Search results for: digital linked process

Authors: K. Hariohm, V. Prakash, J. Saravana Kumar

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Introduction and Rationale: Increased scope of Physiotherapy (PT) practice also has contributed to research in the field of PT. It is essential to determine the production and quality of the clinical trials from India since, it may reflect the scientific growth of the profession. These trends can be taken as a baseline to measure our performance and also can be used as a guideline for the future trials. Objective: To quantify and analyze qualitatively the RCT’s from India from the period 2000-2013’ May, and classify data for the information process. Methods: Studies were searched in the Medline database using the key terms “India”, “Indian”, “Physiotherapy”. Clinical trials only with PT authors were included. Trials out of scope of PT practice and on animals were excluded. Retrieved valid articles were analyzed for published year, type of participants, area of study, PEDro score, outcome measure domains of impairment, activity, participation; ‘a priori’ sample size calculation, region, and explanation of the intervention. Result: 45 valid articles were retrieved from the year 2000-2013’ May. The majority of articles were done on symptomatic participants (81%). The frequencies of conditions repeated more were low back pain (n-7) and diabetes (n-4). PEDro score with mode 5 and upper limit of 8 and lower limit 4 was found. 97.2% of studies measure the outcome at the impairment level, 34% in activity level, and 27.8% in participation level. 29.7% of studies did ‘a priori’ sample size calculation. Correlation of year trend and PEDro score found to be not significant (p>.05). Individual PEDro item analysis showed, randomization (100%), concealment (33%) baseline (76%), blinding-subject, therapist, assessor (9.1%, 0%, 10%), follow-up (89%) ITT (15%), statistics between groups (100%), measures of variance (88 %). Conclusion: The trend shows an upward slope in terms of RCTs published from India which is a good indicator. The qualitative analysis showed some gaps in the clinical trial design, which can be expected to be, fulfilled by the future researchers.

Keywords: RCT, PEDro, physical therapy, rehabilitation

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Authors: Bruno Nascimento, Cristina Wanzeller, Jorge Silva, João A. Dias, André Barbosa, José Ribeiro

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The increasing complexity of logistics operations stems from evolving business needs, such as the shift from mass production to mass customization, which demands greater efficiency and flexibility. In response, Industry 4.0 and 5.0 technologies provide improved solutions to enhance operational agility and better meet market demands. The management of kitting zones, combined with the use of Autonomous Mobile Robots, faces challenges related to coordination, resource optimization, and rapid response to customer demand fluctuations. Additionally, implementing lean manufacturing practices in this context must be carefully orchestrated by intelligent systems and human operators to maximize efficiency without sacrificing the agility required in an advanced production environment. This paper proposes and implements a microservices-based architecture integrating principles from Industry 4.0 and 5.0 with lean manufacturing practices. The architecture enhances communication and coordination between autonomous vehicles and kitting management systems, allowing more efficient resource utilization and increased scalability. The proposed architecture focuses on the modularity and flexibility of operations, enabling seamless flexibility to change demands and the efficient allocation of resources in realtime. Conducting this approach is expected to significantly improve logistics operations’ efficiency and scalability by reducing waste and optimizing resource use while improving responsiveness to demand changes. The implementation of this architecture provides a robust foundation for the continuous evolution of kitting management and process optimization. It is designed to adapt to dynamic environments marked by rapid shifts in production demands and real-time decision-making. It also ensures seamless integration with automated systems, aligning with Industry 4.0 and 5.0 needs while reinforcing Lean Manufacturing principles.

Keywords: microservices, event-driven, kitting, AMR, lean manufacturing, industry 4.0, industry 5.0

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Authors: Defne Uz

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Horizontal Tail of helicopter is exposed to repeated oscillatory loading generated by aerodynamic and inertial loads, and bending moments depending on operating conditions and maneuvers of the helicopter. In order to ensure that maximum stress levels do not exceed certain fatigue limit of the material and to prevent damage, a numerical analysis approach can be utilized through the Finite Element Method. Therefore, in this paper, fatigue analysis of the Horizontal Tail model is studied numerically to predict high-cycle and low-cycle fatigue life related to defined loading. The analysis estimates the stress field at stress concentration regions such as around fastener holes where the maximum principal stresses are considered for each load case. Critical element identification of the main load carrying structural components of the model with rivet holes is performed as a post-process since critical regions with high-stress values are used as an input for fatigue life calculation. Once the maximum stress is obtained at the critical element and the related mean and alternating components, it is compared with the endurance limit by applying Soderberg approach. The constant life straight line provides the limit for several combinations of mean and alternating stresses. The life calculation based on S-N (Stress-Number of Cycles) curve is also applied with fully reversed loading to determine the number of cycles corresponds to the oscillatory stress with zero means. The results determine the appropriateness of the design of the model for its fatigue strength and the number of cycles that the model can withstand for the calculated stress. The effect of correctly determining the critical rivet holes is investigated by analyzing stresses at different structural parts in the model. In the case of low life prediction, alternative design solutions are developed, and flight hours can be estimated for the fatigue safe operation of the model.

Keywords: fatigue analysis, finite element method, helicopter horizontal tail, life prediction, stress concentration

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Authors: Muhammad Dawood Idrees, Maria Hafeez, Arsalan Ansari

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Toll tax collection is the earliest method of tax collection and revenue generation. This revenue is utilized for the development of roads networks, maintenance, and connecting to roads and highways across the country. Pakistan is one of the biggest countries, covers a wide area of land, roads networks, and motorways are important source of connecting cities. Every day millions of people use motorways, and they have to stop at toll plazas to pay toll tax as majority of toll plazas are manually collecting toll tax. The purpose of this study is to calculate the waiting time of vehicles at Karachi Hyderabad (M-9) motorway. As Karachi is the biggest city of Pakistan and hundreds of thousands of people use this route to approach other cities. Currently, toll tax collection is manual system which is a major cause for long time waiting at toll plaza. This study calculates the waiting time of vehicles, fuel consumed in waiting time, manpower employed at toll plaza as all process is manual, and it also leads to mental and physical fatigue of driver. All wastages of sources are also calculated, and a most feasible automatic toll tax collection system is proposed which is not only beneficial to reduce waiting time but also beneficial in reduction of fuel, reduction of manpower employed, and reduction in physical and mental fatigue. A cost comparison in terms of wastages is also shown between manual and automatic toll tax collection system (E-Z Pass). Results of this study reveal that, if automatic tool collection system is implemented at Karachi to Hyderabad motorway (M-9), there will be a significance reduction in waiting time of vehicles, which leads to reduction of fuel consumption, environmental pollution, mental and physical fatigue of driver. All these reductions are also calculated in terms of money (Pakistani rupees) and it is obtained that millions of rupees can be saved by using automatic tool collection system which will lead to improve the economy of country.

