Search results for: technology assessment

Authors: Ginevra Addis

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The possibility of reproducing physical artifacts in a digital format is one of the opportunities offered by the technological advancements in information and communication most frequently promoted by museums. Indeed, the study and conservation of our cultural heritage have seen significant advancement due to the three-dimensional acquisition and modeling technology. A variety of laser scanning systems has been developed, based either on optical triangulation or on time-of-flight measurement, capable of producing digital 3D images of complex structures with high resolution and accuracy. It is necessary, however, to explore the challenges and opportunities that this practice brings within museums. The purpose of this paper is to understand what change is introduced by digital techniques in those museums that are hosting digital masterpieces. The methodology used will investigate three distinguished Italian exhibitions, related to the territory of Milan, trying to analyze the following issues about museum practices: 1) how digitizing art masterpieces increases the number of visitors; 2) what the need that calls for the digitization of artworks; 3) which techniques are most used; 4) what the setting is; 5) the consequences of a non-publication of hard copies of catalogues; 6) envision of these practices in the future. Findings will show how interconnection plays an important role in rebuilding a collection spread all over the world. Secondly how digital artwork duplication and extension of reality entail new forms of accessibility. Thirdly, that collection and preservation through digitization of images have both a social and educational mission. Fourthly, that convergence of the properties of different media (such as web, radio) is key to encourage people to get actively involved in digital exhibitions. The present analysis will suggest further research that should create museum models and interaction spaces that act as catalysts for innovation.

Keywords: digital masterpieces, education, interconnection, Italian museums, preservation

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Authors: Stefan Gruden, Charlott Brunmark, Bo Holmqvist, Erwin D. Brenndorfer, Martin Johansson, Jian Liu, Ying Zhao, Niklas Axen, Moustapha Hassan

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Aim: The study was designed to evaluate the ability of the calcium sulfate-based NanoZolid® drug delivery technology to locally release the epidermal growth factor (EGF) protein while maintaining its biological activity. Methods: NanoZolid-formulated EGF protein labelled with a near-infrared dye (EGF-NIR) depots or EGF-NIR dissolved in PBS were injected subcutaneously into mice bearing EGF receptor (EGFR) positive human A549 lung cancer tumors inoculated subcutaneously. The release and biodistribution of the EGF-NIR were investigated in vivo longitudinally up to 96 hours post-administration, utilizing whole-body fluorescence imaging. In order to confirm the in vivo findings, histological analysis of tumor cryosections was performed to investigate EGF-NIR fluorescent signal and EGFR expression level by immunofluorescence labelling. Results: The in vivo fluorescence imaging showed a controlled release profile of the EGF-NIR loaded in the NanoZolid depots compared to free EGF-NIR. Histological analysis of the tumors further demonstrated a prevailing distribution of EGF-NIR in regions with high levels of EGFR expression. Conclusion: Calcium sulfate based depots can be used to formulate EGF while maintaining its biological activity, e.g., receptor binding capability. This may have good clinical potential for local delivery of biomolecules to enhance treatment efficacy and minimize systemic adverse effects.

Keywords: bioresorbable, calcium sulfate, controlled release, NanoZolid

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Authors: Anchal Rana

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Indian Himalayas with their diverse climatic conditions are home to many rare and endangered medicinal flora. One such species is Polygonatum verticillatum Linn., popularly known as King Solomon’s Seal or Solomon’s Seal. Its mention as an incredible medicinal herb comes from 5000 years ago in Indian Materia Medica as a component of Ashtavarga, a poly-herbal formulation comprising of eight herbs illustrated as world’s first ever revitalizing and rejuvenating nutraceutical food, which is now commercialised in the name ‘Chaywanprash’. It is an erect tall (60 to 120 cm) perennial herb with sessile, linear leaves and white pendulous flowers. The species grows well in an altitude range of 1600 to 3600 m amsl, and propagates mostly through rhizomes. The rhizomes are potential source for significant phytochemicals like flavonoids, phenolics, lectins, terpenoids, allantoin, diosgenin, β-Sitosterol and quinine. The presence of such phytochemicals makes the species an asset for antioxidant, cardiotonic, demulcent, diuretic, energizer, emollient, aphrodisiac, appetizer, glactagogue, etc. properties. Having profound concentrations of macro and micronutrients, species has fine prospects of being used as a diet supplement. However, due to unscientific and gregarious uprooting, it has been assigned a status of ‘vulnerable’ and ‘endangered’ in the Conservation Assessment and Management Plan (CAMP) process conducted by Foundation for Revitalisation of Local Health Traditions (FRLHT) during 2010, according to IUCN Red-List Criteria. Further, destructive harvesting, land use disturbances, heavy livestock grazing, climatic changes and habitat fragmentation have substantially contributed towards anomaly of the species. It, therefore, became imperative to conserve the diversity of the species and make judicious use in future research and commercial programme and schemes. A Gene Bank was therefore established at High Altitude Herbal Garden of the Forest Research Institute, Dehradun, India situated at Chakarata (30042’52.99’’N, 77051’36.77’’E, 2205 m amsl) consisting 149 accessions collected from thirty-one geographical locations spread over three Himalayan States of Jammu and Kashmir, Himachal Pradesh, and Uttarakhand. The present investigations purport towards sampling and collection of divergent germplasm followed by planting and cultivation techniques. The ultimate aim is thereby focussed on analysing genetic diversity of the species and capturing promising genotypes for carrying out further genetic improvement programme so to contribute towards sustainable development and healthcare.

Keywords: Polygonatum verticillatum Linn., phytochemicals, genetic diversity, conservation, gene bank

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Authors: Arpine Maghakyan

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The purpose of this paper is to study the relationship between the level of industry digitalization and audit fees, especially, the relationship between Big 4 auditor fees and industry digitalization level. On the one hand, automation of business processes decreases internal control weakness and manual mistakes; increases work effectiveness and integrations. On the other hand, it may cause serious misstatements, high business risks or even bankruptcy, typically in early stages of automation. Incomplete automation can bring high audit risk especially if the auditor does not fully understand client’s business automation model. Higher audit risk consequently will cause higher audit fees. Higher audit fees for clients with high automation level are more highlighted in Big 4 auditor’s behavior. Using data of US firms from 2005-2015, we found that industry level digitalization is an interaction for the auditor quality on audit fees. Moreover, the choice of Big4 or non-Big4 is correlated with client’s industry digitalization level. Big4 client, which has higher digitalization level, pays more than one with low digitalization level. In addition, a high-digitalized firm that has Big 4 auditor pays higher audit fee than non-Big 4 client. We use audit fees and firm-specific variables from Audit Analytics and Compustat databases. We analyze collected data by using fixed effects regression methods and Wald tests for sensitivity check. We use fixed effects regression models for firms for determination of the connections between technology use in business and audit fees. We control for firm size, complexity, inherent risk, profitability and auditor quality. We chose fixed effects model as it makes possible to control for variables that have not or cannot be measured.

