Search results for: learning outcomes assessment

Authors: Utkarsh A. Mishra, Ankit Bansal

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At high temperature, radiative heat transfer is the dominant mode of heat transfer. It is governed by various phenomena such as photon emission, absorption, and scattering. The solution of the governing integrodifferential equation of radiative transfer is a complex process, more when the effect of participating medium and wavelength properties are taken into consideration. Although a generic formulation of such radiative transport problem can be modeled for a wide variety of problems with non-gray, non-diffusive surfaces, there is always a trade-off between simplicity and accuracy of the problem. Recently, solutions of complicated mathematical problems with statistical methods based on randomization of naturally occurring phenomena have gained significant importance. Photon bundles with discrete energy can be replicated with random numbers describing the emission, absorption, and scattering processes. Photon Monte Carlo (PMC) is a simple, yet powerful technique, to solve radiative transfer problems in complicated geometries with arbitrary participating medium. The method, on the one hand, increases the accuracy of estimation, and on the other hand, increases the computational cost. The participating media -generally a gas, such as CO₂, CO, and H₂O- present complex emission and absorption spectra. To model the emission/absorption accurately with random numbers requires a weighted sampling as different sections of the spectrum carries different importance. Importance sampling (IS) was implemented to sample random photon of arbitrary wavelength, and the sampled data provided unbiased training of MC estimators for better results. A better replacement to uniform random numbers is using deterministic, quasi-random sequences. Halton, Sobol, and Faure Low-Discrepancy Sequences are used in this study. They possess better space-filling performance than the uniform random number generator and gives rise to a low variance, stable Quasi-Monte Carlo (QMC) estimators with faster convergence. An optimal supervised learning scheme was further considered to reduce the computation costs of the PMC simulation. A one-dimensional plane-parallel slab problem with participating media was formulated. The history of some randomly sampled photon bundles is recorded to train an Artificial Neural Network (ANN), back-propagation model. The flux was calculated using the standard quasi PMC and was considered to be the training target. Results obtained with the proposed model for the one-dimensional problem are compared with the exact analytical and PMC model with the Line by Line (LBL) spectral model. The approximate variance obtained was around 3.14%. Results were analyzed with respect to time and the total flux in both cases. A significant reduction in variance as well a faster rate of convergence was observed in the case of the QMC method over the standard PMC method. However, the results obtained with the ANN method resulted in greater variance (around 25-28%) as compared to the other cases. There is a great scope of machine learning models to help in further reduction of computation cost once trained successfully. Multiple ways of selecting the input data as well as various architectures will be tried such that the concerned environment can be fully addressed to the ANN model. Better results can be achieved in this unexplored domain.

Keywords: radiative heat transfer, Monte Carlo Method, pseudo-random numbers, low discrepancy sequences, artificial neural networks

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Authors: Charity Ngoatle, Tebogo M. Mothiba, Mahlapahlapana J. Themane

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Misapprehension of medications instructions due to poor health literacy is common in diabetic patients, predominantly leading to suboptimal medication therapy caused by taking less than expected, or getting inadequate medication concentration. Globally, 50% of adults have been reported to have misunderstood medication instructions which could be the cause of not using medication as prescribed. Reading material has been found not to improve people’s knowledge to the extent where they would be informed and knowledgeable about their health. This, therefore, depicts that instructive materials alone cannot improve health literacy but further patient education is still needed to explain what the information really mean. The aim of this study was to investigate patients’ interpretation of prescribed medication instructions at Makanye Clinic in Limpopo Province, South Africa. The study used a mixed method approach. A non-probability purposive and simple random sampling strategies will be used to select ten (10) participants for the pilot study. Semi-structured interviews with a guide and self- administered structured questionnaires will be used to collect data. Tesch’s eight steps for qualitative data analysis and SPSS version 24 with descriptive statistics will be adopted. The preliminary findings from other studies show that: (a) poor health literacy negatively affect medication adherence, (b) general literacy influence health literacy, and (c) there are poor health outcomes and medication adverse effects due to poor medication comprehension.

Keywords: instructions, diabetes mellitus, patients, prescribed medication

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Authors: Badla Oualid

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A great number of existing buildings are designed without seismic design criteria and detailing rules for dissipative structural behavior. Thus, it is of critical importance that the structures that need seismic retrofitting are correctly identified, and an optimal retrofitting is conducted in a cost effective fashion. Among the retrofitting techniques available, steel braces can be considered as one of the most efficient solution among seismic performance upgrading methods of RC structures. This paper investigates the seismic behavior of RC buildings strengthened with different types of steel braces, X-braced, inverted V braced, ZX braced, and Zipper braced. Static non linear pushover analysis has been conducted to estimate the capacity of three story and six story buildings with different brace-frame systems and different cross sections for the braces. It is found that adding braces enhances the global capacity of the buildings compared to the case with no bracing and that the X and Zipper bracing systems performed better depending on the type and size of the cross section.

