Search results for: procedure checklist
Commenced in January 2007
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Paper Count: 2403

Search results for: procedure checklist

1923 The Use of Project to Enhance Learning Domains Stated by National Qualifications Framework: TQF

Authors: Duangkamol Thitivesa

Abstract:

This paper explores the use of project work in a content-based instruction in a Rajabhat University, Thailand. The use of project is to promote kinds of learning expected of student teachers as stated by Thailand Quality Framework: TQF. The kinds of learning are grouped into five domains: Ethical and moral development, knowledge, cognitive skill, interpersonal skills and responsibility, and analytical and communication skills. The content taught in class is used to lead the student teachers to relate their previously-acquired linguistic knowledge to meaningful realizations of the language system in passages of immediate relevance to their professional interests, teaching methods in particular. Two research questions are formulate to guide this study: 1) To what degree are the five domains of learning expected of student teachers after the use of project in a content class?, and 2) What is the academic achievement of the students’ writing skills, as part of the learning domains stated by TQF, against the 70% attainment target after the use of project to enhance the skill? The sample of the study comprised of 38 fourth-year English major students. The data was collected by means of a summative achievement test, student writing works, an observation checklist, and project diary. The scores in the summative achievement test were analyzed by mean score, standard deviation, and t-test. Project diary serves as students’ record of the language acquired during the project. List of structures and vocabulary noted in the diary has shown students’ ability to attend to, recognize, and focus on meaningful patterns of language forms.

Keywords: Thailand quality framework, project Work, writing skill, summative

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1922 Optimal Energy Management System for Electrical Vehicles to Further Extend the Range

Authors: M. R. Rouhi, S. Shafiei, A. Taghavipour, H. Adibi-Asl, A. Doosthoseini

Abstract:

This research targets at alleviating the problem of range anxiety associated with the battery electric vehicles (BEVs) by considering mechanical and control aspects of the powertrain. In this way, all the energy consuming components and their effect on reducing the range of the BEV and battery life index are identified. On the other hand, an appropriate control strategy is designed to guarantee the performance of the BEV and the extended electric range which is evaluated by an extensive simulation procedure and a real-world driving schedule.

Keywords: battery, electric vehicles, ultra-capacitor, model predictive control

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1921 Rapid Parallel Algorithm for GPS Signal Acquisition

Authors: Fabricio Costa Silva, Samuel Xavier de Souza

Abstract:

A Global Positioning System (GPS) receiver is responsible to determine position, velocity and timing information by using satellite information. To get this information's are necessary to combine an incoming and a locally generated signal. The procedure called acquisition need to found two information, the frequency and phase of the incoming signal. This is very time consuming, so there are several techniques to reduces the computational complexity, but each of then put projects issues in conflict. I this papers we present a method that can reduce the computational complexity by reducing the search space and paralleling the search.

Keywords: GPS, acquisition, low complexity, parallelism

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1920 Modal Approach for Decoupling Damage Cost Dependencies in Building Stories

Authors: Haj Najafi Leila, Tehranizadeh Mohsen

Abstract:

Dependencies between diverse factors involved in probabilistic seismic loss evaluation are recognized to be an imperative issue in acquiring accurate loss estimates. Dependencies among component damage costs could be taken into account considering two partial distinct states of independent or perfectly-dependent for component damage states; however, in our best knowledge, there is no available procedure to take account of loss dependencies in story level. This paper attempts to present a method called "modal cost superposition method" for decoupling story damage costs subjected to earthquake ground motions dealt with closed form differential equations between damage cost and engineering demand parameters which should be solved in complex system considering all stories' cost equations by the means of the introduced "substituted matrixes of mass and stiffness". Costs are treated as probabilistic variables with definite statistic factors of median and standard deviation amounts and a presumed probability distribution. To supplement the proposed procedure and also to display straightforwardness of its application, one benchmark study has been conducted. Acceptable compatibility has been proven for the estimated damage costs evaluated by the new proposed modal and also frequently used stochastic approaches for entire building; however, in story level, insufficiency of employing modification factor for incorporating occurrence probability dependencies between stories has been revealed due to discrepant amounts of dependency between damage costs of different stories. Also, more dependency contribution in occurrence probability of loss could be concluded regarding more compatibility of loss results in higher stories than the lower ones, whereas reduction in incorporation portion of cost modes provides acceptable level of accuracy and gets away from time consuming calculations including some limited number of cost modes in high mode situation.

Keywords: dependency, story-cost, cost modes, engineering demand parameter

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1919 Application of Scoring Rubrics by Lecturers towards Objective Assessment of Essay Questions in the Department of Social Science Education, University of Calabar, Nigeria

Authors: Donald B. Enu, Clement O. Ukpor, Abigail E. Okon

Abstract:

Unreliable scoring of students’ performance by lecturers short-chains students’ assessment in terms of underequipping the school authority with facts as intended by society through the curriculum hence, the learners, the school and the society are cheated because the usefulness of testing is defeated. This study, therefore, examined lecturers’ scoring objectivity of essay items in the Department of Social Science Education, University of Calabar, Nigeria. Specifically, it assessed lecturers’ perception of the relevance of scoring rubrics and its level of application. Data were collected from all the 36 lecturers in the Department (28 members and 8 non-members adjourned to the department), through a 20-item questionnaire and checklist instruments. A case-study design was adopted. Descriptive statistics of frequency counts, weighted means, standard deviations, and percentages were used to analyze data gathered. A mean score of 2.5 and or 60 percent and above formed the acceptance or significant level in decision taking. It was found that lecturers perceived the use of scoring rubrics as a relevant practice to ensure fairness and reliable treatment of examiners scripts particularly in marking essay items and that there is a moderately high level of adherence to the application of scoring rubrics. It was also observed that some criteria necessary for the scoring objectivity of essay items were not fully put in place in the department. It was recommended strongly that students’ identities be hidden while marking and that pre-determined marking scheme should be prepared centrally and strictly adhered to during marking and recording of scores. Conference marking should be enforced in the department.

