Search results for: real time expression
Commenced in January 2007
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Edition: International
Paper Count: 21837

Search results for: real time expression

12177 Use of Misoprostol in Pregnancy Termination in the Third Trimester: Oral versus Vaginal Route

Authors: Saimir Cenameri, Arjana Tereziu, Kastriot Dallaku

Abstract:

Introduction: Intra-uterine death is a common problem in obstetrical practice, and can lead to complications if left to resolve spontaneously. The cervix is unprepared, making inducing of labor difficult. Misoprostol is a synthetic prostaglandin E1 analogue, inexpensive, and is presented valid thanks to its ability to bring about changes in the cervix that lead to the induction of uterine contractions. Misoprostol is quickly absorbed when taken orally, resulting in high initial peak serum concentrations compared with the vaginal route. The vaginal misoprostol peak serum concentration is not as high and demonstrates a more gradual serum concentration decline. This is associated with many benefits for the patient; fast induction of labor; smaller doses; and fewer side effects (dose-depended). Mostly it has been used the regime of 50 μg/4 hour, with a high percentage of success and limited side effects. Objective: Evaluation of the efficiency of the use of oral and vaginal misoprostol in inducing labor, and comparing it with its use not by a previously defined protocol. Methods: Participants in this study included patients at U.H.O.G. 'Koco Gliozheni', Tirana from April 2004-July 2006, presenting with an indication for inducing labor in the third trimester for pregnancy termination. A total of 37 patients were randomly admitted for birth inducing activity, according to protocol (26), oral or vaginal protocol (10 vs. 16), and a control group (11), not subject to the protocol, was created. Oral or vaginal misoprostol was administered at a dose of 50 μg/4 h, while the fourth group participants were treated individually by the members of the medical staff. The main result of interest was the time between induction of labor to birth. Kruskal-Wallis test was used to compare the average age, parity, women weight, gestational age, Bishop's score, the size of the uterus and weight of the fetus between the four groups in the study. The Fisher exact test was used to compare day-stay and causes in the four groups. Mann-Whitney test was used to compare the time of the expulsion and the number of doses between oral and vaginal group. For all statistical tests used, the value of P ≤ 0.05 was considered statistically significant. Results: The four groups were comparable with regard to woman age and weight, parity, abortion indication, Bishop's score, fetal weight and the gestational age. There was significant difference in the percentage of deliveries within 24 hours. The average time from induction to birth per route (vaginal, oral, according to protocol and not according to the protocol) was respectively; 10.43h; 21.10h; 15.77h, 21.57h. There was no difference in maternal complications in groups. Conclusions: Use of vaginal misoprostol for inducing labor in the third trimester for termination of pregnancy appears to be more effective than the oral route, and even more to uses not according to the protocols approved before, where complications are greater and unjustified.

Keywords: inducing labor, misoprostol, pregnancy termination, third trimester

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12176 Assessment of the Road Safety Performance in National Scale

Authors: Abeer K. Jameel, Harry Evdorides

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The Assessment of the road safety performance is a challengeable issue. This is not only because of the ineffective and unreliability of road and traffic crash data system but also because of its systematic character. Recent strategic plans and interventions implemented in some of the developed countries where a significant decline in the rate of traffic and road crashes considers that the road safety is a system. This system consists of four main elements which are: road user, road infrastructure, vehicles and speed in addition to other supporting elements such as the institutional framework and post-crash care system. To assess the performance of a system, it is required to assess all its elements. To present an understandable results of the assessment, it is required to present a unique term representing the performance of the overall system. This paper aims to develop an overall performance indicator which may be used to assess the road safety system. The variables of this indicators are the main elements of the road safety system. The data regarding these variables will be collected from the World Health Organization report. Multi-criteria analysis method is used to aggregate the four sub-indicators for the four variables. Two weighting methods will be assumed, equal weights and different weights. For the different weights method, the factor analysis method is used. The weights then will be converting to scores. The total score will be the overall indicator for the road safety performance in a national scale. This indicator will be used to compare and rank countries according to their road safety performance indicator. The country with the higher score is the country which provides most sustainable and effective interventions for successful road safety system. These indicator will be tested by comparing them with the aggregate real crash rate for each country.

Keywords: factor analysis, Multi-criteria analysis, road safety assessment, safe system indicator

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12175 Performance and Structural Evaluation of the Torrefaction of Bamboo under a High Gravity (Higee) Environment Using a Rotating Packed Bed

Authors: Mark Daniel De Luna, Ma. Katreena Pillejera, Wei-Hsin Chen

Abstract:

The raw bamboo (Phyllostachys mankinoi), with a moisture content of 13.54 % and a higher heating value (HHV) of 17.657 MJ/kg, was subjected to torrefaction under a high gravity (higee) environment using a rotating packed bed. The performance of the higee torrefaction was explored in two parts: (1) effect of rotation and temperature and (2) effect of duration on the solid yield, HHV and energy yield. By statistical analyses, the results indicated that the rotation, temperature and their interaction has a significant effect on the three responses. Same remarks on the effect of duration where when the duration (temperature and rotation) increases, the HHV increases, while the solid yield and energy yield decreases. Graphical interpretations showed that at 300 °C, the rotating speed has no evident effect on the responses. At 30-min holding time, the highest HHV reached (28.389 MJ/kg) was obtained in the most severe torrefaction condition (the rotating speed at 1800 rpm and temperature at 300 °C) with an enhancement factor of HHV corresponding to 1.61 and an energy yield of 63.51%. Upon inspection, the recommended operating condition under a 30-min holding time is at 255 °C-1800 rpm since the enhancement factor of HHV (1.53), HHV (26.988 MJ/kg), and energy yield (65.21%) values are relatively close to that of the aforementioned torrefaction condition. The Van Krevelen diagram of the torrefied biomass showed that the ratios decrease as the torrefaction intensifies, hence improving the hydrophobicity of the product. The spreads of the results of the solid yield, enhancement factor (EF) of HHV, energy yield, and H/C and O/C ratios were in accordance with the trends of the responses. Overall, from the results presented, it can be concluded that the quality of the product from the process is at par to that of coal (i.e. HHV of coal is 21-35 MJ/kg). The Fourier transform infrared (FTIR) spectroscopy results indicated that cellulose and lignin may have been degraded at a lower temperature accompanied with a high rotating speed. The results suggested that torrefaction under higee environment indicates promising process for the utilization of bamboo.