Keywords: seismic design, strengthening, RC frames, steel bracing, pushover analysis

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Authors: Mehrdad Taghipour, Mina Rostami, Mahdi Eskandarlou

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Partial-thickness skin graft is the cornerstone for scalp defect repair. Given the potential side effects following harvesting from these sites, this study aimed to compare the outcomes of graft harvesting from scalp and lower limb. This clinical trial was conducted among a sample number of 40 partial thickness graft candidates (20 case and 20 control group) with scalp defect presenting to Plastic Surgery Clinic at Besat Hospital, Hamadan, Iran during 2018-2019. Sampling was done by simple randomization using random digit table. The donor site in case group and control group was scalp and lower limb respectively. Overall, 28 patients (70%) were male and 12 (30%) were female. Basal cell carcinoma (BCC) and trauma were the most common etiology for the defects. There was a statistically meaningful relationship between two groups regarding the etiology of defect (P=0.02). The mean diameter of defect was 24.28±45.37 mm for all of the patients. The difference between diameters of defect in both groups were statistically meaningful while no such difference between graft diameters was seen. The graft “Take” was completely successful in both groups according to evaluations. The level of postoperative pain was lower in the case group compared to the control according to VAS scale and the satisfaction was higher in them per Likert scale. Scalp can safely be used as donor site for skin graft to be used for scalp defects associated with better results and lower complication rates compared to other donor sites.

Keywords: donor site, graft, scalp, partial thickness

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Authors: Ravande Kishore

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The paper present the results of experimental investigation carried out to understand the mechanical properties of concrete containing marble dust. Two grades of concrete viz. M25 and M35 have been considered for investigation. For each grade of concrete five replacement percentages of sand viz. 5%, 10%, 15%, 20% and 25% by marble dust have been considered. In all, 12 concrete mix cases including two control concrete mixtures have been studied to understand the key properties such as Compressive strength, Modulus of elasticity, Modulus of rupture and Split tensile strength. Development of Compressive strength is also investigated. In general, the results of investigation indicated improved performance of concrete mixture containing marble dust. About 21% increase in Compressive strength is noticed for concrete mixtures containing 20% marble dust and 80% river sand. An overall assessment of investigation results pointed towards high potential for marble dust as alternative construction material coming from waste generated in marble industry.

Keywords: construction material, partial replacement, marble dust, compressive strength

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Authors: Meruyert Burumbayeva, Aiman Mussina, Gulnoza Aldabekova, Aiymtory Abildaeva, Gulshat Yerdenova, Aigul Kairgeldina

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this article introduces results of a research which purpose is evaluation the quality of life, the psychophysiological status, expressiveness of uneasiness at women teachers of the senior age group. At a research of quality of life of teachers the lowest values have been received from the indicators of the general state of health, vital activity, role emotional functioning and mental health. Every second woman-teacher noted high personal uneasiness; every third woman-teacher noted moderate situational uneasiness, confirming the existence of a professional stress. Revealed the interrelation between alarming conditions and a decrease in a mental component of health. Moreover, there was revealed exhaustion signs at low activity values that indicate a high tension of labor process.

Keywords: expressiveness of uneasiness, quality of life, psychophysiological status, component of health

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Authors: Yeliz Karaca, Carlo Cattani

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This study focuses on the local Holder exponent as a measure of the function regularity for time series related to finance data. In this study, the attributes of the finance dataset belonging to 13 countries (India, China, Japan, Sweden, France, Germany, Italy, Australia, Mexico, United Kingdom, Argentina, Brazil, USA) located in 5 different continents (Asia, Europe, Australia, North America and South America) have been examined.These countries are the ones mostly affected by the attributes with regard to financial development, covering a period from 2012 to 2017. Our study is concerned with the most important attributes that have impact on the development of finance for the countries identified. Our method is comprised of the following stages: (a) among the multi fractal methods and Brownian motion Holder regularity functions (polynomial, exponential), significant and self-similar attributes have been identified (b) The significant and self-similar attributes have been applied to the Artificial Neuronal Network (ANN) algorithms (Feed Forward Back Propagation (FFBP) and Cascade Forward Back Propagation (CFBP)) (c) the outcomes of classification accuracy have been compared concerning the attributes that have impact on the attributes which affect the countries’ financial development. This study has enabled to reveal, through the application of ANN algorithms, how the most significant attributes are identified within the relevant dataset via the Holder functions (polynomial and exponential function).

