Search results for: critical success factors (csf)
10839 Applying Systems Thinking and a System of Systems Approach to Facilitate Sustainable Grid Integration of Variable Renewable Energy
Authors: Edward B. Ssekulima, Amir Etemadi
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This paper presents a Systems Thinking and System of Systems (SoS) viewpoint for managing requirements complexity in the grid integration of Variable Renewable Energy (VRE). To achieve a SoS approach, it is often necessary to inculcate a Systems Thinking (ST) perspective in the planning and design of the attendant system. We show how this approach can support the enhanced integration of VRE (wind, solar small hydro) for which intermittency is a key inhibiting factor to their sustainable grid integration. The results indicate that a ST and SoS approach are a critical tool for decision makers in the planning, design and deployment of VRE Sources for their sustainable grid-integration in accordance with relevant techno-economic, social and environmental requirements.Keywords: sustainable grid-integration, system of systems, systems thinking, variable energy resources
Procedia PDF Downloads 13210838 Effectiveness of Using Phonemic Awareness Based Activities in Improving Decoding Skills of Third Grade Students Referred for Reading Disabilities in Oman
Authors: Mahmoud Mohamed Emam
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In Oman the number of students referred for reading disabilities is on the rise. Schools serve these students by placement in the so-called learning disabilities unit. Recently the author led a strategic project to train teachers on the use of curriculum based measurement to identify students with reading disabilities in Oman. Additional the project involved training teachers to use phonemic awareness based activities to improve reading skills of those students. Phonemic awareness refers to the ability to notice, think about, and work with the individual sounds in words. We know that a student's skill in phonemic awareness is a good predictor of later reading success or difficulty. Using multiple baseline design across four participants the current studies investigated the effectiveness of using phonemic awareness based activities to improve decoding skills of third grade students referred for reading disabilities in Oman. During treatment students received phonemic awareness based activities that were designed to fulfill the idiosyncratic characteristics of Arabic language phonology as well as orthography. Results indicated that the phonemic awareness based activities were effective in substantially increasing the number of correctly decoded word for all four participants. Maintenance of strategy effects was evident for the weeks following the termination of intervention for the four students. In addition, the effects of intervention generalized to decoding novel words for all four participants.Keywords: learning disabilities, phonemic awareness, third graders, Oman
Procedia PDF Downloads 64410837 Fast-Tracking University Education for Youth Employment: Empirical Evidence from University Graduates in Rwanda
Authors: Fred Alinda, Marjorie Negesa, Gerald Karyeija
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Like elsewhere in the world, youth unemployment remains a big problem more so to the most educated youth and female. In Rwanda, unemployment is estimated at 13.2% among youth graduates compared to 10.9% and 2.6 among secondary and primary graduates respectively. Though empirical evidence elsewhere associate youth unemployment with education level, relevance of skills and access to business support opportunities, mixed evidence still exist on the significance of these factors to youth employment. As youth employment strategies in countries like Rwanda continue to recognize the potential role university education can play to enhance employment, there is a need to understand the catalysts or barriers. This paper, therefore, draws empirical evidence from a survey on the influence of education qualification, skills relevance and access to business support opportunities on employment of the youth university graduates in Masaka sector, Rwanda. The analysis tested four hypotheses; access to university education significantly affects youth employment, Relevance of university education significantly contributes to youth employment; access to business support opportunities significantly contributes to youth employment, and significant gender differences exist in the employment of youth university graduates. A cross-section survey was used in lieu of the need to explore the prevailing status of youth employment and contributing factors across the sector. A questionnaire was used to collect data on a large sample of 269 youth to allow statistical analysis. This was beefed up with qualitative views of leaders and technical officials in the sector. The youth University graduates were selected using simple random sampling while the leaders and technical officials were selected purposively. Percentages were used to describe respondents in line with the variables under while a regression model for youth employment was fitted to determine the significant factors. The model results indicated a significant influence (p<0.05) of gender, education level and access to business support opportunities on employment of youth university graduates. This finding was also affirmed by the qualitative views of key informants. Qualitative views pointed to the fact that university education generally equipped the youth with skills that enabled their transition into employment mainly for a salary or wage. The skills were, however, deficient in technical and practical aspects. In addition, the youth generally lacked limited access to business support opportunities particularly guarantees for loans, business advisory, and grants for business as well as training in business skills that would help them gain salaried employment or transit into self-employment. The study findings bear an implication on the strategy for catalyzing youth employment through university education. The findings imply that university education should be embraced but with greater emphasis on or supplementation with specialized training in practical and technical skills as well as extending business support opportunities to the youth. This will accelerate the contribution of university education to youth employment.Keywords: education, employment, self-employment, youth
Procedia PDF Downloads 26010836 Behavior of Reinforced Concrete Structures Subjected to Multiple Floor Fire Loads
Authors: Suresh Narayana, Chaitanya Akkannavar
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Assessment of behavior of reinforced concrete structures subjected to fire load, and its behavior for the multi-floor fire have been presented in this paper. This research is the part of the study to evaluate the performance of ten storied RC structure when it is subjected to fire loads at multiple floors and to evaluate the post-fire effects on structure such as deflection and stresses occurring due to combined effect of static and thermal loading. Thermal loading has been assigned to different floor levels to estimate the critical floors that initiate the collapse of the structure. The structure has been modeled and analyzed in Solid Works and commercially available Finite Element Software ABAQUS. Results are analyzed, and particular design solution has been suggested.Keywords: collapse mechanism, fire analysis, RC structure, stress vs temperature
Procedia PDF Downloads 47510835 Working Women and Leave in India
Authors: Ankita Verma
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Women transform the group of people into a family and a house into a home. When a woman embraces motherhood, she undergoes several stresses – both physical and mental. Therefore, to be supportive of women during this critical stage is a societal responsibility. India is in the league of many developed nations in formulating women-friendly policies. One such initiative is the Maternity Benefits Act; first passed in 1961 and later amended from time to time with the latest amended Act of 2017. This review paper critically analyzes provisions of the Act, its implementation, and the legal issues arising out of implementation of the Act. The review suggests that the Act has made a positive impact and the judiciary also has played its role in streamlining the process of implementation of the Act. However, at the same time, it is also felt that employers often hesitate in hiring a mother or an expectant mother.Keywords: maternity benefits, maternity benefits act 1961 & 2017, motherhood, maternity and paternity leave, medical bonus, work environment
