Search results for: cultural sensitivity
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 5570

Search results for: cultural sensitivity

4940 A Review of Methods for Handling Missing Data in the Formof Dropouts in Longitudinal Clinical Trials

Authors: A. Satty, H. Mwambi

Abstract:

Much clinical trials data-based research are characterized by the unavoidable problem of dropout as a result of missing or erroneous values. This paper aims to review some of the various techniques to address the dropout problems in longitudinal clinical trials. The fundamental concepts of the patterns and mechanisms of dropout are discussed. This study presents five general techniques for handling dropout: (1) Deletion methods; (2) Imputation-based methods; (3) Data augmentation methods; (4) Likelihood-based methods; and (5) MNAR-based methods. Under each technique, several methods that are commonly used to deal with dropout are presented, including a review of the existing literature in which we examine the effectiveness of these methods in the analysis of incomplete data. Two application examples are presented to study the potential strengths or weaknesses of some of the methods under certain dropout mechanisms as well as to assess the sensitivity of the modelling assumptions.

Keywords: incomplete longitudinal clinical trials, missing at random (MAR), imputation, weighting methods, sensitivity analysis

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4939 Unveiling The Nexus: A Holistic Investigation On The Role Of Family Dynamics And Cultural Beliefs In Shaping Maternal Health In Primigravida Women

Authors: Anum Obaid, Bushra Noor, Zoshia Zainab

Abstract:

In South Asian countries, Pakistan faces significant public health challenges regarding maternal and neonatal health (MNH). Despite global efforts to improve maternal, newborn, child, and health (MNCH) outcomes through initiatives like the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs), high maternal and neonatal mortality rates persist. In patriarchal societies, cultural norms, family dynamics, and gender roles heavily influence healthcare accessibility and decision-making processes, often leading to delayed and inadequate maternal care. Addressing these socio-cultural barriers and enhancing healthcare resources is crucial to improving maternal health outcomes in areas like Faisalabad. A qualitative study was conducted involving two groups of informants: gynecologists practicing in private clinics and first-time pregnant women receiving care in government hospitals. Data collection included obtaining institutional permission, conducting semi-structured in-depth interviews, and using non-probability sampling techniques. A proactive strategy to overcome maternal health challenges involves using aversion therapy and disseminating knowledge among family members. This approach aims to foster a deep understanding within the family unit regarding the importance of maternal well-being, thereby creating a supportive environment and facilitating informed decision-making related to healthcare access and lifestyle choices. The findings indicate that maternal health is compromised both physiologically and psychologically, with significant implications for the baby's health. Mental well-being, in particular, is profoundly affected, largely due to familial behavior and entrenched cultural taboos.

Keywords: maternal health, neonatal health, socio-cultural norms, primigravida women, gynecologist, familial conduct, cultural taboos

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4938 Unveiling the Nexus: A Holistic Investigation on the Role of Cultural Beliefs and Family Dynamics in Shaping Maternal Health in Primigravida Women

Authors: Anum Obaid, Bushra Noor, Zoshia Zainab

Abstract:

In South Asian countries, Pakistan faces significant public health challenges regarding maternal and neonatal health (MNH). Despite global efforts to improve maternal, newborn, child, and health (MNCH) outcomes through initiatives like the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs), high maternal and neonatal mortality rates persist. In patriarchal societies, cultural norms, family dynamics, and gender roles heavily influence healthcare accessibility and decision-making processes, often leading to delayed and inadequate maternal care. Addressing these socio-cultural barriers and enhancing healthcare resources is crucial to improving maternal health outcomes in areas like Faisalabad. A qualitative study was conducted involving two groups of informants: gynecologists practicing in private clinics and first-time pregnant women receiving care in government hospitals. Data collection included obtaining institutional permission, conducting semi-structured in-depth interviews, and using non-probability sampling techniques. A proactive strategy to overcome maternal health challenges involves using aversion therapy and disseminating knowledge among family members. This approach aims to foster a deep understanding within the family unit regarding the importance of maternal well-being, thereby creating a supportive environment and facilitating informed decision-making related to healthcare access and lifestyle choices. The findings indicate that maternal health is compromised both physiologically and psychologically, with significant implications for the baby's health. Mental well-being, in particular, is profoundly affected, largely due to familial behavior and entrenched cultural taboos.

Keywords: maternal health, neonatal health, socio-cultural norms, primigravida women, gynecologist, familial conduct, cultural taboos.

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4937 Valorization of Surveillance Data and Assessment of the Sensitivity of a Surveillance System for an Infectious Disease Using a Capture-Recapture Model

Authors: Jean-Philippe Amat, Timothée Vergne, Aymeric Hans, Bénédicte Ferry, Pascal Hendrikx, Jackie Tapprest, Barbara Dufour, Agnès Leblond

Abstract:

The surveillance of infectious diseases is necessary to describe their occurrence and help the planning, implementation and evaluation of risk mitigation activities. However, the exact number of detected cases may remain unknown whether surveillance is based on serological tests because identifying seroconversion may be difficult. Moreover, incomplete detection of cases or outbreaks is a recurrent issue in the field of disease surveillance. This study addresses these two issues. Using a viral animal disease as an example (equine viral arteritis), the goals were to establish suitable rules for identifying seroconversion in order to estimate the number of cases and outbreaks detected by a surveillance system in France between 2006 and 2013, and to assess the sensitivity of this system by estimating the total number of outbreaks that occurred during this period (including unreported outbreaks) using a capture-recapture model. Data from horses which exhibited at least one positive result in serology using viral neutralization test between 2006 and 2013 were used for analysis (n=1,645). Data consisted of the annual antibody titers and the location of the subjects (towns). A consensus among multidisciplinary experts (specialists in the disease and its laboratory diagnosis, epidemiologists) was reached to consider seroconversion as a change in antibody titer from negative to at least 32 or as a three-fold or greater increase. The number of seroconversions was counted for each town and modeled using a unilist zero-truncated binomial (ZTB) capture-recapture model with R software. The binomial denominator was the number of horses tested in each infected town. Using the defined rules, 239 cases located in 177 towns (outbreaks) were identified from 2006 to 2013. Subsequently, the sensitivity of the surveillance system was estimated as the ratio of the number of detected outbreaks to the total number of outbreaks that occurred (including unreported outbreaks) estimated using the ZTB model. The total number of outbreaks was estimated at 215 (95% credible interval CrI95%: 195-249) and the surveillance sensitivity at 82% (CrI95%: 71-91). The rules proposed for identifying seroconversion may serve future research. Such rules, adjusted to the local environment, could conceivably be applied in other countries with surveillance programs dedicated to this disease. More generally, defining ad hoc algorithms for interpreting the antibody titer could be useful regarding other human and animal diseases and zoonosis when there is a lack of accurate information in the literature about the serological response in naturally infected subjects. This study shows how capture-recapture methods may help to estimate the sensitivity of an imperfect surveillance system and to valorize surveillance data. The sensitivity of the surveillance system of equine viral arteritis is relatively high and supports its relevance to prevent the disease spreading.

