Search results for: clinical prediction models

Authors: Harini Chakkera

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Background: Inpatient hyperglycemia is an established independent risk factor among several patient cohorts with hospital readmission. This has not been studied after kidney transplantation. Nearly one-third of patients who have undergone a kidney transplant reportedly experience 30-day readmission. Methods: Data on first-time solitary kidney transplantations were retrieved between September 2015 to December 2018. Information was linked to the electronic health record to determine a diagnosis of diabetes mellitus and extract glucometeric and insulin therapy data. Univariate logistic regression analysis and the XGBoost algorithm were used to predict 30-day readmission. We report the average performance of the models on the testing set on five bootstrapped partitions of the data to ensure statistical significance. Results: The cohort included 1036 patients who received kidney transplantation, and 224 (22%) experienced 30-day readmission. The machine learning algorithm was able to predict 30-day readmission with an average AUC of 77.3% (95% CI 75.30-79.3%). We observed statistically significant differences in the presence of pretransplant diabetes, inpatient-hyperglycemia, inpatient-hypoglycemia, and minimum and maximum glucose values among those with higher 30-day readmission rates. The XGBoost model identified the index admission length of stay, presence of hyper- and hypoglycemia and recipient and donor BMI values as the most predictive risk factors of 30-day readmission. Additionally, significant variations in the therapeutic management of blood glucose by providers were observed. Conclusions: Suboptimal glucose metrics during hospitalization after kidney transplantation is associated with an increased risk for 30-day hospital readmission. Optimizing the hospital blood glucose management, a modifiable factor, after kidney transplantation may reduce the risk of 30-day readmission.

Keywords: kidney, transplant, diabetes, insulin

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Authors: Atia Alam

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Growing liberalisation and intense market competition increase firm’s risk exposure and induce corporations to use derivatives extensively as a risk management instrument, which results in decrease in firm’s risk, and increase in value. Present study contributes towards existing literature by providing an in-depth analysis regarding the effect of extent of derivative usage on firm’s risk and value by using panel data models and seemingly unrelated regression technique. New evidence is established in current literature by dividing the sample data based on firm’s Exchange Rate (ER) and Interest Rate (IR) exposure. Analysis is performed for the effect of extent of derivative usage on firm’s risk and value and its variation with respect to the ER and IR exposure. Sample data consists of 166 Pakistani firms listed on Pakistan stock exchange for the period of 2004-2010. Results show that extensive usage of derivative instruments significantly increases firm value and reduces firm’s risk. Furthermore, comprehensive analysis depicts that Pakistani corporations having higher exchange rate exposure, with respect to foreign sales, and higher interest rate exposure, on the basis of industry adjusted leverage, have higher firm value and lower risk. Findings from seemingly unrelated regression also provide robustness to results obtained through panel data analysis. Study also highlights the role of derivative usage as a risk management instrument in high and low ER and IR risk and helps practitioners in understanding how value increasing effect of extent of derivative usage varies with the intensity of firm’s risk exposure.

Keywords: extent of derivative usage, firm value, risk, Pakistan, non-financial firms

Procedia PDF Downloads 339

Authors: Yongsheng Guo

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This study explores the perceptions and conducts of Chinese foreign direct investment (FDI) in Africa from ethical and cultural perspectives. It offers a better understanding of how ethical and cultural factors affect Chinese investment in Africa and how the investment projects performed in Africa from both Chinese investors and African stakeholders’ perceptions. It adopted a grounded theory approach and conducted 30 in-depth interviews with corporate managers. Grounded theory models are developed to link the ethical and cultural factors, actions, and consequences. Results reveal that some ethical concepts like the unity of humans and nature, benevolence, virtue and responsibility, and cultural traits including propriety, righteousness, sincerity, equilibrium, long-term orientation, and principles affect Chinese investors when making investments in Africa. Most Chinese investors harmonize with local managers, cooperate with each other, and are gentle and courteous to partners. They take stable and steady actions and invest in infrastructure and agriculture projects and adopt a virtue governance system in the organization. This study finds that consequently, Chinese investors and local partners take complementary advantages, make achievements sequentially, and therefore both sides can win. They recognize great potentials and make sustainable development in Africa to achieve the Great Together in the future. This study proposes a Chinese ethics and governance system including economic, social, and political perspectives and compares it with alternative systems. It makes implications to the world island theory and propose suggestions to solve the Clash of Civilizations problem.

Keywords: foreign direct investment, ethics, national culture, China, Africa

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Authors: Getnet Gedefaw, Fentanesh Endalew, Bitewush Azmeraw, Bethelhem Walelign, Eyob Shitie

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Introduction: The issue of menstrual hygiene is often overlooked and has not been sufficiently addressed in the fields of reproductive health in low and middle-income countries. Inadequate menstrual hygiene practices can increase the risk of various infectious and chronic obstetric and gynaecological complications for girls and adolescents. Hence, this study seeks to investigate the knowledge, attitudes, and practices related to menstrual hygiene, along with the factors influencing them, among high school students. Methods: A facility based cross-sectional study was conducted involving a total of 423 study subjects. A systematic random sampling technique was utilized. Data was entered and analyzed through Epi data 3.1 and SPSS 22, respectively. Both univariable and multivariable logistic regression models were employed. A p-value of less than 0.05 was considered statistically significant. Results: This study revealed that 365(89.2%), 200(48.9%) and 196(47.9%) of the study participants have good knowledge, good practice, and good attitudes about menstrual hygiene, respectively. Being higher grade students (grade 10) [AOR=3.96, 95% CI =2.0-7.8] and having good practice of menstrual hygiene (AOR=2.52, 95% CI= 1.26-5) had a positive association with menstrual hygiene knowledge. Whereas maternal education level (AOR=1.86, 95% CI=1.18-2.9) and being a grade 10 student (AOR=2.3, 95% CI=1.48-3.56) were associated factors for practising menstrual hygiene. Additionally, being higher grade students (AOR=1.9, 95% CI=1.2-2.8), age ≥18 years (AOR=1.67, 95% CI=1.09-2.55) were statistically and positively associated with the attitude of menstrual hygiene. Conclusion: The study findings indicated that the knowledge of the study participants regarding menstrual hygiene was high, while their attitudes and practices towards menstrual hygiene were low. It is suggested that raising awareness among reproductive health groups and educating their families and parents could potentially lead to a positive change in their poor practices and attitudes towards menstrual hygiene.