Procedia PDF Downloads 17310834 Food Security of Migrants in a Regional Area of Australia: A Qualitative Study
Authors: Joanne Sin Wei Yeoh, Quynh Lê, Rosa McManamey
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Food security indicates the ability of individuals, households and communities to acquire food that is healthy, sustainable, affordable, appropriate and accessible. Despite Australia’s current ability to produce enough food to feed a population larger than its current population, there has been substantial evidence over the last decades to demonstrate many Australians struggle to feed themselves, including those from a cultural and linguistically diverse (CALD) background. The study aimed to investigate migrants’ perceptions and experiences on food security in Tasmania. Semi-structured interviews were conducted with 33 migrants residing in North, South and North West Tasmania, who were recruited through purposive sampling. Thematic analysis was employed to analyse the interview data. Four main themes were identified from the interview data: (1) Understanding of food security; (2) Experiences with the food security in Tasmania; (3) Factors that influence migrants’ food security in Tasmania; and (4) Acculturation strategies. Various sub-themes have emerged under each of these four major themes. Though the findings indicate participants are satisfied with their current food security in Tasmania, they still encounter some challenges in food availability, accessibility, and affordability in Tasmania. Factors that influence migrants’ food security were educational background, language barrier, socioeconomic status, geographical isolation, and cultural background. By using different acculturation strategies, migrants managed to adapt to the new food culture. In addition, social and cultural capitals were also treated as vital roles in improving migrants’ food security. The findings indicate migrants residing in Tasmania face different challenges on food security. They use different strategies for food security while acculturating into a new environment. The findings may provide useful information for migrants in Australia and various private organisations or relevant government departments that address food security for migrants.Keywords: experiences, food security, migrants, perceptions
Procedia PDF Downloads 42610833 Influenza Vaccine Uptake Among Tunisian Physicians in the 2018-2019 Influenza Season
Authors: Ines Cherif, Ghassen Kharroubi, Leila Bouabid, Adel Gharbi, Aicha Boukthir, Margaret Mccarron, Nissaf Ben Alaya, Afif Ben Salah, Jihene Bettaieb
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Healthcare workers' flu vaccination prevents influenza disease among both patients and caregivers. We aimed in this study to assess influenza vaccine (IV) coverage in 2018-2019 among Tunisian physicians and to determine factors associated with IV receipt. A cross sectional study was carried out in Tunisian primary and secondary health care facilities in the 2018-2019 influenza season. Physicians with direct patient contact were recruited according to a self-weighted multistage sampling. Data were collected through a face to face questionnaire containing questions on knowledge, attitudes, and practices regarding IV. Bivariate analysis was used in order to determine factors associated with IV receipt. A total of 167 physicians were included in the study with a mean age of 48.2 ± 7.7 years and a sex-ratio (M: F) of 0.37. Among participants, 15.1% (95% CI: [9.7%-20.3%]) were vaccinated against influenza in the 2018-2019 influenza season. Bivariate analysis revealed that previous flu immunization in the four years preceding the 2018-2019 influenza season (OR=32.3; p < 10-3), belief that vaccinating healthcare workers may reduce work absenteeism (OR=4.7, p=0.028), belief that flu vaccine should be mandatory to healthcare workers (OR=3.3, p=0.01) and high confidence towards IV efficacy in preventing influenza among caregivers (OR= 4.5, p=0.01) were associated with a higher IV receipt in 2018-2019 among physicians. Less than one fifth of Tunisian physicians were vaccinated against influenza in 2018-2019. Higher vaccine uptake was related to a higher belief in vaccine efficacy in preventing influenza disease among both patients and caregivers. This underscores the need for periodic educational campaigns to raise physicians' awareness about IV efficacy. The switch to an IV mandatory policy should also be considered.Keywords: influenza vaccine, physicians, Tunisia, vaccination uptake
Procedia PDF Downloads 13910832 Capital Accumulation and Unemployment in Namibia, Nigeria and South Africa
Authors: Abubakar Dikko
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The research investigates the causes of unemployment in Namibia, Nigeria and South Africa, and the role of Capital Accumulation in reducing the unemployment profile of these economies as proposed by the post-Keynesian economics. This is conducted through extensive review of literature on the NAIRU models and focused on the post-Keynesian view of unemployment within the NAIRU framework. The NAIRU (non-accelerating inflation rate of unemployment) model has become a dominant framework used in macroeconomic analysis of unemployment. The study views the post-Keynesian economics arguments that capital accumulation is a major determinant of unemployment. Unemployment remains the fundamental socio-economic challenge facing African economies. It has been a burden to citizens of those economies. Namibia, Nigeria and South Africa are great African nations battling with high unemployment rates. In 2013, the countries recorded high unemployment rates of 16.9%, 23.9% and 24.9% respectively. Most of the unemployed in these economies comprises of youth. Roughly about 40% working age South Africans has jobs, whereas in Nigeria and Namibia is less than that. Unemployment in Africa has wide implications on households which has led to extensive poverty and inequality, and created a rampant criminality. Recently in South Africa there has been a case of xenophobic attacks which were caused by the citizens of the country as a result of unemployment. The high unemployment rate in the country led the citizens to chase away foreigners in the country claiming that they have taken away their jobs. The study proposes that there is a strong relationship between capital accumulation and unemployment in Namibia, Nigeria and South Africa, and capital accumulation is responsible for high unemployment rates in these countries. For the economies to achieve steady state level of employment and satisfactory level of economic growth and development there is need for capital accumulation to take place. The countries in the study have been selected after a critical research and investigations. They are selected based on the following criteria; African economies with high unemployment rates above 15% and have about 40% of their workforce unemployed. This level of unemployment is the critical level of unemployment in Africa as expressed by International Labour Organization (ILO). The African countries with low level of capital accumulation. Adequate statistical measures have been employed using a time-series analysis in the study and the results revealed that capital accumulation is the main driver of unemployment performance in the chosen African countries. An increase in the accumulation of capital causes unemployment to reduce significantly. The results of the research work will be useful and relevant to federal governments and ministries, departments and agencies (MDAs) of Namibia, Nigeria and South Africa to resolve the issue of high and persistent unemployment rates in their economies which are great burden that slows growth and development of developing economies. Also, the result can be useful to World Bank, African Development Bank and International Labour Organization (ILO) in their further research and studies on how to tackle unemployment in developing and emerging economies.Keywords: capital accumulation, unemployment, NAIRU, Post-Keynesian economics
