Search results for: Greek public hospital sector

Authors: Chin Ku, Han liang Lin

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The purpose of this study is to visualize how the rule related to urban design influences the building form by 3D modeling software CityEngine. In order to make the goal of urban design clearly connect to urban form, urban planner or designer should understand how the rule affects the form, especially the building form. In Taiwan, the rule pertained to urban design includes traditional zoning, urban design review and building codes. However, zoning cannot precisely expect the outcome of building form and lack of thinking about public realm and 3D form. In addition to that, urban design review is based on case by case, do not have a comprehensive regulation plan and the building code is just for general regulation. Therefore, rule cannot make the urban form reach the vision or goal of the urban design. Consequently, another kind of zoning called Form-based code (FBC) has arisen. This study uses the component of FBC which pertained to urban fabric such as street width, block and plot size, etc., to be the variants of building form, and find out the relationship between the rule and building form. There are three stages of this research, it will start from a field survey of Taichung City in Taiwan to induce the rule-building form relationship by using cluster analysis and descriptive Statistics. Second, visualize the relationship through the parameterized and codified process in CityEngine which is the procedural modeling, and can analyze, monitor and visualize the 3D world. Last, compare the CityEngine result with real world to examine how extent do this model represent the real world appearance.

Keywords: 3D visualization, CityEngine, form-based code, urban form

Procedia PDF Downloads 550

Authors: Kwaku Damoah

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This paper presents a methodology and software application (App) designed to empower users in accessing, retrieving, and comparatively exploring data within the hierarchical network framework of the Government Finance Statistics (GFS) system. It explores the ease of navigating the GFS system and identifies the gaps filled by the new methodology and App. The GFS, embodies a complex Hierarchical Network Classification (HNC) structure, encapsulating institutional units, revenues, expenses, assets, liabilities, and economic activities. Navigating this structure demands specialized knowledge, experience, and skill, posing a significant challenge for effective analytics and fiscal policy decision-making. Many professionals encounter difficulties deciphering these classifications, hindering confident utilization of the system. This accessibility barrier obstructs a vast number of professionals, students, policymakers, and the public from leveraging the abundant data and information within the GFS. Leveraging R programming language, Data Science Analytics and Machine Learning, an efficient methodology enabling users to access, navigate, and conduct exploratory comparisons was developed. The machine learning Fiscal Analytics App (FLOWZZ) democratizes access to advanced analytics through its user-friendly interface, breaking down expertise barriers.

Keywords: data science, data wrangling, drilldown analytics, government finance statistics, hierarchical network classification, machine learning, web application.

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Authors: Kemka Ihemelandu, Chukwuemeka Ihemelandu

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Melanoma remains a public health crisis, with incidence rates increasing rapidly in the past decades. Improving diagnostic accuracy to decrease misdiagnosis using Artificial intelligence (AI) continues to be documented. Unfortunately, unintended racially biased outcomes, a product of lack of diversity in the dataset used, with a noted class imbalance favoring lighter vs. darker skin tone, have increasingly been recognized as a problem.Resulting in noted limitations of the accuracy of the Convolutional neural network (CNN)models. CNN models are prone to biased output due to biases in the dataset used to train them. Our aim in this study was the optimization of convolutional neural network algorithms to mitigate bias in the automated diagnosis of melanoma. We hypothesized that our proposed training algorithms based on a data augmentation method to optimize the diagnostic accuracy of a CNN classifier by generating new training samples from the original ones will reduce bias in the automated diagnosis of melanoma. We applied geometric transformation, including; rotations, translations, scale change, flipping, and shearing. Resulting in a CNN model that provided a modifiedinput data making for a model that could learn subtle racial features. Optimal selection of the momentum and batch hyperparameter increased our model accuracy. We show that our augmented model reduces bias while maintaining accuracy in the automated diagnosis of melanoma.

Keywords: bias, augmentation, melanoma, convolutional neural network

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Authors: Aghasadeghi MR., Bahramali G., Sadat SM., Sadeghi SA., Yousefi M., Khodaei K., Ghorbani M., Sadat Larijani M.

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Background:The emerging COVID-19 pandemic is a serious concernfor the public health worldwide. Despite the many mutations in the virus genome, it is important to find an effective vaccine against viral mutations. Therefore, in current study, we aimed at immunoinformatic evaluation of the virus proteins immunogenicity to design a preventive vaccine candidate, which could elicit humoral and cellular immune responses as well. Methods:Three antigenic regions are included;Spike, Membrane, and Nucleocapsid amino acid sequences were obtained, and possible fusion proteins were assessed andcompared by immunogenicity, structural features, and population coverage. The best fusion protein was also evaluated for MHC-I and MHC-II T-cell epitopes and the linear and conformational B-cell epitopes. Results: Among the four predicted models, the truncated Spike protein in fusion with M and N proteins is composed of 24 highly immunogenic human MHC class I and 29 MHC class II, along with 14 B-cell linear and 61 discontinues epitopes. Also, the selected protein has high antigenicity and acceptable population coverage of 82.95% in Iran and 92.51% in Europe. Conclusion: The data indicate that the truncated Spike-M-N SARS-CoV-2form which could be potential targets of neutralizing antibodies. The protein also has the ability to stimulate humoral and cellular immunity. The in silico study provided the fusion protein as a potential preventive vaccine candidate for further in vivo evaluation.

Keywords: SARS-CoV-2, immunoinformatic, protein, vaccine

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Authors: Oluwole Victor Falobi, Lawrence Olusola Ige

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The cardinal drawing force of this study is to examine the influence of audio-visual resources in teaching business subjects in selected secondary schools in IfakoIjaiye Local Government Area of Lagos State, Nigeria. A descriptive survey research design was employed for the study. By using a quantitative research approach and a sample size of 120 students were randomly selected from four public schools. Three research questions with one hypothesis guided the study. Data collected were analysed using frequency, the mean and standard deviation for the research questions, and Pearson Product Moment Correlation PPMC were used to analysed the inferential statistic. Findings from the study revealed that the Influence of audio-visual resources in teaching business subjects in selected secondary schools in IfakoIjaiye Local Government Area of Lagos State is low. It further revealed data the knowledge of teachers on the use of audio-visual resources is high in Ifako Local Government Area. It was recommended that government should create a timely monitoring system in other to check secondary school laboratories and classrooms to replace outdated facilities and also purchase needed facilities for effective teaching and learning to take place.

