Search results for: information security systems

Authors: Vaibhav Rathi, Soumen Maity, Achu R. Sekhar, Abhijit Banerjee

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Construction sector in India is extremely resource and carbon intensive. It contributes to significantly to national greenhouse emissions. At the resource end the industry consumes significant portions of the output from mining. Resources such as sand and soil are most exploited and their rampant extraction is becoming constant source of impact on environment and society. Cement is another resource that is used in abundance in building and construction and has a direct impact on limestone resources. Though India is rich in cement grade limestone resource, efforts have to be made for sustainable consumption of this resource to ensure future availability. Use of these resources in high volumes in India is a result of rapid urbanization. More cities have grown to a population of million plus in the last decade and million plus cities are growing further. To cater to needs of growing urban population of construction activities are inevitable in the coming future thereby increasing material consumption. Increased construction will also lead to substantial increase in end of life waste generation from Construction and Demolition (C&D). Therefore proper management of C&D waste has the potential to reduce environmental pollution as well as contribute to the resource efficiency in the construction sector. The present study deals with estimation, characterisation and documenting current management practices of C&D waste in 10 Indian cities of different geographies and classes. Based on primary data the study draws conclusions on the potential of C&D waste to be used as an alternative to primary raw materials. The estimation results show that India generates 716 million tons of C&D waste annually, placing the country as second largest C&D waste generator in the world after China. The study also aimed at utilization of C&D waste in to building materials. The waste samples collected from various cities have been used to replace 100% stone aggregates in paver blocks without any decrease in strength. However, management practices of C&D waste in cities still remains poor instead of notification of rules and regulations notified for C&D waste management. Only a few cities have managed to install processing plant and set up management systems for C&D waste. Therefore there is immense opportunity for management and reuse of C&D waste in Indian cities.

Keywords: building materials, construction and demolition waste, cities, environmental pollution, resource efficiency

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Authors: Binod C. Agrawal

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In modern history, industrial and media merchandising in South Asia from East Asia, Europe, United States and other countries of the West is over 200 years old. Hence, continued external technology and media exposure is not a new experience in multi-lingual and multi religious South Asia which evolved cultural means to withstand structural change. In the post-World War II phase, media exposure especially of telecommunication, film, Internet, radio, print media and television have increased manifold. South Asia did not lose any time in acquiring and adopting digital media accelerated by chip revolution, computer and satellite communication. The penetration of digital media and utilization are exceptionally high though the spread has an unequal intensity, use and effects. The author argues that industrial and media products are “cultural products” apart from being “technological products”; hence their influences are most felt in the cultural domain which may lead to blunting of unique cultural specifics in the multi-cultural, multi-lingual and multi religious South Asia. Social scientists, political leaders and parents have voiced concern of “Cultural domination”, “Digital media colonization” and “Westernization”. Increased digital media access has also opened up doors of pornography and other harmful information that have sparked fresh debates and discussions about serious negative, harmful, and undesirable social effects especially among youth. Within ‘techno-social’ perspective, based on recent research studies, the paper aims to describe and analyse possible socio-economic change due to digital media penetration. Further, analysis supports the view that the ancient multi-lingual and multi-religious cultures of South Asia due to inner cultural strength may sustain without setting in a process of irreversible structural changes in South Asia.

Keywords: cultural sustainability, digital media effects, digital media impact in South Asia, social change in South Asia

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Authors: Mary Kiviiri Nakawuka, Mary Namugalu, Andrew Otiti

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BACKGROUND Cervical cancer is the fourth most common cancer in women and seventh overall among all cancers worldwide. It accounts for about 7.5% of all female-cancer deaths with 85% occurring in low and middle-income countries and the first most common female cancer in women aged 15 to 44 years in Uganda with an annual number of new cases at 3,915 and 2,275 annual number of cervical cancer deaths in 2012 (ICO INFORMATION CENTRE ON HPV AND CANCER, 2017).Despite the available free cervical cancer screening services whose uptake has been documented to improve the chances of successful treatment of pre-cancers and cancers among women of reproductive age, there is a low uptake of these services thus we sought to examine the uptake of cervical cancer services and associated factors among women of reproductive age (25-49) attending the ART clinic of KISWA HCII in Kampala, Uganda METHODS The research was carried out in the ART clinic of KISWA HCII among 385 participants. An analytical, cross-sectional study with quantitative methods of data collection was used. The study adopted a non-probability convenience sampling method to select participants. Quantitative data was collected through structured questionnaires. RESULTS 72.2% of the participants were found to have been screened for cervical cancer. 36 % of the screened women had a positive HPV or VIA result ,59.2% of the screened women had a negative HPV or VIA result and 4.8% had an invalid HPV test result. Only 39.5% of the participants had adequate overall knowledge about cervical cancer, more than a third of the participants (50%) had moderate or low knowledge and minority of them (10.5%) had no knowledge. There was no significant association between the uptake of cervical cancer screening services among participants and their socio-demographic characteristics. CONCLUSIONS Although majority of the women surveyed had been screened for cervical cancer, a comparatively large number of participants had inadequate knowledge about cervical cancer and therefore there is still need to continue teaching about cervical cancer and this may include education campaigns, improvements to the accessibility and convenience of the screening services.

Keywords: cervical cancer uptake, cervical cancer screening, women of reproductive age., cervical cancer knowledge

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Authors: Lara Dutil-Fafard, Caroline Rhéaume, Patrick Archambault, Daniel Lafond, Neal W. Pollock

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Improving resources for medical autonomy of astronauts in prolonged space missions, such as a Mars mission, requires not only technology development, but also decision-making support systems. The Advanced Crew Medical System - Medical Condition Requirements study, funded by the Canadian Space Agency, aimed to create knowledge content and a scenario-based query capability to support medical autonomy of astronauts. The key objective of this study was to create a prototype tool for identifying medical infrastructure requirements in terms of medical knowledge, skills and materials. A multicriteria decision-making method was used to prioritize the highest risk medical events anticipated in a long-term space mission. Starting with those medical conditions, event sequence diagrams (ESDs) were created in the form of decision trees where the entry point is the diagnosis and the end points are the predicted outcomes (full recovery, partial recovery, or death/severe incapacitation). The ESD formalism was adapted to characterize and compare possible outcomes of medical conditions as a function of available medical knowledge, skills, and supplies in a given mission scenario. An extensive literature review was performed and summarized in a medical condition database. A PostgreSQL relational database was created to allow query-based evaluation of health outcome metrics with different medical infrastructure scenarios. Critical decision points, skill and medical supply requirements, and probable health outcomes were compared across chosen scenarios. The three medical conditions with the highest risk rank were acute coronary syndrome, sepsis, and stroke. Our efforts demonstrate the utility of this approach and provide insight into the effort required to develop appropriate content for the range of medical conditions that may arise.