Keywords: audit fees, auditor quality, digitalization, Big4

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Authors: Fiona Jensen, Barb Goodwin, Nancy Kleiman, Rhonda Usunier

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Background: Clinical simulation is now a common component in many health profession curricula in preparation for clinical practice. In the Rady Faculty of Health Sciences (RFHS) college leads in simulation and interprofessional (IP) education, planned an eight hour simulated hospital day shift, where seventy students from six health professions across two campuses, learned with each other in a safe, realistic environment. Learning about interprofessional collaboration, an expected competency for many health professions upon graduation, was a primary focus of the simulation event. Method: Faculty representatives from the Colleges of Nursing, Medicine, Pharmacy and Rehabilitation Sciences (Physical Therapy, Occupation Therapy, Respiratory Therapy) and Pharmacy worked together to plan the IP event in a simulation facility in the College of Nursing. Each college provided a faculty mentor to guide the same profession students. Students were placed in interprofessional teams consisting of a nurse, physician, pharmacist, and then sharing respiratory, occupational, and physical therapists across the team depending on the needs of the patients. Eight patient scenarios were role played by health profession students, who had been provided with their patient’s story shortly before the event. Each team was guided by a facilitator. Results and Outcomes: On the morning of the event, all students gathered in a large group to meet mentors and facilitators and have a brief overview of the six competencies for effective collaboration and the session objectives. The students assuming their same profession roles were provided with their patient’s chart at the beginning of the shift, met with their team, and then completed professional specific assessments. Shortly into the shift, IP team rounds began, facilitated by the team facilitator. During the shift, each patient role-played a spontaneous health incident, which required collaboration between the IP team members for assessment and management. The afternoon concluded with team rounds, a collaborative management plan, and a facilitated de-brief. Conclusions: During the de-brief sessions, students responded to set questions related to the session learning objectives and expressed many positive learning moments. We believe that we have a sustainable simulation IP collaborative learning opportunity, which can be embedded into curricula, and has the capacity to grow to include more health profession faculties and students. Opportunities are being explored in the RFHS at the administrative level, to offer this event more frequently in the academic year to reach more students. In addition, a formally structured event evaluation tool would provide important feedback and inform the qualitative feedback to event organizers and the colleges about the significance of the simulation event to student learning.

Keywords: simulation, collaboration, teams, interprofessional

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Authors: Lemar Blake, Chris Oura, Ayanna C. N. Phillips Savage

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Improved DNA sequencing technology has greatly enhanced bacterial identification, especially for organisms that are difficult to culture. Mycobacteriosis with consistent hyphema, bilateral exophthalmia, open mouth gape and ocular lesions, were observed in various fish populations at the School of Veterinary Medicine, Aquaculture/Aquatic Animal Health Unit. Objective: To identify the species of Mycobacterium that is affecting aquarium fish at the School of Veterinary Medicine, Aquaculture/Aquatic Animal Health Unit. Method: A total of 13 fish samples were collected and analyzed via: Ziehl-Neelsen, conventional polymerase chain reaction (PCR) and real-time PCR. These tests were carried out simultaneously for confirmation. The following combination of conventional primers: 16s rRNA (564 bp), rpoB (396 bp), sod (408 bp) were used. Concatenation of the gene fragments was carried out to phylogenetically classify the organism. Results: Acid fast non-branching bacilli were detected in all samples from homogenized internal organs. All 13 acid fast samples were positive for Mycobacterium via real-time PCR. Partial gene sequences using all three primer sets were obtained from two samples and demonstrated a novel strain. A strain 99% related to Mycobacterium marinum was also confirmed in one sample, using 16srRNA and rpoB genes. The two novel strains were clustered with the rapid growers and strains that are known to affect humans. Conclusions: Phylogenetic analysis demonstrated two novel Mycobacterium strains with the potential of being zoonotic and one strain 99% related to Mycobacterium marinum.

Keywords: polymerase chain reaction, phylogenetic, DNA sequencing, zoonotic

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Authors: Nisar Ahmad, Xuyi, Ali Akbar

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As healthcare systems worldwide strive for improvement, the integration of advanced health information systems (HIS) has emerged as a pivotal strategy. This study aims to investigate the critical role of leadership in the implementation and enhancement of HIS in Chinese hospitals and how such leadership can drive improvements in patient outcomes and overall healthcare satisfaction. We propose a comprehensive study to be conducted across various hospitals in China, targeting healthcare professionals as the primary population. The research will leverage established theories of transformational leadership and technology acceptance to underpin the analysis. In our approach, data will be meticulously gathered through surveys and interviews, focusing on the experiences and perceptions of healthcare professionals regarding HIS implementation and its impact on patient care. The study will utilize SPSS and SmartPLS software for robust data analysis, ensuring precise and comprehensive insights into the correlation between leadership effectiveness and HIS success. We hypothesize that strong, visionary leadership is essential for the successful adoption and optimization of HIS, leading to enhanced patient outcomes and increased satisfaction with healthcare services. By applying advanced statistical methods, we aim to identify key leadership traits and practices that significantly contribute to these improvements. Our research will provide actionable insights for policymakers and healthcare administrators in China, offering evidence-based recommendations to foster leadership that champions HIS and drives continuous improvement in healthcare delivery. This study will contribute to the global discourse on health information systems, emphasizing the future role of leadership in transforming healthcare environments and outcomes.

Keywords: health information systems, leadership, patient outcomes, healthcare satisfaction

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Authors: Ju Young Kim, Mohammad Zahirul Islam, Mahmuda Akter Mele, Su Jeong Han, Hyuk Sung Yoon, In-Lee Choi, Ho-Min Kang

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Strawberry and tomato fruits were harvested at the red ripens maturity stage in the Republic of Korea. The fruits were dipped in fungi solution and afterwards were sterilized with sodium hypochlorite (NaOCl) and chlorine dioxide (ClO2) gas. Some fruits were dipped in 150μL/L NaOCl solution for 10 minutes, and others were treated with 5μL/L ClO2 gas for 12 hours and packed with 20,000 cc OTR (oxygen transmission rate) film, the rest were packed in 10,000 cc OTR film inserted with 5μL/L ClO2 gas. 5μL/L ClO2 gas insert treatment showed the lowest carbon dioxide and ethylene, and the highest oxygen concentration was on the final storage day (15th day) in both strawberry and tomato fruits. Tomato fruits showed the lowest fresh weight loss in 5μL/L ClO2 gas insert treatment. The visual quality as well as shelf life showed the highest in 5μL/L ClO2 gas insert treatment of both strawberry and tomato fruits. In addition, the fungal incidence of strawberry and tomato fruits were the most suppressed in 5μL/L ClO2 gas insert treatment. 5μL/L ClO2 gas insert treatment showed higher firmness and soluble solids in both strawberry and tomato fruits. So, 5μL/L ClO2 gas insert treatment may be useful to prevent the fungal incidence as well as retaining the postharvest quality, and increase the shelf life of strawberry and tomato fruits for long term storage. This study was supported by Export Promotion Technology Development Program (314027-03), IPET, Ministry of Agriculture, Food and Rural Affairs, Republic of Korea.

