Search results for: multi criteria decision analysis (MCDA)

Authors: Almutazballlah Bassam Qablan, Jihan M. Muhaidat, bana Abu Rajab

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Background: Acne vulgaris is considered one of the most common skin conditions encountered by dermatologists. It is a chronic inflammation affecting the pilosebaceous unit. Although acne vulgaris is not fatal, it leads to permanent scarring and disfigurement, and even without scarring, it has a huge effect on patients, causing negative health outcomes. Acne vulgaris patients experience psychological, and emotional ramifications as those with chronic health problems; they feel depressed, angry, anxious, and confused. Although acne is a popular disease, many thoughts and myths are still discussed about its origins and triggering factors. These myths can make you feel guilt as if you were somehow responsible for your acne. In this case control study, we want to define the relationship between two modifiable risk factors ;BMI and smoking, with acne vulgaris. Methods: A case-control study was conducted at King Abdullah University Hospital in Ramtha, Jordan in 2019/2020. A total number of 325 participants between 14 and 33 years of age were interviewed by the authors; including 163 acne vulgaris cases and 162 controls without acne vulgaris. Anthropometric measures and smoking for Acne patients and control participants were the independent variables used to assess acne. Univariate and multivariate analysis were used to compare the characteristics of people who reported acne with those with no acne. The collected data analyzed by using the Statistical Package for Social Sciences (SPSS). Results: Cigarette smoking was highly associated with controls; odds ratio 0.4 (95% CI: 0.2–0.9) , P-value = 0.018. BMI and waterpipe smoking were statistically insignificant with acne in the multivariate analysis. Conclusion: We found that cigarette smoking was protective against Acne. There was a statistically insignificant relation between BMI, waterpipe smoking and the development of Acne Vulgaris.

Keywords: acne, adolescents, BMI, smoking, case-control, risk factors

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Authors: Clara Tramuta, Floris Irene, Daniela Manila Bianchi, Monica Pitti, Giulia Federica Cazzaniga, Lucia Decastelli

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This work presents the results obtained by the Regional Reference Centre for Salmonella Typing (CeRTiS) in a retrospective study aimed to investigate, through Pulsed-field Gel Electrophoresis (PFGE) analysis, the genetic relatedness of emerging Salmonella serotypes of human origin circulating in North-West of Italy. Furthermore, the goal of this work was to create a Regional database to facilitate foodborne outbreak investigation and to monitor them at an earlier stage. A total of 112 strains, isolated from 2016 to 2018 in hospital laboratories, were included in this study. The isolates were previously identified as Salmonella according to standard microbiological techniques and serotyping was performed according to ISO 6579-3 and the Kaufmann-White scheme using O and H antisera (Statens Serum Institut®). All strains were characterized by PFGE: analysis was conducted according to a standardized PulseNet protocol. The restriction enzyme XbaI was used to generate several distinguishable genomic fragments on the agarose gel. PFGE was performed on a CHEF Mapper system, separating large fragments and generating comparable genetic patterns. The agarose gel was then stained with GelRed® and photographed under ultraviolet transillumination. The PFGE patterns obtained from the 112 strains were compared using Bionumerics version 7.6 software with the Dice coefficient with 2% band tolerance and 2% optimization. For each serotype, the data obtained with the PFGE were compared according to the geographical origin and the year in which they were isolated. Salmonella strains were identified as follow: S. Derby n. 34; S. Infantis n. 38; S. Napoli n. 40. All the isolates had appreciable restricted digestion patterns ranging from approximately 40 to 1100 kb. In general, a fairly heterogeneous distribution of pulsotypes has emerged in the different provinces. Cluster analysis indicated high genetic similarity (≥ 83%) among strains of S. Derby (n. 30; 88%), S. Infantis (n. 36; 95%) and S. Napoli (n. 38; 95%) circulating in north-western Italy. The study underlines the genomic similarities shared by the emerging Salmonella strains in Northwest Italy and allowed to create a database to detect outbreaks in an early stage. Therefore, the results confirmed that PFGE is a powerful and discriminatory tool to investigate the genetic relationships among strains in order to monitoring and control Salmonellosis outbreak spread. Pulsed-field gel electrophoresis (PFGE) still represents one of the most suitable approaches to characterize strains, in particular for the laboratories for which NGS techniques are not available.

Keywords: emerging Salmonella serotypes, genetic characterization, human strains, PFGE

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Authors: Prasad Kalagura, B. Veeresh kumar

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We constructed an interface system that would allow a similarly paralyzed user to interact with a computer with almost full functional capability. A real-time tracking algorithm is implemented based on adaptive skin detection and motion analysis. The clicking of the mouse is activated by the user's eye blinking through a sensor. The keyboard function is implemented by voice recognition kit.

Keywords: embedded ARM7 processor, mouse pointer control, voice recognition

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Authors: Shinji Ukita, Naohiro Nakamura, Yuji Miyazu

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In considering the dynamic characteristics of structure, natural frequency and damping ratio are useful indicator. When performing dynamic design, it's necessary to select an appropriate initial damping model and hysteretic model. In the linear region, the setting of initial damping model influences the response, and in the nonlinear region, the combination of initial damping model and hysteretic model influences the response. However, the dynamic characteristics of structure in the nonlinear region remain unclear. In this paper, we studied the effect of setting of initial damping model and hysteretic model on the dynamic characteristics of structure. On initial damping model setting, Initial stiffness proportional, Tangent stiffness proportional, and Rayleigh-type were used. On hysteretic model setting, TAKEDA model and Normal-trilinear model were used. As a study method, dynamic analysis was performed using a lumped mass model of base-fixed. During analysis, the maximum acceleration of input earthquake motion was gradually increased from 1 to 600 gal. The dynamic characteristics were calculated using the ARX model. Then, the characteristics of 1st and 2nd natural frequency and 1st damping ratio were evaluated. Input earthquake motion was simulated wave that the Building Center of Japan has published. On the building model, an RC building with 30×30m planes on each floor was assumed. The story height was 3m and the maximum height was 18m. Unit weight for each floor was 1.0t/m2. The building natural period was set to 0.36sec, and the initial stiffness of each floor was calculated by assuming the 1st mode to be an inverted triangle. First, we investigated the difference of the dynamic characteristics depending on the difference of initial damping model setting. With the increase in the maximum acceleration of the input earthquake motions, the 1st and 2nd natural frequency decreased, and the 1st damping ratio increased. Then, in the natural frequency, the difference due to initial damping model setting was small, but in the damping ratio, a significant difference was observed (Initial stiffness proportional≒Rayleigh type>Tangent stiffness proportional). The acceleration and the displacement of the earthquake response were largest in the tangent stiffness proportional. In the range where the acceleration response increased, the damping ratio was constant. In the range where the acceleration response was constant, the damping ratio increased. Next, we investigated the difference of the dynamic characteristics depending on the difference of hysteretic model setting. With the increase in the maximum acceleration of the input earthquake motions, the natural frequency decreased in TAKEDA model, but in Normal-trilinear model, the natural frequency didn’t change. The damping ratio in TAKEDA model was higher than that in Normal-trilinear model, although, both in TAKEDA model and Normal-trilinear model, the damping ratio increased. In conclusion, in initial damping model setting, the tangent stiffness proportional was evaluated the most. In the hysteretic model setting, TAKEDA model was more appreciated than the Normal-trilinear model in the nonlinear region. Our results would provide useful indicator on dynamic design.

