Search results for: clinical decision support systems

Authors: Slim Chokri

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Load forecasting is one of the central functions in power systems operations. Electricity cannot be stored, which means that for electric utility, the estimate of the future demand is necessary in managing the production and purchasing in an economically reasonable way. A majority of the recently reported approaches are based on neural network. The attraction of the methods lies in the assumption that neural networks are able to learn properties of the load. However, the development of the methods is not finished, and the lack of comparative results on different model variations is a problem. This paper presents a new approach in order to predict the Tunisia daily peak load. The proposed method employs a computational intelligence scheme based on the Fuzzy neural network (FNN) and support vector regression (SVR). Experimental results obtained indicate that our proposed FNN-SVR technique gives significantly good prediction accuracy compared to some classical techniques.

Keywords: neural network, load forecasting, fuzzy inference, machine learning, fuzzy modeling and rule extraction, support vector regression

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Authors: Golshid Gilani, Albert De La Fuente, Ana Blanco

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Sustainability assessment of new and existing buildings has generated a growing interest due to the evident environmental, social and economic impacts during their construction and service life. Façades, as one of the most important exterior elements of a building, may contribute to the building sustainability by reducing the amount of energy consumption and providing thermal comfort for the inhabitants, thus minimizing the environmental impact on both the building and on the environment. Various methods have been used for the sustainability assessment of buildings due to the importance of this issue. However, most of the existing methods mainly concentrate on environmental and economic aspects, disregarding the third pillar of sustainability, which is the social aspect. Besides, there is a little focus on comprehensive sustainability assessment of facades, as an important element of a building. This confirms the need of developing methods for assessing the sustainable performance of building façades as an important step in achieving building sustainability. In this respect, this paper aims at presenting a model for assessing the global sustainability of façade systems. for that purpose, the Integrated Value Model for Sustainable Assessment (MIVES), a Multi-Criteria Decision Making model that integrates the main sustainability requirements (economic, environmental and social) and includes the concept of value functions, used as an assessment tool.

Keywords: façade, MCDM, MIVES, sustainability

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Authors: Aleksandra Zysk, Pawel Badura

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Recognizing and controlling vocal registers during singing is a difficult task for beginner vocalist. It requires among others identifying which part of natural resonators is being used when a sound propagates through the body. Thus, an application has been designed allowing for sound recording, automatic vocal register recognition (VRR), and a graphical user interface providing real-time visualization of the signal and recognition results. Six spectral features are determined for each time frame and passed to the support vector machine classifier yielding a binary decision on the head or chest register assignment of the segment. The classification training and testing data have been recorded by ten professional female singers (soprano, aged 19-29) performing sounds for both chest and head register. The classification accuracy exceeded 93% in each of various validation schemes. Apart from a hard two-class clustering, the support vector classifier returns also information on the distance between particular feature vector and the discrimination hyperplane in a feature space. Such an information reflects the level of certainty of the vocal register classification in a fuzzy way. Thus, the designed recognition and training application is able to assess and visualize the continuous trend in singing in a user-friendly graphical mode providing an easy way to control the vocal emission.

Keywords: classification, singing, spectral analysis, vocal emission, vocal register

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Authors: Mustapha Ouardouz, Mina Amharref, Abdessamed Bernoussi

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The future energy, for limited energy resources countries, goes through renewable energies (solar, wind etc.). The renewable energies constitute a major component of the energy strategy to cover a substantial part of the growing needs and contribute to environmental protection by replacing fossil fuels. Indeed, sustainable development involves the promotion of renewable energy and the preservation of the environment by the use of clean energy technologies to limit emissions of greenhouse gases and reducing the pressure exerted on the forest cover. So the impact studies, of the energy use on the environment and farm-related risks are necessary. For that, a global approach integrating all the various sectors involved in such project seems to be the best approach. In this paper we present an approach based on the multi criteria analysis and the realization of one pilot to achieve the development of an innovative geo-intelligent environmental platform. An implementation of this platform will collect, process, analyze and manage environmental data in connection with the nature of used energy in the studied region. As an application we consider a region in the north of Morocco characterized by intense agricultural and industrials activities and using diverse renewable energy. The strategic goals of this platform are; the decision support for better governance, improving the responsiveness of public and private companies connected by providing them in real time with reliable data, modeling and simulation possibilities of energy scenarios, the identification of socio-technical solutions to introduce renewable energies and estimate technical and implantable potential by socio-economic analyzes and the assessment of infrastructure for the region and the communities, the preservation and enhancement of natural resources for better citizenship governance through democratization of access to environmental information, the tool will also perform simulations integrating environmental impacts of natural disasters, particularly those linked to climate change. Indeed extreme cases such as floods, droughts and storms will be no longer rare and therefore should be integrated into such projects.

Keywords: renewable energies, decision aided tool, environment, simulation

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Authors: Alba Prats-Bisbe, Jaume López-Carballo, David Leno-Colorado, Alberto García Molina, Alicia Romero Marquez, Elena Hernández Pena, Eloy Opisso Salleras, Raimon Jané Campos