Keywords: heat transfer, high gravity environment, FTIR, rotation, rotating speed, torrefaction

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12174 Monitoring and Management of Aquatic Macroinvertebrates for Determining the Level of Water Pollution Catchment Basin of Debed River, Armenia

Authors: Inga Badasyan

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Every year we do monitoring of water pollution of catchment basin of Debed River. Next, the Ministry of Nature Protection does modeling programme. Finely, we are managing the impact of water pollution in Debed river. Ecosystem technologies efficiency performance were estimated based on the physical, chemical, and macrobiological analyses of water on regular base between 2012 to 2015. Algae community composition was determined to assess the ecological status of Debed river, while vegetation was determined to assess biodiversity. Last time, experts werespeaking about global warming, which is having bad impact on the surface water, freshwater, etc. As, we know that global warming is caused by the current high levels of carbon dioxide in the water. Geochemical modelling is increasingly playing an important role in various areas of hydro sciences and earth sciences. Geochemical modelling of highly concentrated aqueous solutions represents an important topic in the study of many environments such as evaporation ponds, groundwater and soils in arid and semi-arid zones, costal aquifers, etc. The sampling time is important for benthic macroinvertebrates, for that reason we have chosen in the spring (abundant flow of the river, the beginning of the vegetation season) and autumn (the flow of river is scarce). The macroinvertebrates are good indicator for a chromic pollution and aquatic ecosystems. Results of our earlier investigations in the Debed river reservoirs clearly show that management problem of ecosystem reservoirs is topical. Research results can be applied to studies of monitoring water quality in the rivers and allow for rate changes and to predict possible future changes in the nature of the lake.

Keywords: ecohydrological monitoring, flood risk management, global warming, aquatic macroinvertebrates

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12173 Development of Electronic Waste Management Framework at College of Design Art, Design and Technology

Authors: Wafula Simon Peter, Kimuli Nabayego Ibtihal, Nabaggala Kimuli Nashua

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The worldwide use of information and communications technology (ICT) equipment and other electronic equipment is growing and consequently, there is a growing amount of equipment that becomes waste after its time in use. This growth is expected to accelerate since equipment lifetime decreases with time and growing consumption. As a result, e-waste is one of the fastest-growing waste streams globally. The United Nations University (UNU) calculates in its second Global E-waste Monitor 44.7 million metric tonnes (Mt) of e-waste were generated globally in 2016. The study population was 80 respondents, from which a sample of 69 respondents was selected using simple and purposive sampling techniques. This research was carried out to investigate the problem of e-waste and come up with a framework to improve e-waste management. The objective of the study was to develop a framework for improving e-waste management at the College of Engineering, Design, Art and Technology (CEDAT). This was achieved by breaking it down into specific objectives, and these included the establishment of the policy and other Regulatory frameworks being used in e-waste management at CEDAT, the determination of the effectiveness of the e-waste management practices at CEDAT, the establishment of the critical challenges constraining e-waste management at the College, development of a framework for e-waste management. The study reviewed the e-waste regulatory framework used at the college and then collected data which was used to come up with a framework. The study also established that weak policy and regulatory framework, lack of proper infrastructure, improper disposal of e-waste and a general lack of awareness of the e-waste and the magnitude of the problem are the critical challenges of e-waste management. In conclusion, the policy and regulatory framework should be revised, localized and strengthened to contextually address the problem. Awareness campaigns, the development of proper infrastructure and extensive research to establish the volumes and magnitude of the problems will come in handy. The study recommends a framework for the improvement of e-waste.

Keywords: e-waste, treatment, disposal, computers, model, management policy and guidelines

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12172 Highly-Efficient Photoreaction Using Microfluidic Device

Authors: Shigenori Togashi, Yukako Asano

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We developed an effective microfluidic device for photoreactions with low reflectance and good heat conductance. The performance of this microfluidic device was tested by carrying out a photoreactive synthesis of benzopinacol and acetone from benzophenone and 2-propanol. The yield reached 36% with an irradiation time of 469.2 s and was improved by more than 30% when compared to the values obtained by the batch method. Therefore, the microfluidic device was found to be effective for improving the yields of photoreactions.

Keywords: microfluidic device, photoreaction, black aluminum oxide, benzophenone, yield improvement

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12171 Antibiofilm Activities of Biogenic Silver Nanoparticles against Human Pathogenic Bacteria

Authors: Muhammad Shahzad Tufail, Iram Liaqat, Umer Sohail Meer, Muhammad Ishtaiq, Muhammad Sattar

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Nanotechnology is a vibrant field with numerous applications in many different branches of science and technology. Several methods are used to synthesize nanoparticles (NPs), which have multiple range of applications. Comparatively, the biogenic synthesis of NPs is a more economical and environmentally favourable method than the traditional chemical method. The current study aims to synthesize biogenically silver nanoparticles (AgNPs) using bacterial isolates. Four bacterial strains Escherichia coli (MT448673), Pseudomonas aeruginosa (MN900691), Bacillus subtilis (MN900684) and Bacillus licheniformis (MN900686) were used for the synthesis of AgNPs from silver nitrate (AgNO3) solution. The biofilm time kinetics of four bacterial isolates (P. aeruginosa, E. coli, B. licheniformis and B. subtilis) was analysed by incubating bacterial cultures at 37◦C in test tubes over a period of different time intervals i.e., 2, 3, 5 and 7 days following crystal violet staining method. All the four strains had ability to form strong biofilms between 48 to 72 hours of incubation. Two strains (B. subtilis and B. licheniformis) formed significant (p < 0.05) biofilm after 3 days of incubation period. The other two strains (E. coli and P. aeruginosa) showed strong biofilm formation after 2 days of incubation. Next, the antibiofilm activity of biogenically synthesized AgNPs (10 - 100 µgmL-1) was analysed against biofilm forming human pathogenic bacteria. Findings of the work revealed that 60-90% inhibition was observed at 60 µgmL-1 of AgNPs, while maximum inhibition (i.e.,100%) was found at highest concentration (90 µgmL-1). It was evident that highly significant (p < 0.05) decrease in biofilm formation was observed with increasing concentration of AgNPs.