Keywords: initial damping model, damping ratio, dynamic analysis, hysteretic model, natural frequency

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Authors: Mariko Hara, Mari Aoki, Takako Ito, Masao Sugita

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Social distancing measures due to the COVID-19 crisis had a severe impact on music and art practices based in community settings. They had to re-think how to connect with their dispersed community using online tools. As the social distancing continues, there is an urgent need to investigate the possibilities of online community music and art practices. Are they sustainable actions that can have positive impacts on the community and the quality of lives of people over time? The Online Lindgren Café (hereafter ‘OLC’) is a monthly online literature event which started in June 2020. In the OLC, up to 14 members meet online to discuss the works of Astrid Lindgren and similar authors. Members come from various places in Japan and Norway, with a variety of expertise from music therapy, music education, psychotherapy, music sociology, storytelling, and theatre, and their family members join them. In these meetings, music and arts activities emerged in response to interests among the members. The resources and experiences of the members helped to develop these activities further. This paper first introduces one of the music and art activities in one specific event, a collaborative picture book-making with music, which was initiated and led by the second author. The third author chose the music, and the activity itself was recorded. This is followed by the description of a reflecting event, where the recording of the collaborative picture book-making activity was shared to facilitate further creations (drawings, haiku, and fabric weaving) as well as group reflections on the trajectories of the Online Lindgren Café. Finally, we will discuss the preliminary findings using the data collected at the reflecting event. Key findings suggest that the resource-driven approach of the OLC leveled the relationships among the intergenerational, multi-cultural, and interdisciplinary members. This enabled the members to set aside their professional and/or predominant identities, which allowed them to discover their own and others’ resources. The relaxed, unstructured, and liminal phenomenon at OLC can be regarded as a form of communitas, where members gain a sense of liberation and belonging in a different way from in-person communications. Participation from one’s home, as well as a video conferencing function that allowed the members to position themselves among the other participants in equal-sized windows, seems to have enabled members to feel safe to express themselves openly at the same time feel a sense of belonging. Furthermore, in the OLC, music and arts activities acted to inclusively connect and re-connect dispersed, intergenerational members with each other. For instance, in a music and drawing activity, music acted as a means for each member to engage in their own ‘drawing space’ while still feeling connected with the others. The positive experiences from these activities inspired the members to use similar approaches outside of the OLC. The finding suggests that, because of its resource-driven approach supported by the music and arts activities, the OLC could be developed further as a permeable and sustainable action even after any current social distancing measures are lifted.

Keywords: communitas, COVID-19, musical affordances, online community of practices, resource-driven approach

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Authors: L. Calcagni, A. Battisti, M. Hensel, D. S. Hensel

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Since the beginning of the 21st century, we have seen a dynamic growth of water-based (WB) architecture, mainly due to the increasing threat of floods caused by sea level rise and heavy rains, all correlated with climate change. At the same time, the shortage of land available for urban development also led architects, engineers, and policymakers to reclaim the seabed or to build floating structures. Furthermore, the drive to produce energy from renewable resources has expanded the sector of offshore research, mining, and energy industry which seeks new types of WB structures. In light of these considerations, the time is ripe to consider floating architecture as a full-fledged building typology. Currently, there is no universally recognized academic definition of a floating building. Research on floating architecture lacks a proper, commonly shared vocabulary and typology distinction. Moreover, there is no global international legal framework for urban development on water, and there is no structured performance based building design (PBBD) approach for floating architecture in most countries, let alone national regulatory systems. Thus, first of all, the research intends to overcome the semantic and typological issues through the conceptualization of floating architecture, laying the proto-ontological conditions for floating development, and secondly to identify the parameters to be considered in the definition of a specific PBBD framework, setting the scene for national planning strategies. The theoretical overview and re-semanticization process involve the attribution of a new meaning to the term floating architecture. This terminological work of semantic redetermination is carried out through a systematic literature review and involves quantitative and historical research as well as logical argumentation methods. As it is expected that floating urban development is most likely to take place as an extension of coastal areas, the needs and design criteria are definitely more similar to those of the urban environment than to those of the offshore industry. Therefore, the identification and categorization of parameters –looking towards the potential formation of a PBBD framework for floating development– takes the urban and architectural guidelines and regulations as the starting point, taking the missing aspects, such as hydrodynamics (i.e. stability and buoyancy) from the offshore and shipping regulatory frameworks. This study is carried out through an evidence-based assessment of regulatory systems that are effective in different countries around the world, addressing on-land and on-water architecture as well as offshore and shipping industries. It involves evidence-based research and logical argumentation methods. Overall, inhabiting water is proposed not only as a viable response to the problem of rising sea levels, thus as a resilient frontier for urban development, but also as a response to energy insecurity, clean water, and food shortages, environmental concerns, and urbanization, in line with Blue Economy principles and the Agenda 2030. This review shows how floating architecture is to all intents and purposes, an urban adaptation measure and a solution towards self-sufficiency and energy-saving objectives. Moreover, the adopted methodology is, to all extents, open to further improvements and integrations, thus not rigid and already completely determined. Along with new designs and functions that will come into play in the practice field, eventually, life on water will seem no more unusual than life on land, especially by virtue of the multiple advantages it provides not only to users but also to the environment.

Keywords: adaptation measures, building typology, floating architecture, performance based building design, rising sea levels

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Authors: Muhammad Ghaffar Doggar, Farah

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The primary objective of this feasibility study is to conduct a techno-financial assessment for installation of biomass based power plant in Faisalabad division. The study involves identification of best site for power plant followed by an assessment of biomass resource potential in the area and propose power plant of suitable size. The study also entailed comprehensive supply chain analysis to determine biomass fuel pricing, transportation and storage. Further technical and financial analyses have been done for selection of appropriate technology for the power plant and its financial viability, respectively. The assessment of biomass resources and the subsequent technical analysis revealed that 20 MW biomass power plant could be implemented at one of the locations near Faisalabad city i.e. AARI Site, Near Chak Jhumra district Faisalabad, Punjab province. Three options for steam pressure; namely, 70 bar, 90 bar and 100 bar boilers have been considered. Using international experience and prices on power plant technology and local prices on locally available equipment, the study concludes biomass fuel price of around 50 US dollars (USD) per ton when delivered to power plant site. The electricity prices used for feasibility calculations were 0.13 USD per KWh for electricity from a locally financed project and 0.11 USD per KWh for internationally financed power plant. For local financing the most viable choice is the 70 bar solution and with international financing, the most feasible solution is using a 90 bar boiler. Between the two options, the internationally financed 90 bar boiler setup gives better financial results than the locally financed 70 bar boiler project. It has been concluded that 20 MW with 90 bar power plant and internationally financed would have an equity IRR of 23% and a payback period of 7 years. This will be a cheap option for installation of power plants.