Keywords: menstrual hygiene, menstruation, students, reproductive health

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Authors: Vanessa Do, Lauren Smith, Leslie Carver

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It is widely known that individuals with autism spectrum disorder (ASD) may exhibit sensitivity to stimuli. Even at a young age, they tend to display stimuli-related discomfort in their behavior during play. Play serves a crucial role in a child’s early years as it helps support healthy brain development, socio-emotional skills, and adaptation to their environment There is research dedicated to studying infant preferences for toys, especially in regard to: gender preferences, the advantages of promoting play, and the caregiver’s role in their child’s play routines. However, there is a disproportionate amount of literature examining how play patterns may differ in children with sensory sensitivity, such as children diagnosed with ASD. Prior literature has studied and found supporting evidence that individuals with ASD have deficits in social communication and have increased presence of repetitive behaviors and/or restricted interests, which also display in early childhood play patterns. This study aims to examine potential differences in toy preference between infants with (FH+) and without (FH-) a familial history of ASD ages 6. 9, and 12 months old. More specifically, this study will address the question, “do FH+ infants tend to play more with toys that require less social engagement compared to FH- infants?” Infants and their caregivers were recruited and asked to engage in a free-play session in their homes that lasted approximately 5 minutes. The sessions were recorded and later coded offline for engagement behaviors categorized by toy; each toy that the infants interacted with was coded as belonging to one of 6 categories: sensory (designed to stimulate one or more senses such as light-up toys or musical toys) , construction (e.g., building blocks, rubber suction cups), vehicles (e.g., toy cars), instructional (require steps to accomplish a goal such as flip phones or books), imaginative (e.g., dolls, stuffed animals), and miscellaneous (toys that do not fit into these categories). Toy engagement was defined as the infant looking and touching the toy (ILT) or looking at the toy while their caregiver was holding it (IL-CT). Results reported include/will include the proportion of time the infant was actively engaged with the toy out of the total usable video time per subject — distractions observed during the session were excluded from analysis. Data collection is still ongoing; however, the prediction is that FH+ infants will have higher engagement with sensory and construction toys as they require the least amount of social effort. Furthermore, FH+ infants will have the least engagement with the imaginative toys as prior literature has supported the claim that individuals with ASD have a decreased likelihood to engage in play that requires pretend play and other social skills. Looking at what toys are more or less engaging to FH+ infants is important as it provides significant contributions to their healthy cognitive, social, and emotional development. As play is one of the first ways for a child to understand the complexities of the larger world, the findings of this study may help guide further research into encouraging play with toys that are more engaging and sensory-sensitive for children with ASD.

Keywords: autism engagement, children’s play, early development, free-play, infants, toy

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Authors: Md. Zahirul Islam, Chad A. Ulven

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Fiber-reinforced polymer matrix composites have a wide range of applications in the sectors of automotive, aerospace, sports utilities, among others, due to their high specific strength, stiffness as well as reduced weight. In addition to those favorable properties, composites composed of natural fibers and bio-based resins (i.e., biocomposites) have eco-friendliness and biodegradability. However, the applications of biocomposites are limited due to the lack of knowledge about their long-term reliability under fluctuating loads. In order to explore the long-term reliability of flax fiber reinforced composites under fluctuating loads through high cycle fatigue strength (HCFS), fatigue test were conducted on unidirectional flax fiber reinforced thermoset composites at different percentage loads of ultimate tensile strength (UTS) with a loading frequency of 5 Hz. Change of temperature of the sample during cyclic loading was captured using an IR camera. Initially, the temperature increased rapidly, but after a certain time, it stabilized. A mathematical model was developed to predict the fatigue life from the data of stabilized temperature. Stabilized temperature and dissipated energy per cycle were compared with applied stress. Both showed bilinear behavior and the intersection of those curves were used to determine HCFS. HCFS for unidirectional flax fiber reinforced composites is around 45% of UTS for a loading frequency of 5Hz. Unlike fatigue life, stabilized temperature and dissipated energy-based models are convenient to define HCFS as they have little variation from sample to sample.

Keywords: energy method, fatigue, flax fiber reinforced composite, HCFS, thermographic approach

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Authors: J.P. Henriques, E. R. Neto, G. Almeida, G. Ribeiro, J.V. Coutinho, A.B. Lugli

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Industry 4.0, or the Fourth Industrial Revolution, is transforming the relationship between people and machines. In this scenario, some technologies such as Cloud Computing, Internet of Things, Augmented Reality, Artificial Intelligence, Additive Manufacturing, among others, are making industries and devices increasingly intelligent. One of the most powerful technologies of this new revolution is the Digital Twin, which allows the virtualization of a real system or process. In this context, the present paper addresses the linear and nonlinear dynamic study of a didactic level plant using Digital Twin. In the first part of the work, the level plant is identified at a fixed point of operation, BY using the existing method of least squares means. The linearized model is embedded in a Digital Twin using Automation Studio® from Famous Technologies. Finally, in order to validate the usage of the Digital Twin in the linearized study of the plant, the dynamic response of the real system is compared to the Digital Twin. Furthermore, in order to develop the nonlinear model on a Digital Twin, the didactic level plant is identified by using the method proposed by Hammerstein. Different steps are applied to the plant, and from the Hammerstein algorithm, the nonlinear model is obtained for all operating ranges of the plant. As for the linear approach, the nonlinear model is embedded in the Digital Twin, and the dynamic response is compared to the real system in different points of operation. Finally, yet importantly, from the practical results obtained, one can conclude that the usage of Digital Twin to study the dynamic systems is extremely useful in the industrial environment, taking into account that it is possible to develop and tune controllers BY using the virtual model of the real systems.

Keywords: industry 4.0, digital twin, system identification, linear and nonlinear models

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Authors: H.C. Chen, S. W. C. Chan, K. Cheng, A. Vathsala, H. K. Sran, H. He

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Background: End-stage renal disease (ESRD) is the last stage of chronic kidney disease. The numbers of patients with ESRD have increased worldwide due to the growing number of aging, diabetes and hypertension populations. Patients with ESRD suffer from physical illness and psychological distress due to complex treatment regimens, which often affect the patients’ social and psychological functioning. As a result, the patients may fail to perform daily self-care and self-management, and consequently experience worsening conditions. Aims: The study aims to examine the effectiveness of a self-efficacy psychoeducational programme on primary outcome (self-efficacy) and secondary outcomes (psychological wellbeing, treatment adherence, and quality of life) in patients with ESRD and haemodialysis in Singapore. Methodology: A randomised controlled, two-group pretest and repeated posttests design will be carried out. A total of 154 participants (n=154) will be recruited. The participants in the control group will receive a routine treatment. The participants in the intervention group will receive a self-efficacy psychoeducational programme in addition to the routine treatment. The programme is a two-session of educational intervention in a week. A booklet, two consecutive sessions of face-to-face individual education, and an abdominal breathing exercise are adopted in the programme. Outcome measurements include Dialysis Specific Self-efficacy Scale, Kidney Disease Quality of Life- 36 Hospital Anxiety and Depression Scale, Renal Adherence Attitudes Questionnaire and Renal Adherence Behaviour Questionnaire. The questionnaires will be used to measure at baseline, 1- and 3- and 6-month follow-up periods. Process evaluation will be conducted with a semi-structured face to face interview. Quantitative data will be analysed using SPSS21.0 software. Qualitative data will be analysed by content analysis. Significance of the study: This study will identify a clinically useful and potentially effective approach to help patients with end-stage renal disease and haemodialysis by enhancing their self-efficacy in self-care behaviour, and therefore improving their psychological wellbeing, treatment adherence and quality of life. This study will provide information to develop clinical guidelines to improve patients’ disease self-management and to enhance health-related outcomes. Hopefully it will help reducing disease burden.

