Search results for: European treatment and outcome study score
53925 The Role of Heat Pumps in the Decarbonization of European Regions
Authors: Domenico M. Mongelli, Michele De Carli, Laura Carnieletto, Filippo Busato
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Europe's dependence on imported fossil fuels has been particularly highlighted by the Russian invasion of Ukraine. Limiting this dependency with a massive replacement of fossil fuel boilers with heat pumps for building heating is the goal of this work. Therefore, with the aim of diversifying energy sources and evaluating the potential use of heat pump technologies for residential buildings with a view to decarbonization, the quantitative reduction in the consumption of fossil fuels was investigated in all regions of Europe through the use of heat pumps. First, a general overview of energy consumption in buildings in Europe has been assessed. The consumption of buildings has been addressed to the different uses (heating, cooling, DHW, etc.) as well as the different sources (natural gas, oil, biomass, etc.). The analysis has been done in order to provide a baseline at the European level on the current consumptions and future consumptions, with a particular interest in the future increase of cooling. A database was therefore created on the distribution of residential energy consumption linked to air conditioning among the various energy carriers (electricity, waste heat, gas, solid fossil fuels, liquid fossil fuels, and renewable sources) for each region in Europe. Subsequently, the energy profiles of various European cities representative of the different climates are analyzed in order to evaluate, in each European climatic region, which energy coverage can be provided by heat pumps in replacement of natural gas and solid and liquid fossil fuels for air conditioning of the buildings, also carrying out the environmental and economic assessments for this energy transition operation. This work aims to make an innovative contribution to the evaluation of the potential for introducing heat pump technology for decarbonization in the air conditioning of buildings in all climates of the different European regions.Keywords: heat pumps, heating, decarbonization, energy policies
Procedia PDF Downloads 12953924 Effects of a Bioactive Subfraction of Strobilanthes Crispus on the Tumour Growth, Body Weight and Haematological Parameters in 4T1-Induced Breast Cancer Model
Authors: Yusha'u Shu'aibu Baraya, Kah Keng Wong, Nik Soriani Yaacob
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Strobilanthes crispus (S. crispus), is a Malaysian herb locally known as ‘Pecah kaca’ or ‘Jin batu’ which have demonstrated potent anticancer effects in both in vitro and in vivo models. In particular, S. crispus subfraction (SCS) significantly reduced tumor growth in N-methyl-N-Nitrosourea-induced breast cancer rat model. However, there is paucity of information on the effects of SCS in breast cancer metastasis. Thus, in this study, the antimetastatic effects of SCS (100 mg/kg) was investigated following 30 days of treatment in 4T1-induced mammary tumor (n = 5) model. The response to treatment was assessed based on the outcome of the tumour growth, body weight and hematological parameters. The results demonstrated that tumor bearing mice treated with SCS (TM-S) had significant (p<0.05) reduction in the mean tumor number and tumor volume as well as tumor weight compared to the tumor bearing mice (TM), i.e. tumor untreated group. Also, there was no secondary tumor formation or tumor-associated lesions in the major organs of TM-S compared to the TM group. Similarly, comparable body weights were observed among the TM-S, normal (uninduced) mice treated with SCS and normal (untreated/control) mice (NM) groups compared to the TM group (p<0.05). Furthermore, SCS administration does not cause significant changes in the hematological parameters as compared to the NM group, which indicates no sign of anemia and toxicity related effects. In conclusion, SCS significantly inhibited the overall tumor growth and metastasis in 4T1-induced breast cancer mouse model suggesting its promising potentials as therapeutic agent for breast cancer treatment.Keywords: 4T1-cells, breast cancer, metastasis, Strobilanthes crispus
Procedia PDF Downloads 15153923 Analysis of the Lung Microbiome in Cystic Fibrosis Patients Using 16S Sequencing
Authors: Manasvi Pinnaka, Brianna Chrisman
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Cystic fibrosis patients often develop lung infections that range anywhere in severity from mild to life-threatening due to the presence of thick and sticky mucus that fills their airways. Since many of these infections are chronic, they not only affect a patient’s ability to breathe but also increase the chances of mortality by respiratory failure. With a publicly available dataset of DNA sequences from bacterial species in the lung microbiome of cystic fibrosis patients, the correlations between different microbial species in the lung and the extent of deterioration of lung function were investigated. 16S sequencing technologies were used to determine the microbiome composition of the samples in the dataset. For the statistical analyses, referencing helped distinguish between taxonomies, and the proportions of certain taxa relative to another were determined. It was found that the Fusobacterium, Actinomyces, and Leptotrichia microbial types all had a positive correlation with the FEV1 score, indicating the potential displacement of these species by pathogens as the disease progresses. However, the dominant pathogens themselves, including Pseudomonas aeruginosa and Staphylococcus aureus, did not have statistically significant negative correlations with the FEV1 score as described by past literature. Examining the lung microbiology of cystic fibrosis patients can help with the prediction of the current condition of lung function, with the potential to guide doctors when designing personalized treatment plans for patients.Keywords: bacterial infections, cystic fibrosis, lung microbiome, 16S sequencing
Procedia PDF Downloads 9953922 Attitude towards Doping of High-Performance Athletes in a Sports Institute of the City of Medellin, Colombia
Authors: Yuban Sebastian Cuartas-Agudelo, Sandra Marcela López-Hincapié, Vivianna Alexandra Garrido-Altamar, María de los Ángeles Rodríguez-Gázquez, Camilo Ruiz-Mejía, Lina María Martínez-Sánchez, Gloria Inés Martínez-Domínguez, Luis Eduardo Contreras, Felipe Eduardo Marino-Isaza
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Introduction: Doping is a prohibited practice in competitive sports with potential adverse effects; therefore, it is crucial to describe the attitudes of athletes towards this behavior and to determine which o these increase the susceptibility to carry out this practice. Objective: To determine the attitude of high-performance athletes towards doping in a sports institute in the city of Medellin, Colombia. Methods: We performed a cross-sectional study during 2016, with a sample taken to convenience consisting of athletes over 18 years old enrolled in a sports institute of the city of Medellin (Colombia). The athletes filled by themselves the Petroczi and Aidman questionnaire: Performance Enhancement Attitude Scale (PEAS) adapted to the Spanish language by Morente-Sánchez et al. This scale has 17 items with likert answer options, with a score ranging from 1 to 6, with a higher score indicating a stronger tendency towards doping practices. Results: 112 athletes were included with an average age of 21.6 years old, a 60% of them were male and the most frequent sports were karate 17%, judo 12.5% and athletics 9.8%. The average score of the questionnaire was 35.5 points of a 102 possible points. The lowest score was obtained in the following items: Is Doping necessary 1,4 and Doping isn’t cheating, everyone does it 1,5. Conclusion: In our population, there is a low tendency towards doping practices.Keywords: sports, doping in sports, athletic performance, attitude