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Neurological disorders are a leading cause of disability and premature mortality worldwide. Neurorehabilitation (NRHB) is a clinical process aimed at reducing functional impairment, promoting societal participation, and improving the quality of life for affected individuals. Virtual reality (VR) technology is emerging as a promising NRHB support tool. Its immersive nature fosters a strong sense of agency and embodiment, motivating patients to engage in meaningful tasks and increasing adherence to therapy. However, the clinical benefits of VR interventions are challenging to determine due to the high heterogeneity among health applications. This study explores a stepwise development approach for creating VR-based tools to assist individuals with neurological disorders in medical practice, aiming to enhance reproducibility, facilitate comparison, and promote the generalization of findings. Building on previous research, the step-by-step methodology encompasses: Needs Identification– conducting cross-disciplinary meetings to brainstorm problems, solutions, and address barriers. Intervention Definition– target population, set goals, and conceptualize the VR system (equipment and environments). Material Selection and Placement– choose appropriate hardware and software, place the device within the hospital setting, and test equipment. Co-design– collaboratively create VR environments, user interfaces, and data management strategies. Prototyping– develop VR prototypes, conduct user testing, and make iterative redesigns. Usability and Feasibility Assessment– design protocols and conduct trials with stakeholders in the hospital setting. Efficacy Assessment– conduct clinical trials to evaluate outcomes and long-term effects. Cost-Effectiveness Validation– assess reproducibility, sustainability, and balance between costs and benefits. NRHB is complex due to the multifaceted needs of patients and the interdisciplinary healthcare architecture. VR has the potential to support various applications, such as motor skill training, cognitive tasks, pain management, unilateral spatial neglect (diagnosis and treatment), mirror therapy, and ecologically valid activities of daily living. Following this methodology was crucial for launching a VR-based system in a real hospital environment. Collaboration with neuropsychologists lead to develop A) a VR-based tool for cognitive rehabilitation in patients with acquired brain injury (ABI). The system comprises a head-mounted display (HTC Vive Pro Eye) and 7 tasks targeting attention, memory, and executive functions. A desktop application facilitates session configuration, while database records in-game variables. The VR tool's usability and feasibility were demonstrated in proof-of-concept trials with 20 patients, and effectiveness is being tested through a clinical protocol with 12 patients completing 24-session treatment. Another case involved collaboration with nurses and paediatric physiatrists to create B) a VR-based distraction tool during invasive techniques. The goal is to alleviate pain and anxiety associated with botulinum toxin (BTX) injections, blood tests, or intravenous placements. An all-in-one headset (HTC Vive Focus 3) deploys 360º videos to improve the experience for paediatric patients and their families. This study presents a framework for developing clinically relevant and technologically feasible VR-based support tools for hospital settings. Despite differences in patient type, intervention purpose, and VR system, the methodology demonstrates usability, viability, reproducibility and preliminary clinical benefits. It highlights the importance approach centred on clinician and patient needs for any aspect of NRHB within a real hospital setting.

Keywords: neurological disorders, neurorehabilitation, stepwise development approach, virtual reality

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Authors: G. Dottavio, M. F. Andrade, F. Renard, V. Cheutet, A.-L. Ladier, S. Vercraene, P. Hoang, S. Briet, R. Dachicourt, Y. Baizet

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An important number of technological equipment and high-skilled workers over long periods of time have to be mobilized during nuclear decommissioning processes. The related operations generate complex flows of waste and high inventory levels, associated to information flows of heterogeneous types. Taking into account that more than 10 decommissioning operations are on-going in France and about 50 are expected toward 2025: A big challenge is addressed today. The management of decommissioning and dismantling of nuclear installations represents an important part of the nuclear-based energy lifecycle, since it has an environmental impact as well as an important influence on the electricity cost and therefore the price for end-users. Bringing new technologies and new solutions into decommissioning methodologies is thus mandatory to improve the quality, cost and delay efficiency of these operations. The purpose of our project is to improve decommissioning management efficiency by developing a decision-support framework dedicated to plan nuclear facility decommissioning operations and to optimize waste evacuation by means of a logistic approach. The target is to create an easy-to-handle tool capable of i) predicting waste flows and proposing the best decommissioning logistics scenario and ii) managing information during all the steps of the process and following the progress: planning, resources, delays, authorizations, saturation zones, waste volume, etc. In this article we present our results from waste nuclear flows simulation during decommissioning process, including discrete-event simulation supported by FLEXSIM 3-D software. This approach was successfully tested and our works confirms its ability to improve this type of industrial process by identifying the critical points of the chain and optimizing it by identifying improvement actions. This type of simulation, executed before the start of the process operations on the basis of a first conception, allow ‘what-if’ process evaluation and help to ensure quality of the process in an uncertain context. The simulation of nuclear waste flows before evacuation from the site will help reducing the cost and duration of the decommissioning process by optimizing the planning and the use of resources, transitional storage and expensive radioactive waste containers. Additional benefits are expected for the governance system of the waste evacuation since it will enable a shared responsibility of the waste flows.

Keywords: nuclear decommissioning, logistical optimization, decision-support framework, waste management

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Authors: H. W. Meerveld, R. H. A. Lindelauf

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In contemporary warfare, data science is crucial for the military in achieving information superiority. Yet, to the authors’ knowledge, no extensive literature survey on data science in military decision-making has been conducted so far. In this study, 156 peer-reviewed articles were analysed through an integrative, semi-systematic literature review to gain an overview of the topic. The study examined to what extent literature is focussed on the opportunities or risks of data science in military decision-making, differentiated per level of war (i.e. strategic, operational, and tactical level). A relatively large focus on the risks of data science was observed in social science literature, implying that political and military policymakers are disproportionally influenced by a pessimistic view on the application of data science in the military domain. The perceived risks of data science are, however, hardly addressed in formal science literature. This means that the concerns on the military application of data science are not addressed to the audience that can actually develop and enhance data science models and algorithms. Cross-disciplinary research on both the opportunities and risks of military data science can address the observed research gaps. Considering the levels of war, relatively low attention for the operational level compared to the other two levels was observed, suggesting a research gap with reference to military operational data science. Opportunities for military data science mostly arise at the tactical level. On the contrary, studies examining strategic issues mostly emphasise the risks of military data science. Consequently, domain-specific requirements for military strategic data science applications are hardly expressed. Lacking such applications may ultimately lead to a suboptimal strategic decision in today’s warfare.

