Search results for: independent variable

Authors: Shannon Steinmetz, Ellen Gethner

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In this paper, a theoretical foundation is developed for patterned segmentation of audio using the geometry of music and statistical manifold. We demonstrate image content clustering using conic space sonification. The algorithm takes a geodesic curve as a model estimator of the three-parameter Gamma distribution. The random variable is parameterized by musical centricity and centric velocity. Model parameters predict audio segmentation in the form of duration and frame count based on the likelihood of musical geometry transition. We provide an example using a database of randomly selected images, resulting in statistically significant clusters of similar image content.

Keywords: sonification, musical information geometry, image, content extraction, automated quantification, audio segmentation, pattern recognition

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Authors: Hannele Kuusisto, Paivi Makila, Ursula Hyrkkanen

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Introduction: There have been arguments about the skills university students should have when graduated. Current trends argue that as well as the specific job-related skills the graduated students need problem-solving, interaction and networking skills as well as self-management skills. Skills required in working life are also considered in the Finnish national project called VALTE (short for 'prepared for working life'). The project involves 11 Finnish school organizations. As one result of this project, a five-credit independent online course in study and job engagement as well as in study and job crafting was developed at Turku University of Applied Sciences. The aim of the oral or e-poster presentation is to present the online course developed in the project. The purpose of this abstract is to present the development work of the online course and the feedback received from the pilots. Method: As the University of Turku is the leading partner of the VALTE project, the collaborative education platform ViLLE (https://ville.utu.fi, developed by the University of Turku) was chosen as the online platform for the course. Various exercise types with automatic assessment were used; for example, quizzes, multiple-choice questions, classification exercises, gap filling exercises, model answer questions, self-assessment tasks, case tasks, and collaboration in Padlet. In addition, the free material and free platforms on the Internet were used (Youtube, Padlet, Todaysmeet, and Prezi) as well as the net-based questionnaires about the study engagement and study crafting (made with Webropol). Three teachers with long teaching experience (also with job crafting and online pedagogy) and three students working as trainees in the project developed the content of the course. The online course was piloted twice in 2017 as an elective course for the students at Turku University of Applied Sciences, a higher education institution of about 10 000 students. After both pilots, feedback from the students was gathered and the online course was developed. Results: As the result, the functional five-credit independent online course suitable for students of different educational institutions was developed. The student feedback shows that students themselves think that the developed online course really enhanced their job and study crafting skills. After the course, 91% of the students considered their knowledge in job and study engagement as well as in job and study crafting to be at a good or excellent level. About two-thirds of the students were going to exploit their knowledge significantly in the future. Students appreciated the variability and the game-like feeling of the exercises as well as the opportunity to study online at the time and place they chose themselves. On a five-point scale (1 being poor and 5 being excellent), the students graded the clarity of the ViLLE platform as 4.2, the functionality of the platform as 4.0 and the easiness of operating as 3.9.

Keywords: job crafting, job engagement, online course, study crafting, study engagement

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Authors: Tao Peng

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This paper presents a holistic model of political economy based on Daoism – the foundational philosophy of classical Chinese epistemology. Daoism is both comprehensive and subtle in its manifestations and applications in all aspects of nature and society. Based on Daoist creation theory of the universe, life theory and five element functioning theory, a holistic model in economics with minimal assumptions and independent of ideology are constructed. Under this framework, different schools of economics, such as neo-liberal, Marxism, and Austrian school, are explored and shed new light on. Economic and financial predictions can be realized in applications to Qi Men Dun Jia. This framework can provide guidelines and inspirations to economic modelling, economic policies formulation and strategy development and guide society towards a more sustainable future.

Keywords: daoism, economics, holistic, philosophy

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Authors: Tahani Salman Alangari

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Student success can be impacted by internal factors such as their emotional well-being and external factors such as organizational support and instructional support in the classroom. This study is to identify at least one factor that forecasts student engagement. It is a cross-sectional, conducted on 6206 teachers and encompassed three years of data collection and observations of math instruction in approximately 50 schools and 300 classrooms. A multiple linear regression revealed that a model predicting student engagement from emotional support, classroom organization, and instructional support was significant. Four linear regression models were tested using hierarchical regression to examine the effects of independent variables: emotional support was the highest predictor of student engagement while instructional support was the lowest.