Keywords: toll tax collection, waiting time, wastages, driver fatigue

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Authors: Addin Osman, Anwar Ali Yahya, Mohammed Basit Kamal

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Datasets or collections are becoming important assets by themselves and now they can be accepted as a primary intellectual output of a research. The quality and usage of the datasets depend mainly on the context under which they have been collected, processed, analyzed, validated, and interpreted. This paper aims to present a collection of program educational objectives mapped to student’s outcomes collected from self-study reports prepared by 32 engineering programs accredited by ABET. The manual mapping (classification) of this data is a notoriously tedious, time consuming process. In addition, it requires experts in the area, which are mostly not available. It has been shown the operational settings under which the collection has been produced. The collection has been cleansed, preprocessed, some features have been selected and preliminary exploratory data analysis has been performed so as to illustrate the properties and usefulness of the collection. At the end, the collection has been benchmarked using nine of the most widely used supervised multiclass classification techniques (Binary Relevance, Label Powerset, Classifier Chains, Pruned Sets, Random k-label sets, Ensemble of Classifier Chains, Ensemble of Pruned Sets, Multi-Label k-Nearest Neighbors and Back-Propagation Multi-Label Learning). The techniques have been compared to each other using five well-known measurements (Accuracy, Hamming Loss, Micro-F, Macro-F, and Macro-F). The Ensemble of Classifier Chains and Ensemble of Pruned Sets have achieved encouraging performance compared to other experimented multi-label classification methods. The Classifier Chains method has shown the worst performance. To recap, the benchmark has achieved promising results by utilizing preliminary exploratory data analysis performed on the collection, proposing new trends for research and providing a baseline for future studies.

Keywords: ABET, accreditation, benchmark collection, machine learning, program educational objectives, student outcomes, supervised multi-class classification, text mining

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Authors: Cesar Leines

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The social effects of the pandemic are significant and diverse, most of those effects have widened the gap of economic inequality. Without a doubt, each country faces difficulties associated with the strengths and weaknesses of its own institutions that can address these causes and consequences. Around the world, pricing practices that have no connection to production costs have been used extensively in numerous markets beyond those relating to the supply of essential goods and services, and although it is not unlawful to adjust pricing considering the increased demand of certain products, shortages and disruption of supply chains, illegitimate pricing practices may arise and these tend to transfer wealth from consumers to producers that affect the purchasing power of the former, making people worse off. High prices with no objective justification indicate a poor state of the competitive process in any market and the impact of those underlying competition issues leading to inefficiency is increased when national competition agencies are weak and ineffective in enforcing competition in law and policy. It has been observed that in those countries where competition authorities are perceived as weak or ineffective, price increases of a wide range of products and services were more significant during the pandemic than those price increases observed in countries where the perception of the effectiveness of the competition agency is high. When a perception is created of a highly effective competition authority, one which enforces competition law and its non-enforcement activities result in the fulfillment of its substantive functions of protecting competition as the means to create efficient markets, the price rise observed in markets under its jurisdiction is low. A case study focused on the effectiveness of the national competition agency in Mexico (COFECE) points to institutional weakness as one of the causes leading to excessive pricing. There are many factors that contribute to its low effectiveness and which, in turn, have led to a very significant price hike, potentiated by the pandemic. This paper contributes to the discussion of these factors and proposes different steps that overall help COFECE or any other competition agency to increase the perception of effectiveness for the benefit of the consumers.

Keywords: agency effectiveness, competition, institutional weakness, price gouging

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Authors: Amy Lebar, Kim L. Trenbath, Bennett Doherty, William Livingood

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Plug and process loads (PPLs) account for 47% of U.S. commercial building energy use. There is a huge potential to reduce whole building consumption by targeting PPLs for energy savings measures or implementing some form of plug load management (PLM). Despite this potential, there has yet to be a widely adopted commercial PLM technology. This paper describes the Automatic Type and Location Identification System (ATLIS), a PLM system framework with automatic and dynamic load detection (ADLD). ADLD gives PLM systems the ability to automatically identify devices as they are plugged into the outlets of a building. The ATLIS framework takes advantage of smart, connected devices to identify device locations in a building, meter and control their power, and communicate this information to a central database. ATLIS includes five primary capabilities: location identification, communication, control, energy metering and data storage. A laboratory proof of concept (PoC) demonstrated all but the data storage capabilities and these capabilities were validated using an office building scenario. The PoC can identify when a device is plugged into an outlet and the location of the device in the building. When a device is moved, the PoC’s dashboard and database are automatically updated with the new location. The PoC implements controls to devices from the system dashboard so that devices maintain correct schedules regardless of where they are plugged in within a building. ATLIS’s primary technology application is improved PLM, but other applications include asset management, energy audits, and interoperability for grid-interactive efficient buildings. A system like ATLIS could also be used to direct power to critical devices, such as ventilators, during a brownout or blackout. Such a framework is an opportunity to make PLM more widespread and reduce the amount of energy consumed by PPLs in current and future commercial buildings.

Keywords: commercial buildings, grid-interactive efficient buildings (GEB), miscellaneous electric loads (MELs), plug loads, plug load management (PLM)

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Authors: Madrine King'endo

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This study dealt with the influence of spelling errors on English language performance among learners with dysgraphia in public primary schools in West Embu, Embu County, Kenya. The study purposed to investigate the influence of spelling errors on the English language performance among the class three pupils with dysgraphia in public primary schools. The objectives of the study were to identify the spelling errors that learners with dysgraphia make when writing English words and classify the spelling errors they make. Further, the study will establish how the spelling errors affect the performance of the language among the study participants, and suggest the remediation strategies that teachers could use to address the errors. The study could provide the stakeholders with relevant information in writing skills that could help in developing a responsive curriculum to accommodate the teaching and learning needs of learners with dysgraphia, and probably ensure training of teachers in teacher training colleges is tailored within the writing needs of the pupils with dysgraphia. The study was carried out in Embu county because the researcher did not find any study in related literature review concerning the influence of spelling errors on English language performance among learners with dysgraphia in public primary schools done in the area. Moreover, besides being relatively populated enough for a sample population of the study, the area was fairly cosmopolitan to allow a generalization of the study findings. The study assumed the sampled schools will had class three pupils with dysgraphia who exhibited written spelling errors. The study was guided by two spelling approaches: the connectionist stimulation of spelling process and orthographic autonomy hypothesis with a view to explain how participants with learning disabilities spell written words. Data were collected through interviews, pupils’ exercise books, and progress records, and a spelling test made by the researcher based on the spelling scope set for class three pupils by the ministry of education in the primary education syllabus. The study relied on random sampling techniques in identifying general and specific participants. Since the study used children in schools as participants, voluntary consent was sought from themselves, their teachers and the school head teachers who were their caretakers in a school setting.