Keywords: data science, decision-making, information superiority, literature review, military

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Authors: Fausto Morais

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Artificial intelligence has been widely used in law. Programs are able to classify suits, to identify decision-making patterns, to predict outcomes, and to formalize legal arguments as well. In Brazil, the artificial intelligence victor has been classifying cases to supreme court’s standards. When those programs act doing those tasks, they simulate some kind of legal decision and legal arguments, raising doubts about how artificial intelligence can be integrated into legal reasoning. Taking this into account, the following three issues are identified; the problem of hypernormatization, the argument of legal anthropocentrism, and the artificial legal principles. Hypernormatization can be seen in the Brazilian legal context in the Supreme Court’s usage of the Victor program. This program generated efficiency and consistency. On the other hand, there is a feasible risk of over standardizing factual and normative legal features. Then legal clerks and programmers should work together to develop an adequate way to model legal language into computational code. If this is possible, intelligent programs may enact legal decisions in easy cases automatically cases, and, in this picture, the legal anthropocentrism argument takes place. Such an argument argues that just humans beings should enact legal decisions. This is so because human beings have a conscience, free will, and self unity. In spite of that, it is possible to argue against the anthropocentrism argument and to show how intelligent programs may work overcoming human beings' problems like misleading cognition, emotions, and lack of memory. In this way, intelligent machines could be able to pass legal decisions automatically by classification, as Victor in Brazil does, because they are binding by legal patterns and should not deviate from them. Notwithstanding, artificial intelligent programs can be helpful beyond easy cases. In hard cases, they are able to identify legal standards and legal arguments by using machine learning. For that, a dataset of legal decisions regarding a particular matter must be available, which is a reality in Brazilian Judiciary. Doing such procedure, artificial intelligent programs can support a human decision in hard cases, providing legal standards and arguments based on empirical evidence. Those legal features claim an argumentative weight in legal reasoning and should serve as references for judges when they must decide to maintain or overcome a legal standard.

Keywords: artificial intelligence, artificial legal principles, hypernormatization, legal anthropocentrism argument, legal reasoning

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Authors: Chris Cadman, Marcel Strauss

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Background: In 2020, the University Hospital Wishaw in the United Kingdom became the centre for trauma and orthopaedics within its health board. This resulted in the majority of patients with suspected cauda equina syndrome (CES) being assessed and imaged at this site, putting an increased demand on MR imaging and displacing other previous activity. Following this transition, imaging requests for CES did not always follow national guidelines and would often be missing important clinical and safety information. There also appeared to be a very low positive scan rate compared with previously reported studies. In an attempt to improve patient selection and reduce the burden of CES imaging at this site clinical audit was performed. Methods: A total of 250 consecutive patients imaged to assess for CES were evaluated. Patients had to have presented to either the emergency or orthopaedic department acutely with a presenting complaint of suspected CES. Patients were excluded if they were not admitted acutely or were assessed by other clinical specialities. In total, 233 patients were included. Requests were assessed for appropriate clinical history, accurate and complete clinical assessment and MRI safety information. Clinical assessment was allocated a score of 1-6 based on information relating to history of pain, level of pain, dermatomes/myotomes affected, peri-anal paraesthesia/anaesthesia, anal tone and post-void bladder volume with each element scoring one point. Images were assessed for positive findings of CES, acquired spinal stenosis or nerve root compression. Results: Overall, 73% of requests had a clear clinical history of CES. The urgency of the request for imaging was given in 23% of cases. The mean clinical assessment score was 3.7 out of a total of 6. Overall, 2% of scans were positive for CES, 29% had acquired spinal stenosis and 30% had nerve root compression. For patients with CES, 75% had acute neurological signs compared with 68% of the study population. CES patients had a mean clinical history score of 5.3 compared with 3.7 for the study population. Overall, 95% of requests had appropriate MRI safety information. Discussion: it study included 233 patients who underwent specialist assessment and referral for MR imaging for suspected CES. Despite the serious nature of this condition, a large proportion of imaging requests did not have a clear clinical query of CES and the level of urgency was not given, which could potentially lead to a delay in imaging and treatment. Clinical examination was often also incomplete, which can make triaging of patients presenting with similar symptoms challenging. The positive rate for CES was only 2%, much below other studies which had positive rates of 6–40% with a large meta-analysis finding a mean positive rate of 19%. These findings demonstrate an opportunity to improve the quality of imaging requests for suspected CES. This may help to improve patient selection for imaging and result in a positive rate for CES imaging that is more in line with other centres.

Keywords: cauda equina syndrome, acute back pain, MRI, spine

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Authors: Tiedan Huang, Chun Zhang, Caitlin Coe

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This study investigated the quality of instructional support for young Emergent Multilingual Learners (EMLs) in 50 Universal Prekindergarten (UPK) classroom in New York City (NYC). This is one of the first empirical studies examining the instructional support for this student population. We collected data using a mixed method of structured observations of teacher-child interactions in 50 classrooms, and surveys and interviews with program leaders and the teaching teams. We found that NYC’s UPK classrooms offered warm and supportive environments for EMLs. Nevertheless, in general, instructional support was relatively low. This study identified large mindset, knowledge, and practice gaps—and a real opportunity—among NYC early childhood professionals, specifically in the areas of providing adequate instructional and linguistic support for EMLs as well as partnering with families in capturing their cultural and home literacy assets. Consistent, rigorous, and meaningful use of data is necessary to support both EMLs’ language and literacy development and teachers’/leaders’ professional development.

Keywords: high quality instruction, culturally and linguistically responsive practices, professional development, workforce development

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Authors: Mojtaba Hakimi-Moghaddam

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Positive realness as the most important property of driving point impedance of passive electrical networks appears in the control systems stability theory in 1960’s. There are three important subsets of positive real (PR) systems are introduced by researchers, that is, loos-less positive real (LLPR) systems, weakly strictly positive real (WSPR) systems and strictly positive real (SPR) systems. In this paper, definitions, properties, lemmas, and theorems related to family of positive real systems are summarized. Properties in both frequency domain and state space representation of system are explained. Also, several illustrative examples are presented.