Keywords: decision support system, event-sequence diagram, exploration mission, medical autonomy, scenario-based queries, space medicine

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Authors: J. DeBoard, R. Dietrich, J. Hughes, K. Yurko, G. Harms

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Alzheimer’s disease (AD) is a predominant type of dementia and is likely a major cause of neural network impairment. The pathogenesis of this neurodegenerative disorder has yet to be fully elucidated. There are currently no known cures for the disease, and the best hope is to be able to detect it early enough to impede its progress. Beyond age and genetics, another prevalent risk factor for AD might be traumatic brain injury (TBI), which has similar neurodegenerative hallmarks. Our research focuses on obtaining information and methods to be able to predict when neurodegenerative effects might occur at a clinical level by observation of events at a cellular and molecular level in model mice. First, we wish to introduce our evidence that brain damage can be observed via brain imaging prior to the noticeable loss of neuromuscular control in model mice of AD. We then show our evidence that some blood biomarkers might be able to be early predictors of AD in the same model mice. Thus, we were interested to see if we might be able to predict which mice might show long-term neurodegenerative effects due to differing degrees of TBI and what level of TBI causes further damage and earlier death to the AD model mice. Upon application of TBIs via an apparatus to effectively induce extremely mild to mild TBIs, wild-type (WT) mice and AD mouse models were tested for cognition, neuromuscular control, olfactory ability, blood biomarkers, and brain imaging. Experiments are currently still in process, and more results are therefore forthcoming. Preliminary data suggest that neuromotor control diminishes as well as olfactory function for both AD and WT mice after the administration of five consecutive mild TBIs. Also, seizure activity increases significantly for both AD and WT after the administration of the five TBI treatment. If future data supports these findings, important implications about the effect of TBI on those at risk for AD might be possible.

Keywords: Alzheimer's disease, blood biomarker, neurodegeneration, neuromuscular control, olfaction, traumatic brain injury

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Authors: Denise Levy, Helen J. Khoury

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Nuclear technology is a controversial issue among a great share of the Brazilian population. Misinformation and common wrong beliefs confuse public’s perceptions and the scientific community is expected to offer a wider perspective on the benefits and risks resulting from ionizing radiation in everyday life. Attentive to the need of new approaches between science and society, the Nuclear Energy Museum, in northeast Brazil, is an initiative created to communicate the growing impact of the beneficial applications of nuclear technology in medicine, industry, agriculture and electric power generation. Providing accessible scientific information, the museum offers a rich learning environment, making use of different educational strategies, such as films, interactive panels and multimedia learning tools, which not only increase the enjoyment of visitors, but also maximize their learning potential. Developed according to modern active learning instructional strategies, multimedia materials are designed to present the increasingly role of nuclear science in modern life, transforming science education into a meaningful learning experience. In year 2016, nine different interactive computer-based activities were developed, presenting curiosities about ionizing radiation in different landmarks around the world, such as radiocarbon dating works in Egypt, nuclear power generation in France and X-radiography of famous paintings in Italy. Feedback surveys have reported a high level of visitors’ satisfaction, proving the high quality experience in learning nuclear science at the museum. The Nuclear Energy Museum is the first and, up to the present time, the only permanent museum in Brazil devoted entirely to nuclear science.

Keywords: nuclear technology, multimedia learning tools, science museum, society and education

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Authors: Raul Chavez Jr.

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Green roof's body of knowledge appears to be in its infancy stage in the Philippines. To contribute to its development, this study intends to answer the question: Does the existing green roof in Metro Manila perform well in providing thermal comfort and satisfaction to users? Relatively, this study focuses on thermal sensation and satisfaction of users, surface temperature comparison, weather data comparison of the site (Sky Garden) and local weather station (PAG-ASA), and its thermal resistance capacity. Initially, the researcher conducted a point-in-time survey in parallel with weather data gathering from PAG-ASA and Sky Garden. In line with these, ambient and surface temperature are conducted through the use of a digital anemometer, with humidity and temperature, and non-contact infrared thermometer respectively. Furthermore, to determine the Sky Garden's overall thermal resistance, materials found on site were identified and tabulated based on specified locations. It revealed that the Sky Garden can be considered comfortable based from PMV-PPD Model of ASHRAE Standard 55 having similar results from thermal comfort and thermal satisfaction survey, which is contrary to the actual condition of the Sky Garden by means of a psychrometric chart which falls beyond the contextualized comfort zone. In addition, ground floor benefited the most in terms of lower average ambient temperature and humidity compared to the Sky Garden. Lastly, surface temperature data indicates that the green roof portion obtained the highest average temperature yet performed well in terms of heat resistance compared to other locations. These results provided the researcher valuable baseline information of the actual performance of a certain green roof in Metro Manila that could be vital in locally enhancing the system even further and for future studies.

Keywords: Green Roof, Thermal Analysis, Thermal Comfort, Thermal Performance

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Authors: Donato Vese

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According to the common interpretation, in a legal system, public powers are established by law. Exceptions are admitted in an emergency or particular relationship with public power. However, we currently agree that law allows public administration a margin of decision, even in the case of non-discretionary acts. Hence, the administrative decision not exclusively established by law becomes the rule in the ordinary state of things, non-only in state of exception. This paper aims to analyze and discuss different ideas on discretionary power on the Rule of Law and Rechtsstaat. Observing the legal literature in Europe and Nord and South America, discretionary power can be described as follow: it could be considered a margin that law accords to the executive power for political decisions or a choice between different interpretations of vague legal previsions. In essence, this explanation admits for the executive a decision not established by law or anyhow not exclusively established by law. This means that the discretionary power of public administration integrates the law. However, integrating law does not mean to decide according to the law, but it means to integrate law with a decision involving public power. Consequently, discretionary power is essentially free will. In this perspective, also the Rule of Law and the Rechtsstaat are notions explained differently. Recently, we can observe how the European notion of Rechtsstaat is founded on the formal validity of the law; therefore, for this notion, public authority’s decisions not regulated by law represent a problem. Thus, different systems of law integration have been proposed in legal literature, such as values, democracy, reasonableness, and so on. This paper aims to verify how, looking at those integration clauses from a logical viewpoint, integration based on the recourse to the legal system itself does not resolve the problem. The aforementioned integration clauses are legal rules that require hard work to explain the correct meaning of the law; in particular, they introduce dangerous criteria in favor of the political majority. A different notion of public power can be proposed. This notion includes two main features: (a) sovereignty belongs to persons and not the state, and (b) fundamental rights are not grounded but recognized by Constitutions. Hence, public power is a system based on fundamental rights. According to this approach, it can also be defined as the notion of public interest as concrete maximization of fundamental rights enjoyments. Like this, integration of the law, vague or subject to several interpretations, must be done by referring to the system of fundamental individual rights. We can think, for instance, to fundamental rights that are right in an objective view but not legal because not established by law.