Keywords: AARI, Ayub agriculture research institute, biomass - crops residue, KWh - electricity Units, MG - Muhammad Ghaffar

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Authors: Mohd Ritzman Abdul Karim, Zhaohui Huang

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A current focus in seismic engineering practice is the development of seismic design approach that focuses on the performance-based design. Performance-based design aims to design the structures to achieve specified performance based on the damage limit states. This damage limit is more restrictive limit than life safety and needs to be carefully estimated to avoid damage in piers due to failure in transverse reinforcement. In this paper, a different perspective of damage limit states has been explored by integrating two damage control material limit state, concrete and reinforcement by introduced parameters such as expected yield stress of transverse reinforcement where peak tension strain prior to bar buckling is introduced in a recent study. The different perspective of damage limit states with modified yield displacement and the modified plastic-hinge length is used in order to predict damage-control target displacement for reinforced concreate (RC) bridge pier. Three-dimensional (3D) finite element (FE) model has been developed for estimating damage target displacement to validate proposed damage limit states. The result from 3D FE analysis was validated with experimental study found in the literature. The validated model then was applied to predict the damage target displacement for RC bridge pier and to validate the proposed study. The tensile strain on reinforcement and compression on concrete were used to determine the predicted damage target displacement and compared with the proposed study. The result shows that the proposed damage limit states were efficient in predicting damage-control target displacement consistent with FE simulations.

Keywords: damage-control target displacement, damage limit states, reinforced concrete bridge pier, yield displacement

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Authors: Peter Iyobosa Asemota

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This study on solid waste management practices addressed aspects of environmental and health impacts resulting from poor management of solid waste. The study was occasioned by the observed rate and volume of illegal and indiscriminate dumping of solid waste materials especially in informal settlements. The main focus of this study was to establish the impact of waste management practices on human health and the environment. The study, therefore, presents a critical analysis of the state of solid waste management in the study area and the implications for human health and the environment. The study was carried out in Kayamandi informal settlement within Stellenbosch municipality. The sustainable management of solid waste is very important in order to minimize the environmental and public health risks associated with improper solid waste management. There is no denying the fact that the problems of waste management will become critical as time goes on because of improper and inefficient waste management practices. Towns and cities exhibit the burdens of waste management which is a characteristics feature of most African cities. The study critically assess the implementation of waste management practices by the residents of the informal settlement; identify the factors affecting management issues in the operation of solid waste management system by the municipality; identify factors militating against the implementation of waste management policies and legislation. Furthermore, a waste assessment study was carried out to assess the generation; composition of the waste stream and also determine the attitudes and behavior of the residents with regard to waste management practices. Findings from the study revealed that Kayamandi is not different from other informal settlements with regards to waste management. People are of the opinion that solid waste management is the sole responsibility of municipal authorities and as such, the government should be responsible for bearing the cost of solid waste management.

Keywords: environment, waste, waste composition, waste stream, policy, waste categories, sanitary landfill, waste collection, integrated solid waste management

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Authors: Wen Feiming

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As the ecological barrier of the Yangtze River, the ecological security of the Parallel Range-Valley area is very important. However, the unique geomorphic features aggravate the contradiction between man and land, resulting in the encroachment of ecological space. In recent years , relevant researches has focused on the single field of land science, ecology and landscape ecology, and it is difficult to systematically reflect the regularities of distribution and evolution trends of ecological patterns in the process of urban development. Therefore, from the perspective of "Production-Living-Ecological space", using spatial analysis methods such as Remote Sensing (RS) and Geographic Information Systems (GIS), this paper analyzes the evolution characteristics and driving factors of the ecological pattern of mountain towns in the parallel range-valley region from the aspects of land use structure, change rate, transformation relationship, and spatial correlation. It is concluded that the ecological pattern of mountain towns presents a trend from expansion and diffusion to agglomeration, and the dynamic spatial transfer is a trend from artificial transformation to the natural origin, while the driving effect analysis shows the significant characteristics of terrain attraction and construction barrier. Finally, combined with the evolution characteristics and driving mechanism, the evolution modes of "mountain area - concentrated growth", "trough area - diffusion attenuation" and "flat area - concentrated attenuation" are summarized, and the differentiated zoning and stratification ecological planning strategies are proposed here, in order to provide the theoretical basis for the sustainable development of mountain towns in parallel range-valley areas.

Keywords: parallel range-valley, ecological pattern, evolution characteristics, driving factors

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Authors: Nikitha Francis, Anjana Hoode, Vinitha George, Jayashree S. Bhat

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The interaction between cognition and language, referred as cognitive-communication, is very intricate, involving several mental processes such as perception, memory, attention, lexical retrieval, decision making, motor planning, self-monitoring and knowledge. Cognitive-communication disorders are difficulties in communicative competencies that result from underlying cognitive impairments of attention, memory, organization, information processing, problem solving, and executive functions. Traumatic brain injury (TBI) is an acquired, non - progressive condition, resulting in distinct deficits of cognitive communication abilities such as naming, word-finding, self-monitoring, auditory recognition, attention, perception and memory. Cognitive-communication intervention in TBI is individualized, in order to enhance the person’s ability to process and interpret information for better functioning in their family and community life. The present case report illustrates the cognitive-communicative behaviors and the intervention outcomes of an adult with TBI, who was brought to the Department of Audiology and Speech Language Pathology, with cognitive and communicative disturbances, consequent to road traffic accident. On a detailed assessment, she showed naming deficits along with perseverations and had severe difficulty in recalling the details of the accident, her house address, places she had visited earlier, names of people known to her, as well as the activities she did each day, leading to severe breakdowns in her communicative abilities. She had difficulty in initiating, maintaining and following a conversation. She also lacked orientation to time and place. On administration of the Manipal Manual of Cognitive Linguistic Abilities (MMCLA), she exhibited poor performance on tasks related to visual and auditory perception, short term memory, working memory and executive functions. She attended 20 sessions of cognitive-communication intervention which followed a domain-general, adaptive training paradigm, with tasks relevant to everyday cognitive-communication skills. Compensatory strategies such as maintaining a dairy with reminders of her daily routine, names of people, date, time and place was also recommended. MMCLA was re-administered and her performance in the tasks showed significant improvements. Occurrence of perseverations and word retrieval difficulties reduced. She developed interests to initiate her day-to-day activities at home independently, as well as involve herself in conversations with her family members. Though she lacked awareness about her deficits, she actively involved herself in all the therapy activities. Rehabilitation of moderate to severe head injury patients can be done effectively through a holistic cognitive retraining with a focus on different cognitive-linguistic domains. Selection of goals and activities should have relevance to the functional needs of each individual with TBI, as highlighted in the present case report.

Keywords: cognitive-communication, executive functions, memory, traumatic brain injury

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Authors: Kirti Tewari, Rahul Dev

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Solar water heating is a thermodynamic process of heating water using sunlight with the help of solar water heater. Thus, solar water heater is a device used to harness solar energy. In this paper, a modified solar water heating system (MSWHS) has been proposed over flat plate collector (FPC) and Evacuated tube collector (ETC). The modifications include selection of materials other than glass, and glass wool which are conventionally used for fabricating FPC and ETC. Some modifications in design have also been proposed. Its collector is made of double layer of semi-cylindrical acrylic tubes and fibre reinforced plastic (FRP) insulation base. Water tank is made of double layer of acrylic sheet except base and north wall. FRP is used in base and north wall of the water tank. A concept of equivalent thickness has been utilised for calculating the dimensions of collector plate, acrylic tube and tank. A thermal model for the proposed design of MSWHS is developed and simulation is carried out on MATLAB for the capacity of 200L MSWHS having collector area of 1.6 m2, length of acrylic tubes of 2m at an inclination angle 25° which is taken nearly equal to the latitude of the given location. Latitude of Allahabad is 24.45° N. The results show that the maximum temperature of water in tank and tube has been found to be 71.2°C and 73.3°C at 17:00hr and 16:00hr respectively in March for the climatic data of Allahabad. Theoretical performance analysis has been carried out by varying number of tubes of collector, the tank capacity and climatic data for given months of winter and summer.