Keywords: end-stage renal disease (ESRD), haemodialysis, psychoeducation, self-efficacy

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Authors: Revalin Herdianto

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Recent climate changes increase uncertainties in vegetation conditions such as health and biomass globally and locally. The detection is, however, difficult due to the spatial and temporal scale of vegetation coverage. Due to unique vegetation response to its environmental conditions such as water availability, the interplay between vegetation dynamics and hydrologic conditions leave a signature in their feedback relationship. Vegetation indices (VI) depict vegetation biomass and photosynthetic capacity that indicate vegetation dynamics as a response to variables including hydrologic conditions and microclimate factors such as rainfall characteristics and land surface temperature (LST). It is hypothesized that the signature may be depicted by VI in its relationship with other variables. To study this signature, several catchments in Asia, Australia, and Indonesia were analysed to assess the variations in hydrologic characteristics with vegetation types. Methods used in this study includes geographic identification and pixel marking for studied catchments, analysing time series of VI and LST of the marked pixels, smoothing technique using Savitzky-Golay filter, which is effective for large area and extensive data. Time series of VI, LST, and rainfall from satellite and ground stations coupled with digital elevation models were analysed and presented. This study found that the hydrologic response of vegetation to rainfall variations may be shown in one hydrologic year, in which a drought event can be detected a year later as a suppressed growth. However, an annual rainfall of above average do not promote growth above average as shown by VI. This technique is found to be a robust and tractable approach for assessing catchment dynamics in changing climates.

Keywords: vegetation indices, land surface temperature, vegetation dynamics, catchment

Procedia PDF Downloads 271

Authors: Yuning Guan

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Under the background of rapid urbanization, mountainous counties need to break through mountain barriers for urban expansion due to undulating topography, resulting in ecological problems such as landscape fragmentation and reduced biodiversity. Green infrastructure networks are constructed to alleviate the contradiction between urban expansion and ecological protection, promoting the healthy and sustainable development of urban ecosystems. This study applies the MSPA model, the MCR model and Linkage Mapper Tools to identify eco-sources and eco-corridors in the Shapingba District of Chongqing and combined with landscape connectivity assessment and circuit theory to delineate the importance levels to extract ecological pinch point areas on the corridors. The results show that: (1) 20 ecological sources are identified, with a total area of 126.47 km², accounting for 31.88% of the study area, and showing a pattern of ‘one core, three corridors, multi-point distribution’. (2) 37 ecological corridors are formed in the area, with a total length of 62.52km, with a ‘more in the west, less in the east’ pattern. (3) 42 ecological pinch points are extracted, accounting for 25.85% of the length of the corridors, which are mainly distributed in the eastern new area. Accordingly, this study proposes optimization strategies for sub-area protection of ecological sources, grade-level construction of ecological corridors, and precise restoration of ecological pinch points.

Keywords: green infrastructure network, morphological spatial pattern, minimal cumulative resistance, mountainous counties, circuit theory, shapingba district

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Authors: Mónica P. Cala, Juan S. Carreño, Roland J.W. Meesters

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Recently, collection of biological fluids on special filter papers has become a popular micro-sampling technique. Especially, the dried blood spot (DBS) micro-sampling technique has gained much attention and is momently applied in various life sciences reserach areas. As a result of this popularity, DBS are not only intensively competing with the venous blood sampling method but are at this moment widely applied in numerous bioanalytical assays. In particular, in the screening of inherited metabolic diseases, pharmacokinetic modeling and in therapeutic drug monitoring. Recently, microsampling techniques were also introduced in “omics” areas, whereunder metabolomics. For a metabolic profiling study we applied micro-sampling of biological fluids (blood and plasma) from healthy controls and from women with breast cancer. From blood samples, dried blood and plasma samples were prepared by spotting 8uL sample onto pre-cutted 5-mm paper disks followed by drying of the disks for 100 minutes. Dried disks were then extracted by 100 uL of methanol. From liquid blood and plasma samples 40 uL were deproteinized with methanol followed by centrifugation and collection of supernatants. Supernatants and extracts were evaporated until dryness by nitrogen gas and residues derivated by O-methyxyamine and MSTFA. As internal standard C17:0-methylester in heptane (10 ppm) was used. Deconvolution and alignment of and full scan (m/z 50-500) MS data were done by AMDIS and SpectConnect (http://spectconnect.mit.edu) software, respectively. Statistical Data analysis was done by Principal Component Analysis (PCA) using R software. The results obtained from our preliminary study indicate that the use of dried blood/plasma on paper disks could be a powerful new tool in metabolic profiling. Many of the metabolites observed in plasma (liquid/dried) were also positively identified in whole blood samples (liquid/dried). Whole blood could be a potential substitute matrix for plasma in Metabolomic profiling studies as well also micro-sampling techniques for the collection of samples in clinical studies. It was concluded that the separation of the different sample methodologies (liquid vs. dried) as observed by PCA was due to different sample treatment protocols applied. More experiments need to be done to confirm obtained observations as well also a more rigorous validation .of these micro-sampling techniques is needed. The novelty of our approach can be found in the application of different biological fluid micro-sampling techniques for metabolic profiling.

Keywords: biofluids, breast cancer, metabolic profiling, micro-sampling

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Authors: Paria Saadatjoo

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Given that HVAC systems are the main sources of carbon dioxide producers, developing ways to reduce dependence on these systems and making use of natural resources is too important to achieve environmentally friendly buildings. A major part of building potential in terms of using natural energy resources depends on its physical features. So architectural decisions at the first step of the design process can influence the building's energy efficiency significantly. Implementation of semi-open spaces into solid apartment blocks inspired by the concept of courtyard in ancient buildings as a passive cooling strategy is currently enjoying great popularity. However, the analysis of these features and their effect on wind behavior at initial design steps is a difficult task for architects. The main objective of this research was to investigate the influence of semi-open to closed space ratio on airflow patterns in and around midrise buildings and introduce the best ratio in terms of harnessing natural ventilation. The main strategy of this paper was semi-experimental, and the research methodology was descriptive statistics. At the first step, by changing the terrace area, 6 models with various open to closed space ratios were created. These forms were then transferred to CFD software to calculate the primary indicators of natural ventilation potentials such as wind force coefficient, air flow rate, age of air distribution, etc. Investigations indicated that modifying the terrace area and, in other words, the open to closed space ratio influenced the wind force coefficient, airflow rate, and age of air distribution.