Keywords: chlorine dioxide, ethylene, fungi, sodium hypochlorite

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Authors: Bishnupriya Sahoo, Prasad K. Bhaskaran

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Tropical cyclone is one among the worst natural hazards that results in a trail of destruction causing enormous damage to life, property, and coastal infrastructures. In a global perspective, the Indian Ocean is considered as one of the cyclone prone basins in the world. Specifically, the frequency of cyclogenesis in the Bay of Bengal is higher compared to the Arabian Sea. Out of the four maritime states in the East coast of India, Odisha is highly susceptible to tropical cyclone landfall. Historical records clearly decipher the fact that the frequency of cyclones have reduced in this basin. However, in the recent decades, the intensity and size of tropical cyclones have increased. This is a matter of concern as the risk and vulnerability level of Odisha coast exposed to high wind speed and gusts during cyclone landfall have increased. In this context, there is a need to assess and evaluate the severity of coastal risk, area of exposure under risk, and associated vulnerability with a higher dimension in a multi-risk perspective. Changing climate can result in the emergence of a new hazard and vulnerability over a region with differential spatial and socio-economic impact. Hence there is a need to have coastal vulnerability projections in a changing climate scenario. With this motivation, the present study attempts to estimate the destructiveness of tropical cyclones based on Power Dissipation Index (PDI) for those cyclones that made landfall along Odisha coast that exhibits an increasing trend based on historical data. The study also covers the futuristic scenarios of integral coastal vulnerability based on the trends in PDI for the Odisha coast. This study considers 11 essential and important parameters; the cyclone intensity, storm surge, onshore inundation, mean tidal range, continental shelf slope, topo-graphic elevation onshore, rate of shoreline change, maximum wave height, relative sea level rise, rainfall distribution, and coastal geomorphology. The study signifies that over a decadal scale, the coastal vulnerability index (CVI) depends largely on the incremental change in variables such as cyclone intensity, storm surge, and associated inundation. In addition, the study also performs a critical analysis on the modulation of PDI on storm surge and inundation characteristics for the entire coastal belt of Odisha State. Interestingly, the study brings to light that a linear correlation exists between the storm-tide with PDI. The trend analysis of PDI and its projection for coastal Odisha have direct practical applications in effective coastal zone management and vulnerability assessment.

Keywords: Bay of Bengal, coastal vulnerability index, power dissipation index, tropical cyclone

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Authors: Olanrewaju Aladeitan, Obiageli Phina Anaghara-Uzor

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Despite the abundance of natural gas deposits in Nigeria and the immense potential, this presents both for the domestic and export oriented revenue, there exists an imbalance in the preference for export as against the development and optimal utilization of natural gas for the domestic industry. Considerable amounts of gas are still being wasted by flaring in the country to this day. Although the government has set in place initiatives to harness gas at the flare and thereby reduce volumes flared, the gas producers would rather direct the gas produced to the export market whereas gas apportioned to the domestic market is often marred by the low domestic gas price which is often discouraging to the gas producers. The exported fraction of gas production no doubt yields healthy revenues for the government and an encouraging return on investment for the gas producers and for this reason export sales remain enticing and preferable to the domestic sale of gas. This export pull impacts negatively if left unchecked, on the domestic market which is in no position to match the price at the international markets. The issue of gas price remains critical to the optimal development of the domestic gas industry, in that it comprises the basis for investment decisions of the producers on the allocation of their scarce resources and to what project to channel their output in order to maximize profit. In order then to rebalance the domestic industry and streamline the market for gas, the Gas Aggregation Company of Nigeria, also known as the Strategic Aggregator was proposed under the Nigerian Gas Master Plan of 2008 and then established pursuant to the National Gas Supply and Pricing Regulations of 2008 to implement the domestic gas supply obligation which focuses on ramping-up gas volumes for domestic utilization by mandatorily requiring each gas producer to dedicate a portion of its gas production for domestic utilization before having recourse to the export market. The 2008 Regulations further stipulate penalties in the event of non-compliance. This study, in the main, assesses the adequacy of the legal framework for the Nigerian Gas Industry, given that the operational laws are structured more for oil than its gas counterpart; examine the legal basis for the Strategic Aggregator in the light of the Domestic Gas Supply and Pricing Policy 2008 and the National Domestic Gas Supply and Pricing Regulations 2008 and makes a case for a review of the pivotal role of the Aggregator in the Nigerian Gas market. In undertaking this assessment, the doctrinal research methodology was adopted. Findings from research conducted reveal the reawakening of the Federal Government to the immense potential of its gas industry as a critical sector of its economy and the need for a sustainable domestic natural gas market. A case for the review of the ownership structure of the Aggregator to comprise a balanced mix of the Federal Government, gas producers and other key stakeholders in order to ensure the effective implementation of the domestic supply obligations becomes all the more imperative.

Keywords: domestic supply obligations, natural gas, Nigerian gas sector, strategic gas aggregator

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Authors: Saidalavi Kannattippadi

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It is a culture based study on revealing how the indebtedness of the west belongs to the moral and scientific culture of Islam, even to such a way to be said there was no room for renaissance and the enlightment of the west without the active intervention of the Islamic culture in thoughts and activities of the European thinkers. The study focuses on the exact causes that led the west to the renaissance and goes through analyzing each of historical evidences for confirming the continuous cultural assimilations that occurred between east and west, through transmissions of knowledge, translations of unique treatises, study trips and so on. The west had deeply influenced by the thought and culture of Islam after having a long bitter experience from the blind rituals and customs introduced by the church and was expecting for a movement that can raise them upwards from the bankruptcy of morality and spirituality. The sequence of crusades and voyages of thinkers from west to eastern wards made the western people aware of the best culture ever found in the world as in name of Islam and they become ready to assimilate its notable cultural values and to borrow its cultural achievements. The west had two types of influences from the Islam; moral and scientific. the uprooting of untouchablitlity and racism from western society and their accepting the ideologies of equality and fraternity are moral influence and the innumerable inventions and discoveries found in modern science and technology are the scientific influences. Without the frantic efforts of Muslims in translating, modifying and commenting the science and philosophy of the Greek the west would not have even a chance to peep to the cultural values of the Greek. Here the Muslims are the guides and channels through which the west got educated and well cultured. The study also briefly sheds light on the cultural achievements of Muslims in material science, human science, etc.