Keywords: administrative discretion, free will, fundamental rights, public power, sovereignty

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Authors: Martin Hofmann, Diego Stutzer, Thomas Niederhauser, Juergen Burger

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Dental biofilm is the main etiologic factor for caries, periodontal and peri-implant infections. In addition to the risk of tooth loss, periodontitis is also associated with an increased risk of systemic diseases such as atherosclerotic cardiovascular disease and diabetes. For this reason, dental hygienists use ultrasonic scalers for prophylactic and periodontal care of the teeth. However, the current instruments are limited to their dimensions and operating frequencies. The innovative design of a planar ultrasonic transducer introduces a new type of dental scalers. The flat titanium-based design allows the mass to be significantly reduced compared to a conventional screw-mounted Langevin transducer, resulting in a more efficient and controllable scaler. For the development of the novel device, multi-physics finite element analysis was used to simulate and optimise various design concepts. This process was supported by prototyping and electromechanical characterisation. The feasibility and potential of a planar ultrasonic transducer have already been confirmed by our current prototypes, which achieve higher performance compared to commercial devices. Operating at the desired resonance frequency of 28 kHz with a driving voltage of 40 Vrms results in an in-plane tip oscillation with a displacement amplitude of up to 75 μm by having less than 8 % out-of-plane movement and an energy transformation factor of 1.07 μm/mA. In a further step, we will adapt the design to two additional resonance frequencies (20 and 40 kHz) to obtain information about the most suitable mode of operation. In addition to the already integrated characterization methods, we will evaluate the clinical efficiency of the different devices in an in vitro setup with an artificial biofilm pocket model.

Keywords: ultrasonic instrumentation, ultrasonic scaling, piezoelectric transducer, finite element simulation, dental biofilm, dental calculus

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Authors: Adeleye Johnson Adelagunayeja

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The concept of making cities, communities, and neighborhoods smart, intelligent, and responsive is relatively new to Africa and its urban renewal agencies. Efforts must be made by relevant agencies to begin a holistic review of the implementation of infrastructural facilities and urban renewal methodologies that will revolve around the appreciation and application of artificial intelligence. The propagation of the ideals and benefits of the smart city concept are key factors that can encourage governments of African nations, the African Union, and other regional organizations in Africa to embrace the ideology. The ability of this smart city concept to curb insecurities – armed robbery, assassination, terrorism, and civil disorder – is one major reason, amongst others, why African governments must speedily embrace this contemporary developmental concept whose time has come! The seamlessness to access information and virtually cross-pollinate ideas with people living in already established smart cities, when combined with the great efficiency that the emergence of smart cities brings with it, are other reasons why Africa must come up with action plans that can enable the existing cities to metamorphose into smart cities. Innovations will be required to enable Africa to develop a smart city concept that will be compatible with the basic patterns of livelihood because the essence of the smart city evolution is to make life better for people to co-exist, to be productive and to enjoy standard infrastructural facilities. This research paper enumerates the multifaceted adaptive factors that have the potentials of making the adoption of smartcity concept in Africa seamless. It also proffers solutions to potential bottlenecks capable of undermining the execution of the smart city concept in Africa.

Keywords: smartcity compactibility innovation Africa government evolution, Africa as global village member, evolution in Africa, ways to make Africa adopt smartcity, localizing smartcity concept in Africa, bottleneck to smartcity developmet in Africa

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Authors: Omur F. Karakullukcu, Bilal Okudan, Yusuf Can

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The aim of this study is to analyze sports managers’ managerial competence levels and job satisfaction’s correlation with career satisfaction. In the study, it has also been analyzed if there is any significant difference in sports managers’ managerial competence, job and career satisfaction in terms of gender, age, duty status, year of service and level of education. 256 sports managers, who work at department of sports service’s central and field organization at least as a chief in the manager position, have been chosen with random sampling method and they have voluntarily participated in the study. In the study, the managerial competence scale which was developed by Cetinkaya (2009), job satisfaction scale developed by Weiss at al.(1967) and Career Satisfaction Scale developed by Vatansever (2008) have been used as a data collection tool. The questionnaire form used as a data collection tool in the study includes a personal information form consisting of 5 questions; questioning gender, age, duty status, years of service and level of education. In the study, pearson correlation analysis has been used for defining the correlation of managerial competence levels, job satisfaction, and career satisfaction levels of sports managers. T-test analysis for binary grouping and anova analysis for more than binary groups have been used in the level of self-efficacy, collective and managerial competence in terms of the participants’ duty status, year of service and level of education. According to the research results, it has been found that there is a positive correlation between sports managers’ managerial competence levels, job satisfaction, and career satisfaction levels. Also, the results show that there is a significant difference in managerial competence levels, job satisfaction and career satisfaction of sports managers in terms of duty status, year of service and level of education; however, the results reveal that there is no significant difference in terms of age groups and gender.

Keywords: sports manager, managerial competence, job satisfaction, career satisfaction

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Authors: Emmanuelle Maria, Pierre Crançon, Gaëtane Lespes

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The knowledge of uranium migration processes within underground environments is a major issue in the environmental risk assessment associated with nuclear activities. This process is identified as strongly controlled by adsorption mechanisms, thus leading to strongly delayed migration paths. Colloidal ligands are likely to significantly increase the mobility of uranium in natural environments. The ability of colloids to mobilize and transport uranium depends on their origin, their nature, their structure, their stability and their reactivity with uranium. Thus, the colloidal mobilization and transport properties are often described as site-specific. In this work, the colloidal phases of two leachates obtained from two different horizons of the same podzolic soil were characterized with a speciation approach. For this purpose, a multi-technique strategy was used, based on Field-Flow Fractionation coupled to Ultraviolet, Multi-Angle Light Scattering and Inductively Coupled Plasma Mass Spectrometry (AF4-UV-MALS-ICPMS), Transmission Electron Microscopy (TEM), Electrospray Ionization Orbitrap Mass Spectrometry (ESI-Orbitrap), and Time-Resolved Laser Fluorescence Spectroscopy (TRLFS-EEM). Thus, elemental composition, size distribution, microscopic structure, colloidal stability and possible organic and/or inorganic content of colloids were determined, as well as their association with uranium. The leachates exhibit differences in their physical and chemical characteristics, mainly in the nature of organic matter constituents. The multi-technique investigation strategy used provides original data about colloidal phase structure and composition, offering a new vision of the way the uranium can be mobilized and transported in the considered soil. This information is a real significant contribution opening the way to our understanding and predicting of the colloidal transport.

