Search results for: START triage system
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 18011

Search results for: START triage system

11471 Interfacial Adhesion and Properties Improvement of Polyethylene/Thermoplastic Starch Blend Compatibilized by Stearic Acid-Grafted-Starch

Authors: Nattaporn Khanoonkon, Rangrong Yoksan, Amod A. Ogale

Abstract:

Polyethylene (PE) is one of the most petroleum-based thermoplastic materials used in many applications including packaging due to its cheap, light-weight, chemically inert and capable to be converted into various shapes and sizes of products. Although PE is a commercially potential material, its non-biodegradability caused environmental problems. At present, bio-based polymers become more interesting owing to its bio-degradability, non-toxicity, and renewability as well as being eco-friendly. Thermoplastic starch (TPS) is a bio-based and biodegradable plastic produced from the plasticization of starch under applying heat and shear force. In many researches, TPS was blended with petroleum-based polymers including PE in order to reduce the cost and the use of those polymers. However, the phase separation between hydrophobic PE and hydrophilic TPS limited the amount of TPS incorporated. The immiscibility of two different polarity polymers can be diminished by adding compatibilizer. PE-based compatibilizers, e.g. polyethylene-grafted-maleic anhydride, polyethylene-co-vinyl alcohol, etc. have been applied for the PE/TPS blend system in order to improve their miscibility. Until now, there is no report about the utilization of starch-based compatibilizer for PE/TPS blend system. The aims of the present research were therefore to synthesize a new starch-based compatibilizer, i.e. stearic acid-grafted starch (SA-g-starch) and to study the effect of SA-g-starch on chemical interaction, morphological properties, tensile properties and water vapor as well as oxygen barrier properties of the PE/TPS blend films. PE/TPS blends without and with incorporating SA-g-starch with a content of 1, 3 and 5 part(s) per hundred parts of starch (phr) were prepared using a twin screw extruder and then blown into films using a film blowing machine. Incorporating 1 phr and 3 phr of SA-g-starch could improve miscibility of the two polymers as confirmed from the reduction of TPS phase size and the good dispersion of TPS phase in PE matrix. In addition, the blend containing SA-g-starch with contents of 1 phr and 3 phr exhibited higher tensile strength and extensibility, as well as lower water vapor and oxygen permeabilities than the naked blend. The above results suggested that SA-g-starch could be potentially applied as a compatibilizer for the PE/TPS blend system.

Keywords: blend, compatibilizer, polyethylene, thermoplastic starch

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11470 Resilient Modulus and Deformation Responses of Waste Glass in Flexible Pavement System

Authors: M. Al-Saedi, A. Chegenizadeh, H. Nikraz

Abstract:

Experimental investigations are conducted to assess a layered structure of glass (G) - rock (R) blends under the impact of repeated loading. Laboratory tests included sieve analyses, modified compaction test and repeated load triaxial test (RLTT) is conducted on different structures of stratified GR samples to reach the objectives of this study. Waste materials are such essential components in the climate system, and also commonly used in minimising the need for natural materials in many countries. Glass is one of the most widely used groups of waste materials which have been extensively using in road applications. Full range particle size and colours of glass are collected and mixed at different ratios with natural rock material trying to use the blends in pavement layers. Whole subsurface specimen sequentially consists of a single layer of R and a layer of G-R blend. 12G/88R and 45G/55R mix ratios are employed in this research, the thickness of G-R layer was changed, and the results were compared between the pure rock and the layered specimens. The relations between resilient module (Mr) and permanent deformation with sequence number are presented. During the earlier stages of RLTT, the results indicated that the 45G/55R specimen shows higher moduli than R specimen.

Keywords: Rock base course, Layered Structure, Glass, Resilient Modulus

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11469 Meticulous Doxorubicin Release from pH-Responsive Nanoparticles Entrapped within an Injectable Thermoresponsive Depot

Authors: Huayang Yu, Nicola Ingram, David C. Green, Paul D. Thornton

Abstract:

The dual stimuli-controlled release of doxorubicin from gel-embedded nanoparticles is reported. Non-cytotoxic polymer nanoparticles are formed from poly(ethylene glycol)-b-poly(benzyl glutamate) that, uniquely, contain a central ester link. This connection renders the nanoparticles pH-responsive, enabling extensive doxorubicin release in acidic solutions (pH 6.5), but not in solutions of physiological pH (pH 7.4). Doxorubicin loaded nanoparticles were found to be stable for at least 31 days and lethal against the three breast cancer cell lines tested. Furthermore, doxorubicin-loaded nanoparticles could be incorporated within a thermoresponsive poly(2-hydroxypropyl methacrylate) gel depot, which forms immediately upon injection of poly(2-hydroxypropyl methacrylate) into aqueous solution. The combination of the poly(2-hydroxypropyl methacrylate) gel and poly(ethylene glycol)-b-poly(benzyl glutamate) nanoparticles yields an injectable doxorubicin delivery system that facilities near-complete drug release when maintained at elevated temperatures (37 °C) in acidic solution (pH 6.5). In contrast, negligible payload release occurs when the material is stored at room temperature in a non-acidic solution (pH 7.4). The system has great potential as a vehicle for the prolonged, site-specific release of chemotherapeutics.

Keywords: biodegradable, nanoparticle, polymer, thermoresponsive

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11468 Everolimus Loaded Polyvinyl Alcohol Microspheres for Sustained Drug Delivery in the Treatment of Subependymal Giant Cell Astrocytoma

Authors: Lynn Louis, Bor Shin Chee, Marion McAfee, Michael Nugent

Abstract:

This article aims to develop a sustained release formulation of microspheres containing the mTOR inhibitor Everolimus (EVR) using Polyvinyl alcohol (PVA) to enhance the bioavailability of the drug and to overcome poor solubility characteristics of Everolimus. This paper builds on recent work in the manufacture of microspheres using the sessile droplet technique by freezing the polymer-drug solution by suspending the droplets into pre-cooled ethanol vials immersed in liquid nitrogen. The spheres were subjected to 6 freezing cycles and 3 freezing cycles with thawing to obtain proper geometry, prevent aggregation, and achieve physical cross-linking. The prepared microspheres were characterised for surface morphology by SEM, where a 3-D porous structure was observed. The in vitro release studies showed a 62.17% release over 12.5 days, indicating a sustained release due to good encapsulation. This result is comparatively much more than the 49.06% release achieved within 4 hours from the solvent cast Everolimus film as a control with no freeze-thaw cycles performed. The solvent cast films were made in this work for comparison. A prolonged release of Everolimus using a polymer-based drug delivery system is essential to reach optimal therapeutic concentrations in treating SEGA tumours without systemic exposure. These results suggest that the combination of PVA and Everolimus via a rheological synergism enhanced the bioavailability of the hydrophobic drug Everolimus. Physical-chemical characterisation using DSC and FTIR analysis showed compatibility of the drug with the polymer, and the stability of the drug was maintained owing to the high molecular weight of the PVA. The obtained results indicate that the developed PVA/EVR microsphere is highly suitable as a potential drug delivery system with improved bioavailability in treating Subependymal Giant cell astrocytoma (SEGA).