Procedia PDF Downloads 23053921 Underdiagnosis of Supraclavicular Brachial Plexus Metastasis in the Shadow of Cervical Disc Herniation: Insights from a Lung Cancer Case Study
Authors: Eunhwa Jun
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This case report describes the misdiagnosis of a patient who presented with right arm pain as cervical disc herniation. The patient had several underlying conditions, including hypertension, diabetes mellitus, liver cirrhosis, a history of lung cancer with left lower lobe lobectomy, and adjuvant chemoradiotherapy. An external cervical spine MRI revealed central protruding discs at the C4-5-6-7 levels. Despite treatment with medication and epidural blocks, the patient's pain persisted. A C-RACZ procedure was planned, but the patient's pain had worsened before admission. Using ultrasound, a brachial plexus block was attempted, but the brachial plexus eluded clear visualization, hinting at underlying neurological complexities. Chest CT revealed a new, large soft tissue mass in the right supraclavicular region with adjacent right axillary lymphadenopathy, leading to the diagnosis of metastatic squamous cell carcinoma. Palliative radiation therapy and chemotherapy were initiated as part of the treatment plan, and the patient's pain score decreased to 3 out of 10 on the Numeric Rating Scale (NRS), revealing the pain was due to metastatic lung cancer.Keywords: supraclavicula brachial plexus metastasis, cervical disc herniation, brachial plexus block, metastatic lung cancer
Procedia PDF Downloads 4453920 The Application of Bayesian Heuristic for Scheduling in Real-Time Private Clouds
Authors: Sahar Sohrabi
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The emergence of Cloud data centers has revolutionized the IT industry. Private Clouds in specific provide Cloud services for certain group of customers/businesses. In a real-time private Cloud each task that is given to the system has a deadline that desirably should not be violated. Scheduling tasks in a real-time private CLoud determine the way available resources in the system are shared among incoming tasks. The aim of the scheduling policy is to optimize the system outcome which for a real-time private Cloud can include: energy consumption, deadline violation, execution time and the number of host switches. Different scheduling policies can be used for scheduling. Each lead to a sub-optimal outcome in a certain settings of the system. A Bayesian Scheduling strategy is proposed for scheduling to further improve the system outcome. The Bayesian strategy showed to outperform all selected policies. It also has the flexibility in dealing with complex pattern of incoming task and has the ability to adapt.Keywords: cloud computing, scheduling, real-time private cloud, bayesian
Procedia PDF Downloads 35953919 The Predictive Value of Extensor Grip Test for the Effectiveness of Treatment for Tennis Elbow: A Randomized Controlled Trial
Authors: Mohammad Javad Zehtab, S. Alireza Mirghasemi, Ali Majlesara, Parvin Tajik, Babak Siavashi
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Objective: There are different modalities proposed for tennis elbow treatment with few randomized trials comparing them. We designed a study to compare the effectiveness of five different modalities and determine the usefulness of recently proposed extensor grip test (EGT) in predicting the response to treatment. Methods: In a randomized controlled clinical trial 92 of 98 tennis elbow patients in Sina hospital of Tehran, Iran between 2006 and 2007 fulfill trial entry criteria, among these patients 56 (60.9%) had positive EGT result. Stratified on EGT result, patients allocated randomly to 5 treatment groups: Brace (B) group, physiotherapy (P), brace + physiotherapy (BP), injection (I) and injection + physiotherapy (IP). Results: Patients who had positive result of EGT had better response to treatments: less SOC (p = 0.06), less PFFQ and patients’ satisfaction scores (p < 0.001). Among the treatment IP was the most successful, then BP, P and B, respectively; injection was the worst treatment modality. Response to treatment was comparable in all groups between EGT positive and negative patients except bracing; in which positive EGT was correlated with a dramatic response to treatment. Conclusion: In all patients IP and then BP is recommended but in EGT negatives, bracing seems to be of no use. Injection alone is not recommended in either group.Keywords: tennis elbow, extensor grip test, physiotherapy, tennis elbow treatment
Procedia PDF Downloads 28453918 Dehydration of Residues from WTP for Application in Building Materials and Reuse of Water from the Waste Treatment: A Feasible Solution to Complete Treatment Systems
Authors: Marco Correa, Flavio Araujo, Paulo Scalize, Antonio Albuquerque
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The increasing reduction of the volumes of surface water sources which supply most municipalities, as well as the continued rise of demand for treated water, combined with the disposal of effluents from washing of decanters and filters of the water treatment plants, generates a continuous search for correct environmentally solutions to these problems. The effluents generated by the water treatment industry need to be suitably processed for return to the environment or re-use. This article shows an alternative for the dehydration of sludge from the water treatment plants (WTP) and eventual disposal of sludge drained. Using the simple design methodology, we present a case study for a drainage in tanks geotextile, full-scale, which involve five sludge drainage tanks from WTP of the Rio Verde City. Aiming to the reutilization the water drained from the sludge and enabling its reuse both at the beginning of the treatment process at the WTP and in less noble services as for watering the gardens of the local town hall. The sludge will be used to production of building materials.Keywords: re-use, residue, sustainable, water treatment plants, sludge
Procedia PDF Downloads 49053917 [Keynote] Implementation of Quality Control Procedures in Radiotherapy CT Simulator
Authors: B. Petrović, L. Rutonjski, M. Baucal, M. Teodorović, O. Čudić, B. Basarić