Keywords: acrylic, fibre reinforced plastic, solar water heating, thermal model, conventional water heaters

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Authors: Jiujie Cai, Fengxia LI, Haibo Wang

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After years of research, offshore oil and gas development now are shifted to unconventional reservoirs, where multi-stage hydraulic fracturing technology has been widely used. However, the simulation of complex hydraulic fractures in tight reservoirs is faced with geological and engineering difficulties, such as large burial depths, sand-shale interbeds, and complex stress barriers. The objective of this work is to simulate the hydraulic fracture propagation in the tight sandstone matrix of the marine-continental transitional reservoirs, where the Shanxi Formation in Tianhuan syncline of the Dongsheng gas field was used as the research target. The characteristic parameters of the vertical rock samples with rich beddings were clarified through rock mechanics experiments. The influence of rock mechanical parameters, vertical stress difference of pay-zone and bedding layer, and fracturing parameters (such as injection rates, fracturing fluid viscosity, and number of perforation clusters within single stage) on fracture initiation and propagation were investigated. In this paper, a 3-D fracture propagation model was built to investigate the complex fracture propagation morphology by boundary element method, considering the strength of bonding surface between layers, vertical stress difference and fracturing parameters (such as injection rates, fluid volume and viscosity). The research results indicate that on the condition of vertical stress difference (3 MPa), the fracture height can break through and enter the upper interlayer when the thickness of the overlying bedding layer is 6-9 m, considering effect of the weak bonding surface between layers. The fracture propagates within the pay zone when overlying interlayer is greater than 13 m. Difference in fluid volume distribution between clusters could be more than 20% when the stress difference of each cluster in the segment exceeds 2MPa. Fracture cluster in high stress zones cannot initiate when the stress difference in the segment exceeds 5MPa. The simulation results of fracture height are much higher if the effect of weak bonding surface between layers is not involved. By increasing the injection rates, increasing fracturing fluid viscosity, and reducing the number of clusters within single stage can promote the fracture height propagation through layers. Optimizing the perforation position and reducing the number of perforations can promote the uniform expansion of fractures. Typical curves of fracture height estimation were established for the tight sandstone of the Lower Permian Shanxi Formation. The model results have good consistency with micro-seismic monitoring results of hydraulic fracturing in Well 1HF.

Keywords: fracture propagation, boundary element method, fracture height, offshore oil and gas, marine-continental transitional reservoirs, rock mechanics experiment

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Authors: Biaou Jean-Baptiste Kouchoro, Anissa Meziane, Philippe Micheau, Mathieu Renier, Nicolas Quaegebeur

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Numerous experimental and numerical studies have shown the interest of the local defects resonance (LDR) for the Non-Destructive Testing of metallic and composite plates. Indeed, guided ultrasonic waves such as Lamb waves, which are increasingly used for the inspection of these flat structures, enable the generation of local resonance phenomena by their interaction with a damaged area, allowing the detection of defects. When subjected to a large amplitude motion, a nonlinear behavior can predominate in the damaged area. This work presents a 2D Finite Element Model of the local resonance of a 12 mm long and 5 mm deep Flat Bottom Hole (FBH) in a 6 mm thick aluminum plate under the excitation induced by an incident A0 Lamb mode. The analysis of the transient response of the FBH enables the precise determination of its resonance frequencies and the associate modal deformations. Then, a linear parametric study varying the geometrical properties of the FBH highlights the sensitivity of the resonance frequency with respect to the plate thickness. It is demonstrated that the resonance effect disappears when the ratio of thicknesses between the FBH and the plate is below 0.1. Finally, the nonlinear behavior of the FBH is considered and studied introducing geometrical (taken into account the nonlinear component of the strain tensor) nonlinearities that occur at large vibration amplitudes. Experimental analysis allows observation of the resonance effects and nonlinear response of the FBH. The differences between these experimental results and the numerical results will be commented on. The results of this study are promising and allow to consider more realistic defects such as delamination in composite materials.

Keywords: guided waves, non-destructive testing, dynamic field testing, non-linear ultrasound/vibration

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Authors: Haftay Abraha Tadesse

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Background: Staphylococcus is a genus of worldwide distributed bacteria correlated to several infectious of different sites in humans and animals. They are among the most important causes of infection that are associated with the consumption of contaminated food. Objective: The objective of this study was to determine the isolates, antimicrobial susceptibility patterns and Public Health Significance of Staphylococcus aureus in raw meat from butchery and abattoir houses of Mekelle, Northern Ethiopia. Methodology: A cross-sectional study was conducted from April to October 2019. Socio-demographic data and Public Health Significance were collected using a predesigned questionnaire. The raw meat samples were collected aseptically in the butchery and abattoir houses and transported using an ice box to Mekelle University, College of Veterinary Sciences, for isolating and identification of Staphylococcus aureus. Antimicrobial susceptibility tests were determined by the disc diffusion method. Data obtained were cleaned and entered into STATA 22.0 and a logistic regression model with odds ratio was calculated to assess the association of risk factors with bacterial contamination. A P-value < 0.05 was considered statistically significant. Results: In the present study, 88 out of 250 (35.2%) were found to be contaminated with Staphylococcus aureus. Among the raw meat specimens, the positivity rate of Staphylococcus aureus was 37.6% (n=47) and (32.8% (n=41), butchery and abattoir houses, respectively. Among the associated risks, factories not using gloves reduces risk was found to (AOR=0.222; 95% CI: 0.104-0.473), Strict Separation b/n clean & dirty (AOR= 1.37; 95% CI: 0.66-2.86) and poor habit of hand washing (AOR=1.08; 95%CI: 0.35 3.35) was found to be statistically significant and have associated with Staphylococcus aureus contamination. All isolates of thirty-seven of Staphylococcus aureus were checked and displayed (100%) sensitive to doxycycline, trimethoprim, gentamicin, sulphamethoxazole, amikacin, CN, Co trimoxazole and nitrofurantoi. Whereas the showed resistance to cefotaxime (100%), ampicillin (87.5%), Penicillin (75%), B (75%), and nalidixic acid (50%) from butchery houses. On the other hand, all isolates of Staphylococcus aureus isolate 100% (n= 10) showed sensitive chloramphenicol, gentamicin and nitrofurantoin, whereas they showed 100% resistance of Penicillin, B, AMX, ceftriaxone, ampicillin and cefotaxime from abattoirs houses. The overall multi-drug resistance pattern for Staphylococcus aureus was 90% and 100% of butchery and abattoir houses, respectively. Conclusion: 35.3% Staphylococcus aureus isolated were recovered from the raw meat samples collected from the butchery and abattoirs houses. More has to be done in the development of hand washing behavior and availability of safe water in the butchery houses to reduce the burden of bacterial contamination. The results of the present finding highlight the need to implement protective measures against the levels of food contamination and alternative drug options. The development of antimicrobial resistance is nearly always a result of repeated therapeutic and/or indiscriminate use of them. Regular antimicrobial sensitivity testing helps to select effective antibiotics and to reduce the problems of drug resistance development towards commonly used antibiotics.