Keywords: student engagement, emotional support, organizational support, instructional support, well-being

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Authors: Viji Vijayakumar, R. Divya, A. Vivek

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This paper deals with a quadratic boost converter which belongs to cascade boost family, controlled by sliding mode controller. In the cascade boost family, quadratic boost converter is the best trade-off when circuit complexity and modulator saturation is considered. Sliding mode control being a nonlinear control results in a robust and stable system when applied to switching converters which are inherently variable structured systems. The stability of this system is analyzed through Lyapunov’s approach. Analysis is done for load regulation, line regulation and step response of the system. Also these results are compared with that of PID controller based system.

Keywords: DC-DC converter, quadratic boost converter, sliding mode control, PID control

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Authors: Mohammad Mahmoud Mandurah

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The existence of InfoMiracles in scripture is evidence that the scripture has a divine origin. It is also evidence to the existence of God. An InfoMiracle is an information-based miracle. The basic component of an InfoMiracle is a piece of information that could not be obtained by a human except through a divine channel. The existence of a sufficient number of convincing InfoMiracles in a scripture necessitates the existence of the divine source to these InfoMiracles. A mathematical equation is developed to prove that the Qur’an has a divine origin, and hence, prove the existence of God. The equation depends on a single variable only, which is the number of InfoMiracles in the Qur’an. The Qur’an is rich with InfoMiracles. It is shown that the existence of less than 30 InfoMiracles in the Qur’an is sufficient proof to the existence of God and that the Qur’an is a revelation from God.

Keywords: InfoMiracle, God, mathematical proof, miracle, probability

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Authors: M. Khalid, G. N. Singh

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In this paper, we have considered the problem of estimation for population mean, on current (second) occasion in the presence of random non response in two-occasion successive sampling under two phase set-up. Modified exponential type estimators have been proposed, and their properties are studied under the assumptions that numbers of sampling units follow a distribution due to random non response situations. The performances of the proposed estimators are compared with linear combinations of two estimators, (a) sample mean estimator for fresh sample and (b) ratio estimator for matched sample under the complete response situations. Results are demonstrated through empirical studies which present the effectiveness of the proposed estimators. Suitable recommendations have been made to the survey practitioners.

Keywords: successive sampling, random non-response, auxiliary variable, bias, mean square error

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Authors: Michele Charpentier

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This article examines the experiences of aging of older immigrant women. The data are based on qualitative research that was conducted in Quebec/Canada with 83 elderly women from different ethno-cultural backgrounds (Arab, African, Haitian, Japanese, Chinese, Portuguese, Romanian, etc.). The results on how such immigrant women deal with material conditions of existence such as deskilling, aging alone, being more economically independent and the combined effects of liberation from social and family norms associated with age and gender in the light of the migration route, will be presented. For the majority, migration opened up possibilities for personal development and self-affirmation. The findings demonstrated the relevance of the intersectional approach in understanding the complexity and social conditionings of women’s experiences of aging.

Keywords: older immigrant women, qualitative research, experiences of aging, intersectional approach

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Authors: K. E. Daryani, H. Mohamad

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Uncertainties in the geo-structure analysis and design have a significant impact on the safety of slopes. Traditionally, uncertainties in the geotechnical design are addressed by incorporating a conservative factor of safety in the analytical model. In this paper, a risk-based approach is adopted to assess the influence of the geotechnical variable uncertainties on the stability of infinite slopes in cohesionless soils using the “partial factor of safety on shear strength” approach as stated in Eurocode 7. Analyses conducted using Monte Carlo simulation show that the same partial factor can have very different levels of risk depending on the degree of uncertainty of the mean values of the soil friction angle and void ratio.

Keywords: Safety, Probability of Failure, Reliability, Infinite Slopes, Sand.

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Authors: Syed Umair Aziz, Muhammad Faheem, Sameer Hussain, Faraz Idris

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Content centric network is the network based on the mechanism of sending and receiving the data based on the interest and data request to the specified node (which has cached data). In this network, the security is bind with the content not with the host hence making it host independent and secure. In this network security is applied by taking content’s MAC (message authentication code) and encrypting it with the public key of the receiver. On the receiver end, the message is first verified and after verification message is saved and decrypted using the receiver's private key.