Keywords: artificial neural networks, finance data, Holder regularity, multifractals

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Authors: Ahmet Faruk Akyuz, Hasan Sakir Bilge

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Depth estimation using stereo images is a challenging problem in computer vision. Many different studies have been carried out to solve this problem. With advancing machine learning, tackling this problem is often done with neural network-based solutions. The images used in these studies are mostly in the visible spectrum. However, the need to use the Infrared (IR) spectrum for depth estimation has emerged because it gives better results than visible spectra in some conditions. At this point, we recommend using thermal-thermal (IR) image pairs for depth estimation. In this study, we used two well-known networks (PSMNet, FADNet) with minor modifications to demonstrate the viability of this idea.

Keywords: thermal stereo matching, deep neural networks, CNN, Depth estimation

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Authors: Eun Kyung Kim, Kyehan Rhee

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Viscoelastic wall properties of the arterial plaques change as the disease progresses, and estimation of wall viscoelasticity can provide a valuable assessment tool for plaque rupture prediction. Cross section of the stenotic coronary artery was modeled based on the IVUS image, and the finite element analysis was performed to get wall deformation under pulsatile pressure. The effects of viscoelastic parameters of the plaque on luminal diameter variations were explored. The result showed that decrease of viscous effect reduced the phase angle between the pressure and displacement waveforms, and phase angle was dependent on the viscoelastic properties of the wall. Because viscous effect of tissue components could be identified using the phase angle difference, wall deformation waveform analysis may be applied to predict plaque wall composition change and vascular wall disease progression.

Keywords: atherosclerotic plaque, diameter variation, finite element method, viscoelasticity

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Authors: Maher El-Masri, Jamie Crawley, Judy Bornais, Abeer Omar

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Background: Misuse of Emergency Department (ED) for non-urgent healthcare results in unnecessary crowdedness that can result in long ED waits and delays in treatment, diversion of ambulances to other hospitals, poor health outcomes for patients, and increased risk of death Objectives: The main purpose of this study was to explore the independent predictors of non-urgent ED visits in Erie St. Clair LHIN. Secondary purposes of the study include comparison of the rates of non-urgent ED visits between urban and rural hospitals Design: A secondary analysis of archived population-based data on 597,373 ED visits in southwestern Ontario Results The results suggest that older (OR = .992; 95% CI .992 – .993) and female patients (OR = .940; 95% CI .929 - .950) were less likely to visit ED for non-urgent causes. Non-urgent ED visits during the winter, spring, and fall were 13%, 5.8%, and 7.5%, respectively, lesser than they were during the summer time. The data further suggest that non-urgent visits were 19.6% and 21.3% less likely to occur in evening and overnight shifts compared to the day shift. Non-urgent visits were 2.76 times more likely to present to small community hospitals than large community hospitals. Health care providers were 1.92 times more likely to refer patients with non-urgent health problem to the ED than the decision taken by patients, family member or caretakers. Conclusion: In conclusion, our study highlights a number of important factors that are associated with inappropriate use of ED visits for non-urgent health problems. Knowledge of these factors could be used to address the issue of unnecessary ED crowdedness.

Keywords: emergency department, non-urgent visits, predictors, logistic regression

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Authors: H. Al-Baghli

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Laboratory trial results of mixing crumb rubber produced from discarded tires with 60/70 pen grade Kuwaiti bitumen are presented on this paper. PG grading and multiple stress creep recovery tests were conducted on Kuwaiti bitumen blended with 15% and 18% crumb rubber at temperatures ranging from 40 to 70 °C. The results from elastic recovery and non-recoverable creep presented optimum performance at 18% rubber content. The optimum rubberized-bitumen mix was next transformed into a pelletized form (PelletPave^®), and was used as a partial replacement to the conventional bitumen in the manufacture of continuously graded hot mix asphalts at a number of binder contents. The trialed PelletPave^® contents were at 2.5%, 3.0%, and 3.5% by mass of asphalt mix. In this investigation, it was not possible to utilize the results of standard Marshall method of mix design (i.e. volumetric, stability and flow tests) and subsequently additional assessment of mix compactability was carried out using gyratory compactor in order to determine the optimum PelletPave^® and total binder contents.