Keywords: drug delivery system, everolimus, freeze-thaw cycles, polyvinyl alcohol

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11467 Study of Two MPPTs for Photovoltaic Systems Using Controllers Based in Fuzzy Logic and Sliding Mode

Authors: N. Ould cherchali, M. S. Boucherit, L. Barazane, A. Morsli

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Photovoltaic power is widely used to supply isolated or unpopulated areas (lighting, pumping, etc.). Great advantage is that this source is inexhaustible, it offers great safety in use and it is clean. But the dynamic models used to describe a photovoltaic system are complicated and nonlinear and due to nonlinear I-V and P–V characteristics of photovoltaic generators, a maximum power point tracking technique (MPPT) is required to maximize the output power. In this paper, two online techniques of maximum power point tracking using robust controller for photovoltaic systems are proposed, the first technique use fuzzy logic controller (FLC) and the second use sliding mode controller (SMC) for photovoltaic systems. The two maximum power point tracking controllers receive the partial derivative of power as inputs, and the output is the duty cycle corresponding to maximum power. A Photovoltaic generator with Boost converter is developed using MATLAB/Simulink to verify the preferences of the proposed techniques. SMC technique provides a good tracking speed in fast changing irradiation and when the irradiation changes slowly or is constant the panel power of FLC technique presents a much smoother signal with less fluctuations.

Keywords: fuzzy logic controller, maximum power point, photovoltaic system, tracker, sliding mode controller

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11466 Development of Colorimetric Based Microfluidic Platform for Quantification of Fluid Contaminants

Authors: Sangeeta Palekar, Mahima Rana, Jayu Kalambe

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In this paper, a microfluidic-based platform for the quantification of contaminants in the water is proposed. The proposed system uses microfluidic channels with an embedded environment for contaminants detection in water. Microfluidics-based platforms present an evident stage of innovation for fluid analysis, with different applications advancing minimal efforts and simplicity of fabrication. Polydimethylsiloxane (PDMS)-based microfluidics channel is fabricated using a soft lithography technique. Vertical and horizontal connections for fluid dispensing with the microfluidic channel are explored. The principle of colorimetry, which incorporates the use of Griess reagent for the detection of nitrite, has been adopted. Nitrite has high water solubility and water retention, due to which it has a greater potential to stay in groundwater, endangering aquatic life along with human health, hence taken as a case study in this work. The developed platform also compares the detection methodology, containing photodetectors for measuring absorbance and image sensors for measuring color change for quantification of contaminants like nitrite in water. The utilization of image processing techniques offers the advantage of operational flexibility, as the same system can be used to identify other contaminants present in water by introducing minor software changes.

Keywords: colorimetric, fluid contaminants, nitrite detection, microfluidics

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11465 Possibilities of Building Regional Migration Governance due to the Venezuelan Diaspora in Ibero-America (2015-2018)

Authors: Jonathan Palatz Cedeño

Abstract:

The paper will seek to examine the scope and limitations of the process of construction of ordinary and extraordinary migration regulatory tools of the countries of Latin America, due to the Venezuelan diaspora in Ibero-America (2015-2018). The analysis methodology will be based on a systematic presentation of the existing advances in the subject under a qualitative approach, in which the results are detailed. We hold that an important part of the Latin American countries that used to be the emitters of migrants have had to generate, with greater or lesser success both nationally and regionally, ordinary and extraordinary migration regulatory tools to respond to the rapid intensification of the current Venezuelan migratory flows. This fact beyond implementing policies for the reception and integration of this population marks a new moment that represents a huge challenge both for the receiving States and for the young Ibero-American institutional migration system. Therefore, we can say that measures to adopt reception and solidarity policies, despite being supported by organs of the multilateral system such as UNHCR and IOM, are not found as guidelines for national and regional action, at the expense of the reactions of the respective public opinions and the influence of what to do of the neighboring countries in the face of the problem.

Keywords: Venezuela, migration, migration policies and governance, Venezuelan diaspora

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11464 Economic and Environmental Life Cycle Analysis of Construction and Demolition Waste Management System

Authors: Yanqing Yi, Maria Cristina Lavagnolo, Alessandro Manzardo

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Construction and demolition waste (C&DW) is a major challenge in the European Union, emphasizing the urgent need for appropriate waste management processes. Selecting these solutions is challenging, as it requires identifying efficient C&DW management techniques that balance acceptable practices, regulatory compliance, resource conservation, economic viability, and environmental concerns. Techniques for analyzing many kinds of criteria allow for the use of multi-criteria analysis in life cycle assessment (LCA). Although LCA is commonly used to analyze environmental effects, the economic factor has not been fully integrated into the LCA approach in C&DW management. The life cycle costing (LCC) approach was designed to assess economic performance in the C&DW management process. The choice of an effective multi-criteria decision-making (MCDM) technique is critical for the C&DW system. This study seeks to propose a model that employs MCDM by considering LCA and LCC results, thereby augmenting both environmental and economic sustainability. A widely used compensatory MCDM technique, TOPSIS, has been chosen to identify the most effective C&DW management scheme by comparing and ranking various scenarios. Four waste management alternatives were examined in the Lombardy region of Italy, namely, (i) landfill; (ii) recycling for concrete production and road construction, incineration with energy recovery; (iii) recycling for road construction; (iv) recycling for concrete production and road construction. We determine that, with the implementation of various scenarios, the most suitable scenario emerges to be recycled for concrete production and road construction, with a score of 0.711/1; recycling for road construction, with a final score of 0.291/1, ranks second; recycling for concrete production and road construction, incineration with energy recovery scores 0.002/1, ranks third; and landfill (scores: 0/1) is the worst choice, indicating it has the highest environmental impact. Finally, suggestions were developed to improve the system's environmental performance.