Keywords: essay items, objective scoring, scorers reliability, scoring rubrics

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1918 Pancreatic Adenocarcinoma Correctly Diagnosed by EUS but nor CT or MRI

Authors: Yousef Reda

Abstract:

Pancreatic cancer has an overall dismal prognosis. CT, MRI and Endoscopic Ultrasound are most often used to establish the diagnosis. We present a case of a patient found on abdominal CT and MRI to have an 8 mm cystic lesion within the head of the pancreas which was thought to be a benign intraductal papillary mucinous neoplasm (IPMN). Further evaluation by EUS demonstrated a 1 cm predominantly solid mass that was proven to be an adenocarcinoma by EUS-guided FNA. The patient underwent a Whipple procedure. The final pathology confirmed a 1 cm pT1 N0 pancreatic ductal adenocarcinoma. Case: A 63-year-old male presented with left upper quadrant pain and an abdominal CT demonstrated an 8 mm lesion within the head of the pancreas that was thought to represent a side branch IPMN. An MRI also showed similar findings. Four months later due to ongoing symptoms an EUS was performed to re-evaluate the pancreatic lesion. EUS revealed a predominantly solid hypoechoic, homogeneous mass measuring 12 mm x 9 mm. EUS-guided FNA was performed and was positive for adenocarcinoma. The patient underwent a Whipple procedure that confirmed it to be a ductal adenocarcinoma, pT1N0. The solid mass was noted to be adjacent to a cystic dilation with no papillary architecture and scant epithelium. The differential diagnosis resided between cystic degeneration of a primary pancreatic adenocarcinoma versus malignant degeneration within a side-branch IPMN. Discussion: The reported sensitivity of CT for pancreatic cancer is approximately 90%. For pancreatic tumors, less than 3 cm the sensitivity of CT is reduced ranging from 67-77%. MRI does not significantly improve overall detection rates compared to CT. EUS, however is superior to CT in the detection of pancreatic cancer, in particular among lesions smaller than 3 cm. EUS also outperforms CT and MRI in distinguishing neoplastic from non-neoplastic cysts. In this case, both MRI and CT failed to detect a small pancreatic adenocarcinoma. The addition of EUS and FNA to abdominal imaging can increase overall accuracy for the diagnosis of neoplastic pancreatic lesions. It may be prudent that when small lesions although appearing as a benign IPMN should further be evaluated by EUS as this would lead to potentially identifying earlier stage pancreatic cancers and improve survival in a disease which has a dismal prognosis.

Keywords: IPMN, MRI, EUS, CT

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1917 Urban Health and Strategic City Planning: A Case from Greece

Authors: Alexandra P. Alexandropoulou, Andreas Fousteris, Eleni Didaskalou, Dimitrios A. Georgakellos

Abstract:

As urbanization is becoming a major stress factor not only for the urban environment but also for the wellbeing of city dwellers, incorporating the issues of urban health in strategic city planning and policy-making has never been more relevant. The impact of urbanization can vary from low to severe and relates to all non-communicable diseases caused by the different functions of cities. Air pollution, noise pollution, water and soil pollution, availability of open green spaces, and urban heat island are the major factors that can compromise citizens' health. Urban health describes the effects of the social environment, the physical environment, and the availability and accessibility to health and social services. To assess the quality of urban wellbeing, all urban characteristics that might have an effect on citizens' health must be considered, evaluated, and introduced in integrated local planning. A series of indices and indicators can be used to better describe these effects and set the target values in policy making. Local strategic planning is one of the most valuable development tools a local city administration can possess; thus, it has become mandatory under Greek law for all municipalities. It involves a two-stage procedure; the first aims to collect, analyse and evaluate data on the current situation of the city (administrative data, population data, environmental data, social data, swot analysis), while the second aims to introduce a policy vision described and supported by distinct (nevertheless integrated) actions, plans and measures to be implemented with the aim of city development and citizen wellbeing. In this procedure, the element of health is often neglected or under-evaluated. A relative survey was conducted among all Greek local authorities in order to shed light on the current situation. Evidence shows that the rate of incorporation of health in strategic planning is lacking behind. The survey also highlights key hindrances and concerns raised by local officials and suggests a path for the way forward.

Keywords: urban health, strategic planning, local authorities, integrated development

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1916 Estimation of Fragility Curves Using Proposed Ground Motion Selection and Scaling Procedure

Authors: Esra Zengin, Sinan Akkar

Abstract:

Reliable and accurate prediction of nonlinear structural response requires specification of appropriate earthquake ground motions to be used in nonlinear time history analysis. The current research has mainly focused on selection and manipulation of real earthquake records that can be seen as the most critical step in the performance based seismic design and assessment of the structures. Utilizing amplitude scaled ground motions that matches with the target spectra is commonly used technique for the estimation of nonlinear structural response. Representative ground motion ensembles are selected to match target spectrum such as scenario-based spectrum derived from ground motion prediction equations, Uniform Hazard Spectrum (UHS), Conditional Mean Spectrum (CMS) or Conditional Spectrum (CS). Different sets of criteria exist among those developed methodologies to select and scale ground motions with the objective of obtaining robust estimation of the structural performance. This study presents ground motion selection and scaling procedure that considers the spectral variability at target demand with the level of ground motion dispersion. The proposed methodology provides a set of ground motions whose response spectra match target median and corresponding variance within a specified period interval. The efficient and simple algorithm is used to assemble the ground motion sets. The scaling stage is based on the minimization of the error between scaled median and the target spectra where the dispersion of the earthquake shaking is preserved along the period interval. The impact of the spectral variability on nonlinear response distribution is investigated at the level of inelastic single degree of freedom systems. In order to see the effect of different selection and scaling methodologies on fragility curve estimations, results are compared with those obtained by CMS-based scaling methodology. The variability in fragility curves due to the consideration of dispersion in ground motion selection process is also examined.

Keywords: ground motion selection, scaling, uncertainty, fragility curve

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1915 Synchronization of a Perturbed Satellite Attitude Motion using Active Sliding Mode Controller

Authors: Djaouida Sadaoui

Abstract:

In this paper, the design procedure of the active sliding mode controller which is a combination of the active controller and the sliding mode controller is given first and then the problem of synchronization of two satellites systems is discussed for the proposed method. Finally, numerical results are presented to evaluate the robustness and effectiveness of the proposed control strategy.