Keywords: crumb rubber, Marshall mix design, PG grading, rubberized-bitumen

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Authors: R. Hassan, J. Duncombe, E. Darke, A. Dias, K. Anderson, R. G. Middleton

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NHS England has set itself the task of delivering a “Net Zero” National Health service by 2040. It is incumbent upon all health care practioners to work towards this goal. Orthopaedic surgeons are no exception. Distal radial fractures are the most common fractures sustained by the adult population. However, studies are shortcoming on individual patient experience. The aim of this study was to assess the patient’s satisfaction and outcomes with woodcast used in the conservative management of distal radius fractures. For all patients managed with woodcast in our unit, we undertook a structured questionnaire that included the Patient Rated Wrist Evaluation (PRWE) score, The EQ-5D-5L score and the pain numerical score at the time of injury and six weeks after. 30 patients were initially managed with woodcast. 80% of patients tolerated woodcast for the full duration of their treatment. Of these, 20% didn’t tolerate woodcast and had their casts removed within 48 hours. Of the remaining, 79.1% were satisfied about woodcast comfort, 66% were very satisfied about woodcast weight, 70% were satisfied with temperature and sweatiness, 62.5% were very satisfied about the smell/odour, and 75% were satisfied about the level of support woodcast provided. During their treatment, 83.3% of patients rated their pain as five or less. For those who completed their treatment in woodcast, none required any further intervention or utilised the open appointment because of ongoing wrist problems. In conclusion, when woodcast is tolerated, patients’ satisfaction and outcome levels were good. However, we acknowledged 20% of patients in our series were not able to tolerate woodacst, Therefore, we suggest a comparison between the widely used synthetic plaster of Paris casting and woodcast to come in order.

Keywords: distal radius fractures, ecological cast, sustainability, woodcast

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Authors: Yao Song, Danni Cheng, Jianjun Ren

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Objectives: We aimed to explore the prognostic effects of absolute values and dynamic changes of common hematological indices on oropharynx squamous cell carcinoma (OPSCC) patients treated with radiation. Methods and materials: The absolute values of white blood cell (WBC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), hemoglobin (Hb), platelet (Plt), albumin (Alb), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) at baseline (within 45 days before radiation), 1-, 3-, 6- and 12-months after the start of radiotherapy were retrospectively collected. Locally-estimated smoothing scatterplots were used to describe the smooth trajectory of each index. A mixed-effect model with a random slope was fitted to describe the changing rate and trend of indices over time. Cox proportional hazard analysis was conducted to assess the correlation between hematological indices and treatment outcomes. Results: Of the enrolled 85 OPSCC patients, inflammatory indices, such as WBC and ALC, dropped rapidly during acute treatment and gradually recovered, while NLR and PLR increased at first three months and subsequently declined within 3-12 months. Higher absolute value or increasing trend of nutritional indices (Alb and Hb) was associated with better prognosis (all p<0.05). In contrast, patients with higher absolute value or upward trend of inflammatory indices (WBC, ANC, Plt, PLR and NLR) had worse survival (all p<0.05). Conclusions: The absolute values and dynamic changes of hematological indices were valuable prognostic factors for OPSCC patients who underwent radiotherapy.

Keywords: hematological indices, oropharyngeal cancer, radiotherapy, NLR, PLR

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Authors: Jyoti Pandey, Rajiv Kumar Bhatt

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In the absence of proper sanitation, people suffered from high levels of infectious diseases leading to high incidences of morbidity and mortality. This directly affected the ability of a country to maintain an efficient economy and implied great personal suffering among infected individuals and their families. This paper aims to estimate the catastrophic expenditure of households in terms of direct and indirect losses which a person has to face due to the illness of WASH diseases; the severity of the scenario is answered by finding out the impoverishment effect. We used the primary data survey for the objective outlined. Descriptive and analytical research types are used. The survey is done with the questionnaire formulated precisely, taking care of the inclusion of all the variables and probable outcomes. A total of 300 households is covered under this study. In order to pursue the objectives outlined, multistage random sampling of households is used. In this study, the cost of illness approach is followed for accessing economic impact. The study brought out the attention that a significant portion of the total consumption expenditure is going lost for the treatment of water and sanitation related diseases. The infectious and water vector-borne disease can be checked by providing sufficient required sanitation facility, and that 2.02% loss in income can be gained if the mechanisms of the pathogen is checked.

Keywords: water, sanitation, impoverishment, catastrophic expenditure

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Authors: Mohammad Tayefeh Norooz, Amirhossein Kargarzadeh

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Overweight and obesity as an abnormality are health threatening factors. Body mass index (BMI) above 25 is referred to as overweight and above 30 as obese. Apollo Endosurgery, Inc., a pioneering company in endoscopy surgeries, is poised to revolutionize patient care with its minimally invasive treatment options. Some product solutions are designed to improve patient outcomes and redefine the future of healthcare. Weight gain post-weight-loss surgery may stem from an enlarged stomach opening, reducing fullness and increasing food intake. Apollo Endosurgery's OverStitch system, a minimally invasive approach, addresses this by using sutures to reduce stomach opening size. This reflects Apollo's commitment to transformative improvements in healing endoscopy, emphasizing a shift towards minimally invasive options. The system's versatility and precision in full-thickness suturing offer treatment alternatives, exemplified in applications like Endoscopic Sleeve Gastroplasty for reshaping obesity management. Apollo’s dedication to pioneering advancements suggests ongoing breakthroughs in minimally invasive surgery, positioning the OverStitch systems as a testament to innovation in patient care.