Keywords: content centric network, client-server, host security threats, message authentication code, named data network, network caching, peer-to-peer

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Authors: Şirin Küçük, Ayşe Kök, İsmail Şahin

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Mobile devices are very popular and useful tools for assisting people in daily life. With the advancement of mobile technologies, the issue of mobile learning has been widely investigated in education. Many researches consider that it is important to integrate pedagogical and technical strengths of mobile technology into learning environments. For this reason, the purpose of this research is to examine the effect of mobile technology use in education with meta-analysis method. Meta-analysis is a statistical technique which combines the findings of independent studies in a specific subject. In this respect, the articles will be examined by searching the databases for researches which are conducted between 2005 and 2014. It is expected that the results of this research will contribute to future research related to mobile technology use in education.

Keywords: mobile learning, meta-analysis, mobile technology, education

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Authors: Frederick Nyakudya

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In this paper, we examine the relationship between human capital, personal wealth and social capital to explain the differential start-up rates between female and male entrepreneurs. Since our dependent variable is dichotomous, we examine the determinants of these using a maximum likelihood logit estimator. We used the Global Entrepreneurship Monitor database covering the period 2006 to 2009 with 421 usable cases drawn from drawn from the Lower Layer Super Output Areas in the East Midlands in the United Kingdom. we found evidence that indicates that a female positively moderate the positive relationships between indicators of human capital, personal wealth and social capital with start-up activity. The findings have implications for programs, policies, and practices to encourage more females to engage in start-up activity.

Keywords: entrepreneurship, star-up, gender, GEM

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Authors: M. Demir, A. Demir

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The aim of this study is to examine the family sense of coherence of early childhood education students. The Family Sense of Coherence Inventory has applied to 233 (108 girls and 125 boys) early childhood education students in Turkey. At the stage of data collection, with the aim of determining the family sense of coherence of early childhood education students, Family Sense of Coherence Inventory which was developed by Çeçen (2007) was used. In the process of the analysis of data, independent samples t-test, and one-way ANOVA were used. According to the results of the study, there were significant differences between some demographic variables in terms of the family sense of coherence.

Keywords: family sense of coherence, early childhood education students

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Authors: Aparna Gulhane

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Biometrics is the science and technology of measuring and analyzing biological data form the basis of research in biological measuring techniques for the purpose of people identification and recognition. In information technology, biometrics refers to technologies that measure and analyze human body characteristics, such as DNA, fingerprints, eye retinas and irises, voice patterns, facial patterns and hand measurements. Biometric systems are used to authenticate the person's identity. The idea is to use the special characteristics of a person to identify him. These papers present a biometric authentication techniques and actual deployment of potential by overall invocation of biometrics recognition, with an independent testing of various biometric authentication products and technology.

Keywords: types of biometrics, importance of biometric, review for biometrics and getting a new implementation, biometric authentication technique

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Authors: Damanjit Kaur, Avani Bhatia

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Color constancy is significant for human vision since color is a pictorial cue that helps in solving different visions tasks such as tracking, object recognition, or categorization. Therefore, several computational methods have tried to simulate human color constancy abilities to stabilize machine color representations. Two different kinds of methods have been used, i.e., normalization and constancy. While color normalization creates a new representation of the image by canceling illuminant effects, color constancy directly estimates the color of the illuminant in order to map the image colors to a canonical version. Color constancy is the capability to determine colors of objects independent of the color of the light source. This research work studies the most of the well-known color constancy algorithms like white point and gray world.