Keywords: Bayesian inference, capture-recapture, epidemiology, equine viral arteritis, infectious disease, seroconversion, surveillance

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4936 Design, Construction and Characterization of a 3He Proportional Counter for Detecting Thermal Neutron

Authors: M. Fares, S. Mameri, I. Abdlani, K. Negara

Abstract:

Neutron detectors in general, proportional counters gas filling based isotope 3He in particular are going to be essential for monitoring and control of certain nuclear facilities, monitoring of experimentation around neutron beams and channels nuclear research reactors, radiation protection instruments and other tools multifaceted exploration and testing of materials, etc. This work consists of a measurement campaign features two Proportional Counters 3He (3He: LND252/USA CP, CP prototype: 3He LND/DDM). This is to make a comparison study of a CP 3He LND252/USA reference one hand, and in the context of routine periodic monitoring of the characteristics of the detectors for controlling the operation especially for laboratory prototypes. In this paper, we have described the different characteristics of the detectors and the experimental protocols used. Tables of measures have been developed and the different curves were plotted. The experimental campaign at stake: 2 PC 3He were thus characterized: Their characteristics (sensitivity, energy pulse height distribution spectra, gas amplification etc.) Were identified: 01 PC 3He 1'' Type: prototype DEDIN/DDM, 01 PC 3He 1'' Type: LND252/USA.

Keywords: PC 3He, sensitivity, pulse height distribution spectra, gas amplification

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4935 Challenges and Prospects of Preservation of Tangible Cultural Heritage Management: A Case Study in Lake Tana Islands, Ethiopia

Authors: Ayele Tamene

Abstract:

Cultural heritage is the legacy of physical artifacts and intangible attributes of a group or society that are inherited from past generations, maintained in the present and bestowed for the benefit of future generations. Tangible heritage e includes buildings and historic places, monuments, artifacts, etc., which are considered worthy of preservation for the future. These include objects significant to the archaeology, architecture, science or technology of a specific culture. The research addressed the challenges and prospects of preservation of tangible cultural heritage management in Lake Tana islands; Amahara Regional State. Specifically, the research inquired the major factors which affected tangible cultural heritage management, investigated how communities successfully involved in tangible cultural heritage management, and described the contribution of cultural management to tourism development. It employed qualitative research approaches to grasp the existing condition in the study area. Major techniques of data gathering such as in-depth interview, observation/photographing and Focus Group Discussion (FGDs) were used. Related documents collected through secondary sources were examined and analyzed. In Lake Tana Islands precious heritages such as ancient religious manuscripts (written since 9th century), sacral wall paintings, gold and silver Crosses, crowns and prestigious clothes of the various kings of the medieval and the 19th century are found. The study indicated that heritages in Tana islands were affected by both natural and manmade problems. In Lake Tana Islands, movable heritages were looted several times by foreign aggressors, tourists, and local people who serve there. Some heritages were affected by visitors by their camera flash light and hand touch. Most heritages in the Tana islands lacked community ownership and preserved non- professionally which highly affected their originality and authenticity. Therefore, the local community and the regional government should work together in the preservation of these heritage sites and enhance their role for socio-economic development as a center of research and tourist destinations.

Keywords: cultural heritages, heritage preservation, lake Tana heritages, non professional preservation tangible heritages

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4934 The Science of Successful Intimate Relationship in China: A Discourse Analytic Examination of Sex and Relationships Advice in Ayawawa’s Book

Authors: Hanlei Yang

Abstract:

As a kind of popular culture in modern China, advice book on intimate relationship is turning into an important and controversial site with conflicts among neoliberalism, authoritative socialism, market-oriented principles, the science of successful sex and relationship, cosmopolitan notions of nuclear families, and the revitalization of Confucian conservatism and patriarchy. Accelerated modernization and marketization has contributed to great changes in China’s culture and social relations, which accordingly reconceptualizes and reconstructs family structures and moral ethics, particularly urban middle-class nuclear families. To comprehend the meaning of advice book fad in moral and social order, this research proposes to (i) understand the implication of Ayawawa through discourse analysis and how she mobilizes rhetorical devices and cultural resources to present a persuasive and scientific method of managing intimate relationship, (ii) examine the critical role of neoliberalism, post-feminism, and Confucian patriarchy assumed by Ayawawa in her books, (iii) explore how Ayawawa and her fans engage in establishing a model of intimate relationship and sexual subjectivity ordered by neoliberalism, class identity and authoritative socialism. Finally, this research argues that such new fad of a cultural phenomenon is gradually completed in the process of cooperation and negotiation of the state, commercial institutions, and intellectual elite agents. It helps to further learn about (i) the routine life under the influence of neoliberalism and modern hegemony, (ii) the perplexing relationship between China's indigenous cultural forms, global socio-economic and cultural influences in the late modern era.

Keywords: cultural study, intimate relationship, culture sociology, gender study

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4933 Prediction of Coronary Artery Stenosis Severity Based on Machine Learning Algorithms

Authors: Yu-Jia Jian, Emily Chia-Yu Su, Hui-Ling Hsu, Jian-Jhih Chen

Abstract:

Coronary artery is the major supplier of myocardial blood flow. When fat and cholesterol are deposit in the coronary arterial wall, narrowing and stenosis of the artery occurs, which may lead to myocardial ischemia and eventually infarction. According to the World Health Organization (WHO), estimated 740 million people have died of coronary heart disease in 2015. According to Statistics from Ministry of Health and Welfare in Taiwan, heart disease (except for hypertensive diseases) ranked the second among the top 10 causes of death from 2013 to 2016, and it still shows a growing trend. According to American Heart Association (AHA), the risk factors for coronary heart disease including: age (> 65 years), sex (men to women with 2:1 ratio), obesity, diabetes, hypertension, hyperlipidemia, smoking, family history, lack of exercise and more. We have collected a dataset of 421 patients from a hospital located in northern Taiwan who received coronary computed tomography (CT) angiography. There were 300 males (71.26%) and 121 females (28.74%), with age ranging from 24 to 92 years, and a mean age of 56.3 years. Prior to coronary CT angiography, basic data of the patients, including age, gender, obesity index (BMI), diastolic blood pressure, systolic blood pressure, diabetes, hypertension, hyperlipidemia, smoking, family history of coronary heart disease and exercise habits, were collected and used as input variables. The output variable of the prediction module is the degree of coronary artery stenosis. The output variable of the prediction module is the narrow constriction of the coronary artery. In this study, the dataset was randomly divided into 80% as training set and 20% as test set. Four machine learning algorithms, including logistic regression, stepwise regression, neural network and decision tree, were incorporated to generate prediction results. We used area under curve (AUC) / accuracy (Acc.) to compare the four models, the best model is neural network, followed by stepwise logistic regression, decision tree, and logistic regression, with 0.68 / 79 %, 0.68 / 74%, 0.65 / 78%, and 0.65 / 74%, respectively. Sensitivity of neural network was 27.3%, specificity was 90.8%, stepwise Logistic regression sensitivity was 18.2%, specificity was 92.3%, decision tree sensitivity was 13.6%, specificity was 100%, logistic regression sensitivity was 27.3%, specificity 89.2%. From the result of this study, we hope to improve the accuracy by improving the module parameters or other methods in the future and we hope to solve the problem of low sensitivity by adjusting the imbalanced proportion of positive and negative data.

Keywords: decision support, computed tomography, coronary artery, machine learning

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4932 Kurma (Kerma Culture) at Nubia: Migration to Dholavira (Indus Valley Civilization)

Authors: Dhanpat Singh Dhania

Abstract:

Kurma-avatara and the Kachchhapraj is the name of the same person. Tortoise is called Kurma in Kerma valley (Nubia) and also called Kachchhap in India. Wherever a culture migrates, its faiths and beliefs remain intact. The tortoise culture of Kurma valley migrated to Dholavira, and its cultural symbolism remained the same as Kurma, the tortoise. Culture is known by burial traditions, pottery formations, language use, faiths, and beliefs. Following the cultural identification methodology, the Kurma culture buried their dead in circular burials found during excavation at Toshka, Nubia, and built their houses the type of tortoise shell. The Nubian tortoise of a specific species had a triangular on the shell found to be extinct was the cultural symbolism of the culture found on the excavated pottery. Kurma cultural head known as the Seth was known as Kurma-avatara. The Seth of Egypt came to know when the combined efforts of the Seth and the Osiris defeated the Egyptian 1st dynastic rule in about 2775 BCE. Osiris became the king of the 2nd dynastic Egypt. It annoyed Seth. He killed the Osiris and went to Rann of Kachchh and declared him as the Chachchhapraj, the king of Kachchh (now Gujarat, India). The Kurma (Kachchhap) culture migration at Dholavira (Gujarat) attested by the Dholavira signboard found during excavation and deciphered as the ‘Chakradhar’, the eighth incarnation of Kurma-avatara.

Keywords: Kurma, Egyptian, Kachchhap, Dholavira, Harappan

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4931 Recreating Home: Restoration and Reflections on the Traditional Houses of Kucapungane

Authors: Sasala Taiban

Abstract:

This paper explores the process and reflections on the restoration of traditional slate houses in the Rukai tribe's old settlement of Kucapungane. Designated as a ‘Class II Historical Site’ by the Ministry of the Interior in 1991 and listed by UNESCO's World Monuments Fund in 2016, Kucapungane holds significant historical and cultural value. However, due to government neglect, tribal migration, and the passing of elders, the traditional knowledge and techniques for constructing slate houses face severe discontinuity. Over the past decades, residents have strived to preserve and transmit these traditional skills through the restoration and reconstruction of their homes. This study employs qualitative methodology, combining ethnographic fieldwork, historical analysis, and participatory observation. The research includes in-depth interviews, focus group discussions, and hands-on participation in restoration activities to gather comprehensive data. The paper reviews the historical evolution of Kucapungane, the restoration process, and the challenges encountered, such as insufficient resources, technical preservation issues, material acquisition problems, and lack of community recognition. Furthermore, it highlights the importance of house restoration in indigenous consciousness and cultural revival, proposing strategies to address current issues and promote preservation. Through these efforts, the cultural heritage of the Rukai tribe can be sustained and carried forward into the future.

Keywords: Rukai, Kucapungane, slate house restoration, cultural heritage

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4930 A Development of a Conceptual Framework for Safety Culture and Safety Risk Assessment: The Case of Chinese International Construction Projects under the “New Belt and Road” Initiative in Africa

Authors: Bouba Oumarou Aboubakar, HongXia Li, Sardar Annes Farooq

Abstract:

The Belt and Road Initiative’s success strongly depends on the safety of all the million workers on construction projects sites. As the new BRI is directed toward Africa and meets a completely different culture from the Chinese project managers, maintaining low risk for workers risks shall be closely related to cultural sharing and mutual understanding. This is why this work introduces a cultural-wise safety management framework for Chinese Construction projects in Africa. The theoretical contribution of this paper is an improved risk assessment framework that integrates language, culture and difficulty of controlling risk factors into one approach. Practically, this study provides not only a useful tool for project safety management practitioners but the full understanding of all risks that may arise in the BRI projects in Africa.

Keywords: cultural-wise, safety culture, risk assessment, Chinese construction, BRI projects, Africa

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4929 Strategic Analysis of Hospitality Marketing Driven by Culture in Historical City: Comparable Case Studies in Tainan City

Authors: Tsung-Han Lin, Chia-Han Yang

Abstract:

Recently, it’s obvious that many hotels not only provide customized service, but offer local culture to give customers different experiences. Luxury decoration and fancy equipment are not enough anymore. Customers expect that hotels not just as an accommodation, but connecting to their trips. Therefore, culture becomes significant when developing marketing strategy for hotels. Tainan, located in south of Taiwan, is the city full of culture that some hospitality industries promote their hotels exactly base on culture. Historic Tainan (台南; táinán), is a city of ancient monuments, delicious food and, above all, temples: there are more gods worshipped and more festivals and rituals observed in Tainan than in any other place in Taiwan. The oldest and most absorbing parts of Tainan are historic Anping, on the west side of town by the sea, and the cultural zones in the heart of the old city; the latter were created specifically to make things easier for visitors, with city information, signs and maps tailored to each zone and well-marked in English. The Chihkan, Dong-an Fang, Five Canals and Confucius Temple cultural zones contain the richest concentration of sights – reckon on spending at least two days to do them justice. As a result, the study aims to analyze the significance of culture on marketing strategies and C and H two hotels in Tainan city as case studies conducting the comparison of cultural marketing and experience marketing to provide a framework for hotels to develop their marketing strategies.