Keywords: antibiofilm, biofilm formation, nanotechnology, pathogenic bacteria, silver nanoparticles

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12170 Impact of Entrepreneurship Education on Entrepreneurial Intention: A Case Study of Al Akhawayn University

Authors: Sara atibi, Azzeddine Atibi, Salim Ahmed, Khadija El Kababi

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Given the crucial impact of entrepreneurship on socio-economic development, nations are making various efforts to support and encourage it. Entrepreneurship education has proven to be a vital lever in stimulating business creation. This research is part of this dynamic, which is increasingly attracting the attention of educational policymakers. Indeed, entrepreneurship education provides students with the skills, knowledge, and motivation needed to succeed in various entrepreneurial contexts. it objective is to demonstrate the impact of entrepreneurship education on the development of entrepreneurial intention among students at Al Akhawayn University and to determine whether introducing this discipline at the secondary school level can strengthen this intention, with the aim of proposing measures to foster entrepreneurship. To achieve this objective, it conducted a literature review on entrepreneurship, entrepreneurial intention, and entrepreneurship education to draw from existing experiences in the field. it then carried out an exploratory study through a qualitative survey. it collected real data via an online questionnaire hosted on Google Drive. This questionnaire was tested on a sample of 100 students, adjusted, and validated by three university professors who are experts in the field, and then administered to the students of Al Akhawayn University. The results of our survey among students at Al Akhawayn University clearly show that the development of entrepreneurial intention increases among students who have taken entrepreneurship courses or participated in seminars, thus promoting business creation and entrepreneurship. A minority of these students still choose to work in the private or public sector; however, the majority express a strong desire to become entrepreneurs. We also noted that some students believe entrepreneurship depends solely on entrepreneurial training, while others think it relies on a combination of training, resources, and personal will.

Keywords: entrepreneurship education, entrepreneurial intention, business creation, al akhawayn university, secondary school curriculum

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12169 Potentialities of Onopordum Tauricum (Willd.) as Milk Clotting Agent

Authors: Massimo Mozzon, Nadia Raffaelli

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Proteases from herbs, woody plants, and trees are exploited for cheesemaking in several countries, especially in South Europe and West Africa. Particularly, “thistles” belonging to several genera within the Asteraceae family (Cynara, Silybum, Centaurea, Carlina, Cirsium, Onopordum) are traditionally used in Mediterranean countries for clotting raw ewe’s and goat’s milk. For the first time, the clotting performance of an aqueous extract from flowers of Onopordum tauricum Willd. (Taurian thistle, bull cottonthistle) were tested in milk of different origin (cow, goat, ewe). The vegetable material was collected in the Central Apennines range, between the Marche and Umbria regions. A response surface methodology (RSM) approach was used to study the effect of the curdling variables (temperature, pH, amount of enzymatic extract) on the technological performance of the thistle extract. A three-step procedure for the purification of the enzyme (ammonium sulphate precipitation, gel filtration and ion-exchange chromatography) was also carried out. The milk clotting activity (MCA) of O. tauricum crude extracts was strongly affected by temperature, pH and by the interaction between these two variables, according to a second-order response surface model, while the milk/coagulant ratio did not affect in a significant way the clotting properties. Experimental data showed that the addition of 10 mM CaCl2 reduced the clotting time of ewe’s, goat’s, and cow’s milk by about 3-fold, 8-fold, and 14-fold, respectively, at 35°C and pH 6.7-6.8. After purification, an enzymatic preparation very close to homogeneity was obtained, which showed a major band at about 30 kDa when analyzed by SDS-PAGE. The identity of the enzyme as an aspartic protease was confirmed by inhibition studies. Cheese-making trials were carried out to check the scale-up (1 to 5 L of milk; 37 °C; 10 mM CaCl2 fortification) and set the recipe: 35-45% of curd yields were recorded, according to curd cutting and pressing.

Keywords: milk clotting activity, Onopordum tauricum, plant proteases, vegetable rennet

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12168 3-D Modeling of Particle Size Reduction from Micro to Nano Scale Using Finite Difference Method

Authors: Himanshu Singh, Rishi Kant, Shantanu Bhattacharya

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This paper adopts a top-down approach for mathematical modeling to predict the size reduction from micro to nano-scale through persistent etching. The process is simulated using a finite difference approach. Previously, various researchers have simulated the etching process for 1-D and 2-D substrates. It consists of two processes: 1) Convection-Diffusion in the etchant domain; 2) Chemical reaction at the surface of the particle. Since the process requires analysis along moving boundary, partial differential equations involved cannot be solved using conventional methods. In 1-D, this problem is very similar to Stefan's problem of moving ice-water boundary. A fixed grid method using finite volume method is very popular for modelling of etching on a one and two dimensional substrate. Other popular approaches include moving grid method and level set method. In this method, finite difference method was used to discretize the spherical diffusion equation. Due to symmetrical distribution of etchant, the angular terms in the equation can be neglected. Concentration is assumed to be constant at the outer boundary. At the particle boundary, the concentration of the etchant is assumed to be zero since the rate of reaction is much faster than rate of diffusion. The rate of reaction is proportional to the velocity of the moving boundary of the particle. Modelling of the above reaction was carried out using Matlab. The initial particle size was taken to be 50 microns. The density, molecular weight and diffusion coefficient of the substrate were taken as 2.1 gm/cm3, 60 and 10-5 cm2/s respectively. The etch-rate was found to decline initially and it gradually became constant at 0.02µ/s (1.2µ/min). The concentration profile was plotted along with space at different time intervals. Initially, a sudden drop is observed at the particle boundary due to high-etch rate. This change becomes more gradual with time due to declination of etch rate.

Keywords: particle size reduction, micromixer, FDM modelling, wet etching

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12167 Image Segmentation Using 2-D Histogram in RGB Color Space in Digital Libraries

Authors: El Asnaoui Khalid, Aksasse Brahim, Ouanan Mohammed

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This paper presents an unsupervised color image segmentation method. It is based on a hierarchical analysis of 2-D histogram in RGB color space. This histogram minimizes storage space of images and thus facilitates the operations between them. The improved segmentation approach shows a better identification of objects in a color image and, at the same time, the system is fast.

Keywords: image segmentation, hierarchical analysis, 2-D histogram, classification

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12166 The Importance of Development Evaluation to Preterm Children in Remote Area

Authors: Chung-Yuan Wang, Min Hsu, Bo-Ya Juan, Hsiv Ching Lin, Hsveh Min Lin, Hsiu-Fang Yeh