Keywords: life cycle assessment, life cycle costing, construction and demolition waste, multi-criteria decision making

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11463 Seismic Retrofit of Reinforced Concrete Structures by Highly Dissipative Technologies

Authors: Stefano Sorace, Gloria Terenzi, Giulia Mazzieri, Iacopo Costoli

Abstract:

The prolonged earthquake sequence that struck several urban agglomerations and villages in Central Italy, starting from 24 August 2016 through January 2017, highlighted once again the seismic vulnerability of pre-normative reinforced concrete (R/C) structures. At the same time, considerable damages were surveyed in recently retrofitted R/C buildings too, one of which also by means of a dissipative bracing system. The solution adopted for the latter did not expressly take into account the performance of non-structural elements, and namely of infills and partitions, confirming the importance of their dynamic interaction with the structural skeleton. Based on this consideration, an alternative supplemental damping-based retrofit solution for this representative building, i.e., a school with an R/C structure situated in the municipality of Norcia, is examined in this paper. It consists of the incorporation of dissipative braces equipped with pressurized silicone fluid viscous (FV) dampers, instead of the BRAD system installed in the building, the delayed activation of which -caused by the high stiffness of the constituting metallic dampers- determined the observed non-structural damages. Indeed, the alternative solution proposed herein, characterized by dissipaters with mainly damping mechanical properties, guarantees an earlier activation of the protective system. A careful assessment analysis, preliminarily carried out to simulate and check the case study building performance in originally BRAD-retrofitted conditions, confirms that the interstorey drift demand related to the Norcia earthquake's mainshock and aftershocks is beyond the response capacity of infills. The verification analyses developed on the R/C structure, including the FV-damped braces, highlight their higher performance, giving rise to a completely undamaged response both of structural and non-structural elements up to the basic design earthquake normative level of seismic action.

Keywords: dissipative technologies, performance assessment analysis, concrete structures, seismic retrofit

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11462 Analyzing Speech Acts in Reddit Posts of Formerly Incarcerated Youths

Authors: Yusra Ibrahim

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This study explores the online discourse of justice-involved youth on Reddit, focusing on how anonymity and asynchronicity influence their ability to share and reflect on their incarceration experiences within the "Ask Me Anything" (AMA) community. The study utilizes a quantitative analysis of speech acts to examine the varied communication patterns exhibited by youths and commenters across two AMA threads. The results indicate that, although Reddit is not specifically designed for formerly incarcerated youths, its features provide a supportive environment for them to share their incarceration experiences with non-incarcerated individuals. The level of empathy and support from the audience varies based on the audience’s perspectives on incarceration and related traumatic experiences. Additionally, the study identifies a reciprocal relationship where youths benefit from community support while offering insights into the juvenile justice system and helping the audience understand the experience of incarceration. The study also reveals cultural shocks in physical and digital environments that youth experience after release and when using social media platforms and the internet. The study has implications for juvenile justice personnel, policymakers, and researchers in the juvenile justice system.

Keywords: juvenile justice, online discourse, reddit AMA, anonymity, speech acts taxonomy, reintegration, online community support

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11461 Media Response to Kashmir Conflict: How Press Differed in Highlighting Protest Shutdowns between 1990-2010

Authors: Danish Gadda

Abstract:

Kashmir has been a bleeding-spot in the South Asian politics since 1947 when the subcontinent was bifurcated into Hindu, India and Muslim Pakistan by the departing British colonisers. Kashmir couldn’t accede to either of the two new-born, sovereign nations until tribal invasion from Pakistan forced an unfortunate change of events. India, driven by conditional accession signed by the Kashmir’s last monarch, sent its army to defend Kashmir Valley, with a promise, made subsequently, that the region’s fate would be decided by the natives through an internationally-monitored plebiscite. The country, however, broke its promise, choosing not to withdraw its military to allow the plebiscite, and, instead, strengthened its claim over Kashmir, which it later started describing as her integral part. War, fought in the shape of three and a half bloody battles, ensued between India and Pakistan, even as the United Nations’ intervention managed a ceasefire as early as in the 1950s, though not before Kashmir had come to be divided into its India-controlled and Pakistan-controlled halves. Prolonged, the dispute over Kashmir took a violent turn in 1989-90 with the start of an anti-India armed rebellion. Kashmiris have been fighting for their right to self-determination, and bringing their own life to a grinding halt has been one of their preferred forms of protest against the Indian rule. This form of resistance is locally called ‘Hartals’, and recognised as shutdowns, which have often been prolonged and violent. Since 1989-90, the shutdowns have become only more frequent and forceful, and there are marked days on which Kashmir shuts down in protest every year, like a ritual. This paper is based on a study of how the Indian and Kashmir press covered the shutdowns observed in the troubled valley on four such days: January 26 (Indian Republic Day), February 11 (the day on which India executed a prominent Kashmiri resistance leader), August 15 (India’s Independence Day), and October 27 (the day on which the Indian military has landed in Kashmir). The coverage given by the Indian and Kashmiri press to the shutdowns observed on these days has been studied using the multi-tier content analysis approach: 1) Difference in the number of shutdowns covered by the two section is looked at, 2) the placement of the stories in the two section of the press is analysed, 3) the discourse highlighted by the two section of the press is compared, and 4) the editorials written by the two section of the press about the shutdowns are analysed. The findings show the Indian and the local press have been focussing on the two, predictable extremes of the situation: the Indian press has favoured the state, while the Kashmir or the local press has focussed on the narrative opposing the state’s. The difference is noticed in the quantitative as well as the qualitative aspects of their coverage.

Keywords: Indo-Pak tension, Kashmir conflict, protest shutdowns, South-Asian politics

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11460 Risk Mitigation of Data Causality Analysis Requirements AI Act

Authors: Raphaël Weuts, Mykyta Petik, Anton Vedder

Abstract:

Artificial Intelligence has the potential to create and already creates enormous value in healthcare. Prescriptive systems might be able to make the use of healthcare capacity more efficient. Such systems might entail interpretations that exclude the effect of confounders that brings risks with it. Those risks might be mitigated by regulation that prevents systems entailing such risks to come to market. One modality of regulation is that of legislation, and the European AI Act is an example of such a regulatory instrument that might mitigate these risks. To assess the risk mitigation potential of the AI Act for those risks, this research focusses on a case study of a hypothetical application of medical device software that entails the aforementioned risks. The AI Act refers to the harmonised norms for already existing legislation, here being the European medical device regulation. The issue at hand is a causal link between a confounder and the value the algorithm optimises for by proxy. The research identifies where the AI Act already looks at confounders (i.a. feedback loops in systems that continue to learn after being placed on the market). The research identifies where the current proposal by parliament leaves legal uncertainty on the necessity to check for confounders that do not influence the input of the system, when the system does not continue to learn after being placed on the market. The authors propose an amendment to article 15 of the AI Act that would require high-risk systems to be developed in such a way as to mitigate risks from those aforementioned confounders.