Keywords: real rational matrix transfer functions, positive realness property, strictly positive realness property, Hermitian form asymptotic property, pole-zero properties

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Authors: Chia Han Lee

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Without energy, the economy would grind to a halt. Germany's prosperity and security depend on a reliable and affordable energy supply. In recent years, Germany's energy policy has undergone major changes. Due to the sharp turn in energy, Germany cannot extend the service of nuclear power plants and can only find a rapid transition energy source: natural gas for a limited time. This study attempts to use processes of decision entrapment behavior and document analysis to explain research questions. Through primary and secondary information such as official reports, parliamentary minutes, media interview records, and speech records, the author sorted out the important events experienced by the three coalition governments (Gerhard Schröder, Angela Merkel, and Olaf Scholz) and the relationship between Nord Stream 1 and Nord Stream 2 with primary and secondary sources. Also, compare it with the processes of decision entrapment behavior, which designed in this study, and divide it into four stages to explore its key elements one by one. In this regard, the following conclusions are drawn: First, from the perspective of processes of decision entrapment behavior, Merkel’s government firmly believes that she can overcome difficulties because of her past experience in crisis management capabilities. However, the outbreak of war between Ukraine and Russia was beyond Merkel's planning. Second, in the face of the crisis, the Scholz’s government increased the import of natural gas from other countries and began to import liquefied natural gas to make up for the energy gap of Russian natural gas.

Keywords: german research, nord stream gas pipeline, energy policy, processes of decision entrapment behavior

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Authors: Paivi Hietanen

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At family with children, divorce is a risk for a child to lose the relationship to the parent with whom the child doesn't live. A child has the right to the get care from both parents after the divorce. Even though your ex-spouse isn’t longer your companion, to the child he or she is still unique as a parent and parents must cooperate and support their child in the new family situation. To divorcee, it's necessary to understand the difference between the intimate relationship that ends and parenthood that continues. Cooperative parenting takes a lot of effort and flexibility for the parents to make joint custody work well. It is vital that parents get help to understand the situation from child points of view. When parent is facing divorce, and all the emotions that it brings along, can the child easily be forgotten. To help children, we must help parents to understand, that a relationship can end, parenthood cannot. As professionals, we should help the parents to see the significance and value of both parents to the child and try to support and protect parenthood-relationship between parents. The Federation of Mother and Child Homes and Shelters have developed group models to work with parents during or after divorce. These support groups are led by professionals, but peer support is also used. These support groups have been held over 10 years and there are found from 20 different cities in Finland. Eroneuvo event (divorce advice) service is intended for parents who are considering or have already divorced. The Vanhemman neuvo (parents' council) is a peer support group that helps parents with post-divorce parenting issues. From these groups, parents receive information and peer support for matters related to divorcing and how to support the child and do co-parenting. At the groups and in given information for divorced parents, is used a method called the 'Irreversible triangle'. It's a way to picture the intimate relationship and parenthood after the divorce and what is the difference between these two things. 'Irreversible triangle' is used to help parents and professionals to understand, what happens if a child loses the relationship to the other parent or if parents co-parenting doesn't work well. From the largely collected feedback, group members tell that they feel themselves relieved after taking part of the group. Parents also experience that talking with other parents helps to survive. Group members learn to co-operate with the other parent, and they'll also learn to see the best interest of the child after the divorce. Parents would highly recommend these groups to other parents.

Keywords: child's right, co-parenting, parenthood after the divorce, peer support

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Authors: Buket Metin

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Buildings cause a variety of loads on the environment due to activities performed at each stage of the building life cycle. Construction is the first stage that affects both the natural and built environments at different steps of the process, which can be defined as transportation of materials within the construction site, formation and preparation of materials on-site and the application of materials to realize the building subsystems. All of these steps require the use of technology, which varies based on the facilities that contractors and subcontractors have. Hence, environmental consequences of the construction process should be tackled by focusing on construction technology options used in every step of the process. This paper presents an environmental decision-making model for assessing on-site performances of subcontractors based on the construction technology options which they can supply. First, construction technologies, which constitute information, tools and methods, are classified. Then, environmental performance criteria are set forth related to resource consumption, ecosystem quality, and human health issues. Finally, the model is developed based on the relationships between the construction technology components and the environmental performance criteria. The Fuzzy Analytical Hierarchy Process (FAHP) method is used for weighting the environmental performance criteria according to environmental priorities of decision-maker(s), while the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method is used for ranking on-site environmental performances of subcontractors using quantitative data related to the construction technology components. Thus, the model aims to provide an insight to decision-maker(s) about the environmental consequences of the construction process and to provide an opportunity to improve the overall environmental performance of construction sites.

Keywords: construction process, construction technology, decision making, environmental performance, subcontractor

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Authors: Azadeh Bashiri

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Introduction: In order to better designing of electronic health record system in Iran, integration of health information systems based on a common language must be done to interpret and exchange this information with this system is required. Background: This study, provides a conceptual model of radiology reporting system using unified modeling language. The proposed model can solve the problem of integration this information system with electronic health record system. By using this model and design its service based, easily connect to electronic health record in Iran and facilitate transfer radiology report data. Methods: This is a cross-sectional study that was conducted in 2013. The student community was 22 experts that working at the Imaging Center in Imam Khomeini Hospital in Tehran and the sample was accorded with the community. Research tool was a questionnaire that prepared by the researcher to determine the information requirements. Content validity and test-retest method was used to measure validity and reliability of questioner respectively. Data analyzed with average index, using SPSS. Also, Visual Paradigm software was used to design a conceptual model. Result: Based on the requirements assessment of experts and related texts, administrative, demographic and clinical data and radiological examination results and if the anesthesia procedure performed, anesthesia data suggested as minimum data set for radiology report and based it class diagram designed. Also by identifying radiology reporting system process, use case was drawn. Conclusion: According to the application of radiology reports in electronic health record system for diagnosing and managing of clinical problem of the patient, provide the conceptual Model for radiology reporting system; in order to systematically design it, the problem of data sharing between these systems and electronic health records system would eliminate.

Keywords: structured radiology report, information needs, minimum data set, electronic health record system in Iran

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Authors: Khushi, Simrat

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The study aims to investigate the relationship between emotions and employee's social cognition and decision-making among employees. The sample of the study was the total number of participants, which included employees from various industries and job positions. Research papers in the same area were reviewed, providing a comprehensive review of existing literature and theoretical frameworks and shedding light on the interpersonal effects of emotions in the workplace. It emphasizes how one worker's emotions can significantly impact the overall work environment and productivity as well as the work of a common phenomenon known as Emotional contagion at the workplace, affecting social interactions and group dynamics. Therefore, this study concludes that Emotional contagion can lead to a ripple effect within the workplace, influencing the overall atmosphere and productivity. Emotions can shape how employees process information and make choices, ultimately impacting organizational outcomes.

