of India. A higher cut-off value of Gm3 ≥ 80 mgA/L provides a higher serologic specificity towards definite ABPA. Long-term studies would provide us more information if those patients with 'possible' APBA and positive Gm3 later develop clear ABPA, and are different from the Gm3 negative group in this respect. Serologic testing with clear defined cut-offs are a valuable adjunct in the diagnosis of ABPA.

Keywords: allergic bronchopulmonary aspergillosis, Aspergillus fumigatus, asthma, IgE level

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Authors: M. A. Talha, M. Osman Gani, M. Ferdows

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This paper focuses on the study of two dimensional magnetohydrodynamic (MHD) steady incompressible viscous Williamson nanofluid with exponential internal heat generation containing gyrotactic microorganism over a stretching sheet. The governing equations and auxiliary conditions are reduced to a set of non-linear coupled differential equations with the appropriate boundary conditions using similarity transformation. The transformed equations are solved numerically through spectral relaxation method. The influences of various parameters such as Williamson parameter γ, power constant λ, Prandtl number P_r, magnetic field parameter M, Peclet number P_e, Lewis number Le, Bioconvection Lewis number Lb, Brownian motion parameter Nb, thermophoresis parameter Nt, and bioconvection constant σ are studied to obtain the momentum, heat, mass and microorganism distributions. Moment, heat, mass and gyrotactic microorganism profiles are explored through graphs and tables. We computed the heat transfer rate, mass flux rate and the density number of the motile microorganism near the surface. Our numerical results are in better agreement in comparison with existing calculations. The Residual error of our obtained solutions is determined in order to see the convergence rate against iteration. Faster convergence is achieved when internal heat generation is absent. The effect of magnetic parameter M decreases the momentum boundary layer thickness but increases the thermal boundary layer thickness. It is apparent that bioconvection Lewis number and bioconvection parameter has a pronounced effect on microorganism boundary. Increasing brownian motion parameter and Lewis number decreases the thermal boundary layer. Furthermore, magnetic field parameter and thermophoresis parameter has an induced effect on concentration profiles.

Keywords: convection flow, similarity, numerical analysis, spectral method, Williamson nanofluid, internal heat generation

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Authors: Ankit Tyagi, Reet Kamal Tiwari, Naveen James

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In India, landslides are the most frequently occurring disaster in the regions of the Himalayas and the Western Ghats. The steep slopes and land use in these areas are quite apprehensive. In the recent past, many landslide hazard zonation (LHZ) works have been carried out in the Himalayas. However, the preparation of LHZ maps considering temporal factors such as seismic ground shaking, seismic amplification at surface level, and rainfall are limited. Hence this study presents a comprehensive use of the multi-criteria decision-making (MCDM) method in landslide risk assessment. In this research, we conducted both geospatial and geotechnical analysis to minimize the danger of landslides. Geospatial analysis is performed using high-resolution satellite data to produce landslide causative factors which were given weightage using the MCDM method. The geotechnical analysis includes a slope stability check, which was done to determine the potential landslide slope. The landslide risk map can provide useful information which helps people to understand the risk of living in an area.

Keywords: landslide hazard zonation, PHA, AHP, GIS

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Authors: Sohan Sengupta, Arnab Pramanik, Abhrajyoti Ghosh, Maitree Bhattacharyya