Procedia PDF Downloads 26710831 A Bayesian Approach for Health Workforce Planning in Portugal
Authors: Diana F. Lopes, Jorge Simoes, José Martins, Eduardo Castro
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Health professionals are the keystone of any health system, by delivering health services to the population. Given the time and cost involved in training new health professionals, the planning process of the health workforce is particularly important as it ensures a proper balance between the supply and demand of these professionals and it plays a central role on the Health 2020 policy. In the past 40 years, the planning of the health workforce in Portugal has been conducted in a reactive way lacking a prospective vision based on an integrated, comprehensive and valid analysis. This situation may compromise not only the productivity and the overall socio-economic development but the quality of the healthcare services delivered to patients. This is even more critical given the expected shortage of the health workforce in the future. Furthermore, Portugal is facing an aging context of some professional classes (physicians and nurses). In 2015, 54% of physicians in Portugal were over 50 years old, and 30% of all members were over 60 years old. This phenomenon associated to an increasing emigration of young health professionals and a change in the citizens’ illness profiles and expectations must be considered when planning resources in healthcare. The perspective of sudden retirement of large groups of professionals in a short time is also a major problem to address. Another challenge to embrace is the health workforce imbalances, in which Portugal has one of the lowest nurse to physician ratio, 1.5, below the European Region and the OECD averages (2.2 and 2.8, respectively). Within the scope of the HEALTH 2040 project – which aims to estimate the ‘Future needs of human health resources in Portugal till 2040’ – the present study intends to get a comprehensive dynamic approach of the problem, by (i) estimating the needs of physicians and nurses in Portugal, by specialties and by quinquenium till 2040; (ii) identifying the training needs of physicians and nurses, in medium and long term, till 2040, and (iii) estimating the number of students that must be admitted into medicine and nursing training systems, each year, considering the different categories of specialties. The development of such approach is significantly more critical in the context of limited budget resources and changing health care needs. In this context, this study presents the drivers of the healthcare needs’ evolution (such as the demographic and technological evolution, the future expectations of the users of the health systems) and it proposes a Bayesian methodology, combining the best available data with experts opinion, to model such evolution. Preliminary results considering different plausible scenarios are presented. The proposed methodology will be integrated in a user-friendly decision support system so it can be used by politicians, with the potential to measure the impact of health policies, both at the regional and the national level.Keywords: bayesian estimation, health economics, health workforce planning, human health resources planning
Procedia PDF Downloads 25410830 Revolutionizing Healthcare Communication: The Transformative Role of Natural Language Processing and Artificial Intelligence
Authors: Halimat M. Ajose-Adeogun, Zaynab A. Bello
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Artificial Intelligence (AI) and Natural Language Processing (NLP) have transformed computer language comprehension, allowing computers to comprehend spoken and written language with human-like cognition. NLP, a multidisciplinary area that combines rule-based linguistics, machine learning, and deep learning, enables computers to analyze and comprehend human language. NLP applications in medicine range from tackling issues in electronic health records (EHR) and psychiatry to improving diagnostic precision in orthopedic surgery and optimizing clinical procedures with novel technologies like chatbots. The technology shows promise in a variety of medical sectors, including quicker access to medical records, faster decision-making for healthcare personnel, diagnosing dysplasia in Barrett's esophagus, boosting radiology report quality, and so on. However, successful adoption requires training for healthcare workers, fostering a deep understanding of NLP components, and highlighting the significance of validation before actual application. Despite prevailing challenges, continuous multidisciplinary research and collaboration are critical for overcoming restrictions and paving the way for the revolutionary integration of NLP into medical practice. This integration has the potential to improve patient care, research outcomes, and administrative efficiency. The research methodology includes using NLP techniques for Sentiment Analysis and Emotion Recognition, such as evaluating text or audio data to determine the sentiment and emotional nuances communicated by users, which is essential for designing a responsive and sympathetic chatbot. Furthermore, the project includes the adoption of a Personalized Intervention strategy, in which chatbots are designed to personalize responses by merging NLP algorithms with specific user profiles, treatment history, and emotional states. The synergy between NLP and personalized medicine principles is critical for tailoring chatbot interactions to each user's demands and conditions, hence increasing the efficacy of mental health care. A detailed survey corroborated this synergy, revealing a remarkable 20% increase in patient satisfaction levels and a 30% reduction in workloads for healthcare practitioners. The poll, which focused on health outcomes and was administered to both patients and healthcare professionals, highlights the improved efficiency and favorable influence on the broader healthcare ecosystem.Keywords: natural language processing, artificial intelligence, healthcare communication, electronic health records, patient care
Procedia PDF Downloads 7710829 Finite-Sum Optimization: Adaptivity to Smoothness and Loopless Variance Reduction
Authors: Bastien Batardière, Joon Kwon
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For finite-sum optimization, variance-reduced gradient methods (VR) compute at each iteration the gradient of a single function (or of a mini-batch), and yet achieve faster convergence than SGD thanks to a carefully crafted lower-variance stochastic gradient estimator that reuses past gradients. Another important line of research of the past decade in continuous optimization is the adaptive algorithms such as AdaGrad, that dynamically adjust the (possibly coordinate-wise) learning rate to past gradients and thereby adapt to the geometry of the objective function. Variants such as RMSprop and Adam demonstrate outstanding practical performance that have contributed to the success of deep learning. In this work, we present AdaLVR, which combines the AdaGrad algorithm with loopless variance-reduced gradient estimators such as SAGA or L-SVRG that benefits from a straightforward construction and a streamlined analysis. We assess that AdaLVR inherits both good convergence properties from VR methods and the adaptive nature of AdaGrad: in the case of L-smooth convex functions we establish a gradient complexity of O(n + (L + √ nL)/ε) without prior knowledge of L. Numerical experiments demonstrate the superiority of AdaLVR over state-of-the-art methods. Moreover, we empirically show that the RMSprop and Adam algorithm combined with variance-reduced gradients estimators achieve even faster convergence.Keywords: convex optimization, variance reduction, adaptive algorithms, loopless
Procedia PDF Downloads 7310828 Designing the First Oil Tanker Shipyard Facility in Kuwait
Authors: Fatma Al Abdullah, Shahad Al Ameer, Ritaj Jaragh, Fatimah Khajah, Rawan Qambar, Amr Nounou