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The success of Taiwan's National Health Insurance (NHI) system attracts widespread praise from the international society. However, the availability of medical care in a emote area is limited. Without the convenient public transportation system and mature social welfare policy, these people are difficult to regain their health and prevent disability. Preterm children have more risk to get development delay. Preterm children in a remote area have the human right to get rehabilitation resources as those in the city area. Therefore, the aim of this study was to show the importance of development screening to preterm children in a remote area and a tract the government to notice the issue. In Pingtung, children who are suspected development delay would be suggested to take a skillful screening evaluation in our hospital. Those preterm children (within 1-year-old) visited our pediatric clinic would also be referred to take the development evaluation. After the physiatrist’s systemic evaluation, the subjects would be scheduled to take the development evaluation. Gross motor, fine motor, speech comprehension/expression and mental study were included. The evaluation was in-charged by a physical therapist, occupational therapy, speech therapist and pediatric psychologist. The tools were Peabody developmental scale, Bayley Scales of Infant and Toddler Development (Bayley-III) and Wechsler Preschool & Primary Scale of Intelligence-Revised (WPPSI-R). In 2013, 459 children received the service in our hospital. Among these children, fifty-seven were noted with preterm baby history (gestation within 37 weeks). Thirty-six of these preterm children, who had never receive development evaluation, were included in this study. Thirty-six subjects (twenty-six male and ten female) were included. Nineteen subjects were found development delay. Six subjects were found suspected development delay. In gross motor, six subjects were development delay and eight were suspected development delay. In fine motor, five subjects were development delay and three were suspected development delay. In speech, sixteen subjects were development delay and six were suspected development delay. In our study, through the provision of development evaluation service, 72.2% preterm baby were found their development delay or suspected delay. They need further early intervention rehabilitation service. We made their parents realize that when development delay was recognized at the early stage, they are often reversible. No only the patients but also their families were improved their health status. The number of the subjects was limited in our study. Further study might be needed. Compared with 770 physical therapist (PT) and 370 occupational therapy (OT) in Taipei, there are only 108 PT and 54 OT in Pingtung. Further, there are much fewer therapists working on the field of pediatric rehabilitation. Living healthy is a human's right, no matter where does he live. For those development delay children in remote area, particularly preterm children, early detection, and early intervention rehabilitation service could play an important role in decreasing their disability and improving their quality of life. Through this study, we suggest the government to add more national resources on the development evaluation to preterm children in a remote area.

Keywords: development, early intervention, preterm children, rehabilitation

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12165 Prospective Cohort Study on Sequential Use of Catheter with Misoprostol vs Misoprostol Alone for Second Trimester Medical Abortion

Authors: Hanna Teklu Gebregziabher

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Background: A variety of techniques for medical termination of second-trimester pregnancy can be used, but there is no consensus about which is the best. Even though most evidence suggests the combined use of intracervical Foley catheter and vaginal misoprostol is safe, effective, and acceptable method for termination of second-trimester pregnancy, which is comparable to mifepristone-misoprostol combination regimen with lower cost and no additional maternal risks. The use of mifepristone and misoprostol alone with no other procedure is still the most common procedure in different institutions for 2nd-trimester pregnancy. Methods: A cross-sectional comparative prospective study design is employed on women who were admitted for 2nd-trimester medical abortion and medical abortion failed or if there was no change in cervical status after 24 hours of 1st dose of misoprostol. The study was conducted at St. Paulose Hospital Millennium Medical College. A sample of 44 participants in each arm was necessary to give a two-tailed test, a type 1 error of 5%, 80% statistical power, and a 1:1 ratio among groups. Thus, a total of 94 cases, 47 from each arm, were recruited. Data was entered and cleaned by using Epi-info and analyzed using SPSS version 29.0 statistical software and was presented in descriptive and tabular forms. Different variables were cross-tabulated and compared for significant differences and statistical analysis using the chi-square test and independent t-test, to conclude. Result: There was a significant difference between the two groups on induction to expulsion time and number of doses used. The mean ± SD of induction to expulsion time for those used misoprostol alone was 48.09 ± 11.86 and those who used trans-cervical catheter sequentially with misoprostol were 36.7 ±6.772. Conclusion: The use of a trans-cervical Foley catheter in conjunction with misoprostol in a sequential manner is a more effective, safe, and easily accessible procedure. In addition, the cost of utilizing the catheter is less compared to the cost of misoprostol and is readily available. As a good substitute, we advised using Trans-cervical Catether even for medical abortions performed in the second trimester.

Keywords: second trimester, medical abortion, catheter, misoprostol

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12164 Conduction Transfer Functions for the Calculation of Heat Demands in Heavyweight Facade Systems

Authors: Mergim Gasia, Bojan Milovanovica, Sanjin Gumbarevic

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Better energy performance of the building envelope is one of the most important aspects of energy savings if the goals set by the European Union are to be achieved in the future. Dynamic heat transfer simulations are being used for the calculation of building energy consumption because they give more realistic energy demands compared to the stationary calculations that do not take the building’s thermal mass into account. Software used for these dynamic simulation use methods that are based on the analytical models since numerical models are insufficient for longer periods. The analytical models used in this research fall in the category of the conduction transfer functions (CTFs). Two methods for calculating the CTFs covered by this research are the Laplace method and the State-Space method. The literature review showed that the main disadvantage of these methods is that they are inadequate for heavyweight façade elements and shorter time periods used for the calculation. The algorithms for both the Laplace and State-Space methods are implemented in Mathematica, and the results are compared to the results from EnergyPlus and TRNSYS since these software use similar algorithms for the calculation of the building’s energy demand. This research aims to check the efficiency of the Laplace and the State-Space method for calculating the building’s energy demand for heavyweight building elements and shorter sampling time, and it also gives the means for the improvement of the algorithms used by these methods. As the reference point for the boundary heat flux density, the finite difference method (FDM) is used. Even though the dynamic heat transfer simulations are superior to the calculation based on the stationary boundary conditions, they have their limitations and will give unsatisfactory results if not properly used.

Keywords: Laplace method, state-space method, conduction transfer functions, finite difference method

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12163 The Effect of Antibiotic Use on Blood Cultures: Implications for Future Policy