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Purpose/Objective: Radiotherapy treatment planning requires use of CT simulator, in order to acquire CT images. The overall performance of CT simulator determines the quality of radiotherapy treatment plan, and at the end, the outcome of treatment for every single patient. Therefore, it is strongly advised by international recommendations, to set up a quality control procedures for every machine involved in radiotherapy treatment planning process, including the CT scanner/ simulator. The overall process requires number of tests, which are used on daily, weekly, monthly or yearly basis, depending on the feature tested. Materials/Methods: Two phantoms were used: a dedicated phantom CIRS 062QA, and a QA phantom obtained with the CT simulator. The examined CT simulator was Siemens Somatom Definition as Open, dedicated for radiation therapy treatment planning. The CT simulator has a built in software, which enables fast and simple evaluation of CT QA parameters, using the phantom provided with the CT simulator. On the other hand, recommendations contain additional test, which were done with the CIRS phantom. Also, legislation on ionizing radiation protection requires CT testing in defined periods of time. Taking into account the requirements of law, built in tests of a CT simulator, and international recommendations, the intitutional QC programme for CT imulator is defined, and implemented. Results: The CT simulator parameters evaluated through the study were following: CT number accuracy, field uniformity, complete CT to ED conversion curve, spatial and contrast resolution, image noise, slice thickness, and patient table stability.The following limits are established and implemented: CT number accuracy limits are +/- 5 HU of the value at the comissioning. Field uniformity: +/- 10 HU in selected ROIs. Complete CT to ED curve for each tube voltage must comply with the curve obtained at comissioning, with deviations of not more than 5%. Spatial and contrast resultion tests must comply with the tests obtained at comissioning, otherwise machine requires service. Result of image noise test must fall within the limit of 20% difference of the base value. Slice thickness must meet manufacturer specifications, and patient stability with longitudinal transfer of loaded table must not differ of more than 2mm vertical deviation. Conclusion: The implemented QA tests gave overall basic understanding of CT simulator functionality and its clinical effectiveness in radiation treatment planning. The legal requirement to the clinic is to set up it’s own QA programme, with minimum testing, but it remains user’s decision whether additional testing, as recommended by international organizations, will be implemented, so to improve the overall quality of radiation treatment planning procedure, as the CT image quality used for radiation treatment planning, influences the delineation of a tumor and calculation accuracy of treatment planning system, and finally delivery of radiation treatment to a patient.Keywords: CT simulator, radiotherapy, quality control, QA programme
Procedia PDF Downloads 53353916 Clinical Signs of Neonatal Calves in Experimental Colisepticemia
Authors: Samad Lotfollahzadeh
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Escherichia coli (E.coli) is the most isolated bacteria from blood circulation of septicemic calves. Given the prevalence of septicemia in animals and its economic importance in veterinary practice, better understanding of changes in clinical signs following disease, may contribute to early detection of the disorder. The present study has been carried out to detect changes of clinical signs in induced sepsis in calves with E.coli. Colisepticemia has been induced in 10 twenty-day old healthy Holstein- Frisian calves with intravenous injection of 1.5 X 109 colony forming units (cfu) of O111: H8 strain of E.coli. Clinical signs including rectal temperature, heart rate, respiratory rate, shock, appetite, sucking reflex, feces consistency, general behavior, dehydration and standing ability were recorded in experimental calves during 24 hours after induction of colisepticemia. Blood culture was also carried out from calves four times during the experiment. ANOVA with repeated measure is used to see changes of calves’ clinical signs to experimental colisepticemia, and values of P≤ 0.05 was considered statistically significant. Mean values of rectal temperature and heart rate as well as median values of respiratory rate, appetite, suckling reflex, standing ability and feces consistency of experimental calves increased significantly during the study (P<0.05). In the present study, median value of shock score was not significantly increased in experimental calves (P> 0.05). The results of present study showed that total score of clinical signs in calves with experimental colisepticemia increased significantly, although the score of some clinical signs such as shock did not change significantly.Keywords: calves, clinical signs scoring, E. coli O111:H8, experimental colisepticemia
Procedia PDF Downloads 37653915 Temporal Change in Bonding Strength and Antimicrobial Effect of a Zirconia after Nonthermal Atmospheric Pressure Plasma Treatment
Authors: Chan Park, Sang-Won Park, Kwi-Dug Yun, Hyun-Pil Lim
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Purpose: Plasma treatment under various conditions has been studied to increase the bonding strength and surface sterilization of dental ceramic materials. We assessed the evolution of the shear bond strength (SBS) and antimicrobial effect of nonthermal atmospheric pressure plasma (NTAPP) treatment over time. Methods: Presintered zirconia specimens were manufactured as discs (diameter: 15 mm, height: 2 mm) after final sintering. The specimens then received a 30-min treatment with argon gas (Ar², 99.999%; 10 L/min) using an NTAPP device. Five post-treatment intervals were evaluated: control (no treatment), P0 (within 1 h), P1 (24 h), P2 (48 h), and P3 (72 h). This study investigated the surface characteristics, SBS of two different resin cement (RelyXTM U200 self-adhesive resin cement, Panavia F2.0 methacryloyloxydecyl dihydrogen phosphate (MDP)-based resin cement), and Streptococcus mutans biofilm formation. Results: The SBS of RelyXTM U200 increased significantly (p < 0.05) within 2 days following plasma treatment (P0, P1, P2). For Panavia F 2.0, a significant decrease (p < 0.05) was detected only in the group that had undergone cementation immediately after plasma treatment (P0). S. mutans adhesion decreased significantly (p < 0.05) within 2 days of plasma treatment (P0, P1, P2) compared to the control group. The P0 group displayed a lower biofilm thickness than the P1 and P2 groups (p < 0.05). Conclusions: After NTAPP treatment of zirconia, the effects on bonding strength and antimicrobial growth persist for a limited duration. The effect of NTAPP treatment on bonding strength depends on the resin cement.Keywords: NTAPP, SBS, antimicrobial effect, zirconia
Procedia PDF Downloads 24453914 Mechanical Properties of Aspen Wood of Structural Dimensions
Authors: Barbora Herdová, Rastislav Lagaňa
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The paper investigates the mechanical properties of European aspen (Populus tremula L.) as a potential replacement for load-bearing elements in historical structures. One of the main aims of the research has been the quantification of mechanical properties via destructive testing and the subsequent calculation of characteristic values of these properties. The research encompasses experimental testing of wood specimens for the determination of dynamic modulus of elasticity (MOEdyn), modulus of elasticity (MOE), modulus of rupture (MOR), and density. The results were analyzed and compared to established standards for structural timber. The results confirmed statistically significant dependence between MOR and MOEdyn. The correlation between the MOR and the dynamic MOEdyn enabled non-destructive strength grading using the Sylvatest Duo® system. The findings of this research contribute to the potential use of European aspen as a structural timber, which could have implications for the sustainable use of this abundant and renewable resource in the construction industry. They also show the usability of European aspen in the reconstruction of historical buildings.Keywords: populus tremula, MOE, MOR, sylvatest Duo®.