Keywords: colloids, migration, multi-technique, speciation, transport, uranium

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Authors: Ahmad Haidar

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Modern economic systems are characterized by growing complexity, and addressing their challenges requires innovative approaches. This study examines the implications of artificial intelligence (AI) on unemployment in Europe from a macroeconomic perspective, employing data modeling techniques to understand the relationship between AI integration and labor market dynamics. To understand the AI-unemployment nexus comprehensively, this research considers factors such as sector-specific AI adoption, skill requirements, workforce demographics, and geographical disparities. The study utilizes a panel data model, incorporating data from European countries over the last two decades, to explore the potential short-term and long-term effects of AI implementation on unemployment rates. In addition to investigating the direct impact of AI on unemployment, the study also delves into the potential indirect effects and spillover consequences. It considers how AI-driven productivity improvements and cost reductions might influence economic growth and, in turn, labor market outcomes. Furthermore, it assesses the potential for AI-induced changes in industrial structures to affect job displacement and creation. The research also highlights the importance of policy responses in mitigating potential negative consequences of AI adoption on unemployment. It emphasizes the need for targeted interventions such as skill development programs, labor market regulations, and social safety nets to enable a smooth transition for workers affected by AI-related job displacement. Additionally, the study explores the potential role of AI in informing and transforming policy-making to ensure more effective and agile responses to labor market challenges. In conclusion, this study provides a comprehensive analysis of the macroeconomic implications of AI on unemployment in Europe, highlighting the importance of understanding the nuanced relationships between AI adoption, economic growth, and labor market outcomes. By shedding light on these relationships, the study contributes valuable insights for policymakers, educators, and researchers, enabling them to make informed decisions in navigating the complex landscape of AI-driven economic transformation.

Keywords: artificial intelligence, unemployment, macroeconomic analysis, european labor market

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Authors: Deniz Ünal Özpalamutcu, Burcu Altman

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Actuaria uses mathematics, statistic and financial information when analyzing the financial impacts of uncertainties, risks, insurance and pension related issues. In other words, it deals with the likelihood of potential risks, their financial impacts and especially the financial measures. Handling these measures require some long-term payment and investments. So, it is obvious it is inevitable to plan the periodic payments with equal time intervals considering also the changing value of money over time. These series of payment made specific intervals of time is called annuity or rant. In literature, rants are classified based on start and end dates, start times, payments times, payments amount or frequency. Classification of rants based on payment amounts changes based on the constant, descending or ascending payment methods. The literature about handling the annuity is very limited. Yet in a daily life, especially in today’s world where the economic issues gained a prominence, it is very crucial to use the variable annuity method in line with the demands of the customers. In this study, the types of annuities with flexible payment are discussed. In other words, we focus on calculating payment amount of a period by adding a certain percentage of previous period payment was studied. While studying this problem, formulas were created considering both start and end period payments for cash value and accumulated. Also increase of each period payment by r interest rate each period payments calculated with previous periods increases. And the problem of annuities (rants) of which each period payment increased with previous periods’ increase by r interest rate has been analyzed. Cash value and accumulated value calculation of this problem were studied separately based on the period start/end and their relations were expressed by formulas.

Keywords: actuaria, annuity, flexible payment, rant

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Authors: Francisco Miroslav Ulloa-Stanojlovic, Gina Polo, Ricardo Augusto Dias

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In Brazil, there is a high incidence of rabies in herbivores of economic interest (HEI) transmitted by the common vampire bat Desmodus rotundus, the presence of human rabies cases and the huge economic losses in the world's largest cattle industry, it is important to assist the National Program for Control of Rabies in herbivores in Brazil, that aims to reduce the incidence of rabies in HEI populations, mainly through epidemiological surveillance, vaccination of herbivores and control of vampire-bat roosts. Material and Methods: A spatiotemporal retrospective Kulldorff's spatial scan statistic based on a Poisson model and Monte Carlo simulation and an Anselin's Local Moran's I statistic were used to uncover spatial clustering of HEI rabies from 2000 – 2014. Results: Were identify three important clusters with significant year-to-year variation (Figure 1). In 2000, was identified one area of clustering in the North region, specifically in the State of Tocantins. Between the year 2000 and 2004, a cluster centered in the Midwest and Southeast region including the States of Goiás, Minas Gerais, Rio de Janeiro, Espirito Santo and São Paulo was prominent. And finally between 2000 and 2005 was found an important cluster in the North, Midwest and South region. Conclusions: The HEI rabies is endemic in the country, in addition, appears to be significant differences among the States according to their surveillance services, that may be difficulting the control of the disease, also other factors could be influencing in the maintenance of this problem like the lack of information of vampire-bat roosts identification, and limited human resources for realization of field monitoring. A review of the program control by the authorities it’s necessary.

Keywords: Brazil, Desmodus rotundus, herbivores, rabies

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Authors: Gabrielle O'Donoghue

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Background: Pre-operative radiographs facilitate assessment and treatment planning in minor oral surgery. Quality assurance for dental radiography advocates the As Low As Reasonably Achievable (ALARA) principle in collecting accurate diagnostic information. Aims: To audit the quality of digital intraoral periapicals (IOPAs) taken prior to dental extractions in a metropolitan general dental practice setting. Standards: The National Radiological Protection Board (NRPB) guidance outlines three grades of radiograph quality: excellent (Grade 1 > 70% of total exposures), diagnostically acceptable (Grade 2 <20%), and unacceptable (Grade 3 <10%). Methodology: A study of pre-operative radiographs taken prior to dental extractions across 12 private general dental practices in a large metropolitan area by 44 practitioners. A total of 725 extractions were assessed, allowing 258 IOPAs to be reviewed in one audit cycle. Results: First cycle: Of 258 IOPAs: 223(86.4%) scored Grade 1, 27(10.5%) Grade 2, and 8(3.1%) Grade 3. The standard was met. 35 dental extractions were performed without an available pre-operative radiograph. Action Plan & Recommendations: Results were distributed to all staff and a continuous professional development evening organized to outline recommendations to improve image quality. A second audit cycle is proposed at a six-month interval to review the recommendations and appraise results. Conclusion: The overall standard of radiographs met the published guidelines. A significant improvement in the number of procedures undertaken without pre-operative imaging is expected at a six-month interval period. An investigation into undiagnostic imaging and associated adverse patient outcomes is being considered. Maintenance of the standards achieved is predicted in the second audit cycle to ensure consistent high quality imaging.

