Search results for: major depressive disorder

Authors: Nduduzo Andrias Ngxongo, Nsizwazikhona Simon Chili

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This analytical exploration illustrates how the non-existence of a proper marketing strategy for a tourism destination may have resulted in a radical decline in both financial outputs and visitor arrivals. The marketing strategy is considered as the foundation for any tourism destination’s marketing tactics. Tourism destinations are ought to have dynamic and adaptive marketing strategies that will develop a promotional approach to help the destination to gain market share, identify its target markets, stay relevant to its existing clients, attract new visitors, and increase profits-earned. Accordingly, the Moses Mabhida Stadium (MMS), one of the prominent tourist attractions in KwaZulu-Natal; boasting a world-class architectural design, several international prestigious awards, and vibrant, adventurous activities, has in recent years suffered a gradual slump in both visitors and profits. Therefore, the basis of this paper was to thoroughly establish precisely how the existing MMS marketing strategy may be a basis for a decline in the number of visitors and profits-earned in recent years. The study adopted mixed method research strategy, with 380 participants. The outcome of the study suggests some costly disparities in the marketing strategy of MMS which has led to poor performance and a loss in tourism market share. In consequence, the outcome further suggests that the non-existence of market research analysis and destination marketing tools contributed vastly to the in-progress dilemma. This fact-finding exploration provides a birds-eye outlook of MMS marketing strategy, and based on the results, the study recommends for the introduction of a more far-reaching and revitalising marketing strategy through; constant and persistent market research initiatives, minimal political interference in the administration of state-funded organisations, reassessment of the feasibility study, vigorous, and sourcing of proficient personnel.

Keywords: tourism, destination, marketing , marketing strategy

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Authors: Jagannath Prasad Tegar, Zeeshan Ahmad

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The Ordinary Portland Cement (OPC) is a major constituent of concrete, which is being used extensively since last half century. The production of cement is impacting not only environment alone, but depleting natural materials. During the past 3 decades, the scholars have carried out studies and researches to explore the supplementary cementatious materials such as Ground granulated Blast furnace slag (GGBFS), silica fumes (SF), metakaolin or fly ash (FA). This has contributed towards improved cementatious materials which are being used in construction, but not the way it is supposed to be. The alkali activated slag concrete is another innovation which has constituents of cementatious materials like Ground Granuled Blast Furnace Slag (GGBFS), Fly Ash (FA), Silica Fumes (SF) or Metakaolin. Alkaline activators like Sodium Silicate (Na₂SiO₃) and Sodium Hydroxide (NaOH) is utilized. In view of evaluating properties of alkali activated slag concrete blended with polypropylene shredding and accelerator, research study is being carried out. This research study is proposed to evaluate the effect of polypropylene shredding and accelerating admixture on mechanical properties of alkali-activated slag concrete. The mechanical properties include the compressive strength, splitting tensile strength and workability. The outcomes of this research are matched with the hypothesis and it is found that 27% of cement can be replaced with the ground granulated blast furnace slag (GGBFS) and for split tensile strength 20% replacement is achieved. Overall it is found that 20% of cement can be replaced with ground granulated blast furnace slag. The tests conducted in the laboratory for evaluating properties such as compressive strength test, split tensile strength test, and slump cone test. On the aspect of cost, it is substantially benefitted.

Keywords: ordinary Portland cement, activated slag concrete, ground granule blast furnace slag, fly ash, silica fumes

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Authors: Md Motibur Rahman

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The present paper attempts to study the electoral politics and voting behavior of 2011 assembly election of West Bengal state in India. Electoral geography is considered as the study of geographical aspects of the organization, conduct, and result of elections. It deals with the spatial voting patterns/behaviour or the study of the spatial distribution of political phenomena of voting. Voting behavior is a form of political psychology which played a great role in political decision-making process. The voting behavior of the electorates is largely influenced by their perception that existing during the time of election. The main focus of the study will be to analyze the electoral politics of the party organizations and political profile of the electorates. The principle objectives of the present work are i) to study the spatial patterns of voting behavior in 2011 assembly election in West Bengal, ii) to analysis the result and finding of 2011 assembly election. The whole study based on the secondary source of data. The electoral data have taken from Election Commission of India, New Delhi and Centre for the study of Developing Societies (CSDS) in New Delhi. In the battle of 2011 Assembly election in West Bengal, the two major parties were Left Front and Trinamool Congress. This election witnessed the remarkable successes of Trinamool Congress and decline of 34 years longest ruler party that is Left Front. Trinamool Congress won a majority of seats that 227 out of 294 but Left Front won only 62 seats out of 294 seats. The significance of the present study is that it helps in understanding the voting pattern, voting behaviour, trends of voting and also helps for further study of electoral geography in West Bengal. The study would be highly significant and helpful to the planners, politicians, and administrators who are involved in the formulation of development plans and programmes for the people of the state.

Keywords: assembly election, electoral geography, electoral politics, voting behaviour

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Authors: Vikneswaran Murugaiyah, Sultan Ayesh Mohammed Saghir, Kisantini Murugesu, Mohd. Zaini Asmawi, Amirin Sadikun

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Gynura procumbens is a popular medicinal plant used as a folk medicine in Southeast Asia to treat kidney diseases, diabetes mellitus and hyperlipidemia. The present study aims to investigate the antihyperlipidemic potential of phenolic acids rich fraction (PARF) from G. procumbens in chemically-induced acute and high fat diet-induced chronic hyperlipidemic rats. Ethanolic extract of G. procumbens leaves exhibited significant reductions in total cholesterol (TC) and triglycerides (TG) levels (P < 0.01 and P < 0.001, respectively) of poloxamer 407-induced rats compared to hyperlipidemic control after 58 h of treatment. Upon bioactivity guided fractionation the antihyperlipidemic activity was found to be concentrated in the PARF, which significantly reduced the TC and TG levels (P < 0.001). HPLC analysis revealed that 3,5-dicaffeoylquinic acid; 4,5-dicaffeoylquinic acid and chlorogenic acid are the major compounds in the PARF. Likewise, chlorogenic acid (60 mg/kg) exhibited significant reductions in TC and TG levels of hyperlipidemic rats (P < 0.001). Both chlorogenic acid and PARF significantly reduced LDL, VLDL and atherogenic index (P<0.01), while PARF increased the HDL (P < 0.01) compared to hyperlipidemic control. Both were found to be not cytotoxic against normal and cancer cell lines. In addition, LD50 of orally administered PARF was more than 5,000 mg/kg. Further investigation in high fat diet-induced chronic hyperlipidemic rats revealed that chronic administration of PARF dose-dependently restored the increase in lipids parameters. In summary, the phenolic acids rich fraction of G. procumbens leaves showed promising antihyperlipidemic effect in both chemically- and diet-induced hyperlipidemic rats that warrants further elucidation on its mechanisms of action.