Keywords: natural ventilation, wind, midrise, open space, energy

Procedia PDF Downloads 152

Authors: Maria Del Carmen Millan-Linares, Ana Lemus Conejo, Rocio Toscano, Alvaro Villanueva, Francisco Millan, Justo Pedroche, Sergio Montserrat-De La Paz

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GPETAFLR (Glycine-Proline-Glutamine-Threonine-Alanine-Phenylalanine-Leucine-Arginine) is a peptide isolated from Lupinus angustifolius L. protein hydrolysate (LPH). Herein, the effect of this peptide was investigated in two different models of neuroinflammation: in the immortalized murine microglia cell line BV-2 and in a high-fat-diet-induced obesity mouse model. Methods and Results: Effects of GPETAFLR on neuroinflammation were evaluated by RT-qPCR, flow cytometry, and ELISA techniques. In BV-2 microglial cells, Lipopolysaccharides (LPS) enhanced the release of pro-inflammatory cytokines (TNF-α, IL-1β, and IL-6) whereas GPETAFLR decreased pro-inflammatory cytokine levels and increased the release of the anti-inflammatory cytokine IL-10 in BV2 microglial cells. M1 (CCR7 and iNOS) and M2 (Arg-1 and Ym-1) polarization markers results showed how the GPETAFLR octapeptide was able to decrease M1 polarization marker expression and increase the M2 polarization marker expression compared to LPS. Animal model results indicate that GPETAFLR has an immunomodulatory capacity, both decreasing pro-inflammatory cytokine IL-6 and increasing the anti-inflammatory cytokine IL-10 in brain tissue. Polarization markers in the brain tissue were also modulated by GPETAFLR that decreased the pro-inflammatory expression (M1) and increased the anti-inflammatory expression (M2). Conclusion: Our results suggest that GPETAFLR isolated from LPH has significant potential for management of neuroinflammatory conditions and offer benefits derived from the consumption of Lupinus angustifolius L. in the prevention of neuroinflammatory-related diseases.

Keywords: GPETAFLR peptide, BV-2 cell line, neuroinflammation, cytokines, high-fat-diet

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Authors: Shivam Patel, Abdullah Y. Usmani

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Physiological flow under rest and exercise conditions in patient-specific cerebral aneurysm models is numerically investigated. A finite-volume based code with BiCGStab as the linear equation solver is used to simulate unsteady three-dimensional flow field through the incompressible Navier-Stokes equations. Flow characteristics are first established in a healthy cerebral artery for both physiological conditions. The effect of saccular aneurysm on cerebral hemodynamics is then explored through a comparative analysis of the velocity distribution, nature of flow patterns, wall pressure and wall shear stress (WSS) against the reference configuration. The efficacy of coil embolization as a potential strategy of surgical intervention is also examined by modelling coil as a homogeneous and isotropic porous medium where the extended Darcy’s law, including Forchheimer and Brinkman terms, is applicable. The Carreau-Yasuda non-Newtonian blood model is incorporated to capture the shear thinning behavior of blood. Rest and exercise conditions correspond to normotensive and hypertensive blood pressures respectively. The results indicate that the fluid impingement on the outer wall of the arterial bend leads to abnormality in the distribution of wall pressure and WSS, which is expected to be the primary cause of the localized aneurysm. Exercise correlates with elevated flow velocity, vortex strength, wall pressure and WSS inside the aneurysm sac. With the insertion of coils in the aneurysm cavity, the flow bypasses the dilatation, leading to a decline in flow velocities and WSS. Particle residence time is observed to be lower under exercise conditions, a factor favorable for arresting plaque deposition and combating atherosclerosis.

Keywords: 3D FVM, Cerebral aneurysm, hypertension, coil embolization, non-Newtonian fluid

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Authors: Brian Considine, Aonghus McNabola, John Gallagher, Prashant Kumar

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Passive air pollution control devices known as aspiration efficiency reducers (AER) have been developed using aspiration efficiency (AE) concepts. Their purpose is to reduce the concentration of particulate matter (PM) drawn into a building air handling unit (AHU) through alterations in the inlet design improving energy consumption. In this paper an examination is conducted into the effect of installing a deflector system around an AER-AHU inlet for both a forward and rear-facing orientations relative to the wind. The results of the study found that these deflectors are an effective passive control method for reducing AE at various ambient wind speeds over a range of microparticles of varying diameter. The deflector system was found to induce a large wake zone at low ambient wind speeds for a rear-facing AER-AHU, resulting in significantly lower AE in comparison to without. As the wind speed increased, both contained a wake zone but have much lower concentration gradients with the deflectors. For the forward-facing models, the deflector system at low ambient wind speed was preferred at higher Stokes numbers but there was negligible difference as the Stokes number decreased. Similarly, there was no significant difference at higher wind speeds across the Stokes number range tested. The results demonstrate that a deflector system is a viable passive control method for the reduction of ventilation energy consumption.

Keywords: air handling unit, air pollution, aspiration efficiency, energy efficiency, particulate matter, ventilation

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Authors: Raymond Awinbilla

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The call for tree planting has long been set in motion by the government of Ghana. The Forestry Commission encourages plantation development through numerous interventions including formulating policies and enacting legislations. However, forest policies have failed and that has generated a major concern over the vast gap between the intentions of national policies and the realities established. This study addresses three objectives;1) Assessing the farmers' response and contribution to the tree planting initiative, 2) Identifying socio-economic factors hindering the development of smallholder plantations as a livelihood strategy, and 3) Determining the level of support available for smallholder tree growers and the factors influencing it. The field work was done in 12 farming communities in Ghana. The article illuminates that farmers have responded to the call for tree planting and have planted both exotic and indigenous tree species. Farmers have converted 17.2% (369.48ha) of their total land size into plantations and have no problem with land tenure. Operations and marketing constraints include lack of funds for operations, delay in payment, low price of wood, manipulation of price by buyers, documentation by buyers, and no ready market for harvesting wood products. Environmental institutions encourage tree planting; the only exception is with the Lands Commission. Support availed to farmers includes capacity building in silvicultural practices, organisation of farmers, linkage to markets and finance. Efforts by the Government of Ghana to enhance forest resources in the country could rely on the input of local populations.