Keywords: cultural assimilation, culture and civilization, indebtedness, Muslim world, west, translation, transmission

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Authors: Yu-Ting Tsai, Chiun-Chieh Hsu, Yu-Chun Chu

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In recent years, due to the development of wireless network technology, many researchers have devoted to the study of wireless sensor networks. The applications of wireless sensor network mainly use the sensor nodes to collect the required information, and send the information back to the users. Since the sensed area is difficult to reach, there are many restrictions on the design of the sensor nodes, where the most important restriction is the limited energy of sensor nodes. Because of the limited energy, researchers proposed a number of ways to reduce energy consumption and balance the load of sensor nodes in order to increase the network lifetime. In this paper, we proposed the Energy-Balanced Clustering method with Auxiliary Members on Wireless Sensor Networks（EBCAM）based on the cluster routing. The main purpose is to balance the energy consumption on the sensed area and average the distribution of dead nodes in order to avoid excessive energy consumption because of the increasing in transmission distance. In addition, we use the residual energy and average energy consumption of the nodes within the cluster to choose the cluster heads, use the multi hop transmission method to deliver the data, and dynamically adjust the transmission radius according to the load conditions. Finally, we use the auxiliary cluster members to change the delivering path according to the residual energy of the cluster head in order to its load. Finally, we compare the proposed method with the related algorithms via simulated experiments and then analyze the results. It reveals that the proposed method outperforms other algorithms in the numbers of used rounds and the average energy consumption.

Keywords: auxiliary nodes, cluster, load balance, routing algorithm, wireless sensor network

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Authors: Onu Theresa Chinyere

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The study evaluates the perceived effect of climate change on nutritional status of women in Nigeria. Five research questions and two hypotheses were formulated to guide the study. The study adopted a survey and experimental study research design. One thousand two hundred and fifty one (1,250) respondents were selected from different State in Nigeria using multistage sampling technique. The instruments used to collect data were questionnaire and personal interview on socio economic characteristics of respondents, while Anthropometric data (height and weight) were also used. The data was analyzed using t-test statistic, decided at 50% level of significance. The study found that most states in Nigeria experience high winds, warmer and frequent hot days and night over most land areas, droughts and tides during climate change events. The respondent unanimously agree that climate change causes reduction in food yields, decline in food availability/supply, negatively affecting soil quality, carbon fertilization, decreases flexibilities in technology choices to strengthen food production. The Anthropometric analysis shows that out of 1250 women sampled, 560 (44.8%) maintain normal weight, while 405 (32.40%) women were found to be underweight, since their body mass index is less that 18.5. There were few cases of obesity among the surveyed women since only 80 out of 1250 which represent 6.4% of the women were obese. Bases on the findings, the following recommendations were made-local fertilizer should be encouraged to boost foods yield especially during climate change: women should imbibe the culture of preservation or reservoir that will help in mitigating the effects of climate on food intake and nutritional status, especially during the crisis period, among others.

Keywords: climate change, nutrition anthropometric analysis, obesity culture, environment and women among others

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Authors: Borja Ruiz de Arbulo Alonso

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This paper analyzes the impact of flipped instruction in adult learners of Spanish as a second language in a face-to-face course at Boston University. Given the limited amount of contact hours devoted to studying world languages in the American higher education system, implementing strategies to free up classroom time for communicative language practice is key to ensure student success in their learning process. In an effort to improve the way adult learners acquire a second language, this paper examines the role that regular pre-class and web-based exposure to Spanish grammar plays in student performance at the end of the academic term. It outlines different types of web-based pre-class activities and compares this approach to more traditional classroom practice. To do so, this study works for three months with two similar groups of adult learners in an intermediate-level Spanish class. Both groups use the same course program and have the same previous language experience, but one receives an additional set of instructor-made online materials containing a variety of grammar explanations and online activities that need to be reviewed before attending class. Since the online activities cover material and concepts that have not yet been studied in class, students' oral and written production in both groups is measured by means of a writing activity and an audio recording at the end of the three-month period. These assessments will ascertain the effects of exposing the control group to the grammar of the target language prior to each lecture throughout and demonstrate where flipped instruction helps adult learners of Spanish achieve higher performance, but also identify potential problems.

Keywords: educational technology, flipped classroom, second language acquisition, student success

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Authors: Klaus Froehlich-Gildhoff, Ullrich Boettinger, Katharina Rauh, Angela Schickler

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The Prevention Network Ortenaukreis, PNO, funded by the German Ministry of Education and Research, aims to promote physical and mental health as well as the social inclusion of 3 to 10 years old children and their families in the Ortenau district. Within a period of four years starting 11/2014 a community network will be established. One regional and five local prevention representatives are building networks with stakeholders of the prevention and health promotion field bridging the health care, educational and youth welfare system in a multidisciplinary approach. The regional prevention representative implements regularly convening prevention and health conferences. On a local level, the 5 local prevention representatives implement round tables in each area as a platform for networking. In the setting approach, educational institutions are playing a vital role when gaining access to children and their families. Thus the project will offer 18 month long organizational development processes with specially trained coaches to 25 kindergarten and 25 primary schools. The process is based on a curriculum of prevention and health promotion which is adapted to the specific needs of the institutions. Also to ensure that the entire region is reached demand oriented advanced education courses are implemented at participating day care centers, kindergartens and schools. Evaluation method: The project is accompanied by an extensive research design to evaluate the outcomes of different project components such as interview data from community prevention agents, interviews and network analysis with families at risk on their support structures, data on community network development and monitoring, as well as data from kindergarten and primary schools. The latter features a waiting-list control group evaluation in kindergarten and primary schools with a mixed methods design using questionnaires and interviews with pedagogues, teachers, parents, and children. Results: By the time of the conference pre and post test data from the kindergarten samples (treatment and control group) will be presented, as well as data from the first project phase, such as qualitative interviews with the prevention coordinators as well as mixed methods data from the community needs assessment. In supporting this project, the Federal Ministry aims to gain insight into efficient components of community prevention and health promotion networks as it is implemented and evaluated. The district will serve as a model region, so that successful components can be transferred to other regions throughout Germany. Accordingly, the transferability to other regions is of high interest in this project.

Keywords: childhood research, health promotion, physical health, prevention network, psychological well-being, social inclusion

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Authors: Stephan Printz, Kristina Lahl, René Vossen, Sabina Jeschke

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Strategic investment decisions are characterized by high innovation potential and long-term effects on the competitiveness of enterprises. Due to the uncertainty and risks involved in this complex decision making process, the need arises for well-structured support activities. A method that considers cost and the long-term added value is the cost-benefit effectiveness estimation. One of those methods is the “profitability estimation focused on benefits – PEFB”-method developed at the Institute of Management Cybernetics at RWTH Aachen University. The method copes with the challenges associated with strategic investment decisions by integrating long-term non-monetary aspects whilst also mapping the chronological sequence of an investment within the organization’s target system. Thus, this method is characterized as a holistic approach for the evaluation of costs and benefits of an investment. This participation-oriented method was applied to business environments in many workshops. The results of the workshops are a library of more than 96 cost aspects, as well as 122 benefit aspects. These aspects are preprocessed and comparatively analyzed with regards to their alignment to a series of risk levels. For the first time, an accumulation and a distribution of cost and benefit aspects regarding their impact and probability of occurrence are given. The results give evidence that the PEFB-method combines precise measures of financial accounting with the incorporation of benefits. Finally, the results constitute the basics for using information technology and data science for decision support when applying within the PEFB-method.