Keywords: cultural marketing, hospitality, historical city, Tainan city

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4928 Mellowing the Mélange: Ancient Southeast Asian Kingdoms in the Asian Civilizations Museum

Authors: Rin Li Si Samantha

Abstract:

The Asian Civilisations Museum in Singapore contains artifacts spanning thousands of years of history and possibly hundreds of communities and nations. Based in Singapore, its collections history and curation are deeply rooted in Singapore’s national and international agendas: to be a cultural center within Southeast Asia and a global hub representing Asia to the world. As such, the position of Southeast Asian histories, particularly Southeast Asian ancient kingdoms, is a carefully negotiated one; its presence contingent on the territorialization and depoliticization of Southeast Asian ancient kingdoms, such that they remain palatable to modern nation-states and governments; its absence noted, strategically overlooked in favour of ‘grander’ cultural and global — oftentimes a misnomer for Western — narratives. This study undertakes a close reading of several key permanent exhibitions at the Asian Civilisations Museum in pursuit of how ancient Southeast Asian kingdoms are framed and forgotten to reveal a conscious mellowing of the mélange such that Singapore may be positioned as inheritor of Asia’s cultural wealth.

Keywords: museum, Southeast Asia, art history, pre-colonial, national narratives

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4927 [Keynote Talk]: Water Resources Vulnerability Assessment to Climate Change in a Semi-Arid Basin of South India

Authors: K. Shimola, M. Krishnaveni

Abstract:

This paper examines vulnerability assessment of water resources in a semi-arid basin using the 4-step approach. The vulnerability assessment framework is developed to study the water resources vulnerability which includes the creation of GIS-based vulnerability maps. These maps represent the spatial variability of the vulnerability index. This paper introduces the 4-step approach to assess vulnerability that incorporates a new set of indicators. The approach is demonstrated using a framework composed of a precipitation data for (1975–2010) period, temperature data for (1965–2010) period, hydrological model outputs and the water resources GIS data base. The vulnerability assessment is a function of three components such as exposure, sensitivity and adaptive capacity. The current water resources vulnerability is assessed using GIS based spatio-temporal information. Rainfall Coefficient of Variation, monsoon onset and end date, rainy days, seasonality indices, temperature are selected for the criterion ‘exposure’. Water yield, ground water recharge, evapotranspiration (ET) are selected for the criterion ‘sensitivity’. Type of irrigation and storage structures are selected for the criterion ‘Adaptive capacity’. These indicators were mapped and integrated in GIS environment using overlay analysis. The five sub-basins, namely Arjunanadhi, Kousiganadhi, Sindapalli-Uppodai and Vallampatti Odai, fall under medium vulnerability profile, which indicates that the basin is under moderate stress of water resources. The paper also explores prioritization of sub-basinwise adaptation strategies to climate change based on the vulnerability indices.

Keywords: adaptive capacity, exposure, overlay analysis, sensitivity, vulnerability

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4926 An Assessment into the Drift in Direction of International Migration of Labor: Changing Aspirations for Religiosity and Cultural Assimilation

Authors: Syed Toqueer Akhter, Rabia Zulfiqar

Abstract:

This paper attempts to trace the determining factor- as far as individual preferences and expectations are concerned- of what causes the direction of international migration to drift in certain ways owing to factors such as Religiosity and Cultural Assimilation. The narrative on migration has graduated from the age long ‘push/pull’ debate to that of complex factors that may vary across each individual. We explore the longstanding factor of religiosity widely acknowledged in mentioned literature as a key variable in the assessment of migration, wherein the impact of religiosity in the form of a drift into the intent of migration has been analyzed. A more conventional factor cultural assimilation is used in a contemporary way to estimate how it plays a role in affecting the drift in direction. In particular what our research aims at achieving is to isolate the effect our key variables: Cultural Assimilation and Religiosity have on direction of migration, and to explore how they interplay as a composite unit- and how we may be able to justify the change in behavior displayed by these key variables. In order to establish a true sense of what drives individual choices we employ the method of survey research and use a questionnaire to conduct primary research. The questionnaire was divided into six sections covering subjects including household characteristics, perceptions and inclinations of the respondents relevant to our study. Religiosity was quantified using a proxy of Migration Network that utilized secondary data to estimate religious hubs in recipient countries. To estimate the relationship between Intent of Migration and its variants three competing econometric models namely: the Ordered Probit Model, the Ordered Logit Model and the Tobit Model were employed. For every model that included our key variables, a highly significant relationship with the intent of migration was estimated.

Keywords: international migration, drift in direction, cultural assimilation, religiosity, ordered probit model

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4925 The Role of Community Museum in Ethnic Identity: A Case of Tharu Cultural Museum and Research Center in Chitwan Nepal

Authors: Birendra Mahato, Shiva Narayan Chaudhary

Abstract:

Tharus are indigenous inhabitants of the Tarai, the narrow strip of flat and fertile land that lies at the foothills of the Himalayas. They have unique rituals, festivals, and music, while their clothes and ornaments are similar to some ethnic groups of India. After the control of malaria in the Terai between 1955 to 1965, (with the help of the U.S. Government, the WHO and the government of Nepal) the rate of in-migration skyrocketed, particularly of Nepal’s hill people, whose culture, along with the use of the Western education system, was gradually adopted by the Tharus. Among the many challenges, the Tharus face is their assimilation into the dominant Nepali culture. .The Tharus are thus under threat of slowly losing their ethnic identity and cultural values. In order to preserve the indigenous Tharu Culture, Tharu Cultural Museum, and Research Center. It is a community based non-governmental and non-profitable museum established in 2005 by Tharu intellectuals, traditional leaders and youths. The main goal of the museum is to preserve Tharu culture through different activities with direct and indirect involvement of community people. It aims to preserve arts, culture, handicrafts, and artifacts related to Indigenous Tharu People. Similarly, the museum displays an exhibition about the Tharu histories, lives, culture, and their indigenous knowledge and skills. The paper aims to demonstrate that community museums can be one of the key hubs for the preservation of culture with the collection and promotion of cultural objects, artifacts, and intangible cultural heritages. The preservation of culture not only has contributed to establishing their ethnic identity but also has contributed to establishing their recognition of their political space in the mainstream politics - the constitution of Nepal has recognized Tharus to provide reservation for the political space.