Keywords: color constancy, gray world, white patch, modified white patch

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Authors: Tapiwa Shumba

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The right to fairness and access to appeals and reviews enshrined under the South African Constitution seeks to ensure that justice is served. In essence, the constitution and the law have put in place mechanisms to ensure that a miscarriage of justice through wrongful convictions does not occur. However, once convicted and sentenced on appeal the procedural safeguards seem to resign as if to say, the accused has met his fate. The challenge with this construction is that even within an ideally perfect legal system wrongful convictions would still occur. Therefore, it is not so much of the failings of a legal system that demand attention but mechanisms to redress the results of such failings where evidence becomes available that a wrongful conviction occurred. In this context, this paper looks at the South African criminal procedural mechanisms for litigating innocence post-conviction. The discussion focuses on the role of section 327 of the South African Criminal Procedure Act and its apparent shortcomings in providing an avenue for victims of miscarriages to litigate their innocence by adducing new evidence at any stage during their wrongful incarceration. By looking at developments in other jurisdiction such as the United Kingdom, where South African criminal procedure draws much of its history, and the North Carolina example which in itself was inspired by the UK Criminal Cases Review Commission, this paper is able to make comparisons and draw invaluable lessons for the South African criminal justice system. Lessons from these foreign jurisdictions show that South African post-conviction criminal procedures need reform in line with constitutional values of human dignity, equality before the law, openness and transparency. The paper proposes an independent review of the current processes to assess the current post-conviction procedures under section 327. The review must look into the effectiveness of the current system and how it can be improved in line with new substantive legal provisions creating access to DNA evidence for post-conviction exonerations. Although the UK CCRC body should not be slavishly followed, its operations and the process leading to its establishment certainly provide a good point of reference and invaluable lessons for the South African criminal justice system seeing that South African law on this aspect has generally followed the English approach except that current provisions under section 327 are a mirror of the discredited system of the UK’s previous dispensation. A new independent mechanism that treats innocent victims of the criminal justice system with dignity away from the current political process is proposed to enable the South African criminal justice to benefit fully from recent and upcoming advances in science and technology.

Keywords: innocence, forensic law, post-conviction remedies, South African criminal justice system, wrongful conviction

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Authors: Roikhan Mochamad Aziz

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This study aims to analze the interdependence of several variables simultaneously in order to simplify the form of the relationship between some of the variables studied a number of factors less than the variable studied which means it can also describe the data structure of a research. Based 100 respondents from the public, such as the people of South Tangerang, this study used factor analysis tool. The results of this study indicate that the studied variables being formed into nine factors, namely faith factors, community factors, factors of social care, confidence factor, factor income, educational factors, self-satisfaction factors, factors work, and knowledge factor. Total variance of the 9 factors is 67,30% means that all nine of these factors are factors that can contribute too paying zakat of muzakki consciousness of 67,30% while the remaining 32,70% is supported by other factors outside the 9 factors.

Keywords: zakat, analysis factor, faith, education, knowledge

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Authors: Minna Salim, James Brady

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Postoperative nausea and pain (PONV) are adverse effects following surgical procedures. It is especially pronounced in patients undergoing orthognathic surgery, as their mouth is closed postoperatively using wires or rubber bands. Postoperative mouth closure increases the discomfort and risk of complications associated with nausea and vomiting. Many surgeons and institutions apply gastric decompression in hopes of aspirating stomach contents and, therefore, decreasing PONV incidence. This review observed that PONV incidence was not affected by gastric decompression overall. However, the effect of gastric decompression on PONV in orthognathic surgery was variable. This paper aims to summarize the findings of gastric decompression on PONV and to determine the need for it in orthognathic surgery.

Keywords: gastric decompression, nasogastric tube, orthognathic surgery, postoperative nausea, vomiting

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Authors: S. Arun Prakash, V. Malathi, M. S. Mani Rajan

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The analytical bright two soliton solution of the 3-coupled nonlinear Schrödinger equations with variable coefficients in birefringent optical fiber is obtained by Darboux transformation method. To the design of ultra-speed optical devices, Soliton interaction and control in birefringence fiber is investigated. Lax pair is constructed for N coupled NLS system through AKNS method. Using two soliton solution, we demonstrate different interaction behaviors of solitons in birefringent fiber depending on the choice of control parameters. Our results shows that interactions of optical solitons have some specific applications such as construction of logic gates, optical computing, soliton switching, and soliton amplification in wavelength division multiplexing (WDM) system.