Procedia PDF Downloads 6453913 Anyword: A Digital Marketing Tool to Increase Productivity in Newly Launching Businesses
Authors: Jana Atteah, Wid Jan, Yara AlHibshi, Rahaf AlRougi
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Anyword is an AI copywriting tool that helps marketers create effective campaigns for specific audiences. It offers a wide range of templates for various platforms, brand voice guidelines, and valuable analytics insights. Anyword is used by top global companies and has been recognized as one of the "Fastest Growing Products" in the 2023 software awards. A recent study examined the utilization and impact of AI-powered writing tools, specifically focusing on the adoption of AI in writing pursuits and the use of the Anyword platform. The results indicate that a majority of respondents (52.17%) had not previously used Anyword, but those who had were generally satisfied with the platform. Notable productivity improvements were observed among 13% of the participants, while an additional 34.8% reported a slight increase in productivity. A majority (47.8%) maintained a neutral stance, suggesting that their productivity remained unaffected. Only a minimal percentage (4.3%) claimed that their productivity did not improve with the usage of Anyword AI. In terms of the quality of written content generated, the participants responded positively. Approximately 91% of participants gave Anyword AI a score of 5 or higher, with roughly 17% giving it a perfect score. A small percentage (approximately 9%) gave a low score between 0-2. The mode result was a score of 7, indicating a generally positive perception of the quality of content generated using Anyword AI. These findings suggest that AI can contribute to increased productivity and positively influence the quality of written content. Further research and exploration of AI tools in writing pursuits are warranted to fully understand their potential and limitations.Keywords: artificial intelligence, marketing platforms, productivity, user interface
Procedia PDF Downloads 6353912 Sustainability in Luxury Hotels: Between a Necessary Evolution and a Way of Differentiation
Authors: Katharina Schuck
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For a long time, luxury hotels devoted little effort to sustainability, and also scientists were fairly attracted to this subject. While some luxury hotels are now increasingly showing engagement in sustainability, the extent of their commitment varies greatly, which makes the whole industry quite intransparent when it comes to sustainable practices. In general, each hotel companyand each individual hotel can decide for themselves to what extent they commit to sustainability as long as there are no legally prescribed minimum requirements in the respective countries. Despite pleading and compelling calls from industry experts and representatives of relevant sustainability institutions, this is still reality – although climate change and environmental disasters as well as poor treatment of workers and the local population are also issues in progressive and hotel-dense European cities. This paper therefore deals with the question which sustainability activities (environmental and social) have been established by European luxury hotels so far and to what extent these activities are rather a way to differentiate in the market or are simply evaluated as part of a necessary adaptation of the luxury hotel industry. For this purpose, interviews were conducted with both industry experts and hotel representatives in order to obtain a diverse picture of the current status. The studyrevealed that a clear agenda is missing so far, which takes luxury hotels by the handand supports them in the process towards more sustainable hotel management. While a large part of the luxury hotels addressed have already established initiatives and activities regarding sustainability, they are extremely diverse, and range from recyclable toiletries use to comprehensive concepts for energy generation. The study's findings provide insights for both practitioners who seek to implement sustainability in a luxury hotel setting as well as offer an extension of the existing research base on sustainability in hospitality.Keywords: luxury hospitality, qualitative research methods, sustainability, sustainable hotels
Procedia PDF Downloads 11453911 Landfill Leachate and Settled Domestic Wastewater Co-Treatment Using Activated Carbon in Sequencing Batch Reactors
Authors: Amin Mojiri, Hamidi Abdul Aziz
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Leachate is created while water penetrates through the waste in a landfill, carrying some forms of pollutants. In literature, for treatment of wastewater and leachate, different ways of biological treatment were used. Sequencing batch reactor (SBR) is a kind of biological treatment. This study investigated the co-treatment of landfill leachate and domestic waste water by SBR and powdered activated carbon augmented (PAC) SBR process. The response surface methodology (RSM) and central composite design (CCD) were employed. The independent variables were aeration rate (L/min), contact time (h), and the ratio of leachate to wastewater mixture (%; v/v)). To perform an adequate analysis of the aerobic process, three dependent parameters, i.e. COD, color, and ammonia-nitrogen (NH3-N or NH4-N) were measured as responses. The findings of the study indicated that the PAC-SBR showed a higher performance in elimination of certain pollutants, in comparison with SBR. With the optimal conditions of aeration rate (0.6 L/min), leachate to waste water ratio (20%), and contact time (10.8 h) for the PAC-SBR, the removal efficiencies for color, NH3-N, and COD were 72.8%, 98.5%, and 65.2%, respectively.Keywords: co-treatment, landfill Leachate, wastewater, sequencing batch reactor, activate carbon
Procedia PDF Downloads 46653910 The Role of Cognitive Impairment in Asthma Self-Management Behaviors and Outcomes in Older Adults
Authors: Gali Moritz, Jacqueline H. Becker, Jyoti V. Ankam, Kimberly Arcoleo, Matthew Wysocki, Roee Holtzer, Juan Wisnivesky, Paula J. Busse, Alex D. Federman, Sunit P. Jariwala, Jonathan M. Feldman
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Objective: Cognitive impairment (CI), whose incidence is greater among ethnic/racial minorities, is a significant barrier to asthma self-management (SM) behaviors and outcomes in older adults. The aim of this study was to examine the relationships between CI, assessed using the Montreal Cognitive Assessment (MoCA), and asthma SM behaviors and outcomes in a sample of predominantly Black and Hispanic participants. Additionally, we evaluated whether using two different MoCA cutoff scores influenced the association between CI and study outcomes. Methods: Baseline cross-sectional data were extracted from a longitudinal study of older adults with asthma (N=165) age≥ 60 years and used for analysis. Cognition was assessed using the MoCA. Asthma control, asthma-related quality of life (QOL), inhaled corticosteroid (ICS) dosing, and ICS adherence were assessed using self-report. The inhaler technique was observed and rated. Results: Using established MoCA cutoff scores of 23 and 26 yielded 45% and 74% CI rates, respectively. CI, defined using the 23 cutoff score, was significantly associated with worse asthma control (p=.04) and worse ICS adherence (p=.01). With a cutoff score of 26, only asthma-related QOL was significantly associated with CI (p=.03). Race/ethnicity and education did not moderate the relationships between CI and asthma SM behaviors and outcomes. Conclusions: CI in older adults with asthma is associated with important clinical outcomes, but this relationship is influenced by the cutoff score used to define CI.Keywords: cognition, respiratory, elderly, testing, adherence, validity
Procedia PDF Downloads 8053909 Corporate Sustainability Practices in Asian Countries: Pattern of Disclosure and Impact on Financial Performance
Authors: Santi Gopal Maji, R. A. J. Syngkon
