Search results for: systematic analysis
28294 A Systemic Review and Comparison of Non-Isolated Bi-Directional Converters
Authors: Rahil Bahrami, Kaveh Ashenayi
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This paper presents a systematic classification and comparative analysis of non-isolated bi-directional DC-DC converters. The increasing demand for efficient energy conversion in diverse applications has spurred the development of various converter topologies. In this study, we categorize bi-directional converters into three distinct classes: Inverting, Non-Inverting, and Interleaved. Each category is characterized by its unique operational characteristics and benefits. Furthermore, a practical comparison is conducted by evaluating the results of simulation of each bi-directional converter. BDCs can be classified into isolated and non-isolated topologies. Non-isolated converters share a common ground between input and output, making them suitable for applications with minimal voltage change. They are easy to integrate, lightweight, and cost-effective but have limitations like limited voltage gain, switching losses, and no protection against high voltages. Isolated converters use transformers to separate input and output, offering safety benefits, high voltage gain, and noise reduction. They are larger and more costly but are essential for automotive designs where safety is crucial. The paper focuses on non-isolated systems.The paper discusses the classification of non-isolated bidirectional converters based on several criteria. Common factors used for classification include topology, voltage conversion, control strategy, power capacity, voltage range, and application. These factors serve as a foundation for categorizing converters, although the specific scheme might vary depending on contextual, application, or system-specific requirements. The paper presents a three-category classification for non-isolated bi-directional DC-DC converters: inverting, non-inverting, and interleaved. In the inverting category, converters produce an output voltage with reversed polarity compared to the input voltage, achieved through specific circuit configurations and control strategies. This is valuable in applications such as motor control and grid-tied solar systems. The non-inverting category consists of converters maintaining the same voltage polarity, useful in scenarios like battery equalization. Lastly, the interleaved category employs parallel converter stages to enhance power delivery and reduce current ripple. This classification framework enhances comprehension and analysis of non-isolated bi-directional DC-DC converters. The findings contribute to a deeper understanding of the trade-offs and merits associated with different converter types. As a result, this work aids researchers, practitioners, and engineers in selecting appropriate bi-directional converter solutions for specific energy conversion requirements. The proposed classification framework and experimental assessment collectively enhance the comprehension of non-isolated bi-directional DC-DC converters, fostering advancements in efficient power management and utilization.The simulation process involves the utilization of PSIM to model and simulate non-isolated bi-directional converter from both inverted and non-inverted category. The aim is to conduct a comprehensive comparative analysis of these converters, considering key performance indicators such as rise time, efficiency, ripple factor, and maximum error. This systematic evaluation provides valuable insights into the dynamic response, energy efficiency, output stability, and overall precision of the converters. The results of this comparison facilitate informed decision-making and potential optimizations, ensuring that the chosen converter configuration aligns effectively with the designated operational criteria and performance goals.Keywords: bi-directional, DC-DC converter, non-isolated, energy conversion
Procedia PDF Downloads 10028293 A Systematic Review of Business Strategies Which Can Make District Heating a Platform for Sustainable Development of Other Sectors
Authors: Louise Ödlund, Danica Djuric Ilic
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Sustainable development includes many challenges related to energy use, such as (1) developing flexibility on the demand side of the electricity systems due to an increased share of intermittent electricity sources (e.g., wind and solar power), (2) overcoming economic challenges related to an increased share of renewable energy in the transport sector, (3) increasing efficiency of the biomass use, (4) increasing utilization of industrial excess heat (e.g., approximately two thirds of the energy currently used in EU is lost in the form of excess and waste heat). The European Commission has been recognized DH technology as of essential importance to reach sustainability. Flexibility in the fuel mix, and possibilities of industrial waste heat utilization, combined heat, and power (CHP) production and energy recovery through waste incineration, are only some of the benefits which characterize DH technology. The aim of this study is to provide an overview of the possible business strategies which would enable DH to have an important role in future sustainable energy systems. The methodology used in this study is a systematic literature review. The study includes a systematic approach where DH is seen as a part of an integrated system that consists of transport , industrial-, and electricity sectors as well. The DH technology can play a decisive role in overcoming the sustainability challenges related to our energy use. The introduction of biofuels in the transport sector can be facilitated by integrating biofuel and DH production in local DH systems. This would enable the development of local biofuel supply chains and reduce biofuel production costs. In this way, DH can also promote the development of biofuel production technologies that are not yet developed. Converting energy for running the industrial processes from fossil fuels and electricity to DH (above all biomass and waste-based DH) and delivering excess heat from industrial processes to the local DH systems would make the industry less dependent on fossil fuels and fossil fuel-based electricity, as well as the increasing energy efficiency of the industrial sector and reduce production costs. The electricity sector would also benefit from these measures. Reducing the electricity use in the industry sector while at the same time increasing the CHP production in the local DH systems would (1) replace fossil-based electricity production with electricity in biomass- or waste-fueled CHP plants and reduce the capacity requirements from the national electricity grid (i.e., it would reduce the pressure on the bottlenecks in the grid). Furthermore, by operating their central controlled heat pumps and CHP plants depending on the intermittent electricity production variation, the DH companies may enable an increased share of intermittent electricity production in the national electricity grid.Keywords: energy system, district heating, sustainable business strategies, sustainable development
Procedia PDF Downloads 16928292 Antibiotic Prescribing Pattern and Associated Risk Factors Promoting Antibiotic Resistance, a Cross Sectional Study in a Regional Hospital in Ghana
Authors: Nicholas Agyepong, Paul Gyan