Keywords: audio-visual resources, business subjects, school, teaching

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Authors: Irfan Khairi

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It is arguable that today's social media has dramatically redefined human contact, and chiefly because the platforms enable communication opportunities unprecedented. Without question, billions of individuals globally engage in the media, a reality by no means lost on businesses and social entrepreneurs desirous of generating interest in a cause, movement, or other social effort. If, however, the opportunities are immense, so too is the competition. Private persons and entrepreneurial concerns alike virtually saturate the popular sites of Facebook, Twitter, and Instagram, and most are intent on capturing as much external interest as possible. At the same time, however, the social entrepreneur possesses an advantage over the individual concerned only the social aspects of the sites, as they express interests in, and measures applicable to, important causes of which the public at large may be unaware. There is, unfortunately, no single means of assuring success in using the media outlets to generate interest. Nonetheless, a general awareness of how social media sites function, as well as the psychological elements relevant to the functioning, is necessary. It is as important to comprehend basic realities of the platforms and approaches that fail as it is to develop strategy, for the latter relies on knowledge of the former. This awareness in place, the social entrepreneur is then better enabled to determine strategy, in terms of which sites to focus upon and how to most effectively convey their message. What is required is familiarity with the online communities, with attention to the specific advantages each provides. Ultimately, today's social entrepreneur may establish a highly effective platform of promotion and engagement, provided they fully comprehend the social investment necessary for success.

Keywords: social media, marketing, e-commerce, internet business

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Authors: Ofosuhene O. Apenteng, Noor Azina Ismail

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The human immunodeficiency virus (HIV) that causes acquired immune deficiency syndrome (AIDS) remains a global cause of morbidity and mortality. It has caused panic since its emergence. Relationships between migration and HIV/AIDS have become complex. In the absence of prospectively designed studies, dynamic mathematical models that take into account the migration movement which will give very useful information. We have explored the utility of mathematical models in understanding transmission dynamics of HIV and AIDS and in assessing the magnitude of how migration has impact on the disease. The model was calibrated to HIV and AIDS incidence data from Malaysia Ministry of Health from the period of 1986 to 2011 using Bayesian analysis with combination of Markov chain Monte Carlo method (MCMC) approach to estimate the model parameters. From the estimated parameters, the estimated basic reproduction number was 22.5812. The rate at which the susceptible individual moved to HIV compartment has the highest sensitivity value which is more significant as compared to the remaining parameters. Thus, the disease becomes unstable. This is a big concern and not good indicator from the public health point of view since the aim is to stabilize the epidemic at the disease-free equilibrium. However, these results suggest that the government as a policy maker should make further efforts to curb illegal activities performed by migrants. It is shown that our models reflect considerably the dynamic behavior of the HIV/AIDS epidemic in Malaysia and eventually could be used strategically for other countries.

Keywords: epidemic model, reproduction number, HIV, MCMC, parameter estimation

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Authors: Shadi Fathi, Moura Mehravar, Mujib Rahman

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Over the years,increased demands on railways, the emergence of high-speed trains and heavy axle loads, ageing, and deterioration of the existing tracks, is imposing costly maintenance actions on the railway sector. The need for developing a fast andcost-efficient non-destructive assessment method for the structural evaluation of railway tracksis therefore critically important. The layer modulus is the main parameter used in the structural design and evaluation of the railway track substructure (foundation). Among many recently developed NDTs, Falling Weight Deflectometer (FWD) test, widely used in pavement evaluation, has shown promising results for railway track substructure monitoring. The surface deflection data collected by FWD are used to estimate the modulus of substructure layers through the back-analysis technique. Although there are different commerciallyavailableback-analysis programs are used for pavement applications, there are onlya limited number of research-based techniques have been so far developed for railway track evaluation. In this paper, the suitability, accuracy, and reliability of the BAKFAAsoftware are investigated. The main rationale for selecting BAKFAA as it has a relatively straightforward user interfacethat is freely available and widely used in highway and airport pavement evaluation. As part of the study, a finite element (FE) model of a railway track section near Leominsterstation, Herefordshire, UK subjected to the FWD test, was developed and validated against available field data. Then, a virtual experimental database (including 218 sets of FWD testing data) was generated using theFE model and employed as the measured database for the BAKFAA software. This database was generated considering various layers’ moduli for each layer of track substructure over a predefined range. The BAKFAA predictions were compared against the cone penetration test (CPT) data (available from literature; conducted near to Leominster station same section as the FWD was performed). The results reveal that BAKFAA overestimatesthe layers’ moduli of each substructure layer. To adjust the BAKFA with the CPT data, this study introduces a correlation model to make the BAKFAA applicable in railway applications.

Keywords: back-analysis, bakfaa, railway track substructure, falling weight deflectometer (FWD), cone penetration test (CPT)

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Authors: Alexander G. Yushchenko

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From a multi-science point of view, we analyze threats to security resulting from globalization of international information space and information and communication aggression of Russia. A definition of Ruschism is formulated as an ideology supporting aggressive actions of modern Russia against the Euro-Atlantic community. Stages of the hybrid war Russia is leading against Ukraine are described, including the elements of subversive activity of the special services, the activation of the military phase and the gradual shift of the focus of confrontation to the realm of information and communication technologies. We reveal an emergence of a threat for democratic states resulting from the destabilizing impact of a target state’s mass media and social networks being exploited by Russian secret services under freedom-of-speech disguise. Thus, we underline the vulnerability of cyber- and information security of the network society in regard of hybrid war. We propose to define the latter a synergetic war. Our analysis is supported with a long-term qualitative monitoring of representation of top state officials on popular TV channels and Facebook. From the memetics point of view, we have detected a destructive psycho-information technology used by the Kremlin, a kind of information catastrophe, the essence of which is explained in detail. In the conclusion, a comprehensive plan for information protection of the public consciousness and mentality of Euro-Atlantic citizens from the aggression of the enemy is proposed.

Keywords: cyber and information security, hybrid war, psycho-information technology, synergetic war, Ruschism

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Authors: Mohammad U. A. Khan, Md. D. Hossain

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Background: Department of Physiology finds difficulty in managing ‘subjects’ in practical procedure. To avoid this difficulty fellow examinees of other group may be used as subjects. Objective: To find out the merits and demerits of using fellow examinees as subjects in the practical procedure. Method: This cross-sectional descriptive study was conducted in the Department of Physiology, Noakhali Medical College, Bangladesh during May-June’14. Forty-two 1st year undergraduate medical students from a selected public medical college of Bangladesh were enrolled for the study purposively. Consent of students and authority was taken. Eighteen of them were selected as subjects and designated as subject-examinees. Other fellow examinees (non-subject) examined their blood pressure and pulse as part of ‘observed structured practical examination’ (OSPE). The opinion of all examinees regarding the merits and demerits of using fellow examinee as subjects in the practical procedure was recorded. Result: Examinees stated that they could perform their practical procedure without nervousness (24/42, 57.14%), accurately and comfortably (14/42, 33.33%) and subjects were made available without wasting time (2/42, 4.76%). Nineteen students (45.24%) found no disadvantage and 2 (4.76%) felt embracing when the subject was of opposite sex. The subject-examinees narrated that they could learn from the errors done by their fellow examinee (11/18, 61.1%). 75% non-subject examinees expressed their willingness to be subject so that they can learn from their fellows’ error. Conclusion: Using fellow examinees as subjects is beneficial for both the non-subject and subject examinees. Funding sources: Navana, Beximco, Unihealth, Square & Acme Pharma, Bangladesh Ltd.