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The changing attitude of the corporate enterprises from maximizing economic benefit to corporate sustainability after the publication of Brundtland Report has attracted the interest of researchers to investigate the sustainability practices of firms and its impact on financial performance. To enrich the empirical literature in Asian context, this study examines the disclosure pattern of corporate sustainability and the influence of sustainability reporting on financial performance of firms from four Asian countries (Japan, South Korea, India and Indonesia) that are publishing sustainability report continuously from 2009 to 2016. The study has used content analysis technique based on Global Reporting Framework (3 and 3.1) reporting framework to compute the disclosure score of corporate sustainability and its components. While dichotomous coding system has been employed to compute overall quantitative disclosure score, a four-point scale has been used to access the quality of the disclosure. For analysing the disclosure pattern of corporate sustainability, box plot has been used. Further, Pearson chi-square test has been used to examine whether there is any difference in the proportion of disclosure between the countries. Finally, quantile regression model has been employed to examine the influence of corporate sustainability reporting on the difference locations of the conditional distribution of firm performance. The findings of the study indicate that Japan has occupied first position in terms of disclosure of sustainability information followed by South Korea and India. In case of Indonesia, the quality of disclosure score is considerably less as compared to other three countries. Further, the gap between the quality and quantity of disclosure score is comparatively less in Japan and South Korea as compared to India and Indonesia. The same is evident in respect of the components of sustainability. The results of quantile regression indicate that a positive impact of corporate sustainability becomes stronger at upper quantiles in case of Japan and South Korea. But the study fails to extricate any definite pattern on the impact of corporate sustainability disclosure on the financial performance of firms from Indonesia and India.Keywords: corporate sustainability, quality and quantity of disclosure, content analysis, quantile regression, Asian countries
Procedia PDF Downloads 19453908 Effects of Modified Low-Dye Taping on First Ray Mobility Test and Sprint Time
Authors: Yu-Ju Tsai, Ching-Chun Wang, Wen-Tzu Tang, Huei-Ming Chai
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A pronated foot is frequently associated with a hypermobile first ray, then developing further severe foot problems. Low-Dye taping with athletic tape has been widely used to restrict excessive first ray motion and re-build height of the medial longitudinal arch in general population with pronated foot. It is not the case, however, for sprinters since they feel too much restriction of foot motions. Currently, the kinesio tape, more elastic than the athletic tape, has been widely used to re-adjust joint positions. It was interesting whether modified low-Dye taping using kinesio tape was beneficial for altering first ray mobility and still giving enough arch support. The purpose of this study was to investigate the effect of modified low-Dye taping on first ray mobility test and 60-m sprint time for sprinters with pronated foot. The significance of this study provides new insight into a treatment alternative of modified low-Dye taping for sprinter with pronated foot. Ten young male sprinters, aged 20.8±1.6 years, with pronated foot were recruited for this study. The pronated foot was defined as the foot that the navicular drop test was greater than 1.0 cm. Three optic shutters were placed at the start, 30-m, and 60-m sites to record sprint time. All participants were asked to complete 3 trials of the 60-m dash with both taping and non-taping conditions in a random order. The low-Dye taping was applied using the method postulated by Ralph Dye in 1939 except the kinesio tape was used instead. All outcome variables were recorded for taping and non-taping conditions. Paired t-tests were used to analyze all outcome variables between 2 conditions. Although there were no statistically significant differences in dorsal and plantar mobility between taping and non-taping conditions, a statistical significance was found in a total range of motion (dorsiflexion plus plantarflexion angle) of the first ray when a modified low-Dye taping was applied (p < 0.05). Time to complete 60-m sprint was significantly increased with low-Dye taping (p < 0.05) while no significance was found for time to 30-m. it indicated that modified low-Dye taping changed maximum sprint speed of 60-m dash. Conclusively, modified low-Dye taping was capable of increasing first ray mobility and further altered maximum sprint speed.Keywords: first ray mobility, kinesio taping, pronated foot, sprint time
Procedia PDF Downloads 27753907 Effects of Exposure to Domestic Physical Violence on Children's Behavior: A Chinese Community-Based Sample
Authors: Cao Yuping, Li Longfei, Zhao Xingfu, Zhang Yalin
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Purpose: This study examined the effects of exposure to domestic physical violence (DPV) on children’s behavior in a community sample. Method: Ninety-three 12-16 year-old adolescents exposed to DPV were matched with 54 adolescents with no exposure to DPV based on age, gender, family composition and parental age and education level. Participation included assessment with the Childhood Trauma Questionnaire (CTQ-SF) and Child Behavior Checklist (CBCL) by the adolescents and their parents respectively. Results: CBCL total score and anxiety/depression, social interaction problems, attention problems, delinquency, aggression and externalizing scores were significantly higher in adolescents exposed to DPV than those in controls (all ps<0.05).The CBCL total score and scores of anxiety/depression, social interaction problems, attention problems, delinquency, aggression and externalizing behaviors of boys were significantly higher in the research group than in the controls (all ps<0.05). Delinquency scores in abused adolescents were significantly higher than in DPV witnessed (p<0.05), but no other scores of CBCL were significant different. Different subtypes of behavioral problems were associated with different types of abuse. Conclusions: DPV exposure is associated with adverse behaviors in children, especially among boys. Children witness DPV alone have similar behavioral scores as the abused children. We recommend that both abused and DPV witness adolescents in Chinese communities need treatment to mitigate the effects on maladjusted behaviors.Keywords: domestic violence, child, behavior, community, China
Procedia PDF Downloads 37253906 Cost-Benefit Analysis for the Optimization of Noise Abatement Treatments at the Workplace
Authors: Paolo Lenzuni
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Cost-effectiveness of noise abatement treatments at the workplace has not yet received adequate consideration. Furthermore, most of the published work is focused on productivity, despite the poor correlation of this quantity with noise levels. There is currently no tool to estimate the social benefit associated to a specific noise abatement treatment, and no comparison among different options is accordingly possible. In this paper, we present an algorithm which has been developed to predict the cost-effectiveness of any planned noise control treatment in a workplace. This algorithm is based the estimates of hearing threshold shifts included in ISO 1999, and on compensations that workers are entitled to once their work-related hearing impairments have been certified. The benefits of a noise abatement treatment are estimated by means of the lower compensation costs which are paid to the impaired workers. Although such benefits have no real meaning in strictly monetary terms, they allow a reliable comparison between different treatments, since actual social costs can be assumed to be proportional to compensation costs. The existing European legislation on occupational exposure to noise it mandates that the noise exposure level be reduced below the upper action limit (85 dBA). There is accordingly little or no motivation for employers to sustain the extra costs required to lower the noise exposure below the lower action limit (80 dBA). In order to make this goal more appealing for employers, the algorithm proposed in this work also includes an ad-hoc element that promotes actions which bring the noise exposure down below 80 dBA. The algorithm has a twofold potential: 1) it can be used as a quality index to promote cost-effective practices; 2) it can be added to the existing criteria used by workers’ compensation authorities to evaluate the cost-effectiveness of technical actions, and support dedicated employers.Keywords: cost-effectiveness, noise, occupational exposure, treatment