Authors: Avirup Chowdhury, Angus K. McFadyen, Linsey Batchelor

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Blood cultures (BCs) are an important aspect of management of the septic patient, identifying the underlying pathogen and its antibiotic sensitivities. However, while the current literature outlines indications for initial BCs to be taken, there is little guidance for repeat sampling in the following 5-day period and little information on how antibiotic use can affect the usefulness of this investigation. A retrospective cohort study was conducted using inpatients who had undergone 2 or more BCs within 5 days between April 2016 and April 2017 at a 400-bed hospital in the west of Scotland and received antibiotic therapy between the first and second BCs. The data for BC sampling was collected from the electronic microbiology database, and cross-referenced with data from the hospital electronic prescribing system. Overall, 283 BCs were included in the study, taken from 92 patients (mean 3.08 cultures per patient, range 2-10). All 92 patients had initial BCs, of which 83 were positive (90%). 65 had a further sample within 24 hours of commencement of antibiotics, with 35 positive (54%). 23 had samples within 24-48 hours, with 4 (17%) positive; 12 patients had sampling at 48-72 hours, 12 at 72-96 hours, and 10 at 96-120 hours, with none positive. McNemar’s Exact Test was used to calculate statistical significance for patients who received blood cultures in multiple time blocks (Initial, < 24h, 24-120h, > 120h). For initial vs. < 24h-post BCs (53 patients tested), the proportion of positives fell from 46/53 to 29/53 (one-tailed P=0.002, OR 3.43, 95% CI 1.48-7.96). For initial vs 24-120h (n=42), the proportions were 38/42 and 4/42 respectively (P < 0.001, OR 35.0, 95% CI 4.79-255.48). For initial vs > 120h (n=36), these were 33/36 and 2/36 (P < 0.001,OR ∞). These were also calculated for a positive in initial or < 24h vs. 24-120h (n=42), with proportions of 41/42 and 4/42 (P < 0.001, OR 38.0, 95% CI 5.22-276.78); and for initial or < 24h vs > 120h (n=36), with proportions of 35/36 and 2/36 respectively (P < 0.001, OR ∞). This data appears to show that taking an initial BC followed by a BC within 24 hours of antibiotic commencement would maximise blood culture yield while minimising the risk of false negative results. This could potentially remove the need for as many as 46% of BC samples without adversely affecting patient care. BC yield decreases sharply after 48 hours of antibiotic use, and may not provide any clinically useful information after this time. Further multi-centre studies would validate these findings, and provide a foundation for future health policy generation.

Keywords: antibiotics, blood culture, efficacy, inpatient

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12162 Important Factors for Successful Solution of Emotional Situations: Empirical Study on Young People

Authors: R. Lekaviciene, D. Antiniene

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Attempts to split the construct of emotional intelligence (EI) into separate components – ability to understand own and others’ emotions and ability to control own and others’ emotions may be meaningful more theoretically than practically. In real life, a personality encounters various emotional situations that require exhibition of complex EI to solve them. Emotional situation solution tests enable measurement of such undivided EI. The object of the present study is to determine sociodemographic and other factors that are important for emotional situation solutions. The study involved 1,430 participants from various regions of Lithuania. The age of participants varied from 17 years to 27 years. Emotional social and interpersonal situation scale EI-DARL-V2 was used. Each situation had two mandatory answering formats: The first format contained assignments associated with hypothetical theoretical knowledge of how the situation should be solved, while the second format included the question of how the participant would personally resolve the given situation in reality. A questionnaire that contained various sociodemographic data of subjects was also presented. Factors, statistically significant for emotional situation solution, have been determined: gender, family structure, the subject’s relation with his or her mother, mother’s occupation, subjectively assessed financial situation of the family, level of education of the subjects and his or her parents, academic achievement, etc. The best solvers of emotional situations are women with high academic achievements. According to their chosen study profile/acquired profession, they are related to the fields in social sciences and humanities. The worst solvers of emotional situations are men raised in foster homes. They are/were bad students and mostly choose blue-collar professions.

Keywords: emotional intelligence, emotional situations, solution of situation, young people

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12161 Analysis of Rockfall Hazard along Himalayan Road Cut Slopes

Authors: Sarada Prasad Pradhan, Vikram Vishal, Tariq Siddique

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With a vast area of India comprising of hilly terrain and road cut slopes, landslides and rockfalls are a common phenomenon. However, while landslide studies have received much attention in the past in India, very little literature and analysis is available regarding rockfall hazard of many rockfall prone areas, specifically in Uttarakhand Himalaya, India. The subsequent lack of knowledge and understanding of the rockfall phenomenon as well as frequent incidences of rockfall led fatalities urge the necessity of conducting site-specific rockfall studies to highlight the importance of addressing this issue as well as to provide data for safe design of preventive structures. The present study has been conducted across 10 rockfall prone road cut slopes for a distance of 15 km starting from Devprayag, India along National Highway 58 (NH-58). In order to make a qualitative assessment of Rockfall Hazard posed by these slopes, Rockfall Hazard Rating using standards for Indian Rockmass has been conducted at 10 locations under different slope conditions. Moreover, to accurately predict the characteristics of the possible rockfall phenomenon, numerical simulation was carried out to calculate the maximum bounce heights, total kinetic energies, translational velocities and trajectories of the falling rockmass blocks when simulated on each of these slopes according to real-life conditions. As it was observed that varying slope geometry had more fatal impacts on Rockfall hazard than size of rock masses, several optimizations have been suggested for each slope regarding location of barriers and modification of slope geometries in order to minimize damage by falling rocks. This study can be extremely useful in emphasizing the significance of rockfall studies and construction of mitigative barriers and structures along NH-58 around Devprayag.

Keywords: rockfall, slope stability, rockmass, hazard

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12160 Juvenile Justice in China: A Historical Approach

Authors: Xianlu Zeng

Abstract:

China has undergone rapid economic growth over the last three decades. During this time, China-focused study has become one of the most popular areas of research. However, even though China has one of the oldest legal traditions in the world, there is limited research available regarding the development and operation of China’s juvenile justice system. This article will provide general information about China’s juvenile justice tradition along with a review of its reformation in 2013. A discussion is presented that provides some thoughts about how successful these reforms have been and where China may need to head.

Keywords: China, history, juvenile justice, legal traditions

Procedia PDF Downloads 481
12159 Model for Calculating Traffic Mass and Deceleration Delays Based on Traffic Field Theory

Authors: Liu Canqi, Zeng Junsheng

Abstract:

This study identifies two typical bottlenecks that occur when a vehicle cannot change lanes: car following and car stopping. The ideas of traffic field and traffic mass are presented in this work. When there are other vehicles in front of the target vehicle within a particular distance, a force is created that affects the target vehicle's driving speed. The characteristics of the driver and the vehicle collectively determine the traffic mass; the driving speed of the vehicle and external variables have no bearing on this. From a physical level, this study examines the vehicle's bottleneck when following a car, identifies the outside factors that have an impact on how it drives, takes into account that the vehicle will transform kinetic energy into potential energy during deceleration, and builds a calculation model for traffic mass. The energy-time conversion coefficient is created from an economic standpoint utilizing the social average wage level and the average cost of motor fuel. Vissim simulation program measures the vehicle's deceleration distance and delays under the Wiedemann car-following model. The difference between the measured value of deceleration delay acquired by simulation and the theoretical value calculated by the model is compared using the conversion calculation model of traffic mass and deceleration delay. The experimental data demonstrate that the model is reliable since the error rate between the theoretical calculation value of the deceleration delay obtained by the model and the measured value of simulation results is less than 10%. The article's conclusion is that the traffic field has an impact on moving cars on the road and that physical and socioeconomic factors should be taken into account while studying vehicle-following behavior. The deceleration delay value of a vehicle's driving and traffic mass have a socioeconomic relationship that can be utilized to calculate the energy-time conversion coefficient when dealing with the bottleneck of cars stopping and starting.