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Inappropriate prescribing of antibiotic is a common healthcare concern globally resulted in an increased risk of adverse reactions and the emergence of antimicrobial resistance. The wrong antibiotic prescribing habits may lead to ineffective and unsafe treatment, worsening of disease condition, and thus increase in health care costs. The study was to examine the antibiotic prescribing pattern and associated risk factors at Regional Hospital in the Bono region of Ghana. A retrospective cross-sectional study was conducted to describe the current prescribing practices at the Hospital from January 2014 to December, 2021. A systematic random sampling method was used to select the participants for the study. STATA version 16 software was used for data management and analysis. Descriptive statistics and logistic regression analysis were used to analyze the data. Statistical significance set at p<0.05. Antibiotic consumption was equivalent to 11 per 1000 inhabitants consuming 1 DDD per day. Most common prescribed antibiotic was amoxicillin/clavulanic acid (14.39%) followed by erythromycin (11.44%), and ciprofloxacin (11.36%). Antibiotics prescription have been steadily increased over the past eight years (2014: n=59,280 to 2021: n=190,320). Prescribers above the age of 35 were more likely to prescribe antibiotics than those between the ages of 20 and 25 (COR=21.00; 95% CI: 1.78 – 48.10; p=0.016). Prescribers with at least 6 years of experience were also significantly more likely to prescribe antibiotics than those with at most 5 years of experience (COR=14.17; 95% CI: 2.39 – 84.07; p=0.004). Thus, the establishment of an antibiotic stewardship program in the hospitals is imperative, and further studies need to be conducted in other facilities to establish the national antibiotic prescription guideline.Keywords: antibiotic, antimicrobial resistance, prescription, prescribers
Procedia PDF Downloads 4628291 Analysis of the Factors of Local Acceptance of Wind Power Generation Facilities
Authors: Hyunjoo Park, Taehyun Kim, Taehyun Kim
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The government that declared 'de-nuclearization' pushes up renewable energy policies such as solar power and wind power as an alternative to nuclear power generation. However, local residents who are concerned about the development and natural disasters have been hit by opposition, and related businesses around the country are experiencing difficulties. There is also a voice saying that installing a large wind power generator will cause landslides, low frequencies and noise, which will have a bad influence. Renewal is only a harmful and disgusting facility for the residents. In this way, it is expected that extreme social conflicts will occur in the decision making process related to the locally unwanted land-use (LULU). The government's efforts to solve this problem have been steadily progressing, but the systematic methodology for bringing in active participation and opinion gathering of the residents has not yet been established except for the simple opinion poll or referendum. Therefore, it is time to identify the factors that concern the local residents about the wind power generation facilities, and to find ways to make policy decision-making possible. In this study, we analyze the perception of people about offshore and onshore wind power facilities through questionnaires or interviews, and examine quantitative and qualitative precedent studies to analyze them. In addition, the study evaluates what factors affect the local acceptance of wind power facilities. As a result of the factor analysis of the questionnaire items, factors affecting the residents' acceptance of the wind power facility were extracted from four factors such as environmental, economic, risk, social, and management factor. The study also found that the influence of the determinants of local acceptance on the regional acceptability differs according to the demographic characteristics such as gender and income level. This study will contribute to minimizing the conflict on the installation of wind power facilities through communication among the local residents.Keywords: factor analysis, local acceptance, locally unwanted land-use, LULU, wind power generation facilities
Procedia PDF Downloads 15628290 Cities Idioms Together with ICT and Countries Interested in the Smart City: A Review of Current Status
Authors: Qasim HamaKhurshid HamaMurad, Normal Mat Jusoh, Uznir Ujang
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The concept of the city with an infrastructure of (information and communication) Technology embraces several definitions depending on the meanings of the word "smart" are (intelligent city, smart city, knowledge city, ubiquitous city, sustainable city, digital city). Many definitions of the city exist, but this chapter explores which one has been universally acknowledged. From literature analysis, it emerges that Smart City is the most used terminologies in literature through the digital database to indicate the smartness of a city. This paper share exploration the research from main seven website digital databases and journal about Smart City from "January 2015 to the February of 2020" to (a) Time research, to examine the causes of the Smart City phenomenon and other concept literature in the last five years (b) Review of words, to see how and where the smart city specification and relation different definition And(c) Geographical research to consider where Smart Cities' greatest concentrations are in the world and are Malaysia has interacting with the smart city, and (d) how many papers published from all Malaysia from 2015 to 2020 about smart citie. Three steps are followed to accomplish the goal. (1)The analysis covered publications Build a systematic literature review search strategy to gather a representative sub-set of papers on Smart City and other definitions utilizing (GoogleScholar, Elsevier, Scopus, ScienceDirect, IEEEXplore, WebofScience, Springer) January2015-February2020. (2)A bibliometric map was formed based on the bibliometric evaluation using the mapping technique VOSviewer to visualize differences. (3)VOSviewer application program was used to build initial clusters. The Map of Bibliometric Visualizes the analytical findings which targeted the word harmony.Keywords: bibliometric research, smart city, ICT, VOSviewer, urban modernization
Procedia PDF Downloads 20228289 Effect of Perioperative Multimodal Analgesia on Postoperative Opioid Consumption and Complications in Elderly Traumatic Hip Fracture Patients: A Systematic Review of Randomised Controlled Trials
Authors: Raheel Shakoor Siddiqui, Shahbaz Malik, Manikandar Srinivas Cheruvu, Sanjay Narayana Murthy, Livio DiMascio
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Background: elderly traumatic hip fracture patients frequently present to trauma services globally. Rising low energy falls amongst an osteoporotic aging population is the commonest cause for injury. Hip fractures in this population are a major cause for severe pain, morbidity and mortality. The term hip fracture is interchangeable with neck of femur fracture, fractured neck of femur or proximal femur fracture. Hip fracture pain management protocols and guidelines suggest conventional analgesia, nerve block and opioid based treatment as rescue analgesia. There is a current global opioid crisis with overuse, abuse and dependence. Adverse opioid related complications in vulnerable elderly patients further adds to morbidity and mortality. Systematic reviews in literature have evidenced superiority of multimodal analgesia in osteoarthritic primary joint replacements compared to opioids however, this has not yet been conducted for elderly traumatic hip fracture patients. Aims: The primary aim of this systematic review is to provide standardised evidence following Cochrane and PRISMA guidance in determining advantages of perioperative multimodal analgesia over conventional opioid based treatments in elderly traumatic hip fractures. Methods: 5 databases were searched from January 2000-2023 which identified 8 randomised controlled trials and 446 total participants. These trials met defined PICOS eligibility criteria of patient mean age ≥ 65 years presenting with a unilateral traumatic fractured neck of femur for operative intervention. Analgesic intervention with perioperative multimodal analgesia has been compared to conventional opioid based analgesia. Outcomes of interest include, primarily, the change in postoperative opioid consumption within a 0-30 postoperative period and secondarily, the change in postoperative adverse events and complications. A qualitative synthesis has been performed due to clinical heterogenicity and variance amongst trials. Results: GRADE evidence of moderate quality supports perioperative multimodal analgesia leads to a reduction in postoperative opioid consumption however, low quality evidence supports a reduction of adverse effects and complications. Conclusion: Perioperative multimodal analgesia whether used preoperative, intraoperative and/or postoperative leads to a reduction in postoperative opioid consumption for elderly traumatic hip fracture patients. This review recommends the use of perioperative multimodal analgesia as part of hip fracture pain protocols however, caution and clinical judgement should be used as the risk of adverse effects may not be lower.Keywords: trauma, orthopaedics, hip, fracture, neck of femur fracture, analgesia, multimodal analgesia, opioid
