Search results for: internal hemorrhoid

Authors: Warangkana Juangjandee

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The rapidly increasing number of population in the limited area creates an effect on the idea of the improvement of the area to suit the environment and the needs of people. Faculty of architecture Chiang Mai University is also expanding in both variety fields of study and quality of education. In 2020, the new department will be introduced in the faculty which is Department of Landscape Architecture. With the limitation of the area in the existing building, the faculty plan to renovate some parts of its school for anticipates the number of students who will join the program in the next two years. As a result, the old wooden workshop area is selected to be renovated as student studio space. With such condition, it is necessary to study the restriction and the distinctive environment of the site prior to the improvement in order to find ways to manage the existing space due to the fact that the primary functions that have been practiced in the site, an old wooden workshop space and the new function, studio space, are too different. 72.9% of the annual times in the room are considered to be out of the thermal comfort condition with high relative humidity. This causes non-comfort condition for occupants which could promote mould growth. This study aims to analyze thermal comfort condition in the Landscape Learning Studio Area for finding the solution to improve indoor air quality and respond to local conditions. The research methodology will be in two parts: 1) field gathering data on the case study 2) analysis and finding the solution of improving indoor air quality. The result of the survey indicated that the room needs to solve non-comfort condition problem. This can be divided into two ways which are raising ventilation and indoor temperature, e.g. improving building design and stack driven ventilation, using fan for enhancing more internal ventilation.

Keywords: relative humidity, renovation, temperature, thermal comfort

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Authors: L. Cesari, L. Canabady-Rochelle, F. Mutelet

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The thermal conversion of lignin produces bio-oils that contain many compounds with high added-value such as phenolic compounds. In order to efficiently extract these compounds, the possible use of choline bis(trifluoromethylsulfonyl)imide [Choline][NTf2] ionic liquid was explored. To this end, a multistep approach was implemented. First, binary (phenolic compound and solvent) and ternary (phenolic compound and solvent and ionic liquid) solutions were investigated. Eight binary systems of phenolic compound and water were investigated at atmospheric pressure. These systems were quantified using the turbidity method and UV-spectroscopy. Ternary systems (phenolic compound and water and [Choline][NTf2]) were investigated at room temperature and atmospheric pressure. After stirring, the solutions were let to settle down, and a sample of each phase was collected. The analysis of the phases was performed using gas chromatography with an internal standard. These results were used to quantify the values of the interaction parameters of thermodynamic models. Then, extractions were performed on synthetic solutions to determine the influence of several operating conditions (temperature, kinetics, amount of [Choline][NTf2]). With this knowledge, it has been possible to design and simulate an extraction process composed of one extraction column and one flash. Finally, the extraction efficiency of [Choline][NTf2] was quantified with real bio-oils from lignin pyrolysis. Qualitative and quantitative analysis were performed using gas chromatographic connected to mass spectroscopy and flame ionization detector. The experimental measurements show that the extraction of phenolic compounds is efficient at room temperature, quick and does not require a high amount of [Choline][NTf2]. Moreover, the simulations of the extraction process demonstrate that [Choline][NTf2] process requires less energy than an organic one. Finally, the efficiency of [Choline][NTf2] was confirmed in real situations with the experiments on lignin pyrolysis bio-oils.

Keywords: bio-oils, extraction, lignin, phenolic compounds

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Authors: Sharon Waichman, Shahaf Froim, Ido Zukerman, Shmuel Barzilai, Shmual Hayun, Avi Raveh

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Boron carbide is a ceramic material with superior properties such as high chemical and thermal stability, high hardness and high wear resistance. Moreover, it has a big cross section for neutron absorption and therefore can be employed in nuclear based applications. However, an efficient attachment of boron carbide to a metal such as aluminum can be very challenging, mainly because of the formation of aluminum-carbon bonds that are unstable in humid environment, the affinity of oxygen to the metal and the different thermal expansion coefficients of the two materials that may cause internal stresses and a subsequent failure of the bond. Here, we aimed to achieving a strong and a durable attachment between the boron carbide coating and the aluminum substrate. For this purpose, we applied Ti as a thin intermediate layer that provides a gradual change in the thermal expansion coefficients of the configured layers. This layer is continuous and therefore prevents the formation of aluminum-carbon bonds. Boron carbide coatings with a thickness of 1-5 µm were deposited on the aluminum substrate by pulse-DC magnetron sputtering. Prior to the deposition of the boron carbide layer, the surface was pretreated by energetic ion plasma followed by deposition of the Ti intermediate adhesive layer in a continuous process. The properties of the Ti intermediate layer were adjusted by the bias applied to the substrate. The boron carbide/aluminum bond was evaluated by various methods and complementary techniques, such as SEM/EDS, XRD, XPS, FTIR spectroscopy and Glow Discharge Spectroscopy (GDS), in order to explore the structure, composition and the properties of the layers and to study the adherence mechanism of the boron carbide/aluminum contact. Based on the interfacial bond characteristics, we propose a desirable solution for improved adhesion of boron carbide to aluminum using a highly efficient intermediate adhesive layer.