Keywords: cost-benefit analysis, multi-criteria decision, profitability estimation focused on benefits, risk and uncertainty analysis

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Authors: Asli Yagmur Akbulut

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Despite a robust and growing job market and lucrative salaries, there is a global shortage of Information Technology (IT) professionals. To make matters worse, women continue to be underrepresented in the IT workforce and among IT degree holders. In today’s knowledge based economy and society, it is extremely important to increase the presence of women in the IT field. In order to do so, it is necessary to reduce entry barriers and attract more women to pursue degrees in various IT fields including the field of Management Information Systems (MIS). Even though MIS is considered to have a more feminine nature, women still tend to avoid majoring in this field. Unfortunately, there is a lack of research that investigates the specific factors that may deter women from pursuing a degree in MIS. To address this research gap, this study examined a set of key environmental barriers that might prevent women from pursuing an MIS degree and explored whether there were any gender differences between female and male students in terms of these key barriers. Based on a survey of 280 students enrolled in an introductory level MIS course, the study empirically confirmed that there were significant differences between male and female students in terms of the key contextual barriers perceived. Female students demonstrated major concerns about gender discrimination related barriers, whereas male students were more concerned about negative social influences. Both male and female students were equally concerned about not being able to fit in well with other MIS majors. The findings have important implications for MIS programs, as the information gained can be used to design and implement specific intervention strategies to overcome the barriers and attract larger pools of women to the MIS discipline. The paper concludes with a discussion of the findings, implications, and future research directions.

Keywords: gender differences, MIS major, underrepresentation, women in IT

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Authors: Yohannes Haile, Dipo Onipede, Jr., Omar Ashour

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The main thrust of our research is to determine Industry 4.0 readiness of small and mid-size manufacturing companies in our region and assist them to implement Cyber Physical Production System (CPPS) capabilities. Adopting CPPS capabilities will help organizations realize improved quality, order delivery, throughput, new value creation, and reduced idle time of machines and work centers of their manufacturing operations. The key metrics for the assessment include the level of intelligence, internal and external connections, responsiveness to internal and external environmental changes, capabilities for customization of products with reference to cost, level of additive manufacturing, automation, and robotics integration, and capabilities to manufacture hybrid products in the near term, where near term is defined as 0 to 18 months. In our initial evaluation of several manufacturing firms which are profitable and successful in what they do, we found low level of Physical-Digital-Physical (PDP) loop in their manufacturing operations, whereas 100% of the firms included in this research have specialized manufacturing core competencies that have differentiated them from their competitors. The level of automation and robotics integration is low to medium range, where low is defined as less than 30%, and medium is defined as 30 to 70% of manufacturing operation to include automation and robotics. However, there is a significant drive to include these capabilities at the present time. As it pertains to intelligence and connection of manufacturing systems, it is observed to be low with significant variance in tying manufacturing operations management to Enterprise Resource Planning (ERP). Furthermore, it is observed that the integration of additive manufacturing in general, 3D printing, in particular, to be low, but with significant upside of integrating it in their manufacturing operations in the near future. To hasten the readiness of the local and regional manufacturing companies to Industry 4.0 and transitions towards CPPS capabilities, our working group (ADMAR Working Group) in partnership with our university have been engaged with the local and regional manufacturing companies. The goal is to increase awareness, share know-how and capabilities, initiate joint projects, and investigate the possibility of establishing the Center for Cyber Physical Production Systems Innovation (C2P2SI). The center is intended to support the local and regional university-industry research of implementing intelligent factories, enhance new value creation through disruptive innovations, the development of hybrid and data enhanced products, and the creation of digital manufacturing enterprises. All these efforts will enhance local and regional economic development and educate students that have well developed knowledge and applications of cyber physical manufacturing systems and Industry 4.0.

Keywords: automation, cyber-physical production system, digital manufacturing enterprises, disruptive innovation, new value creation, physical-digital-physical loop

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Authors: Alejandro Cittadino, David Allende

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Landfilling of municipal solid waste is a common waste management practice in Argentina as in many parts of the world. There is extensive scientific literature on the potential negative effects of landfill leachates on the environment, so it’s necessary to be rigorous with the control and monitoring systems. Due to the specific municipal solid waste composition in Argentina, local landfill leachates contain large amounts of organic matter (biodegradable, but also refractory to biodegradation), as well as ammonia-nitrogen, small trace of some heavy metals, and inorganic salts. In order to investigate the surface water quality in the Reconquista river adjacent to the Norte III landfill, water samples both upstream and downstream the dumpsite are quarterly collected and analyzed for 43 parameters including organic matter, heavy metals, and inorganic salts, as required by the local standards. The objective of this study is to apply a water quality index that considers the leachate characteristics in order to determine the quality status of the watercourse through the landfill. The water pollution index method has been widely used in water quality assessments, particularly rivers, and it has played an increasingly important role in water resource management, since it provides a number simple enough for the public to understand, that states the overall water quality at a certain location and time. The chosen water quality index (ICA) is based on the values of six parameters: dissolved oxygen (in mg/l and percent saturation), temperature, biochemical oxygen demand (BOD5), ammonia-nitrogen and chloride (Cl-) concentration. The index 'ICA' was determined both upstream and downstream the Reconquista river, being the rating scale between 0 (very poor water quality) and 10 (excellent water quality). The monitoring results indicated that the water quality was unaffected by possible leachate runoff since the index scores upstream and downstream were ranked in the same category, although in general, most of the samples were classified as having poor water quality according to the index’s scale. The annual averaged ICA index scores (computed quarterly) were 4.9, 3.9, 4.4 and 5.0 upstream and 3.9, 5.0, 5.1 and 5.0 downstream the river during the study period between 2014 and 2017. Additionally, the water quality seemed to exhibit distinct seasonal variations, probably due to annual precipitation patterns in the study area. The ICA water quality index appears to be appropriate to evaluate landfill impacts since it accounts mainly for organic pollution and inorganic salts and the absence of heavy metals in the local leachate composition, however, the inclusion of other parameters could be more decisive in discerning the affected stream reaches from the landfill activities. A future work may consider adding to the index other parameters like total organic carbon (TOC) and total suspended solids (TSS) since they are present in the leachate in high concentrations.

Keywords: landfill, leachate, surface water, water quality index

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Authors: George Vernon Byrd, Bhim Bahadur Ghaley, Eri Hayashi

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In urban farming, research and innovation are taking place at an unprecedented pace, and soilless growing technologies are emerging at different rates motivated by different objectives in various parts of the world. Local food production is ultimately a main objective everywhere, but adoption rates and expressions vary with socio-economic drivers. Herein, the status of hydroponics and aquaponics is summarized for four countries with diverse socio-economic settings: Europe (Denmark), Asia (Japan and Nepal) and North America (US). In Denmark, with a strong environmental ethic, soilless growing is increasing in urban agriculture because it is considered environmentally friendly. In Japan, soil-based farming is being replaced with commercial plant factories using advanced technology such as complete environmental control and computer monitoring. In Nepal, where rapid loss of agriculture land is occurring near cities, dozens of hydroponics and aquaponics systems have been built in the past decade, particularly in “non-traditional” sites such as roof tops to supplement family food. In the US, where there is also strong interest in locally grown fresh food, backyard and commercial systems have proliferated. Nevertheless, soilless growing is still in the research and development and early adopter stages, and the broad contribution of hydroponics and aquaponics to food security is yet to be fully determined. Nevertheless, current adoption of these technologies in diverse environments in different socio-economic settings highlights the potential contribution to food security with social and environmental benefits which contribute to several Sustainable Development Goals.