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Newly emerged phyto-pathogens and multi drug resistance have been threating the world for last few decades. Actinomycetes, the most endowed group of microorganisms isolated from unexplored regions of the world may be the ultimate solution to these problems. Thus the aim of this study was to isolate several bioactive actinomycetes strains capable of producing antimicrobial secondary metabolite from Sundarbans, the only mangrove tiger land of the world. Fifty four actinomycetes were isolated and analyzed for antimicrobial activity against fifteen test organisms including three phytopathogens. Nine morphologically distinct and biologically active isolates were subjected to polyphasic identification study. 16s rDNA sequencing indicated eight isolates to reveal maximum similarity to the genus streptomyces, whereas one isolate presented only 93.57% similarity with Streptomyces albogriseolus NRRL B-1305T. Seventy-one carbon sources and twenty-three chemical sources utilization assay revealed their metabolic relatedness. Among these nine isolates three specific strains were found to have notably higher degree of antimicrobial potential effective in a broader range including phyto-pathogenic fungus. PCR base whole genome screen for PKS and NRPS genes, confirmed the occurrence of bio-synthetic gene cluster in some of the isolates for novel antibiotic production. Finally the strain SMS_SU21, which showed antimicrobial activity with MIC value of 0.05 mg ml-1and antioxidant activity with IC50 value of 0.242±0.33 mg ml-1 was detected to be the most potential one. True prospective of this strain was evaluated utilizing GC-MS and the bioactive compound responsible for antimicrobial activity was purified and characterized. Rare bioactive actinomycetes were isolated from unexplored heritage site. Diversity of the biosynthetic gene cluster for antimicrobial compound production has also been evaluated. Antimicrobial compound SU21-C has been identified and purified which is active against a broad range of pathogens.

Keywords: actinomycetes, sundarbans, antimicrobial, pks nrps, phyto-pathogens, GC-MS

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Authors: Uroš Durlević, Ivan Novković, Nina Čegar, Stefanija Stojković

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Snow avalanches represent one of the most dangerous natural phenomena in mountain regions worldwide. Material and human casualties caused by snow avalanches can be very significant. In this study, using geographic information systems and remote sensing, the natural conditions of the Šar Mountains were analyzed for geospatial modeling of dry slab avalanches. For this purpose, the Fuzzy Analytic Hierarchy Process (FAHP) multi-criteria analysis method was used, within which fifteen environmental criteria were analyzed and evaluated. Based on the existing analyzes and results, it was determined that a significant area of the Šar Mountains is very highly susceptible to the occurrence of dry slab avalanches. The obtained data can be of significant use to local governments, emergency services, and other institutions that deal with natural disasters at the local level. To our best knowledge, this is one of the first research in the Republic of Serbia that uses the FAHP method for geospatial modeling of dry slab avalanches.

Keywords: GIS, FAHP, Šar Mountains, snow avalanches, environmental protection

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Authors: Walid Al-Qerem, Ruba Zumot

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Background: The rise of obesity among children and adolescents remains a primary challenge for healthcare providers globally and in the Middle East. The aim of the present study is to determine the prevalence of obesity among 5-20 years old Jordanians based on CDC criteria. Method: A total of 5722 Jordanians (37% males; 63% females) aged 5-20 years data were retrieved from the Jordanian Ministry of Health electronic database (Hakeem). As per the CDC selection criteria, the chosen data pertains exclusively to healthy Jordanian children and adolescents who are medically sound, not suffering from health conditions, and not undergoing any treatments that could hinder normal growth patterns, such as severe infection, chronic kidney disease (CKD), Down’s syndrome, attention deficit hyperactivity disorder, cancer, heart disease, lung disease, cystic fibrosis, Crohn’s disease, type 1 diabetes, hormonal disturbances, any stress-related conditions, hormonal therapy such as corticosteroids, Growth hormones (GHS) or gonadotropin-releasing hormone agonists, insulin, and amphetamines or any other stimulants. In addition, participants with missing or invalid data values for anthropometric measurements were excluded from the study. Weight for age and body mass index for age were analyzed comparatively for Jordanian children and adolescents against the international growth standards. The Z-score for each record was computed based on CDC equations. As per CDC classifications, BMI for age percentiles, values ≥85th and < 95th are classified as overweight, and value at ≥ 95th is classified as obesity. Results: The average age of the evaluated sample was 12.33 ±4.39 years (10.79 ±3.39 for males and 13.23 ± 4.66 for females). The mean weight for males and females were 33.16±14.17 Kg and 133.54±17.17 cm for males, 43.86 ±18.82 Kg, and 142.19±18.35 for females, while for BMI the mean was for boys and girls 17.81±3.88 and 20.52±5.03 respectively. The results indicated that based on CDC criteria, 8.9% of males were classified as children/adolescents with overweight, and 9.7% were classified as children/adolescents with obesity, while in females, 17.8% were classified as children/adolescents with overweight and 10.2% were classified as children/adolescents with obesity. Discussion: The high prevalence of obesity reported in the present study emphasizes the importance of applying different strategies to prevent childhood obesity, including encouraging physical activity, promoting healthier food options, and behavioral changes. Conclusion: The results presented in this study indicated the high prevalence of overweight/obesity among Jordanian adolescents and children, which must be tagged by healthcare planners and providers.