Keywords: Antihyperlipidemic, Gynura procumbens, phenolic acids, chlorogenic acid, poloxamer-407, high fat diet

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Authors: Shilpa Balan

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Radio Frequency Identification, also popularly known as RFID is used to automatically identify and track tags attached to items. This study focuses on the application of RFID in healthcare. The adoption of RFID in healthcare is a crucial technology to patient safety and inventory management. Data from RFID tags are used to identify the locations of patients and inventory in real time. Medical errors are thought to be a prominent cause of loss of life and injury. The major advantage of RFID application in healthcare industry is the reduction of medical errors. The healthcare industry has generated huge amounts of data. By discovering patterns and trends within the data, big data analytics can help improve patient care and lower healthcare costs. The number of increasing research publications leading to innovations in RFID applications shows the importance of this technology. This study explores the current state of research of RFID in healthcare using a text mining approach. No study has been performed yet on examining the current state of RFID research in healthcare using a data mining approach. In this study, related articles were collected on RFID from healthcare journal and news articles. Articles collected were from the year 2000 to 2015. Significant keywords on the topic of focus are identified and analyzed using open source data analytics software such as Rapid Miner. These analytical tools help extract pertinent information from massive volumes of data. It is seen that the main benefits of adopting RFID technology in healthcare include tracking medicines and equipment, upholding patient safety, and security improvement. The real-time tracking features of RFID allows for enhanced supply chain management. By productively using big data, healthcare organizations can gain significant benefits. Big data analytics in healthcare enables improved decisions by extracting insights from large volumes of data.

Keywords: RFID, data mining, data analysis, healthcare

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Authors: Manpreet Kaur, Badaruddoza, Sandeep Kaur Brar

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The increasing prevalence of adolescent obesity is one of the major causes to be hypertensive in adulthood. Various statistical methods have been applied to examine the performance of anthropometric indices for the identification of adverse cardiovascular risk profile. The present work was undertaken to determine the significant traditional risk factors through principal component factor analysis (PCFA) among population based Punjabi adolescents aged 10-18 years. Data was collected among adolescent children from different schools situated in urban areas of Punjab, India. Principal component factor analysis (PCFA) was applied to extract orthogonal components from anthropometric and physiometric variables. Association between components were explained by factor loadings. The PCFA extracted four factors, which explained 84.21%, 84.06% and 83.15% of the total variance of the 14 original quantitative traits among boys, girls and combined subjects respectively. Factor 1 has high loading of the traits that reflect adiposity such as waist circumference, BMI and skinfolds among both sexes. However, waist circumference and body mass index are the indicator of abdominal obesity which increases the risk of cardiovascular diseases. The loadings of these two traits have found maximum in girls adolescents (WC=0.924; BMI=0.905). Therefore, factor 1 is the strong indicator of atherosclerosis in adolescents. Factor 2 is predominantly loaded with blood pressures and related traits (SBP, DBP, MBP and pulse rate) which reflect the risk of essential hypertension in adolescent girls and combined subjects, whereas, factor 2 loaded with obesity related traits in boys (weight and hip circumferences). Comparably, factor 3 is loaded with blood pressures in boys and with height and WHR in girls, while factor 4 contains high loading of pulse pressure among boys, girls and combined group of adolescents.

Keywords: adolescent obesity, cvd, hypertension, punjabi population

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Authors: Yuet Wah Echo Yeung

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Working with people from minority ethnic groups, refugees and asylum seeking communities who have limited proficiency in the language of the host country often presents a major challenge for social workers. Because of language differences, social workers need to work with interpreters to ensure accurate information is collected for their assessment and intervention. Drawing from social learning theory, this paper discusses how role play was used as an experiential learning exercise in a training session to help social work students develop skills when working with interpreters. Social learning theory posits that learning is a cognitive process that takes place in a social context when people observe, imitate and model others’ behaviours. The roleplay also helped students understand the role of the interpreter and the challenges they may face when they rely on interpreters to communicate with service users and their family. The first part of the session involved role play. A tutor played the role of social worker and deliberately behaved in an unprofessional manner and used inappropriate body language when working alongside the interpreter during a home visit. The purpose of the roleplay is not to provide a positive role model for students to ‘imitate’ social worker’s behaviours. Rather it aims to active and provoke internal thinking process and encourages students to critically consider the impacts of poor practice on relationship building and the intervention process. Having critically reflected on the implications for poor practice, students were then asked to play the role of social worker and demonstrate what good practice should look like. At the end of the session, students remarked that they learnt a lot by observing the good and bad example; it showed them what not to do. The exercise served to remind students how practitioners can easily slip into bad habits and of the importance of respect for the cultural difference when working with people from different cultural backgrounds.

Keywords: role play, social learning theory, social work practice, working with interpreters

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Authors: N. Noori, P. Taherkhani, A. Akhondzadeh Basti, H. Gandomi, M. Alimohammadi

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Research on natural antimicrobial agents, especially of plant origin, highly noticed in recent years and evaluation of antimicrobial effects of native plants such as Bunium persicum Boiss. is especially important. In the present study, sensory characteristics and microbiological properties of Gouda cheese affected by different concentrations of Bunium persicum Boiss. essential oil were investigated. Extraction of the essential oil was performed by hydro distillation. The oil was analyzed by GC using flame ionization (FID) and GC/ MS for detection. The antimicrobial effects were determined against various microbial groups (aerobic mesophilic bacteria, enterococci, mesophilic lactobacilli, enterobacteriaceae, lactococcus and yeasts). Microbial groups were counted during ripening period using plate count on specific culture media. Organoleptic evaluation including teture, flavor, odor, color and total acceptability were determined at the end of aging. According to results, the essential oil yield was 4/1 % ( W/ W). Twenty- six compounds were identified in the oil that concluded 99.7 % of the total oil. The major components of Bunium persicum Boiss. essential oil were γ- terpinene- 7- al (26.9 %) and cuminaldehyde (23.3 %). Generally, the increase of Black Cumin essential oil concentration led to reduction in microbial counts in different groups. The maximum antimicrobial effect was seen in yeast that reduced by 2 log compared to the control group at EO concentration of 4µl/ ml at day 90.The minimum reduction was observed in enterobacteriaceae that showed only 0.75 log decreese compared to the control at the same concentration of EO. Addition of EO improved organoleptic properties of Gouda cheese especially in the case of flavor and odor characteristic. However, no significant differences were observed in texture and color between treatment and control groups. Bunium persicum Boiss. essential oil could be used as preservative material and flavoring agent in some kinds of food such as cheese and also could be provided consumers health.