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Kuwait currently manufactures its tankers in foreign countries. Oil tankers play a role in the supply chain of the oil industry. Therefore, with Kuwait’s sufficient financial resources, the country should secure itself strategically in order to protect its oil industry to sustain economic development. The purpose of this report is designing an oil tankers’ shipyard facility. Basing the shipyard facility in Kuwait will have great economic rewards. The shipbuilding industry directly enhances the industrial chain in terms of new job and business opportunities as well as educational fields. Heavy Engineering Industries & Shipbuilding Co. K.S.C. (HEISCO) was chosen as a host due to benefits that will result from HEISCO’s existing infrastructure and expertise to reduce cost. The Facility Design methodology chosen has been used because it covers all aspects needed for the report. The oil tanker market is witnessing a shift from crude tankers to product tankers. Therefore the Panamax tanker (product tanker) was selected to be manufactured in the facility. The different departments needed in shipyards were identified based on studying different global shipyards. Technologies needed to build ships helped in the process design. It was noticed that ships are engineer to order. The new layout development of the proposed shipyard is currently in progress. A feasibility study will be conducted to ensure the success of the facility after developing the shipyard’s layout.Keywords: oil tankers, shipbuilding, shipyard, facility design, Kuwait
Procedia PDF Downloads 46810827 Requirements for the Development of Competencies to Mentor Trainee Teachers: A Case Study of Vocational Education Cooperating Teachers in Quebec
Authors: Nathalie Gagnon, Andréanne Gagné, Julie Courcy
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Quebec's vocational education teachers experience an atypical induction process into the workplace and thus face unique challenges. In contrast to elementary and high school teachers, who must undergo initial teacher training in order to access the profession, vocational education teachers, in most cases, are hired based on their professional expertise in the trade they are teaching, without prior pedagogical training. In addition to creating significant stress, which does not foster the acquisition of teaching roles and skills, this approach also forces recruits into a particular posture during their practical training: that of juggling their dual identities as teacher and trainee simultaneously. Recruits are supported by Cooperating Teachers (CPs) who, as experienced educators, take a critical and constructive look at their practices, observe them in the classroom, give them constructive feedback, and encourage them in their reflective practice. Thus, the vocational setting CP also assumes a distinctive posture and role due to the characteristics of the trainees they support. Although it is recognized that preparation, training, and supervision of CPs are essential factors in improving the support provided to trainees, there is little research about how CPs develop their support skills, and very little research focuses on the distinct posture they occupy. However, in order for them to be properly equipped for the important role they play in recruits’ practical training, it is vital to know more about their experience. An individual’s competencies cannot be studied without first examining what characterizes their experience, how they experience any given situation on cognitive, emotional, and motivational levels, in addition to how they act and react in situ. Depending on its nature, the experience will or will not promote the development of a specific competency. The research from which this communication originates focuses on describing the overall experience of vocational education CP in an effort to better understand the mechanisms linked to the development of their mentoring competencies. Experience and competence were, therefore, the two main theoretical concepts leading the research. As per methodology choices, case study methods were used since it proves to be adequate to describe in a rich and detailed way contemporary phenomena within contexts of life. The set of data used was collected from semi-structured interviews conducted with 15 vocational education CP in Quebec (Canada), followed by the use of a data-driven semi-inductive analysis approach to let the categories emerge organically. Focusing on the development needs of vocational education CP to improve their mentoring skills, this paper presents the results of our research, namely the importance of adequate training, better support offered by university supervisors, greater recognition of their role, and specific time slots dedicated to trainee support. The knowledge resulting from this research could improve the quality of support for trainee teachers in vocational education settings and to a more successful induction into the workplace. This communication also presents recommendations regarding the development of training systems that meet the specific needs of vocational education CP.Keywords: development of competencies, cooperating teacher, mentoring trainee teacher, practical training, vocational education
Procedia PDF Downloads 11810826 Analysis of Municipal Solid Waste Management in Nigeria
Authors: Anisa Gumel
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This study examines the present condition of solid waste management in Nigeria. The author explores the challenges and opportunities affecting municipal solid waste management in "Nigeria" and determines the most profound challenges by analysing the interdependence and interrelationship among identified variables. In this study, multiple stakeholders, including 15 waste management professionals interviewed online, were utilised to identify the difficulties and opportunities affecting municipal solid waste in Nigeria. The interviews were transcribed and coded using NVivo to produce pertinent variables. An online survey of Nigerian internet and social media users was done to validate statements made by experts on the identified variable. In addition, a panel of five experts participated in a focus group discussion to discover the most influential factors that influence municipal solid waste management in Nigeria by analysing the interrelationships as well as the driving and reliant power of variables. The results show significant factors affecting municipal solid waste in Nigeria, including inadequate funding, lack of knowledge, and absence of legislation, as well as behavioural, financial, technological, and legal concerns grouped into five categories. Some claims stated by experts in the interview are supported by the survey data, while others are not. In addition, the focus group reveals patterns, correlations, and driving forces between variables that have been analysed. This study will provide decision-makers with a roadmap for resolving important waste management concerns in Nigeria and managing scarce resources effectively. It will also help non-governmental organisations combat malaria in Nigeria and other underdeveloped nations. In addition, the work contributes to the literature for future scholars to consult.Keywords: municipal solid waste, stakeholders, public, experts
Procedia PDF Downloads 8210825 Fluorescence Quenching as an Efficient Tool for Sensing Application: Study on the Fluorescence Quenching of Naphthalimide Dye by Graphene Oxide
Authors: Sanaz Seraj, Shohre Rouhani
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Recently, graphene has gained much attention because of its unique optical, mechanical, electrical, and thermal properties. Graphene has been used as a key material in the technological applications in various areas such as sensors, drug delivery, super capacitors, transparent conductor, and solar cell. It has a superior quenching efficiency for various fluorophores. Based on these unique properties, the optical sensors with graphene materials as the energy acceptors have demonstrated great success in recent years. During quenching, the emission of a fluorophore is perturbed by a quencher which can be a substrate or biomolecule, and due to this phenomenon, fluorophore-quencher has been used for selective detection of target molecules. Among fluorescence dyes, 1,8-naphthalimide is well known for its typical intramolecular charge transfer (ICT) and photo-induced charge transfer (PET) fluorophore, strong absorption and emission in the visible region, high photo stability, and large Stokes shift. Derivatives of 1,8-naphthalimides have found applications in some areas, especially fluorescence sensors. Herein, the fluorescence quenching of graphene oxide has been carried out on a naphthalimide dye as a fluorescent probe model. The quenching ability of graphene oxide on naphthalimide dye was studied by UV-VIS and fluorescence spectroscopy. This study showed that graphene is an efficient quencher for fluorescent dyes. Therefore, it can be used as a suitable candidate sensing platform. To the best of our knowledge, studies on the quenching and absorption of naphthalimide dyes by graphene oxide are rare.Keywords: fluorescence, graphene oxide, naphthalimide dye, quenching