Keywords: CDC, obesity, childhood, Jordan

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Authors: Herlena Hayati, Diyan Reni Jayathi, Hairida Anggun, Citra Amelia

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This systematic review research is aimed to find out anemia maternal during pregnancy as a risk factor of low birth weight. This research was done by searching some journals which have associated to maternal anemia during pregnancy with low birth weight that had been published in journal accreditation and scopus index. Study literature that researcher had been done by March – April 2016 through online library of UI. The journals that had been selected according to inclusive criteria and exclusive criteria had been through the critial appraisal process. This systematic review towards 4 journals that had been selected and published showed the significant result statistically that anemia maternal is one of the risk factors which causes low birth weight. Anemia maternal on the first-trimester pregnancy showed significant association with low birth weight. Moderate anemia and severe anemia also showed significant association with low birth weight. Meanwhile, mild anemia doesn’t have an association with low birth weight. The conclusion of this study is anemia maternal (as an independent risk factor) have an influence towards low birth weight.

Keywords: anemia maternal, low birth weight, pregnancy, systematic review

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Authors: Jaci Mastrandrea

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Background: The National Comprehensive Cancer Network (NCCN) recommends that healthcare institutions have established processes for integrating palliative care (PC) into cancer treatment and that all cancer patients be screened for PC needs upon initial diagnosis as well as throughout the entire continuum of care (National Comprehensive Cancer Network, 2021). Early PC screening is directly correlated with improved patient outcomes. The Sky Lakes Cancer Treatment Center (SLCTC) is an institution that has access to PC services yet does not have protocols in place for identifying patients with palliative needs or a standardized referral process. The aim of this quality improvement project is to improve early access to PC services by establishing a standardized screening and referral process for outpatient oncology patients. Method: The sample population included all adult patients with an oncology diagnosis who presented to the SLCTC for treatment during the project timeline from March 15th, 2022, to April 29th, 2022. The “Palliative and Supportive Needs Assessment'' (PSNA) screening tool was developed from validated and evidence-based PC referral criteria. The tool was initially implemented using paper forms and later was integrated into the Epic-Beacon EHR system. Patients were screened by registered nurses on the SLCTC treatment team. Nurses responsible for screening patients received an educational inservice prior to implementation. Patients with a PSNA score of three or higher were considered to be a positive screen. Scores of five or higher triggered a PC referral order in the patient’s EHR for the oncologist to review and approve. All patients with a positive screen received an educational handout on the topic of PC, and the EHR was flagged for follow-up. Results: Prior to implementation of the PSCNA screening tool, the SLCTC had zero referrals to PC in the past year, excluding referrals to hospice. Data was collected from the first 100 patient screenings completed within the eight-week data collection period. Seventy-three percent of patients met criteria for PC referral with a score greater than or equal to three. Of those patients who met referral criteria, 53.4% (39 patients) were referred for a palliative and supportive care consultation. Patients that were not referred to PC upon meeting the criteria were flagged in the EHR for re-screening within one to three months. Patients with lung cancer, chronic hematologic malignancies, breast cancer, and gastrointestinal malignancy most frequently met criteria for PC referral and scored highest overall on the scale of 0-12. Conclusion: The implementation of a standardized PC screening tool at the SLCTC significantly increased awareness of PC needs among cancer patients in the outpatient setting. Additionally, data derived from this quality improvement project supports the national recommendation for PC to be an integral component of cancer treatment across the entire continuum of care.