Procedia PDF Downloads 32253905 Study of a Complete Free Route Implementation in the European Airspace
Authors: Cesar A. Nava-Gaxiola, C. Barrado
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Harmonized with SESAR (Single European Sky Research) initiatives, a new concept related with airspace structures have been introduced in Europe, the Free Route Airspace. The key of free route is based in an airspace where users may freely plan a route between a defined entry and exit waypoint, with the possibility of routing via intermediate points, the free route flights remain subject to air traffic control (ATC) for the established separations. Free route airspace does not present anymore fixed airways to airspace users, as a consequence it brings a new paradigm for managing safe separations of aircrafts inside these airspace blocks . Nowadays, several European nations have been introduced the concept, some of them in a complete or partial stage, but finally offering limited benefits to airspace users for this condition. This research evaluates the future scenario of free route implementation across Europe, considering a unique airspace block configuration with a complete upper airspace with free route. The paper is centered in investigating the benefits for airspace users, and the study of possible increments of Air Traffic Controllers task loads with a full application. In this research, fast time simulations are carrying out for discovering how much flight time and distance aircrafts can save with an overall free route establishment. In the other side, the paper explains the evolution of conflicts derivate from possible separation losses between aircrafts in this new environment. Free route conflicts can emerges in any points of the airspace, requiring a great effort for solving it, in comparison with fixed airways, where conflicts normally were found by controllers in known waypoints, and they solved using the fixed network as reference. The airspace configuration modelled in this study take into account the actual navigation waypoints structure, moving into a future scenario, where new ones waypoints are added and new traffic flow patterns appears. In this sense, this research explores the advantages and unknown difficulties that a large scale application of free route concept can carry out in the European airspace.Keywords: ATC conflicts, efficiency, free route airspace, SESAR
Procedia PDF Downloads 18853904 Regulating User Experience Design, in the European Union, as a Way to Narrow Down the Gap Between Consumers’ Protection and Algorithms Employment
Authors: Prisecaru Diana-Sorina
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The paper will show that, while the EU legislator tackled a series of UX patterns used in e-commerce to induce the consumers take actions that they would not normally undertake, it leaves out many other aspects related to misuse or poor UX design that adversely affect EU consumers. Further, the paper proposes a reevaluation of the regulatory addressability of the issue and hand and focuses on explaining why a joint strategy, based on the interplay between provisions aiming consumer protection and personal data protection is the key approach to this matter.Keywords: algorithms, consumer protection, European Union, user experience design
Procedia PDF Downloads 13653903 Schooling Competent Citizens: A Normative Analysis of Citizenship Education Policy in Europe
Authors: M. Joris, O. Agirdag
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For over two decades, calls for citizenship education (CE) have been rising to the top of educational policy agendas in Europe. The main motive for the current treatment of CE as a key topic is a sense of crisis: social and political threats that go beyond the reach of nations and require action at the international and European level. On the one hand, this context has triggered abundant attention to the promotion of citizenship through education. On the other hand, the ubiquity of citizenship and education in policy language is paired with a self-evident manner of using the concepts: the more we call for citizenship in and through education, the less the concepts seem to be made explicit or be defined. Research and reflection on the normativity of the concepts of citizenship and CE in Europe are scarce. Departing from the idea that policies are always normative, this study, therefore, investigates the normativity of the current concepts of citizenship and education, in ’key’ European CE policy texts. The study consists of a content analysis of these texts, based on a normative framework developed around the different dimensions of citizenship as status, identity, virtues and agency. The framework also describes the purposes of education and its learning processes, content and practices, based on the assumption that good education always includes, next to qualification and socialisation, a purpose of emancipation: of helping young people become autonomous and independent subjects. The analysis shows how contemporary European citizenship is conceptualised around the dimension of competences. This focus on competences is also visible in the normative framing of education and its relationship to citizenship in the texts: CE should help young people learn how to become good citizens by acquiring a toolkit of competences, consisting of knowledge, skills, values and attitudes that can be predetermined, measured and evaluated. This ideal of citizenship-as-competence entails a focus on the educational purposes of socialisation and qualification. Current policy texts thus seem to leave out the educational purpose of emancipating young people, allowing them to take on citizenship as something to which they can determine their own relation and position. It is, however, this purpose of CE that seems increasingly important in our current context. Young people are stepping out of school and onto the streets by the thousands in Belgium and throughout Europe, protesting for more and better environmental policies. They are making use of existing modes of citizenship, exactly to indicate to policymakers how these are falling short and are claiming their right and entitlement to a future that established practices of politics are putting at risk. The importance of citizenship education might then lie, now more than ever, not in the fact that it would prepare young people for competent citizenship, but in offering them a possibility, an emancipatory experience of being able to do something new. It seems that this is what we might want to expect from the school if we want it to educate our truly future citizens.Keywords: citizenship education, normativity, policy, purposes of education
Procedia PDF Downloads 13453902 Determinants of Quality of Life in Patients with Atypical Prarkinsonian Syndromes: 1-Year Follow-Up Study
Authors: Tatjana Pekmezovic, Milica Jecmenica-Lukic, Igor Petrovic, Vladimir Kostic