Keywords: active control, sliding mode control, synchronization, satellite attitude

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1914 Planning and Design Criteria to Make Urban Transport More Sustainable: The Case of Baku

Authors: Gülnar Bayramoğlu Barman

Abstract:

Since the industrial revolution, technological developments and increased population have caused environmental damages. To protect the nature and architectural environment, firstly, green architecture, ecological architecture and then sustainability occurred. This term has been proposed not to be a new term but a response to environmental disturbances caused by human activities and it is re-conceptualization of architecture. Sustainable architecture or sustainability is lot more extensive than ecological and green architecture. It contains the imbalance between environmental problems that is natural environment and consumption that occurred all around the world. An important part of sustainability debate focused on urban planning and design for more sustainable forms and patterns. In particular, it is discussed that planning and design of urban areas have a major effect on transport and therefore can help reduce car usage, emissions, global warming and climate change. There are many planning and design approaches and movement that introduce certain criteria and strategies to prevent car dependency and encourage people to use public transportation and walking. However, when review the literature, it is seen that planning movements, such as New Urbanism and Transit Oriented Development originated and were implemented mostly in West European and North American Cities. The purpose of this study is to find out whether all those criteria, principles and strategies are also relevant planning approaches for more non-western cities like Baku, which has a very different planning background and therefore possibly different urban form and transport issues. In order to answer the above mentioned question, planning and design approaches in the literature and these recent planning movements were studied and a check list was formed which indicate planning and design approaches that can help attain a more sustainable transport outcome. The checklist was then applied to the case of Baku.

Keywords: sustainability, sustainable development, sustainable transportation, transport, urban design

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1913 Methodology for the Integration of Object Identification Processes in Handling and Logistic Systems

Authors: L. Kiefer, C. Richter, G. Reinhart

Abstract:

The uprising complexity in production systems due to an increasing amount of variants up to customer innovated products leads to requirements that hierarchical control systems are not able to fulfil. Therefore, factory planners can install autonomous manufacturing systems. The fundamental requirement for an autonomous control is the identification of objects within production systems. In this approach an attribute-based identification is focused for avoiding dose-dependent identification costs. Instead of using an identification mark (ID) like a radio frequency identification (RFID)-Tag, an object type is directly identified by its attributes. To facilitate that it’s recommended to include the identification and the corresponding sensors within handling processes, which connect all manufacturing processes and therefore ensure a high identification rate and reduce blind spots. The presented methodology reduces the individual effort to integrate identification processes in handling systems. First, suitable object attributes and sensor systems for object identification in a production environment are defined. By categorising these sensor systems as well as handling systems, it is possible to match them universal within a compatibility matrix. Based on that compatibility further requirements like identification time are analysed, which decide whether the combination of handling and sensor system is well suited for parallel handling and identification within an autonomous control. By analysing a list of more than thousand possible attributes, first investigations have shown, that five main characteristics (weight, form, colour, amount, and position of subattributes as drillings) are sufficient for an integrable identification. This knowledge limits the variety of identification systems and leads to a manageable complexity within the selection process. Besides the procedure, several tools, as an example a sensor pool are presented. These tools include the generated specific expert knowledge and simplify the selection. The primary tool is a pool of preconfigured identification processes depending on the chosen combination of sensor and handling device. By following the defined procedure and using the created tools, even laypeople out of other scientific fields can choose an appropriate combination of handling devices and sensors which enable parallel handling and identification.

Keywords: agent systems, autonomous control, handling systems, identification

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1912 Fluid Prescribing Post Laparotomies

Authors: Gusa Hall, Barrie Keeler, Achal Khanna

Abstract:

Introduction: NICE guidelines have highlighted the consequences of IV fluid mismanagement. The main aim of this study was to audit fluid prescribing post laparotomies to identify if fluids were prescribed in accordance to NICE guidelines. Methodology: Retrospective database search of eight specific laparotomy procedures (colectomy right and left, Hartmann’s procedure, small bowel resection, perforated ulcer, abdominal perineal resection, anterior resection, pan proctocolectomy, subtotal colectomy) highlighted 29 laparotomies between April 2019 and May 2019. Two of 29 patients had secondary procedures during the same admission, n=27 (patients). Database case notes were reviewed for date of procedure, length of admission, fluid prescribed and amount, nasal gastric tube output, daily bloods results for electrolytes sodium and potassium and operational losses. Results: n=27 based on 27 identified patients between April 2019 – May 2019, 93% (25/27) received IV fluids, only 19% (5/27) received the correct IV fluids in accordance to NICE guidelines, 93% (25/27) who received IV fluids had the correct electrolytes levels (sodium & potassium), 100% (27/27) patients received blood tests (U&E’s) for correct electrolytes levels. 0% (0/27) no documentation on operational losses. IV fluids matched nasogastric tube output in 100% (3/3) of the number of patients that had a nasogastric tube in situ. Conclusion: A PubMed database literature review on barriers to safer IV prescribing highlighted educational interventions focused on prescriber knowledge rather than how to execute the prescribing task. This audit suggests IV fluids post laparotomies are not being prescribed consistently in accordance to NICE guidelines. Surgical management plans should be clearer on IV fluids and electrolytes requirements for the following 24 hours after the plan has been initiated. In addition, further teaching and training around IV prescribing is needed together with frequent surgical audits on IV fluid prescribing post-surgery to evaluate improvements.

Keywords: audit, IV Fluid prescribing, laparotomy, NICE guidelines

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1911 The Technique of Mobilization of the Colon for Pull-Through Procedure in Hirschsprung's Disease

Authors: Medet K. Khamitov, Marat M. Ospanov, Vasiliy M. Lozovoy, Zhenis N. Sakuov, Dastan Z. Rustemov

Abstract:

With a high rectosigmoid transitional zone in children with Hirschsprung’s disease, the upper rectal, sigmoid, left colon arteries are ligated during the pull-through of the descending part of the colon. As a result, the inferior mesenteric artery ceases to participate in the blood supply to the descending part of the colon. As a result, the reduced colon is supplied with blood only by the middle colon artery, which originates from the superior mesenteric artery. Insufficiency of blood supply to the reduced colon is the cause of the development of chronic hypoxia of the intestinal wall or necrosis of the reduced descending colon. Some surgeons prefer to preserve the left colon artery. However, it is possible to stretch the mesentery, which can lead to bowel retraction to anastomotic leaks and stenosis. Chronic hypoxia of the reduced colon, in turn, is the cause of acquired (secondary) aganglionosis. The highest frequency of anastomotic leaks is observed in children older than five years. The purpose is to reduce the risk of complications in the pull-through procedure of the descending part of the colon in patients with Hirschsprung’s disease by ensuring its sufficient mobility and maintaining blood supply to the lower mesenteric artery. Methodology and events. Two children aged 5 and 7 years with Hirschsprung’s disease were operated under the conditions of the hospital in Nur-Sultan. The diagnosis was made using x-ray contrast enema and histological examination. Operational technique. After revision of the left part of the colon and assessment of the architectonics of its blood vessels, parietal mobilization of the affected sigmoid and rectum was performed on laparotomy access, while maintaining the arterial and venous terminal arcades of the sigmoid vessels. Then, the descending branch of the left colon artery was crossed (if there is an insufficient length of the reduced intestine, the left colonic artery itself may also be crossed). This manipulation provides additional mobility of the pull-through descending part of the colon. The resulting "windows" in the mesentery of the reduced intestine were sutured to prevent the development of an internal hernia. Formed a full-blooded, sufficiently long transplant from the transverse loops of the splenic angle and the descending parts of the colon with blood supply from the upper and lower mesenteric artery, freely, without tension, is reduced to the rectal zone with the coloanal anastomosis 1.5 cm above the dentate line. Results. The postoperative period was uneventful. Patients were discharged on the 7th day. The observation was carried out for six months. In no case, there was a bowel retraction, anastomotic leak, anastomotic stenosis, or other complications. Conclusion. The presented technique of mobilization of the colon for the pull-through procedure in a high transitional rectosigmoid zone of Hirschsprung’s disease allows to maintain normal blood supply to the distal part of the colon and to avoid the tension of the colon. The technique allows reducing the risk of anastomotic leak, bowel necrosis, chronic ischemia, to exclude colon retraction and anastomotic stenosis.