Keywords: Bunium persicum Boiss. essential oil, Microbiological properties, sensory evaluation, gouda cheese

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Authors: Policarpio Jr. Joves

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Physicians in most teaching hospitals are commonly promoted into managerial roles, yet their training is mostly in clinical and scientific skills but not in leadership competencies. When they shift into roles of physician leadership, the majority hold on to their primary identity of physicians. These conflicting roles affect their identity and eventually their work. The physician leaders also face additional challenges related to academics which include incorporation of new knowledge into the existing curriculum, use of technology in the delivery of teaching, the need to train medical students outside of hospital wards, etc. The study aims to explore how physician leaders in teaching hospitals of private medical schools enact their leadership roles and how they face the challenges as physician leaders. The study setting shall be teaching hospitals of three private medical schools situated in the National Capital Region, Philippines. A multiple case study design shall be adopted in this research. Physicians shall be eligible to participate in the study if they are practicing clinicians limited to the five major clinical specialty: Internal Medicine, Pediatrics, Family Medicine, Surgery, Obstetrics and Gynecology. They must be teaching in the College of Medicine prior to their appointments as physician leaders in both medical school and teaching hospital. Semi-structured face-to-face interviews shall be utilized as a means of data collection, with open-ended questions, enabling physician leaders to present narratives about their identity, role enactment, conflicts, reaction of colleagues, and the challenges encountered in their day-to-day work as physician leaders. Interviews shall be combined with observations and review of records to gain more insights into how the physician leaders are 'doing' management. Within-case analysis shall be done initially followed by a thematic analysis across the cases, referred to as cross–case analysis or cross-case synthesis.

Keywords: academic leaders, academic managers, physician leaders, physician managers

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Authors: Md. Mahamud Hassan, Shantanu Biswas Linkon, Nur Mohammad Khan

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Over the last three decades, the primary education system in Bangladesh has experienced significant improvement, but it has failed to cope with different social and cultural aspects, which present many challenges for children, families, and the public school system. Neglecting our own contextual learning environment, it is a matter of sorrow that much attention has been paid to the more physical outcome-focused model, which is nothing but mere infrastructural development, and less subtle to the environment that suits the child's psychology and improves their social, emotional, physical, and moral competency. In South Asia, the symbol of education was never the little red house of colonial architecture but “A Guru sitting under a tree", whereas a responsive and inclusive design approach could help to create more innovative learning environments. Such an approach incorporates how the built, natural, and cultural environment shapes the learner; in turn, learners shape the learning. This research will be conducted to, i) identify the major issues and drawbacks of government policy for primary education development programs; ii) explore and evaluate the morphology of the conventional model of school, and iii) propose an alternative model in a collaborative design process with the stakeholders for maximizing the relationship between the physical learning environments and learners by treating “the built environment” as “the third teacher.” Based on observation, this research will try to find out to what extent built, and natural environments can be utilized as a teaching tool for a more optimal learning environment. It should also be evident that there is a significant gap in the state policy, predetermined educational specifications, and implementation process in response to stakeholders’ involvement. The outcome of this research will contribute to a people-place sensitive design approach through a more thoughtful and responsive architectural process.

Keywords: built environment, conventional planning, indigenous learning space, responsive design

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Authors: Etienne Gaborit, Dorothy Durnford, Daniel Deacu, Marco Carrera, Nathalie Gauthier, Camille Garnaud, Vincent Fortin

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A new experimental streamflow forecasting system was recently implemented at the Environment and Climate Change Canada’s (ECCC) Canadian Centre for Meteorological and Environmental Prediction (CCMEP). It relies on CaLDAS (Canadian Land Data Assimilation System) for the assimilation of surface variables, and on a surface prediction system that feeds a routing component. The surface energy and water budgets are simulated with the SVS (Soil, Vegetation, and Snow) Land-Surface Scheme (LSS) at 2.5-km grid spacing over Canada. The routing component is based on the Watroute routing scheme at 1-km grid spacing for the Great Lakes and Nelson River watersheds. The system is run in two distinct phases: an analysis part and a forecast part. During the analysis part, CaLDAS outputs are used to force the routing system, which performs streamflow assimilation. In forecast mode, the surface component is forced with the Canadian GEM atmospheric forecasts and is initialized with a CaLDAS analysis. Streamflow performances of this new system are presented over 2019. Performances are compared to the current ECCC’s operational streamflow forecasting system, which is different from the new experimental system in many aspects. These new streamflow forecasts are also compared to persistence. Overall, the new streamflow forecasting system presents promising results, highlighting the need for an elaborated assimilation phase before performing the forecasts. However, the system is still experimental and is continuously being improved. Some major recent improvements are presented here and include, for example, the assimilation of snow cover data from remote sensing, a backward propagation of assimilated flow observations, a new numerical scheme for the routing component, and a new reservoir model.

Keywords: assimilation system, distributed physical model, offline hydro-meteorological chain, short-term streamflow forecasts

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Authors: Ermias A. Tegegn, Million Meshesha

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Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS) is a major cause of death for most African countries. Ethiopia is one of the seriously affected countries in sub Saharan Africa. Previously in Ethiopia, having HIV/AIDS was almost equivalent to a death sentence. With the introduction of Antiretroviral Therapy (ART), HIV/AIDS has become chronic, but manageable disease. The study focused on a data mining technique to predict future living status of HIV/AIDS patients at the time of drug regimen change when the patients become toxic to the currently taking ART drug combination. The data is taken from University of Gondar Hospital ART program database. Hybrid methodology is followed to explore the application of data mining on ART program dataset. Data cleaning, handling missing values and data transformation were used for preprocessing the data. WEKA 3.7.9 data mining tools, classification algorithms, and expertise are utilized as means to address the research problem. By using four different classification algorithms, (i.e., J48 Classifier, PART rule induction, Naïve Bayes and Neural network) and by adjusting their parameters thirty-two models were built on the pre-processed University of Gondar ART program dataset. The performances of the models were evaluated using the standard metrics of accuracy, precision, recall, and F-measure. The most effective model to predict the status of HIV patients with drug regimen substitution is pruned J48 decision tree with a classification accuracy of 98.01%. This study extracts interesting attributes such as Ever taking Cotrim, Ever taking TbRx, CD4 count, Age, Weight, and Gender so as to predict the status of drug regimen substitution. The outcome of this study can be used as an assistant tool for the clinician to help them make more appropriate drug regimen substitution. Future research directions are forwarded to come up with an applicable system in the area of the study.