Keywords: physiology, teaching, practical, OSPE

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Authors: Zhou Congling

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The integration of private tutoring has emerged as an indispensable facet in the acquisition of language proficiency beyond formal educational settings. Notably, there has been a discernible surge in the demand for private English tutoring, specifically geared towards the preparation for internationally recognized gatekeeping examinations, such as IELTS, TOEFL, GMAT, and GRE. This trajectory has engendered an escalating need for English Language Teaching Assistants (ELTAs) operating within the realm of Private Tutoring Schools (PTSs). The objective of this study is to unravel the intricate process by which these ELTAs formulate their professional identities in the nascent stages of their careers as English educators, as well as to delineate their perceptions regarding their professional trajectories. The construct of language teacher identity is inherently multifaceted, shaped by an amalgamation of individual, societal, and cultural determinants, exerting a profound influence on how language educators navigate their professional responsibilities. This investigation seeks to scrutinize the experiential and influential factors that mold the identities of ELTAs in PTSs, particularly post the culmination of their language-oriented academic programs. Employing a qualitative narrative inquiry approach, this study aims to delve into the nuanced understanding of how ELTAs conceptualize their professional identities and envision their future roles. The research methodology involves purposeful sampling and the conduct of in-depth, semi-structured interviews with ten participants. Data analysis will be conducted utilizing Barkhuizen’s Short Story Analysis, a method designed to explore a three-dimensional narrative space, elucidating the intricate interplay of personal experiences and societal contexts in shaping the identities of ELTAs. The anticipated outcomes of this study are poised to contribute substantively to a holistic comprehension of ELTA identity formation, holding practical implications for diverse stakeholders within the private tutoring sector. This research endeavors to furnish insights into strategies for the retention of ELTAs and the enhancement of overall service quality within PTSs.

Keywords: China, English language teacher, narrative inquiry, private tutoring school, teacher identity

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Authors: Recep Kesli, Huseyin Bilgin, Yasar Unlu, Gokhan Gungor

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Aim: The aim of this study was to compare diagnostic values of two different molecular-based tests (GenoType® HelicoDR ve Seeplex® H. pylori-ClaR- ACE Detection) in detection presence of the H. pylori from gastric biopsy specimens. In addition to this also was aimed to determine resistance ratios of H. pylori strains against to clarytromycine and quinolone isolated from gastric biopsy material cultures by using both the genotypic (GenoType® HelicoDR, Seeplex ® H. pylori -ClaR- ACE Detection) and phenotypic (gradient strip, E-test) methods. Material and methods: A total of 266 patients who admitted to Konya Education and Research Hospital Department of Gastroenterology with dyspeptic complaints, between January 2011-June 2013, were included in the study. Microbiological and histopathological examinations of biopsy specimens taken from antrum and corpus regions were performed. The presence of H. pylori in all the biopsy samples was investigated by five differnt dignostic methods together: culture (C) (Portagerm pylori-PORT PYL, Pylori agar-PYL, GENbox microaer, bioMerieux, France), histology (H) (Giemsa, Hematoxylin and Eosin staining), rapid urease test (RUT) (CLOtest, Cimberly-Clark, USA), and two different molecular tests; GenoType® HelicoDR, Hain, Germany, based on DNA strip assay, and Seeplex ® H. pylori -ClaR- ACE Detection, Seegene, South Korea, based on multiplex PCR. Antimicrobial resistance of H. pylori isolates against clarithromycin and levofloxacin was determined by GenoType® HelicoDR, Seeplex ® H. pylori -ClaR- ACE Detection, and gradient strip (E-test, bioMerieux, France) methods. Culture positivity alone or positivities of both histology and RUT together was accepted as the gold standard for H. pylori positivity. Sensitivity and specificity rates of two molecular methods used in the study were calculated by taking the two gold standards previously mentioned. Results: A total of 266 patients between 16-83 years old who 144 (54.1 %) were female, 122 (45.9 %) were male were included in the study. 144 patients were found as culture positive, and 157 were H and RUT were positive together. 179 patients were found as positive with GenoType® HelicoDR and Seeplex ® H. pylori -ClaR- ACE Detection together. Sensitivity and specificity rates of studied five different methods were found as follows: C were 80.9 % and 84.4 %, H + RUT were 88.2 % and 75.4 %, GenoType® HelicoDR were 100 % and 71.3 %, and Seeplex ® H. pylori -ClaR- ACE Detection were, 100 % and 71.3 %. A strong correlation was found between C and H+RUT, C and GenoType® HelicoDR, and C and Seeplex ® H. pylori -ClaR- ACE Detection (r:0.644 and p:0.000, r:0.757 and p:0.000, r:0.757 and p:0.000, respectively). Of all the isolated 144 H. pylori strains 24 (16.6 %) were detected as resistant to claritromycine, and 18 (12.5 %) were levofloxacin. Genotypic claritromycine resistance was detected only in 15 cases with GenoType® HelicoDR, and 6 cases with Seeplex ® H. pylori -ClaR- ACE Detection. Conclusion: In our study, it was concluded that; GenoType® HelicoDR and Seeplex ® H. pylori -ClaR- ACE Detection was found as the most sensitive diagnostic methods when comparing all the investigated other ones (C, H, and RUT).

Keywords: Helicobacter pylori, GenoType® HelicoDR, Seeplex ® H. pylori -ClaR- ACE Detection, antimicrobial resistance

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Authors: Usha S. Adiga, Sachidanada Adiga

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Introduction: Diabetes Mellitus (DM) is one of the most common non-communicable diseases which imposes a large economic burden on the global health-care system. Cost of illness studies in India have assessed the health care cost of DM, but have certain limitations due to lack of standardization of the methods used, improper documentation of data, lack of follow up, etc. The objective of the study was to estimate the cost of illness of uncomplicated versus complicated type 2 diabetes mellitus in Coastal Karnataka, India. The study also aimed to find out the trend of cost of illness of the disease over a decade. Methodology: A prevalence based bottom-up approach study was carried out in two tertiary care hospitals located in Coastal Karnataka after ethical approval. Direct Medical costs like annual laboratory costs, pharmacy cost, consultation charges, hospital bed charges, surgical /intervention costs of 238 diabetics and 340 diabetic patients respectively from two hospitals were obtained from the medical record sections. Patients were divided into six groups, uncomplicated diabetes, diabetic retinopathy(DR), nephropathy(DN), neuropathy(DNeu), diabetic foot(DF), and ischemic heart disease (IHD). Different costs incurred in 2008 and 2017 in these groups were compared, to study the trend of cost of illness. Kruskal Wallis test followed by Dunn’s test were used to compare median costs between the groups and Spearman's correlation test was used for correlation studies. Results: Uncomplicated patients had significantly lower costs (p <0.0001) compared to other groups. Patients with IHD had highest Medical expenses (p < 0.0001), followed by DN and DF (p < 0.0001 ). Annual medical costs incurred were 1.8, 2.76, 2.77, 1.76, and 4.34 times higher in retinopathy, nephropathy, diabetic foot, neuropathy and IHD patients as compared to the cost incurred in managing uncomplicated diabetics. Other costs also showed a similar pattern of rising. A positive correlation was observed between the costs incurred and duration of diabetes, a negative correlation between the glycemic status and cost incurred. The cost incurred in the management of DM in 2017 was found to be elevated 1.4 - 2.7 times when compared to that in 2008. Conclusion: It is evident from the study that the economic burden due to diabetes mellitus is substantial. It poses a significant financial burden on the healthcare system, individual and society as a whole. There is a need for the strategies to achieve optimal glycemic control and operationalize regular and early screening methods for complications so as to reduce the burden of the disease.