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Background: A group of atypical parkinsonian syndromes (APS) includes a variety of rare neurodegenerative disorders characterized by reduced life expectancy, increasing disability, and considerable impact on health-related quality of life (HRQoL). Aim: In this study we wanted to answer two questions: a) which demographic and clinical factors are main contributors of HRQoL in our cohort of patients with APS, and b) how does quality of life of these patients change over 1-year follow-up period. Patients and Methods: We conducted a prospective cohort study in hospital settings. The initial study comprised all consecutive patients who were referred to the Department of Movement Disorders, Clinic of Neurology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade (Serbia), from January 31, 2000 to July 31, 2013, with the initial diagnoses of ‘Parkinson’s disease’, ‘parkinsonism’, ‘atypical parkinsonism’ and ‘parkinsonism plus’ during the first 8 months from the appearance of first symptom(s). The patients were afterwards regularly followed in 4-6 month intervals and eventually the diagnoses were established for 46 patients fulfilling the criteria for clinically probable progressive supranuclear palsy (PSP) and 36 patients for probable multiple system atrophy (MSA). The health-related quality of life was assessed by using the SF-36 questionnaire (Serbian translation). Hierarchical multiple regression analysis was conducted to identify predictors of composite scores of SF-36. The importance of changes in quality of life scores of patients with APS between baseline and follow-up time-point were quantified using Wilcoxon Signed Ranks Test. The magnitude of any differences for the quality of life changes was calculated as an effect size (ES). Results: The final models of hierarchical regression analysis showed that apathy measured by the Apathy evaluation scale (AES) score accounted for 59% of the variance in the Physical Health Composite Score of SF-36 and 14% of the variance in the Mental Health Composite Score of SF-36 (p<0.01). The changes in HRQoL were assessed in 52 patients with APS who completed 1-year follow-up period. The analysis of magnitude for changes in HRQoL during one-year follow-up period have shown sustained medium ES (0.50-0.79) for both Physical and Mental health composite scores, total quality of life as well as for the Physical Health, Vitality, Role Emotional and Social Functioning. Conclusion: This study provides insight into new potential predictors of HRQoL and its changes over time in patients with APS. Additionally, identification of both prognostic markers of a poor HRQoL and magnitude of its changes should be considered when developing comprehensive treatment-related strategies and health care programs aimed at improving HRQoL and well-being in patients with APS.Keywords: atypical parkinsonian syndromes, follow-up study, quality of life, APS
Procedia PDF Downloads 30553901 Gender Specific Differences in Clinical Outcomes of Knee Osteoarthritis Treated with Micro-Fragmented Adipose Tissue
Authors: Tiffanie-Marie Borg, Yasmin Zeinolabediny, Nima Heidari, Ali Noorani, Mark Slevin, Angel Cullen, Stefano Olgiati, Alberto Zerbi, Alessandro Danovi, Adrian Wilson
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Knee Osteoarthritis (OA) is a critical cause of disability globally. In recent years, there has been growing interest in non-invasive treatments, such as intra-articular injection of micro-fragmented fat (MFAT), showing great potential in treating OA. Mesenchymal stem cells (MSCs), originating from pericytes of micro-vessels in MFAT, can differentiate into mesenchymal lineage cells such as cartilage, osteocytes, adipocytes, and osteoblasts. Secretion of growth factor and cytokines from MSCs have the capability to inhibit T cell growth, reduced pain and inflammation, and create a micro-environment that through paracrine signaling, can promote joint repair and cartilage regeneration. Here we have shown, for the first time, data supporting the hypothesis that women respond better in terms of improvements in pain and function to MFAT injection compared to men. Historically, women have been underrepresented in studies, and studies with both sexes regularly fail to analyse the results by sex. To mitigate this bias and quantify it, we describe a technique using reproducible statistical analysis and replicable results with Open Access statistical software R to calculate the magnitude of this difference. Genetic, hormonal, environmental, and age factors play a role in our observed difference between the sexes. This observational, intention-to-treat study included the complete sample of 456 patients who agreed to be scored for pain (visual analogue scale (VAS)) and function (Oxford knee score (OKS)) at baseline regardless of subsequent changes to adherence or status during follow-up. We report that a significantly larger number of women responded to treatment than men: [90% vs. 60% change in VAS scores with 87% vs. 65% change in OKS scores, respectively]. Women overall had a stronger positive response to treatment with reduced pain and improved mobility and function. Pre-injection, our cohort of women were in more pain with worse joint function which is quite common to see in orthopaedics. However, during the 2-year follow-up, they consistently maintained a lower incidence of discomfort with superior joint function. This data clearly identifies a clear need for further studies to identify the cell and molecular biological and other basis for these differences and be able to utilize this information for stratification in order to improve outcome for both women and men.Keywords: gender differences, micro-fragmented adipose tissue, knee osteoarthritis, stem cells
Procedia PDF Downloads 18153900 Challenges in Curriculum Development in Eastern European Countries: A Case Study of Georgia and Ukraine
Authors: Revaz Tabatadze
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This research aims to describe and analyze the intricacies of curriculum development within the broader context of general education reforms undertaken in Eastern European Countries. Importantly, this study is the first of its kind, examining Georgian and Ukrainian National Curriculum documents locally and internationally. The significance of this research lies in its potential to guide the Ministry of Education and Science of the mentioned countries in revising existing curriculum documents to address contemporary challenges in general education. The findings will not only benefit post-Soviet countries but also offer insights for nations facing curriculum development and effectiveness issues. By examining the peculiarities of curriculum development amid globalization, this research aims to contribute to overcoming educational challenges at both local and international levels. This study defines key concepts related to curriculum, distinguishing between intended, implemented, and attained curricula. It also explores the historical context of curriculum development in Georgia and Ukraine from 1991 to 2021, highlighting changes in teacher standards and teacher certification examinations. The literature review section emphasizes the importance of curriculum development as a complex and evolving process, especially in the context of globalization. It underscores the need for a curriculum that fosters critical thinking, problem-solving, and collaboration skills in students. In summary, this research offers a comprehensive examination of curriculum development in Georgia and Ukraine, shedding light on the challenges and opportunities in the age of globalization, with potential implications for educational systems worldwide.Keywords: curriculum development, general education reforms, eastern European countries, globalization in education
Procedia PDF Downloads 6453899 Analysis of Veterinary Drug Residues and Pesticide Residues in Beehive Products
Authors: Alba Luna Jimenez, Maria Dolores Hernando