Procedia PDF Downloads 59310824 Jejunostomy and Protective Ileostomy in a Patient with Massive Necrotizing Enterocolitis: A Case Report
Authors: Rafael Ricieri, Rogerio Barros
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Objective: This study is to report a case of massive necrotizing enterocolitis in a six-month-old patient, requiring ileostomy and protective jejunostomy as a damage control measure in the first exploratory laparotomy surgery in massive enterocolitis without a previous diagnosis. Methods: This study is a case report of success in making and closing a protective jejunostomy. However, the low number of publications on this staged and risky measure of surgical resolution encouraged the team to study the indication and especially the correct time for closing the patient's protective jejunostomy. The main study instrument will be the six-month-old patient's medical record. Results: Based on the observation of the case described, it was observed that the time for the closure of the described procedure (protective jejunostomy) varies according to the level of compromise of the health status of your patient and of an individual of each person. Early closure, or failure to close, can lead to a favorable problem for the patient since several problems can result from this closure, such as new intestinal perforations, hydroelectrolyte disturbances. Despite the risk of new perforations, we suggest closing the protective jejunostomy around the 14th day of the procedure, thus keeping the patient on broad-spectrum antibiotic therapy and absolute fasting, thus reducing the chances of new intestinal perforations. Associated with the closure of the jejunostomy, a gastric tube for decompression is necessary, and care in an intensive care unit and electrolyte replacement is necessary to maintain the stability of the case.Keywords: jejunostomy, ileostomy, enterocolitis, pediatric surgery, gastric surgery
Procedia PDF Downloads 8710823 Ex-Offenders’ Labelling, Stigmatisation and Unsuccessful Re-Integration as Factors Leading into Recidivism: A South African Context
Authors: Tshimangadzo Oscar Magadze
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For successful re-integration, the individual offender must adapt and transform, which requires that the offender should adopt and internalise socially approved norms, attitudes, values, and beliefs. However, the offender’s labelling and community stigmatisation decide the destination of the offender. Community involvement in ex-offenders’ re-integration is an important issue in efforts to reduce recidivism and to control overcrowding in our correctional facilities. Crime is a social problem that requires society to come together to fight against it. This study was conducted in the Limpopo Province in Vhembe District Municipality within four local municipalities, namely Musina, Makhado, Mutale, and Thulamela. A total number of 30 participants were interviewed, and all were members of the Community Corrections Forums. This was necessitated by the fact that Musina is a very small area, which compelled the Department of Correctional Services to combine the two (Musina and Makhado) into one social re-integration entity. This is a qualitative research study where participants were selected through the use of purposive sampling. Participants were selected based on the value they would add to this study in order to achieve the objectives. The data collection method of this study was the focus group, which comprised of three groups of 10 participants each. Thulamela and Mutale local municipalities formed a group with (10) participants each, whereas Musina (2) and Makhado (8) formed another. Results indicate that the current situation is not conducive for re-integration to be successful. Participants raised many factors that need serious redress, namely offenders’ discrimination, lack of forgiveness by members of the community, which is fuelled by lack of community awareness due to the failure of the Department of Correctional Services in educating communities on ex-offenders’ re-integration.Keywords: ex-offender, labeling, re-integration, stigmatization
Procedia PDF Downloads 15310822 Development of selective human matrix metalloproteinases-9 (hMMP-9) inhibitors as potent diabetic wound healing agents
Authors: Geetakshi Arora, Danish Malhotra
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Diabetic wounds are serious health issues and often fail to heal, leading to limb amputation that makes the life of the patient miserable. Delayed wound healing has been characterized by an increase in matrix metalloproteinase-9 (MMP-9). Thus research throughout the world has been going on to develop selective MMP-9 inhibitors for aiding diabetic wound healing. Bioactive constituents from natural sources always served as potential leads in drug development with high rates of success. Considering the need for novel selective MMP-9 inhibitors and the importance of natural bioactive compounds in drug development, we have screened a library of bioactive constituents from plant sources that were effective in diabetic wound healing on human MMP-9 (hMMP-9) using molecular docking studies. Screened constituents are ranked according to their dock score, ∆G value (binding affinity), and Ligand efficiency evaluated from FleXX docking and Hyde scoring modules available with drug designing platform LeadIT. Rhamnocitrin showed the highest correlation between dock score, ∆G value (binding affinity), and Ligand efficiency was further explored for binding interactions with hMMP-9. The overall study suggest that Rhamnocitrin is sufficiently decorated with both hydrophilic and hydrophobic substitutions that perfectly block hMMP-9 and act as a potential lead in the design and development of selective hMMP-9 inhibitors.Keywords: MMP-9, diabetic wound, molecular docking, phytoconstituents
Procedia PDF Downloads 12810821 ADP Approach to Evaluate the Blood Supply Network of Ontario
Authors: Usama Abdulwahab, Mohammed Wahab
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This paper presents the application of uncapacitated facility location problems (UFLP) and 1-median problems to support decision making in blood supply chain networks. A plethora of factors make blood supply-chain networks a complex, yet vital problem for the regional blood bank. These factors are rapidly increasing demand; criticality of the product; strict storage and handling requirements; and the vastness of the theater of operations. As in the UFLP, facilities can be opened at any of $m$ predefined locations with given fixed costs. Clients have to be allocated to the open facilities. In classical location models, the allocation cost is the distance between a client and an open facility. In this model, the costs are the allocation cost, transportation costs, and inventory costs. In order to address this problem the median algorithm is used to analyze inventory, evaluate supply chain status, monitor performance metrics at different levels of granularity, and detect potential problems and opportunities for improvement. The Euclidean distance data for some Ontario cities (demand nodes) are used to test the developed algorithm. Sitation software, lagrangian relaxation algorithm, and branch and bound heuristics are used to solve this model. Computational experiments confirm the efficiency of the proposed approach. Compared to the existing modeling and solution methods, the median algorithm approach not only provides a more general modeling framework but also leads to efficient solution times in general.Keywords: approximate dynamic programming, facility location, perishable product, inventory model, blood platelet, P-median problem