Keywords: oncology, palliative care, symptom management, symptom screening, ambulatory oncology, cancer, supportive care

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Authors: Hans Marquez Ramos, Cesar Hernandez, Ingrid Páez

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This paper develops a multiple channel assignment model, which allows to take advantage in most efficient way, spectrum opportunities in cognitive radio networks. Developed scheme allows make several available and frequency adjacent channel assignments, which require a bigger wide band, under an equality environment. The hybrid assignment model it is made by to algorithms, one who makes the ranking and select available frequency channels and the other one in charge of establishing an equality criteria, in order to not restrict spectrum opportunities for all other secondary users who wish to make transmissions. Measurements made were done for average bandwidth, average delay, as well fairness computation for several channel assignment. Reached results were evaluated with experimental spectrum occupational data from GSM frequency band captured. Developed model, shows evidence of improvement in spectrum opportunity use and a wider average transmit bandwidth for each secondary user, maintaining equality criteria in channel assignment.

Keywords: bandwidth, fairness, multichannel, secondary users

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Authors: Arpit Gite

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Purpose: We have evaluated the role of Total Neoadjuvant Therapy in patients with Locally Advanced Rectal cancer by giving Chemoradiotherapy followed by consolidation chemotherapy (CRT-CNCT) and, after that, the strategy of wait and watch. Methods: In this prospective case series, we evaluated the results of three locally advanced Rectal cancers, two cases Stage II (cT3N0) and one case Stage III ( cT4aN2). All three patients' growth was 4-6 cm from the anal verge. We have treated with Chemoradiotherapy to dose of 45Gy/25 Fractions to elective nodal regions (Inguinal node in anal canal Involvement)and Primary and mesorectum (Phase I) followed by 14.4Gy/8 Fractions to Primary and Mesorectum(Phase II) to a total dose of 59.4Gy/33 Fractions with concurrent chemotherapy Tab Capecitabine 825mg/m2 PO BD with Radiation therapy. After 6 weeks of completion of Chemoradiotherapy, advised six cycles of consolidative chemotherapy, CAPEOX regimen, Oxaliplatin 130mg/m2 on day 1 and Capecitabine 1000mg/m2 PO BD on days 1-14 repeated on a 21-day cycle for a total of six cycles. The primary endpoint is Disease-free survival (DFS); the secondary endpoint is adverse events related to chemoradiotherapy. Radiation toxicity is assessed by RTOG criteria, and chemotherapy toxicity is assessed by Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. Results: After 6 weeks of completion of Chemoradiotherapy, we did PET-CT of all three patients; all three patients had a clinically complete response and we advised 6 cycles of consolidative chemotherapy. After completion of consolidative chemotherapy, again PET-CT and sigmoidoscopy, all three patients had complete response on PET-CT and no lesions on sigmoidoscopy and kept all three patients on wait and watch.2 patients had Grade 2 skin toxicities,1 patient had Grade 1 skin toxicity, .2 patients had Grade 2 lower GI toxicities, and 1 patient had Grade lower GI toxicity, both according to RTOG criteria. 3 patients had Grade 2 diarrhea due to capecitabine, and 1 patient had Grade 1 thrombocytopenia due to oxaliplatin assessed by Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. Conclusion: Sphincter Preservation is possible with this regimen in those who don’t want to opt for surgery or in case of low-lying rectal cancer.

Keywords: locally advanced rectal cancer, sphincter preservation, chemoradiotherapy, consolidative chemotherapy

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