Procedia PDF Downloads 9728288 Method of Parameter Calibration for Error Term in Stochastic User Equilibrium Traffic Assignment Model
Authors: Xiang Zhang, David Rey, S. Travis Waller
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Stochastic User Equilibrium (SUE) model is a widely used traffic assignment model in transportation planning, which is regarded more advanced than Deterministic User Equilibrium (DUE) model. However, a problem exists that the performance of the SUE model depends on its error term parameter. The objective of this paper is to propose a systematic method of determining the appropriate error term parameter value for the SUE model. First, the significance of the parameter is explored through a numerical example. Second, the parameter calibration method is developed based on the Logit-based route choice model. The calibration process is realized through multiple nonlinear regression, using sequential quadratic programming combined with least square method. Finally, case analysis is conducted to demonstrate the application of the calibration process and validate the better performance of the SUE model calibrated by the proposed method compared to the SUE models under other parameter values and the DUE model.Keywords: parameter calibration, sequential quadratic programming, stochastic user equilibrium, traffic assignment, transportation planning
Procedia PDF Downloads 29928287 Maternal Obesity in Nigeria: An Exploratory Study
Authors: Ojochenemi J. Onubi, Debbi Marais, Lorna Aucott, Friday Okonofua, Amudha Poobalan
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Background: Obesity is a worldwide epidemic with major health and economic consequences. Pregnancy is a trigger point for the development of obesity, and maternal obesity is associated with significant adverse effects in the mother and child. Nigeria is experiencing a double burden of under- and over-nutrition with rising levels of obesity particularly in women. However, there is scarcity of data on maternal obesity in Nigeria and other African countries. Aims and Objectives: This project aimed at identifying crucial components of potential interventions for maternal obesity in Nigeria. The objectives were to assess the prevalence, effects, and distribution of maternal obesity; knowledge, attitude and practice (KAP) of pregnant women and maternal healthcare providers; and identify existing interventions for maternal obesity in Nigeria. Methodology: A systematic review and meta-analysis were initially conducted to appraise the existing literature on maternal obesity in Africa. Following this, a quantitative questionnaire survey of the KAP of pregnant women and a qualitative interview study of the KAP of Health Care Workers (HCW) were conducted in seven secondary and tertiary hospitals across Nigeria. Quantitative data was analysed using SPSS statistical software, while thematic analysis was conducted for qualitative data. Results: Twenty-nine studies included in the systematic review showed significant prevalence, socio-demographic associations, and adverse effects of maternal obesity on labour, maternal, and child outcomes in Africa. The questionnaire survey of 435 mothers revealed a maternal obesity prevalence of 17.9% among mothers who registered for antenatal care in the first trimester. The mothers received nutrition information from different sources and had insufficient knowledge of their own weight category or recommended Gestational Weight Gain (GWG), causes, complications, and safe ways to manage maternal obesity. However, majority of the mothers were of the opinion that excess GWG is avoided in pregnancy and some practiced weight management (diet and exercise) during pregnancy. For the qualitative study, four main themes were identified: ‘Concerns about obesity in pregnancy’, ‘Barriers to care for obese pregnant women’, ‘Practice of care for obese pregnant women’, and ‘Improving care for obese pregnant women’. HCW expressed concerns about rising levels of maternal obesity, lack of guidelines for the management of obese pregnant women and worries about unintended consequences of antenatal interventions. ‘Barriers’ included lack of contact with obese women before pregnancy, late registration for antenatal care, and perceived maternal barriers such as socio-cultural beliefs of mothers and poverty. ‘Practice’ included anticipatory care and screening for possible complications, general nutrition education during antenatal care and interdisciplinary care for mothers with complications. HCW offered suggestions on improving care for obese women including timing, type, and settings of interventions; and the need for involvement of other stake holders in caring for obese pregnant women. Conclusions: Culturally adaptable/sensitive interventions should be developed for the management of obese pregnant women in Africa. Education and training of mothers and health care workers, and provision of guidelines are some of the components of potential interventions in Nigeria.Keywords: Africa, maternal, obesity, pregnancy
Procedia PDF Downloads 26628286 The Influence of the Form of Grain on the Mechanical Behaviour of Sand
Authors: Mohamed Boualem Salah
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The size and shape of soil particles reflect the formation history of the grains. In turn, the macro scale behavior of the soil mass results from particle level interactions which are affected by particle shape. Sphericity, roundness and smoothness characterize different scales associated to particle shape. New experimental data and data from previously published studies are gathered into two databases to explore the effects of particle shape on packing as well as small and large-strain properties of sandy soils. Data analysis shows that increased particle irregularity (angularity and/or eccentricity) leads to: an increase in emax and emin, a decrease in stiffness yet with increased sensitivity to the state of stress, an increase in compressibility under zero-lateral strain loading, and an increase in critical state friction angle φcs and intercept Γ with a weak effect on slope λ. Therefore, particle shape emerges as a significant soil index property that needs to be properly characterized and documented, particularly in clean sands and gravels. The systematic assessment of particle shape will lead to a better understanding of sand behavior.Keywords: angularity, eccentricity, shape particle, behavior of soil
Procedia PDF Downloads 41328285 Roadway Maintenance Management System
Authors: Chika Catherine Ayogu
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Rehabilitation plays an important and integral part in the life of roadway rehabilitation management system. It is a systematic method for inspection and rating the roadway condition in a given area. The system performs a cost effective analysis of various maintenance and rehabilitation strategies. Finally the system prioritize and recommend roadway rehabilitation and maintenance to maximize results within a given budget amount. During execution of maintenance activity, the system also tracks labour, materials, equipment and cost for activities performed. The system implements physical assessment field inspection and rating of each street segment which is then entered into a database. The information is analyzed using a software, and provide recommendations and project future conditions. The roadway management system provides a deterioration curve for each segment based on input then assigns the most cost-effective maintenance strategy based on conditions, surface type and functional classification, and available budget. This paper investigates the roadway management system and its capabilities to assist in applying the right treatment to the right roadway at the right time so that expected service life of the roadway is extended as long as possible with acceptable cost.Keywords: effectiveness, rehabilitation, roadway, software system
Procedia PDF Downloads 15028284 Quantifying Automation in the Architectural Design Process via a Framework Based on Task Breakdown Systems and Recursive Analysis: An Exploratory Study