Keywords: livelihood strategy, marketing constraints, environmental institutions, silvicultural practices

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Authors: Nehir Nebioglu

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Chemotherapy is widely used for the treatment of cancer. Doxorubicin is an anti-cancer chemotherapy drug that is classified as an anthracycline antibiotic. Antitumor antibiotics consist of natural products produced by species of the soil fungus Streptomyces. These drugs act in multiple phases of the cell cycle and are known cell-cycle specific. Although DOX is a precious clinical antineoplastic agent, resistance is also a problem that limits its utility besides cardiotoxicity problem. The drug resistance of cancer cells results from multiple factors including individual variation, genetic heterogeneity within a tumor, and cellular evolution. The mechanism of resistance is thought to involve, in particular, ABCB1 (MDR1, Pgp) and ABCC1 (MRP1) as well as other transporters. Several studies on DOX-resistant cell lines have shown that resistance can be overcome by an inhibition of ABCB1, ABCC1, and ABCC2. This study attempts to understand the effects of different concentration levels of glucose treatment and starvation on the proliferation of Doxorubicin resistant cancer cells lines. To understand the effect of starvation, K562/Dox and K562 cell lines were treated with 0, 5 nM, 50 nM, 500 nM, 5 uM and 50 uM Dox concentrations in both starvation and normal medium conditions. In addition to this, to interpret the effect of glucose treatment, different concentrations (0, 1 mM, 5 mM, 25 mM) of glucose were applied to Dox-treated (with 0, 5 nM, 50 nM, 500 nM, 5 uM and 50 uM) K562/Dox and K652 cell lines. All results show significant decreasing in the cell count of K562/Dox, when cells were starved. However, while proliferation of K562/Dox lines decrease is associated with the increasingly applied Dox concentration, K562/Dox starved ones remain at the same proliferation level. Thus, the results imply that an amount of K562/Dox lines gain starvation resistance and remain resistant. Furthermore, for K562/Dox, there is no clear effect of glucose treatment in terms of cell proliferation. In the presence of a moderate level of glucose (5 mM), proliferation increases compared to other concentration of glucose for each different Dox application. On the other hand, a significant increase in cell proliferation in moderate level of glucose is only observed in 5 uM Dox concentration. The moderate concentration level of Dox can be examined in further studies. For the high amount of glucose (25 mM), cell proliferation levels are lower than moderate glucose application. The reason could be high amount of glucose may not be absorbable by cells. Also, in the presence of low amount of glucose, proliferation is decreasing in an orderly manner of increase in Dox concentration. This situation can be explained by the glucose depletion -Warburg effect- in the literature.

Keywords: drug resistance, cancer cells, chemotherapy, doxorubicin

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Authors: M. Çevik, S. Sabancı, D. Tezcan, C. Çelebi, F. İçier

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Ultrasound technology is the one of the non-thermal food processing method in recent years which has been used widely in the food industry. Ultrasound application in the food industry is divided into two groups: low and high intensity ultrasound application. While low intensity ultrasound is used to obtain information about physicochemical properties of foods, high intensity ultrasound is used to extract bioactive components and to inactivate microorganisms and enzymes. In this study, the ultrasound pre-treatment at a constant power (1500 W) and fixed frequency (20 kHz) was applied to the red beetroot slices having the dimension of 25×25×50 mm at the constant temperature (25°C) for different application times (0, 5, 10, 15 and 20 min). The red beet root slices pretreated with ultrasonication was squeezed immediately. The changes on rheological properties of red beet root juice depending on ultrasonication duration applied to slices were investigated. Rheological measurements were conducted by using Brookfield viscometer (LVDV-II Pro, USA). Shear stress-shear rate data was obtained from experimental measurements for 0-200 rpm range by using spindle 18. Rheological properties of juice were determined by fitting this data to some rheological models (Newtonian, Bingham, Power Law, Herschel Bulkley). It was investigated that the best model was Power Law model for both untreated red beet root juice (R2=0.991, χ2=0.0007, RMSE=0.0247) and red beetroot juice produced from ultrasonicated slices (R2=0.993, χ2=0.0006, RMSE=0.0216 for 20 min pre-treatment). k (consistency coefficient) and n (flow behavior index) values of red beetroot juices were not affected from the duration of ultrasonication applied to the slices. Ultrasound treatment does not result in any changes on the rheological properties of red beetroot juice. This can be explained by lack of ability to homogenize of the intensity of applied ultrasound.

Keywords: ultrasonication, rheology, red beet root slice, juice

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Authors: H. M. Soroush

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The problem of scheduling products and services for on-time deliveries is of paramount importance in today’s competitive environments. It arises in many manufacturing and service organizations where it is desirable to complete jobs (products or services) with different weights (penalties) on or before their due dates. In such environments, schedules should frequently decide whether to schedule a job based on its processing time, due-date, and the penalty for tardy delivery to improve the system performance. For example, it is common to measure the weighted number of late jobs or the percentage of on-time shipments to evaluate the performance of a semiconductor production facility or an automobile assembly line. In this paper, we address the problem of scheduling a set of jobs on a server where processing times or due-dates of jobs are random variables and fixed weights (penalties) are imposed on the jobs’ late deliveries. The goal is to find the schedule that minimizes the expected weighted number of tardy jobs. The problem is NP-hard to solve; however, we explore three scenarios of the problem wherein: (i) both processing times and due-dates are stochastic; (ii) processing times are stochastic and due-dates are deterministic; and (iii) processing times are deterministic and due-dates are stochastic. We prove that special cases of these scenarios are solvable optimally in polynomial time, and introduce efficient heuristic methods for the general cases. Our computational results show that the heuristics perform well in yielding either optimal or near optimal sequences. The results also demonstrate that the stochasticity of processing times or due-dates can affect scheduling decisions. Moreover, the proposed problem is general in the sense that its special cases reduce to some new and some classical stochastic single machine models.