Keywords: community museum, tharu, , identity, culture

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4924 Internal Capital Market Efficiency Study Based on Improved Cash Flow Sensitivity Coefficient - Take Tomorrow Group as an Example

Authors: Peng Lu, Liu Ting

Abstract:

Because of the difficulty of financing from the external capital market, the reorganization and merger of private enterprises have formed a family group, seeking the help of the internal capital market to alleviate the capital demand. However, the inefficiency of the internal capital market can damage the effect it should have played, and even hinder the development of enterprises. This paper takes the "Tomorrow Group" as the research object to carry on the case analysis. After using the improved cash flow sensitivity coefficient to measure the efficiency of the internal capital market of Tomorrow Group, the inefficiency phenomenon is found. Then the analysis reveals that the reasons for its inefficiency include that the pyramidal equity structure is conducive to control, the separation of cash flow rights and control rights, the concentration of equity leads to poor balance, the abandonment of real industries and information asymmetry.

Keywords: tomorrow group, internal capital market, related-party transactions, Baotou tomorrow technology Co., LTD

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4923 Investigation on Mesh Sensitivity of a Transient Model for Nozzle Clogging

Authors: H. Barati, M. Wu, A. Kharicha, A. Ludwig

Abstract:

A transient model for nozzle clogging has been developed and successfully validated against a laboratory experiment. Key steps of clogging are considered: transport of particles by turbulent flow towards the nozzle wall; interactions between fluid flow and nozzle wall, and the adhesion of the particle on the wall; the growth of the clog layer and its interaction with the flow. The current paper is to investigate the mesh (size and type) sensitivity of the model in both two and three dimensions. It is found that the algorithm for clog growth alone excluding the flow effect is insensitive to the mesh type and size, but the calculation including flow becomes sensitive to the mesh quality. The use of 2D meshes leads to overestimation of the clog growth because the 3D nature of flow in the boundary layer cannot be properly solved by 2D calculation. 3D simulation with tetrahedron mesh can also lead to an error estimation of the clog growth. A mesh-independent result can be achieved with hexahedral mesh, or at least with triangular prism (inflation layer) for near-wall regions.

Keywords: clogging, continuous casting, inclusion, simulation, submerged entry nozzle

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4922 Diverse Sensitivity to Ultraviolet Radiation of DNA and RNA Viruses

Authors: Nickolay Nosik, Dmitry Nosik, Marina Bochkova, Nina Kondrashina, Olga Lobach

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The bactericidal effect of UV radiation is known for long time and widely used for inactivation of pathogens but for viruses it is not so uniform. Due to a wide variety of viruses their sensitivity to UV radiation is quite different and not quite predictable. The goal of the study was to determine the inactivation kinetics of UV radiation ( 254 nm) of the viruses of social importance (HIV), as well as test-viruses (poliovirus, adenovirus) used for the evaluation of the viral inactivation efficacy of germicides. Methods: DNA viruses- adenovirus, type 5; Herpes simplex virus (HSV), type 1, and RNA viruses–human immunodeficiency virus (HIV), type 1 and poliovirus, type 1 (Sabin strain) were obtained from State collection of viruses ( The D.I. Ivanovsky Institute of Virology). The source of UV radiation was a 15-watt low-pressure mercury vapor lamp (over 60% 254nm). The samples of 5cm2 were placed direct under the UV lamp flow (h-0.3m). Log reduction value was used as a marker for the rate of virus inactivation. Results: The data obtained indicate that poliovirus (one of the viruses most resistant to chemical germicides) and HSV are rather sensitive to UV radiation ( D90 =250-311 J/m2). Adenovirus is much more resistant to UV radiation (750 J/m2 ). The kinetics of adenovirus inactivation : 0 min- 5.0 lg TCID50, 10 min - 5,0, 15 min -4,0, 30 min – 3.5, 60 min – 1,0, 75 min -0,5 lg TCID50, 90 min –virus not detectable. HIV is most resistant to UV radiation among the studied viruses. It takes more than 4 hrs to inactivate the virus on the surface. D90 = 2000 J/m2 Conclusion: The results of the study show that there is no direct dependence between sensitivity to UV light and the size of the virion or presence\absence of the envelope of the virus. Poliovirus and adenovirus are small viruses (20-30nm poliovirus and 70-90nm adenovirus) and both are non-enveloped viruses but adenovirus 3-fold more resistant to UV radiation than poliovirus. It can be expected that viruses with more complicate structure, like Herpes virus (200nm) or HIV (80-100 nm), would be more sensitive to UV light. However, the very high resistance of HIV to UV radiation needs further investigation. The diverse resistance of the different viruses to UV radiation should be taken into the account when UV light is used to inactivate infectious viruses in hospitals and other public environments.

Keywords: HIV, HSV, inhibition of viruses, UV radiation

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4921 Crossing Boundaries: Emerging Identities from Folk Theatre

Authors: Sonia Wahengbam, Natasha Elangbam

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Female impersonation has existed through the length of human civilization and the breadth of its cultures. Transvestism and drag queen cultures have created multi-sited spaces where in the shadow of art, one can cross the gender barrier and express one’s hidden identity. This paper will explore a dynamic cultural space that exists in Manipur, a state in the northeastern region of India, where the female impersonators (nupi shabis) of a folk theater (Shumang Leela) are using this traditional and popular art form to claim social acceptance of their homosexual identities through the medium of entertainment. It will highlight how by crossing the gender boundary, this third gender group has carved out a unique socio-economic niche where they have exploited their sexual identities to their advantage. The paper will trace the expanding cultural ‘’borderland’’ of Manipur where there is an increasing sense of ‘becoming’, belonging and sharing” of identities through the interweaving of old and new media. The research will be based on interviews with the nupi shabis, cultural critics and other experts.