Keywords: COI, diabetes mellitus, a bottom up approach, economics

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Authors: Gayle Nunley

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Between the mid-nineteenth and early twentieth century, a number of Western European women broke with gender norms of their time and undertook to write and publish accounts of their own international journeys. In addition to contributing to their contemporaries’ progressive reimagining of the space and place of female experience within the public sphere, these often orientalism-tinged texts have come to provide key source material for the analysis of gendered voice in the narration of Empire, particularly with regard to works associated with Europe’s then-ascendant imperial powers, Britain and France. Incorporation of contemporaneous writings from the once-dominant Empires of Iberian Europe introduces an important additional lens onto this process. By bringing to bear geographic notions of placedness together with discourse analysis, the examination of works by Iberian Europe’s female travelers in conjunction with those of their more celebrated Northern European peers reveals a pervasive pattern of conjoined belonging and displacement traceable throughout the broader corpus, while also underscoring the insufficiency of binary paradigms of gendered voice. The re-situating of women travelers’ participation in the European imperial project to include voices from the Iberian south creates a more robust understanding of these writers’ complex, and often unexpectedly modern, engagement with notions of gender, mobility, ‘otherness’ and contact-zone encounter acted out both within and against the imperial paradigm.

Keywords: colonialism, orientalism, Spain, travel writing, women travelers

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Authors: F. O Anugom

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The general functions of the university amongst other things include teaching, research and community service. Universities are recognized as the apex of learning, accumulating and imparting knowledge and skills of all kinds to students to enable them to be productive, earn their living and to make optimum contributions to national development. This is equivalent to the production of human capital in the form of high level manpower needed to administer the educational society, be useful to the society and manage the economy. Quality has become a matter of major importance for university education in Nigeria. Accreditation is the systematic review of educational programs to ensure that acceptable standards of education, scholarship and infrastructure are being maintained. Accreditation ensures that institution maintain quality. The process is designed to determine whether or not an institution has met or exceeded the published standards for accreditation, and whether it is achieving its mission and stated purposes. Ensuring quality assurance in accreditation process falls in the hands of university management which justified the need for this study. This study examined accreditation and quality assurance: the management imperative. Three research questions and three hypotheses guided the study. The design was a correlation survey with a population of 2,893 university administrators out of which 578 Heads of department and Dean of faculties were sampled. The instrument for data collection was titled Programme Accreditation Exercise scale with high levels of reliability. The research questions were answered with Pearson ‘r’ statistics. T-test statistics was used to test the hypotheses. It was found among others that the quality of accredited programme depends on the level of funding of universities in Nigeria. It was also indicated that quality of programme accreditation and physical facilities of universities in Nigeria have high relationship. But it was also revealed that programme accreditation is positively related to staffing in Nigerian universities. Based on the findings of the study, the researcher recommend that academic administrators should be included in the team of those who ensure quality programs in the universities. Private sector partnership should be encouraged to fund programs to ensure quality of programme in the universities. Independent agencies should be engaged to monitor the activities of accreditation teams to avoid bias.

Keywords: accreditation, quality assurance, national universities commission , physical facilities, staffing

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Authors: Melissa Langevin, Natalie Ward, Colleen Fitzgibbons, Christa Ramsey, Melanie Hogue, Anna Theresa Lobos

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Description: Root Cause Analysis (RCA) is used by health care teams to examine adverse events (AEs) to identify causes which then leads to recommendations for prevention Despite widespread use, RCA has limitations. Best practices have not been established for implementing recommendations or tracking the impact of interventions after AEs. During phase 1 of this study, we used simulation to analyze two fictionalized AEs that occurred in hospitalized paediatric patients to identify and understand how the errors occurred and generated recommendations to mitigate and prevent recurrences. Scenario A involved an error of commission (inpatient drug error), and Scenario B involved detecting an error that already occurred (critical care drug infusion error). Recommendations generated were: improved drug labeling, specialized drug kids, alert signs and clinical checklists. Aim: Use simulation to optimize interventions recommended post critical event analysis prior to implementation in the clinical environment. Methods: Suggested interventions from Phase 1 were designed and tested through scenario simulation in the clinical environment (medicine ward or pediatric intensive care unit). Each scenario was simulated 8 times. Recommendations were tested using different, voluntary teams and each scenario was debriefed to understand why the error was repeated despite interventions and how interventions could be improved. Interventions were modified with subsequent simulations until recommendations were felt to have an optimal effect and data saturation was achieved. Along with concrete suggestions for design and process change, qualitative data pertaining to employee communication and hospital standard work was collected and analyzed. Results: Each scenario had a total of three interventions to test. In, scenario 1, the error was reproduced in the initial two iterations and mitigated following key intervention changes. In scenario 2, the error was identified immediately in all cases where the intervention checklist was utilized properly. Independently of intervention changes and improvements, the simulation was beneficial to identify which of these should be prioritized for implementation and highlighted that even the potential solutions most frequently suggested by participants did not always translate into error prevention in the clinical environment. Conclusion: We conclude that interventions that help to change process (epinephrine kit or mandatory checklist) were more successful at preventing errors than passive interventions (signage, change in memory aids). Given that even the most successful interventions needed modifications and subsequent re-testing, simulation is key to optimizing suggested changes. Simulation is a safe, practice changing modality for institutions to use prior to implementing recommendations from RCA following AE reviews.

Keywords: adverse events, patient safety, pediatrics, root cause analysis, simulation

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Authors: Fabiana Souza Orlandi, Izabel Cristina Chavez Gomes, Barbara Isabela De Paula Morais, Ana Carolina Ottaviani

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Chronic Kidney Disease (CKD) is considered a public health problem. Patients who present CKD in their more advanced stages usually present several biopsychosocial changes, which may include pain. Pain can be considered subjective and personal, and its perception is characterized as a multidimensional experience. The objective of this study was to evaluate the level and descriptors of pain of adults and elderly patients with chronic kidney disease, through the Multidimensional Pain Evaluation Scale (EMADOR). This is a descriptive cross-sectional study with a quantitative approach. The sample consisted of 100 subjects with CKD in hemodialysis treatment at a Renal Replacement Therapy Service in the interior of the state of São Paulo. Data were collected through an individual interview, using a Sociodemographic Characterization and Multidimensional Pain Evaluation Scale (EMADOR). All ethical precepts were respected. The majority of the respondents were men (61.0%), white (56.0%) and with a high school education (34.0%). Regarding the pain of the individuals, 89 patients reported pain, with Chronic Pain predominating (50.0%, n = 50), followed by Acute Pain (39.0%, n = 39). Of the subjects who presented acute pain most of the 89.0% described the pain felt as unbearable, and of those who presented chronic pain, 35.0% described the pain felt as painful, unbearable and uncomfortable. It was concluded that there was a significant presence of pain, being the chronic pain dominant in the studied population. Faced with such factors, the present study motivates researches in this population, in order to establish interventions with the objective of improving the quality of life of these individuals.