Keywords: aquaponics, hydroponics, soilless agriculture, urban agriculture

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Authors: Ana Maria Carmen Ilie, Carmela Vaccaro

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Gas migration through wellbore failure, in particular from abandoned wells, is repeatedly identified as the highest risk mechanism. The vadose zone was subject to monitoring system close to the wellbore in Minerbio, methane storage site. The new technology has been well-developed and used with the purpose to provide reliable estimates of leakage parameters. Of these techniques, soil flux sampling at the soil surface, via the accumulation chamber method and soil flux sampling at the depths of 100cm below the ground surface, have been an important technique for characterizing the gas concentrations at the gas storage site. We present results of soil Radon Bq/m3, CO2%, CH4% and O2% concentration gases. Measurements have been taken for radon concentrations with an Durridge RAD7 Company, Inc., USA, instrument. We used for air and soil quality an Biogas ETG instrument monitoring system, with NDIR CO2, CH4 gas sensor and electrochemical O2 gas sensor. The measurements started in September-October 2015, where no outliers have been identified. The measurements have continued in March-April-July-August-September 2016, almost at the same time in the same place around the gas storage site, values measured 15 minutes for each sampling, to determine their concentration, their distribution and to understand the relationship among gases and atmospheric conditions. At a depth of 100 cm, the maximum soil radon gas concentrations were found to be 1770 ±±582 Bq/m3, the soil consists of 64.31% sand, 20.75% silt and 14.94% clay, and with 0.526 ppm of Uranium. The maximum concentration (September 2016), in soil at 100cm below the ground surface, with 83% sand, 8.96% silt and 7.89% clay, was about 0.06% CH4, and in atmosphere 0.06% CH4 at 40°C (T). In the other months the values have been on the range of 0.01% to 0.03% CH4. Since we did not have outliers in the gas storage site, soil-gas samples for isotopic analysis have not been done.

Keywords: leakage gas monitoring, lithology, soil gas, methane

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Authors: Worku Dejene Bekele, András Marczika Csilla Sörös

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Silver nanoparticles are silver metal with a size of 1-100nm. The most common source of silver nanoparticles is inorganic salts. Nanoparticles can be ingested through our foods and constitute nanoparticles and silver ions, whether as an additive or by migrants and, in some cases, as a pollutant. Silver nanoparticles are the most widely applicable engineered nanomaterials, especially for antimicrobial function. Ag nanoparticles give different advantages in the case of food safety, quality, and overall acceptability; however, they affect the health of humans and animals, putting them at risk of health problems and environmental pollution. Silver nanoparticles have been used widely in food packaging technologies, especially in water treatments, meat and meat products, fruit, and many other food products. This is for bio-preservation from food products. The primary goal of this review is to determine the safety and health impact of Ag nanoparticles application in food packaging and analysis of the human organs more affected by this preservative technology, to assess the implications of a nanoparticle on food safety, to determine the effects of nanoparticles on consumers health and to determine the impact of nanotechnology on product acceptability. But currently, much research has demonstrated that there is cause to believe that silver nanoparticles may have toxicological effects on biological organs and systems. The silver nanoparticles affect DNA expression, gastrointestinal barriers, lungs, and other breathing organs illness. Silver particles and molecules are very toxic. During its application in food packaging, food industries used the thinnest particle. This particle can potentially affect the gastrointestinal tracts-it suffers from mucus production, DNA, lungs, and other breezing organs. This review is targeted to demonstrate the knowledge gap that industrials use in the application of silver nanoparticles in food packaging and preservation and its health effects on the consumer.

Keywords: food preservatives, health impact, nanoparticle, silver nanoparticle

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Authors: Maliheh Raji, Hossein Abolghasemi, Jaber Safdari, Ali Kargari

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Dysprosium is a rare earth element which is essential for many growing high-technology applications. Dysprosium along with neodymium plays a significant role in different applications such as metal halide lamps, permanent magnets, and nuclear reactor control rods preparation. The purification and separation of rare earth elements are challenging because of their similar chemical and physical properties. Among the various methods, membrane processes provide many advantages over the conventional separation processes such as ion exchange and solvent extraction. In this work, selective extraction and separation of dysprosium from aqueous solutions containing an equimolar mixture of dysprosium and neodymium by emulsion liquid membrane (ELM) was investigated. The organic membrane phase of the ELM was a nanofluid consisting of multiwalled carbon nanotubes (MWCNT), Span80 as surfactant, Cyanex 272 as carrier, kerosene as base fluid, and nitric acid solution as internal aqueous phase. Factors affecting separation of dysprosium such as carrier concentration, MWCNT concentration, feed phase pH and stripping phase concentration were analyzed using Taguchi method. Optimal experimental condition was obtained using analysis of variance (ANOVA) after 10 min extraction. Based on the results, using MWCNT nanofluid in ELM process leads to increase the extraction due to higher stability of membrane and mass transfer enhancement and separation factor of 6 for dysprosium over neodymium can be achieved under the optimum conditions. Additionally, demulsification process was successfully performed and the membrane phase reused effectively in the optimum condition.

Keywords: emulsion liquid membrane, MWCNT nanofluid, separation, Taguchi method

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Authors: Masih Nikgou

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ICU nurses or intensive care nurses are highly specialized and trained healthcare personnel. These nurses provide nursing care for patients with life-threatening illnesses or conditions. They provide the experience, knowledge and specialized skills that patients need to survive and recover. Intensive care nurses (ICU) are trained to make momentary decisions and act quickly when the patient's condition changes. Their primary work environment is in the hospital in intensive care units. Typically, ICU patients require a high level of care. ICU nurses work in challenging and complex fields in their nursing profession. They have the primary duty of caring for and saving patients who are fighting for their lives. Intensive care (ICU) nurses are highly trained to provide exceptional care to patients who depend on 24/7 nursing care. A patient in the ICU is often equipped with a ventilator, intubated and connected to several life support machines and medical equipment. Intensive Care Nurses (ICU) have full expertise in considering all aspects of bringing back their patients. Some of the specific responsibilities of ICU nurses include (a) Assessing and monitoring the patient's progress and identifying any sudden changes in the patient's medical condition. (b) Administration of drugs intravenously by injection or through gastric tubes. (c) Provide regular updates on patient progress to physicians, patients, and their families. (d) According to the clinical condition of the patient, perform the approved diagnostic or treatment methods. (e) In case of a health emergency, informing the relevant doctors. (f) To determine the need for emergency interventions, evaluate laboratory data and vital signs of patients. (g) Caring for patient needs during recovery in the ICU. (h) ICU nurses often provide emotional support to patients and their families. (i) Regulating and monitoring medical equipment and devices such as medical ventilators, oxygen delivery devices, transducers, and pressure lines. (j) Assessment of pain level and sedation needs of patients. (k) Maintaining patient reports and records. As the name suggests, critical care nurses work primarily in ICU health care units. ICUs are completely healthy and have proper lighting with strict adherence to health and safety from medical centers. ICU nurses usually move between the intensive care unit, the emergency department, the operating room, and other special departments of the hospital. ICU nurses usually follow a standard shift schedule that includes morning, afternoon, and night schedules. There are also other relocation programs depending on the hospital and region. Nurses who are passionate about data and managing a patient's condition and outcomes typically do well as ICU nurses. An inquisitive mind and attention to processes are equally important. ICU nurses are completely compassionate and are not afraid to advocate for their patients and family members. who are distressed.