Keywords: optical soliton, soliton interaction, soliton switching, WDM

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Authors: Lorena C. Cintra, Izadora M. De Oliveira, Amanda G. Fernandes, Francieli Colussi, Rosália S. A. Jesuíno, Fabrícia P. Faria, Cirano J. Ulhoa

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Xylan is the main component of hemicellulose and for its complete degradation is required cooperative action of a system consisting of several enzymes including endo-xylanases (XYN), β-xylosidases (XYL) and α-L-arabinofuranosidases (ABF). The recombinant hemicellulolytic enzymes an endoxylanase (HXYN2), β-xylosidase (HXYLA), and an α-L-arabinofuranosidase (ABF3) were used in hydrolysis tests. These three enzymes are produced by filamentous fungi and were expressed heterologously and produced in Pichia pastoris previously. The aim of this work was to evaluate the effect of recombinant hemicellulolytic enzymes on the enzymatic hydrolysis of sugarcane bagasse (SCB). The interaction between the three recombinant enzymes during SCB pre-treated by steam explosion hydrolysis was performed with different concentrations of HXYN2, HXYLA and ABF3 in different ratios in according to a central composite rotational design (CCRD) 23, including six axial points and six central points, totaling 20 assays. The influence of the factors was assessed by analyzing the main effects and interaction between the factors, calculated using Statistica 8.0 software (StatSoft Inc. Tulsa, OK, USA). The Pareto chart was constructed with this software and showed the values of the Student’s t test for each recombinant enzyme. It was considered as response variable the quantification of reducing sugars by DNS (mg/mL). The Pareto chart showed that the recombinant enzyme ABF3 exerted more significant effect during SCB hydrolysis, with higher concentrations and with the lowest concentration of this enzyme. It was performed analysis of variance according to Fisher method (ANOVA). In ANOVA for the release of reducing sugars (mg/ml) as the variable response, the concentration of ABF3 showed significance during hydrolysis SCB. The result obtained by ANOVA, is in accordance with those presented in the analysis method based on the statistical Student's t (Pareto chart). The degradation of the central chain of xylan by HXYN2 and HXYLA was more strongly influenced by ABF3 action. A model was obtained, and it describes the performance of the interaction of all three enzymes for the release of reducing sugars, and can be used to better explain the results of the statistical analysis. The formulation capable of releasing the higher levels of reducing sugars had the following concentrations: HXYN2 with 600 U/g of substrate, HXYLA with 11.5 U.g-1 and ABF3 with 0.32 U.g-1. In conclusion, the recombinant enzyme that has a more significant effect during SCB hydrolysis was ABF3. It is noteworthy that the xylan present in the SCB is arabinoglucoronoxylan, due to this fact debranching enzymes are important to allow access of enzymes that act on the central chain.

Keywords: experimental design, hydrolysis, recombinant enzymes, sugar cane bagasse

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Authors: Desiree Llaguno Cerezo, Elizabeth Valdes-Miranda Fernandez

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Women have a critical role in sustaining the economy and in the development of trade. However, such a role has long been invisible due to orthodox conceptions that have ignored the gender variable in commercial analyses. Today, it is generally accepted that neither the economy nor business are gender-neutral and that the performance of these activities often impact negatively the lives of women. Women’s participation in trade, on equal terms as men, in any of the various possible roles -producer, wage earner, consumer, merchant, taxpayer- will not only favour the lives of women but also the performance of the economies in which they participate. Transparency, as a principle of the multilateral trading system, can play a significant role as a strategy for the empowerment of women.

Keywords: trade, human rights, gender equality, transparency, WTO, women workers, women's economic empowerment

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Authors: Liubov Evstigneeva

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In this paper an attempt is made to establish causal nexuses between innovation and international trade in Russia. The topicality of this issue is determined by the necessity of choosing policy instruments for economic modernization and transition to innovative development. The vector auto regression (VAR) model and Granger test are applied for the Russian monthly data from 2005 until the second quartile of 2015. Both lagged import and export at the national level cause innovation, the latter starts to stimulate foreign trade since it is a remote lag. In comparison to aggregate data, the results by patent’s categories are more diverse. Importing technologies from foreign countries stimulates patent activity, while innovations created in Russia are only Granger causality for import to Commonwealth of Independent States.