Keywords: HIV drug regimen, data mining, hybrid methodology, predictive model

Procedia PDF Downloads 142

Authors: Xiaomin Zhong, Alexander Pate, Ya-Ting Yang, Ali Fahmi, Darren M. Ashcroft, Ben Goldacre, Brian Mackenna, Amir Mehrkar, Sebastian C. J. Bacon, Jon Massey, Louis Fisher, Peter Inglesby, Kieran Hand, Tjeerd van Staa, Victoria Palin

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Background: This study aimed to predict risks of potentially inappropriate antibiotic type and repeat prescribing and assess changes during COVID-19. Methods: With the approval of NHS England, we used the OpenSAFELY platform to access the TPP SystmOne electronic health record (EHR) system and selected patients prescribed antibiotics from 2019 to 2021. Multinomial logistic regression models predicted the patient’s probability of receiving an inappropriate antibiotic type or repeating the antibiotic course for each common infection. Findings: The population included 9.1 million patients with 29.2 million antibiotic prescriptions. 29.1% of prescriptions were identified as repeat prescribing. Those with same-day incident infection coded in the EHR had considerably lower rates of repeat prescribing (18.0%), and 8.6% had a potentially inappropriate type. No major changes in the rates of repeat antibiotic prescribing during COVID-19 were found. In the ten risk prediction models, good levels of calibration and moderate levels of discrimination were found. Important predictors included age, prior antibiotic prescribing, and region. Patients varied in their predicted risks. For sore throat, the range from 2.5 to 97.5th percentile was 2.7 to 23.5% (inappropriate type) and 6.0 to 27.2% (repeat prescription). For otitis externa, these numbers were 25.9 to 63.9% and 8.5 to 37.1%, respectively. Interpretation: Our study found no evidence of changes in the level of inappropriate or repeat antibiotic prescribing after the start of COVID-19. Repeat antibiotic prescribing was frequent and varied according to regional and patient characteristics. There is a need for treatment guidelines to be developed around antibiotic failure and clinicians provided with individualised patient information.

Keywords: antibiotics, infection, COVID-19 pandemic, antibiotic stewardship, primary care

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Authors: Muhammed Ordu, Eren Demir, Chris Tofallis

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The number of inpatient admissions in the UK has been significantly increasing over the past decade. These increases cause bed occupancy rates to exceed the target level (85%) set by the Department of Health in England. Therefore, hospital service managers are struggling to better manage key resource such as beds. On the other hand, this severe demand pressure might lead to confusion in wards. For example, patients can be admitted to the ward of another inpatient specialty due to lack of resources (i.e., bed). This study aims to develop a simulation-optimization model to reallocate the available number of beds in a mid-sized hospital in the UK. A hospital simulation model was developed to capture the stochastic behaviours of the hospital by taking into account the accident and emergency department, all outpatient and inpatient services, and the interactions between each other. A couple of outputs of the simulation model (e.g., average length of stay and revenue) were generated as inputs to be used in the optimization model. An integer linear programming was developed under a number of constraints (financial, demand, target level of bed occupancy rate and staffing level) with the aims of maximizing number of admitted patients. In addition, a sensitivity analysis was carried out by taking into account unexpected increases on inpatient demand over the next 12 months. As a result, the major findings of the approach proposed in this study optimally reallocate the available number of beds for each inpatient speciality and reveal that 74 beds are idle. In addition, the findings of the study indicate that the hospital wards will be able to cope with 14% demand increase at most in the projected year. In conclusion, this paper sheds a new light on how best to reallocate beds in order to cope with current and future demand for healthcare services.

Keywords: bed occupancy rate, bed reallocation, discrete event simulation, inpatient admissions, integer linear programming, projected usage

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Authors: P. Hari Prasad Reddy, Shimna Paulose, V. Sai Kumar, C. H. Rama Vara Prasad

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Soil environment gets contaminated due to rapid industrialisation, agricultural-chemical application and improper disposal of waste generated by the society. Unexpected volume changes can occur in soil in the presence of certain contaminants usually after the long duration of interaction. Alkali is one of the major soil contaminant that has a considerable effect on behaviour of soils and capable of inducing swelling potential in soil. Chemical heaving of clayey soils occurs when they are wetted by aqueous solutions of alkalis. Mineralogical composition of the soil is one of the main factors influencing soil- alkali interaction. In the present work, studies are carried out to understand the swell potential of soils due to soil-alkali interaction with different concentrations of NaOH solution. Locally available soil, namely, red earth containing kaolinite which is of non-swelling nature is selected for the study. In addition to this, two commercially available clayey soils, namely ball clay and china clay containing mainly of kaolinite are selected to understand the effect of alkali interaction in various kaolinitic soils. Non-swelling red earth shows maximum swell at lower concentrations of alkali solution (0.1N) and a slightly decreasing trend of swelling with further increase in concentration (1N, 4N, and 8N). Marginal decrease in swell potential with increase in concentration indicates that the increased concentration of alkali solution exists as free solution in case of red earth. China clay and ball clay both falling under kaolinite group of clay minerals, show swelling with alkaline solution. At lower concentrations of alkali solution both the soils shows similar swell behaviour, but at higher concentration of alkali solution ball clay shows high swell potential compared to china clay which may be due to lack of well ordered crystallinity in ball clay compared to china clay. The variations in the results obtained were corroborated by carrying XRD and SEM studies.

Keywords: alkali, kaolinite, swell potential, XRD, SEM

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Authors: F. Christie, M. Staber

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Malnutrition is a predictor of poor clinical outcome in the elderly. Up to 60% of hip fracture patients are clinically malnourished on admission. This study assessed the perioperative nutritional state of patients admitted with a proximal femoral fracture and examined if adequate nutritional support was achieved. Methods: Prospective, the observational audit of 30 patients, admitted with a proximal femoral fracture, over a one-month period. We recorded: patient demographics; surgical delay; nutritional state on admission; documentation of Malnutrition Universal Screening Tool (MUST) score; dietician input and daily calorie intake through food charts. The nutritional state was re-assessed weekly and at discharge. The outcome was measured by the length of hospital stay and thirty-day mortality. Results: Mean age 87, M:F 1:2 and all patients were ASA three or four. Five patients (17%) had a prolonged ( >24 hours) fasting period. All patients had a MUST score completed on admission, 27% were underweight and 30% were high risk for malnutrition. Twenty-six patients (87%) were appropriately assessed for dietician referral. Thirteen patients had food charts; on average, hospital meals provided 1500kcal daily. No patient achieved > 75% of the provided calories with 69% of patients achieving 50% or less. Only three patients were started on nutritional supplements. Twenty-three patients (77%) lost weight, averaging 6% weight loss during admission. Mean length of stay (LOS) was 23 days and 30-day mortality 9%. Four patients (13%) gained weight, their mean LOS was 17 days and 30-day mortality 0%. Discussion: Malnutrition in the elderly originates in the community. Following major trauma it’s difficult to reverse nutritional deficits in hospitals. It’s therefore concerning that no high-risk patient achieved their recommended calorie intake. Perioperative optimisation needs to include early nutritional intervention, early anaesthetic review and adjusted anaesthetic techniques to support feeding.