Procedia PDF Downloads 50910820 Continued usage of Wearable FItness Technology: An Extended UTAUT2 Model Perspective
Authors: Rasha Elsawy
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Aside from the rapid growth of global information technology and the Internet, another key trend is the swift proliferation of wearable technologies. The future of wearable technologies is very bright as an emerging revolution in this technological world. Beyond this, individual continuance intention toward IT is an important area that drew academics' and practitioners' attention. The literature review exhibits that continuance usage is an important concern that needs to be addressed for any technology to be advantageous and for consumers to succeed. However, consumers noticeably abandon their wearable devices soon after purchase, losing all subsequent benefits that can only be achieved through continued usage. Purpose-This thesis aims to develop an integrated model designed to explain and predict consumers' behavioural intention(BI) and continued use (CU) of wearable fitness technology (WFT) to identify the determinants of the CU of technology. Because of this, the question arises as to whether there are differences between technology adoption and post-adoption (CU) factors. Design/methodology/approach- The study employs the unified theory of acceptance and use of technology2 (UTAUT2), which has the best explanatory power, as an underpinning framework—extending it with further factors, along with user-specific personal characteristics as moderators. All items will be adapted from previous literature and slightly modified according to the WFT/SW context. A longitudinal investigation will be carried out to examine the research model, wherein a survey will include these constructs involved in the conceptual model. A quantitative approach based on a questionnaire survey will collect data from existing wearable technology users. Data will be analysed using the structural equation modelling (SEM) method based on IBM SPSS statistics and AMOS 28.0. Findings- The research findings will provide unique perspectives on user behaviour, intention, and actual continuance usage when accepting WFT. Originality/value- Unlike previous works, the current thesis comprehensively explores factors that affect consumers' decisions to continue using wearable technology. That is influenced by technological/utilitarian, affective, emotional, psychological, and social factors, along with the role of proposed moderators. That novel research framework is proposed by extending the UTAUT2 model with additional contextual variables classified into Performance Expectancy, Effort Expectancy, Social Influence (societal pressure regarding body image), Facilitating Conditions, Hedonic Motivation (to be split up into two concepts: perceived enjoyment and perceived device annoyance), Price value, and Habit-forming techniques; adding technology upgradability as determinants of consumers' behavioural intention and continuance usage of Information Technology (IT). Further, using personality traits theory and proposing relevant user-specific personal characteristics (openness to technological innovativeness, conscientiousness in health, extraversion, neuroticism, and agreeableness) to moderate the research model. Thus, the present thesis obtains a more convincing explanation expected to provide theoretical foundations for future emerging IT (such as wearable fitness devices) research from a behavioural perspective.Keywords: wearable technology, wearable fitness devices/smartwatches, continuance use, behavioural intention, upgradability, longitudinal study
Procedia PDF Downloads 11510819 Identifying Chaotic Architecture: Origins of Nonlinear Design Theory
Authors: Mohammadsadegh Zanganehfar
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Since the modernism, movement, and appearance of modern architecture, an aggressive desire for a general design theory in the theoretical works of architects in the form of books and essays emerges. Since Robert Venturi and Denise Scott Brown’s published complexity and contradiction in architecture in 1966, the discourse of complexity and volumetric composition has been an important and controversial issue in the discipline. Ever since various theories and essays were involved in this discourse, this paper attempt to identify chaos theory as a scientific model of complexity and its relation to architecture design theory by conducting a qualitative analysis and multidisciplinary critical approach through architecture and basic sciences resources. As a result, we identify chaotic architecture as the correlation of chaos theory and architecture as an independent nonlinear design theory with specific characteristics and properties.Keywords: architecture complexity, chaos theory, fractals, nonlinear dynamic systems, nonlinear ontology
Procedia PDF Downloads 37810818 Bayesian Optimization for Reaction Parameter Tuning: An Exploratory Study of Parameter Optimization in Oxidative Desulfurization of Thiophene
Authors: Aman Sharma, Sonali Sengupta
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The study explores the utility of Bayesian optimization in tuning the physical and chemical parameters of reactions in an offline experimental setup. A comparative analysis of the influence of the acquisition function on the optimization performance is also studied. For proxy first and second-order reactions, the results are indifferent to the acquisition function used, whereas, while studying the parameters for oxidative desulphurization of thiophene in an offline setup, upper confidence bound (UCB) provides faster convergence along with a marginal trade-off in the maximum conversion achieved. The work also demarcates the critical number of independent parameters and input observations required for both sequential and offline reaction setups to yield tangible results.Keywords: acquisition function, Bayesian optimization, desulfurization, kinetics, thiophene
Procedia PDF Downloads 18410817 Assessing Household Energy Savings and Consumer Behavior in Padang City
Authors: Prima Fithri, Lusi Susanti, Karin Bestarina
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Indonesia's electrification ratio is still around 80.1%, which means that approximately 19.9% of households in Indonesia have not been getting the flow of electrical energy. Household electricity consumptions in Indonesia are generally still dominated by the public urban. In the city of Padang, West Sumatera, Indonesia, about 94.10% are power users of government services (PLN). The most important thing of the issue is human resources efficient energy. Consumer behavior in utilizing electricity becomes significant. Intensive questioner survey, in-depth interview and statistical analysis are carried out to collect scientific evidences of the behavioral based changes instruments to reduce electricity consumption in household sector. The questioner was developed to include five factors assuming affect the electricity consumption pattern in household sector. They are: attitude, energy price, household income, knowledge and other determinants. The survey was carried out in Padang, West Sumatra Province Indonesia. About 210 questioner papers were proportionally distributed to households in 11 districts in Padang. Stratified sampling was used as a method to select respondents. The results show that the household size, income, payment methods and size of house are factors affecting electricity saving behavior in residential sector. Household expenses on electricity are strongly influenced by gender, type of job, level of education, size of house, income, payment method and level of installed power. These results provide a scientific evidence for stakeholders on the potential of controlling electricity consumption and designing energy policy by government in residential sector.Keywords: electricity, energy saving, household, behavior, policy
Procedia PDF Downloads 52810816 'CardioCare': A Cutting-Edge Fusion of IoT and Machine Learning to Bridge the Gap in Cardiovascular Risk Management
Authors: Arpit Patil, Atharav Bhagwat, Rajas Bhope, Pramod Bide