Keywords: AI Act, healthcare, confounders, risks

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11459 Role of Numerical Simulation as a Tool to Enhance Climate Change Adaptation and Resilient Societies: A Case Study from the Philippines

Authors: Pankaj Kumar

Abstract:

Rapid global changes resulted in unfavorable hydrological, ecological, and environmental changes and cumulatively affected natural resources. As a result, the local communities become vulnerable to water stress, poor hygiene, the spread of diseases, food security, etc.. However, the central point for this vulnerability revolves around water resources and the way people interrelate with the hydrological system. Also, most of the efforts to minimize the adverse effect of global changes are centered on the mitigation side. Hence, countries with poor adaptive capacities and poor governance suffer most in case of disasters. However, several transdisciplinary numerical tools are well designed and are capable of answering “what-if questions” through scenario analysis using a system approach. This study has predicted the future water environment in Marikina River in the National Capital Region, Metro Manila of Philippines, using Water Evaluation and Planning (WEAP), an integrated water resource management tool. Obtained results can answer possible adaptation measures along with their associated uncertainties. It also highlighted various challenges for the policy planners to design adaptation countermeasures as well as to track the progress of achieving SDG 6.0.

Keywords: water quality, Philippines, climate change adaptation, hydrological simulation, wastewater management, weap

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11458 Practical Software for Optimum Bore Hole Cleaning Using Drilling Hydraulics Techniques

Authors: Abdulaziz F. Ettir, Ghait Bashir, Tarek S. Duzan

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A proper well planning is very vital to achieve any successful drilling program on the basis of preventing, overcome all drilling problems and minimize cost operations. Since the hydraulic system plays an active role during the drilling operations, that will lead to accelerate the drilling effort and lower the overall well cost. Likewise, an improperly designed hydraulic system can slow drill rate, fail to clean the hole of cuttings, and cause kicks. In most cases, common sense and commercially available computer programs are the only elements required to design the hydraulic system. Drilling optimization is the logical process of analyzing effects and interactions of drilling variables through applied drilling and hydraulic equations and mathematical modeling to achieve maximum drilling efficiency with minimize drilling cost. In this paper, practical software adopted in this paper to define drilling optimization models including four different optimum keys, namely Opti-flow, Opti-clean, Opti-slip and Opti-nozzle that can help to achieve high drilling efficiency with lower cost. The used data in this research from vertical and horizontal wells were recently drilled in Waha Oil Company fields. The input data are: Formation type, Geopressures, Hole Geometry, Bottom hole assembly and Mud reghology. Upon data analysis, all the results from wells show that the proposed program provides a high accuracy than that proposed from the company in terms of hole cleaning efficiency, and cost break down if we consider that the actual data as a reference base for all wells. Finally, it is recommended to use the established Optimization calculations software at drilling design to achieve correct drilling parameters that can provide high drilling efficiency, borehole cleaning and all other hydraulic parameters which assist to minimize hole problems and control drilling operation costs.

Keywords: optimum keys, namely opti-flow, opti-clean, opti-slip and opti-nozzle

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11457 Haemoperitoneum in a Case of Dengue Fever

Authors: Sagarjyoti Roy

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Dengue is an arboviral infection, belonging to family flaviviridae, comprising of four serotypes; DENV1, DENV2, DENV3 and DENV4. All four serotypes are capable of causing full-spectrum of clinical features, ranging from self-limiting fever to severe dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Complications may affect any organ system, including those involving gastrointestinal system and serositis. We report a case, of a 28 years, non-alcoholic male, presenting with a 7 day history of fever and malaise followed by abdominal pain and distension, from 4th day of fever. He was admitted in medicine department of RG KAR medical college hospital. Dengue fever was confirmed by NS1 and dengue IgM positivity. Platelet count was 30,000/cc (1.5- 4 lac/cc) and haematocrit was 52% (38- 50% for men). Clinicoradiological findings revealed bilateral pleural effusion, ascites and splenomegaly. Ascitic fluid was hemorrhagic in nature, with a high protein and RBC content. Liver function tests revealed mild transaminitis with normal coagulation profile. Patient was managed conservatively. A diagnosis of dengue fever complicated by serositis and spontaneous haemoperitoneum was made. The symptoms subsided after a hospital stay of 10 days. The case highlights haemorrhage into peritoneal cavity as a possible complication of dengue fever. Although a definite explanation requires more detailed studies, platelet or endothelial cell dysfunction might be contributory.

Keywords: ascites, dengue, haemoperitoneum, serositis

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11456 Ancient Malay and Spice Trade Routes: A Study of Ancient Malay from the Perspectives of Linguistics and Archaeology

Authors: Totok Suhardijanto, Ninie Susanti Tedjowasono

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This paper discusses the relationship between the distribution of Ancient Malay inscriptions and Spice Trade Route, especially in the relation with material cultures that accompany them, to understand how Malay could spread out around the archipelago beyond its original native-speakers’ region. The archipelago was known as the Spice Islands from the very beginning of the first century due to mace, cloves, and nutmeg that were originally exclusively found there. According to the Indian record, since the 2nd century, there has been a contact established between Indian and Indonesian people. A Chinese document from 3rd Century has mentioned Wangka (now widely known as Bangka) an island near Sumatra where some Chinese expeditions had visited. All of these records supported the existence of a maritime trade system and route between the archipelago and other countries during the first millennium. This paper will discuss first the Ancient Malay inscription spread around the archipelago from the perspectives of language variation and writing system style. Analyzing language variations of inscriptions certainly is not as easy as studying current spoken language variations in modern sociolinguistics. A huge amount of data is available for such kind of studies. On the contrary, in language variation research with inscription texts as an object, data is insufficient. Other resources will be needed to support the linguistic analysis. For this reason, this research made use of epigraphical evidence in the surrounding areas of the inscriptions to explain the variation of language and writing style. The research next expands the analysis to figure out the relationship between language variation and inscriptions distribution to the Spice Trade Route that spreads from the Molucca Sea to Mediterranian Sea. Data in this research consists of six different inscriptions: Kedukan Bukit, Koto Kapur, Dapunta Salendra, Sang Hyang Wintang, Ligor, and Laguna from the 7th-9th Century and found in Sumatra, Jawa, and the Philippines. In addition, as a comparative resource, this research also used Hikayat Tanjung Tanah, the first-founded Ancient Malay manuscript. In language analysis, we conduct a sociolinguistic method to explore the language variation and writing style of the inscriptions. For dealing with archaeological data, we conducted a hermeneutic method to analyze the possible meaning and social uses of the data. Language variations and writing system style in this research can be classified into two main groups. The language, epigraphical, and archaeological evidence explain that Ancient Malay had been widely used in the Eastern area of Spice Trade Route because it played an important role in the region as a lingua franca between people from different ethnic groups with different languages.