Keywords: apollo endosurgery, endoscopic sleeve gastroplasty, weight loss system, overstitch endoscopic suturing system, therapeutic, perforations, fistula

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Authors: Samiah H. Ghounaim

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The topic of this paper is significant because of the increasing need for intercultural training for foreign language teachers due to the continuous challenges they face in their diverse classrooms. First, the structure of the intercultural training program designed will be briefly described, and the structure of a 3D vignette and its intended purposes will be elaborated on. This was the first stage where the program was designed and implemented on the period of three months with a group of local and expatriate foreign language teachers/practitioners at a university in the Middle East. After that, a set of primary data collected during the first stage of this research on the design and co-construction process of a 3D vignette will be reviewed and analysed in depth. Each practitioner designed a personal incident into a 3D vignette where each dimension of the vignette viewed the same incident from a totally different perspective. Finally, the results and the implications of having participant construct their personal incidents into a 3D vignette as a reflective practice will be discussed in detail as well as possible extensions for the research. This process proved itself to be an effective reflective practice where the participants were stimulated to view their incidents in a different light. Co-constructing one’s own critical incidents –be it a positive experience or not– into a structured 3D vignette encouraged participants to decentralise themselves from the incidents and, thus, creating a personal reflective space where they had the opportunity to see different potential outcomes for each incident, as well as prepare for the reflective discussion of their vignette with their peers. This provides implications for future developments in reflective writing practices and possibilities for educators’ continuous professional development (CPD).

Keywords: 3D vignettes, intercultural competence training, reflective practice, teacher training

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Authors: C. Pacheco, A. Cipriano

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A new concept of response system is proposed for filling the gap that exists in reducing vulnerability during immediate response to natural disasters. Real Time Early Response Systems (RTERSs) incorporate real time information as feedback data for closing control loop and for generating real time situation assessment. A review of the state of the art works that fit the concept of RTERS is presented, and it is found that they are mainly focused on manmade disasters. At the same time, in response phase of natural disaster management many works are involved in creating early warning systems, but just few efforts have been put on deciding what to do once an alarm is activated. In this context a RTERS arises as a useful tool for supporting people in their decision making process during natural disasters after an event is detected, and also as an innovative context for applying well-known automation technologies and automatic control concepts and tools.

Keywords: disaster management, emergency response system, natural disasters, real time

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Authors: Abhishek Jain, Kavish Kejriwal, V. Balaji Rao, Abhigna Chavda

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Increasing environmental and social concerns are forcing companies to take a fresh view of the impact of supply chain operations on environment and society when designing a supply chain. A challenging task in today’s food industry is the distribution of high-quality food items throughout the food supply chain. Improper storage and unwanted transportation are the major hurdles in food supply chain and can be tackled by making dynamic storage facility location decisions with the distribution network. Since food supply chain in India is one of the biggest supply chains in the world, the companies should also consider environmental impact caused by the supply chain. This project proposes a multi-objective optimization model by integrating sustainability in decision-making, on distribution in a food supply chain network (SCN). A Multi-Objective Mixed-Integer Linear Programming (MOMILP) model between overall cost and environmental impact caused by the SCN is formulated for the problem. The goal of MOMILP is to determine the pareto solutions for overall cost and environmental impact caused by the supply chain. This is solved by using GAMS with CPLEX as third party solver. The outcomes of the project are pareto solutions for overall cost and environmental impact, facilities to be operated and the amount to be transferred to each warehouse during the time horizon.

Keywords: multi-objective mixed linear programming, food supply chain network, GAMS, multi-product, multi-period, environment

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Authors: Jutamas Wisansing, Thanakarn Vongvisitsin, Udom Hongchatikul

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Food could be used to open up a dialogue about local heritage. Contributing to the world sustainable consumption mission, this research aims to explore the linkages between agriculture, senses of place and performing arts. Thailand and its destination marketing ‘Discover Thainess’ was selected as a working principle, enabling a case example of how the three elements could be conceptualized. The model offered an integrated institutional arrangement where diverse entities could be formed to design how Thainess (local heritage) could be interpreted and embedded into an art of food. Using case study research approach, three areas (Chiangmai, Samutsongkram and Ban Rai Gong King) representing 3 different scales of tourism development were selected. Based on a theoretical analysis, a working model was formulated. An action research was then designed to experiment how the model could be materialized. Brainstorming elicitation and in-depth interview were employed to reflect on how each element could be integrated. The result of this study offered an innovation on how food tourism could be profoundly interpreted and how tourism development could enhance value creation for agricultural based community. The outcomes of the research present co-creative multi-stakeholder model and the value creation method through the whole supply chain of Thai gastronomy. The findings have been eventually incorporated into ‘gastro-diplomacy’ strategy for Thai tourism.