Keywords: export, import, innovation, patents

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Authors: Kevin Wongleedee

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The objective of this research was to study the level of importance of motivation factors from the perspective of international tourist who visited Bangkok, Thailand. The independent variables included gender, age, levels of education, occupation, and income while the dependent variables were ten motivation factors. A simple random sampling method was utilized to get 200 respondents. The majority of respondents were both male and female in almost the same proportion and most were between 21-40 years old. Most were married and had a graduate degree. The average income of the respondents was between $30,000-50,000. The findings revealed the ranking levels of importance by highest mean to lowest mean as follows: Thai food, nature-beaches, spa, tradition markets, shopping places, museums, festivals, night entertainment, conference/expo, and visiting friends. In addition, the overall means is 4.11 with 0.812 SD.

Keywords: international tourist, motivation, revisit, Thailand

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Authors: Marziehossadat Moezzi

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In this paper, electromagnetically induced transparency (EIT) is investigated in a cylindrical quantum dot (QD) with a parabolic confinement potential. We study the effect of control lasers polarization on absorption coefficient, refractive index and also on the generation of the double transparency windows in this system. Considering an effective mass method, the time-independent Schrödinger equation is solved to obtain the energy structure of the QD. Also, we study the effect of structural characteristics of the QD on refraction and absorption of the QD in the presence of EIT.

Keywords: electromagnetically induced transparency, cylindrical quantum dot, absorption coefficient, refractive index

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Authors: Yo-Seph Byun, Gyu-Phil Lee, Young-Bin Park, Gye-Chun Cho, Seong-Won Lee

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In Korea, a study on Limit State Design (LSD) for underground structures is being conducted in order to perform more effective design. In this study, as a result of MCS (Monte-Carlo Simulation) technique, failure probabilities of the structure during normal and earthquake are estimated in reliability analysis. Target reliability indexes are determined depending on load combinations for underground structure, and then, design variables such as load and material factors in LSD are decided. As a result, through the research in order to determine more reliable design variables, a specification of LSD for underground structures is able to be developed.

Keywords: design variable, limit state design, target reliability index, underground structure

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Authors: Suphaporn Rattanaphinanchai

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The purpose of this study is to 1) describe and analyze the travel motivations of tourists visiting Phi Phi Islands after the Tsunami in 2004 and 2) to better understand whether there are significant differences in the tourists’ motivations in visiting Phi Phi Island after the Tsunami hit across tourists with different demographic profile. This study used Phi Phi Islands, which was damaged by the 2004 Indian Ocean tsunami as a case study. The instrument used in the present study is a self-administered questionnaire. A survey with 200 questionnaires was collected in May - December, 2015. Descriptive statistics, Independent Sample Mean T-tests, and Analysis of Variances was used to analyze the data. The result of the study showed that beauty of nature, good climate, and relaxing atmosphere motivated tourists in visiting Phi Phi Islands after the tsunami.

Keywords: motivation, Thailand, Thai tourism, Thai beaches

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Authors: Narges Solaymani

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medical training of patients. Nursing is a very important profession in the societies of the world. Although in the past, all caregivers of the sick and disabled were called nurses, nowadays, a nurse is a person who has a university education in this field. There are nurses in bachelor's, master's, and doctoral degrees in nursing. New courses have been launched in the master's degree based on duty-oriented nurses. A nurse cannot have an independent treatment center but is a member of the treatment team in established treatment centers such as hospitals, clinics, or offices. Nurses can establish counseling centers and provide nursing services at home. According to the standards, the number of nurses should be three times the number of doctors or twice the number of hospital beds, or there should be three nurses for every thousand people. Also, international standards show that in the internal and surgical department, every 4 to 6 patients should have a nurse.