Keywords: traffic field, social economics, traffic mass, bottleneck, deceleration delay

Procedia PDF Downloads 49
12158 Technological Developments to Reduce Wind Blade Turbine Levelized Cost of Energy

Authors: Pedro Miguel Cardoso Carneiro, Ricardo André Nunes Borges, João Pedro Soares Loureiro, Hermínio Maio Graça Fernandes

Abstract:

Wind energy has been exponentially growing over the last years and will allow countries to progress regarding the decarbonization objective. In parallel, the maintenance activities have also been increasing in consequence of ageing and deterioration of the wind farms. The time available for wind blade maintenance is given by the weather window that is based upon weather conditions. Most of the wind blade repair and maintenance activities require a narrow window of temperature and humidity. Due to this limitation, the current weather windows result only on approximately 35% days/year are used for maintenance, that takes place mostly during summertime. This limitation creates large economic losses in the energy production of the wind towers, since they can be inoperative or with the energy production output reduced for days or weeks due to existing damages. Another important aspect is that the maintenance costs are higher due to the high standby time and seasonality imposed on the technicians. To reduce the relevant maintenance costs of blades and energy loses some technological developments were carried out to significantly improve this reality. The focus of this activity was to develop a series of key developments to have in the near future a suspended access equipment that can operate in harsh conditions, wind rain, cold/hot environment. To this end we have identified key areas that need to be revised and require new solutions to be found; a habitat system, multi-configurable roof and floor, roof and floor interface to blade, secondary attachment solutions to the blade and to the tower. On this paper we will describe the advances produced during a national R&D project made in partnership with an end-user (Onrope) and a test center (ISQ).

Keywords: wind turbine maintenance, cost reduction, technological innovations, wind turbine blade

Procedia PDF Downloads 76
12157 The Effectiveness of Tehran Municipality's Transformation of a Metro Station into Pedestrian-Friendly Public Spaces

Authors: Homa Hedayat

Abstract:

Public spaces have been a central concern of urban planners for centuries but have been neglected for a long time. In the modernist planning, the focus has been on the requirements of cars rather than the needs and expectations of pedestrians, and therefore, cities have lost many qualities. Urban public space is a space within the city area which is accessible to all people and is the ground for their activity. People’s public life occurs in urban public spaces in a complex set of forms and functions. These spaces must facilitate diverse behavior, uses, and activities such as shopping, walking, conversation, entertainment, relaxation or even passing the time during festivities and events. One of the public spaces is the surrounding space of public transportation stations. Subway stations, although potentially encompass many different groups of people accommodate few social interactions. Making the surrounding areas of subway stations pedestrian-oriented, potentially increases the socialization capacity. The Sadeghieh Subway Station can be considered as the most important subway station in Tehran, which on the one hand is the rail port of Tehran's western entrance, and on the other is the port for railway journeys inside the city. The main concern of this study is to assess the success or failure of the interventions made by the municipality for changing the surrounding area of the Sadeghieh Subway Station into a pedestrian-oriented space and examine the amount of the area's improvement into a desirable space. The method used in this study is surveying, in which the data were collected using a questionnaire and interview. The study's population is all people who use Sadeghieh Subway, and the sample size for the study was 140 subjects. Using parametric one-sample t-test, we found improvement in factors such as transportation, security, pedestrian infrastructure, vitality and climate comfort. However, there was no improvement in mix use, recreational activity, readability.

Keywords: public space, public transportation stations, pedestrian-oriented space, socialization

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12156 Winning the Future of Education in Africa through Project Base Learning: How the Implementation of PBL Pedagogy Can Transform Africa’s Educational System from Theory Base to Practical Base in School Curriculum

Authors: Bismark Agbemble

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This paper talks about how project-based learning (PBL) is being infused or implemented in the educational sphere of Africa. The paper navigates through the liminal aspects of PBL as a pedagogical approach to bridge the divide between theoretical knowledge and its application within school curriculums. Given that contextualized learning can be embodied, the abstract vehemently discusses that PBL creates an opportunity for students to work on projects that are of academic relevance in their local settings. It presents PBL’s growth of critical thinking, problem-solving, cooperation, and communications, which is vital in getting young citizens to prepare for the 21st-century revolution. In addition, the abstract stresses the possibility that PBL could become a stimulus to creativity and innovation wherein learning becomes motivated from within by intrinsic motivations. The paper advocates for a holistic approach that is based on teacher’s professional development with the provision of adequate infrastructural facilities and resource allocation, thus ensuring the success and sustainability of PBLs in African education systems. In the end, the paper positions this as a transformative educational methodology that has great potential in helping to shape an African generation that is prepared for a great future.

Keywords: student centered pedagogy, constructivist learning theory, self-directed learning, active exploration, real world challenges, STEM, 21st century skills, curriculum design, classroom management, project base learning curriculum, global intelligence, social and communication skills, transferable skills, critical thinking, investigatable learning, life skills

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12155 Safety Assessment of Tuberous Roots of Boerhaavia diffusa Root Extract: Acute and Sub-Acute Toxicity Studies

Authors: Surender Singh, Yogendra Kumar Gupta

Abstract:

Boerhaavia diffusa (BD) Linn. belonging to family Nyctaginaceae is a herbaceous plant and known as ‘punarnava’ in Hindi, used as herbal medicine for pain relief and various ailments. It is widely used as a green leafy vegetable in many Asian and African countries. The objective of present study was to investigate potential adverse effects, if any, of standardized root extract of Boerhaavia diffusa in rats following subchronic administration. In acute toxicity study, no mortality was found at a dose of 2000mg/kg which indicates that oral LD50 of Boerhaavia diffusa root extract is more than 2000mg/kg. The chronic administration of Boerhaavia diffusa for 28 days at a dose of 1000mg/kg body weight did not produce any significant changes in hematological (RBC, WBC, platelets, hemoglobin, bleeding time, clotting time) and biochemical (triglycerides, blood glucose, high density lipoprotein, serum creatinine, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase) parameters of male and female rats as compared to normal control group. All the animals survived until the scheduled necropsy, and their physical and behavioral examinations did not reveal any treatment-related adverse effects. No pathological changes were observed in histological section of heart, kidney, liver, testis, ovaries and brain of Boerhaavia diffusa treated male and female rats as compared to normal control animals.These observations from oral acute toxicitystudy suggest that the extract is practically non-toxic. Thus, it can be inferred that the Boerhaavia diffusa root extract at levels up to 1000 mg/kg/day was found to be safe and does not cause adverse effects in rats. So, the no-observed effect level (NOAEL) of the extract was found to be 1000mg/kg/day.