Keywords: trauma, nutrition, neck of femur fracture

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Authors: Payman Tajalli, Steven Segal

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Applied ethics is an area of ethics which is looked upon most favorably as the most appropriate and useful for educational purposes; after all if ethics finds no application would any investment of time, effort and finance by the educational institutions be warranted? The current approaches to ethics in business and management often entail appealing to various types of moral theories and to this end almost every major philosophical approach has been enlisted. In this paper, we look at ethics through the philosophy of Emmanuel Levinas to argue that since ethics is ‘first philosophy’ it can neither be rule-based nor rule-governed, not something that can be worked out first and then applied to a given situation, hence the overwhelming emphasis on ‘applied ethics’ as a field of study in business and management education is unjustified. True ethics is not applied ethics. This assertion does not mean that teaching ethical theories and philosophies need to be abandoned rather it is the acceptance of the fact that an increase in cognitive awareness of such theories and ethical models and frameworks, or the mastering of techniques and procedures for ethical decision making, will not affect the desired ethical transformation in our students. Levinas himself argued for an ethics without a foundation, not one that required us to go ‘beyond good and evil’ as Nietzsche contended, rather an ethics which necessitates going ‘before good and evil'. Such an ethics does not provide us with a set of methods or techniques or a decision tree that enable us determine the rightness of an action and what we ought to do, rather it is about a way of being, an ethical posture or approach one takes in the inter-subjective relationship with the other that holds the promise of ethical conduct. Ethics in this Levinasian sense then is one of infinite and unconditional responsibility for the other person in relationship, an ethics which is not subject to negotiation, calculation or reciprocity, and as such it could neither be applied nor taught through conventional pedagogy with its focus on knowledge transfer from the teacher to student, and to this end Levinas offers a non-maieutic, non-conventional approach to pedagogy. The paper concludes that from a Levinasian perspective on ethics and education, we may need to guide our students to move away from the clear and objective professionalism of the management and applied ethics towards the murky individual spiritualism. For Levinas, this is ‘the Copernican revolution’ in ethics.

Keywords: business ethics, ethics education, Levinas, maieutic teaching, ethics without foundation

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Authors: Chandrabati Chakraborty

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The progressive emergence, in the course of the evolution of life, mind and personality, requires us to assume a creative Principle operating timeless Reality in the temporal. The difference between Western philosophy and that of India, concerns the origin and the purpose of the philosophical enquiry. While the former wonders at the external world, the latter is awareness of perennial suffering associated with human existence. The present world suffers from a basic form of rootlessness,reflecting many psychological, philosophical studies. Alienation,a major theme of human condition in the contemporary epoch has emerged as natural consequences of existential predicament. As Edmund Fuller also observes that individuals suffer not only from famine, ruin or even war but also from devastating inner problems, which are that of estrangement, hopelessness and utter despair. This existentialism is thus considered by Jean Wahl as the “Philosophies of existence”.The post world war scenario well analyses the chaos,annihilation,frustration and anguished estrangement. In such conditions when the West cries out , “What is there?I know first of all that I am.But who am I?.....I am sepeated.What I am seperated from I cannot name it. But I am seperated.”(Dostoevsky:The Confession), Vedantic philosophy looks upon the Pilgrim’s Progress of Humanity as being essentially one,operationg squarely within the bounds of reality, reflecting a basic human experience, outbraving indecorous dictims that have failed to give due honour to human beings,echoing for centuries the Sanskrit slokas with ultimate certitude: II Esa Atma samaha plusina samo masakena samo nagena sama ebhis tribhir lokaih.....sama nena sarvena II (The Atman (Divine Soul) is the same in the ant, the same in the gnat, the same in the elephant, the same in these three worlds....the same in the whole Universe). The present paper aims at a comparative study of cultural and philosophical expression taking into view extensive illustrations from Western Philosophers and The Vedantic,Upanishadic lores of Indian philosophy.

Keywords: existentialism, Vedanta, philosophy, absurdism

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Authors: Carmen Maria Hernandez-Nicolas, Juan Francisco Martín-Ugedo, Antonio Mínguez-Vera

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This paper analyses the influence of gender of the mayors of Spanish local governments on different budget items using a sample of 8,243 town councils between 2002 and 2010 period and 64,361 observations. The system Generalized Method of Moments (GMM) technique was employed to examine this panel data. This powerful methodology allows controlling for the endogenity of the variables and the heterogeneity of the sample. Unlike previous works focused on the study of gender influence on firm decisions, the present work analyzes the influence of the gender of the major in the council’s decisions. Specifically, we examine the differences in financial liabilities, security, protection and social promotion expenses and income items relating to public management. In addition, the study focuses on the Spanish context, which is characterized by the presence of decentralization of public responsibility to a greater extent than in neighboring countries, feeding the debate on the operational efficiency of local government increased with an open debate on the importance of gender in public management. The results show that female mayors tend to have lower expenses in general without significant differences in incomes obtained for men and women majors. We also find that female majors incur fewer financial liabilities, one of the most important problems in the Spanish public sector. However, despite of cutting in the public sector, these councils have higher expenditure on security, protection and social promotion. According to these evidences, the presence of women in politics may serve to improve the councils’ economic situation and it is not only necessary for social justice but for economics efficiency. Besides, in councils with more inhabitants, women mayors are more common, but women who served for a very long time are less common.