Keywords: audit, oral radiology, oral surgery, periapical radiographs, quality assurance

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Authors: Oleg Redkin, Olga Bernikova

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Globalization and migrations have made cross-cultural contacts more frequent and intensive. Sometimes, these contacts may lead to misunderstanding between partners of communication and misinterpretations of the verbal messages that some researchers tend to consider as the 'clash of civilizations'. In most cases, reasons for that may be found in cultural and linguistic differences and hence misinterpretations of intentions and behavior. The current research examines factors of verbal and non-verbal communication that should be taken into consideration in verbal and non-verbal contacts. Language is one of the most important manifestations of the cultural code, and it is often considered as one of the special features of a civilization. The Arabic language, in particular, is commonly associated with Islam and the language and the Arab-Muslim civilization. It is one of the most important markers of self-identification for more than 200 million of native speakers. Arabic is the language of the Quran and hence the symbol of religious affiliation for more than one billion Muslims around the globe. Adequate interpretation of Arabic texts requires profound knowledge of its grammar, semantics of its vocabulary. Communicating sides who belong to different cultural groups are guided by different models of behavior and hierarchy of values, besides that the vocabulary each of them uses in the dialogue may convey different semantic realities and vary in connotations. In this context direct, literal translation in most cases cannot adequately convey the original meaning of the original message. Besides that peculiarities and diversities of the extralinguistic information, such as the body language, communicative etiquette, cultural background and religious affiliations may make the dialogue even more difficult. It is very likely that the so called 'clash of civilizations' in most cases is due to misinterpretation of counterpart's means of discourse such as language, cultural codes, and models of behavior rather than lies in basic contradictions between partners of communication. In the process of communication, one has to rely on universal values rather than focus on cultural or religious peculiarities, to take into account current linguistic and extralinguistic context.

Keywords: Arabic, civilization, discourse, language, linguistic

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Authors: Yetunde M. Dairo, Johnny Collett, Helen Dawes

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Background and Aim: Engagement with physical activity (PA) research is poor among adults with intellectual disabilities (ID), particularly in those from residential homes. This study explored why, by asking managers of residential homes, adults with ID and their carers. Methods: Participants: A convenient sample of 23 individuals from two UK local authorities, including a group of ID residential home managers, adults with ID and their support staff. Procedures: A) Residential home managers (n=6) were asked questions about their willingness to allow their residents to participate in PA research; B) eleven adults with ID and their support workers (n=6) were asked questions about their willingness to accept 7-day accelerometer monitoring and/or the International Physical Activity Questionnaire-short version (IPAQ-s) as PA measures. The IPAQ-s was administered by the researcher and they were each provided with samples of accelerometers to try on. Results: A) Five out of six managers said that the burden of wearing the accelerometer for seven days would be too high for the people they support, the majority of whom might be unable to express their wishes. They also said they would be unwilling to act as proxy respondents for the same reason. Additionally, they cited time pressure, understaffing, and reluctance to spend time on the research paperwork as further reasons for non-participation. B) All 11 individuals with ID completed the IPAQ-s while only three accepted the accelerometer, one of whom was deemed inappropriate to wear it. Reasons for rejecting accelerometers included statements from participants of: ‘too expensive’, ‘too heavy’, ‘uncomfortable’, and two people said they would not want to wear it for more than one day. All adults with ID (11) and their support workers (6) provided information about their physical activity levels through the IPAQ-s. Conclusions: Care home managers are a barrier to research participation. However, adults with ID would be happy for the IPAQ-s as a PA measure, but less so for the 7-day accelerometer monitoring. In order to improve participation in this population, the choice of PA measure is considered important. Moreover, there is a need for studies exploring how best to engage ID residential home managers in PA research.

Keywords: intellectual disability, physical activity measurement, research engagement, research participation

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Authors: Reem Alshiha, Tanzila Saba

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Physical rehabilitation is the process of helping people to recover and be able to go back to their former activities that have been delayed due to external factors such as car accidents, old age and victims of strokes (chronic diseases and accidents, and those related to sport activities).The cost of hiring a personal nurse or driving the patient to and from the hospital could be costly and time-consuming. Also, there are other factors to take into account such as forgetfulness, boredom and lack of motivation. In order to solve this dilemma, some experts came up with rehabilitation software to be used with Microsoft Kinect to help the patients and their families for in-home rehabilitation. In home rehabilitation software is becoming more and more popular, since it is more convenient for all parties affiliated with the patient. In contrast to the other costly market-based systems that have no portability, Microsoft’s Kinect is a portable motion sensor that reads body movements and interprets it. New software development has made rehabilitation games available to be used at home for the convenience of the patient. The game will benefit its users (rehabilitation patients) in saving time and money. There are many software's that are used with the Kinect for rehabilitation, but the software that is chosen in this research is Kinectotherapy. Kinectotherapy software is used for rehabilitation patients in Riyadh clinics to test its acceptance by patients and their physicians. In this study, we used Kinect because it was affordable, portable and easy to access in contrast to expensive market-based motion sensors. This paper explores the importance of in-home rehabilitation by using Kinect with Kinectotherapy software. The software targets both upper and lower limbs, but in this research, the main focus is on upper-limb functionality. However, the in-home rehabilitation is applicable to be used by all patients with motor disability, since the patient must have some self-reliance. The targeted subjects are patients with minor motor impairment that are somewhat independent in their mobility. The presented work is the first to consider the implementation of in-home rehabilitation with real-time feedback to the patient and physician. This research proposes the implementation of in-home rehabilitation in Riyadh, Saudi Arabia. The findings show that most of the patients are interested and motivated in using the in-home rehabilitation system in the future. The main value of the software application is due to these factors: improve patient engagement through stimulating rehabilitation, be a low cost rehabilitation tool and reduce the need for expensive one-to-one clinical contact. Rehabilitation is a crucial treatment that can improve the quality of life and confidence of the patient as well as their self-esteem.