Keywords: nursing, intensive care unit, pediatric intensive care unit, mobile intensive care unit, surgical intensive care unite

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Authors: Oya A. Urucu, Aslı B. Çiğil, Hatice Birtane, Ece K. Yetimoğlu, Memet Vezir Kahraman

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Chlorpyrifos is an organophosphorus pesticide which can be found in environmental water samples. The efficiency and reuse of a molecularly imprinted polymer (chlorpyrifos - MIP) were investigated for the selective removal of chlorpyrifos residues. MIP was prepared with UV curing thiol-ene polymerization technology by using multifunctional thiol and ene monomers. The thiol-ene curing reaction is a radical induced process, however unlike other photoinitiated polymerization processes, this polymerization process is a free-radical reaction that proceeds by a step-growth mechanism, involving two main steps; a free-radical addition followed by a chain transfer reaction. It assures a very rapidly formation of a uniform crosslinked network with low shrinkage, reduced oxygen inhibition during curing and excellent adhesion. In this study, thiol-ene based UV-curable polymeric materials were prepared by mixing pentaerythritol tetrakis(3-mercaptopropionate), glyoxal bis diallyl acetal, polyethylene glycol diacrylate (PEGDA) and photoinitiator. Chlorpyrifos was added at a definite ratio to the prepared formulation. Chemical structure and thermal properties were characterized by FTIR and thermogravimetric analysis (TGA), respectively. The pesticide analysis was performed by gas chromatography-mass spectrometry (GC-MS). The influences of some analytical parameters such as pH, sample volume, amounts of analyte concentration were studied for the quantitative recoveries of the analyte. The proposed MIP method was applied to the determination of chlorpyrifos in river and tap water samples. The use of the MIP provided a selective and easy solution for removing chlorpyrifos from the water.

Keywords: molecularly imprinted polymers, selective removal, thilol-ene, uv-curable polymer

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Authors: Faizah Almalki, Simeon Gill, Steve G. Hayes, Lisa Taylor

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A core element of cultural identity is the traditional costumes that provide insight into the heritage that has been acquired over time. This heritage is apparent in the use of colour, the styles and the functions of the clothing and it also reflects the skills of those who created the items and the time taken to produce them. Modern flat pattern drafting methods for making garment patterns are simple in comparison to the relatively laborious traditional approaches that would require personal interaction with the wearer throughout the production process. The current study reflects on the main elements of the pattern cutting system and how this has evolved in Saudi Arabia to affect the design of the Sawan garment. Analysis of the traditional methods for constructing Sawan garments was undertaken through observation of the practice and the garments and consulting documented guidance. This provided a foundation through which to explore how modern technology can be applied to improve the process. In this research, modern methods are proposed for producing traditional Saudi garments more efficiently while retaining elements of the conventional style and design. The current study has documented the vital aspects of Sawan garment style. The result showed that the method had been used to take the body measurements and pattern making was elementary and offered simple geometric shape and the Sawan garment is composed of four pieces. Consequently, this research allows for classical pattern shapes to be embedded in garments now worn in Saudi Arabia and for the continuation of cultural heritage.

Keywords: traditional Sawan garment technique, modern pattern cutting technique, the shape of the garment and software, Lectra Modaris

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Authors: Nasser Koleini Mamaghani, Sara Mostowfi

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The complexity of public space design makes it difficult for designers to simultaneously consider all issues for thorough decision-making. Among public spaces, the public space around people’s house is the most prominent space that affects and impacts people’s daily life. Considering recreational public spaces in cities, their main purpose would be to design for experiences that enable a deep feeling of peace and a moment of being away from the hectic daily life. Respecting human emotions and restoring natural environments, although difficult and to some extent out of reach, are key issues for designing such spaces. In this paper we propose to analyse the structure of recreational public spaces and the related emotional impressions. Furthermore, we suggest investigating how these structures influence people’s choice for public spaces by using differential semantics. According to Kansei methodology, in order to evaluate a situation appropriately, the assessment variables must be adapted to the user’s mental scheme. This means that the first step would have to be the identification of a space’s conceptual scheme. In our case study, 32 Kansei words and 4 different locations, each with a different sensual experience, were selected. The 4 locations were all parks in the city of Tehran (Iran), each with a unique structure and artifacts such as a fountain, lighting, sculptures, and music. It should be noted that each of these parks has different combination and structure of environmental and artificial elements like: fountain, lightning, sculpture, music (sound) and so forth. The first one was park No.1, a park with natural environment, the selected space was a fountain with motion light and sculpture. The second park was park No.2, in which there are different styles of park construction: ways from different countries, the selected space was traditional Iranian architecture with a fountain and trees. The third one was park No.3, the park with modern environment and spaces, and included a fountain that moved according to music and lighting. The fourth park was park No.4, the park with combination of four elements: water, fire, earth, wind, the selected space was fountains squirting water from the ground up. 80 participant (55 males and 25 females) aged from 20-60 years participated in this experiment. Each person filled the questionnaire in the park he/she was in. Five-point semantic differential scale was considered to determine the relation between space details and adjectives (kansei words). Received data were analyzed by multivariate statistical technique (factor analysis using SPSS statics). Finally the results of this analysis are criteria as inspiration which can be used in future space designing for creating pleasant feeling in users.