Keywords: dysgraphia, writing, language, performance

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Authors: Tamara Matevosyan

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In this globalized world, intercultural communication is becoming essential for understanding communication among people, for developing understanding of cultures, to appreciate the opportunities and challenges that each culture presents to people. Moreover, it plays an important role in developing an ideal personification to understand different behaviors in different cultures. Native speakers assimilate sociolinguistic knowledge in natural conditions, while it is a great problem for language learners, and in this context feature films reveal cultural peculiarities and involve students in real communication. As we know nowadays the key role of language learning is the development of intercultural competence as communicating with someone from a different cultural background can be exciting and scary, frustrating and enlightening. Intercultural competence is important in FL learning classroom and here feature films can perform as essential tools to develop this competence and overcome the intercultural gap that foreign students face. Current proposal attempts to reveal the correlation of the given culture and language through feature films. To ensure qualified, well-organized and practical classes on Intercultural Communication for language learners a number of methods connected with movie watching have been implemented. All the pre-watching, while watching and post-watching methods and techniques are aimed at developing students’ communicative competence. The application of such activities as Climax, Role-play, Interactive Language, Daily Life helps to reveal and overcome mistakes of cultural and pragmatic character. All the above-mentioned activities are directed at the assimilation of the language vocabulary with special reference to the given culture. The study dwells into the essence of culture as one of the core concepts of intercultural communication. Sometimes culture is not a priority in the process of language learning which leads to further misunderstandings in real life communication. The application of various methods and techniques with feature films aims at developing students’ cultural competence, their understanding of norms and values of individual cultures. Thus, feature film activities will enable learners to enlarge their knowledge of the particular culture and develop a fundamental insight into intercultural communication.

Keywords: climax, intercultural competence, interactive language, role-play

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Authors: Dar-Bin Shieh, Gwo-Bin Lee, Chen-Ming Chang, Chen Sheng Yeh, Chih-Chia Huang, Tsung-Ju Li

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Mitochondrial defects have a significant impact in many human diseases and aging associated phenotypes. The pathogenic mitochondrial DNA (mtDNA) mutations are diverse and usually present as heteroplasmic. mtDNA 4977bps deletion is one of the common mtDNA defects, and the ratio of mutated versus normal copy is significantly associated with clinical symptoms thus their quantitative detection has become an important unmet needs for advanced disease diagnosis and therapeutic guidelines. This study revealed a Micro-electro-mechanical-system (MEMS) enabled automatic microfluidic chip that only required minimal sample. The system integrated multiple laboratory operation steps into a Lab-on-a-Chip for high-sensitive and prompt measurement. The entire process including magnetic nanoparticle based mtDNA extraction in chip, mutation selective photonic DNA cleavage, and nanoparticle accelerated photonic quantitative polymerase chain reaction (qPCR). All subsystems were packed inside a miniature three-dimensional micro structured system and operated in an automatic manner. Integration of magnetic beads with microfluidic transportation could promptly extract and enrich the specific mtDNA. The near infrared responsive magnetic nanoparticles enabled micro-PCR to be operated by pulse-width-modulation controlled laser pulsing to amplify the desired mtDNA while quantified by fluorescence intensity captured by a complementary metal oxide system array detector. The proportions of pathogenic mtDNA in total DNA were thus obtained. Micro capillary electrophoresis module was used to analyze the amplicone products. In conclusion, this study demonstrated a new magnetophotonic based qPCR MEMS system that successfully detects and quantify specific disease related DNA mutations thus provides a promising future for rapid diagnosis of mitochondria diseases.

Keywords: mitochondrial DNA, micro-electro-mechanical-system, magnetophotonics, PCR

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Authors: Jinchen Cao, Tiantian Du

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As waxy crude oil is easy to crystallization and deposition in the pipeline wall, it causes pipeline clogging and leads to the reduction of oil and gas gathering and transmission efficiency. In this paper, a mesoscopic scale dissipative particle dynamics method is employed, and constructed four pipe wall models, including smooth wall (SW), hydroxylated wall (HW), rough wall (RW), and single-layer graphene wall (GW). Snapshots of the simulation output trajectories show that paraffin molecules interact with each other to form a network structure that constrains water molecules as their nucleation sites. Meanwhile, it is observed that the paraffin molecules on the near-wall side are adsorbed horizontally between inter-lattice gaps of the solid wall. In the pressure range of 0 - 50 MPa, the pressure change has less effect on the affinity properties of SS, HS, and GS walls, but for RS walls, the contact angle between paraffin wax and water molecules was found to decrease with the increase in pressure, while the water molecules showed the opposite trend, the phenomenon is due to the change in pressure, leading to the transition of paraffin wax molecules from amorphous to crystalline state. Meanwhile, the minimum crystalline phase pressure (MCPP) was proposed to describe the lowest pressure at which crystallization of paraffin molecules occurs. The maximum number of crystalline clusters formed by paraffin molecules at MCPP in the system showed NSS (0.52 MPa) > NHS (0.55 MPa) > NRS (0.62 MPa) > NGS (0.75 MPa). The MCPP on the graphene surface, with the least number of clusters formed, indicates that the addition of graphene inhibited the crystallization process of paraffin deposition on the wall surface. Finally, the thermal conductivity was calculated, and the results show that on the near-wall side, the thermal conductivity changes drastically due to the occurrence of adsorption crystallization of paraffin waxes; on the fluid side the thermal conductivity gradually tends to stabilize, and the average thermal conductivity shows: ĸRS(0.254W/(m·K)) > ĸRS(0.249W/(m·K)) > ĸRS(0.218W/(m·K)) > ĸRS(0.188W/(m·K)).This study provides a theoretical basis for improving the transport efficiency and heat transfer characteristics of waxy crude oil in terms of wall type, wall roughness, and MCPP.

Keywords: waxy crude oil, thermal conductivity, crystallization, dissipative particle dynamics, MCPP

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Authors: Gilad Padva, Sigal Barak Brandes

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This research centers on an unexpected Israeli advertising campaign for Elemento, a local furniture company, which eroticizes male nudity. The discussed campaign includes a series of printed ads that depict naked male models in effeminate positions. This campaign included a series of ads published in Haaretz, a small-scaled yet highly prestigious daily newspaper which is typically read by urban middle-upper-class left-winged Israelis. Apparently, this campaign embodies an alternative masculinity that challenges the prevalent machismo in Israeli society and advertising. Although some of the ads focus on young men in effeminate positions, they never expose their genitals and anuses, and their bodies are never permeable. The 2010s Elemento male models are seemingly contrasted to conventional representation of manhood in contemporary mainstream advertising. They display a somewhat inactive, passive and self-indulgent masculinity which involves 'conspicuous leisure'. In the process of commodity fetishism, the advertised furniture are emptied of the original meaning of their production, and then filled with new meanings in ways that both mystify the product and turn it into a fetish object. Yet, our research critically reconsiders this sensational campaign as sophisticated patriarchal parody that does not subvert but rather reconfirms and even fetishizes patriarchal premises; it parodizes effeminacy rather than the prevalent (Israeli) machismo. Following Pierre Bourdieu's politics of cultural taste, our research reconsiders and criticizes the male models' domesticated masculinity in a fantasized and cosmopolitan hedonistic habitus. Notwithstanding, we suggest that the Elemento campaign, despite its conformity, does question some Israeli and global axioms about gender roles, corporeal ideologies, idealized bodies, and domesticated phalluses and anuses. Although the naked truth is uncovered by this campaign, it does erect a vibrant discussion of contemporary masculinities and their exploitation in current mass consumption.