Authors: D. M. Samartsev, A. G. Copping
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As with all industries, architects are using increasing amounts of automation within practice, with approaches such as generative design and use of AI becoming more commonplace. However, the discourse on the rate at which the architectural design process is being automated is often personal and lacking in objective figures and measurements. This results in confusion between people and barriers to effective discourse on the subject, in turn limiting the ability of architects, policy makers, and members of the public in making informed decisions in the area of design automation. This paper proposes the use of a framework to quantify the progress of automation within the design process. The use of a reductionist analysis of the design process allows it to be quantified in a manner that enables direct comparison across different times, as well as locations and projects. The methodology is informed by the design of this framework – taking on the aspects of a systematic review but compressed in time to allow for an initial set of data to verify the validity of the framework. The use of such a framework of quantification enables various practical uses such as predicting the future of the architectural industry with regards to which tasks will be automated, as well as making more informed decisions on the subject of automation on multiple levels ranging from individual decisions to policy making from governing bodies such as the RIBA. This is achieved by analyzing the design process as a generic task that needs to be performed, then using principles of work breakdown systems to split the task of designing an entire building into smaller tasks, which can then be recursively split further as required. Each task is then assigned a series of milestones that allow for the objective analysis of its automation progress. By combining these two approaches it is possible to create a data structure that describes how much various parts of the architectural design process are automated. The data gathered in the paper serves the dual purposes of providing the framework with validation, as well as giving insights into the current situation of automation within the architectural design process. The framework can be interrogated in many ways and preliminary analysis shows that almost 40% of the architectural design process has been automated in some practical fashion at the time of writing, with the rate at which progress is made slowly increasing over the years, with the majority of tasks in the design process reaching a new milestone in automation in less than 6 years. Additionally, a further 15% of the design process is currently being automated in some way, with various products in development but not yet released to the industry. Lastly, various limitations of the framework are examined in this paper as well as further areas of study.Keywords: analysis, architecture, automation, design process, technology
Procedia PDF Downloads 10428283 Systematic Literature Review and Bibliometric Analysis of Interorganizational Employee Mobility Determinants
Authors: Iva Zdrilić, Petra Došenović Bonča, Darija Aleksić
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Since the boundaryless career, with its emphasis on cross-employer movements, was introduced as a new paradigm of career development, inter-organizational employee mobility has been increasing. Although this phenomenon may have positive implications for individual careers and destination organizations, the consequences for the source organizations losing workers are less clear. The aim of this paper is thus to develop a comprehensive typology of possible inter-organizational employee mobility determinants. Since the most common classification differentiates between mobility determinants at different levels (i.e., economic, organizational, and individual), this paper focuses on building a comprehensive multi-level typology of inter-organizational mobility determinants across diverse sectors and industries. By using a structured literature review approach and bibliometric analysis, the paper reveals both intricate relationships between different mobility determinants and the complexity of inter-organizational networks and social ties. The latter appears as both a mobility determinant (at the organizational and individual level) and a mobility effect. Indeed, inter-organizational employee mobility leads to the formation of networks between source and destination organizations. These networks are practically based on the social ties between mobile employees and their colleagues and, in this way, they close the "inter-organizational employee mobility - inter-organizational network/ties" circle. The paper contributes to the career development literature by uncovering hitherto underexplored diverse determinants of intra- and inter-sectoral mobility as well as the conflicting results of the existing studies on some factors (e.g., inter-organizational networks and/or social ties) that appear both as a mobility determinant and a mobility effect.Keywords: inter-organizational mobility, social ties, inter-organizational network, knowledge transfer
Procedia PDF Downloads 11528282 Factors Associated With Poor Glycaemic Control Among Patients With Type 2 Diabetes at Gatundu Level 5 Hospital. Kiambu County, Kenya: Key Lessons and Way Forward
Authors: Carolyne Ndungu, Wesley Too, Diana Kassaman
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Diabetes is a global public health problem with an increasing morbidity and mortality rate across the globe. It is reported that 422 million people worldwide have diabetes with type 2 diabetes more common in people of African descent. Whilst prevalence of diabetes is four times more than it was in the last three decades, making it the world's ninth greatest cause of mortality, treatment of complications resulting from poor glycemic control is still high, contributing to poverty level in sub-Saharan. Poor treatment adherence has also been identified as a major contributing factor poor glycemic control among diabetic patients and still remains a significant challenge especially among patients living in rural Kenya. This study therefore seeks to identify gaps, barriers and challenges towards medication non-adherence among diabetic patients on follow-up at Kiambu County Referral Hospital, Kenya. Methods: A cross- sectional descriptive study was carried out at Gatundu Level five Hospital in Kiambu County. The study population consisted of adult patients with type two diabetes mellitus (T2DM) on follow up, at the Diabetes clinic between the month of June to July 2022. Systematic sampling of 200 participants was carried out. Ethical approvals from relevant authorities were done and ethical aspects of the study were also observed. Data analysis is ongoing using logistic regression analysis. Results, recommendations -contribution of this study will be highlighted within the next one month.Keywords: adherence, diabetes, medication, Kenya
Procedia PDF Downloads 13228281 Collaborative Planning and Forecasting
Authors: Neha Asthana, Vishal Krishna Prasad
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Collaborative planning and forecasting are the innovative and systematic approaches towards productive integration and assimilation of data synergized into information. The changing and variable market dynamics have persuaded global business chains to incorporate collaborative planning and forecasting as an imperative tool. Thus, it is essential for the supply chains to constantly improvise, update its nature, and mould as per changing global environment.Keywords: information transfer, forecasting, optimization, supply chain management
Procedia PDF Downloads 43528280 Simple Ecofriendly Cyclodextrine-Surfactant Modified UHPLC Method for Quantification of Multivitamins in Pharmaceutical and Food Samples
Authors: Hassan M. Albishri, Abdullah Almalawi, Deia Abd El-Hady