Keywords: employee decision making, social cognition, emotions, industry, emotional contagion, workplace dynamics

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Authors: Garima Singh

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Objectives: Behavioral Crisis Center (BCC) is a community solution to a community problem. There has been an exponential increase in the incidence and prevalence of mental health crises around the world. The effects of the crisis negatively impact our patients and their families and strain the law enforcement and emergency room. The goal of the multi-disciplinary care model is to break the crisis cycle and provide 24-7 rapid access to an acre and crisis stabilization. We initiated our first BCC care center in 2020 in the midst of the COVID pandemic and have seen a remarkable improvement in patient ‘care and positive financial outcome. Background: Mental illnesses are common in the United States. Nearly one in five U.S. adults live with a mental illness (52.9 million in 2020). This number represented 21.0% of all U.S. adults. To address some of these challenges and help our community, In May 2020, we opened our first Behavioral crisis center (BCC). Since then, we have served more than 2500 patients and is the first southwest Missouri’s first 24/7 facility for crisis–level behavioral health and substance use needs. It has been proven to be a more effective place than emergency departments, jails, or local law enforcement. Methods: BCC was started in 2020 to serve the unmet need of the community and provide access to behavioral health and substance use services identified in the community. Funding was possible with significant investment from the county and Missouri Foundation for Health, with contributions from medical partners. It is a multi-disciplinary care center consisting of Physicians, nurse practitioners, nurses, behavioral technicians, peer support specialists, clinical intake specialists, and clinical coordinators and hospitality specialists. The center provides services including psychiatry care, outpatient therapy, community support services, primary care, peer support and engagement. It is connected to a residential treatment facility for substance use treatment for continuity of care and bridging the gap, which has resulted in the completion of treatment and better outcomes. Results: BCC has proven to be a great resource to the community and the Missouri Health Coalition is providing funding to replicate the model in other regions and work on a similar model for children and adolescents. Overall, 29% of the patients seen at BCC are stabilized and discharged with outpatient care. 50% needed acute stabilization in a hospital setting and 21% required long-term admission, mostly for substance use treatment. The local emergency room had a 42% reduction in behavioral health encounters compared to the previous 3 years. Also, by a quick transfer to BCC, the average stay in ER was reduced by 10 hours and time to follow up behavioral health assessment decreased by an average of 4 hours. Uninsured patients are also provided Medicaid application assistance which has benefited 55% of individuals receiving care at BCC. Conclusions: BCC is impacting community health and improving access to quality care and substance use treatment. It is a great investment for our patients and families.

Keywords: BCC, behvaioral health, community health care, addiction treatment

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Authors: Jerome Nyameh

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The most valuable asset in the existence of organization is the employees and their ability in maintain appreciable level of performance which support the goal of the organization and the ability to do that depend largely on the organizational culture and culture has been considered most currently as the factor that relate positively to organizational excellence and sustainable employee’s performance over the period of time An employee engagement program will not go far without first establishing the organizational culture that is required to support sustainability. This means integrating sustainability into the overall employee’s performance, with clear vision, goals and metrics. It means having strong culture and a collaborative governance structure that has been develop as a ways of doing things in the organization for decision making and resource allocation. It requires a rewards and recognition program to support and reinforce sustainability behaviors. With such a culture in place, organization will be able to develop a strategy that fully engages employees, while fully realizing the benefits of their contributions. The study investigated empirically the role of organizational culture building sustainable employee’s performance using Zenith bank PLC a model where organizational culture will build sustainable employees performance strategy for a lasting actualization of organizational was developed. In order to achieve the research objectives of (i) to assess how organizational culture can build sustainable employee’s performance (ii) to analyze the gap that exists between organizational culture and sustainable employee’s performance in the organization, a survey questionnaires of 20 items was administered to sixty respondents. The findings of this study have practical implications for organizational leaders, managers and employees, and their organizations, particularly commercial banks in Nigeria, besides offering scope for further research in the area of organizational culture and sustainable employee’s performance. It will also show a significance and positive relationship that exist between organizational culture and sustainable employee’s performance, as means of building viable organization with cultural uniqueness and excellence performance in the world of competition.

Keywords: organizational culture, sustainable employee’s performance, organizations, Zenith Bank PLC Nigeria

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Authors: Ren-Jieh Kuo, Chun-Shou Huang

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The research of juice flavor forecasting has become more important in China. Due to the fast economic growth in China, many different kinds of juices have been introduced to the market. If a beverage company can understand their customers’ preference well, the juice can be served more attractively. Thus, this study intends to introduce the basic theory and computing process of grapes juice flavor forecasting based on support vector regression (SVR). Applying SVR, BPN and LR to forecast the flavor of grapes juice in real data, the result shows that SVR is more suitable and effective at predicting performance.

Keywords: flavor forecasting, artificial neural networks, Support Vector Regression, China