Keywords: x-box, rehabilitation, physical therapy, rehabilitation software, kinect

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Authors: Rachel Falconer

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Background: The United Nations Convention on the Rights of the Child sets out the duties placed on signatory nations to take measures to protect children from all forms of violence, abuse, neglect and maltreatment. The systems for ensuring this protection vary globally, shaped by national welfare policies. In England and Finland, past research has highlighted differences in how child protection issues are framed and how state agencies respond. However, less is known about how such differences impact processes of social work judgment and decision making in practice. Method: Data was collected as part of a wider PhD project in three stages. First, social workers in sites across England and Finland were asked to complete a short questionnaire. Participants were then asked to comment on two constructed case vignettes, and were interviewed about their experiences of child protection decision making at the point of referral. Interviews were analyzed using NVivo to draw out key themes. Findings: There were similarities in how the English and Finnish social workers responded to the case vignettes; for example, participants in both countries expressed concerns about similar risk factors and all felt further assessment was needed. Differences were observed, in particular, in regard to the sources of support and guidance participants referred to, with the English social workers appearing to rely more upon managerial input for their decisions than the Finnish social workers. These findings suggest evidence for two distinct decision making approaches: ‘supervised’ and ‘supported’ judgement. Implications for practice: The findings have relevance to the conference theme of research and evaluation of social work practice, and support the findings of previous studies that have emphasized the significance of organizational factors in child protection decision making. The comparative methodology has also helped to demonstrate how organizational factors can influence practice in different child protection system ‘orientations’. The presentation will discuss the potential practice implications of ‘supervised’, manager-led approaches to decision making as contrasted with ‘supported’, team-led approaches, inviting discussion about the relevance of these findings for social work in other countries.

Keywords: child protection, comparative research, decision making, social work, vignettes

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Authors: Londeka Ntuli, Frasia Oosthuizen

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Background: Tenefovir disiproxil fumarate (TDF) is a nephrotoxic drug and has been proven to contribute to renal insufficiency necessitating intensive monitoring and management of adverse effects arising from prolonged exposure to the drug. TDF is one of the preferred first-line drugs used in combination therapy in most regions. There are estimated 300 000 patients being initiated on the Efavirenz/TDF/Emtricitabine first-line regimen annually in South Africa. It is against this background that this study aims to investigate the effects of TDF on renal sufficiency of HIV positive patients. Methodology: A retrospective quantitative study was conducted, analysing clinical charts of HIV positive patient’s older than 18 years of age and on a TDF-containing regimen for more than 1 year. Data were obtained from the analysis of patient files and was transcribed into Microsoft® Excel® spreadsheet. Extracted data were coded, categorised and analysed using STATA®. Results: A total of 275 patient files were included in this study. Renal function started decreasing after 3 months of treatment (with 93.5% patients having a normal EGFR), and kept on decreasing as time progressed with only 39.6% normal renal function at year 4. Additional risk factors for renal insufficiency included age below 25, female gender, and additional medication. Conclusion: It is clear from this study that the use of TDF necessitates intensive monitoring and management of adverse effects arising from prolonged exposure to the drug. The findings from this study generated pertinent information on the safety profile of the drug TDF in a resource-limited setting of a public health institution. The appropriate management is of tremendous importance in the South African context where the majority of HIV positive individuals are on the TDF containing regimen; thus it is beneficial to ascertain the possible level of toxicities these patients may be experiencing.

Keywords: renal insufficiency, tenefovir, HIV, risk factors

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Authors: Ella Sèdé Maforikan

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Sustained water management requires quantitative information and the knowledge of spatiotemporal dynamics of hydrological system within the basin. This can be achieved through the research. Several studies have investigated both surface water and groundwater in Beterou catchment. However, there are few published papers on the application of the SWAT modeling in Beterou catchment. The objective of this study was to evaluate the performance of SWAT to simulate the water balance within the watershed. The inputs data consist of digital elevation model, land use maps, soil map, climatic data and discharge records. The model was calibrated and validated using the Sequential Uncertainty Fitting (SUFI2) approach. The calibrated started from 1989 to 2006 with four years warming up period (1985-1988); and validation was from 2007 to 2020. The goodness of the model was assessed using five indices, i.e., Nash–Sutcliffe efficiency (NSE), the ratio of the root means square error to the standard deviation of measured data (RSR), percent bias (PBIAS), the coefficient of determination (R²), and Kling Gupta efficiency (KGE). Results showed that SWAT model successfully simulated river flow in Beterou catchment with NSE = 0.79, R2 = 0.80 and KGE= 0.83 for the calibration process against validation process that provides NSE = 0.78, R2 = 0.78 and KGE= 0.85 using site-based streamflow data. The relative error (PBIAS) ranges from -12.2% to 3.1%. The parameters runoff curve number (CN2), Moist Bulk Density (SOL_BD), Base Flow Alpha Factor (ALPHA_BF), and the available water capacity of the soil layer (SOL_AWC) were the most sensitive parameter. The study provides further research with uncertainty analysis and recommendations for model improvement and provision of an efficient means to improve rainfall and discharges measurement data.

Keywords: watershed, water balance, SWAT modeling, Beterou

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Authors: Li-Kai Kuo, Shyh-Hau Wang

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The kinetic trajectory of the median nerve (MN) in the wrist has shown to be capable of being applied to assess the carpal tunnel syndrome (CTS), and was found able to be detected by high-frequency ultrasound image via motion tracking technique. Yet, previous study may not quickly perform the measurement due to the use of a single element transducer for ultrasound image scanning. Therefore, previous system is not appropriate for being applied to clinical application. In the present study, B-mode ultrasound images of the wrist corresponding to movements of fingers from flexion to extension were acquired by clinical applicable real-time scanner. The kinetic trajectories of MN were off-line estimated utilizing two dimensional Baysian speckle tracking (TDBST) technique. The experiments were carried out from ten volunteers by ultrasound scanner at 12 MHz frequency. Results verified from phantom experiments have demonstrated that TDBST technique is able to detect the movement of MN based on signals of the past and present information and then to reduce the computational complications associated with the effect of such image quality as the resolution and contrast variations. Moreover, TDBST technique tended to be more accurate than that of the normalized cross correlation tracking (NCCT) technique used in previous study to detect movements of the MN in the wrist. In response to fingers’ flexion movement, the kinetic trajectory of the MN moved toward the ulnar-palmar direction, and then toward the radial-dorsal direction corresponding to the extensional movement. TDBST technique and the employed ultrasound image scanner have verified to be feasible to sensitively detect the kinetic trajectory and displacement of the MN. It thus could be further applied to diagnose CTS clinically and to improve the measurements to assess 3D trajectory of the MN.