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A simple and ecofriendly cyclodextrine-surfactant modified UHPLC (CDS-UPLC) method for rapid and sensitive simultaneous determination of multi water-soluble vitamins such as ascorbic acid, pyridoxine hydrochloride and thiamine hydrochloride in commercial pharmaceuticals and milk samples have been firstly developed. Several chromatographic effective parameters have been changed in a systematic way. Adequate results have been achieved by a mixture of β-cyclodextrine (β-CD) and cationic surfactant under acidic conditions as an eco-friendly isocratic mobile phase at 0.02 mL/min flow rate. The proposed CDS- UHPLC method has been validated for the quantitative determination of multivitamins within 8 min in food and pharmaceutical samples. The method showed excellent linearity for analytes in a wide range of 10-1000 ng/µL. The repeatability and reproducibility of data were about 2.14 and 4.69 RSD%, respectively. The limits of detection (LODs) of analytes ranged between 0.86 and 5.6 ng/µL with a range of 81.8 -115.8% recoveries in tablets and milk samples. The current first CDS- UHPLC method could have vast applications for the precise analysis of multivitamins in complicated matrices.Keywords: ecofriendly, cyclodextrine-surfactant, multivitamins, UHPLC
Procedia PDF Downloads 27328279 Taguchi-Based Surface Roughness Optimization for Slotted and Tapered Cylindrical Products in Milling and Turning Operations
Authors: Vineeth G. Kuriakose, Joseph C. Chen, Ye Li
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The research follows a systematic approach to optimize the parameters for parts machined by turning and milling processes. The quality characteristic chosen is surface roughness since the surface finish plays an important role for parts that require surface contact. A tapered cylindrical surface is designed as a test specimen for the research. The material chosen for machining is aluminum alloy 6061 due to its wide variety of industrial and engineering applications. HAAS VF-2 TR computer numerical control (CNC) vertical machining center is used for milling and HAAS ST-20 CNC machine is used for turning in this research. Taguchi analysis is used to optimize the surface roughness of the machined parts. The L9 Orthogonal Array is designed for four controllable factors with three different levels each, resulting in 18 experimental runs. Signal to Noise (S/N) Ratio is calculated for achieving the specific target value of 75 ± 15 µin. The controllable parameters chosen for turning process are feed rate, depth of cut, coolant flow and finish cut and for milling process are feed rate, spindle speed, step over and coolant flow. The uncontrollable factors are tool geometry for turning process and tool material for milling process. Hypothesis testing is conducted to study the significance of different uncontrollable factors on the surface roughnesses. The optimal parameter settings were identified from the Taguchi analysis and the process capability Cp and the process capability index Cpk were improved from 1.76 and 0.02 to 3.70 and 2.10 respectively for turning process and from 0.87 and 0.19 to 3.85 and 2.70 respectively for the milling process. The surface roughnesses were improved from 60.17 µin to 68.50 µin, reducing the defect rate from 52.39% to 0% for the turning process and from 93.18 µin to 79.49 µin, reducing the defect rate from 71.23% to 0% for the milling process. The purpose of this study is to efficiently utilize the Taguchi design analysis to improve the surface roughness.Keywords: surface roughness, Taguchi parameter design, CNC turning, CNC milling
Procedia PDF Downloads 15528278 Structural and Optical Properties of Pr3+ Doped ZnO and PVA:Zn98Pr2O Nanocomposites Free Standing Film
Authors: Pandiyarajan Thangaraj, Mangalaraja Ramalinga Viswanathan, Karthikeyan Balasubramanian, Héctor D. Mansilla, José Ruiz, David Contreras
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We report a systematic study of structural and optical properties of Pr-doped ZnO nanostructures and PVA:Zn98Pr2O polymer matrix nanocomposites free standing films are performed. These particles are synthesized through simple wet chemical route and solution casting technique at room temperature, respectively. Structural studies carried out by X-ray diffraction method, confirms that the prepared pure ZnO and Pr-doped ZnO nanostructures are in hexagonal wurtzite structure and the microstrain is increased upon doping. TEM analysis reveals that the prepared materials are in the sheet-like nature. Absorption spectra show free excitonic absorption band at 370 nm and red shift for the Pr-doped ZnO nanostructures. The PVA:Zn98Pr2O composite film exhibits both free excitonic and PVA absorption bands at 282 nm. Fourier transform infrared spectral studies confirm the presence of A1 (TO) and E1 (TO) modes of Zn-O bond vibration and the formation of polymer composite materials.Keywords: Pr doped ZnO, polymer nanocomposites, optical properties, free standing film
Procedia PDF Downloads 46928277 Assessment of Waste Management Practices in Bahrain
Authors: T. Radu, R. Sreenivas, H. Albuflasa, A. Mustafa Khan, W. Aloqab
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The Kingdom of Bahrain, a small island country in the Gulf region, is experiencing fast economic growth resulting in a sharp increase in population and greater than ever amounts of waste being produced. However, waste management in the country is still very basic, with landfilling being the most popular option. Recycling is still a scarce practice, with small recycling businesses and initiatives emerging in recent years. This scenario is typical for other countries in the region, with similar amounts of per capita waste being produced. In this paper, we are reviewing current waste management practices in Bahrain by collecting data published by the Government and various authors, and by visiting the country’s only landfill site, Askar. In addition, we have performed a survey of the residents to learn more about the awareness and attitudes towards sustainable waste management strategies. A review of the available data on waste management indicates that the Askar landfill site is nearing its capacity. The site uses open tipping as the method of disposal. The highest percentage of disposed waste comes from the building sector (38.4%), followed by domestic (27.5%) and commercial waste (17.9%). Disposal monitoring and recording are often based on estimates of weight and without proper characterization/classification of received waste. Besides, there is a need for assessment of the environmental impact of the site with systematic monitoring of pollutants in the area and their potential spreading to the surrounding land, groundwater, and air. The results of the survey indicate low awareness of what happens with the collected waste in the country. However, the respondents have shown support for future waste reduction and recycling initiatives. This implies that the education of local communities would be very beneficial for such governmental initiatives, securing greater participation. Raising awareness of issues surrounding recycling and waste management and systematic effort to divert waste from landfills are the first steps towards securing sustainable waste management in the Kingdom of Bahrain.Keywords: landfill, municipal solid waste, survey, waste management
Procedia PDF Downloads 15828276 Incidences and Chemico-Mobility of Toxic Heavy Metals in Environmental Samples
Authors: I. Hilia, C. Hange, F. Hakala, M. Matheus, C. Jansen, J. Hidinwa, O. Awofolu
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The article reports on the occurrences, level, and mobility of selected trace metals in environmental samples. The conceptual basis was to examine the possible influence of anthropogenic activities and the impact on human and environmental health. Environmental samples (soil, plant and lower animal) were randomly collected from stratified study/sampling areas, preserved and pre-treated before analysis. Mineral acid digestion procedure was employed for the isolation of metallic contents in samples, and elemental qualitative and quantitative analysis was by ICP-OES. Analytical protocol was validated through the quality assurance process and was found acceptable with quantitative metallic recoveries in the range of 85-90%; hence considered applicable for the analyses of environmental samples. The mean concentration of analysed metals in soil samples ranged from 53.2- 2532.8 mg/kg (Cu); 59.5- 2020.1 mg/kg (Zn); 1.80 – 21.26 mg/kg (Cd) and 19.6- 140.9 mg/kg (Pb). The mean level in grass samples ranged from 9.33 – 38.63 mg/kg (Cu); 64.20-105.18 mg/kg (Zn); 0.28–0.73 mg/kg (Cd) and 0.53 -16.26 mg/kg (Pb) while the mean level in lower animal sample (beetle) varied from 9.6 - 105.3 mg/kg (Cu); 134.1-297.2 mg/kg (Zn); 0.63 – 3.78 (Cd) and 8.0 – 29.1 mg/kg (Pb) across sample collection points (SCPs) 1-4 respectively. Metallic transfer factors (TFs) were in the order Zn >Cd > Cu > Pb with metal Pollution Indices (MPIs) in the order SCP1 > SCP2 > SCP3 > SCP4. About 60-70 % of analysed metals were above the maximum allowable limits (MALs) in soil and plant samples. Results obtained revealed the general prevalence of analysed metals at all sampled sites with indication of metallic mobility across the food chain which portrayed dire consequences for environmental and human health. Systematic environmental remediation and pollution abatement strategies are recommended.Keywords: trace metals, pollution, human health, Incidences, ICP-OES