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Authors: Yuna Lee

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In the current policy process, there has been a growing interest in more open approaches that incorporate creativity and innovation based on the forecasting groups composed by the public and experts together into scientific data-driven foresight methods to implement more effective policymaking. Especially, citizen participation as collective intelligence in policymaking with design and deep scale of innovation at the global level has been developed and human-centred design thinking is considered as one of the most promising methods for strategic foresight. Yet, there is a lack of a common theoretical foundation for a comprehensive approach for the current situation of and post-COVID-19 era, and substantial changes in policymaking practice are insignificant and ongoing with trial and error. This project hypothesized that rigorously developed policy systems and tools that support strategic foresight by considering the public understanding could maximize ways to create new possibilities for a preferable future, however, it must involve a better understating of Behavioural Insights, including individual and cultural values, profit motives and needs, and psychological motivations, for implementing holistic and multilateral foresight and creating more positive possibilities. To what extent is the policymaking system theoretically possible that incorporates the holistic and comprehensive foresight and policy process implementation, assuming that theory and practice, in reality, are different and not connected? What components and environmental conditions should be included in the strategic foresight system to enhance the capacity of decision from policymakers to predict alternative futures, or detect uncertainties of the future more accurately? And, compared to the required environmental condition, what are the environmental vulnerabilities of the current policymaking system? In this light, this research contemplates the question of how effectively policymaking practices have been implemented through the synthesis of scientific, technology-oriented innovation with the strategic design for tackling complex societal challenges and devising more significant insights to make society greener and more liveable. Here, this study conceptualizes the notions of a new collaborative way of strategic foresight that aims to maximize mutual benefits between policy actors and citizens through the cooperation stemming from evolutionary game theory. This study applies mixed methodology, including interviews of policy experts, with the case in which digital transformation and strategic design provided future-oriented solutions or directions to cities’ sustainable development goals and society-wide urgent challenges such as COVID-19. As a result, artistic and sensual interpreting capabilities through strategic design promote a concrete form of ideas toward a stable connection from the present to the future and enhance the understanding and active cooperation among decision-makers, stakeholders, and citizens. Ultimately, an improved theoretical foundation proposed in this study is expected to help strategically respond to the highly interconnected future changes of the post-COVID-19 world.

Keywords: policymaking, strategic design, sustainable innovation, evolution of cooperation

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Authors: Sayantika Biswas, Dipanshu Sur, Amitoj Athwal, Ratnabali Chakravorty

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Title: Impact of serum estrogen and progesterone levels in the outcome pregnancy rate in frozen embryo transfer cycles. A prospective cohort study Objective: The aim of the current study was to evaluate the effect of serum estradiol (E2) and progesterone (P4) levels at different time points on pregnancy outcomes in frozen embryo transfer (FET) cycles. Materials & Method: A prospective cohort study was performed in patients undergoing frozen embryo transfer. Patients under age 37 years of age with at least one good blastocyst or three good day 3 embryos were included in the study. For endometrial preparation, 14 days of oral estradiol use (2X2 mg for 5 days. 3X2 mg for 4 days, and 4X2 mg for 5 days) was followed by vaginal progesterone twice a day and 50 mg intramuscular progesterone twice a day. Embryo transfer was scheduled 72-76 hrs or 116-120hrs after the initiation of progesterone. Serum E2 and P4 levels were examined at 4 times a) at the start of the menstrual cycle prior to the hormone supplementation. b) on the day of P4 start. c) on the day of ET. d) on the third day after ET. Result: A total 41 women were included in this study (mean age 31.8; SD 2.8). Clinical pregnancy rate was 65.55%. Serum E2 levels on at the start of the menstrual cycle prior to the hormone supplementation and on the day of P4 start were high in patients who achieved pregnancy compared to who did not (P=0.005 and P=0.019 respectively). P4 levels on on the day of ET were also high in patients with clinical pregnancy. On the day of P4 start, a serum E2 threshold of 186.4 pg/ml had a sensitivity of 82%, and P4 had a sensitivity of 71% for the prediction of clinical pregnancy at the threshold value 16.00 ng/ml. Conclusion: In women undergoing FET with hormone replacement, serum E2 level >186.4 pg/ml on the day of the start of progesterone and serum P4 levels >16.00 ng/ml on embryo transfer day are associated with clinical pregnancy.

Keywords: serum estradiol, serum progesterone, clinical pregnancy, frozen embryo transfer

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Authors: Annika Kjallman Alm, Ove Hellzen, Malin Rising-Homlstrom

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The concept of dementia‐friendly communities focuses on the lived experience of people who have dementia and is most relevant to addressing their needs and the needs of those people who live with and provide support for them. The goal of communities becoming dementia‐friendly is for dementia to be normalized and recognized as a disabling condition. People with dementia find being connected to self, to others, and to the environment by meaningful activities as important. According to the concept underlying dementia-friendly communities, people with dementia or cognitive decline can continue to live in the community if their residential community has sufficiently strong social capital. The aim of this study is to explore staff and leaders’ experiences in implementing interventions to enhance a more inclusive dementia-friendly community. A municipality in northern Sweden with a population of approx. 100 000 inhabitants decided to create a dementia friendly municipality. As part of the initiative, a Centre for support was established. The Centre offered support for both individuals and groups, did home visits, and provided information about Dementia. Interviews were conducted with staff who had undergone training in a structured form of multidimensional support, the PER-model®, and worked at the Centre for support. The staff consisted of registered nurses, occupational therapists, and specialized nurses who had worked there for more than five years, and all had training in dementia. All interviews were audio-recorded and transcribed verbatim. The transcribed data were analyzed using qualitative content analysis. Results suggest that implementing the PER-model® of support for persons in the early stages of dementia and their next of kin added a much-needed form of support and perceived possibilities to enhance daily life in the early stages of dementia. The staff appreciated that the structure of PER-model® was evidenced based. They also realized that they never even considered that the person with dementia also needed support in the early stages but that they now had tools for that as well. Creating a dementia friendly municipality offering different kinds of support for all stages of dementia is a challenge. However, evidence-based tools and a broad spectrum of different types of support, whether individual or group, are needed to tailor to everyone’s needs. A conviction that all citizens are equal and should all be involved in the community is a strong motivator.

Keywords: dementia, dementia-friendly, municipality, support

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Authors: Margarita Zavala, Julio Rolón, Gabriel Chavira, José González, Jorge Orozco, Roberto Pichardo

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Adolescence is a neuralgic stage in the formation of every human being, generally at this stage is when the middle school level is studied. In 2006 in Mexico incorporated “mentoring" space to assist students in their integration and participation in life. In public middle schools, is sometimes difficult to be aware of situations that affect students because of the number of them and traditional records management. Whit this they lose the opportunity to provide timely support as a preventive way. In order to provide this support, it is required to know the students by detecting the relevant information that has greater impact on their learning process. This research is looking to check if it is possible to identify student’s relevant information to detect when it is at risk, and then to propose a model to manage in a proper way such information.