Keywords: environmental design, differential semantics, Kansei engineering, subjective preferences, space

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Authors: Yogi Sirodz Gaos, Irvan Wiradinata

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In the 500 kW Organic Rankine Cycle (ORC) power plant in Indonesia, an AFT (according to the Tubular Exchanger Manufacturers Association – TEMA) type shell and tube heat exchanger device is used as a pre-heating system for the ORC’s hot water circulation system. The pre-heating source is a waste heat recovery of the brine water, which is tapped from a geothermal power plant. The brine water itself has 5 MWₜₕ capacities, with average temperature of 170ᵒC, and 7 barg working pressure. The aim of this research is to examine the performance of the heat exchanger in the ORC system in a 500 kW ORC power plant. The data for this research were collected during the commissioning on the middle of December 2016. During the commissioning, the inlet temperature and working pressure of the brine water to the shell and tube type heat exchanger was 149ᵒC, and 4.4 barg respectively. Furthermore, the ΔT for the hot water circulation of the ORC system to the heat exchanger was 27ᵒC, with the inlet temperature of 140ᵒC. The pressure in the hot circulation system was dropped slightly from 7.4ᵒC to 7.1ᵒC. The flow rate of the hot water circulation was 80.5 m³/h. The presentation and discussion of a case study on the performance of the heat exchanger on the 500 kW ORC system is presented as follows: (1) the heat exchange duty is 2,572 kW; (2) log mean temperature of the heat exchanger is 13.2ᵒC; (3) the actual overall thermal conductivity is 1,020.6 W/m².K (4) the required overall thermal conductivity is 316.76 W/m².K; and (5) the over design for this heat exchange performance is 222.2%. An analysis of the heat exchanger detailed engineering design (DED) is briefly discussed. To sum up, this research concludes that the shell and tube heat exchangers technology demonstrated a good performance as pre-heating system for the ORC’s hot water circulation system. Further research need to be conducted to examine the performance of heat exchanger system on the ORC’s hot water circulation system.

Keywords: shell and tube, heat exchanger, organic Rankine cycle, performance, commissioning

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Authors: Akshay B. Pawar, Rohit Y. Parasnis

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Heart Rate Variability (HRV) is a widely used indicator of the regulation between the autonomic nervous system (ANS) and the cardiovascular system. Besides being non-invasive, it also has the potential to predict mortality in cases involving critical injuries. The gold standard method for determining HRV is based on the analysis of RR interval time series extracted from ECG signals. However, because it is much more convenient to obtain photoplethysmogramic (PPG) signals as compared to ECG signals (which require the attachment of several electrodes to the body), many researchers have used pulse cycle intervals instead of RR intervals to estimate HRV. They have also compared this method with the gold standard technique. Though most of their observations indicate a strong correlation between the two methods, recent studies show that in healthy subjects, except for a few parameters, the pulse-based method cannot be a surrogate for the standard RR interval- based method. Moreover, the former tends to overestimate short-term variability in heart rate. This calls for improvements in or alternatives to the pulse-cycle interval method. In this study, besides the systolic peak-peak interval method (PP method) that has been studied several times, four recent PPG-based techniques, namely the first derivative peak-peak interval method (P1D method), the second derivative peak-peak interval method (P2D method), the valley-valley interval method (VV method) and the tangent-intersection interval method (TI method) were compared with the gold standard technique. ECG and PPG signals were obtained from 10 young and healthy adults (consisting of both males and females) seated in the armchair position. In order to de-noise these signals and eliminate baseline drift, they were passed through certain digital filters. After filtering, the following HRV parameters were computed from PPG using each of the five methods and also from ECG using the gold standard method: time domain parameters (SDNN, pNN50 and RMSSD), frequency domain parameters (Very low-frequency power (VLF), Low-frequency power (LF), High-frequency power (HF) and Total power or “TP”). Besides, Poincaré plots were also plotted and their SD1/SD2 ratios determined. The resulting sets of parameters were compared with those yielded by the standard method using measures of statistical correlation (correlation coefficient) as well as statistical agreement (Bland-Altman plots). From the viewpoint of correlation, our results show that the best PPG-based methods for the determination of most parameters and Poincaré plots are the P2D method (shows more than 93% correlation with the standard method) and the PP method (mean correlation: 88%) whereas the TI, VV and P1D methods perform poorly (<70% correlation in most cases). However, our evaluation of statistical agreement using Bland-Altman plots shows that none of the five techniques agrees satisfactorily well with the gold standard method as far as time-domain parameters are concerned. In conclusion, excellent statistical correlation implies that certain PPG-based methods provide a good amount of information on the pattern of heart rate variation, whereas poor statistical agreement implies that PPG cannot completely replace ECG in the determination of HRV.

Keywords: photoplethysmography, heart rate variability, correlation coefficient, Bland-Altman plot

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Authors: Zhao Jiashen, Serene Goh, Jerry Goo, Anthony Li, Lim Woan Wui, Paul Drakeford, Chen Qing Yan

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Introduction: Emergency laparotomy (EL) is one of the most common surgeries done in Singapore to treat acute abdominal pathologies. A significant proportion of these surgeries are performed in the geriatric population (65 years and older), who tend to have the highest postoperative morbidity, mortality, and highest utilization of intensive care resources. Frailty, the state of vulnerability to adverse outcomes from an accumulation of physiological deficits, has been shown to be associated with poorer outcomes after surgery and remains a strong driver of healthcare utilization and costs. To date, there is little understanding of the impact it has on emergency laparotomy outcomes. The objective of this study is to examine the impact of frailty on postoperative morbidity, mortality, and length of stay after EL. Methods: A retrospective study was conducted in two tertiary centres in Singapore, Tan Tock Seng Hospital and Khoo Teck Puat Hospital the period from January to December 2019. Patients aged 65 years and above who underwent emergency laparotomy for intestinal obstruction, perforated viscus, bowel ischaemia, adhesiolysis, gastrointestinal bleed, or another suspected acute abdomen were included. Laparotomies performed for trauma, cholecystectomy, appendectomy, vascular surgery, and non-GI surgery were excluded. The Clinical Frailty Score (CFS) developed by the Canadian Study of Health and Aging (CSHA) was used. A score of 1 to 4 was defined as non-frail and 5 to 7 as frail. We compared the clinical outcomes of elderly patients in the frail and non-frail groups. Results: There were 233 elderly patients who underwent EL during the study period. Up to 26.2% of patients were frail. Patients who were frail (CFS 5-9) tend to be older, 79 ± 7 vs 79 ± 5 years of age, p <0.01. Gender distribution was equal in both groups. Indication for emergency laparotomies, time from diagnosis to surgery, and presence of consultant surgeons and anaesthetists in the operating theatre were comparable (p>0.05). Patients in the frail group were more likely to receive postoperative geriatric assessment than in the non-frail group, 49.2% vs. 27.9% (p<0.01). The postoperative complications were comparable (p>0.05). The length of stay in the critical care unit was longer for the frail patients, 2 (IQR 1-6.5) versus 1 (IQR 0-4) days, p<0.01. Frailty was found to be an independent predictor of 90-day mortality but not age, OR 2.9 (1.1-7.4), p=0.03. Conclusion: Up to one-fourth of the elderly who underwent EL were frail. Patients who were frail were associated with a longer length of stay in the critical care unit and a 90-day mortality rate of more than three times that of their non-frail counterparts. PPOSSUM was a better predictor of 90-day mortality in the non-frail group than in the frail group. As frailty scoring was a significant predictor of 90-day mortality, its integration into acute surgical units to facilitate shared decision-making and discharge planning should be considered.

Keywords: frailty elderly, emergency, laparotomy

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