Procedia PDF Downloads 15928275 The Order Russulales of Basidiomycota: Systematics, Ecology and Chemotaxonomy
Authors: Marco Clericuzio, Alfredo Vizzini
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The secondary metabolites of Russulales (one of the main orders of phylum Basidiomycota), have been studied. They are mainly terpenoids, with sesquiterpenes being the most common ones, but also triterpenoids and prenylated phenols have been isolated. We found that classes of specific compounds seem to be often allied to systematic groupings, so that they may have chemotaxonomic significance. Moreover, the ecological implications of such metabolites, as well as their biological activities, are discussed. Lately, we have focused our attention on the anti-arthropod activity of Russula metabolites, in particular on the toxicity against mites and other crop pests.Keywords: chemotaxonomy, fungi, insecticidal activity, russulales, terpenoids
Procedia PDF Downloads 16928274 Analysis of Influence of Intrinsic Motivation on Employee Affective Commitment
Authors: Yashar Ibragimov, Nino Berishvili
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Technological, economic and other innovation-related advances of the 21st century have influenced the old, traditional business models. Presently, organizational change has become an integral part of corporate strategy for the majority of businesses. Such shifts have resulted in both new challenges and opportunities. The expansion of the use of information and communication technologies has driven fundamental shifts towards digital change. Organizations are being forced to revise processes, goals and overall mission in order to stay competitive in the marketplace. However, the implementation of digital transformation brings uncertainty, causes stress and raises concerns about future jobs. The study employs systematic literature review to fill the gap in understanding relationship between employee motivation and commitment during the transformation. A conceptual model proposes the antecedents (OCB and Leader Member Exchange) of employee motivation and investigates its impact on employee commitment to change. The utilized model elucidates how to maintain employee motivation and commitment in the context of organizational transformation and sets the ground for future research.Keywords: employee motivation, change commitment, change management, leader member exchange, organizational citizenship behavior
Procedia PDF Downloads 7728273 Utility of Executive Function Training in Typically Developing Adolescents and Special Populations: A Systematic Review of the Literature
Authors: Emily C. Shepard, Caroline Sweeney, Jessica Grimm, Sophie Jacobs, Lauren Thompson, Lisa L. Weyandt
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Adolescence is a critical phase of development in which individuals are prone to more risky behavior while also facing potentially life-changing decisions. The balance of increased behavioral risk and responsibility indicates the importance of executive functioning ability. In recent years, executive function training has emerged as a technique to enhance this cognitive ability. The aim of the present systematic review was to discuss the reported efficacy of executive functioning training techniques among adolescents. After reviewing 3110 articles, a total of 24 articles were identified which examined the role of executive functioning training techniques among adolescents (age 10-19). Articles retrieved demonstrated points of comparison across psychiatric and medical diagnosis, location of training, and stage of adolescence. Typically developing samples, as well as those with attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), conduct disorder, and physical health concerns were found, allowing for the comparison of the efficacy of techniques considering physical and psychological heterogeneity. Among typically developing adolescents, executive functioning training yielded nonsignificant or low effect size improvements in executive functioning, and in some cases executive functioning ability was decreased following the training. In special populations, including those with ADHD, (ASD), conduct disorder, and physical health concerns significant differences and larger effect sizes in executive functioning were seen following treatment, particularly among individuals with ADHD. Future research is needed to identify the long-term efficacy of these treatments, as well as their generalizability to real-world conditions.Keywords: adolescence, attention-deficit hyperactivity disorder, executive function, executive function training, traumatic brain injury
Procedia PDF Downloads 19028272 Evaluating Forecasts Through Stochastic Loss Order
Authors: Wilmer Osvaldo Martinez, Manuel Dario Hernandez, Juan Manuel Julio
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We propose to assess the performance of k forecast procedures by exploring the distributions of forecast errors and error losses. We argue that non systematic forecast errors minimize when their distributions are symmetric and unimodal, and that forecast accuracy should be assessed through stochastic loss order rather than expected loss order, which is the way it is customarily performed in previous work. Moreover, since forecast performance evaluation can be understood as a one way analysis of variance, we propose to explore loss distributions under two circumstances; when a strict (but unknown) joint stochastic order exists among the losses of all forecast alternatives, and when such order happens among subsets of alternative procedures. In spite of the fact that loss stochastic order is stronger than loss moment order, our proposals are at least as powerful as competing tests, and are robust to the correlation, autocorrelation and heteroskedasticity settings they consider. In addition, since our proposals do not require samples of the same size, their scope is also wider, and provided that they test the whole loss distribution instead of just loss moments, they can also be used to study forecast distributions as well. We illustrate the usefulness of our proposals by evaluating a set of real world forecasts.Keywords: forecast evaluation, stochastic order, multiple comparison, non parametric test
Procedia PDF Downloads 8928271 Research the Causes of Defects and Injuries of Reinforced Concrete and Stone Construction
Authors: Akaki Qatamidze
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Implementation of the project will be a step forward in terms of reliability in Georgia and the improvement of the construction and the development of construction. Completion of the project is expected to result in a complete knowledge, which is expressed in concrete and stone structures of assessing the technical condition of the processing. This method is based on a detailed examination of the structure, in order to establish the injuries and the elimination of the possibility of changing the structural scheme of the new requirements and architectural preservationists. Reinforced concrete and stone structures research project carried out in a systematic analysis of the important approach is to optimize the process of research and development of new knowledge in the neighboring areas. In addition, the problem of physical and mathematical models of rational consent, the main pillar of the physical (in-situ) data and mathematical calculation models and physical experiments are used only for the calculation model specification and verification. Reinforced concrete and stone construction defects and failures the causes of the proposed research to enhance the effectiveness of their maximum automation capabilities and expenditure of resources to reduce the recommended system analysis of the methodological concept-based approach, as modern science and technology major particularity of one, it will allow all family structures to be identified for the same work stages and procedures, which makes it possible to exclude subjectivity and addresses the problem of the optimal direction. It discussed the methodology of the project and to establish a major step forward in the construction trades and practical assistance to engineers, supervisors, and technical experts in the construction of the settlement of the problem.Keywords: building, reinforced concrete, expertise, stone structures