Keywords: baysian speckle tracking, carpal tunnel syndrome, median nerve, motion tracking

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Authors: Gulshan Mammadova

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This paper presents the results of studying the surface microrelief in 2D and 3D models and analyzing the spectroscopy of a three-junction TlInSe₂ crystal. Analysis of the results obtained showed that with a change in the composition of the TlInSe₂ crystal, sharp changes occur in the microrelief of its surface. An X-ray optical diffraction analysis of the TlInSe₂ crystal was experimentally carried out. Based on ellipsometric data, optical functions were determined - the real and imaginary parts of the dielectric permittivity of crystals, the coefficients of optical absorption and reflection, the dependence of energy losses and electric field power on the effective density, the spectral dependences of the real (σᵣ) and imaginary (σᵢ) parts, optical electrical conductivity were experimentally studied. The fluorescence spectra of the ternary compound TlInSe₂ were isolated and analyzed when excited by light with a wavelength of 532 nm. X-ray studies of TlInSe₂ showed that this phase crystallizes into tetragonal systems. Ellipsometric measurements showed that the real (ε₁) and imaginary (ε₂) parts of the dielectric constant are components of the dielectric constant tensor of the uniaxial joints under consideration and do not depend on the angle. Analysis of the dependence of the real and imaginary parts of the refractive index of the TlInSe₂ crystal on photon energy showed that the nature of the change in the real and imaginary parts of the dielectric constant does not differ significantly. When analyzing the spectral dependences of the real (σr) and imaginary (σi) parts of the optical electrical conductivity, it was noticed that the real part of the optical electrical conductivity increases exponentially in the energy range 0.894-3.505 eV. In the energy range of 0.654-2.91 eV, the imaginary part of the optical electrical conductivity increases linearly, reaches a maximum value, and decreases at an energy of 2.91 eV. At 3.6 eV, an inversion of the imaginary part of the optical electrical conductivity of the TlInSe₂ compound is observed. From the graphs of the effective power density versus electric field energy losses, it is known that the effective power density increases significantly in the energy range of 0.805–3.52 eV. The fluorescence spectrum of the ternary compound TlInSe₂ upon excitation with light with a wavelength of 532 nm has been studied and it has been established that this phase has luminescent properties.

Keywords: optical properties, dielectric permittivity, real and imaginary dielectric permittivity, optical electrical conductivity

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Authors: Van Huong Do, Simon Walton, German Amaya, Madeline Batsiokis, Sally Catt, Andrew Taylor-Robinson

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Identification of the most suitable stages of bovine in vitro-derived blastocysts (early, expanded and hatching) prior to vitrification is a straightforward process that facilitates the decision as to which blastocyst stage to use for transfer of fresh and vitrified embryos. Research on in vitro evaluation of suitable stages has shown that the more advanced developmental stage of blastocysts is recommended for fresh embryo transfer while the earlier stage is proposed for embryo transfer following vitrification. There is, however, limited information on blastocyst stages using in vivo assessment. Hence, the aim of the present study was to determine the optimal stage of a blastocyst for vitrification and embryo transfer through a two-step procedure of embryo transfer followed by pregnancy testing at 35, 60 and 90 days of pregnancy. 410 good quality oocytes aspirated by the ovum pick-up technique from 8 donor cows were subjected to in vitro embryo production, vitrification and embryo transfer. Good quality embryos were selected, subjected to vitrification and embryo transfer. Subsequently, 77 vitrified embryos at different blastocyst stages were transferred to synchronised recipient cows. The overall cleavage and blastocyst rates of oocytes were 68.8% and 41.7%, respectively. In addition, the fertility and blastocyst production of 6 bulls used for in vitro fertilization was examined and shown to be statistically different (P<0.05). Results of ongoing pregnancy trials conducted at 35 days, 60 days and 90 days will be discussed. However, preliminary data indicate that individual bulls demonstrate distinctly different fertility performance in vitro. Findings from conception rates would provide a useful tool to aid selection of bovine in vitro-derived embryos for vitrification and embryo transfer in commercial settings.

Keywords: blastocyst, embryo transfer, in vitro-derived embryos, ovum pick-up, vitrification

Procedia PDF Downloads 295

Authors: Margerita Topalli

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In this paper, we analyze the impact of corruption (business environment, informal payments and state capture), crime and tax time, on the enterprise's performance during economic transition in the Central and Eastern Europe and the role of privatization as a moderator. We examine this effect by comparing the performance of the privatized enterprises and the state-owned-enterprises, while controlling for various forms of selection bias. The present study is based on firm-level panel data collected by the BEEPS for 27 transition countries over 2002, 2005, 2007, and 2011. In addition to firm characteristics, BEEPS collects valuable survey information on different forms of corruption, crime, tax time and firm ownership. We estimate the impact of corruption, crime, tax time on the different performance measures (sales, productivity, employment, labor costs and material costs) of the enterprise, whereby we control for firm ownership, with a special focus on the role of the privatization as a moderator. It argues that in general terms, the privatization has positive effects on the performance of enterprises during transition, but these effects are significantly different, depending on the examined performance measure (sales, productivity, employment, labor costs and material costs). When the privatization is effective, the privatized enterprises show a considerable performance improvements, particularly in terms of revenue growth and productivity growth. It also argues that the effects of privatization are different depending on the types of owner (outsider or insider) to whom it gives control. The results show that privatization to insider owners has no significant performance effect.

Keywords: effects of privatization, enterprise performance, state capture, corruption, firm ownership, economic transition, Central and Eastern Europe

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Authors: P. R. Chauhan, S. K. Tyagi

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Adsorption refrigeration technology offers a sustainable and energy-efficient cooling alternative over traditional refrigeration technologies for meeting the fast-growing cooling demands. With its ability to utilize natural refrigerants, low-grade heat sources, and modular configurations, it has the potential to revolutionize the cooling industry. Despite these benefits, the commercial viability of this technology is hampered by several fundamental limiting constraints, including its large size, low uptake capacity, and poor performance as a result of deficient heat and mass transfer characteristics. The primary cause of adequate heat and mass transfer characteristics and magnitude of exergy loss in various real processes of adsorption cooling system can be assessed by the entropy generation rate analysis, i. e. Second law of Thermodynamics. Therefore, this article presents the second law of thermodynamic-based investigation in terms of entropy generation rate (EGR) to identify the energy losses in various processes of the HPCC-based adsorption system using MATLAB R2021b software. The adsorption technology-based cooling system consists of two beds made up of silica gel and arranged in a single stage, while the water is employed as a refrigerant, coolant, and hot fluid. The variation in process-wise EGR is examined corresponding to cycle time, and a comparative analysis is also presented. Moreover, the EGR is also evaluated in the external units, such as the heat source and heat sink unit used for regeneration and heat dump, respectively. The research findings revealed that the combination of adsorber and desorber, which operates across heat reservoirs with a higher temperature gradient, shares more than half of the total amount of EGR. Moreover, the EGR caused by the heat transfer process is determined to be the highest, followed by a heat sink, heat source, and mass transfer, respectively. in case of heat transfer process, the operation of the valve is determined to be responsible for more than half (54.9%) of the overall EGR during the heat transfer. However, the combined contribution of the external units, such as the source (18.03%) and sink (21.55%), to the total EGR, is 35.59%. The analysis and findings of the present research are expected to pinpoint the source of the energy waste in HPCC based adsorption cooling systems.