Keywords: number of late jobs, scheduling, single server, stochastic

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Authors: Grace Fangmin Tan, Elaine Yiling Tay, Elizabeth Huiwen Tham, Andrea Wei Ching Yeo

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Background: While accidental poisonings in children may seem unavoidable, knowledge of circumstances surrounding such incidents and identification of risk factors is important in the development of secondary prevention strategies. Some risk factors include age of the child, lack of adequate supervision and improper storage of substances. The aim of this study is to assess risk factors and circumstances influencing outcomes in these children. Methodology: A retrospective medical record review of all accidental poisoning cases presenting to the Children’s Emergency at National University Hospital (NUH), Singapore between January 2014 and December 2015 was conducted. Information on demographics, poisoning circumstances and clinical outcomes were collected. Results: Ninety-nine of a total of 186 poisoning cases were accidental ingestions, with a mean age of 4.7 (range 0.4 to 18.3 years). The gender distribution is rather equal with 52(52.5%) females and 47(47.5%) males. Seventy-nine (79.8%) were self-administered by the child and in 20 cases (20.2%), the substance was administered erroneously by caregivers 12/20 (60.0%) of whom were given the wrong drug dose while 8/20 (40.0%) were given the wrong substance. Self-administration was associated with presentation to the ED within 12 hours (p=0.027, OR 6.65, 95% CI 1.24-35.72). Notably, 94.9% of the cases involved substances kept within reach of the child. Sixty-nine (82.1%) had the substance kept in the original container, 3(3.6%) in food containers, 8(9.5%) in other containers and 4(4.8%) without a container. Of the 50 cases with information on labelling, 40/50(80.0%) were accurately labelled, 2/50 (4.0%) wrongly labelled, and 8/50 (16.0%) were unlabelled. Implicated substances included personal care products (11.1%), household cleaning products (3.0%), and different classes of drugs such as paracetamol (22.2%), antihistamines (17.2%) and sympathomimetics (8.1%). Children < 3 years of age were 4.8 times more likely to be poisoned by household substances than children >3 years of age (p=0.009, 95% CI 1.48-15.77). Prehospital interventions were more likely to have been done in poisoning with household substances (p=0.005, OR 6.12 95% CI 1.73-21.68). Fifty-nine (59.6%) were asymptomatic, 34 (34.3%) had a Poisoning Severity Score (PSS) grade of 1 (minor) and 6 (6.1%) grade 2 (moderate). Older children were 9.3 times more likely to be symptomatic (p<0.001, 95% CI 3.15-27.25). Thirty (32%) required admission. Conclusion: A significant proportion of accidental poisoning cases were due to medication administration errors by caregivers, which should be preventable. Risk factors for accidental poisoning included lack of adequate caregiver supervision, improper labelling and young age of the child. There is an urgent need to improve caregiver counselling during medication dispensing as well as to educate caregivers on basic child safety measures in the home to prevent future accidental poisonings.

Keywords: accidental, caregiver, paediatrics, poisoning

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Authors: Taher M. Abou-deif, Esmail M. El-Bialy, Essam E. Khalil

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The paper is devoted to numerically investigating the influence of the air supply outlets geometry on human comfort inside living looms. A computational fluid dynamics model is developed to examine the air flow characteristics of a room with different supply air diffusers. The work focuses on air flow patterns, thermal behavior in the room with few number of occupants. As an input to the full-scale 3-D room model, a 2-D air supply diffuser model that supplies direction and magnitude of air flow into the room is developed. Air distribution effect on thermal comfort parameters was investigated depending on changing the air supply diffusers type, angles and velocity. Air supply diffusers locations and numbers were also investigated. The pre-processor Gambit is used to create the geometric model with parametric features. Commercially available simulation software “Fluent 6.3” is incorporated to solve the differential equations governing the conservation of mass, three momentum and energy in the processing of air flow distribution. Turbulence effects of the flow are represented by the well-developed two equation turbulence model. In this work, the so-called standard k-ε turbulence model, one of the most widespread turbulence models for industrial applications, was utilized. Basic parameters included in this work are air dry bulb temperature, air velocity, relative humidity and turbulence parameters are used for numerical predictions of indoor air distribution and thermal comfort. The thermal comfort predictions through this work were based on ADPI (Air Diffusion Performance Index),the PMV (Predicted Mean Vote) model and the PPD (Percentage People Dissatisfied) model, the PMV and PPD were estimated using Fanger’s model.

Keywords: thermal comfort, Fanger's model, ADPI, energy effeciency

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Authors: Justine Cyril E. Nunag, Nestor B. Sabado Jr., Jienne Chester M. Tolosa

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Concrete has high compressive strength but a low-tension strength. The small tensile strength of concrete is regarded as its primary weakness, which is why it is typically reinforced with steel, a material that is resistant to tension. Even with steel, however, cracking can occur. In strengthening concrete, only a few researchers have modified the water to be used in a concrete mix. This study aims to compare the split tensile strength of normal structural concrete to concrete prepared with magnetic water and a quick setting admixture. In this context, magnetic water is defined as tap water that has undergone a magnetic process to become magnetized water. To test the hypothesis that magnetized concrete leads to higher split tensile strength, twenty concrete specimens were made. There were five groups, each with five samples, that were differentiated by the number of cycles (0, 50, 100, and 150). The data from the Universal Testing Machine's split tensile strength were then analyzed using various statistical models and tests to determine the significant effect of magnetized water. The result showed a moderate (+0.579) but still significant degree of correlation. The researchers also discovered that using magnetic water for 50 cycles did not result in a significant increase in the concrete's split tensile strength, which influenced the analysis of variance. These results suggest that a concrete mix containing magnetic water and a quick-setting admixture alters the typical split tensile strength of normal concrete. Magnetic water has a significant impact on concrete tensile strength. The hardness property of magnetic water influenced the split tensile strength of concrete. In addition, a higher number of cycles results in a strong water magnetism. The laboratory test results show that a higher cycle translates to a higher tensile strength.

Keywords: hardness property, magnetic water, quick-setting admixture, split tensile strength, universal testing machine

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Authors: Kebede Gamo Sebehanie, Olu Emmanuel Femi, Alberto Velázquez Del Rosario, Abubeker Yimam Ali, Gudeta Jafo Muleta

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Water pollution is one of the most serious worldwide issues today. Among water pollution, heavy metals are becoming a concern to the environment and human health due to their non-biodegradability and bioaccumulation. In this study, a magnetite-cellulose nanocomposite derived from renewable resources is employed for hexavalent chromium elimination by adsorption. Magnetite nanoparticles were synthesized directly from iron ore using solvent extraction and co-precipitation technique. Cellulose nanofiber was extracted from sugarcane bagasse using the alkaline treatment and acid hydrolysis method. Before and after the adsorption process, the MNPs-CNF composites were evaluated using X-ray diffraction (XRD), Scanning electron microscope (SEM), Fourier transform infrared (FTIR), and Vibrator sample magnetometer (VSM), and Thermogravimetric analysis (TGA). The impacts of several parameters such as pH, contact time, initial pollutant concentration, and adsorbent dose on adsorption efficiency and capacity were examined. The kinetic and isotherm adsorption of Cr (VI) was also studied. The highest removal was obtained at pH 3, and it took 80 minutes to establish adsorption equilibrium. The Langmuir and Freundlich isotherm models were used, and the experimental data fit well with the Langmuir model, which has a maximum adsorption capacity of 8.27 mg/g. The kinetic study of the adsorption process using pseudo-first-order and pseudo-second-order equations revealed that the pseudo-second-order equation was more suited for representing the adsorption kinetic data. Based on the findings, pure MNPs and MNPs-CNF nanocomposites could be used as effective adsorbents for the removal of Cr (VI) from wastewater.