Keywords: male body, campaign, advertising, gender studies, men's studies, Israeli culture, masculinity, parody, effeminacy

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Authors: Ronald L. Kaunda

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The education system in Zambia still bears scars of colonialism in the area of policy, curriculum and implementation. This historical context resulted in the failure by the Government of the Republic of Zambia to achieve literacy goals expected among school going children. Specifically, research shows that the use of English for initial literacy and Western based teaching methods to engage learners in literacy activities at lower levels of education including preschool has exacerbated this situation. In 2014, the Government of the Republic of Zambia implemented a new curriculum that, among others things, required preschool teachers to use local and cultural materials and familiar languages for early literacy teaching from preschool to grade 4. This paper presents findings from a study that sought to establish ways in which preschool teachers use Zambian Indigenous knowledge systems and Indigenous teaching strategies to support literacy development among preschool children. The study used Indigenous research methodology for data collection and iterative feature of Constructivist Grounded Theory (CGT) in the data collection process and analysis. This study established that, as agents of education, preschool teachers represented community adult educators because of some roles which they played beyond their academic mandate. The study further found that classrooms as venues of learning were equipped with learning corners reflecting Indigenous literacy materials and Indigenous ways of learning. Additionally, the study found that learners were more responsive to literacy lessons because of the use of familiar languages and local contextualized environments that supported their own cultural ways of learning. The study recommended that if the education system in Zambia is to be fully inclusive of Indigenous knowledge systems and cultural ways of learning, the education policy and curriculum should include conscious steps on how this should be implemented at the classroom level. The study further recommended that more diverse local literacy materials and teaching aids should be produced for use in the classroom.

Keywords: agents of learning, early literacy, indigenous knowledge systems, venues of education

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Authors: Mina Kalantarzadeh, Claire Lockie-Williams, Caroline Howard

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DNA barcoding is increasingly used for identification of medicinal plants worldwide. In the last decade, a large number of DNA barcodes have been generated, and their application in species identification explored. The success of DNA barcoding process relies on the accuracy of the results from polymerase chain reaction (PCR) amplification step which could be negatively affected due to a presence of inhibitors or degraded DNA in herbal samples. An established DNA reference material can be used to support molecular characterisation protocols and prove system suitability, for fast and accurate identification of plant species. The present study describes the use of a novel reference material, the trnH-psbA British Pharmacopoeia Nucleic Acid Reference Material (trnH-psbA BPNARM), which was produced to aid in the identification of Ocimum tenuiflorum L., a widely used herb. During DNA barcoding of O. tenuiflorum, PCR amplifications of isolated DNA produced inconsistent results, suggesting an issue with either the method or DNA quality of the tested samples. The trnH-psbA BPNARM was produced and tested to check for the issues caused during PCR amplification. It was added to the plant material as control DNA before extraction and was co-extracted and amplified by PCR. PCR analyses revealed that the amplification was not as successful as expected which suggested that the amplification is affected by presence of inhibitors co-extracted from plant materials. Various potential issues were assessed during DNA extraction and optimisations were made accordingly. A DNA barcoding protocol for O. tenuiflorum was published in the British Pharmacopoeia 2016, which included the reference sequence. The trnH-psbA BPNARM accelerated degradation test which investigates the stability of the reference material over time demonstrated that it has been stable when stored at 56 °C for a year. Using this protocol and trnH-psbA reference material provides a fast and accurate method for identification of O. tenuiflorum. The optimisations of the DNA extraction using the trnH-psbA BPNARM provided a signposting method which can assist in overcoming common problems encountered when using molecular methods with medicinal plants.

Keywords: degradation, DNA extraction, nucleic acid reference material, trnH-psbA

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Authors: Anne Y. Faxer, Ellen Olausson, Jens Hagman, Ana Magazinius, Jenny J. Stier, Tommy Fransson, Oscar Enerback

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While electric vehicles (both battery electric vehicles and plug-in hybrids) have been on the market for around 6 years, they are still far from mainstream and the knowledge of them is still low among the public. This is likely one of the reasons that Sweden, having one of the highest penetrations of electric vehicles in Europe, still has a long way to go in reaching a fossil free vehicle fleet. Car dealerships are an important medium that connects consumers to vehicles, but somehow, their role in introducing electric vehicles has not yet been thoroughly studied. Research from other domains shows that salespeople can affect customer decisions in their choice of products. The aim of this study is to explore the role of car dealerships when it comes to promoting electric vehicles. The long-term goal is to understand how they could be a key in the effort of achieving a mass introduction of electric vehicles in Sweden. By emulating the customer’s experience, this study investigates the interaction between car salespeople and customers, particularly examining whether they present electric vehicles as viable options. Covert participatory observations were conducted for data collection from four different brands at in total twelve car dealers. The observers worked in pairs and played the role of a customer with needs that could be matched by an electric vehicle. The data was summarized in observation protocols and analyzed using thematic coding. The result shows that only one of twelve salespeople offered an electric vehicle as the first option. When environmental factors were brought up by the observers, the salespeople followed up with lower fuel consumption internal combustion engine vehicles rather than suggesting an electric vehicle. All salespeople possessed at least basic knowledge about electric vehicles but their interest of selling them were low in most cases. One of the reasons could be that the price of electric vehicles is usually higher. This could be inferred from the finding that salespeople tend to have a strong focus on price and economy in their dialogues with customers, regardless which type of car they were selling. In conclusion, the study suggests that car salespeople have the potential to help the market to achieve mass introduction of electric vehicles; however, their potential needs to be exploited further. To encourage salespeople to prioritize electric vehicles in the sales process, right incentives need to be in place.