Keywords: pain, chronic kidney disease, dialysis, evaluation

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Authors: Clara Tramuta, Floris Irene, Daniela Manila Bianchi, Monica Pitti, Giulia Federica Cazzaniga, Lucia Decastelli

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This work presents the results obtained by the Regional Reference Centre for Salmonella Typing (CeRTiS) in a retrospective study aimed to investigate, through Pulsed-field Gel Electrophoresis (PFGE) analysis, the genetic relatedness of emerging Salmonella serotypes of human origin circulating in North-West of Italy. Furthermore, the goal of this work was to create a Regional database to facilitate foodborne outbreak investigation and to monitor them at an earlier stage. A total of 112 strains, isolated from 2016 to 2018 in hospital laboratories, were included in this study. The isolates were previously identified as Salmonella according to standard microbiological techniques and serotyping was performed according to ISO 6579-3 and the Kaufmann-White scheme using O and H antisera (Statens Serum Institut®). All strains were characterized by PFGE: analysis was conducted according to a standardized PulseNet protocol. The restriction enzyme XbaI was used to generate several distinguishable genomic fragments on the agarose gel. PFGE was performed on a CHEF Mapper system, separating large fragments and generating comparable genetic patterns. The agarose gel was then stained with GelRed® and photographed under ultraviolet transillumination. The PFGE patterns obtained from the 112 strains were compared using Bionumerics version 7.6 software with the Dice coefficient with 2% band tolerance and 2% optimization. For each serotype, the data obtained with the PFGE were compared according to the geographical origin and the year in which they were isolated. Salmonella strains were identified as follow: S. Derby n. 34; S. Infantis n. 38; S. Napoli n. 40. All the isolates had appreciable restricted digestion patterns ranging from approximately 40 to 1100 kb. In general, a fairly heterogeneous distribution of pulsotypes has emerged in the different provinces. Cluster analysis indicated high genetic similarity (≥ 83%) among strains of S. Derby (n. 30; 88%), S. Infantis (n. 36; 95%) and S. Napoli (n. 38; 95%) circulating in north-western Italy. The study underlines the genomic similarities shared by the emerging Salmonella strains in Northwest Italy and allowed to create a database to detect outbreaks in an early stage. Therefore, the results confirmed that PFGE is a powerful and discriminatory tool to investigate the genetic relationships among strains in order to monitoring and control Salmonellosis outbreak spread. Pulsed-field gel electrophoresis (PFGE) still represents one of the most suitable approaches to characterize strains, in particular for the laboratories for which NGS techniques are not available.

Keywords: emerging Salmonella serotypes, genetic characterization, human strains, PFGE

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Authors: Haidy Weliam Megaly Gouda

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Dermatology is often a neglected specialty in low-resource settings despite the high morbidity associated with skin disease. This becomes even more significant when associated with HIV infection, as dermatological conditions are more common and aggressive in HIV-positive patients. African countries have the highest HIV infection rates, and skin conditions are frequently misdiagnosed and mismanaged because of a lack of dermatological training and educational material. The frequent lack of diagnostic tests in the African setting renders basic clinical skills all the more vital. This project aimed to improve the diagnosis and treatment of skin disease in the HIV population in a district hospital in Malawi. A basic dermatological clinical tool was developed and produced in collaboration with local staff and based on available literature and data collected from clinics. The aim was to improve diagnostic accuracy and provide guidance for the treatment of skin disease in HIV-positive patients. A literature search within Embassy, Medline and Google Scholar was performed and supplemented through data obtained from attending 5 Antiretroviral clinics. From the literature, conditions were selected for inclusion in the resource if they were described as specific, more prevalent, or extensive in the HIV population or have more adverse outcomes if they develop in HIV patients. Resource-appropriate treatment options were decided using Malawian Ministry of Health guidelines and textbooks specific to African dermatology. After the collection of data and discussion with local clinical and pharmacy staff, a list of 15 skin conditions was included, and a booklet was created using the simple layout of a picture, a diagnostic description of the disease and treatment options. Clinical photographs were collected from local clinics (with full consent of the patient) or from the book ‘Common Skin Diseases in Africa’ (permission granted if fully acknowledged and used in a not-for-profit capacity). This tool was evaluated by the local staff alongside an educational teaching session on skin disease. This project aimed to reduce uncertainty in diagnosis and provide guidance for appropriate treatment in HIV patients by gathering information into one practical and manageable resource. To further this project, we hope to review the effectiveness of the tool in practice.

Keywords: prevalence and pattern of skin diseases, impact on quality of life, rural Nepal, interventions, quality switched ruby laser, skin color river blindness, clinical signs, circularity index, grey level run length matrix, grey level co-occurrence matrix, local binary pattern, object detection, ring detection, shape identification

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Authors: Beatriz Botella-Gil, Patricio Martínez-Barco, Lea Canales

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The Internet and ICT are an integral element of and omnipresent in our daily lives. Technologies have changed the way we see the world and relate to it. The number of companies in the ICT sector is increasing every year, and there has also been an increase in the work that occurs online, from sending e-mails to the way companies promote themselves. In social life, ICT’s have gained momentum. Social networks are useful for keeping in contact with family or friends that live far away. This change in how we manage our relationships using electronic devices and social media has been experienced differently depending on the age of the person. According to currently available data, people are increasingly connected to social media and other forms of online communication. Therefore, it is no surprise that violent content has also made its way to digital media. One of the important reasons for this is the anonymity provided by social media, which causes a sense of impunity in the victim. Moreover, it is not uncommon to find derogatory comments, attacking a person’s physical appearance, hobbies, or beliefs. This is why it is necessary to develop artificial intelligence tools that allow us to keep track of violent comments that relate to violent events so that this type of violent online behavior can be deterred. The objective of our research is to create a guide for detecting and recording violent messages. Our annotation guide begins with a study on the problem of violent messages. First, we consider the characteristics that a message should contain for it to be categorized as violent. Second, the possibility of establishing different levels of aggressiveness. To download the corpus, we chose the social network Twitter for its ease of obtaining free messages. We chose two recent, highly visible violent cases that occurred in Spain. Both of them experienced a high degree of social media coverage and user comments. Our corpus has a total of 633 messages, manually tagged, according to the characteristics we considered important, such as, for example, the verbs used, the presence of exclamations or insults, and the presence of negations. We consider it necessary to create wordlists that are present in violent messages as indicators of violence, such as lists of negative verbs, insults, negative phrases. As a final step, we will use automatic learning systems to check the data obtained and the effectiveness of our guide.