Keywords: transvestism, Manipur, female impersonators (nupi shabis), Shumang Leela, gender

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4920 Multiracial Society and Oral Tradition: A Study through Secondary Data

Authors: Jesvin Puay-Hwa Yeo, Laavanya Kathiravelu, Sa’Eda Binte Buang

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In the early days, myths and taboos were used by our ancestors to give explanations to the existence of nature and man, as well as to propitiate fortunes and to avoid unluckiness and harm. Myths and taboos are deeply rooted in our cultures and environment, and they form certain characteristics of any society, even in modern societies. With decades of the three main ethnic communities in Singapore – Malay, Indian and Chinese – living together, there has been intermingling and intermixing of traditions and practices. This may mean that what we think is a ‘Malay’ practice is actually one that is a hybrid of the Chinese and Malay. A good example would be the practice of covering all mirrors in a house of mourning. Therefore, the proposed seeks to explore and understand the underlying social influences of Singapore’s oral tradition. As part of a bigger cultural research project: Designing Cultures, the proposed paper focused on using secondary data to contribute to the overall cultural understanding of the integral connections between oral traditions, people and landscapes. The proposed paper will discuss in details the initials findings of the research project, including the two manners that contributed to the intermixing of myths and taboos. The first is the presence of social institutions such as religions, and the second is the presence of cross-cultural minorities such as the Straits Chinese. As well as other observations included the use and influence of Chinese oral traditions such as folklore among the early Chinese immigrants through social institutions.

Keywords: cultural belief, multiracial society, myths, oral tradition

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4919 Cultural Practices as a Coping Measure for Women who Terminated a Pregnancy in Adolescence: A Qualitative Study

Authors: Botshelo Rachel Sebola

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Unintended pregnancy often results in pregnancy termination. Most countries have legalised the termination of a pregnancy, and pregnant adolescents can visit designated clinics without their parents’ consent. In most African and Asian countries, certain cultural practices are performed following any form of childbirth, including abortion, and such practices are ingrained in societies. The aim of this paper was to understand how women who terminated a pregnancy during adolescence coped by embracing cultural practices. A descriptive multiple case study design was adopted for the study. In-depth, semi-structured interviews and reflective diaries were used for data collection. 13 women aged 20 to 35 years who had terminated a pregnancy in adolescence participated in the study. Three women kept their soiled sanitary pads, burned them to ash and waited for the rainy season to scatter the ash in a flowing stream. This ritual was performed to appease the ancestors, ask them for forgiveness and as a send-off for the aborted foetus. Five women secretly consulted Sangoma (traditional healers) to perform certain rituals. Three women isolated themselves to perform herbal cleansings, and the last two chose not to engage in any sexual activity for one year, which led to the loss of their partners. This study offers a unique contribution to understanding the solitary journey of women who terminate a pregnancy. The study challenges healthcare professionals who work in clinics that offer pregnancy termination services to look beyond releasing the foetus to advocating and providing women with the necessary care and support in performing cultural practices.

Keywords: adolescence, culture, case study, pregnancy

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4918 Academic, Socio-Cultural and Psychological Satisfaction of International Higher Degree Research Students (IRHD) in Australia

Authors: Baohua Yu

Abstract:

In line with wider tends in the expansion of international student mobility, the number of international higher degree research students has grown at a significant rate in recent years. In particular, Australia has become a hub for attracting international higher degree research students from around the world. However, research has identified that international higher degree research students often encounter a wide range of academic and socio-cultural challenges in adapting to their new environment. Moreover, this can have a significant bearing on their levels of satisfaction with their studies. This paper outlines the findings of a mixed method study exploring the experiences and perceptions of international higher degree research students in Australia. Findings revealed that IRHD students’ overall and academic satisfaction in Australia were highly related to each other, and they were strongly influenced by their learning and research, moderately influenced by co-national support and intercultural contact ability. Socio-cultural satisfaction seemed to belong to a different domain from academic satisfaction because it was explained by a different set of variables such as living and adaptation and intercultural contact ability. In addition, the most important issues in terms of satisfaction were not directly related to academic studies. Instead, factors such as integration into the community, interacting with other students, relationships with supervisors, and the provision of adequate desk space were often given the greatest weight. Implications for how university policy can better support international doctoral students are discussed.

Keywords: international higher degree research students, academic adaptation, socio-cultural adaptation, student satisfaction

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4917 Towards a Vulnerability Model Assessment of The Alexandra Jukskei Catchment in South Africa

Authors: Vhuhwavho Gadisi, Rebecca Alowo, German Nkhonjera

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This article sets out to detail an investigation of groundwater management in the Juksei Catchment of South Africa through spatial mapping of key hydrological relationships, interactions, and parameters in catchments. The Department of Water Affairs (DWA) noted gaps in the implementation of the South African National Water Act 1998: article 16, including the lack of appropriate models for dealing with water quantity parameters. For this reason, this research conducted a drastic GIS-based groundwater assessment to improve groundwater monitoring system in the Juksei River basin catchment of South Africa. The methodology employed was a mixed-methods approach/design that involved the use of DRASTIC analysis, questionnaire, literature review and observations to gather information on how to help people who use the Juskei River. GIS (geographical information system) mapping was carried out using a three-parameter DRASTIC (Depth to water, Recharge, Aquifer media, Soil media, Topography, Impact of the vadose zone, Hydraulic conductivity) vulnerability methodology. In addition, the developed vulnerability map was subjected to sensitivity analysis as a validation method. This approach included single-parameter sensitivity, sensitivity to map deletion, and correlation analysis of DRASTIC parameters. The findings were that approximately 5.7% (45km2) of the area in the northern part of the Juksei watershed is highly vulnerable. Approximately 53.6% (428.8 km^2) of the basin is also at high risk of groundwater contamination. This area is mainly located in the central, north-eastern, and western areas of the sub-basin. The medium and low vulnerability classes cover approximately 18.1% (144.8 km2) and 21.7% (168 km2) of the Jukskei River, respectively. The shallow groundwater of the Jukskei River belongs to a very vulnerable area. Sensitivity analysis indicated that water depth, water recharge, aquifer environment, soil, and topography were the main factors contributing to the vulnerability assessment. The conclusion is that the final vulnerability map indicates that the Juksei catchment is highly susceptible to pollution, and therefore, protective measures are needed for sustainable management of groundwater resources in the study area.

Keywords: contamination, DRASTIC, groundwater, vulnerability, model

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4916 Model-Based Process Development for the Comparison of a Radial Riveting and Roller Burnishing Process in Mechanical Joining Technology

Authors: Tobias Beyer, Christoph Friedrich

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Modern simulation methodology using finite element models is nowadays a recognized tool for product design/optimization. Likewise, manufacturing process design is increasingly becoming the focus of simulation methodology in order to enable sustainable results based on reduced real-life tests here as well. In this article, two process simulations -radial riveting and roller burnishing- used for mechanical joining of components are explained. In the first step, the required boundary conditions are developed and implemented in the respective simulation models. This is followed by process space validation. With the help of the validated models, the interdependencies of the input parameters are investigated and evaluated by means of sensitivity analyses. Limit case investigations are carried out and evaluated with the aid of the process simulations. Likewise, a comparison of the two joining methods to each other becomes possible.