Keywords: adolescence, mentoring, middle school students, mentoring system support

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Authors: Ricardo Munguia-Perez, Nayeli Remigio-Alvarado, M.Miriam Hernandez-Arroyo, Elsa Castañeda-Roldan

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Fungi have emerged as important pathogens causing morbidity and mortality mainly in immunosuppressed, malnourished and elderly patients. It has detected an increase in resistance to azoles primarily to fluconazol. The fungal infections have become a problem of public health for the resistance to antifungal agents, they have developed new antifungals with broad-spectrum. The aim of this study was determine the antifungal susceptibility of yeasts isolated from clinical samples (respiratory secretions, exudates, wounds, blood cultures, urine cultures) obtained from inpatients and outpatients of a tertiary hospital from State of Puebla. The antifungal susceptibility of the yeast from several clinical samples were determined by the CLS M44-A disk diffusion methods. 149 samples of yeast were analyzed. All species were 100% susceptible to nystatin and amphotericin B. Candida albicans showed resistance of 95.5 % to fluconazole, 50.7 % to 5-flurocytosine and 55.2 % intermediate susceptibility to ketoconazole. Candida glabrata 81.3 % was susceptibility to ketoconazole and 75 % to fluconazole, for the case of 5-flurocytosine the 56.3 % was susceptible. Candida krusei 100 % was susceptible to ketoconazole, 50 % to fluconazole and 37.5 % to 5-flurocytosine. The internal medicine have greater diversity of yeast, the samples have susceptibility of 64.7% to ketoconazole, 47.1 % to fluconazole and 27.5 % to 5-flurocytosine. Hospitalized patients are more resistant to fluconazole and nystatin, but in the case of outpatients presents resistance to ketoconazole.

Keywords: antifungal, susceptibility, yeast, clinical samples

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Authors: Taylan Kabbani, Ekrem Duman

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The design of adaptive systems that take advantage of financial markets while reducing the risk can bring more stagnant wealth into the global market. However, most efforts made to generate successful deals in trading financial assets rely on Supervised Learning (SL), which suffered from various limitations. Deep Reinforcement Learning (DRL) offers to solve these drawbacks of SL approaches by combining the financial assets price "prediction" step and the "allocation" step of the portfolio in one unified process to produce fully autonomous systems capable of interacting with its environment to make optimal decisions through trial and error. In this paper, a continuous action space approach is adopted to give the trading agent the ability to gradually adjust the portfolio's positions with each time step (dynamically re-allocate investments), resulting in better agent-environment interaction and faster convergence of the learning process. In addition, the approach supports the managing of a portfolio with several assets instead of a single one. This work represents a novel DRL model to generate profitable trades in the stock market, effectively overcoming the limitations of supervised learning approaches. We formulate the trading problem, or what is referred to as The Agent Environment as Partially observed Markov Decision Process (POMDP) model, considering the constraints imposed by the stock market, such as liquidity and transaction costs. More specifically, we design an environment that simulates the real-world trading process by augmenting the state representation with ten different technical indicators and sentiment analysis of news articles for each stock. We then solve the formulated POMDP problem using the Twin Delayed Deep Deterministic Policy Gradient (TD3) algorithm, which can learn policies in high-dimensional and continuous action spaces like those typically found in the stock market environment. From the point of view of stock market forecasting and the intelligent decision-making mechanism, this paper demonstrates the superiority of deep reinforcement learning in financial markets over other types of machine learning such as supervised learning and proves its credibility and advantages of strategic decision-making.

Keywords: the stock market, deep reinforcement learning, MDP, twin delayed deep deterministic policy gradient, sentiment analysis, technical indicators, autonomous agent

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Authors: Viviana Ventre, Giacomo Di Tollo, Roberta Martino

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The portfolio selection problem includes the evaluation of many criteria that are difficult to compare directly and is characterized by uncertain elements. The portfolio selection problem can be modeled as a group decision problem in which several experts are invited to present their assessment. In this context, it is important to study and analyze the process of reaching a consensus among group members. Indeed, due to the various diversities among experts, reaching consensus is not necessarily always simple and easily achievable. Moreover, the concept of consensus is accompanied by the concept of false consensus, which is particularly interesting in the dynamics of group decision-making processes. False consensus can alter the evaluation and selection phase of the alternative and is the consequence of the decision maker's inability to recognize that his preferences are conditioned by subjective structures. The present work aims to investigate the dynamics of consensus attainment in a group decision problem in which equivalent portfolios are proposed. In particular, the study aims to analyze the impact of the subjective structure of the decision-maker during the evaluation and selection phase of the alternatives. Therefore, the experimental framework is divided into three phases. In the first phase, experts are sent to evaluate the characteristics of all portfolios individually, without peer comparison, arriving independently at the selection of the preferred portfolio. The experts' evaluations are used to obtain individual Analytical Hierarchical Processes that define the weight that each expert gives to all criteria with respect to the proposed alternatives. This step provides insight into how the decision maker's decision process develops, step by step, from goal analysis to alternative selection. The second phase includes the description of the decision maker's state through Markov chains. In fact, the individual weights obtained in the first phase can be reviewed and described as transition weights from one state to another. Thus, with the construction of the individual transition matrices, the possible next state of the expert is determined from the individual weights at the end of the first phase. Finally, the experts meet, and the process of reaching consensus is analyzed by considering the single individual state obtained at the previous stage and the false consensus bias. The work contributes to the study of the impact of subjective structures, quantified through the Analytical Hierarchical Process, and how they combine with the false consensus bias in group decision-making dynamics and the consensus reaching process in problems involving the selection of equivalent portfolios.