Procedia PDF Downloads 33628270 Magnitude and Factors of Risky Sexual Practice among Day Laborers in Ethiopia: A Systematic Review and Meta-Analysis, 2023
Authors: Kalkidan Worku, Eniyew Tegegne, Menichil Amsalu, Samuel Derbie Habtegiorgis
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Introduction: Because of the seasonal nature of the work, day laborers are exposed to risky sexual practices. Since the majority of them are living far away from their birthplace and family, they engage in unplanned and multiple sexual practices. These unplanned and unprotected sexual experiences are a risk for different types of sexual-related health crises. This study aimed to assess the pooled prevalence of risky sexual practices and its determinants among day laborers in Ethiopia. Methods: Online databases, including PubMed, Google Scholar, Science Direct, African Journal of Online, Academia Edu, Semantic Scholar, and university repository sites, were searched from database inception until March 2023. PRISMA 2020 guideline was used to conduct the review. Among 851 extracted studies, ten articles were retained for the final quantitative analysis. To identify the source of heterogeneity, a sub-group analysis and I² test were performed. Publication bias was assessed by using a funnel plot and the Egger and Beg test. The pooled prevalence of risky sexual practices was calculated. Besides, the association between determinant factors and risky sexual practice was determined using a pooled odds ratio (OR) with a 95% confidence interval. Result: The pooled prevalence of risky sexual practices among day laborers was 46.00% (95% CI: 32.96, 59.03). Being single (OR: 2.49; 95% CI: 1.29 to 4.83), substance use (OR: 1.79; 95% CI: 1.40 to 2.29), alcohol intake (OR: 4.19; 95% CI: 2.19 to 8.04), watching pornographic (OR: 5.49; 95% CI: 2.99 to 10.09), discussion about SRH (OR: 4.21; 95% CI: 1.34 to 13.21), visiting night clubs (OR: 2.86 95% CI: 1.79 to 4.57) and risk perception (OR: 0.37 95% CI: 0.20 to 0.70) were the possible factors for risky sexual practice of day laborers in Ethiopia. Conclusions: A large proportion of day laborers engaged in risky sexual practices. Interventions targeting creating awareness of sexual and reproductive health for day laborers should be implemented. Continuous peer education on sexual health should be given to day laborers. Sexual and reproductive health services should be accessible in their workplaces to maximize condom utilization and to facilitate sexual health education for all day laborers.Keywords: day laborers, sexual health, risky sexual practice, unsafe sex, multiple sexual partners
Procedia PDF Downloads 7928269 Effects of Self-Management Programs on Blood Pressure Control, Self-Efficacy, Medication Adherence, and Body Mass Index among Older Adult Patients with Hypertension: Meta-Analysis of Randomized Controlled Trials
Authors: Van Truong Pham
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Background: Self-management was described as a potential strategy for blood pressure control in patients with hypertension. However, the effects of self-management interventions on blood pressure, self-efficacy, medication adherence, and body mass index (BMI) in older adults with hypertension have not been systematically evaluated. We evaluated the effects of self-management interventions on systolic blood pressure (SBP) and diastolic blood pressure (DBP), self-efficacy, medication adherence, and BMI in hypertensive older adults. Methods: We followed the recommended guidelines of preferred reporting items for systematic reviews and meta-analyses. Searches in electronic databases including CINAHL, Cochrane Library, Embase, Ovid-Medline, PubMed, Scopus, Web of Science, and other sources were performed to include all relevant studies up to April 2019. Studies selection, data extraction, and quality assessment were performed by two reviewers independently. We summarized intervention effects as Hedges' g values and 95% confidence intervals (CI) using a random-effects model. Data were analyzed using Comprehensive Meta-Analysis software 2.0. Results: Twelve randomized controlled trials met our inclusion criteria. The results revealed that self-management interventions significantly improved blood pressure control, self-efficacy, medication adherence, whereas the effect of self-management on BMI was not significant in older adult patients with hypertension. The following Hedges' g (effect size) values were obtained: SBP, -0.34 (95% CI, -0.51 to -0.17, p < 0.001); DBP, -0.18 (95% CI, -0.30 to -0.05, p < 0.001); self-efficacy, 0.93 (95%CI, 0.50 to 1.36, p < 0.001); medication adherence, 1.72 (95%CI, 0.44 to 3.00, p=0.008); and BMI, -0.57 (95%CI, -1.62 to 0.48, p = 0.286). Conclusions: Self-management interventions significantly improved blood pressure control, self-efficacy, and medication adherence. However, the effects of self-management on obesity control were not supported by the evidence. Healthcare providers should implement self-management interventions to strengthen patients' role in managing their health care.Keywords: self-management, meta-analysis, blood pressure control, self-efficacy, medication adherence, body mass index
Procedia PDF Downloads 12828268 Innovation and Technologies Synthesis of Various Components: A Contribution to the New Precision Irrigation Development for Open-Field Fruit Orchards
Authors: Pipop Chatrabhuti, S. Visessri, T. Charinpanitkul
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Precision irrigation (PI) technology has emerged as a solution to optimize water usage in agriculture, aiming to maximize crop yields while minimizing water waste. Developing a new PI for commercialization requires developers to research, synthesize, evaluate, and select appropriate technologies and make use of such information to produce innovative products. The objective of this review is to facilitate innovators by providing them with a summary of existing knowledge and the identification of gaps in research linking to the innovative development of PI. This paper reviews and synthesizes technologies and components relevant to precision irrigation, highlighting its potential benefits and challenges. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) framework is used for the review. The study is intended to contribute to innovators who apply for collaborative approach to problem-solving and idea generation that involves seeking external input and resources from a diverse range of individuals and organizations.Keywords: innovation synthesis, technology assessment, precision irrigation technologies, precision irrigation components, new product development
Procedia PDF Downloads 6528267 Indicators and Sustainability Dimensions of the Mediterranean Diet
Authors: Joana Margarida Bôto, Belmira Neto, Vera Miguéis, Manuela Meireles, Ada Rocha