Keywords: abattoir house, AMR, butchery house, S. aureus

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Authors: Ali Algryani

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Ellipsis involves the omission of an item or items that can be recovered from the preceding clause. Ellipsis is used as a cohesion marker; it enhances the cohesiveness of a text/discourse as a clause is interpretable only through making reference to an antecedent clause. The present study attempts to investigate the linguistic phenomenon of ellipsis from a translation perspective. It is mainly concerned with how ellipsis is translated from English into Arabic. The study covers different forms of ellipsis, such as noun phrase ellipsis, verb phrase ellipsis, gapping, pseudo-gapping, stripping, and sluicing. The primary aim of the study, apart from discussing the use and function of ellipsis, is to find out how such ellipsis phenomena are dealt with in English-Arabic translation and determine the implications of the translations of elliptical structures into Arabic. The study is based on the analysis of Dhofar University (DU) students' translations of sentences containing different forms of ellipsis. The initial findings of the study indicate that due to differences in syntactic structures and stylistic preferences between English and Arabic, Arabic tends to use lexical repetition in the translation of some elliptical structures, thus achieving a higher level of explicitness. This implies that Arabic tends to prefer lexical repetition to create cohesion more than English does. Furthermore, the study also reveals that the improper translation of ellipsis leads to interpretations different from those understood from the source text. Such mistranslations can be attributed to student translators’ lack of awareness of the use and function of ellipsis as well as the stylistic preferences of both languages. This has pedagogical implications on the teaching and training of translation students at DU. Students' linguistic competence needs to be enhanced through teaching linguistics-related issues with reference to translation and both languages, .i.e. source and target languages and with special emphasis on their use, function and stylistic preferences.

Keywords: cohesion, ellipsis, explicitness, lexical repetition

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Authors: Makhdoom Saad Wasim Ghouri, Muneeba Butt, Mohammad Ashraf Tahir, Rashid Bhatti, Akbar Ali, Abdul Rehman, Abdul Basit, Muzzamel Rehman, Shahbaz Aslam, Farakh Mansoor, Ahmad Fayyaz, Hadia Siddiqui

Abstract:

Lip print analysis (Cheiloscopy) is the new emerging technique that might be the guardian angel in establishing the personal identity. Cheiloscopy is basically the study of elevations and depressions present on the external surface of the lips. In our study, 600 lip prints samples were taken (300 males and 300 females). Lip prints of each individual were divided into four quadrants and the upper middle portion. For general classification, middle part of the lower lip almost 10 mm wide would be taken into consideration. After analysis of lip-prints, our results show that lip prints are the unique and permanent character of every individual. No two lip print was matched with each other even of the identical twins. Our study reveals that there is equal distribution of lip print patterns among all the four quadrants of lips and the upper middle portion; these distributions were statistically analyzed by applying chi-square test which shows the significant results. In general classification, 5 lip print types/patterns were studied, Type 1 (Vertical lines), Type 2 (Branched pattern), Type 3 (Intersected pattern), Type 4 (Reticular pattern) and Type 5 (Undetermined). Type 1 and Type 2 were found to be the most frequent patterns in female population, while Type 3 and Type 4 most commonly found in male population. These results were also analyzed by applying Chi-square test, and the results show significance statistically. Thus, establishing sex determination on the basis of lip print types among the gender. Type 5 was the least common pattern among genders.

Keywords: cheiloscopy, distribution, quadrants, sex determination

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Authors: Nkiru Nnaemezie, J. O. Okafor

Abstract:

The high mortality as a result of pregnancy related illnesses is a global public health problem and a source of concern to most countries including Nigeria. This study was therefore designed to determine the Demographic Variables associated with common pregnancy related illnesses among pregnant mothers in Awka South Local Government Area of Anambra State. The design of the study was an expost-facto research design. All the folders of the pregnant mothers that were studied from 2010-2014 formed the population of the study which included 10,250 folders. Based on the content of the folders, a researcher developed pro-forma (RDP) was used for data collection. Five research questions and five hypotheses were postulated for the study. Research questions postulated were answered using simple percentage. Hypotheses stated were analyzed at 0.05 level of significance using chi-square (X²) statistics. The result among others showed that pregnant mothers within 15-29 years had the most pregnancy related illnesses than mothers on other age brackets. Pregnant mothers with 0-1 parity level experienced the most pregnancy related illnesses than mothers on other parity levels. Public servants experienced the most pregnancy related illnesses than mothers in other occupations. Married pregnant mothers experienced the most pregnancy related illnesses than single mothers. Pregnant mothers with secondary education had the most pregnancy related illnesses than mothers in other education levels. There were significant differences in the common pregnancy related illnesses among the pregnant mothers of the study in relation to the demographic variables of the study which included age, parity, occupation, marital status and educational level. Based on the findings, conclusions were drawn, and the following recommendations among others were made: there is need for health education in terms of educating those pregnant mothers during antenatal clinics; single mothers should be advised to register for antenatal early enough.

Keywords: analysis, demographic variables, pregnancy related illnesses, pregnant mothers

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Authors: Meghry Nazarian, Ibrahim Duyar

Abstract:

Effective management of a diverse workforce in the United Arab Emirates (UAE) presents peculiar importance as two-thirds of residents are expatriates who have diverse ethnic and cultural backgrounds. Like any other organization in the country, UAE schools have become upmost diverse settings in the world. The purpose of this study was to examine whether principals’ cultural intelligence has direct and indirect (moderating) influences on teachers’ perceived diversity climate. A quantitative causal-comparative research design was employed to analyze the data. Participants included random samples of principals and teachers working in the private and charter schools in the Emirate of Abu Dhabi. The data-gathering online questionnaires included previously developed and validated scales as the measures of study variables. More specifically, the multidimensional short-form measure of Cultural Intelligence (CQ) and the diversity climate scale were used to measure the study variables. Multivariate statistics, including the analysis of multivariate analysis of variance (MANCOVA) and structural equation modeling (SEM), were employed to examine the relationships between the study variables. The preliminary analyses of data showed that principals and teachers have differing views of diversity management and climate in schools. Findings also showed that principals’ cultural intelligence has both direct and moderating influences on teachers’ perceived diversity climate. The study findings are expected to inform policymakers and practicing educational leaders in addressing diversity management in a country where the majority of the residents are the minority who have diverse ethnic and cultural backgrounds.

Keywords: diversity management, united arab emirates, school principals’ cultural intelligence (CQ), teachers’ perceived diversity climate

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Authors: Pratheeba Subramanian, Anjula Gurtoo, Mary Mathew

Abstract:

Transaction of patents in emerging patent markets is gaining momentum. Pricing patents for a transaction say patent sale remains a challenge. Patents vary in their pricing with some patents fetching higher prices than others. Sale of patents in portfolios further complicates pricing with multiple patents playing a role in pricing a bundle. In this paper, a set of 138 US patents sold individually as single invention lots and 462 US patents sold in bundles of 120 portfolios are investigated to understand the dynamics of selling prices of singletons and portfolios and their determinants. Firstly, price variations when patents are sold individually as singletons and portfolios are studied. Multivariate statistical techniques are used for analysis both at the lot level as well as at the individual patent level. The results show portfolios fetching higher prices than singletons at the lot level. However, at the individual patent level singletons show higher prices than per patent price of individual patent members within the portfolio. Secondly, to understand the price determinants, the effect of patent, seller, and bundling related characteristics on selling prices is studied separately for singletons and portfolios. The results show differences in the set of characteristics determining prices of singletons and portfolios. Selling prices of singletons are found to be dependent on the patent related characteristics, unlike portfolios whose prices are found to be dependent on all three aspects – patent, seller, and bundling. The specific patent, seller and bundling characteristics influencing selling price are discussed along with the implications.