Keywords: Boerhaavia diffusa, histology, toxicity, sub-acute

Procedia PDF Downloads 264
12154 Validation of the Formula for Air Attenuation Coefficient for Acoustic Scale Models

Authors: Katarzyna Baruch, Agata Szelag, Aleksandra Majchrzak, Tadeusz Kamisinski

Abstract:

Methodology of measurement of sound absorption coefficient in scaled models is based on the ISO 354 standard. The measurement is realised indirectly - the coefficient is calculated from the reverberation time of an empty chamber as well as a chamber with an inserted sample. It is crucial to maintain the atmospheric conditions stable during both measurements. Possible differences may be amended basing on the formulas for atmospheric attenuation coefficient α given in ISO 9613-1. Model studies require scaling particular factors in compliance with specified characteristic numbers. For absorption coefficient measurement, these are for example: frequency range or the value of attenuation coefficient m. Thanks to the possibilities of modern electroacoustic transducers, it is no longer a problem to scale the frequencies which have to be proportionally higher. However, it may be problematic to reduce values of the attenuation coefficient. It is practically obtained by drying the air down to a defined relative humidity. Despite the change of frequency range and relative humidity of the air, ISO 9613-1 standard still allows the calculation of the amendment for little differences of the atmospheric conditions in the chamber during measurements. The paper discusses a number of theoretical analyses and experimental measurements performed in order to obtain consistency between the values of attenuation coefficient calculated from the formulas given in the standard and by measurement. The authors performed measurements of reverberation time in a chamber made in a 1/8 scale in a corresponding frequency range, i.e. 800 Hz - 40 kHz and in different values of the relative air humidity (40% 5%). Based on the measurements, empirical values of attenuation coefficient were calculated and compared with theoretical ones. In general, the values correspond with each other, but for high frequencies and low values of relative air humidity the differences are significant. Those discrepancies may directly influence the values of measured sound absorption coefficient and cause errors. Therefore, the authors made an effort to determine an amendment minimizing described inaccuracy.

Keywords: air absorption correction, attenuation coefficient, dimensional analysis, model study, scaled modelling

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12153 Study of the Anaerobic Degradation Potential of High Strength Molasses Wastewater

Authors: M. Mischopoulou, P. Naidis, S. Kalamaras, T. Kotsopoulos, P. Samaras

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The treatment of high strength wastewater by an Upflow Anaerobic Sludge Blanket (UASB) reactor has several benefits, such as high organic removal efficiency, short hydraulic retention time along with low operating costs. In addition, high volumes of biogas are released in these reactors, which can be utilized in several industrial facilities for energy production. This study aims at the examination of the application potential of anaerobic treatment of wastewater, with high molasses content derived from yeast manufacturing, by a lab-scale UASB reactor. The molasses wastewater and the sludge used in the experiments were collected from the wastewater treatment plant of a baker’s yeast manufacturing company. The experimental set-up consisted of a 15 L thermostated UASB reactor at 37 ◦C. Before the reactor start-up, the reactor was filled with sludge and molasses wastewater at a ratio 1:1 v/v. Influent was fed to the reactor at a flowrate of 12 L/d, corresponding to a hydraulic residence time of about 30 h. Effluents were collected from the system outlet and were analyzed for the determination of the following parameters: COD, pH, total solids, volatile solids, ammonium, phosphates and total nitrogen according to the standard methods of analysis. In addition, volatile fatty acid (VFA) composition of the effluent was determined by a gas chromatograph equipped with a flame ionization detector (FID), as an indicator to evaluate the process efficiency. The volume of biogas generated in the reactor was daily measured by the water displacement method, while gas composition was analyzed by a gas chromatograph equipped with a thermal conductivity detector (TCD). The effluent quality was greatly enhanced due to the use of the UASB reactor and high rate of biogas production was observed. The anaerobic treatment of the molasses wastewater by the UASB reactor improved the biodegradation potential of the influent, resulting at high methane yields and an effluent with better quality than the raw wastewater.

Keywords: anaerobic digestion, biogas production, molasses wastewater, UASB reactor

Procedia PDF Downloads 263
12152 Experimental Investigations on Setting Behavior and Compreesive Strength of Flyash Based Geopolymer

Authors: Ishan Tank, Ashmita Rupal, Sanjay Kumar Sharma

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Concrete, a widely used building material, has cement as its main constituent. An excessive amount of emissions are released into the atmosphere during the manufacture of cement, which is detrimental to the environment. To minimize this problem, innovative materials like geopolymer mortar (GPM) seem to be a better alternative. By using fly ash-based geopolymer instead of standard cement mortar as a binding ingredient, this concept has been successfully applied to the building sector. The advancement of this technology significantly reduces greenhouse gas emissions and helps in source reduction, thereby minimizing pollution of the environment. In order to produce mortar and use this geopolymer mortar in the development of building materials, the current investigation is properly introducing this geopolymeric material, namely fly ash, as a binder in place of standard cement. In the domain of the building material industry, fly ash based geopolymer is a new and optimistic replacement for traditional binding materials because it is both environmentally sustainable and has good durability. The setting behaviour and strength characteristics of fly ash, when mixed with alkaline activator solution with varied concentration of sodium hydroxide solution, alkaline liquids mix ratio, and curing temperature, must be investigated, though, in order to determine its suitability and application in comparison with the traditional binding material, by activating the raw materials, which include various elements of silica and alumina, finer material known as geopolymer mortar is created. The concentration of the activator solution has an impact on the compressive strength of the geopolymer concrete formed. An experimental examination of compressive strength after 7, 14, and 28 days of fly ash-based geopolymer concrete is presented in this paper. Furthermore, the process of geopolymerization largely relies on the curing temperature. So, the setting time of Geopolymer mortar due to different curing temperatures has been studied and discussed in this paper.