Keywords: community-based tourism, gastro-diplomacy, gastronomy tourism, sustainable tourism development

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Authors: Layane Sara Vieira, Paulo Egidio Bernardo, Roberto Saverio Souza Costa

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Anthropogenic occupations and agricultural explorations without concern for the preservation and sustainability of the activity result in soil degradation that can make rural activity unfeasible. The objective of this work was to characterize and evaluate the recovery costs of an area degraded by major erosion (gully) in the municipality of Monte Alto (SP). Topographic characterization was carried out by means of a planialtimetric survey with a total station. The contours of the gully, internal area, slope height, contribution area, volume, and costs of operations for the recovery of the gully were delimited. The results obtained showed that the gully has a length of 145.56 m, a maximum width of 36.61 m, and a gap of 19.48 m. The external area of the gully is 1,039.8741 m², and the internal area is 119.3470 m². The calculated volume was 3,282.63 m³. The intervention area for breaking slopes was measured at 8,471.29 m², requiring the construction of 19 terraces in this area, vertically spaced at 2.8 m. The estimated costs for mechanical recovery of the gully were R$ 19,167.84 (US$ 3.657,98).

Keywords: erosion, volumetric assessment, soil degradation, terraces

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Authors: Alemu Moges Belay, Torgeir Welo, Jan Ola Strandhagen

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Lean has long been linked with manufacturing, but its application claimed also by other functions such as product development and services. However, there is a challenge on understanding and defining lean in each function context. This paper aims to investigate the literature that focus mainly on PD process improvement, obtain better understanding and redefine LPD in systematic way. In addition to that, the paper attempts to summarize various proposed transformation strategies, definitions, identifying features of manufacturing and product development that would help to redefining lean in product development context. Finally we redefine LPD in organized way that encompasses different steps such as stage gate, communication and information, events, learning, innovation, knowledge and value creation.

Keywords: lean, lean manufacturing, lean product development, transformation, strategies

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Authors: Anshul, Rajni Kalia, Sachin Kumar

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Introduction: The costoclavicular approach, a modification to the infraclavicular approach, has been described for anesthesia for upper limb surgeries. Material And Methods: In this randomized and single-blind study, fourty patients undergoing emergency/elective upper limb surgery were allocated to two groups. Group C and S received ultrasound-guided Costoclavicular block and Supraclavicular block, respectively, with 20 ml 0.5 % ropivacaine with 8 mg dexamethasone under strict asepsis. The primary outcome assessed was the total duration of sensory and motor block in the postoperative period. Secondary outcomes were to compare the time taken to perform the procedure, block characteristics in terms of onset of motor and sensory blockade, the efficacy of analgesia with respect to the time of administration of the first rescue analgesic dose with both the blocks and note the side effects pertaining to either of the blocks. Results: The mean total duration of sensory and motor blockade was longer in group C vs. group S (p=0.002 and 0.024, respectively). The mean duration to perform a block in group S was more than in group C (p=0.012). The mean onset of sensory and motor Blockade Time in group S was more than in group C (p<0.001 and <0.001, respectively). The mean duration to perform a block in group S was more than in group C (p=0.012). Conclusion: The costoclavicular approach is better than supraclavicular in terms of rapid execution, faster onset of sensory-motor blockade, prolonged postoperative analgesia and similar PONV and safety profile.

Keywords: costoclavicular, supraclavicular, ropivacaine, dexamethasone

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Authors: Swati Srivastava, Ashish Kumar Upadhyay

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Haemophilus influenzae Type B (Hib) cause infections of pneumonia, meningitis, epiglottises and other invasive disease exclusively among children under age five. Occurrence of these infections may impair child growth by causing micronutrient deficiency. Using longitudinal data from first and second waves of Young Lives Study conducted in India during 2002 and 2006-07 respectively and multivariable logistic regression models (using generalised estimation equation to take into account the cluster nature of sample), this study aims to examine the impact of Hib vaccination on child anthropometric outcomes (stunting, underweight and wasting) in India. Bivariate result shows that, a higher percent of children were stunted and underweight among those who were not vaccinated against Hib (39% & 48% respectively) as compare to those who were vaccinated (31% and 39% respectively).The risk of childhood stunting and underweight was significantly lower among children who were vaccinated against Hib (odds ratio: 0.77, 95% CI: 0.62-0.96 and odds ratio: 0.79, 95% C.I: 0.64-0.98 respectively) as compare to the unvaccinated children. No significant association was found between vaccination status against Hib and childhood wasting. Moreover, in the statistical models, about 13% of stunting and 12% of underweight could be attributable to lack of vaccination against Hib in India. Study concludes that vaccination against Hib- in addition to being a major intervention for reducing childhood infectious disease and mortality- can be consider as a potential tool for reducing the burden of undernutrition in India. Therefore, the Government of India must include the vaccine against Hib into the Universal Immunization Programme in India.