Keywords: Ancient Malay, Spice trade route, language variation, writing system variation

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11455 Addressing Supply Chain Data Risk with Data Security Assurance

Authors: Anna Fowler

Abstract:

When considering assets that may need protection, the mind begins to contemplate homes, cars, and investment funds. In most cases, the protection of those assets can be covered through security systems and insurance. Data is not the first thought that comes to mind that would need protection, even though data is at the core of most supply chain operations. It includes trade secrets, management of personal identifiable information (PII), and consumer data that can be used to enhance the overall experience. Data is considered a critical element of success for supply chains and should be one of the most critical areas to protect. In the supply chain industry, there are two major misconceptions about protecting data: (i) We do not manage or store confidential/personally identifiable information (PII). (ii) Reliance on Third-Party vendor security. These misconceptions can significantly derail organizational efforts to adequately protect data across environments. These statistics can be exciting yet overwhelming at the same time. The first misconception, “We do not manage or store confidential/personally identifiable information (PII)” is dangerous as it implies the organization does not have proper data literacy. Enterprise employees will zero in on the aspect of PII while neglecting trade secret theft and the complete breakdown of information sharing. To circumvent the first bullet point, the second bullet point forges an ideology that “Reliance on Third-Party vendor security” will absolve the company from security risk. Instead, third-party risk has grown over the last two years and is one of the major causes of data security breaches. It is important to understand that a holistic approach should be considered when protecting data which should not involve purchasing a Data Loss Prevention (DLP) tool. A tool is not a solution. To protect supply chain data, start by providing data literacy training to all employees and negotiating the security component of contracts with vendors to highlight data literacy training for individuals/teams that may access company data. It is also important to understand the origin of the data and its movement to include risk identification. Ensure processes effectively incorporate data security principles. Evaluate and select DLP solutions to address specific concerns/use cases in conjunction with data visibility. These approaches are part of a broader solutions framework called Data Security Assurance (DSA). The DSA Framework looks at all of the processes across the supply chain, including their corresponding architecture and workflows, employee data literacy, governance and controls, integration between third and fourth-party vendors, DLP as a solution concept, and policies related to data residency. Within cloud environments, this framework is crucial for the supply chain industry to avoid regulatory implications and third/fourth party risk.

Keywords: security by design, data security architecture, cybersecurity framework, data security assurance

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11454 Improved Multilevel Inverter with Hybrid Power Selector and Solar Panel Cleaner in a Solar System

Authors: S. Oladoyinbo, A. A. Tijani

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Multilevel inverters (MLI) are used at high power application based on their operation. There are 3 main types of multilevel inverters (MLI); diode clamped, flying capacitor and cascaded MLI. A cascaded MLI requires the least number of components to achieve same number of voltage levels when compared to other types of MLI while the flying capacitor has the minimum harmonic distortion. However, maximizing the advantage of cascaded H-bridge MLI and flying capacitor MLI, an improved MLI can be achieved with fewer components and better performance. In this paper an improved MLI is presented by asymmetrically integrating a flying capacitor to a cascaded H-bridge MLI also integrating an auxiliary transformer to the main transformer to decrease the total harmonics distortion (THD) with increased number of output voltage levels. Furthermore, the system is incorporated with a hybrid time and climate based solar panel cleaner and power selector which intelligently manage the input of the MLI and clean the solar panel weekly ensuring the environmental factor effect on the panel is reduced to minimum.

Keywords: multilevel inverter, total harmonics distortion, cascaded h-bridge inverter, flying capacitor

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11453 Cloning and Expression of Human Interleukin 15: A Promising Candidate for Cytokine Immunotherapy

Authors: Sadaf Ilyas

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Recombinant cytokines have been employed successfully as potential therapeutic agent. Some cytokine therapies are already used as a part of clinical practice, ranging from early exploratory trials to well established therapies that have already received approval. Interleukin 15 is a pleiotropic cytokine having multiple roles in peripheral innate and adaptive immune cell function. It regulates the activation, proliferation and maturation of NK cells, T-cells, monocytes/macrophages and granulocytes, and the interactions between them thus acting as a bridge between innate and adaptive immune responses. Unraveling the biology of IL-15 has revealed some interesting surprises that may point toward some of the first therapeutic applications for this cytokine. In this study, the human interleukin 15 gene was isolated, amplified and ligated to a TA vector which was then transfected to a bacterial host, E. coli Top10F’. The sequence of cloned gene was confirmed and it showed 100% homology with the reported sequence. The confirmed gene was then subcloned in pET Expression system to study the IPTG induced expression of IL-15 gene. Positive expression was obtained for number of clones that showed 15 kd band of IL-15 in SDS-PAGE analysis, indicating the successful strain development that can be studied further to assess the potential therapeutic intervention of this cytokine in relevance to human diseases.

Keywords: Interleukin 15, pET expression system, immune therapy, protein purification

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11452 Internet of Things Based Patient Health Monitoring System

Authors: G. Yoga Sairam Teja, K. Harsha Vardhan, A. Vinay Kumar, K. Nithish Kumar, Ch. Shanthi Priyag

Abstract:

The emergence of the Internet of Things (IoT) has facilitated better device control and monitoring in the modern world. The constant monitoring of a patient would be drastically altered by the usage of IoT in healthcare. As we've seen in the case of the COVID-19 pandemic, it's important to keep oneself untouched while continuously checking on the patient's heart rate and temperature. Additionally, patients with paralysis should be closely watched, especially if they are elderly and in need of special care. Our "IoT BASED PATIENT HEALTH MONITORING SYSTEM" project uses IoT to track patient health conditions in an effort to address these issues. In this project, the main board is an 8051 microcontroller that connects a number of sensors, including a heart rate sensor, a temperature sensor (LM-35), and a saline water measuring circuit. These sensors are connected via an ESP832 (WiFi) module, which enables the sending of recorded data directly to the cloud so that the patient's health status can be regularly monitored. An LCD is used to monitor the data in offline mode, and a buzzer will sound if any variation from the regular readings occurs. The data in the cloud may be viewed as a graph, making it simple for a user to spot any unusual conditions.