Keywords: councils, gender, local budgets, public management, women mayors

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Authors: Rym Saidi, Pape Alioune Ndiaye, Ibnyasser Ammar, Zineb Rchiad, Khalid Daoui, Issam Kadmiri Meftahi, Adnane Bargaz

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Chickpea (Cicer arietinum L.) is an important leguminous crop grown worldwide and plays a significant role in humans’ dietary consumption. Alongside nitrogen (N), low phosphorus (P) availability within agricultural soils is one of the major factors limiting chickpea growth and productivity. The combined application of beneficial bacterial inoculants and Rock P-fertilizer could boost chickpea performance and productivity, increasing P-utilization efficiency and minimizing nutrient losses under P-deficiency conditions. A greenhouse experiment was conducted to evaluate the response of chickpeas to two P-fertilizer forms (RP and TSP) under N2-fixer and P-solubilizer consortium inoculation to improve biological N fixation and P nutrition under P-deficient conditions. Under inoculation, chickpea chlorophyll content and chlorophyll fluorescence (RP+I and TSP+I) were increased compared to uninoculated treatments. The RP+I treatment increased both shoot and root dry weights by 48,80% and 72,68%, respectively, compared to the uninoculated RP fertilized control. Indeed, the bacterial consortium contributed to enhancing root morphological traits (e.g., root volume, surface area, and diameter) of all inoculated treatments versus the uninoculated treatments. Furthermore, soil available P and root inorganic P were significantly improved in RP+I by 162,84% and 73,24%, respectively, compared to uninoculated RP control. Our research outcomes suggest that the co-inoculation of chickpeas with N2-fixing, and P-solubilizing bacteria improves biomass yield and nutrient uptake. Eventually, enhancing chickpea agrophysiological performance, especially in restricted P-availability conditions.

Keywords: chickpea, consortium, beneficial bacterial inoculants, phosphorus deficiency, rock p-fertilizer, nutrient uptake

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Authors: Chengalappa Seenappa, Narayanappa Devkumar, Narayanappa Nagaraja

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Mulberry leaf is the major economic component in sericulture and quality of leaf produced per unit area has a direct effect on quality of cocoon. Among all the agronomical inputs, irrigation water has highest impact on mulberry leaf quantity and quality. The water productivity in sericulture in the country is inadequate and inefficient though India has the largest irrigated area. There is a need of proper irrigation methods and conservation practices to ensure efficiency and economy in water use. Hence, this field experiment was conducted at College of Sericulture, Chintamani, Chickaballapur district, Karnataka, India during 2013 and 2014 to know the quantity, quality and water productivity of mulberry influenced by different methods, levels of irrigation and mulching in Eastern Dry Zone (EDZ) of Karnataka, India. The results revealed that the mulberry leaf quantity, quality and water productivity were significantly influenced by different methods, levels of irrigation and mulching. Subsurface drip irrigation at 0.8 CPE (Cumulative Pan Evaporation) recorded higher leaf yield, chlorophyll, relative water, protein content and water productivity (42857 kg ha-1 yr-1, 8.54, 65.80%, 22.27% and 364.41 kg hacm-1, respectively) than surface drip at 1.0 CPE (38809 kg ha-1 yr-1, 7.34, 62.76%, 17.75% and 264 10 kg hacm-1, respectively) and micro spray jet at 1.0 CPE (39931 kg ha-1 yr-1, 7.96, 63.50%, 19.00%, 35617 kg ha-1 yr-1 and 271.83 kg hacm-1, respectively). Mulching treatment recorded maximum leaf yield, chlorophyll, relative water, protein content and water productivity (38035 kg ha-1 yr-1, 7.12, 62.11%, 16.14% and 330 kg hacm-1, respectively) compared to without mulching. These results clearly indicated that subsurface drip irrigation at lower level of irrigation (0.8 CPE) and mulching increased the quantity, quality and water productivity of mulberry leaf than surface drip and micro spray jet irrigation at higher level of irrigation (1.0 CPE) by saving 20 per cent of water. Therefore, in the coming days subsurface drip irrigation in mulberry cultivation may be more appropriate to realise higher yield, quality and water productivity in EDZ of Karnataka, India.

Keywords: subsurface drip irrigation, mulching, water productivity, mulberry

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Authors: Mohammad H. Yarmohammadian, Mehdi Nasr Isfahani, Elham Anbari

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Introduction: The awareness of using chemical, biological, and nuclear agents in everyday industrial and non-industrial incidents has increased recently; release of these materials can be accidental or intentional. Since hospitals are the forefronts of confronting Chemical, Biological, Radiological and Nuclear( CBRN) incidents, the goal of the present research was to provide a generic protocol for CBRN incidents through a comparative review of CBRN protocols and guidelines of different countries and reviewing various books, handbooks and papers. Method: The integrative approach or research synthesis was adopted in this study. First a simple narrative review of programs, books, handbooks, and papers about response to CBRN incidents in different countries was carried out. Then the most important and functional information was discussed in the form of a generic protocol in focus group sessions and subsequently confirmed. Results: Findings indicated that most of the countries had various protocols, guidelines, and handbooks for hazardous materials or CBRN incidents. The final outcome of the research synthesis was a 50 page generic protocol whose main topics included introduction, definition and classification of CBRN agents, four major phases of incident and disaster management cycle, hospital response management plan, equipment, and recommended supplies and antidotes for decontamination (radiological/nuclear, chemical, biological); each of these also had subtopics. Conclusion: In the majority of international protocols, guidelines, handbooks and also international and Iranian books and papers, there is an emphasis on the importance of incident command system, determining the safety degree of decontamination zones, maps of decontamination zones, decontamination process, triage classifications, personal protective equipment, and supplies and antidotes for decontamination; these are the least requirements for such incidents and also consistent with the provided generic protocol.

Keywords: hospital, CBRN, decontamination, generic protocol, CBRN Incidents

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Authors: Sali Chinsathit, Haruthai Kaenla

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Organic agriculture has become a major policy theme for agricultural development in Thailand since October 2005. Organic farming is enlisted as an important national agenda, to promote safe food and national export, and many government authorities have initiated projects and activities centered on organic farming promotion. Currently, Thailand has the market share of about 32 million US$ a year by exporting organic products of rice, vegetables, tea, fruits and a few medicinal herbs. There is high potential in organic crop production as there is the tropical environment promoting crop growth and leader farmer in organic farming. However, organic sector is relatively small (0.2%) comparing with conventional agricultural area, since there are many factors affecting farmers’ adoption and success in organic farming. The objective of this project was to get the organic production technology for at least 3 organic crops. The treatment and method were complied with Thai Organic Standard, and were mainly concerned on increase plant biodiversity and soil improvement by using organic fertilizer and bio-extract from fish, egg, plant and fruits. The bio-logical control, plant-extracts, and cultural practices were used to control insect pests and diseases of 3 crops including mangosteen (Garcinia mangostana L.), longkong (Aglaia dookoo Griff.) and banana (Musa (AA group)). The experiments were carried out at research centers of Department of Agriculture and farmers’ farms in Rayong and Chanthaburi provinces from 2009 to 2013. We found that both locations, plant biodiversity by intercropping mangosteen or longkong with banana and soil improvement with composts and bio-extract from fish could increased yield and farmers’ income by 6,835 US$/ha/year. Farmers got knowledge from these technologies to produce organic crops. The organic products were sold both in domestic and international countries. The organic production technologies were also environmental friendly and could be used as an alternative way for farmers in Thailand.