Keywords: Haemophilus influenzae Type-B, Stunting, Underweight, Wasting, Young Lives Study (YLS), India

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Authors: Awais Naeem, Osama Shakeel, Faizan Ullah, Abdul Wahid Anwer

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Introduction: To study the clinic-pathological factors, diagnostic factors and survival of extra-pulmonary small cell carcinoma. Methodology: From 1995 to 2017 all patients with a diagnosis of extra-pulmonary small cell carcinoma were included in the study. Demographic variables and clinic-pathological factors were collected. Management of disease was recorded. Short and long term oncological outcomes were recorded. All data was entered and analyzed in SPSS version 21. Results: A total of 14 patients were included in the study. Median age was 53.42 +/- 16.1 years. There were 5 male and 9 female patients. Most common presentation was dysphagia in 16 patient among esophageal small cell carcinoma and while other patient had pain in abdomen. Mean duration of symptoms was 4.23+/-2.91 months .Most common site is esophagus (n=6) followed by gall bladder(n=3). Almost all of the patients received chemo-radiotherapy. Majority of the patient presented with extensive disease. Five patients (35.7%) died during the follow up period, two (14.3%) were alive and rest of the patients were lost to follow up. Mean follow up period was 22.92 months and median follow up was 15 months. Conclusion: Extra-pulmonary small cell carcinoma is rare and needs to be managed aggressively. All patients should be treated with both systemic and local therapies.

Keywords: small cell carcinoma of esophagus, extrapulmonary small cell carcinoma, small cell carcinoma of gall bladder, small cell carcinoma of rectum, small cell carcinoma of stomach

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Authors: Stefan Ninković

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The main purpose of this paper is to examine the different theoretical approaches and relevant empirical evidence and thus, recognize some of the most pressing challenges faced by school leaders. This paper starts from the fact that the new mission of the school is characterized by the need for stronger coordination among students' academic, social and emotional learning. In this sense, school leaders need to focus their commitment, vision and leadership on the issues of students' attitudes, language, cultural and social background, and sexual orientation. More specifically, they should know what a good teaching is for student’s at-risk, students whose first language is not dominant in school, those who’s learning styles are not in accordance with usual teaching styles, or who are stigmatized. There is a rather wide consensus around the fact that the traditionally popular concept of instructional leadership of the school principal is no longer sufficient. However, in a number of "pro-leadership" circles, including certain groups of academic researchers, consultants and practitioners, there is an established tendency of attributing school principal an extraordinary influence towards school achievements. On the other hand, the situation in which all employees in the school are leaders is a utopia par excellence. Although leadership obviously can be efficiently distributed across the school, there are few findings that speak about sources of this distribution and factors making it sustainable. Another idea that is not particularly new, but has only recently gained in importance is related to the fact that the collective capacity of the school is an important resource that often remains under-cultivated. To understand the nature and power of collaborative school cultures, it is necessary to know that these operate in a way that they make their all collective members' tacit knowledge explicit. In this sense, the question is how leaders in schools can shape collaborative culture and create social capital in the school. Pressure exerted on schools to systematically collect and use the data has been accompanied by the need for school leaders to develop new competencies. The role of school leaders is critical in the process of assessing what data are needed and for what purpose. Different types of data are important: test results, data on student’s absenteeism, satisfaction with school, teacher motivation, etc. One of the most important tasks of school leaders are data-driven decision making as well as ensuring transparency of the decision-making process. Finally, the question arises whether the existing models of school leadership are compatible with the current social and economic trends. It is necessary to examine whether and under what conditions schools are in need for forms of leadership that are different from those that currently prevail. Closely related to this issue is also to analyze the adequacy of different approaches to leadership development in the school.