Keywords: FEM, model-based process development, process simulation, radial riveting, roller burnishing, sensitivity analysis

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4915 Pueblos Mágicos in Mexico: The Loss of Intangible Cultural Heritage and Cultural Tourism

Authors: Claudia Rodriguez-Espinosa, Erika Elizabeth Pérez Múzquiz

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Since the creation of the “Pueblos Mágicos” program in 2001, a series of social and cultural events had directly affected the heritage conservation of the 121 registered localities until 2018, when the federal government terminated the program. Many studies have been carried out that seek to analyze from different perspectives and disciplines the consequences that these appointments have generated in the “Pueblos Mágicos.” Multidisciplinary groups such as the one headed by Carmen Valverde and Liliana López Levi, have brought together specialists from all over the Mexican Republic to create a set of diagnoses of most of these settlements, and although each one has unique specificities, there is a constant in most of them that has to do with the loss of cultural heritage and that is related to transculturality. There are several factors identified that have fostered a cultural loss, as a direct reflection of the economic crisis that prevails in Mexico. It is important to remember that the origin of this program had as its main objective to promote the growth and development of local economies since one of the conditions for entering the program is that they have less than 20,000 inhabitants. With this goal in mind, one of the first actions that many “Pueblos Mágicos” carried out was to improve or create an infrastructure to receive both national and foreign tourists since this was practically non-existent. Creating hotels, restaurants, cafes, training certified tour guides, among other actions, have led to one of the great problems they face: globalization. Although by itself it is not bad, its impact in many cases has been negative for heritage conservation. The entry into and contact with new cultures has led to the undervaluation of cultural traditions, their transformation and even their total loss. This work seeks to present specific cases of transformation and loss of cultural heritage, as well as to reflect on the problem and propose scenarios in which the negative effects can be reversed. For this text, 36 “Pueblos Mágicos” have been selected for study, based on those settlements that are cited in volumes I and IV (the first and last of the collection) of the series produced by the multidisciplinary group led by Carmen Valverde and Liliana López Levi (researchers from UNAM and UAM Xochimilco respectively) in the project supported by CONACyT entitled “Pueblos Mágicos. An interdisciplinary vision”, of which we are part. This sample is considered representative since it forms 30% of the total of 121 “Pueblos Mágicos” existing at that moment. With this information, the elements of its intangible heritage loss or transformation have been identified in every chapter based on the texts written by the participants of that project. Finally, this text shows an analysis of the effects that this federal program, as a public policy applied to 132 populations, has had on the conservation or transformation of the intangible cultural heritage of the “Pueblos Mágicos.” Transculturality, globalization, the creation of identities and the desire to increase the flow of tourists have impacted the changes that traditions (main intangible cultural heritage) have had in the 18 years that the federal program lasted.

Keywords: public policies, cultural tourism, heritage preservation, pueblos mágicos program

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4914 Linguoculturological Analysis of Advertising: An Overview of Previous Researches

Authors: Brankica Bojovic

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Every study of advertising is intrinsically multidisciplinary, as the researcher must take into account the linguistic, social, psychological, economic, political and cultural factors that have all played a significant role in the history of advertising. A linguoculturological analysis of advertising aims to provide insight into the ideologies and archetypal structures that abide in the discourse of advertising messages, and give an overview of the academic research in the area of linguistics, and cultural and social studies that contributed to the demystification of the discourse of advertising. As the process of globalisation is gaining momentum, so is the expansion of businesses and economies, and migration of the population. Yet, the uniqueness of individual cultures prevails, and demonstrates that the process of communication and translation are not only matters of linguistic, but of cultural transferral as well. Therefore, even the world of business and advertising, the world of fast food, fast production, fast living, is programmed in accordance with the uniqueness of those cultures. The fact that culture, beliefs, ideologies, values and societal expectations permeate every sphere of advertising will be addressed through illustrative examples.

Keywords: culturology, ideology, linguistic analysis in advertising, linguistic and visual metaphors, propaganda, translation of advertisements

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4913 Multicenter Evaluation of the ACCESS Anti-HCV Assay on the DxI 9000 ACCESS Immunoassay Analyzer, for the Detection of Hepatitis C Virus Antibody

Authors: Dan W. Rhodes, Juliane Hey, Magali Karagueuzian, Florianne Martinez, Yael Sandowski, Vanessa Roulet, Mahmoud Badawi, Mohammed-Amine Chakir, Valérie Simon, Jérémie Gautier, Françoise Le Boulaire, Catherine Coignard, Claire Vincent, Sandrine Greaume, Isabelle Voisin

Abstract:

Background: Beckman Coulter, Inc. (BEC) has recently developed a fully automated second-generation anti-HCV test on a new immunoassay platform. The objective of this multicenter study conducted in Europe was to evaluate the performance of the ACCESS anti-HCV assay on the recently CE-marked DxI 9000 ACCESS Immunoassay Analyzer as an aid in the diagnosis of HCV (Hepatitis C Virus) infection and as a screening test for blood and plasma donors. Methods: The clinical specificity of the ACCESS anti-HCV assay was determined using HCV antibody-negative samples from blood donors and hospitalized patients. Sample antibody status was determined by a CE-marked anti-HCV assay (Abbott ARCHITECTTM anti-HCV assay or Abbott PRISM HCV assay) with an additional confirmation method (Immunoblot testing with INNO-LIATM HCV Score - Fujirebio), if necessary, according to pre-determined testing algorithms. The clinical sensitivity was determined using known HCV antibody-positive samples, identified positive by Immunoblot testing with INNO-LIATM HCV Score - Fujirebio. HCV RNA PCR or genotyping was available on all Immunoblot positive samples for further characterization. The false initial reactive rate was determined on fresh samples from blood donors and hospitalized patients. Thirty (30) commercially available seroconversion panels were tested to assess the sensitivity for early detection of HCV infection. The study was conducted from November 2019 to March 2022. Three (3) external sites and one (1) internal site participated. Results: Clinical specificity (95% CI) was 99.7% (99.6 – 99.8%) on 5852 blood donors and 99.0% (98.4 – 99.4%) on 1527 hospitalized patient samples. There were 15 discrepant samples (positive on ACCESS anti-HCV assay and negative on both ARCHITECT and Immunoblot) observed with hospitalized patient samples, and of note, additional HCV RNA PCR results showed five (5) samples had positive HCV RNA PCR results despite the absence of HCV antibody detection by ARCHITECT and Immunoblot, suggesting a better sensitivity of the ACCESS anti-HCV assay with these five samples compared to the ARCHITECT and Immunoblot anti-HCV assays. Clinical sensitivity (95% CI) on 510 well-characterized, known HCV antibody-positive samples was 100.0% (99.3 – 100.0%), including 353 samples with known HCV genotypes (1 to 6). The overall false initial reactive rate (95% CI) on 6630 patient samples was 0.02% (0.00 – 0.09%). Results obtained on 30 seroconversion panels demonstrated that the ACCESS anti-HCV assay had equivalent sensitivity performances, with an average bleed difference since the first reactive bleed below one (1), compared to the ARCHITECTTM anti-HCV assay. Conclusion: The newly developed ACCESS anti-HCV assay from BEC for use on the DxI 9000 ACCESS Immunoassay Analyzer demonstrated high clinical sensitivity and specificity, equivalent to currently marketed anti-HCV assays, as well as a low false initial reactive rate.