Keywords: blood supply, children, colon mobilization, Hirschsprung's disease, pull-through

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1910 Screening for Internet Addiction among Medical Students in a Saudi Community

Authors: Nawaf A. Alqahtani, Ali M. Alqahtani, Khalid A. Alqahtani, Huda S. Abdullfattah, Ebtehal A. Alessa, Khalid S. Al Gelban, Ossama A. Mostafa

Abstract:

Background: The internet is an exciting medium that is becoming an essential part of everyday life. Although the internet is fully observed in Saudi Arabia, young people may be vulnerable to problematic internet use, possibly leading to addiction. Aim of study: To explore the magnitude of internet addiction (IA) among medical students associated risk factors and its impact on students' academic achievement. Subjects and Methods: A cross sectional study was conducted in 2014 on 571 medical students (293 males and 278 females) at the College of Medicine, King Khalid University, Abha, Saudi Arabia. Data Collection was done through using the Arabic version of the Compulsive Internet Use Scale and a checklist of demographic characteristics. Results: Age of participants ranged from 19 to 26 years (Mean+SD: 21.9+1.5 years). Internet access was available to 97.4% of students at home and to 80.2% of students at their mobile phones. The most frequently accessed websites by medical students were the social media (90.7%), scientific website (50.4%) and the news websites (31.3%). IA was mild in 47.8% of medical students while 5.8% had moderate IA. None of the students had severe IA. Prevalence of IA was significantly higher among female medical students (p=0.002), availability of internet at home (p=0.022), and availability of internet at the students' mobile phone (p=0.041). The mean General Point Average (GPA) was highest among students with mild IA (4.0+0.6), compared with 3.6+0.6 among those with moderate addiction, and 3.9+0.6 among those who did not show IA. Differences in mean GPA according to grade of IA were statistically significant ((P=0.001). Conclusions: Prevalence of IA is high among medical students in Saudi Arabia. Risk factors for IA include female gender, availability of internet at home or at the mobile phone. IA has a significant impact on students' GPA. Periodic screening of medical students for IA and raising their awareness toward the possible risk of IA are recommended.

Keywords: internet addiction, medical students, risk factors, Saudi Arabia

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1909 An Integreated Intuitionistic Fuzzy ELECTRE Model for Multi-Criteria Decision-Making

Authors: Babek Erdebilli

Abstract:

The aim of this study is to develop and describe a new methodology for the Multi-Criteria Decision-Making (MCDM) problem using IFE (Elimination Et Choix Traduisant La Realite (ELECTRE) model. The proposed models enable Decision-Makers (DMs) on the assessment and use Intuitionistic Fuzzy Numbers (IFN). A numerical example is provided to demonstrate and clarify the proposed analysis procedure. Also, an empirical experiment is conducted to validation the effectiveness.

Keywords: multi-criteria decision-making, IFE, DM’s, fuzzy electre model

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1908 Use of a Symptom Scale Based on Degree of Functional Impairment for Acute Concussion

Authors: Matthew T. McCarthy, Sarah Janse, Natalie M. Pizzimenti, Anthony K. Savino, Brian Crosser, Sean C. Rose

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Concussion is diagnosed clinically using a comprehensive history and exam, supported by ancillary testing. Frequently, symptom checklists are used as part of the evaluation of concussion. Existing symptom scales are based on a subjective Likert scale, without relation of symptoms to clinical or functional impairment. This is a retrospective review of 133 patients under age 30 seen in an outpatient neurology practice within 30 days of a probable or definite concussion. Each patient completed 2 symptom checklists at the initial visit – the SCAT-3 symptom evaluation (22 symptoms, 0-6 scale) and a scale based on the degree of clinical impairment for each symptom (22 symptoms, 0-3 scale related to functional impact of the symptom). Final clearance date was determined by the treating physician. 60.9% of patients were male with mean age 15.7 years (SD 2.3). Mean time from concussion to first visit was 6.9 days (SD 6.2), and 101 patients had definite concussions (75.9%), while 32 were diagnosed as probable (24.1%). 94 patients had a known clearance date (70.7%) with mean clearance time of 20.6 days (SD 18.6) and median clearance time of 19 days (95% CI 16-21). Mean total symptom score was 27.2 (SD 22.9) on the SCAT-3 and 14.7 (SD 11.9) for the functional impairment scale. Pearson’s correlation between the two scales was 0.98 (p < 0.001). After adjusting for patient and injury characteristics, an equivalent increase in score on each scale was associated with longer time to clearance (SCAT-3 hazard ratio 0.885, 95%CI 0.835-0.938, p < 0.001; functional impairment scale hazard ratio 0.851, 95%CI 0.802-0.902, p < 0.001). A concussion symptom scale based on degree of functional impairment correlates strongly with the SCAT-3 scale and demonstrates a similar association with time to clearance. By assessing the degree of impact on clinical functioning, this symptom scale reflects a more intuitive approach to rating symptoms and can be used in the management of concussion.