Keywords: magnetite-cellulose nanocomposite, hexavalent chromium, adsorption, sugarcane bagasse

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Authors: Samane Eftekhari Ranjbar

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Diabetes mellitus, a metabolic disorder characterized by elevated blood glucose levels, ranks among the leading causes of adult mortality. This study investigates the impact of an eight-week high-intensity interval training (HIIT) program combined with sodium nitrite supplementation on TNF- α, MURF1, and PI3K in a type 2 diabetes rodent model. Elevated TNF-α levels have been associated with insulin resistance, while MURF1 and PI3K play roles in muscle atrophy and insulin signaling pathways, respectively. In this experimental study, 15 eight-week-old rats from the Sara Laboratory Center in Tabriz were assigned to one of five groups: healthy control, diabetic control, diabetic with sodium nitrite supplementation, diabetic with eight weeks of intermittent exercise, and diabetic with eight weeks of interval training plus sodium nitrite supplementation. The HIIT protocol was designed to span eight weeks, with five weekly sessions at specified intensities and durations. Sodium nitrite, known for its vasodilatory and cytoprotective properties, was administered via injection. The findings revealed that the HIIT program and sodium nitrite supplementation influenced the examined biomarkers. ANOVA test outcomes indicated statistically significant differences in TNF- α (P=0.001), MURF1 (P=0.001), and PI3K (P=0.001) concentrations among the various groups. The healthy control group exhibited substantially decreased TNF- α, and MURF1 levels, as well as elevated PI3K levels compared to the diabetic control group. The exercise group, in conjunction with sodium nitrite supplementation, demonstrated a significant rise in PI3K levels (P=0.001) and a decline in TNF- α levels (P=0.018) relative to the diabetic control group. These results suggest that the combined intervention may help improve insulin sensitivity and reduce inflammation. However, MURF1 levels, which are related to muscle atrophy, showed no significant difference (P=0.24). In conclusion, in type 2 diabetic rats, an eight-week high-intensity interval training program with sodium nitrite supplementation does not affect MURF1 levels but does influence PI3K and TNF- α levels. This combination may hold potential for improving insulin sensitivity and reducing inflammation in type 2 diabetes patients, warranting further investigation and potential translation to human clinical trials.

Keywords: high-intensity interval training, sodium nitrate supplementation, type 2 diabetes, tumor necrosis factor-alpha, phosphatidylinositol-3-kinase, muscle RING-finger protein-1

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Authors: Shaban Saad, Syed Ahmed, Suher Aburawi, Isabel Fong

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Ruta graveolens is a plant commonly found in north Africa and south Europe. It is reported that Ruta graveolens is used traditionally for epilepsy and some other illnesses. The acute and sub-acute effects of alcoholic extract residue were tested for possible anti-epileptic and skeletal muscle relaxation activity. The effect of extract on rat spontaneous motor activity (SMA) was also investigated using open filed. We previously proved the anti convulsant activity of the plant against pentylenetetrazol and electrically induced convulsions. Therefore in this study strychnine was used to induce convulsions in order to explore the mechanism of anti-convulsant activity of the plant. The skeletal muscle relaxation activity of Ruta graveolens was studied using pull-up and rod hanging tests in rats. At concentration of 5%w/v the extract protected mice against strychnine induced myoclonic jerks and death. The pull-up and rod hanging tests pointed to a skeletal muscle relaxant activity at higher concentrations. Ruta graveolens extract also significantly decreased the number of squares visited by rats in open field apparatus at all tested concentrations (3.5-20%w/v). However, the significant decrease in number of rearings was only noticed at concentrations of (15 and 20%w/v). The results indicate that Ruta graveolens contains compound(s) capable to inhibit convulsions, decrease SMA and/or diminish skeletal muscle tone in animal models. This data and the previously generated data together point to a general depression trend of CNS produced by Ruta graveolens.

Keywords: Ruta graveolens, open field, skeletal muscle relaxation

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Authors: Silvano Salvador, Maryam Zarrinderakht, Alan Martin

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Open pits, which are the result of mining, are filled by water over time until the water reaches the elevation of the local water table and generates mine pit lakes. There are several specific regulations about the water quality of pit lakes, and mining operations should keep the quality of groundwater above pre-defined standards. Therefore, an accurate, acceptable numerical model predicting pit lakes’ water balance and water quality is needed in advance of mine excavation. We carry on analyzing and developing the model introduced by Crusius, Dunbar, et al. (2002) for pit lakes. This model, called “PitMod”, simulates the physical and geochemical evolution of pit lakes over time scales ranging from a few months up to a century or more. Here, a lake is approximated as one-dimensional, horizontally averaged vertical layers. PitMod calculates the time-dependent vertical distribution of physical and geochemical pit lake properties, like temperature, salinity, conductivity, pH, trace metals, and dissolved oxygen, within each model layer. This model considers the effect of pit morphology, climate data, multiple surface and subsurface (groundwater) inflows/outflows, precipitation/evaporation, surface ice formation/melting, vertical mixing due to surface wind stress, convection, background turbulence and equilibrium geochemistry using PHREEQC and linking that to the geochemical reactions. PitMod, which is used and validated in over 50 mines projects since 2002, incorporates physical processes like those found in other lake models such as DYRESM (Imerito 2007). However, unlike DYRESM PitMod also includes geochemical processes, pit wall runoff, and other effects. In addition, PitMod is actively under development and can be customized as required for a particular site.

Keywords: pit lakes, mining, modeling, hydrology

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Authors: Matheus Borges Carneiro, Fabiane Leticia Lizarelli, José Carlos De Toledo

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The evolution of quality management by companies was strongly enabled by, among others, ISO 9001 certification, which is considered a crucial requirement for several customers. Likewise, performance measurement provides useful insights for companies to identify the reflection of their decision-making process on their improvement. One of the most used performance measurement models is the balanced scorecard (BSC), which uses four perspectives to address a firm’s performance: financial, internal process, customer satisfaction, and learning and growth. Studies related to ISO 9001 and business performance have mostly adopted a quantitative approach to identify the standard’s causal effect on a firm’s performance. However, to verify how this influence may occur, an in-depth analysis within a qualitative approach is required. Therefore, this paper aims to verify the impact of ISO 9001:2015 on Brazilian firms’ performance based on the balanced scorecard perspective. Hence, nine certified companies located in the Southeast region of Brazil were studied through a multiple case study approach. Within this study, it was possible to identify the positive impact of ISO 9001 on firms’ overall performance, and four Critical Success Factors (CSFs) were identified as relevant on the linkage among ISO 9001 and firms’ performance: employee involvement, top management, process management, and customer focus. Due to the COVID-19 pandemic, the number of interviews was limited to the quality manager specialist, and the sample was limited since several companies were closed during the period of the study. This study presents an in-depth analysis of how the relationship between ISO 9001 certification and firms’ performance in a developing country is.