Keywords: car dealerships, covert participatory observation, customer perspective , electric vehicle, market penetration

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Authors: Radim Sip, Denisa Denglerova

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It’s impossible to capture complex phenomena, such as inclusion, with reductionism. The most common form of reductionism is the objectivist approach, where processes and relationships are reduced to entities and clearly outlined phases, with a consequent search for relationships between them. Constructivism as a paradigm and situational analysis as a methodological research portfolio represent a way to avoid the dominant objectivist approach. They work with a situation, i.e. with the essential blending of actors and their environment. Primary transactions are taking place between actors and their surroundings. Researchers create constructs based on their need to solve a problem. Concepts therefore do not describe reality, but rather a complex of real needs in relation to the available options how such needs can be met. For examination of a complex problem, corresponding methodological tools and overall design of the research are necessary. Using an original research on inclusion in the Czech Republic as an example, this contribution demonstrates that inclusion is not a substance easily described, but rather a relationship field changing its forms in response to its actors’ behaviour and current circumstances. Inclusion consists of dynamic relationship between an ideal, real circumstances and ways to achieve such ideal under the given circumstances. Such achievement has many shapes and thus cannot be captured by description of objects. It can be expressed in relationships in the situation defined by time and space. Situational analysis offers tools to examine such phenomena. It understands a situation as a complex of dynamically changing aspects and prefers relationships and positions in the given situation over a clear and final definition of actors, entities, etc. Situational analysis assumes creation of constructs as a tool for solving a problem at hand. It emphasizes the meanings that arise in the process of coordinating human actions, and the discourses through which these meanings are negotiated. Finally, it offers “cartographic tools” (situational maps, socials worlds / arenas maps, positional maps) that are able to capture the complexity in other than linear-analytical ways. This approach allows for inclusion to be described as a complex of phenomena taking place with a certain historical preference, a complex that can be overlooked if analyzed with a more traditional approach.

Keywords: constructivism, situational analysis, objective realism, reductionism, inclusion

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Authors: Tingting Huang, Sha Li, Geoffrey Griffiths, Martin Lukac, Jianning Zhu

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Territorial landscapes have experienced a gradual loss of their typical characteristics during long-term human activities. In order to protect the integrity of regional landscapes, it is necessary to characterize, evaluate and protect them in a graded manner. The study takes Fujian, China, as an example and classifies the landscape characters of the site at the regional scale, middle scale, and detailed scale. A multi-scale approach combining parametric and holistic approaches is used to classify and partition the landscape character types (LCTs) and landscape character areas (LCAs) at different scales, and a multi-element landscape assessment approach is adopted to explore the conservation strategies of the landscape character. Firstly, multiple fields and multiple elements of geography, nature and humanities were selected as the basis of assessment according to the scales. Secondly, the study takes a parametric approach to the classification and partitioning of landscape character, Principal Component Analysis, and two-stage cluster analysis (K-means and GMM) in MATLAB software to obtain LCTs, combines with Canny Operator Edge Detection Algorithm to obtain landscape character contours and corrects LCTs and LCAs by field survey and manual identification methods. Finally, the study adopts the Landscape Sensitivity Assessment method to perform landscape character conservation analysis and formulates five strategies for different LCAs: conservation, enhancement, restoration, creation, and combination. This multi-scale identification approach can efficiently integrate multiple types of landscape character elements, reduce the difficulty of broad-scale operations in the process of landscape character conservation, and provide a basis for landscape character conservation strategies. Based on the natural background and the restoration of regional characteristics, the results of landscape character assessment are scientific and objective and can provide a strong reference in regional and national scale territorial spatial planning.

Keywords: parameterization, multi-scale, landscape character identify, landscape character assessment

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Authors: Neha Toppo

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Method and strategies of teaching instruction highly influence learning of students. In second language teaching, number of ways and methods has been suggested by different scholars and researchers through times. The present article deals with the role of teaching instruction in developing compositional ability of students in writing. It focuses on the secondary level students of rural areas, whose exposure to English language is limited and they face challenges even in simple compositions. The students till high school suffer with their disability in writing formal letter, application, essay, paragraph etc. They face problem in note making, writing answers in examination using their own words and depend fully on rote learning. It becomes difficult for them to give language to their own ideas. Teaching writing composition deserves special attention as writing is an integral part of language learning and students at this level are expected to have sound compositional ability for it is useful in numerous domains. Effective method of instruction could help students to learn expression of self, correct selection of vocabulary and grammar, contextual writing, composition of formal and informal writing. It is not limited to school but continues to be important in various other fields outside the school such as in newspaper and magazine, official work, legislative work, material writing, academic writing, personal writing, etc. The study is based on the experimental method, which hypothesize that guided instruction will be more effective in teaching writing compositions than usual instruction in which students are left to compose by their own without any help. In the test, students of one section are asked to write an essay on the given topic without guidance and another section are asked to write the same but with the assistance of guided instruction in which students have been provided with a few vocabulary and sentence structure. This process is repeated in few more schools to get generalize data. The study shows the difference on students’ performance using both the instructions; guided and unguided. The conclusion of the study is followed by the finding that writing skill of the students is quite poor but with the help of guided instruction they perform better. The students are in need of better teaching instruction to develop their writing skills.

Keywords: composition, essay, guided instruction, writing skill

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Authors: Abdulmalek Ahmed

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Formation pressure is the main function that affects drilling operation economically and efficiently. Knowing the pore pressure and the parameters that affect it will help to reduce the cost of drilling process. Many empirical models reported in the literature were used to calculate the formation pressure based on different parameters. Some of these models used only drilling parameters to estimate pore pressure. Other models predicted the formation pressure based on log data. All of these models required different trends such as normal or abnormal to predict the pore pressure. Few researchers applied artificial intelligence (AI) techniques to predict the formation pressure by only one method or a maximum of two methods of AI. The objective of this research is to predict the pore pressure based on both drilling parameters and log data namely; weight on bit, rotary speed, rate of penetration, mud weight, bulk density, porosity and delta sonic time. A real field data is used to predict the formation pressure using five different artificial intelligence (AI) methods such as; artificial neural networks (ANN), radial basis function (RBF), fuzzy logic (FL), support vector machine (SVM) and functional networks (FN). All AI tools were compared with different empirical models. AI methods estimated the formation pressure by a high accuracy (high correlation coefficient and low average absolute percentage error) and outperformed all previous. The advantage of the new technique is its simplicity, which represented from its estimation of pore pressure without the need of different trends as compared to other models which require a two different trend (normal or abnormal pressure). Moreover, by comparing the AI tools with each other, the results indicate that SVM has the advantage of pore pressure prediction by its fast processing speed and high performance (a high correlation coefficient of 0.997 and a low average absolute percentage error of 0.14%). In the end, a new empirical correlation for formation pressure was developed using ANN method that can estimate pore pressure with a high precision (correlation coefficient of 0.998 and average absolute percentage error of 0.17%).