Keywords: educational changes, leaders, leadership, school

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Authors: Eslam Dabbish, Fortuna Ponte, Stefano Scoditti, Emilia Sicilia, Gloria Mazzone

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The medical techniques based on the use of light for activating the drug are occupying a prominent place in the cancer treatment due to their selectivity that contributes to reduce undesirable side effects of conventional chemotherapy. Among these therapeutic treatments, photodynamic therapy (PDT) and photoactivated chemotherapy (PACT) are emerging as complementary approaches for selective destruction of neoplastic tissue through direct cellular damage. Both techniques rely on the employment of a molecule, photosensitizer (PS), able to absorb within the so-called therapeutic window. Thus, the exposure to light of otherwise inert molecules promotes the population of excited states of the drug, that in PDT are able to produce the cytotoxic species, such as 1O2 and other ROS, in PACT can be responsible of the active species release or formation. Following the success of cisplatin in conventional treatments, many other transition metal complexes were explored as anticancer agents for applications in different medical approaches, including PDT and PACT, in order to improve their chemical, biological and photophysical properties. In this field, several crucial characteristics of candidate PSs can be accurately predicted from first principle calculations, especially in the framework of density functional theory and its time-dependent formulation, contributing to the understanding of the entire photochemical pathways involved which can ultimately help in improving the efficiency of a drug. A brief overview of the outcomes on some platinum and ruthenium-based PSs proposed for the application in the two phototherapies will be provided.

Keywords: TDDFT, metal complexes, PACT, PDT

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Authors: M. C. Venter, G. Hitge, S. C. Krygsman, J. Thiart

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For decades, South Africa has been planning transportation systems from a supply, rather than a demand side, perspective. In terms of parking, this relates to requiring the minimum parking provision that is enforced by city officials. Newer insight is starting to indicate that South Africa needs to re-think this philosophy in light of a new policy environment that desires a different outcome. Urban policies have shifted from reliance on the private car for access, to employing a wide range of alternative modes. Car dominated travel is influenced by various parameters, of which the availability and location of parking plays a significant role. The question is therefore, what is the right strategy to achieve the desired transport outcomes for SA. The focus of this paper is used to assess this issue with regard to parking provision, and specifically at a tertiary institution. A parking audit was conducted at the Stellenbosch campus of Stellenbosch University, monitoring occupancy at all 60 parking areas, every hour during business hours over a five-day period. The data from this survey was compared with the prescribed number of parking bays according to the Stellenbosch Municipality zoning scheme (requiring a minimum of 0.4 bays per student). The analysis shows that by providing 0.09 bays per student, the maximum total daily occupation of all the parking areas did not exceed an 80% occupation rate. It is concluded that the prevailing parking standards are not supportive of the new urban and transport policy environment, but that it is extremely conservative from a practical demand point of view.

Keywords: parking provision, parking requirements, travel behaviour, travel demand management

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Authors: Youmen Chaaban

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The study examined the influence of a situated professional development program (PD) aimed at enhancing English language teachers’ knowledge and skills and improving their instructional practices. The PD model under examination was developed upon sound theoretical underpinnings, taking into consideration research-based principles of effective PD. However, the implementation of the PD model within several school contexts required further investigation from the perspectives of the teachers, who were receiving the PD activities, and the instructional coaches, who were providing them. The paper, thus, presents the results of a qualitative study examining the perceptions of seventeen English language teachers and nineteen instructional coaches about the strengths of the PD program, the challenges they faced in the implementation of the program, and their suggestions for the improvement of the program’s implementation and outcomes. Comparisons were further made between the two groups of participants to uncover agreements and contradictions in their perceptions. Data were collected from the teachers through in-depth interviews and observations, while the data collected from the instructional coaches were open-ended surveys followed by focus group interviews. The findings of the study confirm the necessity of structuring PD activities around sound theoretical underpinnings. However, practical considerations specific to the contexts where the PD activities take place should be considered when evaluating the PD’s effectiveness. Finally, the study provides several recommendations for maximizing the influence of the PD program on teachers’ practices and beliefs.

Keywords: English language teachers, situated professional development, teacher beliefs, teacher practices

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Authors: Uyen Tran Tu

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The decision on capital structure is one of the most important and sophisticated decisions in financial management in order to improve firm performance. This article would study the two-way impact between capital structure and firm performance. The study use EVIEWS 6.0 software to determine a two-way relationship between the capital structure and firm performance based on two-stage regression (2SLS - Two-Stage Least Squares). The findings are: capital structure has the opposite effect on the business efficiency and vice versa, factors that effect on business efficiency include Size and Opportunities. Factors effects on the capital structure are size; liquidity. These factors also affect the ratio of capital structure (total debt/ total asset) of companies. In particular, liquidity has the opposite effect; and the size of the business has the same impact. The results of the study are in line with the theory and empirical studies presented, and the results of the study are unchanged for all three years 2015-2017.

Keywords: capital structure, firm performance, factors, two-way relationship

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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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