Keywords: checklist, concussion, neurology, scale, sports, symptoms

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1907 Urinary Mucosal Cryoglobulin: A Review

Authors: Ibrahim M. S. Shnawa, Naeem R. R. Algebory

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The procedure for the assessment of the urinary mucosal cryoglobulin (UMCG) is being reviewed, testified and evaluated. The major features of UMCG are rather similar to that of serum cryoglobulin. Such evident similarities are forming the reality for the existence of the UMCG. There were seven characterizing criteria useable for the identification for UMCG. Upon matching them to the Irish criteria for serum cryoglobulin, some modifications are being proposed to the 16th standards that has been formulated and built as an Irish criterion. The existence of UMCG is being reported for the first time in human chronic infectious bacterial disease.

Keywords: urinary, mucosal, cryoglubulin, standard immunofixation

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1906 Change in Self-Reported Personality in Students of Acting

Authors: Nemanja Kidzin, Danka Puric

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Recently, the field of personality change has received an increasing amount of attention. Previously under-researched variables, such as the intention to change or taking on new social roles (in a working environment, education, family, etc.), have been shown to be relevant for personality change. Following this line of research, our study aimed to determine whether the process of acting can bring about personality changes in students of acting and, if yes, in which way. We hypothesized that there will be a significant difference between self-reported personality traits of students acting at the beginning and the end of preparing for a role. Additionally, as potential moderator variables, we measured the reported personality traits of the roles the students were acting, as well as empathy, disintegration, and years of formal education. The sample (N = 47) was composed of students of acting from the Faculty of Dramatic Arts (first- to fourth-year) and the Faculty of Modern Arts (first-year students only). Participants' mean age was 20.2 (SD = 1.47), and there were 64% of females. The procedure included two waves of testing (T1 at the beginning and T2 at the end of the semester), and students’ acting exercises and character immersion comprised the pseudo-experimental procedure. Students’ personality traits (HEXACO-60, self-report version), empathy (Questionnaire of Cognitive and Affective Empathy, QCAE), and disintegration (DELTA9, 10-item version) were measured at both T1 and T2, while the personality of the role (HEXACO-60 observer version) was measured at T2. Responses to all instruments were given on a 5-point Likert scale. A series of repeated-measures T-tests showed significant differences in emotionality (t(46) = 2.56, p = 0.014) and conscientiousness (t(46) = -2.39, p = 0.021) between T1 and T2. Moreover, an index of absolute personality change was significantly different from 0 for all traits (range .53 to .34, t(46) = 4.20, p < .001 for the lowest index. The average test-retest correlation for HEXACO traits was 0.57, which is lower than proposed by other similar researches. As for moderator variables, neither the personality of the role nor empathy or disintegration explained the change in students’ personality traits. The magnitude of personality change was the highest in fourth-year students, with no significant differences between the remaining three years of studying. Overall, our results seem to indicate some personality changes in students of acting. However, these changes cannot be unequivocally related to the process of preparing for a role. Further and methodologically stricter research is needed to unravel the role of acting in personality change.

Keywords: theater, personality change, acting, HEXACO

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1905 Frequency of Alloimmunization in Sickle Cell Disease Patients in Africa: A Systematic Review with Meta-analysis

Authors: Theresa Ukamaka Nwagha, Angela Ogechukwu Ugwu, Martins Nweke

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Background and Objectives: Blood transfusion is an effective and proven treatment for some severe complications of sickle cell disease. Recurrent transfusions have put patients with sickle cell disease at risk of developing antibodies against the various antigens they were exposed to. This study aims to investigate the frequency of red blood cell alloimmunization in patients with sickle disease in Africa. Materials and Methods: This is a systematic review of peer-reviewed literature published in English. The review was conducted consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Data sources for the review include MEDLINE, PubMed, CINAHL, and Academic Search Complete. Included in this review are articles that reported the frequency/prevalence of red blood cell alloimmunization in sickle cell disease patients in Africa. Eligible studies were subjected to independent full-text screening and data extraction. Risk of bias assessment was conducted with the aid of the mixed method appraisal tool. We employed a random-effects model of meta-analysis to estimate the pooled prevalence. We computed Cochrane’s Q statistics and I2 and prediction interval to quantify heterogeneity in effect size. Results: The prevalence estimates range from 2.6% to 29%. Pooled prevalence was estimated to be 10.4% (CI 7.7.–13.8); PI = 3.0 – 34.0%), with significant heterogeneity (I2 = 84.62; PI = 2.0-32.0%) and publication bias (Egger’s t-test = 1.744, p = 0.0965). Conclusion: The frequency of red cell alloantibody varies considerably in Africa. The alloantibodies appeared frequent in this order: the Rhesus, Kell, Lewis, Duffy, MNS, and Lutheran

Keywords: frequency, red blood cell, alloimmunization, sickle cell disease, Africa

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1904 History of Pediatric Renal Pathology

Authors: Mostafa Elbaba

Abstract:

Because childhood renal diseases are grossly different compared to adult diseases, pediatric nephrology was founded as a specialty in 1965. Renal pathology specialty was introduced at the London Ciba Symposium in 1961. The history of renal pathology can be divided into two eras: one starting in the 1650s with the invention of the microscope, the second in the 1950s with the implementation of renal biopsy, and the presence of electron microscopy and immunofluorescence study. Prior to the 1950s, the study of diseased human kidneys was restricted to postmortem examination by gross pathology. In 1827, Richard Bright first described his triad of kidney disease, which was confirmed by morbid kidney changes at autopsy. In 1905 Friedrich Mueller coined the term “nephrosis” describing the inflammatory form of “degenerative” diseases, and later F. Munk added the term “lipoid nephrosis”. The most profound influence on renal diseases’ classification came from the publication of Volhard and Fahr in 1914. In 1899, Carl Max Wilhelm Wilms described Wilms' tumor of the kidneys in children. Chronic pyelonephritis was a popular renal diagnosis and the most common cause of uremia until the 1960s. Although kidney biopsy had been used early in the 1930s for renal tumors, the earliest reports of its use in the diagnosis of medical kidney disease were by Iversen and Brun in 1951, followed by Alwall in 1952, then by Pardo in 1953. The earliest intentional renal biopsies were done in 1944 by Nils Alwall, while the procedure was abandoned after the death of one of his 13 patients who biopsied. In 1950, Antonino Perez-Ara attempted renal biopsies, but his results were missed because of an unpopular journal publication. In the year 1951, Claus Brun and Poul Iverson developed the biopsy procedure using an aspiration technique. Popularizing renal biopsy practice is accredited to Robert Kark, who published his distinct work in 1954. He perfected the technique of renal biopsy in the prone position using the Vim-Silverman needle and used intravenous pyelography to improve the localization of the kidney.