Keywords: adsorption cooling cycle, heat transfer, mass transfer, entropy generation, silica gel-water

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Authors: Tsega Asresa Mengistu, Getahun Tigistu

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Computer vision is an artificial intelligence subfield that allows computers and systems to retrieve meaning from digital images. It is applied in various fields of study self-driving cars, video surveillance, agriculture, Quality control, Health care, construction, military, and everyday life. Aromatic and medicinal plants are botanical raw materials used in cosmetics, medicines, health foods, and other natural health products for therapeutic and Aromatic culinary purposes. Herbal industries depend on these special plants. These plants and their products not only serve as a valuable source of income for farmers and entrepreneurs, and going to export not only industrial raw materials but also valuable foreign exchange. There is a lack of technologies for the classification and identification of Aromatic and medicinal plants in Ethiopia. The manual identification system of plants is a tedious, time-consuming, labor, and lengthy process. For farmers, industry personnel, academics, and pharmacists, it is still difficult to identify parts and usage of plants before ingredient extraction. In order to solve this problem, the researcher uses a deep learning approach for the efficient identification of aromatic and medicinal plants by using a convolutional neural network. The objective of the proposed study is to identify the aromatic and medicinal plant Parts and usages using computer vision technology. Therefore, this research initiated a model for the automatic classification of aromatic and medicinal plants by exploring computer vision technology. Morphological characteristics are still the most important tools for the identification of plants. Leaves are the most widely used parts of plants besides the root, flower and fruit, latex, and barks. The study was conducted on aromatic and medicinal plants available in the Ethiopian Institute of Agricultural Research center. An experimental research design is proposed for this study. This is conducted in Convolutional neural networks and Transfer learning. The Researcher employs sigmoid Activation as the last layer and Rectifier liner unit in the hidden layers. Finally, the researcher got a classification accuracy of 66.4 in convolutional neural networks and 67.3 in mobile networks, and 64 in the Visual Geometry Group.

Keywords: aromatic and medicinal plants, computer vision, deep convolutional neural network

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Authors: A. Assad, T. Zayed

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Water networks (WNs) are responsible of providing adequate amounts of safe, high quality, water to the public. As other critical infrastructure systems, WNs are subjected to deterioration which increases the number of breaks and leaks and lower water quality. In Canada, 35% of water assets require critical attention and there is a significant gap between the needed and the implemented investments. Thus, the need for efficient rehabilitation programs is becoming more urgent given the paradigm of aging infrastructure and tight budget. The first step towards developing such programs is to formulate a Performance Index that reflects the current condition of water assets along with its criticality. While numerous studies in the literature have focused on various aspects of condition assessment and reliability, limited efforts have investigated the criticality of such components. Critical water mains are those whose failure cause significant economic, environmental or social impacts on a community. Inclusion of criticality in computing the performance index will serve as a prioritizing tool for the optimum allocating of the available resources and budget. In this study, several social, economic, and environmental factors that dictate the criticality of a water pipelines have been elicited from analyzing the literature. Expert opinions were sought to provide pairwise comparisons of the importance of such factors. Subsequently, Fuzzy Logic along with Analytical Network Process (ANP) was utilized to calculate the weights of several criteria factors. Multi Attribute Utility Theories (MAUT) was then employed to integrate the aforementioned weights with the attribute values of several pipelines in Montreal WN. The result is a criticality index, 0-1, that quantifies the severity of the consequence of failure of each pipeline. A novel contribution of this approach is that it accounts for both the interdependency between criteria factors as well as the inherited uncertainties in calculating the criticality. The practical value of the current study is represented by the automated tool, Excel-MATLAB, which can be used by the utility managers and decision makers in planning for future maintenance and rehabilitation activities where high-level efficiency in use of materials and time resources is required.

Keywords: water networks, criticality assessment, asset management, fuzzy analytical network process

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Authors: Poonam Goswami

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Background: The diagnosis of a serious illness like cancer can have an impact on a patient’s emotional well-being and may result in psychological symptoms, anxiety, depression, and loss of control. Advance care planning discussions ensure patients’ values and goals of care, including patients’ freedom to choose their place of death, are respected. Unfortunately, these discussions are often delayed and are not initiated early in patients’ cancer trajectory. As a result, patients’ wishes often remains unknown until the last phase of their life. Evidence suggests that many patients inappropriately receive aggressive treatment near the end of life, which does lead to higher resource utilization, decreased quality of life, and increased cost. Additionally, the novel coronavirus disease 2019 (COVID-19) pandemic challenged the health care systems worldwide and raised important ethical issues, especially regarding the potential need for rationing health care in the context of scarce resources and crisis capacity. The importance of goal concordant care is now even substantially important and is heightened in the context of this pandemic. Problem: Although there is growing evidence on the effects of the ACP on the completion of advanced directives, improved patient and family concordance for preferences for medical care, and receipt of care, there is still a lack of standardized ACP conversation strategies for patients with cancer. Methods: The Key concepts of ACP include (1) assessing patient and family readiness, (2) identifying a surrogate decision maker ( medical power of attorney), (3) exploring patient and family understanding of the disease and treatment options,(4) discussing the values and goals of care, and options for end-of-life care, (5) documenting patient preferences in the medical record, and (6) revisiting the discussions at every change in the treatment plan and /or change in clinical status, including at every hospitalization. Conclusion/Implication for practice: Advance Care Planning (ACP) and end-of-life (EOL) discussions are important for patients, families, and health care providers. Adopting the verbal and nonverbal communication strategies can help overcome the barriers to effective communication on these difficult discussions. ACP with goals of care discussions should not be delayed until the patient is hospitalized.

Keywords: advance care planning, end of life, cancer, global, pandemic

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