Keywords: DxI 9000 ACCESS Immunoassay Analyzer, HCV, HCV antibody, Hepatitis C virus, immunoassay

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4912 Constructivist Grounded Theory of Intercultural Learning

Authors: Vaida Jurgile

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Intercultural learning is one of the approaches taken to understand the cultural diversity of the modern world and to accept changes in cultural identity and otherness and the expression of tolerance. During intercultural learning, students develop their abilities to interact and communicate with their group members. These abilities help to understand social and cultural differences, to form one’s identity, and to give meaning to intercultural learning. Intercultural education recognizes that a true understanding of differences and similarities of another culture is necessary in order to lay the foundations for working together with others, which contributes to the promotion of intercultural dialogue, appreciation of diversity, and cultural exchange. Therefore, it is important to examine the concept of intercultural learning, revealed through students’ learning experiences and understanding of how this learning takes place and what significance this phenomenon has in higher education. At a scientific level, intercultural learning should be explored in order to uncover the influence of cultural identity, i.e., intercultural learning should be seen in a local context. This experience would provide an opportunity to learn from various everyday intercultural learning situations. Intercultural learning can be not only a form of learning but also a tool for building understanding between people of different cultures. The research object of the study is the process of intercultural learning. The aim of the dissertation is to develop a grounded theory of the process of learning in an intercultural study environment, revealing students’ learning experiences. The research strategy chosen in this study is a constructivist grounded theory (GT). GT is an inductive method that seeks to form a theory by applying the systematic collection, synthesis, analysis, and conceptualization of data. The targeted data collection was based on the analysis of data provided by previous research participants, which revealed the need for further research participants. During the research, only students with at least half a year of study experience, i.e., who have completed at least one semester of intercultural studies, were purposefully selected for the research. To select students, snowballing sampling was used. 18 interviews were conducted with students representing 3 different fields of sciences (social sciences, humanities, and technology sciences). In the process of intercultural learning, language expresses and embodies cultural reality and a person’s cultural identity. It is through language that individual experiences are expressed, and the world in which Others exist is perceived. The increased emphasis is placed on the fact that language conveys certain “signs’ of communication and perception with cultural value, enabling the students to identify the Self and the Other. Language becomes an important tool in the process of intercultural communication because it is only through language that learners can communicate, exchange information, and understand each other. Thus, in the process of intercultural learning, language either promotes interpersonal relationships with foreign students or leads to mutual rejection.

Keywords: intercultural learning, grounded theory, students, other

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4911 Non-Invasive Assessment of Peripheral Arterial Disease: Automated Ankle Brachial Index Measurement and Pulse Volume Analysis Compared to Ultrasound Duplex Scan

Authors: Jane E. A. Lewis, Paul Williams, Jane H. Davies

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Introduction: There is, at present, a clear and recognized need to optimize the diagnosis of peripheral arterial disease (PAD), particularly in non-specialist settings such as primary care, and this arises from several key facts. Firstly, PAD is a highly prevalent condition. In 2010, it was estimated that globally, PAD affected more than 202 million people and furthermore, this prevalence is predicted to further escalate. The disease itself, although frequently asymptomatic, can cause considerable patient suffering with symptoms such as lower limb pain, ulceration, and gangrene which, in worse case scenarios, can necessitate limb amputation. A further and perhaps the most eminent consequence of PAD arises from the fact that it is a manifestation of systemic atherosclerosis and therefore is a powerful predictor of coronary heart disease and cerebrovascular disease. Objective: This cross sectional study aimed to individually and cumulatively compare sensitivity and specificity of the (i) ankle brachial index (ABI) and (ii) pulse volume waveform (PVW) recorded by the same automated device, with the presence or absence of peripheral arterial disease (PAD) being verified by an Ultrasound Duplex Scan (UDS). Methods: Patients (n = 205) referred for lower limb arterial assessment underwent an ABI and PVW measurement using volume plethysmography followed by a UDS. Presence of PAD was recorded for ABI if < 0.9 (noted if > 1.30) if PVW was graded as 2, 3 or 4 or a hemodynamically significant stenosis > 50% with UDS. Outcome measure was agreement between measured ABI and interpretation of the PVW for PAD diagnosis, using UDS as the reference standard. Results: Sensitivity of ABI was 80%, specificity 91%, and overall accuracy 88%. Cohen’s kappa revealed good agreement between ABI and UDS (k = 0.7, p < .001). PVW sensitivity 97%, specificity 81%, overall accuracy 84%, with a good level of agreement between PVW and UDS (k = 0.67, p < .001). The combined sensitivity of ABI and PVW was 100%, specificity 76%, and overall accuracy 85% (k = 0.67, p < .001). Conclusions: Combing these two diagnostic modalities within one device provided a highly accurate method of ruling out PAD. Such a device could be utilized within the primary care environment to reduce the number of unnecessary referrals to secondary care with concomitant cost savings, reduced patient inconvenience, and prioritization of urgent PAD cases.

Keywords: ankle brachial index, peripheral arterial disease, pulse volume waveform, ultrasound duplex scan

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