Keywords: history, medicine, nephrology, pediatrics, pathology

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1903 Designing Agile Product Development Processes by Transferring Mechanisms of Action Used in Agile Software Development

Authors: Guenther Schuh, Michael Riesener, Jan Kantelberg

Abstract:

Due to the fugacity of markets and the reduction of product lifecycles, manufacturing companies from high-wage countries are nowadays faced with the challenge to place more innovative products within even shorter development time on the market. At the same time, volatile customer requirements have to be satisfied in order to successfully differentiate from market competitors. One potential approach to address the explained challenges is provided by agile values and principles. These agile values and principles already proofed their success within software development projects in the form of management frameworks like Scrum or concrete procedure models such as Extreme Programming or Crystal Clear. Those models lead to significant improvements regarding quality, costs and development time and are therefore used within most software development projects. Motivated by the success within the software industry, manufacturing companies have tried to transfer agile mechanisms of action to the development of hardware products ever since. Though first empirical studies show similar effects in the agile development of hardware products, no comprehensive procedure model for the design of development iterations has been developed for hardware development yet due to different constraints of the domains. For this reason, this paper focusses on the design of agile product development processes by transferring mechanisms of action used in agile software development towards product development. This is conducted by decomposing the individual systems 'product development' and 'agile software development' into relevant elements and symbiotically composing the elements of both systems in respect of the design of agile product development processes afterwards. In a first step, existing product development processes are described following existing approaches of the system theory. By analyzing existing case studies from industrial companies as well as academic approaches, characteristic objectives, activities and artefacts are identified within a target-, action- and object-system. In partial model two, mechanisms of action are derived from existing procedure models of agile software development. These mechanisms of action are classified in a superior strategy level, in a system level comprising characteristic, domain-independent activities and their cause-effect relationships as well as in an activity-based element level. Within partial model three, the influence of the identified agile mechanism of action towards the characteristic system elements of product development processes is analyzed. For this reason, target-, action- and object-system of the product development are compared with the strategy-, system- and element-level of agile mechanism of action by using the graph theory. Furthermore, the necessity of existence of activities within iteration can be determined by defining activity-specific degrees of freedom. Based on this analysis, agile product development processes are designed in form of different types of iterations within a last step. By defining iteration-differentiating characteristics and their interdependencies, a logic for the configuration of activities, their form of execution as well as relevant artefacts for the specific iteration is developed. Furthermore, characteristic types of iteration for the agile product development are identified.

Keywords: activity-based process model, agile mechanisms of action, agile product development, degrees of freedom

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1902 China Pakistan Economic Corridor: A Changing Mechanism in Pakistan

Authors: Komal Niazi, He Guoqiang

Abstract:

This paper is focused on ‘CPEC (China Pakistan Economic Corridor) a changing mechanism in Pakistan’. China Pakistan Economic Corridor (CPEC) activity under OBOR (One Belt One Road (OBOR) CPEC is a piece of the bigger umbrella and goes for giving another hallway of exchange for China and Pakistan and is relied upon to profit the entire of South Asian area. But this study reveals that significance of acculturation can never be overemphasized in the investigation of diverse impacts and the routes people groups of various ethnic personalities figure out how to adjust and acknowledge the social attributes of a larger part group in a multiethnic culture. This study also deals with the effects of acculturation which can be seen at multiple levels through CPEC for both Pakistani and Chinese people, who were working on this project. China and Pakistan exchanged the cultural and social patterns with each other. Probably the most perceptible gathering level impacts of cultural assimilation regularly incorporate changes in sustenance (food), clothing, and language. At the individual level, the procedure of cultural assimilation alludes to the socialization procedure by which the Pakistani local people and Chinese who were working in Pakistan adopted values, traditions, attitudes, states of mind, and practices. But China has imposed discourse through economic power and language. CPEC dominates Pakistan’s poor area’s and changes their living, social and cultural values. People also claimed this acculturation was a great threat to their cultural values and religious beliefs. Main findings of the study clearly ascertained that research was to find out the conceptual understanding of people about the acculturation process through CPEC. At the cultural level, aggregate activities and social organizations end up plainly adjusted, and at the behavioral level, there are changes in a person's day by day behavioral collection and some of the time in experienced anxiety. Anthropological data methods were used to collect data, like snowball and judgmental sampling, case studied methods.

Keywords: CPEC, acculturation process, language discourse, social norms, cultural values, religious beliefs

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1901 Alumina Nanoparticles in One-Pot Synthesis of Pyrazolopyranopyrimidinones

Authors: Saeed Khodabakhshi, Alimorad Rashidi, Ziba Tavakoli, Sajad Kiani, Sadegh Dastkhoon

Abstract:

Alumina nanoparticles (γ-Al2O3 NPs) were prepared via a new and simple synthetic route and characterized by field emission scanning electron microscope, X-ray diffraction, and Fourier transform infrared spectroscopy. The catalytic activity of prepared γ-Al2O3 NPs was investigated for the one-pot, four-component synthesis of fused tri-heterocyclic compounds containing pyrazole, pyran, and pyrimidine. This procedure has some advantages such as high efficiency, simplicity, high rate and environmental safety.

Keywords: alumina nanoparticles, one-pot, fused tri-heterocyclic compounds, pyran

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1900 The Moderating Roles of Bedtime Activities and Anxiety and Depression in the Relationship between Attention-Deficit/Hyperactivity Disorder and Sleep Problems in Children

Authors: Lian Tong, Yan Ye, Qiong Yan

Abstract:

Background: Children with attention-deficit/hyperactivity disorder (ADHD) often experience sleep problems, but the comorbidity mechanism has not been sufficiently studied. This study aimed to determine the comorbidity of ADHD and sleep problems as well as the moderating effects of bedtime activities and depression/anxiety symptoms on the relationship between ADHD and sleep problems. Methods: We recruited 934 primary students from third to fifth grade and their parents by stratified random sampling from three primary schools in Shanghai, China. This study used parent-reported versions of the ADHD Rating Scale-IV, Children’s Sleep Habits Questionnaire, and Achenbach Child Behavior Checklist. We used hierarchical linear regression analysis to clarify the moderating effects of bedtime activities and depression/anxiety symptoms. Results: We found that children with more ADHD symptoms had shorter sleep durations and more sleep problems on weekdays. Screen time before bedtime strengthened the relationship between ADHD and sleep-disordered breathing. Children with more screen time were more likely to have sleep onset delay, while those with less screen time had more sleep onset problems with increasing ADHD symptoms. The high bedtime eating group experienced more night waking with increasing ADHD symptoms compared with the low bedtime eating group. Anxiety/depression exacerbated total sleep problems and further interacted with ADHD symptoms to predict sleep length and sleep duration problems. Conclusions: Bedtime activities and emotional problems had important moderating effects on the relationship between ADHD and sleep problems. These findings indicate that appropriate bedtime management and emotional management may reduce sleep problems and improve sleep duration for children with ADHD symptoms.