Keywords: geopolymer mortar, setting time, flyash, compressive strength, binder material

Procedia PDF Downloads 51
12151 Recreation and Environmental Quality of Tropical Wetlands: A Social Media Based Spatial Analysis

Authors: Michael Sinclair, Andrea Ghermandi, Sheela A. Moses, Joseph Sabu

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Passively crowdsourced data, such as geotagged photographs from social media, represent an opportunistic source of location-based and time-specific behavioral data for ecosystem services analysis. Such data have innovative applications for environmental management and protection, which are replicable at wide spatial scales and in the context of both developed and developing countries. Here we test one such innovation, based on the analysis of the metadata of online geotagged photographs, to investigate the provision of recreational services by the entire network of wetland ecosystems in the state of Kerala, India. We estimate visitation to individual wetlands state-wide and extend, for the first time to a developing region, the emerging application of cultural ecosystem services modelling using data from social media. The impacts of restoration of wetland areal extension and water quality improvement are explored as a means to inform more sustainable management strategies. Findings show that improving water quality to a level suitable for the preservation of wildlife and fisheries could increase annual visits by 350,000, an increase of 13% in wetland visits state-wide, while restoring previously encroached wetland area could result in a 7% increase in annual visits, corresponding to 49,000 visitors, in the Ashtamudi and Vembanad lakes alone, two large coastal Ramsar wetlands in Kerala. We discuss how passive crowdsourcing of social media data has the potential to improve current ecosystem service analyses and environmental management practices also in the context of developing countries.

Keywords: coastal wetlands, cultural ecosystem services, India, passive crowdsourcing, social media, wetland restoration

Procedia PDF Downloads 139
12150 Collaboration During Planning and Reviewing in Writing: Effects on L2 Writing

Authors: Amal Sellami, Ahlem Ammar

Abstract:

Writing is acknowledged to be a cognitively demanding and complex task. Indeed, the writing process is composed of three iterative sub-processes, namely planning, translating (writing), and reviewing. Not only do second or foreign language learners need to write according to this process, but they also need to respect the norms and rules of language and writing in the text to-be-produced. Accordingly, researchers have suggested to approach writing as a collaborative task in order to al leviate its complexity. Consequently, collaboration has been implemented during the whole writing process or only during planning orreviewing. Researchers report that implementing collaboration during the whole process might be demanding in terms of time in comparison to individual writing tasks. Consequently, because of time constraints, teachers may avoid it. For this reason, it might be pedagogically more realistic to limit collaboration to one of the writing sub-processes(i.e., planning or reviewing). However, previous research implementing collaboration in planning or reviewing is limited and fails to explore the effects of the seconditionson the written text. Consequently, the present study examines the effects of collaboration in planning and collaboration in reviewing on the written text. To reach this objective, quantitative as well as qualitative methods are deployed to examine the written texts holistically and in terms of fluency, complexity, and accuracy. Participants of the study include 4 pairs in each group (n=8). They participated in two experimental conditions, which are: (1) collaborative planning followed by individual writing and individual reviewing and (2) individual planning followed by individual writing and collaborative reviewing. The comparative research findings indicate that while collaborative planning resulted in better overall text quality (precisely better content and organization ratings), better fluency, better complexity, and fewer lexical errors, collaborative reviewing produces better accuracy and less syntactical and mechanical errors. The discussion of the findings suggests the need to conduct more comparative research in order to further explore the effects of collaboration in planning or in reviewing. Pedagogical implications of the current study include advising teachers to choose between implementing collaboration in planning or in reviewing depending on their students’ need and what they need to improve.

Keywords: collaboration, writing, collaborative planning, collaborative reviewing

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12149 Gender Equality: A Constitutional Myth When Featured with Domestic Violence

Authors: Suja S. Nayar, Mayuri Pandya

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The foundation of legal system of any nation is its constitution and the strive to achieve equality amongst different classes prevailing in the social system. The most traditional form of inequality that is prevailing in the society is the gender inequality. The existence of inequality on the basis of gender prevails since the ancient era which has with the passing time merely continued and aggravated to a great extent. The founding fathers of our constitution were well aware of the then prevailing situation and being concerned about the future if this inequality continued to prevail, and in such view, the provisions of Article 14, 15, 38 and 44 of our Constitution were enacted with specific intent for the upliftment of women. The strive for equality is the rule of law embodied with the principle of foreseeability which is necessitated in the stability of justice system of any nation, and when it comes to equality, the first form of equality we need to achieve is gender equality. Time and again various initiatives have been announced and attempted to achieve the objective of gender equality, but analysis of the ground reality always have yielded disappointing results. The research that is proposed to be undertaken intends to cover all the above issues concerning the failures ineffective implementation of the gender-specific laws especially the provisions concerning the protection provided under Domestic Violence Act. The researchers will analyze the judgment of last five years' judgments of Supreme Court of India. In Hiral P. Harsora and ors. v Kusum Narottamdas Harsora and Ors. the Hon'ble Supreme Court recently deleting the words 'adult male' from the definition of respondent disclosed it is intent and understanding that domestic violence is being caused by a female on female also and not only restricted to males on females only. The procedure as prescribed under the act for claiming reliefs though is as per the criminal mandate, but the reliefs are of civil nature and so same needs to deal emphatically which now makes it a lengthier process. The pros and cons of such pronouncements are being weighed on the balance of constitution and social equality that is strived by the entire women fraternity.

Keywords: domestic, violence, constitution, gender, equality, women

Procedia PDF Downloads 492
12148 Bias-Corrected Estimation Methods for Receiver Operating Characteristic Surface

Authors: Khanh To Duc, Monica Chiogna, Gianfranco Adimari

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With three diagnostic categories, assessment of the performance of diagnostic tests is achieved by the analysis of the receiver operating characteristic (ROC) surface, which generalizes the ROC curve for binary diagnostic outcomes. The volume under the ROC surface (VUS) is a summary index usually employed for measuring the overall diagnostic accuracy. When the true disease status can be exactly assessed by means of a gold standard (GS) test, unbiased nonparametric estimators of the ROC surface and VUS are easily obtained. In practice, unfortunately, disease status verification via the GS test could be unavailable for all study subjects, due to the expensiveness or invasiveness of the GS test. Thus, often only a subset of patients undergoes disease verification. Statistical evaluations of diagnostic accuracy based only on data from subjects with verified disease status are typically biased. This bias is known as verification bias. Here, we consider the problem of correcting for verification bias when continuous diagnostic tests for three-class disease status are considered. We assume that selection for disease verification does not depend on disease status, given test results and other observed covariates, i.e., we assume that the true disease status, when missing, is missing at random. Under this assumption, we discuss several solutions for ROC surface analysis based on imputation and re-weighting methods. In particular, verification bias-corrected estimators of the ROC surface and of VUS are proposed, namely, full imputation, mean score imputation, inverse probability weighting and semiparametric efficient estimators. Consistency and asymptotic normality of the proposed estimators are established, and their finite sample behavior is investigated by means of Monte Carlo simulation studies. Two illustrations using real datasets are also given.

Keywords: imputation, missing at random, inverse probability weighting, ROC surface analysis

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