Keywords: balanced scorecard, Brazilian firms’ performance, critical success factors, ISO 9001 certification, performance measurement

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Authors: Mahsa Houshdar, Seyed Mehdi Samimi Ardestani , ُSeyed Saeed Sadr

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Introduction: Online Medicare is a method in which parts of a medical process - whether its diagnostics, monitoring or the treatment itself will be done by using online services. This system has been operated in one boy’s high school, one girl’s high school and one high school in deprived aria. Method: At the first step the students registered for using the system. It was not mandatory and not free. They participated in estimating depression scale, anxiety scale and clinical interview by online medical care system. During this estimation, we could find the existence and severity of depression and anxiety in each one of the participants, also we could find the consequent needs of each one, such as supportive therapy in mild depression or anxiety, need to visited by psychologist in moderate cases, need to visited by psychiatrist in moderate-severe cases, need to visited by psychiatrist and psychologist in severe cases and need to perform medical lab examination tests. The lab examination tests were performed on persons specified by the system. The lab examinations were included: serum level of vitamin D, serum level of vitamin B12, serum level of calcium, fasting blood sugar, HbA1c, thyroid function tests and CBC. All of the students were solely treated by vitamins or minerals therapy and/ or treatment of medical problem (such as hypothyroidism). After a few months, we came back to high schools and estimated the existence and severity of depression and anxiety in treated students. With comparing these results, the affectability of the system could be prof. Results: Totally, we operate this project in 1077 participants in 243 of participant, the lab examination test were performed. In girls high schools: the existence and severity of depression significantly deceased (P value= 0.018<0.05 & P value 0.004< 0.05), but results about anxiety was not significant. In boys high schools: the existence and severity of depression significantly decreased (P value= 0.023<0.05 & P value = 0.004< 0.05 & P value= 0.049< 0.05). In boys high schools: the existence and severity of anxiety significantly decreased (P value= 0.041<0.05 & P value = 0.046< 0.05 &) but in one high school results about anxiety was not significant. In high school in deprived area the students did not have any problem paying for participating in the project, but they could not pay for medical lab examination tests. Thus, operation of the system was not possible in deprived area without a sponsor. Conclusion: This online medical system was successful in creating medical and psychiatric profile without attending physician. It was successful in decreasing depression without using antidepressants, but it was partially successful in decreasing anxiety.

Keywords: depression, diabetes, online medicare, vitamin D deficiency

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Authors: Franklin Chu Buh, Irene Ule Ngole Sumbele, Andrew I. R. Maas, Mathieu Motah, Jogi V. Pattisapu, Eric Youm, Basil Kum Meh, Firas H. Kobeissy, Kevin W. Wang, Peter J. A. Hutchinson, Germain Sotoing Taiwe

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Introduction: Studying TBI characteristics and their relation to outcomes can identify initiatives to improve TBI prevention and care. The objective of this study was to define the features and outcomes of TBI patients seen over a 1-year period in a level-I trauma center in Cameroon. Methods: Data on demographics, causes, injury mechanisms, clinical aspects, and discharge status were prospectively collected over a period of 12 months. The Glasgow Outcome Scale-Extended (GOSE) and the Quality of Life Questionnaire after Brain Injury (QoLIBRI) were used to evaluate outcomes 6-months after TBI. Categorical variables were described as frequencies and percentages. Comparisons between 2 categorical variables were done using Pearson's Chi-square test or Fisher's exact test. Results: A total of 160 TBI patients participated in the study. The age group 15-45 years (78%; 125) was most represented. Males were more affected (90%; 144). Low educational level was recorded in 122 (76%) cases. Road traffic incidents (RTI) were the main cause of TBI (85%), with professional bike riders being frequently involved (27%, 43/160). Assaults (7.5%) and falls (2.5%) represent the second and third most common causes of TBI in Cameroon, respectively. Only 15 patients were transported to the hospital by ambulance, and 14 of these were from a referring hospital. CT-imaging was performed in 78% (125/160) of cases intracranial traumatic abnormality was identified in 77/125 (64%) cases. Financial constraints were the main reason for not performing a CT scan on 35 patients. A total of 46 (33%) patients were discharged against medical advice (DAMA) due to financial constraints. Mortality was 14% (22/160) but disproportionately high in patients with severe TBI (46%). DAMA had poor outcomes with QoLIBRI. Only 4 patients received post-injury physiotherapy services. Conclusion: TBI in Cameroon mainly results from RTIs and commonly affects young adult males, and low educational or socioeconomic status and commercial bike riding appear to be predisposing factors. Lack of pre-hospital care, financial constraints limiting both CT-scanning and medical care, and lack of acute physiotherapy services likely influenced care and outcomes adversely.

Keywords: characteristics, traumatic brain injury, outcome, disparities in care, prospective study

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Authors: Sahani Rathnasiri, Pritee Ray, Sardar M. N. Isalm, Carlos A. Vega-Mejia

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This study develops a cooperative game theory-based cost-sharing contract model for a business to consumer (B2C) e-commerce supply chain to minimize the overall supply chain costs and the individual costs within an information asymmetry scenario. The objective of this study is to address the issues of strategic interactions among the key players of the e-commerce supply chain operation, which impedes the optimal operational outcomes. Game theory has been included in the field of supply chain management to resolve strategic decision-making issues; however, most of the studies are limited only to two-echelons of the supply chains. Multi-echelon supply chain optimizations based on game-theoretic models are less explored in the previous literature. This study adopts a cooperative game model to focus on the common payoff of operations and addresses the issues of information asymmetry and coordination of a three-echelon e-commerce supply chain. The cost-sharing contract model integrates operational features such as production, inventory management and distribution with the contract related constraints. The outcomes of the model highlight the importance of maintaining lower operational costs by all players to obtain benefits from the cost-sharing contract. Further, the cost-sharing contract ensures true cost revelation, and hence eliminates the information asymmetry issues among the players. Comparing the results of the contract model with the de-centralized e-commerce supply chain operation further emphasizes that the cost-sharing contract derives Pareto-improved outcomes and minimizes the costs of overall e-commerce supply chain operation.

Keywords: cooperative game theory, cost-sharing contract, e-commerce supply chain, information asymmetry

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