Keywords: Artificial Intelligence (AI), Formation pressure, Artificial Neural Networks (ANN), Fuzzy Logic (FL), Support Vector Machine (SVM), Functional Networks (FN), Radial Basis Function (RBF)

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Authors: Melissa R. Quispe-Zuniga, Daniel Callo-Concha, Christian Borgemeister, Klaus Greve

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The Peruvian Andes have a high potential for mining, but many of the mining areas overlay with campesino community lands, being these key actors for agriculture and livestock production. Lead by economic incentives, some communities are renting their lands to mining companies for exploration or exploitation. However, a growing number of campesino communities, usually social and economically marginalized, have developed resistance, alluding consequences, such as water pollution, land-use change, insufficient economic compensation, etc. what eventually end up in Socio-Environmental Conflicts (SEC). It is hypothesized that disclosing the information on environmental pollution and enhance the involvement of communities in the decision-making process may contribute to prevent SEC. To assess whether such complains are grounded on the environmental impact of mining activities, we measured the heavy metals concentration in 24 indicative samples from rivers that run across mining exploitations and farming community lands. Samples were taken during the 2016 dry season and analyzed by inductively-coupled-plasma-atomic-emission-spectroscopy. The results were contrasted against the standards of monitoring government institutions (i.e., OEFA). Furthermore, we investigated the water/environmental complains related to mining in the neighboring 14 communities. We explored the relationship between communities and mining companies, via open-ended interviews with community authorities and non-participatory observations of community assemblies. We found that the concentrations of cadmium (0.023 mg/L), arsenic (0.562 mg/L) and copper (0.07 mg/L), surpass the national water quality standards for Andean rivers (0.00025 mg/L of cadmium, 0.15 mg/L of arsenic and 0.01 mg/L of copper). 57% of communities have posed environmental complains, but 21% of the total number of communities were receiving an annual economic benefit from mining projects. However, 87.5% of the communities who had posed complains have high concentration of heavy metals in their water streams. The evidence shows that mining activities tend to relate to the affectation and vulnerability of campesino community water streams, what justify the environmental complains and eventually the occurrence of a SEC.

Keywords: mining companies, campesino community, water, socio-environmental conflict

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Authors: Poonam Sharma, Ankur Srivastav

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Cities are complex and dynamic systems that constitute a significant challenge to urban planning. The increasing size of the built-up area owing to growing population pressure and economic growth have lead to massive Landuse/Landcover change resulted in the loss of natural habitat and thus reducing the green covers in urban areas. Urban environmental quality is influenced by several aspects, including its geographical configuration, the scale, and nature of human activities occurring and environmental impacts generated. Cities have transformed into complex and dynamic systems that constitute a significant challenge to urban planning. Cities and their sustainability are often discussed together as the cities stand confronted with numerous environmental concerns as the world becoming increasingly urbanized, and the cities are situated in the mesh of global networks in multiple senses. A rapid transformed urban setting plays a crucial role to change the green area of natural habitats. To examine the pattern of urban growth and to measure the Landuse/Landcover change in Gurgoan in Haryana, India through the integration of Geospatial technique is attempted in the research paper. Satellite images are used to measure the spatiotemporal changes that have occurred in the land use and land cover resulting into a new cityscape. It has been observed from the analysis that drastically evident changes in land use has occurred with the massive rise in built up areas and the decrease in green cover and therefore causing the sustainability of the city an important area of concern. The massive increase in built-up area has influenced the localised temperatures and heat concentration. To enhance the decision-making process in urban planning, a detailed and real world depiction of these urban spaces is the need of the hour. Monitoring indicators of key processes in land use and economic development are essential for evaluating policy measures.

Keywords: cityscape, geospatial techniques, green cover index, urban environmental quality, urban planning

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Authors: Sima Shakoorjavan, Dawid Stawski, Somaye Akbari

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In this study, great attempts have been made to initially modify polylactide (PLA) nonwoven surface with poly(amidoamine) (PAMMA) dendritic polymer to create amine active sites on PLA surface through aminolysis reaction. Further, layer-by-layer deposition of four layers of two weak polyelectrolytes, including PAMAM as polycation and polyacrylic acid (PAA) as polyanion on activated PLA, was monitored with turbidity analysis of waste-polyelectrolytes after each deposition step. The FTIR-ATR analysis confirmed the successful introduction of amine groups into PLA polymeric chains through the emerging peak around 1650 cm⁻¹ corresponding to N-H bending vibration and a double wide peak at around 3670-3170 cm⁻¹ corresponding to N-H stretching vibration. The adsorption-desorption behavior of (PAMAM) and poly (PAA) deposition was monitored by turbidity test. Turbidity results showed the desorption and removal of the previously deposited layer (second and third layers) upon the desorption of the next layers (third and fourth layers). Also, the importance of proper rinsing after aminolysis of PLA nonwoven fabric was revealed by turbidity test. Regarding the sample with insufficient rinsing process, higher desorption and removal of ungrafted PAMAM from aminolyzed-PLA surface into PAA solution was detected upon the deposition of the first PAA layer. This phenomenon can be due to electrostatic attraction between polycation (PAMAM) and polyanion (PAA). Moreover, the successful layer deposition through LBL was confirmed by the staining test of acid red 1 through spectrophotometry analysis. According to the results, layered PLA with four layers with PAMAM as the top layer showed higher dye absorption (46.7%) than neat (1.2%) and aminolyzed PLA (21.7%). In conclusion, the complicated adsorption-desorption behavior of dendritic polycation and linear polyanion systems was observed. Although desorption and removal of previously adsorbed layers occurred upon the deposition of the next layer, the remaining polyelectrolyte on the substrate is sufficient for the adsorption of the next polyelectrolyte through electrostatic attraction between oppositely charged polyelectrolytes. Also, an increase in dye adsorption confirmed more introduction of PAMAM onto PLA surface through LBL.

Keywords: surface modification, layer-by-layer technique, weak polyelectrolytes, adsorption-desorption behavior

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Authors: Oksana Koval, Stephen Nabareseh

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Talent attraction is identified as a top priority between 2015 – 2020 for Shared Service Centers (SSCs) based on an industry-wide studies. Due to market dynamics and the structure of labour force, shared service industries in Eastern and Central Europe strive for qualified graduates with appropriate and unique skills to occupy such job places. The inbuilt interest and course prescriptions undertaken by prospective job seekers determine whether SSCs will eventually admit such professionals. This paper assesses students’ overall perception of careers in the shared services industry and further diagnosis gender impact and influence on the job preferences among students. Questionnaires were distributed among students in the Czech Republic universities using an online mode. Respondents vary by study year, gender, age, course of study, and work preferences. A total of 1283 student responses has been analyzed using Stata data analytics software. It was discovered that over 70% of respondents who are aware of SSCs are quite ignorant of the job opportunities offered by the centers. While majority of respondents are interested in support positions (e.g. procurement specialist, planning specialist, human resource specialist, process improvement specialist and payroll specialist, etc.), around a third of respondents (32.8 percent) will decline a job offer from SSCs. The analysis also revealed that males are more likely than females to seek careers in international companies, hence, tend to be more favorable towards shared service jobs. Females, however, have stronger preferences towards marketing and PR jobs. The research results provide insights into the job aspirations of students interviewed. The findings provide a huge resource for recruitment agencies and shared service industries to renew and redirect their search for talents into SSCs. Based on the fact that great portion of respondents are planning to start their career within 6-12 months, the research provides important highlights for the talent attraction and recruitment strategies in the industry and provides a curriculum direction in academia.