Keywords: IoT, ESP8266, 8051 microcontrollers, sensors

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11451 A Cloud Computing System Using Virtual Hyperbolic Coordinates for Services Distribution

Authors: Telesphore Tiendrebeogo, Oumarou Sié

Abstract:

Cloud computing technologies have attracted considerable interest in recent years. Thus, these latters have become more important for many existing database applications. It provides a new mode of use and of offer of IT resources in general. Such resources can be used “on demand” by anybody who has access to the internet. Particularly, the Cloud platform provides an ease to use interface between providers and users, allow providers to develop and provide software and databases for users over locations. Currently, there are many Cloud platform providers support large scale database services. However, most of these only support simple keyword-based queries and can’t response complex query efficiently due to lack of efficient in multi-attribute index techniques. Existing Cloud platform providers seek to improve performance of indexing techniques for complex queries. In this paper, we define a new cloud computing architecture based on a Distributed Hash Table (DHT) and design a prototype system. Next, we perform and evaluate our cloud computing indexing structure based on a hyperbolic tree using virtual coordinates taken in the hyperbolic plane. We show through our experimental results that we compare with others clouds systems to show our solution ensures consistence and scalability for Cloud platform.

Keywords: virtual coordinates, cloud, hyperbolic plane, storage, scalability, consistency

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11450 Computer Aided Analysis of Breast Based Diagnostic Problems from Mammograms Using Image Processing and Deep Learning Methods

Authors: Ali Berkan Ural

Abstract:

This paper presents the analysis, evaluation, and pre-diagnosis of early stage breast based diagnostic problems (breast cancer, nodulesorlumps) by Computer Aided Diagnosing (CAD) system from mammogram radiological images. According to the statistics, the time factor is crucial to discover the disease in the patient (especially in women) as possible as early and fast. In the study, a new algorithm is developed using advanced image processing and deep learning method to detect and classify the problem at earlystagewithmoreaccuracy. This system first works with image processing methods (Image acquisition, Noiseremoval, Region Growing Segmentation, Morphological Operations, Breast BorderExtraction, Advanced Segmentation, ObtainingRegion Of Interests (ROIs), etc.) and segments the area of interest of the breast and then analyzes these partly obtained area for cancer detection/lumps in order to diagnosis the disease. After segmentation, with using the Spectrogramimages, 5 different deep learning based methods (specified Convolutional Neural Network (CNN) basedAlexNet, ResNet50, VGG16, DenseNet, Xception) are applied to classify the breast based problems.

Keywords: computer aided diagnosis, breast cancer, region growing, segmentation, deep learning

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11449 The Noun-Phrase Elements on the Usage of the Zero Article

Authors: Wen Zhen

Abstract:

Compared to content words, function words have been relatively overlooked by English learners especially articles. The article system, to a certain extent, becomes a resistance to know English better, driven by different elements. Three principal factors can be summarized in term of the nature of the articles when referring to the difficulty of the English article system. However, making the article system more complex are difficulties in the second acquisition process, for [-ART] learners have to create another category, causing even most non-native speakers at proficiency level to make errors. According to the sequences of acquisition of the English article, it is showed that the zero article is first acquired and in high inaccuracy. The zero article is often overused in the early stages of L2 acquisition. Although learners at the intermediate level move to underuse the zero article for they realize that the zero article does not cover any case, overproduction of the zero article even occurs among advanced L2 learners. The aim of the study is to investigate noun-phrase factors which give rise to incorrect usage or overuse of the zero article, thus providing suggestions for L2 English acquisition. Moreover, it enables teachers to carry out effective instruction that activate conscious learning of students. The research question will be answered through a corpus-based, data- driven approach to analyze the noun-phrase elements from the semantic context and countability of noun-phrases. Based on the analysis of the International Thurber Thesis corpus, the results show that: (1) Although context of [-definite,-specific] favored the zero article, both[-definite,+specific] and [+definite,-specific] showed less influence. When we reflect on the frequency order of the zero article , prototypicality plays a vital role in it .(2)EFL learners in this study have trouble classifying abstract nouns as countable. We can find that it will bring about overuse of the zero article when learners can not make clear judgements on countability altered from (+definite ) to (-definite).Once a noun is perceived as uncountable by learners, the choice would fall back on the zero article. These findings suggest that learners should be engaged in recognition of the countability of new vocabulary by explaining nouns in lexical phrases and explore more complex aspects such as analysis dependent on discourse.

Keywords: noun phrase, zero article, corpus, second language acquisition

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11448 Domain Driven Design vs Soft Domain Driven Design Frameworks

Authors: Mohammed Salahat, Steve Wade

Abstract:

This paper presents and compares the SSDDD “Systematic Soft Domain Driven Design Framework” to DDD “Domain Driven Design Framework” as a soft system approach of information systems development. The framework use SSM as a guiding methodology within which we have embedded a sequence of design tasks based on the UML leading to the implementation of a software system using the Naked Objects framework. This framework has been used in action research projects that have involved the investigation and modelling of business processes using object-oriented domain models and the implementation of software systems based on those domain models. Within this framework, Soft Systems Methodology (SSM) is used as a guiding methodology to explore the problem situation and to develop the domain model using UML for the given business domain. The framework is proposed and evaluated in our previous works, a comparison between SSDDD and DDD is presented in this paper, to show how SSDDD improved DDD as an approach to modelling and implementing business domain perspectives for Information Systems Development. The comparison process, the results, and the improvements are presented in the following sections of this paper.

Keywords: domain-driven design, soft domain-driven design, naked objects, soft language

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11447 Natural Monopolies and Their Regulation in Georgia

Authors: Marina Chavleishvili

Abstract:

Introduction: Today, the study of monopolies, including natural monopolies, is topical. In real life, pure monopolies are natural monopolies. Natural monopolies are used widely and are regulated by the state. In particular, the prices and rates are regulated. The paper considers the problems associated with the operation of natural monopolies in Georgia, in particular, their microeconomic analysis, pricing mechanisms, and legal mechanisms of their operation. The analysis was carried out on the example of the power industry. The rates of natural monopolies in Georgia are controlled by the Georgian National Energy and Water Supply Regulation Commission. The paper analyzes the positive role and importance of the regulatory body and the issues of improving the legislative base that will support the efficient operation of the branch. Methodology: In order to highlight natural monopolies market tendencies, the domestic and international markets are studied. An analysis of monopolies is carried out based on the endogenous and exogenous factors that determine the condition of companies, as well as the strategies chosen by firms to increase the market share. According to the productivity-based competitiveness assessment scheme, the segmentation opportunities, business environment, resources, and geographical location of monopolist companies are revealed. Main Findings: As a result of the analysis, certain assessments and conclusions were made. Natural monopolies are quite a complex and versatile economic element, and it is important to specify and duly control their frame conditions. It is important to determine the pricing policy of natural monopolies. The rates should be transparent, should show the level of life in the country, and should correspond to the incomes. The analysis confirmed the significance of the role of the Antimonopoly Service in the efficient management of natural monopolies. The law should adapt to reality and should be applied only to regulate the market. The present-day differential electricity tariffs varying depending on the consumed electrical power need revision. The effects of the electricity price discrimination are important, segmentation in different seasons in particular. Consumers use more electricity in winter than in summer, which is associated with extra capacities and maintenance costs. If the price of electricity in winter is higher than in summer, the electricity consumption will decrease in winter. The consumers will start to consume the electricity more economically, what will allow reducing extra capacities. Conclusion: Thus, the practical realization of the views given in the paper will contribute to the efficient operation of natural monopolies. Consequently, their activity will be oriented not on the reduction but on the increase of increments of the consumers or producers. Overall, the optimal management of the given fields will allow for improving the well-being throughout the country. In the article, conclusions are made, and the recommendations are developed to deliver effective policies and regulations toward the natural monopolies in Georgia.

Keywords: monopolies, natural monopolies, regulation, antimonopoly service

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11446 Power Quality Improvement Using UPQC Integrated with Distributed Generation Network

Authors: B. Gopal, Pannala Krishna Murthy, G. N. Sreenivas

Abstract:

The increasing demand of electric power is giving an emphasis on the need for the maximum utilization of renewable energy sources. On the other hand maintaining power quality to satisfaction of utility is an essential requirement. In this paper the design aspects of a Unified Power Quality Conditioner integrated with photovoltaic system in a distributed generation is presented. The proposed system consist of series inverter, shunt inverter are connected back to back on the dc side and share a common dc-link capacitor with Distributed Generation through a boost converter. The primary task of UPQC is to minimize grid voltage and load current disturbances along with reactive and harmonic power compensation. In addition to primary tasks of UPQC, other functionalities such as compensation of voltage interruption and active power transfer to the load and grid in both islanding and interconnected mode have been addressed. The simulation model is design in MATLAB/ Simulation environment and the results are in good agreement with the published work.

Keywords: distributed generation (DG), interconnected mode, islanding mode, maximum power point tracking (mppt), power quality (PQ), unified power quality conditioner (UPQC), photovoltaic array (PV)

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11445 Long-Term Subcentimeter-Accuracy Landslide Monitoring Using a Cost-Effective Global Navigation Satellite System Rover Network: Case Study

Authors: Vincent Schlageter, Maroua Mestiri, Florian Denzinger, Hugo Raetzo, Michel Demierre

Abstract:

Precise landslide monitoring with differential global navigation satellite system (GNSS) is well known, but technical or economic reasons limit its application by geotechnical companies. This study demonstrates the reliability and the usefulness of Geomon (Infrasurvey Sàrl, Switzerland), a stand-alone and cost-effective rover network. The system permits deploying up to 15 rovers, plus one reference station for differential GNSS. A dedicated radio communication links all the modules to a base station, where an embedded computer automatically provides all the relative positions (L1 phase, open-source RTKLib software) and populates an Internet server. Each measure also contains information from an internal inclinometer, battery level, and position quality indices. Contrary to standard GNSS survey systems, which suffer from a limited number of beacons that must be placed in areas with good GSM signal, Geomon offers greater flexibility and permits a real overview of the whole landslide with good spatial resolution. Each module is powered with solar panels, ensuring autonomous long-term recordings. In this study, we have tested the system on several sites in the Swiss mountains, setting up to 7 rovers per site, for an 18 month-long survey. The aim was to assess the robustness and the accuracy of the system in different environmental conditions. In one case, we ran forced blind tests (vertical movements of a given amplitude) and compared various session parameters (duration from 10 to 90 minutes). Then the other cases were a survey of real landslides sites using fixed optimized parameters. Sub centimetric-accuracy with few outliers was obtained using the best parameters (session duration of 60 minutes, baseline 1 km or less), with the noise level on the horizontal component half that of the vertical one. The performance (percent of aborting solutions, outliers) was reduced with sessions shorter than 30 minutes. The environment also had a strong influence on the percent of aborting solutions (ambiguity search problem), due to multiple reflections or satellites obstructed by trees and mountains. The length of the baseline (distance reference-rover, single baseline processing) reduced the accuracy above 1 km but had no significant effect below this limit. In critical weather conditions, the system’s robustness was limited: snow, avalanche, and frost-covered some rovers, including the antenna and vertically oriented solar panels, leading to data interruption; and strong wind damaged a reference station. The possibility of changing the sessions’ parameters remotely was very useful. In conclusion, the rover network tested provided the foreseen sub-centimetric-accuracy while providing a dense spatial resolution landslide survey. The ease of implementation and the fully automatic long-term survey were timesaving. Performance strongly depends on surrounding conditions, but short pre-measures should allow moving a rover to a better final placement. The system offers a promising hazard mitigation technique. Improvements could include data post-processing for alerts and automatic modification of the duration and numbers of sessions based on battery level and rover displacement velocity.

Keywords: GNSS, GSM, landslide, long-term, network, solar, spatial resolution, sub-centimeter.

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11444 A Basic Concept for Installing Cooling and Heating System Using Seawater Thermal Energy from the West Coast of Korea

Authors: Jun Byung Joon, Seo Seok Hyun, Lee Seo Young

Abstract:

As carbon dioxide emissions increase due to rapid industrialization and reckless development, abnormal climates such as floods and droughts are occurring. In order to respond to such climate change, the use of existing fossil fuels is reduced, and the proportion of eco-friendly renewable energy is gradually increasing. Korea is an energy resource-poor country that depends on imports for 93% of its total energy. As the global energy supply chain instability experienced due to the Russia-Ukraine crisis increases, countries around the world are resetting energy policies to minimize energy dependence and strengthen security. Seawater thermal energy is a renewable energy that replaces the existing air heat energy. It uses the characteristic of having a higher specific heat than air to cool and heat main spaces of buildings to increase heat transfer efficiency and minimize power consumption to generate electricity using fossil fuels, and Carbon dioxide emissions can be minimized. In addition, the effect on the marine environment is very small by using only the temperature characteristics of seawater in a limited way. K-water carried out a demonstration project of supplying cooling and heating energy to spaces such as the central control room and presentation room in the management building by acquiring the heat source of seawater circulated through the power plant's waterway by using the characteristics of the tidal power plant. Compared to the East Sea and the South Sea, the main system was designed in consideration of the large tidal difference, small temperature difference, and low-temperature characteristics, and its performance was verified through operation during the demonstration period. In addition, facility improvements were made for major deficiencies to strengthen monitoring functions, provide user convenience, and improve facility soundness. To spread these achievements, the basic concept was to expand the seawater heating and cooling system with a scale of 200 USRT at the Tidal Culture Center. With the operational experience of the demonstration system, it will be possible to establish an optimal seawater heat cooling and heating system suitable for the characteristics of the west coast ocean. Through this, it is possible to reduce operating costs by KRW 33,31 million per year compared to air heat, and through industry-university-research joint research, it is possible to localize major equipment and materials and develop key element technologies to revitalize the seawater heat business and to advance into overseas markets. The government's efforts are needed to expand the seawater heating and cooling system. Seawater thermal energy utilizes only the thermal energy of infinite seawater. Seawater thermal energy has less impact on the environment than river water thermal energy, except for environmental pollution factors such as bottom dredging, excavation, and sand or stone extraction. Therefore, it is necessary to increase the sense of speed in project promotion by innovatively simplifying unnecessary licensing/permission procedures. In addition, support should be provided to secure business feasibility by dramatically exempting the usage fee of public waters to actively encourage development in the private sector.

Keywords: seawater thermal energy, marine energy, tidal power plant, energy consumption

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11443 Hydroponic Cultivation Enhances the Morpho-Physiological Traits and Quality Flower Production in Tagetes patula L

Authors: Ujala, Diksha Sharma, Mahinder Partap, Ashish R. Warghat, Bhavya Bhargava

Abstract:

In soil-less agriculture, hydroponic is considered a potential farming system for the production of uniform quality plant material in significantly less time. Therefore, for the first time, the current investigation corroborates the effect of different cultivation conditions (open-field, poly-house, and hydroponic) on morpho-physiological traits, phenolic content, and essential oil components analysis in three flower color variants (yellow, scarlet red, and orange) of Tagetes patula. The results revealed that the maximum plant height, number of secondary branches, number of flowers, photosynthesis, stomatal conductance, and transpiration rate were observed under the hydroponic system as compared to other conditions. However, the maximum content of gallic acid (0.82 mg/g DW), syringic acid (3.98 mg/g DW), epicatechin (0.48 mg/g DW), p-coumaric acid (7.28 mg/g DW), protocatechuic acid (0.59 mg/g DW), ferulic acid (2.58 mg/g DW), and luteolin (8.24 mg/g DW) were quantified maximally under open-field conditions. However, under hydroponic conditions, the higher content of vanillic acid (0.43 mg/g DW), caffeic acid (0.49 mg/g DW), and quercetin (0.92 mg/g DW) were quantified. Moreover, a total of nineteen volatile components were identified in the essential oil of different flower color variants of T. patula cultivated under different conditions. The major reported volatile components in essential oil were (-)-caryophyllene oxide, trans-β-caryophyllene, trans-geraniol, 3 methyl-benzyl alcohol, and 2,2’:5’,2”-terthiophene. It has also been observed that the volatile component percentage range in all variants was observed in open-field (70.85 % to 90.54 %), poly-house (59.03 % to 77.93 %), and hydroponic (68.78 % to 89.41 %). In conclusion, the research highlighted that morpho-physiological performance with flower production was enhanced in the hydroponic system. However, phenolic content and volatile components were maximally observed in open-field conditions. However, significant results have been reported under hydroponic conditions in all studied parameters, so it could be a potential strategy for quality biomass production in T. patula.

Keywords: Tagetes patula, cultivation conditions, hydroponic, morpho-physiology

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11442 Real-world Characterization of Treatment Intensified (Add-on to Metformin) Adults with Type 2 Diabetes in Pakistan: A Multi-center Retrospective Study (Converge)

Authors: Muhammad Qamar Masood, Syed Abbas Raza, Umar Yousaf Raja, Imran Hassan, Bilal Afzal, Muhammad Aleem Zahir, Atika Shaheer

Abstract:

Background: Cardiovascular disease (CVD) is a major burden among people with type 2 diabetes (T2D) with 1 in 3 reported to have CVD. Therefore, understanding real-world clinical characteristics and prescribing patterns could help in better care. Objective: The CONVERGE (Cardiovascular Outcomes and Value in the Real world with GLP-1RAs) study characterized demographics and medication usage patterns in T2D intensified (add-on to metformin) overall population. The data were further divided into subgroups {dipeptidyl peptidase-4 inhibitors (DPP-4is), sulfonylureas (SUs), insulins, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is)}, according to the latest prescribed antidiabetic agent (ADA) in India/Pakistan/Thailand. Here, we report findings from Pakistan. Methods: A multi-center retrospective study utilized data from medical records between 13-Sep-2008 (post-market approval of GLP-1RAs) and 31-Dec-2017 in adults (≥18-year-old). The data for this study were collected from 05 centers / institutes located in major cities of Pakistan, including Karachi, Lahore, Islamabad, and Multan. These centers included National Hospital, Aga Khan University Hospital, Diabetes Endocrine Clinic Lahore, Shifa International Hospital, Mukhtar A Sheikh Hospital Multan. Data were collected at start of medical record and at 6 or 12-months prior to baseline based on variable type; analyzed descriptively. Results: Overall, 1,010 patients were eligible. At baseline, overall mean age (SD) was 51.6 (11.3) years, T2D duration was 2.4 (2.6) years, HbA1c was 8.3% (1.9) and 35% received ≥1CVD medications in the past 1-year (before baseline). Most frequently prescribed ADAs post-metformin were DPP-4is and SUs (~63%). Only 6.5% received GLP-1RAs and SGLT-2is were not available in Pakistan during the study period. Overall, it took a mean of 4.4 years and 5 years to initiate GLP-1RAs and SGLT-2is, respectively. In comparison to other subgroups, more patients from GLP-1RAs received ≥3 types of ADA (58%), ≥1 CVD medication (64%) and had higher body mass index (37kg/m2). Conclusions: Utilization of GLP-1RAs and SGLT-2is was low, took longer time to initiate and not before trying multiple ADAs. This may be due to lack of evidence for CV benefits for these agents during the study period. The planned phase 2 of the CONVERGE study can provide more insights into utilization and barriers to prescribe GLP-1RAs and SGLT-2is post 2018 in Pakistan.

Keywords: type 2 diabetes, GLP-1RA, treatment intensification, cardiovascular disease

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