Keywords: human language technologies, language modelling, offensive language detection, violent online content

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Authors: Hasan Ustun Basaran

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Diesel engines are widely used in transportation sector due to their high thermal efficiency. However, they also release high rates of NOₓ and PM (particulate matter) emissions into the environment which have hazardous effects on human health. Therefore, environmental protection agencies have issued strict emission regulations on automotive diesel engines. Recently, these regulations are even increasingly strengthened. Engine producers search novel on-engine methods such as advanced combustion techniques, utilization of renewable fuels, exhaust gas recirculation, advanced fuel injection methods or use exhaust after-treatment (EAT) systems in order to reduce emission rates on diesel engines. Although those aforementioned on-engine methods are effective to curb emission rates, they result in inefficiency or cannot decrease emission rates satisfactorily at all operating conditions. Therefore, engine manufacturers apply both on-engine techniques and EAT systems to meet the stringent emission norms. EAT systems are highly effective to diminish emission rates, however, they perform inefficiently at low loads due to low exhaust gas temperatures (below 250°C). Therefore, the objective of this study is to demonstrate that engine-out temperatures can be elevated above 250°C at low-loaded cases via cylinder disablement. The engine studied and modeled via Lotus Engine Simulation (LES) software is a six-cylinder turbocharged and intercooled diesel engine. Exhaust temperatures and mass flow rates are predicted at 1200 rpm engine speed and several low loaded conditions using LES program. It is seen that cylinder deactivation results in a considerable exhaust temperature rise (up to 100°C) at low loads which ensures effective EAT management. The method also improves fuel efficiency through reduced total pumping loss. Decreased total air induction due to inactive cylinders is thought to be responsible for improved engine pumping loss. The technique reduces exhaust gas flow rate as air flow is cut off on disabled cylinders. Still, heat transfer rates to the after-treatment catalyst bed do not decrease that much since exhaust temperatures are increased sufficiently. Simulation results are promising; however, further experimental studies are needed to identify the true potential of the method on fuel consumption and EAT improvement.

Keywords: cylinder disablement, diesel engines, exhaust after-treatment, exhaust temperature, fuel efficiency

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Authors: Haiqiao Du, Qian Wang, Shuwei Wang, Jianan Li

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Purpose: The aim is to evaluate the effect of cochlear implantation (CI) in patients with unilateral hearing loss, with a view to providing data support for the selection of therapeutic interventions for patients with single-sided deafness (SSD)/asymmetric hearing loss (AHL) and the broadening of the indications for CI. Methods: The study subjects were patients with unilateral hearing loss who underwent cochlear implantation surgery in our hospital in August 2022 and were willing to cooperate with the test and were divided into 2 groups: SSD group and AHL group. The enrolled patients were followed up for hearing level, tinnitus changes, speech recognition ability, sound source localization ability, and quality of life at five-time points: preoperatively, and 1, 3, 6, and 12 months after postoperative start-up. Results: As of June 30, 2024, a total of nine patients completed follow-up, including four in the SSD group and five in the AHL group. The mean postoperative hearing aid thresholds on the CI side were 31.56 dB HL and 34.75 dB HL in the two groups, respectively. Of the four patients with preoperative tinnitus symptoms (three patients in the SSD group and one patient in the AHL group), all showed a degree of reduction in Tinnitus Handicap Inventory (THI) scores, except for one patient who showed no change. In both the SSD and AHL groups, the sound source localization results (expressed as RMS error values, with smaller values indicating better ability) were 66.87° and 77.41° preoperatively and 29.34° and 54.60° 12 months after postoperative start-up, respectively, which showed that the ability to localize the sound source improved significantly with longer implantation time. The level of speech recognition was assessed by 3 test methods: speech recognition rate of monosyllabic words in a quiet environment and speech recognition rate of different sound source directions at 0° and 90° (implantation side) in a noisy environment. The results of the 3 tests were 99.0%, 72.0%, and 36.0% in the preoperative SSD group and 96.0%, 83.6%, and 73.8% in the AHL group, respectively, whereas they fluctuated in the postoperative period 3 months after start-up, and stabilized at 12 months after start-up to 99.0%, 100.0%, and 100.0% in the SSD group and 99.5%, 96.0%, and 99.0%. Quality of life was subjectively evaluated by three tests: the Speech Spatial Quality of Sound Auditory Scale (SSQ-12), the Quality-of-Life Bilateral Listening Questionnaire (QLBHE), and the Nijmegen Cochlear Implantation Inventory (NCIQ). The results of the SSQ-12 (with a 10-point score out of 10) showed that the scores of preoperative and postoperative 12 months after start-up were 6.35 and 6.46 in the SSD group, while they were 5.61 and 9.83 in the AHL group. The QLBHE scores (100 points out of 100) were 61.0 and 76.0 in the SSD group and 53.4 and 63.7 in the AHL group for the preoperative versus the postoperative 12 months after start-up. Conclusion: Patients with unilateral hearing loss can benefit from cochlear implantation: CI implantation is effective in compensating for the hearing on the affected side and reduces the accompanying tinnitus symptoms; there is a significant improvement in sound source localization and speech recognition in the presence of noise; and the quality of life is improved.

Keywords: single-sided deafness, asymmetric hearing loss, cochlear implant, unilateral hearing loss

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Authors: Shivayogi Charantimath

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Radiotherapy and chemotherapy are effective for treating malignancies but are associated with side effects like oral mucositis. Chlorhexidine gluconate is one of the most commonly used mouthwash in prevention of signs and symptoms of mucositis. Evidence shows that chlorhexidine gluconate has side effects in terms of colonization of bacteria, bad breadth and less healing properties. Thus, it is essential to find a suitable alternative therapy which is more effective with minimal side effects. Curcumin, an extract of turmeric is gradually being studied for its wide-ranging therapeutic properties such as antioxidant, analgesic, anti-inflammatory, antitumor, antimicrobial, antiseptic, chemo sensitizing and radio sensitizing properties. The present study was conducted to evaluate the efficacy and safety of topical curcumin gel on radio-chemotherapy induced oral mucositis in cancer patients. The aim of the study is to evaluate the efficacy and safety of curcumin gel in the management of oral mucositis in cancer patients undergoing radio chemotherapy and compare with chlorhexidine. The study was conducted in K.L.E. Society’s Belgaum cancer hospital. 40 oral cancer patients undergoing the radiochemotheraphy with oral mucositis was selected and randomly divided into two groups of 20 each. The study group A [20 patients] was advised Cure next gel for 2 weeks. The control group B [20 patients] was advised chlorhexidine gel for 2 weeks. The NRS, Oral Mucositis Assessment scale and WHO mucositis scale were used to determine the grading. The results obtained were calculated by using SPSS 20 software. The comparison of grading was done by applying Mann-Whitney U test and intergroup comparison was calculated by Wilcoxon matched pairs test. The NRS scores observed from baseline to 1^st and 2^nd week follow up in both the group showed significant difference. The percentage of change in erythema in respect to group A was 63.3% for first week and for second week, changes were 100.0% with p = 0.0003. The changes in Group A in respect to erythema was 34.6% for 1^st week and 57.7% in second week. The intergroup comparison was significant with p value of 0.0048 and 0.0006 in relation to group A and group B respectively. The size of the ulcer score was measured which showed 35.5% [P=0.0010] of change in Group A for 1^st and 2^nd week showed totally reduction i.e. 103.4% [P=0.0001]. Group B showed 24.7% change from baseline to 1^st week and 53.6% for 2^nd week follow up. The intergroup comparison with Wilcoxon matched pair test was significant with p=0.0001 in group A. The result obtained by WHO mucositis score in respect to group A shows 29.6% [p=0.0004] change in first week and 75.0% [p=0.0180] change in second week which is highly significant in comparison to group B. Group B showed minimum changes i.e. 20.1% in 1^st week and 33.3% in 2^nd week. The p value with Wilcoxon was significant with 0.0025 in Group A for 1^st week follow up and 0.000 for 2^nd week follow up. Curcumin gel appears to an effective and safer alternative to chlorhexidine gel in treatment of oral mucositis.