Keywords: ADHD, sleep problems, anxiety/depression, bedtime activities, children

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1899 A Review of the Handling and Disposal of Botulinum Toxin in a Maxillofacial Unit

Authors: Ashana Gupta

Abstract:

Aim: In the UK, Botulinum Toxin (botox) is authorised for treating chronic myofascial pain secondary to masseter muscle hypertrophy (Fedorowicz et al. 2013). This audit aimed to ensure the Maxillofacial Unit is meeting the trust guidelines for the safe storage and disposal of botox. Method: The trust upholds a strict policy for botox handling. The audit was designed to optimise several elements including Staff awareness of regulations around botox handling A questionnaire was designed to test knowledge of advised storage temperatures, reporting of adverse events, disposal procedures and regulatory authorities. Steps taken to safely delivertoxin and eliminate unused toxin. A checklist was completed. These include marks for storagetemperature, identification checks, disposal of sharps, deactivation of toxin, and disposal. Results: All staff correctly stated storage requirements for toxin. 75% staff (n=8) were unsure about reporting and regulations. Whilst all staff knew how to dispose of vials, 0% staff showed awareness for the crucial step of deactivating toxin. All checklists (n=20) scored 100% for adequate storage, ID checks, and toxin disposal. However, there were no steps taken to deactivate toxin in any cases. Staff training took place with revision to clinical protocols. In line with Trust guidelines, an additional clinical step has been introduced including use of 0.5% sodium hypochlorite to deactivate botox. Conclusion: Deactivation is crucial to ensure residual toxin is not misused. There are cases of stolen botox within South-Tees Hospital (Woodcock, 2014). This audit was successful in increasing compliance to safe handling and disposal of botox by 100% and ensured our hospitalmeets Trust guidance.

Keywords: botulinum toxin, aesthetics, handling, disposal

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1898 A Psychosocial Impact of the Covid-19 Pandemic Among Frontline Workers and General Populations in Kathmandu

Authors: Nabin Prasad Joshi

Abstract:

A new variant of the coronavirus family found in the Wuhan city market of China is causing serious harm to human beings. After the WHO decided COVID-19 was a pandemic situation, everyone started to measure the prevention of infectious diseases according to WHO guidelines. It includes social distancing, isolation, quarantine, lockdown, sanitation, and masking, respectively. During this time, the researcher has observed the difficulties of cultivating the new normal in people in Nepal. People have perceived the single coronavirus differently; common populations and frontline workers have different perceptions of coronavirus. The researcher started to measure the psychosocial impact of the COVID-19 pandemic on frontline workers and general populations in Kathmandu valley. The total number of sample units for this research is 82; it includes 52 general populations and 30 frontline workers. These sample units are selected through convenient sampling and purposive sampling, respectively. This research is based on descriptive and exploratory design. DASS-21 of the Nepali version is a comprehensive data collection tool for depression, anxiety, and stress measurement in this research, and simultaneously the psychosocial checklist, key-informant interview, and case study have been done. Quantitative data are analyzed with the help of excel, and qualitative data are through thematic analysis. The study has shown that the occurrence of psychosocial issues among frontline workers is greater than in general populations. It is found that the informants with higher education status have greater psychosocial issues in comparison to low education status. In the context of a pandemic, family/friends’ support can function as a protective factor when at adequate levels.

Keywords: anxiety, depression, isolation, lockdown

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1897 The Potential in the Use of Building Information Modelling and Life-Cycle Assessment for Retrofitting Buildings: A Study Based on Interviews with Experts in Both Fields

Authors: Alex Gonzalez Caceres, Jan Karlshøj, Tor Arvid Vik

Abstract:

Life cycle of residential buildings are expected to be several decades, 40% of European residential buildings have inefficient energy conservation measure. The existing building represents 20-40% of the energy use and the CO₂ emission. Since net zero energy buildings are a short-term goal, (should be achieved by EU countries after 2020), is necessary to plan the next logical step, which is to prepare the existing outdated stack of building to retrofit them into an energy efficiency buildings. In order to accomplish this, two specialize and widespread tool can be used Building Information Modelling (BIM) and life-cycle assessment (LCA). BIM and LCA are tools used by a variety of disciplines; both are able to represent and analyze the constructions in different stages. The combination of these technologies could improve greatly the retrofitting techniques. The incorporation of the carbon footprint, introducing a single database source for different material analysis. To this is added the possibility of considering different analysis approaches such as costs and energy saving. Is expected with these measures, enrich the decision-making. The methodology is based on two main activities; the first task involved the collection of data this is accomplished by literature review and interview with experts in the retrofitting field and BIM technologies. The results of this task are presented as an evaluation checklist of BIM ability to manage data and improve decision-making in retrofitting projects. The last activity involves an evaluation using the results of the previous tasks, to check how far the IFC format can support the requirements by each specialist, and its uses by third party software. The result indicates that BIM/LCA have a great potential to improve the retrofitting process in existing buildings, but some modification must be done in order to meet the requirements of the specialists for both, retrofitting and LCA evaluators.