Keywords: banana, longkong, mangosteen, organic farming

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Authors: Florence Malongane, Lyndy J. McGaw, Legesse K. Debusho, Fhatuwani N. Mudau

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Rooibos (Aspalathus linearis (Burm.f.) R.Dahlgren), honeybush (Cyclopia Vent. species), bush tea (Athrixia phylicoides DC.) and special tea (Monsonia burkeana) are traditionally consumed herbal teas in South Africa. The volatile and sensory qualities of rooibos and honeybush tea have previously been described although there is a dearth of information regarding the sensory attributes and volatile compounds analysis of special tea and bush tea. The objective of this study was to describe the sensory properties, compare the differences in descriptive sensory analysis (DSA) and volatile compounds of bush tea, special, rooibos, honeybush and the blend of bush tea with special, honeybush and rooibos in a 1:1 ratio and subsequently to determine the influence of blending bush tea with other herbal teas. DSA was used to assess the sensory attributes of the teas while gas chromatography–mass spectrometry (GC-MS) was used to quantitatively determine the volatile components of the teas. Rooibos tea and honeybush tea had an overall sweet-caramel, honey-sweet, perfume floral and woody aroma with slight astringency, consistent with the taste and aftertaste attributes. In contrast, bush tea and special tea depicted green-cut grass, dry green herbal, cooked spinach aroma as well as taste and aftertaste characteristics. GC-MS analyses revealed that the seven tea samples had similar major volatiles, including 2-furanmethanol, 2-methoxy-4-vinylphenol, acetic acid, D-limonene terpene and phytol. Cluster analysis revealed that the sweet and woody flavour of honeybush and rooibos were ascribed to the presence of á-myrcene, phenylethyl alcohol, phytol and vanillin. The bitter, medicinal flavour attributes of special tea were attributed to (-)-carvone. Blending of bush tea with rooibos and honeybush tea toned down its aversive flavour components, typically the bitter, green-cut grass and herbal properties, thus minimising the possibility of consumer aversion.

Keywords: bush tea, rooibos tea, honeybush tea, sensory, volatile compounds

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Authors: Krishnendu Mukhopadhyay, Subhashis Kundu, Mayank Tiwari, Sameeran Pani, Padmapal, Uttam Singh

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Blast Furnace is a counter current process where burden descends from top and hot gases ascend from bottom and chemically reduce iron oxides into liquid hot metal. One of the major problems of blast furnace operation is the erratic burden descent inside furnace. Sometimes this problem is so acute that burden descent stops resulting in Hanging and instability of the furnace. This problem is very frequent in blast furnaces worldwide and results in huge production losses. This situation becomes more adverse when blast furnaces are operated at low coke rate and high coal injection rate with adverse raw materials like high alumina ore and high coke ash. For last three years, H-Blast Furnace Tata Steel was able to reduce coke rate from 450 kg/thm to 350 kg/thm with an increase in coal injection to 200 kg/thm which are close to world benchmarks and expand profitability. To sustain this regime, elimination of irregularities of blast furnace like hanging, channeling, and scaffolding is very essential. In this paper, sustaining of zero hanging spell for consecutive three years with low coke rate operation by improvement in burden characteristics, burden distribution, changes in slag regime, casting practices and adequate automation of the furnace operation has been illustrated. Models have been created to comprehend and upgrade the blast furnace process understanding. A model has been developed to predict the process of maintaining slag viscosity in desired range to attain proper burden permeability. A channeling prediction model has also been developed to understand channeling symptoms so that early actions can be initiated. The models have helped to a great extent in standardizing the control decisions of operators at H-Blast Furnace of Tata Steel, Jamshedpur and thus achieving process stability for last three years.

Keywords: hanging, channelling, blast furnace, coke

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Authors: Manar Makhoul, Buthainah Alsalamah, Salam Lawand, Hassan Azzam

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The major storage proteins in endosperm of 33 cultivated and wild barley genotypes (H.vulgare, H. spontaneum, H. bulbosum, H. murinum, H. marinum) were analyzed to demonstrate the variation in the hordein polypeptides encoded by multigene families in grains. The SDS-PAGE revealed 13 and 17 alleles at the Hor1 and the Hor2 loci respectively, with frequencies from 0.83 to 14 and 0.56 to 13.41% respectively, while seven alleles at the Hor3 locus with frequencies from 3.63 to 30.91% were recognized. The phylogenetic analysis indicated to relevance of the polymorphism in hordein patterns as successful tool in identifying the individual genotypes and discriminating the species according to genome type. We also reported in this research complete nucleotide sequence B-hordein genes of seven wild and cultivated barley genotypes. A 152bp upstream sequence of B-hordein promoter contained a TATA box, CATC box, AAAG motif, N-motif and E-motif. In silico analysis of B-Hordein sequences demonstrated that the coding regions were not interrupted by any intron, and included the complete ORF which varied between 882 and 906 bp, and encoded mature proteins with 293-301 residues characterized by high contents of glutamine (29%), and proline (18%). Comparison of the predicted polypeptide sequences with the published ones suggested that all S-rich prolamins genes are descended from common ancestor. The sequence started at N-terminal with a signal peptide, and then followed directly by two domains; a repetitive one based on the repetition of the repeat unit PQQPFPQQ and C-terminal domain. Also, it was found that positions of the eight cysteine residues were highly conserved in all the B-hordein sequences, but Hordeum bulbosum had additional unpaired one. The phylogenetic tree of B-hordein polypeptide separated the genotypes in distinct seven subgroups. In general, the high homology between B-hordeins and LMW glutenin subunits suggests similar bread-making influences for these B-hordeins.