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This research integrates IoT and ML to predict heart failure risks, utilizing the Framingham dataset. IoT devices gather real-time physiological data, focusing on heart rate dynamics, while ML, specifically Random Forest, predicts heart failure. Rigorous feature selection enhances accuracy, achieving over 90% prediction rate. This amalgamation marks a transformative step in proactive healthcare, highlighting early detection's critical role in cardiovascular risk mitigation. Challenges persist, necessitating continual refinement for improved predictive capabilities.Keywords: cardiovascular diseases, internet of things, machine learning, cardiac risk assessment, heart failure prediction, early detection, cardio data analysis
Procedia PDF Downloads 1610815 From Intuitive to Constructive Audit Risk Assessment: A Complementary Approach to CAATTs Adoption
Authors: Alon Cohen, Jeffrey Kantor, Shalom Levy
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The use of the audit risk model in auditing has faced limitations and difficulties, leading auditors to rely on a conceptual level of its application. The qualitative approach to assessing risks has resulted in different risk assessments, affecting the quality of audits and decision-making on the adoption of CAATTs. This study aims to investigate risk factors impacting the implementation of the audit risk model and propose a complementary risk-based instrument (KRIs) to form substance risk judgments and mitigate against heightened risk of material misstatement (RMM). The study addresses the question of how risk factors impact the implementation of the audit risk model, improve risk judgments, and aid in the adoption of CAATTs. The study uses a three-stage scale development procedure involving a pretest and subsequent study with two independent samples. The pretest involves an exploratory factor analysis, while the subsequent study employs confirmatory factor analysis for construct validation. Additionally, the authors test the ability of the KRIs to predict audit efforts needed to mitigate against heightened RMM. Data was collected through two independent samples involving 767 participants. The collected data was analyzed using exploratory factor analysis and confirmatory factor analysis to assess scale validity and construct validation. The suggested KRIs, comprising two risk components and seventeen risk items, are found to have high predictive power in determining audit efforts needed to reduce RMM. The study validates the suggested KRIs as an effective instrument for risk assessment and decision-making on the adoption of CAATTs. This study contributes to the existing literature by implementing a holistic approach to risk assessment and providing a quantitative expression of assessed risks. It bridges the gap between intuitive risk evaluation and the theoretical domain, clarifying the mechanism of risk assessments. It also helps improve the uniformity and quality of risk assessments, aiding audit standard-setters in issuing updated guidelines on CAATT adoption. A few limitations and recommendations for future research should be mentioned. First, the process of developing the scale was conducted in the Israeli auditing market, which follows the International Standards on Auditing (ISAs). Although ISAs are adopted in European countries, for greater generalization, future studies could focus on other countries that adopt additional or local auditing standards. Second, this study revealed risk factors that have a material impact on the assessed risk. However, there could be additional risk factors that influence the assessment of the RMM. Therefore, future research could investigate other risk segments, such as operational and financial risks, to bring a broader generalizability to our results. Third, although the sample size in this study fits acceptable scale development procedures and enables drawing conclusions from the body of research, future research may develop standardized measures based on larger samples to reduce the generation of equivocal results and suggest an extended risk model.Keywords: audit risk model, audit efforts, CAATTs adoption, key risk indicators, sustainability
Procedia PDF Downloads 7710814 Between Reality and Fiction: Self-Representation as an Avatar and Its Effects on Self-Presence
Authors: Leonie Laskowitz
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A self-confident appearance is a basic prerequisite for success in the world of work 4.0. Within a few seconds, people convey a first impression that usually lasts. Artificial intelligence is making it increasingly important how our virtual selves appear and communicate (nonverbally) in digital worlds such as the metaverse. In addition to the modified creation of an avatar, the field of photogrammetry is developing fast, creating exact likenesses of ourselves in virtual environments. Given the importance of self-representation in virtual space for future collaborations, it is important to investigate the impact of phenotype in virtual worlds and how an avatar type can profitably be used situationally. We analyzed the effect of self-similar versus desirable self-presentation as an avatar on one's self-awareness, considering various theoretical constructs in the area of self-awareness and stress stimuli. The avatars were arbitrarily created on the one hand and scanned on the other hand with the help of a lidar sensor, the state-of-the-art photogrammetry method. All subjects were exposed to the established Trier Social Stress Test. The results showed that especially insecure people prefer to create rather than be scanned when confronted with a stressful work situation. (1) If they are in a casual work environment and a relaxed situation, they prefer a 3D photorealistic avatar that reflects them in detail. (2) Confident people will give their avatar their true appearance in any situation, while insecure people would only do so for honesty and authenticity. (3) Thus, the choice of avatar type has considerable impact on self-confidence in different situations.Keywords: avatar, virtual identity, self-presentation, metaverse, virtual reality, self-awareness
Procedia PDF Downloads 15010813 The Conceptual Exploration of Comfort Zone by Using Content Analysis
Authors: Lilla Szabó Hangya, Szilvia Jambori
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The comfort zone is less studied area in the field of psychology. One of the most important definitions is that comfort zone is a psychological state in which things feel familiar to a person with low level of anxiety and stress. But the validity of comfort zone does not confirm till now. The aim of our pilot research is to test which psychological factors could determine how young adults behave during their decision process to stay in one’s comfort zone or to leave it. Every person has a number of comfort zones, so we are not able to measure it directly, only those personality traits which predict if someone leaves his comfort zone easier or harder. In our study at first we wanted to clarify the meaning of comfort zone. 110 young adults (male: 37, female: 73; ages from 18 to 70, average age: 26,6) took part in the study. Beside their demographic datas we asked them what does the comfort zone mean for them. The results showed that the meaning of the comfort zone can be grouped in five dimensions: comfort (49,6 %), leaving it-change (8,1%), ambivalent feelings (10,6%), related to other people (10,6%), pursuit of self-realization (16,8%). Our results demonstrated age related characteristics. For young people at the age of 19 the comfort zone is related to other people, because during adolescents peer relationships become more important. Subjects at the age 20-30 answered that the comfort zone means comfort and stability for them. Their life becomes stable for a while, they are studying or working. But at the age of 25, when they finish university, most of them answered comfort zone means a changing process for them. On the other hand for subjects at the age of 27 the means of the comfort zone is pursuit of self-realization. After that period at the age of 31 when they have families and stable job the stability will also dominant. We saw that the comfort zone has much more meaning besides a pleasant psychological trait. Further we would like to determine which psychological factors relate to comfort zone, and what kind of personality traits could predict leaving or staying in one’s comfort zone. We want to observe the relationship between comfort zone and subjective well-being, life satisfaction self-efficacy or self-esteem.Keywords: comfort zone, development, personality trait, young adults