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The Mediterranean diet has been recognized as a sustainable model of living with benefits for the environment and human health. However, a complete assessment of its sustainability, encompassing all dimensions and aspects, to our best knowledge, has not yet been realized. This systematic literature review aimed to fill this gap by identifying and describing the indicators used to assess the sustainability of the Mediterranean diet, looking at several dimensions, and presenting the results from their application. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines methodology was used, and searches were conducted in PubMed, Scopus, Web of Science, and GreenFile. There were identified thirty-two articles evaluating the sustainability of the Mediterranean diet. The environmental impact was quantified in twenty-five of these studies, the nutritional quality was evaluated in seven studies, and the daily cost of the diet was assessed in twelve studies. A total of thirty-three indicators were identified and separated by four dimensions of sustainability, specifically, the environmental dimension (ten indicators, namely carbon, water, and ecological footprint), the nutritional dimension (eight indicators, namely Health score and Nutrient Rich Food Index), the economic dimension (one indicator, the dietary cost), the sociocultural dimension (six indicators – with no results). Only eight of the studies used combined indicators. The Mediterranean diet was considered in all articles as a sustainable dietary pattern with a lower impact than Western diets. The carbon footprint ranged between 0.9 and 6.88 kg CO₂/d per capita, the water footprint between 600 and 5280 m³/d per capita, and the ecological footprint between 2.8 and 53.42 m²/d per capita. The nutritional quality was high, obtaining 122 points using the Health score and 12.95 to 90.6 points using the Nutrient Rich Food Index. The cost of the Mediterranean diet did not significantly differ from other diets and varied between 3.33 and 14.42€/d per capita. A diverse approach to evaluating the sustainability of the Mediterranean diet was found.Keywords: Mediterranean diet, sustainability, environmental indicators, nutritional indicators
Procedia PDF Downloads 9828266 Stroke Prevention in Patients with Atrial Fibrillation and Co-Morbid Physical and Mental Health Problems
Authors: Dina Farran, Mark Ashworth, Fiona Gaughran
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Atrial fibrillation (AF), the most prevalent cardiac arrhythmia, is associated with an increased risk of stroke, contributing to heart failure and death. In this project, we aim to improve patient safety by screening for stroke risk among people with AF and co-morbid mental illness. To do so, we started by conducting a systematic review and meta-analysis on prevalence, management, and outcomes of AF in people with Serious Mental Illness (SMI) versus the general population. We then evaluated oral anticoagulation (OAC) prescription trends in people with AF and co-morbid SMI in King’s College Hospital. We also evaluated the association between mental illness severity and OAC prescription in eligible patients in South London and Maudsley (SLaM) NHS Foundation Trust. Next, we implemented an electronic clinical decision support system (eCDSS) consisting of a visual prompt on patient electronic Personal Health Records to screen for AF-related stroke risk in three Mental Health of Older Adults wards at SLaM. Finally, we assessed the feasibility and acceptability of the eCDSS by qualitatively investigating clinicians’ perspectives of the potential usefulness of the eCDSS (pre-intervention) and their experiences and their views regarding its impact on clinicians and patients (post-intervention). The systematic review showed that people with SMI had low reported rates of AF. AF patients with SMI were less likely to receive OAC than the general population. When receiving warfarin, people with SMI, particularly bipolar disorder, experienced poor anticoagulation control compared to the general population. Meta-analysis showed that SMI was not significantly associated with an increased risk of stroke or major bleeding when adjusting for underlying risk factors. The main findings of the first observational study were that among AF patients having a high stroke risk, those with co-morbid SMI were less likely than non-SMI to be prescribed any OAC, particularly warfarin. After 2019, there was no significant difference between the two groups. In the second observational study, patients with AF and co-morbid SMI were less likely to be prescribed any OAC compared to those with dementia, substance use disorders, or common mental disorders, adjusting for age, sex, stroke, and bleeding risk scores. Among AF patients with co-morbid SMI, warfarin was less likely to be prescribed to those having alcohol or substance dependency, serious self-injury, hallucinations or delusions, and activities of daily living impairment. In the intervention, clinicians were asked to confirm the presence of AF, clinically assess stroke and bleeding risks, record risk scores in clinical notes, and refer patients at high risk of stroke to OAC clinics. Clinicians reported many potential benefits for the eCDSS, including improving clinical effectiveness, better identification of patients at risk, safer and more comprehensive care, consistency in decision making and saving time. Identified potential risks included rigidity in decision-making, overreliance, reduced critical thinking, false positive recommendations, annoyance, and increased workload. This study presents a unique opportunity to quantify AF patients with mental illness who are at high risk of severe outcomes using electronic health records. This has the potential to improve health outcomes and, therefore patients' quality of life.Keywords: atrial fibrillation, stroke, mental health conditions, electronic clinical decision support systems
Procedia PDF Downloads 4928265 Evaluating Multiple Diagnostic Tests: An Application to Cervical Intraepithelial Neoplasia
Authors: Areti Angeliki Veroniki, Sofia Tsokani, Evangelos Paraskevaidis, Dimitris Mavridis
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The plethora of diagnostic test accuracy (DTA) studies has led to the increased use of systematic reviews and meta-analysis of DTA studies. Clinicians and healthcare professionals often consult DTA meta-analyses to make informed decisions regarding the optimum test to choose and use for a given setting. For example, the human papilloma virus (HPV) DNA, mRNA, and cytology can be used for the cervical intraepithelial neoplasia grade 2+ (CIN2+) diagnosis. But which test is the most accurate? Studies directly comparing test accuracy are not always available, and comparisons between multiple tests create a network of DTA studies that can be synthesized through a network meta-analysis of diagnostic tests (DTA-NMA). The aim is to summarize the DTA-NMA methods for at least three index tests presented in the methodological literature. We illustrate the application of the methods using a real data set for the comparative accuracy of HPV DNA, HPV mRNA, and cytology tests for cervical cancer. A search was conducted in PubMed, Web of Science, and Scopus from inception until the end of July 2019 to identify full-text research articles that describe a DTA-NMA method for three or more index tests. Since the joint classification of the results from one index against the results of another index test amongst those with the target condition and amongst those without the target condition are rarely reported in DTA studies, only methods requiring the 2x2 tables of the results of each index test against the reference standard were included. Studies of any design published in English were eligible for inclusion. Relevant unpublished material was also included. Ten relevant studies were finally included to evaluate their methodology. DTA-NMA methods that have been presented in the literature together with their advantages and disadvantages are described. In addition, using 37 studies for cervical cancer obtained from a published Cochrane review as a case study, an application of the identified DTA-NMA methods to determine the most promising test (in terms of sensitivity and specificity) for use as the best screening test to detect CIN2+ is presented. As a conclusion, different approaches for the comparative DTA meta-analysis of multiple tests may conclude to different results and hence may influence decision-making. Acknowledgment: This research is co-financed by Greece and the European Union (European Social Fund- ESF) through the Operational Programme «Human Resources Development, Education and Lifelong Learning 2014-2020» in the context of the project “Extension of Network Meta-Analysis for the Comparison of Diagnostic Tests ” (MIS 5047640).Keywords: colposcopy, diagnostic test, HPV, network meta-analysis
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