Keywords: auction, patents, portfolio bundling, seller type, selling price, singleton

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Authors: Yuvraj Singh Dangi, Brajesh Kumar Tiwari, Ashok Kumar Jain, Kamta Prasad Namdeo

Abstract:

The potential use of liposomes as drug carriers by i.v. injection is limited by their low stability in blood stream. Firstly, phospholipid exchange and transfer to lipoproteins, mainly HDL destabilizes and disintegrates liposomes with subsequent loss of content. To avoid the pain associated with injection and to obtain better patient compliance studies concerning various dosage forms, have been developed. Conventional liposomes (unilamellar and multilamellar) have certain drawbacks like low entrapment efficiency, stability and release of drug after single breach in external membrane, have led to the new type of liposomal systems. The challenge has been successfully met in the form of Double Liposomes (DL). DL is a recently developed type of liposome, consisting of smaller liposomes enveloped in lipid bilayers. The outer lipid layer of DL can protect inner liposomes against various enzymes, therefore DL was thought to be more effective than ordinary liposomes. This concept was also supported by in vitro release characteristics i.e. DL formation inhibited the release of drugs encapsulated in inner liposomes. DL consists of several small liposomes encapsulated in large liposomes, i.e., multivesicular vesicles (MVV), therefore, DL should be discriminated from ordinary classification of multilamellar vesicles (MLV), large unilamellar vesicles (LUV), small unilamellar vesicles (SUV). However, for these liposomes, the volume of inner phase is small and loading volume of water-soluble drugs is low. In the present study, the potential of phosphatidylethanolamine (PE) lipid anchored double liposomes (DL) to incorporate two drugs in a single system is exploited as a tool to augment the H. pylori eradication rate. Preparation of DL involves two steps, first formation of primary (inner) liposomes by thin film hydration method containing one drug, then addition of suspension of inner liposomes on thin film of lipid containing the other drug. The success of formation of DL was characterized by optical and transmission electron microscopy. Quantitation of DL-bacterial interaction was evaluated in terms of percent growth inhibition (%GI) on reference strain of H. pylori ATCC 26695. To confirm specific binding efficacy of DL to H. pylori PE surface receptor we performed an agglutination assay. Agglutination in DL treated H. pylori suspension suggested selectivity of DL towards the PE surface receptor of H. pylori. Monotherapy is generally not recommended for treatment of a H. pylori infection due to the danger of development of resistance and unacceptably low eradication rates. Therefore, combination therapy with amoxicillin trihydrate (AMOX) as anti-H. pylori agent and ranitidine bismuth citrate (RBC) as antisecretory agent were selected for the study with an expectation that this dual-drug delivery approach will exert acceptable anti-H. pylori activity.

Keywords: Helicobacter pylorI, amoxicillin trihydrate, Ranitidine Bismuth citrate, phosphatidylethanolamine, multi vesicular systems

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Authors: Vivek Mahadev, Manoj Kumar, Neelu Mathur, Brahm Dutt Pandey

Abstract:

Perimeter guarding and protection of critical installations require prompt intrusion detection and assessment to take effective countermeasures. Currently, visual and electronic surveillance are the primary methods used for perimeter guarding. These methods can be costly and complicated, requiring careful planning according to the location and terrain. Moreover, these methods often struggle to detect stealthy and camouflaged insurgents. The object of the present work is to devise a surveillance technique using seismic sensors that overcomes the limitations of existing systems. The aim is to improve intrusion detection, assessment, and characterization by utilizing seismic sensors. Most of the similar systems have only two types of intrusion detection capability viz., human or vehicle. In our work we could even categorize further to identify types of intrusion activity such as walking, running, group walking, fence jumping, tunnel digging and vehicular movements. A virtual fence of 60 meters at GCNEP, Bahadurgarh, Haryana, India, was created by installing four underground geophones at a distance of 15 meters each. The signals received from these geophones are then processed to find unique seismic signatures called features. Various feature optimization and selection methodologies, such as LightGBM, Boruta, Random Forest, Logistics, Recursive Feature Elimination, Chi-2 and Pearson Ratio were used to identify the best features for training the machine learning models. The trained models were developed using algorithms such as supervised support vector machine (SVM) classifier, kNN, Decision Tree, Logistic Regression, Naïve Bayes, and Artificial Neural Networks. These models were then used to predict the category of events, employing weighted ensemble voting to analyze and combine their results. The models were trained with 1940 training events and results were evaluated with 831 test events. It was observed that using the weighted ensemble voting increased the efficiency of predictions. In this study we successfully developed and deployed the virtual fence using geophones. Since these sensors are passive, do not radiate any energy and are installed underground, it is impossible for intruders to locate and nullify them. Their flexibility, quick and easy installation, low costs, hidden deployment and unattended surveillance make such systems especially suitable for critical installations and remote facilities with difficult terrain. This work demonstrates the potential of utilizing seismic sensors for creating better perimeter guarding and protection systems using multiple machine learning models in weighted ensemble voting. In this study the virtual fence achieved an intruder detection efficiency of over 97%.

Keywords: geophone, seismic perimeter surveillance, machine learning, weighted ensemble method

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Authors: Chrysthia Papacleovoulou

Abstract:

The era of de-regulation, off-shore and tax haven jurisdictions, and shelf companies has come to an end. The usage of complex corporate structures involving trust instruments, special purpose vehicles, holding-subsidiaries in offshore haven jurisdictions, and taking advantage of tax treaties is soaring. States which raced to introduce corporate friendly legislation, tax incentives, and creative international trust law in order to attract greater FDI are now faced with regulatory challenges and are forced to revisit the corporate form and its tax treatment. The fiduciary services industry, which dominated over the last 3 decades, is now striving to keep up with the new regulatory framework as a result of a number of European and international legislative measures. This article considers the challenges to the company and the corporate form as a result of the legislative measures on tax planning and tax avoidance, CRS reporting, FATCA, CFC rules, OECD’s BEPS, the EU Commission's new transparency rules for intermediaries that extends to tax advisors, accountants, banks & lawyers who design and promote tax planning schemes for their clients, new EU rules to block artificial tax arrangements and new transparency requirements for financial accounts, tax rulings and multinationals activities (DAC 6), G20's decision for a global 15% minimum corporate tax and banking regulation. As a result, states are found in a race of over-regulation and compliance. These legislative measures constitute a global up-side down tax-harmonisation. Through the adoption of the OECD’s BEPS, states agreed to an international collaboration to end tax avoidance and reform international taxation rules. Whilst the idea was to ensure that multinationals would pay their fair share of tax everywhere they operate, an indirect result of the aforementioned regulatory measures was to attack private clients-individuals who -over the past 3 decades- used the international tax system and jurisdictions such as Marshal Islands, Cayman Islands, British Virgin Islands, Bermuda, Seychelles, St. Vincent, Jersey, Guernsey, Liechtenstein, Monaco, Cyprus, and Malta, to name but a few, to engage in legitimate tax planning and tax avoidance. Companies can no longer maintain bank accounts without satisfying the real substance test. States override the incorporation doctrine theory and apply a real seat or real substance test in taxing companies and their activities, targeting even the beneficial owners personally with tax liability. Tax authorities in civil law jurisdictions lift the corporate veil through the public registries of UBO Registries and Trust Registries. As a result, the corporate form and the doctrine of limited liability are challenged in their core. Lastly, this article identifies the development of new instruments, such as funds and private placement insurance policies, and the trend of digital nomad workers. The baffling question is whether industry and states can meet somewhere in the middle and exit this over-regulation frenzy.