Keywords: Nurse, Intensive Care, CPR, Bandage

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Authors: Chau-Kuang Chen, Juanita Buford, Colette Davis, Raisha Allen, John Hughes, James Tyus, Dexter Samuels

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During the post-Civil War era, the city of Nashville, Tennessee, had the highest mortality rate in the country. The elevated death and disease among ex-slaves were attributable to the unavailability of healthcare. To address the paucity of healthcare services, the College, an institution with the mission of educating minority professionals and serving the under served population, was established in 1876. This study was designed to assess if the College has accomplished its mission of serving under served communities and contributed to the elimination of health disparities in the United States. The study objective was to quantify the impact of socioeconomic status and adverse health outcomes on primary care professionals serving disadvantaged communities, which, in turn, was significantly associated with a health professional shortage score partly designated by the U.S. Department of Health and Human Services. Various statistical methods were used to analyze the alumni data in years 1975 – 2013. K-means cluster analysis was utilized to identify individual medical and dental graduates into the cluster groups of the practice communities (Disadvantaged or Non-disadvantaged Communities). Discriminant analysis was implemented to verify the classification accuracy of cluster analysis. The independent t test was performed to detect the significant mean differences for clustering and criterion variables between Disadvantaged and Non-disadvantaged Communities, which confirms the “content” validity of cluster analysis model. Chi-square test was used to assess if the proportion of cluster groups (Disadvantaged vs Non-disadvantaged Communities) were consistent with that of practicing specialties (primary care vs. non-primary care). Finally, the partial least squares (PLS) path model was constructed to explore the “construct” validity of analytics model by providing the magnitude effects of socioeconomic status and adverse health outcome on primary care professionals serving disadvantaged community. The social ecological theory along with statistical models mentioned was used to establish the relationship between medical and dental graduates (primary care professionals serving disadvantaged communities) and their social environments (socioeconomic status, adverse health outcome, health professional shortage score). Based on social ecological framework, it was hypothesized that the impact of socioeconomic status and adverse health outcomes on primary care professionals serving disadvantaged communities could be quantified. Also, primary care professionals serving disadvantaged communities related to a health professional shortage score can be measured. Adverse health outcome (adult obesity rate, age-adjusted premature mortality rate, and percent of people diagnosed with diabetes) could be affected by the latent variable, namely socioeconomic status (unemployment rate, poverty rate, percent of children who were in free lunch programs, and percent of uninsured adults). The study results indicated that approximately 83% (3,192/3,864) of the College’s medical and dental graduates from 1975 to 2013 were practicing in disadvantaged communities. In addition, the PLS path modeling demonstrated that primary care professionals serving disadvantaged community was significantly associated with socioeconomic status and adverse health outcome (p < .001). In summary, the majority of medical and dental graduates from the College provide primary care services to disadvantaged communities with low socioeconomic status and high adverse health outcomes, which demonstrate that the College has fulfilled its mission.

Keywords: disadvantaged community, K-means cluster analysis, PLS path modeling, primary care

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Authors: Haoming Ma, Guo Yu, Peiru Zhou

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Background: Previous studies show that dysglycemia, mostly hyperglycemia, hypoglycemia and glycemic variability(GV), are associated with excess mortality in critically ill patients, especially those without diabetes. Glycemic variability is an increasingly important measure of glucose control in the intensive care unit (ICU) due to this association. However, there is limited data pertaining to the relationship between different clinical factors and glycemic variability and clinical outcomes categorized by their DM status. This retrospective study of 958 intensive care unit(ICU) patients was conducted to investigate the relationship between GV and outcome in critically ill patients and further to determine the significant factors that contribute to the glycemic variability. Aim: We hypothesize that the factors contributing to mortality and the glycemic variability are different from critically ill patients with or without diabetes. And the primary aim of this study was to determine which dysglycemia (hyperglycemia\hypoglycemia\glycemic variability) is independently associated with an increase in mortality among critically ill patients in different groups (DM/Non-DM). Secondary objectives were to further investigate any factors affecting the glycemic variability in two groups. Method: A total of 958 diabetic and non-diabetic patients with severe diseases in the ICU were selected for this retrospective analysis. The glycemic variability was defined as the coefficient of variation (CV) of blood glucose. The main outcome was death during hospitalization. The secondary outcome was GV. The logistic regression model was used to identify factors associated with mortality. The relationships between GV and other variables were investigated using linear regression analysis. Results: Information on age, APACHE II score, GV, gender, in-ICU treatment and nutrition was available for 958 subjects. Predictors remaining in the final logistic regression model for mortality were significantly different in DM/Non-DM groups. Glycemic variability was associated with an increase in mortality in both DM(odds ratio 1.05; 95%CI:1.03-1.08,p＜0.001) or Non-DM group(odds ratio 1.07; 95%CI:1.03-1.11,p=0.002). For critically ill patients without diabetes, factors associated with glycemic variability included APACHE II score(regression coefficient, 95%CI:0.29,0.22-0.36,p＜0.001), Mean BG(0.73,0.46-1.01,p＜0.001), total parenteral nutrition(2.87,1.57-4.17,p＜0.001), serum albumin(-0.18,-0.271 to -0.082,p＜0.001), insulin treatment(2.18,0.81-3.55,p=0.002) and duration of ventilation(0.006,0.002-1.010,p=0.003).However, for diabetes patients, APACHE II score(0.203,0.096-0.310,p＜0.001), mean BG(0.503,0.138-0.869,p=0.007) and duration of diabetes(0.167,0.033-0.301,p=0.015) remained as independent risk factors of GV. Conclusion: We found that the relation between dysglycemia and mortality is different in the diabetes and non-diabetes groups. And we confirm that GV was associated with excess mortality in DM or Non-DM patients. Furthermore, APACHE II score, Mean BG, total parenteral nutrition, serum albumin, insulin treatment and duration of ventilation were significantly associated with an increase in GV in Non-DM patients. While APACHE II score, mean BG and duration of diabetes (years) remained as independent risk factors of increased GV in DM patients. These findings provide important context for further prospective trials investigating the effect of different clinical factors in critically ill patients with or without diabetes.