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The administration of veterinary treatments at higher doses than the recommended Varroa mite control in beehive matrices has the potential to generate residues in the honeybee colony and in the derived products for consumption. Honeybee colonies can also be indirectly exposed to residues of plant protection products when foraging in crops, wildflowers near the crops, or in urban gardens just after spraying. The study evaluates the presence of both types of residues, veterinary treatments, and pesticides in beeswax, bee bread, and honey. The study was carried out in apiaries located in agricultural zones and forest areas in Andalusia, Spain. Up to nineteen residues were identified above LOQ using gas chromatography-triple quadrupole-mass spectrometry analysis (GC-MS/MS). Samples were extracted by a modified QuEChERs method. Chlorfenvinphos was detected in beeswax and bee bread despite its use is not authorized for Varroa mite control. Residues of fluvalinate-tau, authorized as veterinary treatment, were detected in most of the samples of beeswax and bee bread, presumably due to overdose or also to its potential for accumulation associated with its marked liposolubility. Residues of plant protection products were also detected in samples of beeswax and bee bread. Pesticide residues were detected above the LOQ that was established at 5 µg.kg⁻¹, which is the minimum concentration that can be quantified with acceptable accuracy and precision, as described in the European guidelines for pesticide residue analysis SANTE/11945/2015. No residues of phytosanitary treatments used in agriculture were detected in honey.Keywords: honeybee colony, mass spectrometry analysis, pesticide residues, Varroa destructor, veterinary treatment
Procedia PDF Downloads 16153898 A Study on Energy Efficiency of Vertical Water Treatment System with DC Power Supply
Authors: Young-Kwan Choi, Gang-Wook Shin, Sung-Taek Hong
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Water supply system consumes large amount of power load during water treatment and transportation of purified water. Many energy conserving high efficiency materials such as DC motor and LED light have recently been introduced to water supply system for energy conservation. This paper performed empirical analysis on BLDC, AC motors, and comparatively analyzed the change in power according to DC power supply ratio in order to conserve energy of a next-generation water treatment system called vertical water treatment system. In addition, a DC distribution system linked with photovoltaic generation was simulated to analyze the energy conserving effect of DC load.Keywords: vertical water treatment system, DC power supply, energy efficiency, BLDC
Procedia PDF Downloads 50353897 Optimizing the Location of Parking Areas Adapted for Dangerous Goods in the European Road Transport Network
Authors: María Dolores Caro, Eugenio M. Fedriani, Ángel F. Tenorio
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The transportation of dangerous goods by lorries throughout Europe must be done by using the roads conforming the European Road Transport Network. In this network, there are several parking areas where lorry drivers can park to rest according to the regulations. According to the "European Agreement concerning the International Carriage of Dangerous Goods by Road", parking areas where lorries transporting dangerous goods can park to rest, must follow several security stipulations to keep safe the rest of road users. At this respect, these lorries must be parked in adapted areas with strict and permanent surveillance measures. Moreover, drivers must satisfy several restrictions about resting and driving time. Under these facts, one may expect that there exist enough parking areas for the transport of this type of goods in order to obey the regulations prescribed by the European Union and its member countries. However, the already-existing parking areas are not sufficient to cover all the stops required by drivers transporting dangerous goods. Our main goal is, starting from the already-existing parking areas and the loading-and-unloading location, to provide an optimal answer to the following question: how many additional parking areas must be built and where must they be located to assure that lorry drivers can transport dangerous goods following all the stipulations about security and safety for their stops? The sense of the word “optimal” is due to the fact that we give a global solution for the location of parking areas throughout the whole European Road Transport Network, adjusting the number of additional areas to be as lower as possible. To do so, we have modeled the problem using graph theory since we are working with a road network. As nodes, we have considered the locations of each already-existing parking area, each loading-and-unloading area each road bifurcation. Each road connecting two nodes is considered as an edge in the graph whose weight corresponds to the distance between both nodes in the edge. By applying a new efficient algorithm, we have found the additional nodes for the network representing the new parking areas adapted for dangerous goods, under the fact that the distance between two parking areas must be less than or equal to 400 km.Keywords: trans-european transport network, dangerous goods, parking areas, graph-based modeling
Procedia PDF Downloads 28053896 Application of Discrete-Event Simulation in Health Technology Assessment: A Cost-Effectiveness Analysis of Alzheimer’s Disease Treatment Using Real-World Evidence in Thailand
Authors: Khachen Kongpakwattana, Nathorn Chaiyakunapruk
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Background: Decision-analytic models for Alzheimer’s disease (AD) have been advanced to discrete-event simulation (DES), in which individual-level modelling of disease progression across continuous severity spectra and incorporation of key parameters such as treatment persistence into the model become feasible. This study aimed to apply the DES to perform a cost-effectiveness analysis of treatment for AD in Thailand. Methods: A dataset of Thai patients with AD, representing unique demographic and clinical characteristics, was bootstrapped to generate a baseline cohort of patients. Each patient was cloned and assigned to donepezil, galantamine, rivastigmine, memantine or no treatment. Throughout the simulation period, the model randomly assigned each patient to discrete events including hospital visits, treatment discontinuation and death. Correlated changes in cognitive and behavioral status over time were developed using patient-level data. Treatment effects were obtained from the most recent network meta-analysis. Treatment persistence, mortality and predictive equations for functional status, costs (Thai baht (THB) in 2017) and quality-adjusted life year (QALY) were derived from country-specific real-world data. The time horizon was 10 years, with a discount rate of 3% per annum. Cost-effectiveness was evaluated based on the willingness-to-pay (WTP) threshold of 160,000 THB/QALY gained (4,994 US$/QALY gained) in Thailand. Results: Under a societal perspective, only was the prescription of donepezil to AD patients with all disease-severity levels found to be cost-effective. Compared to untreated patients, although the patients receiving donepezil incurred a discounted additional costs of 2,161 THB, they experienced a discounted gain in QALY of 0.021, resulting in an incremental cost-effectiveness ratio (ICER) of 138,524 THB/QALY (4,062 US$/QALY). Besides, providing early treatment with donepezil to mild AD patients further reduced the ICER to 61,652 THB/QALY (1,808 US$/QALY). However, the dominance of donepezil appeared to wane when delayed treatment was given to a subgroup of moderate and severe AD patients [ICER: 284,388 THB/QALY (8,340 US$/QALY)]. Introduction of a treatment stopping rule when the Mini-Mental State Exam (MMSE) score goes below 10 to a mild AD cohort did not deteriorate the cost-effectiveness of donepezil at the current treatment persistence level. On the other hand, none of the AD medications was cost-effective when being considered under a healthcare perspective. Conclusions: The DES greatly enhances real-world representativeness of decision-analytic models for AD. Under a societal perspective, treatment with donepezil improves patient’s quality of life and is considered cost-effective when used to treat AD patients with all disease-severity levels in Thailand. The optimal treatment benefits are observed when donepezil is prescribed since the early course of AD. With healthcare budget constraints in Thailand, the implementation of donepezil coverage may be most likely possible when being considered starting with mild AD patients, along with the stopping rule introduced.Keywords: Alzheimer's disease, cost-effectiveness analysis, discrete event simulation, health technology assessment
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