Keywords: company, regulation, TAX, corporate structure, trust vehicles, real seat

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Authors: G. S. Ayyappan, Srinivas Kota, Jaffer R. C. Sheriff, C. Prakash Chandra Joshua

Abstract:

In the present scenario of energy crises, energy conservation in the electrical machines is very important in the industries. In order to conserve energy, one needs to monitor the performance of an induction motor on-site and in-situ. The instruments available for this purpose are very meager and very expensive. This paper deals with the design and development of induction motor performance analyser on-line, on-site, and in-situ. The system measures only few electrical input parameters like input voltage, line current, power factor, frequency, powers, and motor shaft speed. These measured data are coupled to name plate details and compute the operating efficiency of induction motor. This system employs the method of computing motor losses with the help of equivalent circuit parameters. The equivalent circuit parameters of the concerned motor are estimated using the developed algorithm at any load conditions and stored in the system memory. The developed instrument is a reliable, accurate, compact, rugged, and cost-effective one. This portable instrument could be used as a handy tool to study the performance of both slip ring and cage induction motors. During the analysis, the data can be stored in SD Memory card and one can perform various analyses like load vs. efficiency, torque vs. speed characteristics, etc. With the help of the developed instrument, one can operate the motor around its Best Operating Point (BOP). Continuous monitoring of the motor efficiency could lead to Life Cycle Assessment (LCA) of motors. LCA helps in taking decisions on motor replacement or retaining or refurbishment.

Keywords: energy conservation, equivalent circuit parameters, induction motor efficiency, life cycle assessment, motor performance analysis

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Authors: Nada Azhar

Abstract:

The aim of the paper is to investigate the effect of corporate social responsibility (CSR) CSR on the National Commercial Bank (NCB) in Saudi Arabia. In order to achieve this, a case study was made of the CSR activities of this bank from the perspective of its branch managers. The NCB was chosen as it was one of the first Saudi banks to engage in CSR and currently has a wide range of CSR initiatives. A qualitative research method was used. Open-ended questionnaires were administered to eighty branch managers of the NCB, with fifty-five usable questionnaires returned and twenty managers were interviewed as part of the primary research. Data from both questionnaires and interviews were analysed using qualitative content analysis. Six themes emerged from the questionnaire findings were used to develop the interview questions. These themes are the following: Awareness of employees about CSR in the NCB; CSR activities as a type of investment; Government and media support; Increased employee loyalty in the NCB; Prestige and profit to the NCB; and View of CSR in Islam. This paper makes a theoretical contribution in that it investigates and increases understanding of the effect of CSR on the NCB in Saudi Arabia. In addition, it makes a practical contribution by making recommendations which can support the development of CSR in the NCB. A limitation of the paper is that it is a case study of only one bank. It is therefore recommended that future research could be conducted with other banks in Saudi Arabia, or indeed, with a range of other types of firm within the financial services area in Saudi Arabia. In this way, the same issues could be explored but with a greater potential generalisability of findings of CSR within the Saudi Arabian financial services industry. In addition, this paper takes a qualitative approach and it is suggested that future research be carried out using mixed methods, which could provide a greater depth of analysis.

Keywords: branch managers, corporate social responsibility, national commercial bank, Saudi Arabia

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Authors: Rishabh Hans, Saksham Sharma

Abstract:

Drying of a sessile droplet imbibed with colloidal solution is a complex process in many aspects. Till now, most of the work revolves around; conditions for buckling onset, post-buckling effects, nature of change of droplet shape etc. In this work, we are determining the shape of daughter cavity (DC) formed during post-buckling onset, a less explored stage, and its relationship with experimental parameters. We have introduced solid angle as a special parameter that can quantify the shape of DC at any instant. It facilitates us to compare the shape while experimenting across different substrate types, droplet sizes and particle concentration. Furthermore, the angular location of ‘weak spot’ on the periphery of droplet, which marks the initiation of cavity growth, varies in different conditions. To solve this problem, we have evaluated the deflection angle of weak spots w.r.t. the vertical axis going through the middle of droplet. Subsequently, the solid angle subtended by DC is analyzed about that inclined axis. Finally, results of analysis allude that increasing colloidal concentration has inverse effect on the growth rate of cavity’s shape. Moreover, the cap radius of DC is observed lower for high PLR which makes the capillary pressure higher and thus tougher to expedite cavity formation relatively. This analysis can be helpful in further studies to relate the shape, deflection angle, growth rate of daughter cavity to the type of droplet crust formed in the end. Examining DC stage shall add another layer to nano-colloidal research which aims to influence many industrial applications like patterning, coatings, drug delivery, food processing etc.

Keywords: buckling of sessile droplets, daughter cavity, droplet evaporation, nanoporous shell formation, solid angle

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Authors: S. Rozhkova, O. Rozhkova, A. Harlova, V. Lasukov

Abstract:

For optimal unbiased filter as mean-square and in the case of functioning anomalous noises in the observation memory channel, we have proved insensitivity of filter to inaccurate knowledge of the anomalous noise intensity matrix and its equivalence to truncated filter plotted only by non anomalous components of an observation vector.

Keywords: mathematical expectation, filtration, anomalous noise, memory

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Authors: R. Al-Dujele, K. A. Cashell

Abstract:

A tubular flange girder is an I-shaped steel girder with either one of both of the usual flat flange plates replaced with a hollow section. Typically, these hollow sections are either rectangular or circular in shape. Concrete filled tubular flange girders (CFTFGs) are unconventional I-shaped beams that use a hollow structural section as the top flange which is filled with concrete. The resulting section offers very high lateral torsional buckling strength and stiffness compared with conventional steel I-beams of similar depth, width and weight, typically leading to a reduction in lateral bracing requirements. This paper is focussed on investigating the ultimate capacity of concrete filled rectangular tubular flange girders (CFRTFGs). These are complex members and their behaviour is governed by a number of inter-related parameters. The FE model is developed using ABAQUS software, 3-D finite element (FE) model for simply supported CFRTFGs subjected to two point loads applied at the third-span points is built. An initial geometrical imperfection of (L/1000), as well as geometrical and material nonlinearities, are introduced into the model, where L denotes the span of the girder. In this numerical model, the concrete and steel materials are modelled using eight-node solid and four-node shell elements, respectively. In addition to the FE model, simplified analytical expressions for the flexural capacity are also proposed, and the results are compared to those from the FE analyses. The analytical expressions, which are suitable for design, are also shown to be capable of providing an accurate depiction of the bending moment capacity.