Keywords: Czech Republic labour market, gender, talent attraction, shared service centers, students

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Authors: Xi Wang, Yoshio Bando

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Lithium-ion batteries (LIBs) can deliver high levels of energy storage density and offer long operating lifetimes, but their power density is too low for many important applications. Therefore, we developed some new strategies and fabricated novel electrodes for fast Li transport and its facile synthesis including N-doped graphene-SnO2 sandwich papers, bicontinuous nanoporous Cu/Li4Ti5O12 electrode, and binder-free N-doped graphene papers. In addition, by using advanced in-TEM, STEM techniques and the theoretical simulations, we systematically studied and understood their storage mechanisms at the atomic scale, which shed a new light on the reasons of the ultrafast lithium storage property and high capacity for these advanced anodes. For example, by using advanced in-situ TEM, we directly investigated these processes using an individual CuO nanowire anode and constructed a LIB prototype within a TEM. Being promising candidates for anodes in lithium-ion batteries (LIBs), transition metal oxide anodes utilizing the so-called conversion mechanism principle typically suffer from the severe capacity fading during the 1st cycle of lithiation–delithiation. Also we report on the atomistic insights of the GN energy storage as revealed by in situ TEM. The lithiation process on edges and basal planes is directly visualized, the pyrrolic N "hole" defect and the perturbed solid-electrolyte-interface (SEI) configurations are observed, and charge transfer states for three N-existing forms are also investigated. In situ HRTEM experiments together with theoretical calculations provide a solid evidence that enlarged edge {0001} spacings and surface "hole" defects result in improved surface capacitive effects and thus high rate capability and the high capacity is owing to short-distance orderings at the edges during discharging and numerous surface defects; the phenomena cannot be understood previously by standard electron or X-ray diffraction analyses.

Keywords: in-situ TEM, STEM, advanced anode, lithium-ion batteries, storage mechanism

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Authors: Ramzi Shawahna

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Background: Neonatal intensive care units are high-risk settings where medication errors can occur and cause harm to this fragile segment of patients. This multicenter qualitative study was conducted to describe medication errors that occurred in neonatal intensive care units in Palestine from the perspectives of healthcare providers. Methods: This exploratory multicenter qualitative study was conducted and reported in adherence to the consolidated criteria for reporting qualitative research checklist. Semi-structured in-depth interviews were conducted with healthcare professionals (4 pediatricians/neonatologists and 11 intensive care unit nurses) who provided care services for patients admitted to neonatal intensive care units in Palestine. An interview schedule guided the semi-structured in-depth interviews. The qualitative interpretive description approach was used to thematically analyze the data. Results: The total duration of the interviews was 282 min. The healthcare providers described their experiences with 41 different medication errors. These medication errors were categorized under 3 categories and 10 subcategories. Errors that occurred while preparing/diluting/storing medications were related to calculations, using a wrong solvent/diluent, dilution errors, failure to adhere to guidelines while preparing the medication, failure to adhere to storage/packaging guidelines, and failure to adhere to labeling guidelines. Errors that occurred while prescribing/administering medications were related to inappropriate medication for the neonate, using a different administration technique from the one that was intended and administering a different dose from the one that was intended. Errors that occurred after administering the medications were related to failure to adhere to monitoring guidelines. Conclusion: In this multicenter study, pediatricians/neonatologists and neonatal intensive care unit nurses described medication errors occurring in intensive care units in Palestine. Medication errors occur in different stages of the medication process: preparation/dilution/storage, prescription/administration, and monitoring. Further studies are still needed to quantify medication errors occurring in neonatal intensive care units and investigate if the designed strategies could be effective in minimizing medication errors.

Keywords: medication errors, pharmacist, pharmacology, neonates

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Authors: Florence Awde

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In 2023, it was expected 350 parents in Arizona would have a child receive a cancer diagnosis (Welcome Arizona Cancer Foundation For Children, n.d.). The news of a child’s diagnosis with cancer can be overwhelming and confusing, especially for those lucky enough to lack a personal tie to the disease that takes approximately 1800 children’s lives each year in the United States (Deegan et al., n.d.). A parent’s beliefs, attitudes, and understandings surrounding cancer are vital for medical staff to provide adequate and culturally competent care for each patient, especially across cultural and ethnic lines in regions housing multicultural populations. Arizona's cultural/linguistic mosaic houses many White and Latino populations and English and Spanish speakers. Variations in insurance coverage, from those insured through public insurance programs (e.g., Medicaid) or private insurance plans (e.g., employee-sponsored insurance) versus those uninsured, also factor into health-seeking attitudes and behaviors. To further understand parental attitudes, understandings, and beliefs towards childhood cancer, 22 parents (11 of Latino ethnicity, 11 of White ethnicity) were interviewed on these facets of childhood cancer, despite 21 of the 22 never having a child receive a cancer diagnosis. The exploration of these perceptions across ethnic lines revealed a higher report of fear-orientated beliefs amongst Latino parents--hypothesized to be rooted in the starkly contrasting lack of belief in the possibility of recovering for children with cancer, compared to their white counterparts who displayed more optimism in the recovery process. Further, this study’s results lay the foundation for future scholarship to explore avenues of information dispersal to Latino parents that correct misconceptions of health outcomes and enable earlier intervention to be possible, ultimately correlating to better health and treatment outcomes by increasing parental health literacy rates for childhood cancer in the Phoenix Metropolitan.