Procedia PDF Downloads 34410812 Socio-Economic Determinants of Physical Activity of Non-Manual Workers, Including the Early Senior Group, from the City of Wroclaw in Poland
Authors: Daniel Puciato, Piotr Oleśniewicz, Julita Markiewicz-Patkowska, Krzysztof Widawski, Michał Rozpara, Władysław Mynarski, Agnieszka Gawlik, Małgorzata Dębska, Soňa Jandová
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Physical activity as a part of people’s everyday life reduces the risk of many diseases, including those induced by lifestyle, e.g. obesity, type 2 diabetes, osteoporosis, coronary heart disease, degenerative arthritis, and certain types of cancer. That refers particularly to professionally active people, including the early senior group working on non-manual positions. The aim of the study is to evaluate the relationship between physical activity and the socio-economic status of non-manual workers from Wroclaw—one of the biggest cities in Poland, a model setting for such investigations in this part of Europe. The crucial problem in the research is to find out the percentage of respondents who meet the health-related recommendations of the World Health Organization (WHO) concerning the volume, frequency, and intensity of physical activity, as well as to establish if the most important socio-economic factors, such as gender, age, education, marital status, per capita income, savings and debt, determine the compliance with the WHO physical activity recommendations. During the research, conducted in 2013, 1,170 people (611 women and 559 men) aged 21–60 years were examined. A diagnostic poll method was applied to collect the data. Physical activity was measured with the use of the short form of the International Physical Activity Questionnaire with extended socio-demographic questions, i.e. concerning gender, age, education, marital status, income, savings or debts. To evaluate the relationship between physical activity and selected socio-economic factors, logistic regression was used (odds ratio statistics). Statistical inference was conducted on the adopted ex ante probability level of p<0.05. The majority of respondents met the volume of physical effort recommended for health benefits. It was particularly noticeable in the case of the examined men. The probability of compliance with the WHO physical activity recommendations was highest for workers aged 21–30 years with secondary or higher education who were single, received highest incomes and had savings. The results indicate the relations between physical activity and socio-economic status in the examined women and men. People with lower socio-economic status (e.g. manual workers) are physically active primarily at work, whereas those better educated and wealthier implement physical effort primarily in their leisure time. Among the investigated subjects, the youngest group of non-manual workers have the best chances to meet the WHO standards of physical activity. The study also confirms that secondary education has a positive effect on the public awareness on the role of physical activity in human life. In general, the analysis of the research indicates that there is a relationship between physical activity and some socio-economic factors of the respondents, such as gender, age, education, marital status, income per capita, and the possession of savings. Although the obtained results cannot be applied for the general population, they show some important trends that will be verified in subsequent studies conducted by the authors of the paper.Keywords: IPAQ, nonmanual workers, physical activity, socioeconomic factors, WHO
Procedia PDF Downloads 53610811 In Search of Bauman’s Moral Impulse in Shadow Factories of China
Authors: Akram Hatami, Naser Firoozi, Vesa Puhakka
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Ethics and responsibility are rapidly becoming a distinguishing feature of organizations. In this paper, we analyze ethics and responsibility in shadow factories in China. We engage ourselves with Bauman’s moral impulse perspective because his idea can contextualize ethics and responsibility. Moral impulse is a feeling of a selfless, infinite and unconditional responsibility towards, and care for, Others. We analyze a case study from a secondary data source because, for such a critical phenomenon as business ethics in shadow factories, collecting primary data is difficult, since they are unregistered factories. We argue that there has not been enough attention given to the ethics and responsibility in shadow factories in China. Our main goal is to demonstrate that, considering the Other, more importantly the employees, in ethical decision-making is a simple instruction beyond the narrow version of ethics by ethical codes and rules.Keywords: moral impulse, responsibility, shadow factories, Bauman’s moral impulse
Procedia PDF Downloads 33510810 The Confluence between Autism Spectrum Disorder and the Schizoid Personality
Authors: Murray David Schane
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Though years of clinical encounters with patients with autism spectrum disorders and those with a schizoid personality the many defining diagnostic features shared between these conditions have been explored and current neurobiological differences have been reviewed; and, critical and different treatment strategies for each have been devised. The paper compares and contrasts the apparent similarities between autism spectrum disorders and the schizoid personality are found in these DSM descriptive categories: restricted range of social-emotional reciprocity; poor non-verbal communicative behavior in social interactions; difficulty developing and maintaining relationships; detachment from social relationships; lack of the desire for or enjoyment of close relationships; and preference for solitary activities. In this paper autism, fundamentally a communicative disorder, is revealed to present clinically as a pervasive aversive response to efforts to engage with or be engaged by others. Autists with the Asperger presentation typically have language but have difficulty understanding humor, irony, sarcasm, metaphoric speech, and even narratives about social relationships. They also tend to seek sameness, possibly to avoid problems of social interpretation. Repetitive behaviors engage many autists as a screen against ambient noise, social activity, and challenging interactions. Also in this paper, the schizoid personality is revealed as a pattern of social avoidance, self-sufficiency and apparent indifference to others as a complex psychological defense against a deep, long-abiding fear of appropriation and perverse manipulation. Neither genetic nor MRI studies have yet located the explanatory data that identifies the cause or the neurobiology of autism. Similarly, studies of the schizoid have yet to group that condition with those found in schizophrenia. Through presentations of clinical examples, the treatment of autists of the Asperger type is revealed to address the autist’s extreme social aversion which also precludes the experience of empathy. Autists will be revealed as forming social attachments but without the capacity to interact with mutual concern. Empathy will be shown be teachable and, as social avoidance relents, understanding of the meaning and signs of empathic needs that autists can recognize and acknowledge. Treatment of schizoids will be shown to revolve around joining empathically with the schizoid’s apprehensions about interpersonal, interactive proximity. Models of both autism and schizoid personality traits have yet to be replicated in animals, thereby eliminating the role of translational research in providing the kind of clues to behavioral patterns that can be related to genetic, epigenetic and neurobiological measures. But as these clinical examples will attest, treatment strategies have significant impact.Keywords: autism spectrum, schizoid personality traits, neurobiological implications, critical diagnostic distinctions
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