Keywords: hordeum, phylogenetic tree, sequencing, storage protein

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Authors: Afiq Mohd Fahmi, Tony Gutierrez, Sebastian Hennige

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Increasing amounts of CO₂ entering the marine environment, also known as ocean acidification, is documented as having harmful impacts on a variety of marine organisms. When considering the future risk of hydrocarbon pollution, which is generally detrimental to marine life as well, this needs to consider how OA-induced changes to microbial communities will compound this since hydrocarbon degradation is influenced by the community-level microbial response. This study aims to evaluate the effects of increased atmospheric CO₂ conditions and oil enrichment on the phytoplankton-associated bacterial communities. Faroe Shetland Channel (FSC) is a subarctic region in the northeast Atlantic where crude oil extraction has recently been expanded. In the event of a major oil spill in this region, it is vital that we understand the response of the bacterial community and its consequence on primary production within this region—some phytoplankton communities found in the ocean harbor hydrocarbon-degrading bacteria that are associated with its psychosphere. Surface water containing phytoplankton and bacteria from FSC were cultured in ambient and elevated atmospheric CO₂ conditions for 4 days of acclimation in microcosms before introducing 1% (v/v) of crude oil into the microcosms to simulate oil spill conditions at sea. It was found that elevated CO₂ conditions do not significantly affect the chl a concentration, and exposure to crude oil detrimentally affected chl a concentration up to 10 days after exposure to crude oil. The diversity and richness of the bacterial community were not significantly affected by both CO₂ treatment and oil enrichment. The increase in the relative abundance of known hydrocarbon degraders such as Oleispira, Marinobacter and Halomonas indicates potential for biodegradation of crude oil, while the resilience of dominant taxa Colwellia, unclassified Gammaproteobacteria, unclassified Rnodobacteria and unclassified Halomonadaceae could be associated with the recovery of microalgal community 13 days after oil exposure. Therefore, the microbial community from the subsurface of FSC has the potential to recover from crude oil pollution even under elevated CO₂ (750 ppm) conditions.

Keywords: phytoplankton, bacteria, crude oil, ocean acidification

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Authors: Hanan Eltayeb, Reem Al Refaie

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To be able to connect and relate to shows spoken in a foreign language, advanced learners must understand not only linguistics inferences but also cultural, metacognitive, and pragmatic connotations in colloquial Egyptian TV series. These connotations are needed to both understand the different facets of the dramas put before them, and they’re also consistently grown and formulated through watching these shows. The inferences have become a staple in the Egyptian colloquial culture over the years, making their way into day-to-day conversations as Egyptians use them to speak, relate, joke, and connect with each other, without having known one another from previous times. As for advanced learners, they need to understand these inferences not only to watch these shows, but also to be able to converse with Egyptians on a level that surpasses the formal, or standard. When faced with some of the somewhat recent shows on the Egyptian screens, learners faced challenges in understanding pragmatics, cultural, and religious background of the target language and consequently not able to interact effectively with a native speaker in real-life situations. This study aims to enhance the linguistic and cultural proficiency of learners through studying two genres of TV Colloquial Egyptian series. Study samples derived from two recent comedian and social Egyptian series ('The Seventh Neighbor' سابع جار, and 'Nelly and Sherihan' نيللي و شريهان). When learners watch such series, they are usually faced with a problem understanding inferences that have to do with social, religious, and political events that are addressed in the series. Using discourse analysis of the sematic, semantic, pragmatic, cultural, and linguistic characteristics of the target language, some major deductions were highlighted and repeated, showing a pattern in both. The research paper concludes that there are many sets of lingual and para-lingual phrases, idioms, and proverbs to be acquired and used effectively by teaching these series. The strategies adopted in the study can be applied to different types of media, like movies, TV shows, and even cartoons, to enhance student proficiency.

Keywords: Egyptian series, culture, linguistic competence, pragmatics, semantics, social

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Authors: Hubert Feiglstorfer

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The technique of making terrazzo has been known since ancient times. During the Roman Empire, known as opus signinum, at the time of the Renaissance, known as composto terrazzo marmorino or at the turn of the 19th and 20th centuries, the use of terrazzo experienced a common use in Europe. In Asia, especially in the Himalayas and the Tibetan highlands, a particular floor and roof manufacturing technique is commonly used for about 1500 years, known as arga. The research question in this contribution asks for technical and cultural-historical synergies of these floor-making techniques. The making process of an arga floor shows constructive parallels to the European terrazzo. Surface processing by grinding, burnishing and sealing, in particular, reveals technological similarities. The floor structure itself, on the other hand, shows differences, for example in the use of hydraulic aggregate in the terrazzo, while the arga floor is used without hydraulic material, but the result of both techniques is a tight, water-repellent and shiny surface. As part of this comparative study, the materials, processing techniques and quality features of the two techniques are compared and parallels and differences are analysed. In addition to text and archive research, the methods used are results of material analyses and ethnographic research such as participant observation. Major findings of the study are the investigation of the mineralogical composition of arga floors and its comparison with terrazzo floors. The study of the cultural-historical context in which both techniques are embedded will give insight into technical developments in Europe and Asia, parallels and differences. Synergies from this comparison let possible technological developments in the production, conservation and renovation of European terrazzo floors appear in a new light. By making arga floors without cement-based aggregates, the renovation of historical floors from purely natural products and without using energy by means of a burning process can be considered.

Keywords: European and Asian crafts, material culture, floor making technology, terrazzo, arga, Tibetan building traditions

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Authors: Wei-Ting Hung

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Inbound tourist expenditure might not only have influenced by individual tourist characteristics but may also be affected by nationality characteristics. The cross national distance effects on tourist consumption behavior should be incorporated in the analytical framework. Additionally, the often used factor analysis, cluster analysis and regression analysis overlook the hierarchical tourist consumption data structure and may lead to misleading results. The objectives of the present study were twofold. First, we propose a multilevel model that takes individual and cross-national differences into account under a hierarchical framework. Second, we further sought to determine the types of cross-national differences affecting tourist expenditure. Thus, this study incorporates the individual tourist effects and cross national distance effects simultaneously, uses the data of 2010 Annual Survey Report on Visitors’ Expenditure and Trends in Taiwan to investigate the determinants of inbound tourist expenditure. Multilevel analysis was used to investigate the influence of individual tourist effects and cross national distance effects on inbound tourist expenditure. The empirical results show that cross national distance plays a crucial role in tourist consumption behavior. Our findings also indicate age and income have positive influence on tourism expenditure., whereas education and gender do not have significant impact. Regarding macro-level factors, geographic and cultural differences exhibited significant positive relationships on tourism expenditure, while economic differences did not. Based on the above empirical results, it is suggested that tour operators should take tourists’ individual attributes, particularly their income and age, into consideration when arranging tours. In addition, nationality holds sway over tourists’ consumption behavior, of which geographic and cultural differences are the two major factors at play. The empirical results of this study serve as practical suggestions for tourism marketing strategies and policy implications for government policies.

Keywords: cross national distance, inbound tourist, multilevel analysis, tourist expenditure

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