Keywords: curcumin, chemotheraphy, mucositis, radiotheraphy

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Authors: Nattawadee Sinpattanawong

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Oral presentation has been used mostly in business communication. The business presentation is carrying out through an audio and visual presentation material such as statistical documents, projectors, etc. Common examples of business presentation are intra-organization and sales presentations. The study aims at investigating functions, strategies and contents of assessors’ verbal feedback on presenters’ oral presentations and exploring presenters’ learning process and specific views and expectations concerning assessors’ verbal feedback related to the delivery of the oral presentation. This study is designed as a descriptive qualitative research; four master students and one teacher in English for Business and Industry Presentation Techniques class of public university will be selected. The researcher hopes that any understanding how assessors’ verbal feedback on oral presentations and learning process may illuminate issues for other people. The data from this research may help to expand and facilitate the readers’ understanding of assessors’ verbal feedback on oral presentations and learning process in their own situations. The research instruments include an audio recorder, video recorder and an interview. The students will be interviewing in order to ask for their views and expectations concerning assessors’ verbal feedback related to the delivery of the oral presentation. After finishing data collection, the data will be analyzed and transcribed. The findings of this study are significant because it can provide presenters knowledge to enhance their learning process and provide teachers knowledge about providing verbal feedback on student’s oral presentations on a business context.

Keywords: business context, learning process, oral presentation, verbal feedback

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Authors: Hsueh-Ching Wu

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Aims: This study investigated the longitudinal changes in BC were evaluated in patients with T2D who received carbohydrate-restricted diet education (CRDE), and the effects of age and sex on BC were analyzed. Design: This retrospective observational study was conducted between 2018 and 2021. A total of 6164 T2D patients were analyzed. Subjects with T2D who received CRDE (daily carbohydrate intake: 26-45%). A hierarchical linear model (HLM) was used to estimate the change amount and rate of change for the following variables in each group: body weight (BW), body mass index (BMI), body fat mass (BFM), percent body fat (PBF), appendicular skeletal muscle mass (ASM), and skeletal muscle index (SMI). Results: The BW, BMI, ASM, SMI and BFM of T2D patients who received CRDE for 3 years decreased with increasing age; PBF showed the opposite trend. The changes in BW, BMI, ASM, and SMI of patients older than 65 years were higher than those of patients younger than 65 years, and the annual rate of decline for males was higher than that for females. The annual change in BFM and PBF for both sexes changed from a downward trend before the age of 65 to a slow increase after the age of 65, and the slow increase rate for women was higher than that for men. Conclusion: Changes in body composition are associated with age and sex. BW and muscle tissue decrease with age, and attention must be paid to the rebound of adipose tissue after middle age. Patient or Public Contribution: The patient agreed to participate in a retrospective chart review during in the study period.

Keywords: body weight, body composition, carbohydrate-restricted diet, nursing, type 2 diabetes

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Authors: Takaaki Nemoto

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Case presentation: A 69-year-old Japanese man presented with a low-grade fever and fatigue that had persisted for one month. The patient had an aortic dissection on the aortic arch 13 years prior, an abdominal aortic aneurysm seven years prior, and an aortic dissection on the distal aortic arch one year prior, which were all treated with artificial blood-vessel replacement surgery. Laboratory tests revealed an inflammatory response (CRP 7.61 mg/dl), high serum creatinine (Cr 1.4 mg/dL), and elevated transaminase (AST 47 IU/L, ALT 45 IU/L). The patient was admitted to our hospital on suspicion of prosthetic vascular graft infection. Following further workups on the inflammatory response, an enhanced chest computed tomography (CT) and a non-enhanced chest DWI (MRI) were performed. The patient was diagnosed with a pulmonary fistula and a prosthetic vascular graft infection on the distal aortic arch. After admission, the patient was administered Ceftriaxion and Vancomycine for 10 days, but his fever and inflammatory response did not improve. On day 13 of hospitalization, a lung fistula repair surgery and an omental filling operation were performed, and Meropenem and Vancomycine were administered. The fever and inflammatory response continued, and therefore we took repeated blood cultures. M. fortuitum was detected in a blood culture on day 16 of hospitalization. As a result, we changed the treatment regimen to Amikacin (400 mg/day), Meropenem (2 g/day), and Cefmetazole (4 g/day), and the fever and inflammatory response began to decrease gradually. We performed a test of sensitivity for Mycobacterium fortuitum, and found that the MIC was low for fluoroquinolone antibacterial agent. The clinical course was good, and the patient was discharged after a total of 8 weeks of intravenous drug administration. At discharge, we changed the treatment regimen to Levofloxacin (500 mg/day) and Clarithromycin (800 mg/day), and prescribed these two drugs as a long life suppressive therapy. Discussion: There are few cases of prosthetic vascular graft infection caused by mycobacteria, and a standard therapy remains to be established. For prosthetic vascular graft infections, it is ideal to provide surgical and medical treatment in parallel, but in this case, surgical treatment was difficult and, therefore, a conservative treatment was chosen. We attempted to increase the treatment success rate of this refractory disease by conducting a susceptibility test for mycobacteria and treating with different combinations of antimicrobial agents, which was ultimately effective. With our treatment approach, a good clinical course was obtained and continues at the present stage. Conclusion: Although prosthetic vascular graft infection resulting from mycobacteria is a refractory infectious disease, it may be curative to administer appropriate antibiotics based on the susceptibility test in addition to surgical treatment.