Keywords: concrete-filled rectangular tubular flange girders, ultimate capacity, confining effect, finite element analysis

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Authors: Victor Kang, Sirene Bellahnid, Amy Al-Simaani

Abstract:

Efficient documentation and completion of clerical tasks are pillars of efficient patient-centered care in acute settings such as the emergency department (ED). Medical scribes aid physicians with documentation, navigation of electronic health records, results gathering, and communication coordination with other healthcare teams. However, the use of medical scribes is not widespread, with some hospitals even continuing to discontinue their programs. One reason for this could be the lack of studies that have outlined concrete improvements in efficiency and patient and provider satisfaction in emergency departments before and after incorporating scribes. Methods: We conducted a review of the literature concerning the implementation of a medical scribe program and emergency department performance. For this review, a narrative synthesis accompanied by textual commentaries was chosen to present the selected papers. PubMed was searched exclusively. Initially, no date limits were set, but seeing as the electronic medical record was officially implemented in Canada in 2013, studies published after this date were preferred as they provided insight into the interplay between its implementation and scribes on quality improvement. Results: Throughput, efficiency, and cost-effectiveness were the most commonly used parameters in evaluating scribes in the Emergency Department. Important throughput metrics, specifically door-to-doctor and disposition time, were significantly decreased in emergency departments that utilized scribes. Of note, this was shown to be the case in community hospitals, where the burden of documentation and clerical tasks would fall directly upon the attending physician. Academic centers differ in that they rely heavily on residents and students; so the implementation of scribes has been shown to have limited effect on these metrics. However, unique to academic centers was the provider’s perception of incrased time for teaching was unique to academic centers. Consequently, providers express increased work satisfaction in relation to time spent with patients and in teaching. Patients, on the other hand, did not demonstrate a decrease in satisfaction in regards to the care that was provided, but there was no significant increase observed either. Of the studies we reviewed, one of the biggest limitations was the lack of significance in the data. While many individual studies reported that medical scribes in emergency rooms improved relative value units, patient satisfaction, provider satisfaction, and increased number of patients seen, there was no statistically significant improvement in the above criteria when compiled in a systematic review. There is also a clear publication bias; very few studies with negative results were published. To prove significance, data from more emergency rooms with scribe programs would need to be compiled which also includes emergency rooms who did not report noticeable benefits. Furthermore, most data sets focused only on scribes in academic centers. Conclusion: Ultimately, the literature suggests that while emergency room physicians who have access to medical scribes report higher satisfaction due to lower clerical burdens and can see more patients per shift, there is still variability in terms of patient and provider satisfaction. Whether or not this variability exists due to differences in training (in-house trainees versus contractors), population profile (adult versus pediatric), setting (academic versus community), or which shifts scribe work cannot be determined based on the studies that exist. Ultimately, more scribe programs need to be evaluated to determine whether these variables affect outcomes and prove whether scribes significantly improve emergency room efficiency.

Keywords: emergency medicine, medical scribe, scribe, documentation

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Authors: Sonia Butalia, Huong Luu, Alexis Guigue, Karen J. B. Martins, Khanh Vu, Scott W. Klarenbach

Abstract:

Obesity-related health conditions impose a substantial economic burden on payers due to increased healthcare use. Estimates of healthcare resource use and costs associated with obesity-related comorbidities are needed to inform policies and interventions targeting these conditions. Methods: Adults living with obesity were identified (a procedure-related body mass index code for class 2/3 obesity between 2012 and 2019 in Alberta, Canada; excluding those with bariatric surgery), and outcomes were compared over 1-year (2019/2020) between those who had and did not have specific obesity-related comorbidities. The probability of using a healthcare service (based on the odds ratio of a zero [OR-zero] cost) was compared; 95% confidence intervals (CI) were reported. Logistic regression and a generalized linear model with log link and gamma distribution were used for total healthcare cost comparisons ($CDN); cost ratios and estimated cost differences (95% CI) were reported. Potential socio-demographic and clinical confounders were adjusted for, and incremental cost differences were representative of a referent case. Results: A total of 220,190 adults living with obesity were included; 44% had hypertension, 25% had osteoarthritis, 24% had type-2 diabetes, 17% had cardiovascular disease, 12% had insulin resistance, 9% had chronic back pain, and 4% of females had polycystic ovarian syndrome (PCOS). The probability of hospitalization, ED visit, and ambulatory care was higher in those with a following obesity-related comorbidity versus those without: chronic back pain (hospitalization: 1.8-times [OR-zero: 0.57 [0.55/0.59]] / ED visit: 1.9-times [OR-zero: 0.54 [0.53/0.56]] / ambulatory care visit: 2.4-times [OR-zero: 0.41 [0.40/0.43]]), cardiovascular disease (2.7-times [OR-zero: 0.37 [0.36/0.38]] / 1.9-times [OR-zero: 0.52 [0.51/0.53]] / 2.8-times [OR-zero: 0.36 [0.35/0.36]]), osteoarthritis (2.0-times [OR-zero: 0.51 [0.50/0.53]] / 1.4-times [OR-zero: 0.74 [0.73/0.76]] / 2.5-times [OR-zero: 0.40 [0.40/0.41]]), type-2 diabetes (1.9-times [OR-zero: 0.54 [0.52/0.55]] / 1.4-times [OR-zero: 0.72 [0.70/0.73]] / 2.1-times [OR-zero: 0.47 [0.46/0.47]]), hypertension (1.8-times [OR-zero: 0.56 [0.54/0.57]] / 1.3-times [OR-zero: 0.79 [0.77/0.80]] / 2.2-times [OR-zero: 0.46 [0.45/0.47]]), PCOS (not significant / 1.2-times [OR-zero: 0.83 [0.79/0.88]] / not significant), and insulin resistance (1.1-times [OR-zero: 0.88 [0.84/0.91]] / 1.1-times [OR-zero: 0.92 [0.89/0.94]] / 1.8-times [OR-zero: 0.56 [0.54/0.57]]). After fully adjusting for potential confounders, the total healthcare cost ratio was higher in those with a following obesity-related comorbidity versus those without: chronic back pain (1.54-times [1.51/1.56]), cardiovascular disease (1.45-times [1.43/1.47]), osteoarthritis (1.36-times [1.35/1.38]), type-2 diabetes (1.30-times [1.28/1.31]), hypertension (1.27-times [1.26/1.28]), PCOS (1.08-times [1.05/1.11]), and insulin resistance (1.03-times [1.01/1.04]). Conclusions: Adults with obesity who have specific disease-related health conditions have a higher probability of healthcare use and incur greater costs than those without specific comorbidities; incremental costs are larger when other obesity-related health conditions are not adjusted for. In a specific referent case, hypertension was costliest (44% had this condition with an additional annual cost of $715 [$678/$753]). If these findings hold for the Canadian population, hypertension in persons with obesity represents an estimated additional annual healthcare cost of $2.5 billion among adults living with obesity (based on an adult obesity rate of 26%). Results of this study can inform decision making on investment in interventions that are effective in treating obesity and its complications.

Keywords: administrative data, healthcare cost, obesity-related comorbidities, real world evidence

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