Keywords: diabetes, glycemic variability, predictors, severe disease

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Authors: Ainura Tursunalieva, Irene Hudson

Abstract:

Continuous improvement of both the quality and safety of health care is an important goal in Australia and internationally. The intensive care unit (ICU) receives patients with a wide variety of and severity of illnesses. Accurately identifying patients at risk of developing complications or dying is crucial to increasing healthcare efficiency. Thus, it is essential for clinicians and researchers to have a robust framework capable of evaluating the risk profile of a patient. ICU scoring systems provide such a framework. The Acute Physiology and Chronic Health Evaluation III and the Simplified Acute Physiology Score II are ICU scoring systems frequently used for assessing the severity of acute illness. These scoring systems collect multiple risk factors for each patient including physiological measurements then render the assessment outcomes of individual risk factors into a single numerical value. A higher score is related to a more severe patient condition. Furthermore, the Mortality Probability Model II uses logistic regression based on independent risk factors to predict a patient’s probability of mortality. An important overlooked limitation of SAPS II and MPM II is that they do not, to date, include interaction terms between a patient’s vital signs. This is a prominent oversight as it is likely there is an interplay among vital signs. The co-existence of certain conditions may pose a greater health risk than when these conditions exist independently. One barrier to including such interaction terms in predictive models is the dimensionality issue as it becomes difficult to use variable selection. We propose an innovative scoring system which takes into account a dependence structure among patient’s vital signs, such as systolic and diastolic blood pressures, heart rate, pulse interval, and peripheral oxygen saturation. Copulas will capture the dependence among normally distributed and skewed variables as some of the vital sign distributions are skewed. The estimated dependence parameter will then be incorporated into the traditional scoring systems to adjust the points allocated for the individual vital sign measurements. The same dependence parameter will also be used to create an alternative copula-based model for predicting a patient’s probability of mortality. The new copula-based approach will accommodate not only a patient’s trajectories of vital signs but also the joint dependence probabilities among the vital signs. We hypothesise that this approach will produce more stable assessments and lead to more time efficient and accurate predictions. We will use two data sets: (1) 250 ICU patients admitted once to the Chui Regional Hospital (Kyrgyzstan) and (2) 37 ICU patients’ agitation-sedation profiles collected by the Hunter Medical Research Institute (Australia). Both the traditional scoring approach and our copula-based approach will be evaluated using the Brier score to indicate overall model performance, the concordance (or c) statistic to indicate the discriminative ability (or area under the receiver operating characteristic (ROC) curve), and goodness-of-fit statistics for calibration. We will also report discrimination and calibration values and establish visualization of the copulas and high dimensional regions of risk interrelating two or three vital signs in so-called higher dimensional ROCs.

Keywords: copula, intensive unit scoring system, ROC curves, vital sign dependence

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