Keywords: retrofitting, BIM, LCA, energy efficiency

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1896 Evaluation of Intraoral Complications of Buccal Mucosa Graft in Augmentation Urethroplasty

Authors: Dahna Alkahtani, Faryal Suraya, Fadah Alanazi

Abstract:

Background: Buccal mucosal graft for urethral augmentation has surpassed other grafting options, and is now considered the standard of choice for substitution Urethroplasty. The graft has gained its popularity due to its excellent short and long-term results, easy harvesting as well as its ability in withstanding wet environments. However, although Buccal mucosal grafts are an excellent option, it is not free of complications, potential intraoral complications are bleeding, pain, swelling, injury to the nerve resulting in numbness, lip deviation or retraction. Objectives: The current study aims to evaluate the intraoral complications of buccal mucosa grafts harvested from one cheek, and used in Augmentation Urethroplasty. Methodology: The study was conducted retrospectively using the medical records of patients who underwent open augmentation urethroplasty with a buccal mucosa graft at King Khalid University Hospital, Saudi Arabia. Data collection of demographics included the type of graft used, presence or absence of strictures and its etiological factors. Pre-operative and post-operative evaluations were carried out on the subjects including the medical history, physical examination, uroflowmetry, retrograde urethrography, voiding cystourethrography and urine cultures were also noted. Further, the quality of life and complications of the procedure including the presence or occurrence of bleeding within 3-days post-procedure, the severity of pain, oral swelling after grafting, length of return to normal daily diet, painful surgical site, intake of painkillers, presence or absence of speech disturbance, numbness in the cheeks and lips were documented. Results: Thirty-two male subjects with ages ranging from 15 years to 72 years were included in the current study. Following the procedure, a hundred percent of the subjects returned to their normal daily diet by the sixth postoperative day. Further, the majority of the patients reported experiencing mild pain accounting for 61.3%, and 90.3% of the subjects reported using painkillers to control the pain. Surgical wound Pain was reportedly more common at the perineal site as 48.4% of the subjects experienced it; on the other hand, 41.9% of the patients experienced pain in the oral mucosa. The presence of speech disorders, as assessed through medical history, was found to be present in 3.2% of patients. The presence of numbness in the cheeks and lips was found in 3.2% of patients. Other complications such as parotid duct injury, delayed wound healing, non-healing wound and suture granuloma were rare as 90.3% of the subjects denied experiencing any of them, there were nonetheless reports of parotid duct injury by 6.5% of the patients, and non-healing wound by the 3.2% of patients. Conclusion: Buccal Mucosa Graft in Augmentation Urethroplasty is an ideal source of allograft, although not entirely painless; it is considerably safe with minimal intra-oral complication and undetectable strain on the patients’ quality of life.

Keywords: augmentation, buccal, graft, oral

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1895 Effectiveness of Adrenal Venous Sampling in the Management of Primary Aldosteronism: Single Centered Cohort Study at a Tertiary Care Hospital in Sri Lanka

Authors: Balasooriya B. M. C. M., Sujeeva N., Thowfeek Z., Siddiqa Omo, Liyanagunawardana J. E., Jayawardana Saiu, Manathunga S. S., Katulanda G. W.

Abstract:

Introduction and objectives: Adrenal venous sampling (AVS) is the gold standard to discriminate unilateral primary aldosteronism (UPA) from bilateral disease (BPA). AVS is technically demanding and only performed in a limited number of centers worldwide. To the best of our knowledge, Except for one study conducted in India, no other research studies on this area have been conducted in South Asia. This study aimed to evaluate the effectiveness of AVS in the management of primary aldosteronism. Methods: A total of 32 patients who underwent AVS at the National Hospital of Sri Lanka from April 2021 to April 2023 were enrolled. Demographic, clinical and laboratory data were obtained retrospectively. A procedure was considered successful when adequate cannulation of both adrenal veins was demonstrated. Cortisol gradient across the adrenal vein (AV) and the peripheral vein was used to establish the success of venous cannulation. Lateralization was determined by the aldosterone gradient between the two sides. Continuous and categorical variables were summarized with mean, SD, and proportions, respectively. The mean and standard deviation of the contralateral suppression index (CSI) were estimated with an intercept-only Bayesian inference model. Results: Of the 32 patients, the average age was 52.47 +26.14 and 19 (59.4%) were males. Both AVs were successfully cannulated in 12 (37.5%). Among them, lateralization was demonstrated in 11(91.7%), and one was diagnosed as a bilateral disease. There were no total failures. Right AV cannulation was unsuccessful in 18 (56.25%), of which lateralization was demonstrated in 9 (50%), and others were inconclusive. Left AV cannulation was unsuccessful only in 2 (6.25%); one was lateralized, and the other remained inconclusive. The estimated mean of the CSI was 0.33 (89% credible interval 0.11-0.86). Seven patients underwent unilateral adrenalectomy and demonstrated significant improvement in blood pressure during follow-up. Two patients await surgery. Others were treated medically. Conclusions: Despite failure due to procedural difficulties, AVS remained useful in the management of patients with PA. Moreover, the success of the procedure needs experienced hands and advanced equipment to achieve optimal outcomes in PA.

Keywords: adrenal venous sampling, lateralization, contralateral suppression index, primary aldosteronism

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1894 Conjunctive Management of Surface and Groundwater Resources under Uncertainty: A Retrospective Optimization Approach

Authors: Julius M. Ndambuki, Gislar E. Kifanyi, Samuel N. Odai, Charles Gyamfi

Abstract:

Conjunctive management of surface and groundwater resources is a challenging task due to the spatial and temporal variability nature of hydrology as well as hydrogeology of the water storage systems. Surface water-groundwater hydrogeology is highly uncertain; thus it is imperative that this uncertainty is explicitly accounted for, when managing water resources. Various methodologies have been developed and applied by researchers in an attempt to account for the uncertainty. For example, simulation-optimization models are often used for conjunctive water resources management. However, direct application of such an approach in which all realizations are considered at each iteration of the optimization process leads to a very expensive optimization in terms of computational time, particularly when the number of realizations is large. The aim of this paper, therefore, is to introduce and apply an efficient approach referred to as Retrospective Optimization Approximation (ROA) that can be used for optimizing conjunctive use of surface water and groundwater over a multiple hydrogeological model simulations. This work is based on stochastic simulation-optimization framework using a recently emerged technique of sample average approximation (SAA) which is a sampling based method implemented within the Retrospective Optimization Approximation (ROA) approach. The ROA approach solves and evaluates a sequence of generated optimization sub-problems in an increasing number of realizations (sample size). Response matrix technique was used for linking simulation model with optimization procedure. The k-means clustering sampling technique was used to map the realizations. The methodology is demonstrated through the application to a hypothetical example. In the example, the optimization sub-problems generated were solved and analysed using “Active-Set” core optimizer implemented under MATLAB 2014a environment. Through k-means clustering sampling technique, the ROA – Active Set procedure was able to arrive at a (nearly) converged maximum expected total optimal conjunctive water use withdrawal rate within a relatively few number of iterations (6 to 7 iterations). Results indicate that the ROA approach is a promising technique for optimizing conjunctive water use of surface water and groundwater withdrawal rates under hydrogeological uncertainty.

Keywords: conjunctive water management, retrospective optimization approximation approach, sample average approximation, uncertainty

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