Keywords: analytical hierarchical process, consensus building, false consensus effect, markov chains, portfolio selection problem

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Authors: Mohamed ElMasry, Ahmad Ragheb, Tareq AbdelAziz, Mohamed Ghazy

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Choosing the suitable infrastructure system is becoming more challenging with the increase in demand for heavier structures contemporarily. This is the case where piled raft foundations have been widely used around the world to support heavy structures without extensive settlement. In the latter system, piles are rigidly connected to the raft, and most of the load goes to the soil layer on which the piles are bearing. In spite of that, when soil profiles contain thicker soft clay layers near the surface, or at relatively shallow depths, it is unfavorable to use the rigid piled raft foundation system. Consequently, the disconnected piled raft system was introduced as an alternative approach for the rigidly connected system. In this system, piles are disconnected from the raft using a cushion of soil, mostly of a granular interlayer. The cushion is used to redistribute the stresses among the piles and the subsoil. Piles are also used to stiffen the subsoil, and by this way reduce the settlement without being rigidly connected to the raft. However, the seismic loading effect on such disconnected foundation systems remains a problem, since the soil profiles may include thick clay layers which raise risks of amplification of the dynamic earthquake loads. In this paper, the effects of seismic behavior on the connected and disconnected piled raft systems are studied through a numerical model using Midas GTS NX Software. The study concerns the soil-structure interaction and the expected behavior of the systems. Advantages and disadvantages of each foundation approach are studied, and a comparison between the results are presented to show the effects of using disconnected piled raft systems in highly seismic zones. This was done by showing the excitation amplification in each of the foundation systems.

Keywords: soil-structure interaction, disconnected piled-raft, risks, seismic zones

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Authors: Raneem Osama Salem, Ayesha Nuzhat, Fatimah Nasser Al Shehri, Nasser Al Hamdan

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Background: Recently, most medical schools around the globe are using simulation for teaching and assessing students’ clinical skills and competence. There are many obstacles that could face students and faculty when simulation sessions are introduced into undergraduate curriculum. Objective: The aim of this study is to obtain the opinion of undergraduate medical students and our faculty regarding the role of simulation in undergraduate curriculum, the simulation modalities used, and perceived barriers in implementing stimulation sessions. Methods: To address the role of simulation, modalities used, and perceived challenges to implementation of simulation sessions, a self-administered pilot tested questionnaire with 18 items using a 5 point Likert scale was distributed. Participants included undergraduate male medical students (n=125) and female students (n=70) as well as the faculty members (n=14). Result: Various learning outcomes are achieved and improved through the technology enhanced simulation sessions such as communication skills, diagnostic skills, procedural skills, self-confidence, and integration of basic and clinical sciences. The use of high fidelity simulators, simulated patients and task trainers was more desirable by our students and faculty for teaching and learning as well as an evaluation tool. According to most of the students,' institutional support in terms of resources, staff and duration of sessions was adequate. However, motivation to participate in the sessions and provision of adequate feedback by the staff was a constraint. Conclusion: The use of simulation laboratory is of great benefit to the students and a great teaching tool for the staff to ensure students learning of the various skills.

Keywords: simulators, medical students, skills, simulated patients, performance, challenges, skill laboratory

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Authors: Tomi Lois Olatunji, Frances Siebert, Ademola Emmanuel Adetunji, Brian Harvey, Johane Gericke, Josias Hamman, Frank Van Der Kooy

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Ethnopharmacological relevance: Sceletium tortuosum (L.) N.E.Br, the most sought after and widely researched species in the genus Sceletium is a succulent forb endemic to South Africa. Traditionally, this medicinal plant is mainly masticated or smoked and used for the relief of toothache, abdominal pain, and as a mood-elevator, analgesic, hypnotic, anxiolytic, thirst and hunger suppressant, and for its intoxicating/euphoric effects. Sceletium tortuosum is currently of widespread scientific interest due to its clinical potential in treating anxiety and depression, relieving stress in healthy individuals, and enhancing cognitive functions. These pharmacological actions are attributed to its phytochemical constituents referred to as mesembrine-type alkaloids. Aim of the review: The aim of this review was to comprehensively summarize and critically evaluate recent research advances on the phytochemistry, pharmacokinetics, biological and clinical activities of the medicinal plant S. tortuosum. Additionally, current ongoing research and future perspectives are also discussed. Methods: All relevant scientific articles, books, MSc and Ph.D. dissertations on botany, behavioral pharmacology, traditional uses, and phytochemistry of S. tortuosum were retrieved from different databases (including Science Direct, PubMed, Google Scholar, Scopus and Web of Science). For pharmacokinetics and pharmacological effects of S. tortuosum, the focus fell on relevant publications published between 2009 and 2021. Results: Twenty-five alkaloids belonging to four structural classes viz: mesembrine, Sceletium A4, joubertiamine, and tortuosamine, have been identified from S. tortuosum, of which the mesembrine class is predominant. The crude extracts and commercially available standardized extracts of S. tortuosum have displayed a wide spectrum of biological activities (e.g. antimalarial, anti-oxidant, immunomodulatory, anti-HIV, neuroprotection, enhancement of cognitive function) in in vitro or in vivo studies. This plant has not yet been studied in a clinical population, but has potential for enhancing cognitive function, and managing anxiety and depression. Conclusion: As an important South African medicinal plant, S. tortuosum has garnered many research advances on its phytochemistry and biological activities over the last decade. These scientific studies have shown that S. tortuosum has various bioactivities. The findings have further established the link between the phytochemistry and pharmacological application, and support the traditional use of S. tortuosum in the indigenous medicine of South Africa.

Keywords: Aizoaceae, Mesembrine, Serotonin, Sceletium tortuosum, Zembrin®, psychoactive, antidepressant

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Authors: Eko Ganis Sukoharsono, Meivida Medyastanti

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This study explores the Critical Success Factors (CSFs) for successful ERP implementation at the PP Company, a leading state-owned construction company in Indonesia. The study uses a qualitative - Postmodernist approach through an imaginary dialogue between a CEO and a Technologist to analyze ERP implementation from both managerial and technological perspectives. Key CSFs identified include strong support from top management, clear project scope and objectives, effective change management, employee engagement, data accuracy, and robust IT infrastructure. The study’s findings are synthesized into a CSF model that highlights the importance of aligning ERP systems with business objectives and emphasizes the need for continuous post-implementation support. This model provides a strategic framework that can guide other companies, particularly state-owned enterprises, in navigating ERP implementation, ensuring optimal return on investment, and enhancing organizational efficiency.

Keywords: ERP, critical success factors, PT. PP, postmodernist paradigm, management, technology

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