Keywords: Childhood Cancer, Parental Beliefs, Parental Attitudes, Parental Understandings, Phoenix Metropolitan, Culturally Competent Care, Health Disparities, Health Inequities

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Authors: Umamaheswari Shanmugam, Silvia Ronchi

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Software, artificial intelligence, and machine learning can improve healthcare through innovative and advanced technologies that can use the large amount and variety of data generated during healthcare services every day; one of the significant advantages of these new technologies is the ability to get experience and knowledge from real-world use and to improve their performance continuously. Healthcare systems and institutions can significantly benefit because the use of advanced technologies improves the efficiency and efficacy of healthcare. Software-defined as a medical device, is stand-alone software that is intended to be used for patients for one or more of these specific medical intended uses: - diagnosis, prevention, monitoring, prediction, prognosis, treatment or alleviation of a disease, any other health conditions, replacing or modifying any part of a physiological or pathological process–manage the received information from in vitro specimens derived from the human samples (body) and without principal main action of its principal intended use by pharmacological, immunological or metabolic definition. Software qualified as medical devices must comply with the general safety and performance requirements applicable to medical devices. These requirements are necessary to ensure high performance and quality and protect patients' safety. The evolution and the continuous improvement of software used in healthcare must consider the increase in regulatory requirements, which are becoming more complex in each market. The gap between these advanced technologies and the new regulations is the biggest challenge for medical device manufacturers. Regulatory requirements can be considered a market barrier, as they can delay or obstacle the device's approval. Still, they are necessary to ensure performance, quality, and safety. At the same time, they can be a business opportunity if the manufacturer can define the appropriate regulatory strategy in advance. The abstract will provide an overview of the current regulatory framework, the evolution of the international requirements, and the standards applicable to medical device software in the potential market all over the world.

Keywords: artificial intelligence, machine learning, SaMD, regulatory, clinical evaluation, classification, international requirements, MDR, 510k, PMA, IMDRF, cyber security, health care systems

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Authors: Joelle Fong

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Older persons are at greatest risk of becoming frail. As survival to the age of 80 and beyond continues to increase, the health and frailty of older Americans has garnered much recent attention among policy makers and healthcare administrators. This paper examines patterns in old-age frailty within a multistate actuarial model that characterizes the stochastic process of biological ageing. Using aggregate population-level U.S. mortality data, we implement a stochastic aging model to examine cohort trends and gender differences in frailty distributions for older Americans born 1865 – 1894. The stochastic ageing model, which draws from the fields of actuarial science and gerontology, is well-established in the literature. The implications for public health insurance programs are also discussed. Our results suggest that, on average, women tend to be frailer than men at older ages and reveal useful insights about the magnitude of the male-female differential at critical age points. Specifically, we note that the frailty statuses of males and females are actually quite comparable from ages 65 to 80. Beyond age 80, however, the frailty levels start to diverge considerably implying that women are moving quicker into worse states of health than men. Tracking average frailty by gender over 30 successive birth cohorts, we also find that frailty levels for both genders follow a distinct peak-and-trough pattern. For instance, frailty among 85-year old American survivors increased in years 1954-1963, decreased in years 1964-1971, and again started to increase in years 1972-1979. A number of factors may have accounted for these cohort differences including differences in cohort life histories, differences in disease prevalence, differences in lifestyle and behavior, differential access to medical advances, as well as changes in environmental risk factors over time. We conclude with a discussion on the implications of our findings on spending for long-term care programs within the broader health insurance system.

Keywords: actuarial modeling, cohort analysis, frail elderly, health

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Authors: German Hernandez-Alonso, Antonio Lazcano, Arturo Becerra

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Until today, viruses remain controversial and poorly understood; about their origin, this problem represents an enigma and one of the great challenges for the contemporary biology. Three main theories have tried to explain the origin of viruses: regressive evolution, escaped host gene, and pre-cellular origin. Under the perspective of the escaped host gene theory, it can be assumed a cellular origin of viral components, like protein RNA-binding domains. These universal distributed RNA-binding domains are related to the RNA metabolism processes, including transcription, processing, and modification of transcripts, translation, RNA degradation and its regulation. In the case of viruses, these domains are present in important viral proteins like helicases, nucleases, polymerases, capsid proteins or regulation factors. Therefore, they are implicated in the replicative cycle and parasitic processes of viruses. That is why it is possible to think that those domains present low levels of divergence due to selective pressures. For these reasons, the main goal for this project is to create a catalogue of the RNA-binding domains found in all the available viral proteomes, using bioinformatics tools in order to analyze its evolutionary process, and thus shed light on the general virus evolution. ProDom database was used to obtain larger than six thousand RNA-binding domain families that belong to the three cellular domains of life and some viral groups. From the sequences of these families, protein profiles were created using HMMER 3.1 tools in order to find distant homologous within greater than four thousand viral proteomes available in GenBank. Once accomplished the analysis, almost three thousand hits were obtained in the viral proteomes. The homologous sequences were found in proteomes of the principal Baltimore viral groups, showing interesting distribution patterns that can contribute to understand the evolution of viruses and their host-virus interactions. Presence of cellular RNA-binding domains within virus proteomes seem to be explained by closed interactions between viruses and their hosts. Recruitment of these domains is advantageous for the viral fitness, allowing viruses to be adapted to the host cellular environment.

Keywords: bioinformatics tools, distant homology, RNA-binding domains, viral evolution

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Authors: David Mafullul, Jiang Lei, Edward Goacher, Jibin Francis

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PURPOSE: Timely decompressive surgery for cauda equina syndrome (CES) is dependent on efficient referral pathways for patients presenting at local primary or secondary centres to tertiary spinal centres in the United Kingdom (UK). Identifying modifiable points of delay within this process is important as minimising time between presentation and surgery may improve patient outcomes. This study aims to analyse whether adequacy of referral impacts on time to surgery in CES. MATERIALS AND METHODS: Data from all cases of confirmed CES referred to a single tertiary UK hospital between August 2017 to December 2019, via a suspected CES e-referral pathway, were obtained retrospectively. Referral adequacy was defined by the inclusion of sufficient information to determine the presence or absence of several NICE ‘red flags’. Correlation between referral adequacy and delay from referral-to-surgery was then analysed. RESULTS: In total, 118 confirmed CES cases were included. Adequate documentation for saddle anaesthesia was associated with reduced delays of more than 48 hours from referral-to-surgery [X2(1, N=116)=7.12, p=.024], an effect partly attributable to these referrals being accepted sooner [U=16.5; n1=27, n2=4, p=.029, r=.39]. Other red flags had poor association with delay. Referral adequacy was better for somatic red flags [bilateral sciatica (97.5%); severe or progressive bilateral neurological deficit of the legs (95.8%); saddle anaesthesia (91.5%)] compared to autonomic red flags [loss of anal tone (80.5%); urinary retention (79.7%); faecal incontinence or lost sensation of rectal fullness (57.6%)]. Although referral adequacy for urinary retention was 79.7%, only 47.5% of referrals documented a post-void residual numerical value. CONCLUSIONS: Adequate documentation of saddle anaesthesia in e-referrals is associated with reduced delay-to-surgery for confirmed CES, partly attributable to these referrals being accepted sooner. Other red flags had poor association with delay to surgery. Referral adequacy for autonomic red flags, including documentation for post-void residuals, has significant room for improvement.

Keywords: cauda equina, cauda equina syndrome, neurosurgery, spinal surgery, decompression, delay, referral, referral adequacy

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