Keywords: prosthetic vascular graft infection, lung fistula, Mycobacterium fortuitum, conservative treatment

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Authors: R. Chedid, R. Ghajar

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Lebanon electricity crisis continues to escalate. Rationing hours still apply across the country but with different rates. The capital Beirut is subjected to 3 hours cut while other cities, town and villages may endure 9 to 14 hours of power shortage. To mitigate this situation, private diesel generators distributed illegally all over the country are being used to bridge the gap in power supply. Almost each building in large cities has its own generator and individual villages may have more than one generator supplying their loads. These generators together with their private networks form incomplete and ill-designed and managed microgrids (MG) but can be further developed to become renewable energy-based MG operating in island- or grid-connected modes. This paper will analyze the potential of introducing MG to help resolve the energy crisis in Lebanon. It will investigate the usefulness of developing MG under the prevailing situation of existing private power supply service providers and in light of the developed national energy policy that supports renewable energy development. A case study on a distribution feeder in a rural area will be analyzed using HOMER software to demonstrate the usefulness of introducing photovoltaic (PV) arrays along the existing diesel generators for all the stakeholders; namely, the developers, the customers, the utility and the community at large. Policy recommendations regarding MG development in Lebanon will be presented on the basis of the accumulated experience in private generation and the privatization and public-private partnership laws.

Keywords: decentralized systems, distributed generation, microgrids, renewable energy

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Authors: Hai Chien Pham, Thi Phuong Anh Vo, Chansik Park

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Risks management in construction projects is important to ensure the positive feasibility of the projects in which financial risks are most concerned while construction projects always run on a credit basis. Credit risks, therefore, require unique and technical tools to be well managed. Underwriting technique in credit risks, in its most basic sense, refers to the process of evaluating the risks and the potential exposure of losses. Risks analysis and underwriting are applied as a must in banks and financial institutions who are supporters for constructions projects when required. Recently, construction organizations, especially contractors, have recognized the significant increasing of credit risks which caused negative impacts to project performance and profit of construction firms. Despite the successful application of underwriting in banks and financial institutions for many years, there are few contractors who are applying this technique to analyze and mitigate the credit risks of their potential owners before signing contracts with them for delivering their performed services. Thus, contractors have taken credit risks during project implementation which might be not materialized due to the bankruptcy and/or protracted default made by their owners. With this regard, this study proposes a model using the underwriting technique for contractors to analyze and assess credit risks of their owners before making final decisions for the potential construction contracts. Contractor’s underwriters are able to analyze and evaluate the subjects such as owner, country, sector, payment terms, financial figures and their related concerns of the credit limit requests in details based on reliable information sources, and then input into the proposed model to have the Overall Assessment Score (OAS). The OAS is as a benchmark for the decision makers to grant the proper limits for the project. The proposed underwriting model is validated by 30 subjects in Asia Pacific region within 5 years to achieve their OAS, and then compare output OAS with their own practical performance in order to evaluate the potential of underwriting model for analyzing and assessing credit risks. The results revealed that the underwriting would be a powerful method to assist contractors in making precise decisions. The contribution of this research is to allow the contractors firstly to develop their own credit risk management model for proactively preventing the credit risks of construction projects and continuously improve and enhance the performance of this function during project implementation.

Keywords: underwriting technique, credit risk, risk management, construction project

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Authors: Ambuja Raj

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This research will attempt to understand how documents are materially indispensable civic artifacts for migrants in their encounters with the state. Documents such as ID cards are sites of mediation and bureaucratic manifestation which reveal the inherent dynamics of power between the state and a delocalized people. While ID cards allow the holder to retain a different identity and articulate their demands as a citizen, they at the same time transform subjects into ‘objects’ in the exercise of governmental power. The research is based on the study of internal migrants in India, who are ‘visible’ to the state through its host of ID documents such as the ‘Aadhaar card’, electoral IDs, Ration cards, and a variety of region-specific documents, without the possession of which, not only are they unable to access jobs, public goods and services, and accommodation, but are liable to exploitation from state forces and mediators. Through semi-structured interviews with social actors in the processes of documentation and welfare of migrants, as well as with settlements of migrants themselves located in the state of Kerala in India, the thesis will attempt to understand the salience of documentary practices in the lives of inter-state migrants who move within Indian states in the hope of bettering their economic conditions. The research will trace the material and evolving significance of ID cards in the tenacity of states dealing with these ‘illegible’ populations. It will try to bring theories of governmentality, biopolitics and Weberian bureaucracy into the migrant issue while critically grounding itself on secondary literature by scholars who have worked on South Asian ‘governments of paper’.

Keywords: migration, historiography of documents, anthropology of state, documentary practices

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Authors: Abhijit Trailokya

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Background: Cardiovascular diseases (CVD’s) are the major cause of morbidity and mortality in both developed and developing countries. Many clinical trials have demonstrated that low-density lipoprotein cholesterol (LDL-C) lowering, reduces the incidence of coronary and cerebrovascular events across a broad spectrum of patients at risk. Guidelines for the management of patients at risk have been established in Europe and North America. The guidelines have advocated progressively lower LDL-C targets and more aggressive use of statin therapy. In Indian patients, comprehensive data on dyslipidemia management and its treatment outcomes are inadequate. There is lack of information on existing treatment patterns, the patient’s profile being treated, and factors that determine treatment success or failure in achieving desired goals. Purpose: The present study was planned to determine the lipid control status in high-risk dyslipidemic patients treated with lipid-lowering therapy in India. Methods: This cross-sectional, non-interventional, single visit program was conducted across 483 sites in India where male and female patients with high-risk dyslipidemia aged 18 to 65 years who had visited for a routine health check-up to their respective physician at hospital or a healthcare center. Percentage of high-risk dyslipidemic patients achieving adequate LDL-C level (< 70 mg/dL) on lipid-lowering therapy and the association of lipid parameters with patient characteristics, comorbid conditions, and lipid lowering drugs were analysed. Results: 3089 patients were enrolled in the study; of which 64% were males. LDL-C data was available for 95.2% of the patients; only 7.7% of these patients achieved LDL-C levels < 70 mg/dL on lipid-lowering therapy, which may be due to inability to follow therapeutic plans, poor compliance, or inadequate counselling by physician. The physician’s lack of awareness about recent treatment guidelines also might contribute to patients’ poor adherence, not explaining adequately the benefit and risks of a medication, not giving consideration to the patient’s life style and the cost of medication. Statin was the most commonly used anti-dyslipidemic drug across population. The higher proportion of patients had the comorbid condition of CVD and diabetes mellitus across all dyslipidemic patients. Conclusion: As per the European Society of Cardiology guidelines the ideal LDL-C levels in high risk dyslipidemic patients should be less than 70%. In the present study, 7.7% of the patients achieved LDL-C levels < 70 mg/dL on lipid lowering therapy which is very less. Most of high risk dyslipidemic patients in India are on suboptimal dosage of statin. So more aggressive and high dosage statin therapy may be required to achieve target LDLC levels in high risk Indian dyslipidemic patients.

Keywords: cardiovascular disease, diabetes mellitus, dyslipidemia, LDL-C, lipid lowering drug, statins

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