Keywords: adhesion, boron carbide coatings, ceramic/metal bond, intermediate layer, pulsed-DC magnetron sputtering

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Authors: Odenigbo Veronica Ngozi, Ukwuaba Loretta Chika, Ukamaka Eze

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This study delved into youth’s empowerment pathway to unlocking entrepreneurial skills and employability in Enugu state, Nigeria. The purpose of the study is to ascertain the effect of youth joblessness in Enugu State. Two research questions guided the study, and two null hypotheses, which were formulated and tested at a 0.05 level of significance, were used for the analysis. A descriptive survey research design was employed for the study. The population for the study consisted of 103 male and female youths in Enugu state, who were randomly sampled among youths as respondents. A structured questionnaire which was developed by researchers and titled ‘Youth Empowerment a Pathway to Unlocking Entrepreneurial Skills and Employability (YEPUESEQ)’, was used to elicit information from the respondents. The instrument was validated by three experts, one from the Department of Measurement and Evaluation and two from the Department of Continuing Education and Development Studies, all from Enugu State University of Science and Technology, Agbani (ESUT). Cronbach Alpha reliability estimate was used to determine the internal consistency of the instrument with a reliability index of 0.74, indicating that the instrument is highly reliable and suitable to elicit information from the respondent. Data collected were analyzed using mean and standard deviation to answer the two research questions, while the null hypotheses were tested at 0.05 level of significance using a t-test. The findings of the study indicated that when the youths are jobless, they tend to join bad gangs in as much as they can get money, but when they are empowered, they tend towards supporting themselves, the community, and the nation as a whole in bringing in human, economic and social development to society. Based on the findings, the researchers recommended, among others, that the government should establish skill acquisition centers while the youths can enroll for a particular skill of their choice with good facilities, infrastructures and qualified facilitators.

Keywords: youth, empowerment, entrepreneurial skill, employability skill

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Authors: Cody Stolle, Mojdeh Asadollahipajouh, Khaleb Pafford, Jada Iwuoha, Samantha White, Becky Mueller

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Battery-electric vehicles (BEVs) are growing in sales and popularity in the United States as an alternative to traditional internal combustion engine vehicles (ICEVs). BEVs are generally heavier than corresponding models of ICEVs, with large battery packs located beneath the vehicle floorpan, a “skateboard” chassis, and have front and rear crush space available in the trunk and “frunk” or front trunk. The geometrical and frame differences between the vehicles may lead to incompatibilities with gasoline vehicles during vehicle-to-vehicle crashes as well as run-off-road crashes with roadside barriers, which were designed to handle lighter ICEVs with higher centers-of-mass and with dedicated structural chasses. Crash data were collected from 10 states spanning a five-year period between 2017 and 2021. Vehicle Identification Number (VIN) codes were processed with the National Highway Traffic Safety Administration (NHTSA) VIN decoder to extract BEV models from ICEV models. Crashes were filtered to isolate only vehicles produced between 2010 and 2021, and the crash circumstances (weather, time of day, maximum injury) were compared between BEVs and ICEVs. In Washington, 436,613 crashes were identified, which satisfied the selection criteria, and 3,371 of these crashes (0.77%) involved a BEV. The number of crashes which noted a fire were comparable between BEVs and ICEVs of similar model years (0.3% and 0.33%, respectively), and no differences were discernable for the time of day, weather conditions, road geometry, or other prevailing factors (e.g., run-off-road). However, crashes involving BEVs rose rapidly; 31% of all BEV crashes occurred in just 2021. Results indicate that BEVs are performing comparably to ICEVs, and events surrounding BEV crashes are statistically indistinguishable from ICEV crashes.

Keywords: battery-electric vehicles, transportation safety, infrastructure crashworthiness, run-off-road crashes, ev crash data analysis

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Authors: Sylvester S. Horvey, Jones Mensah

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The growing complexities and dynamics in the business environment have led to a new approach to risk management, known as enterprise risk management (ERM). ERM is a system and an approach to managing the risks of an organization in an integrated manner to achieve the corporate goals and strategic objectives. Regardless of the diversities in the business environment, ERM has become an essential factor in managing individual and business risks because ERM is believed to enhance shareholder value and firm growth. Despite the growing number of literature on ERM, the question about what factors drives ERM remains limited. This study provides a comprehensive literature review of the main factors that contribute to ERM implementation. Google Scholar was the leading search engine used to identify empirical literature, and the review spanned between 2000 and 2020. Articles published in Scimago journal ranking and Scopus were examined. Thirteen firm characteristics and sixteen articles were considered for the empirical review. Most empirical studies agreed that firm size, institutional ownership, industry type, auditor type, industrial diversification, earnings volatility, stock price volatility, and internal auditor had a positive relationship with ERM adoption, whereas firm size, institutional ownership, auditor type, and type of industry were mostly seen be statistically significant. Other factors such as financial leverage, profitability, asset opacity, international diversification, and firm complexity revealed an inconclusive result. The growing literature on ERM is not without limitations; hence, this study suggests that further research should examine ERM determinants within a new geographical context while considering a new and robust way of measuring ERM rather than relying on a simple proxy (dummy) for ERM measurement. Other firm characteristics such as organizational culture and context, corporate scandals and losses, and governance could be considered determinants of ERM adoption.

Keywords: enterprise risk management, determinants, ERM adoption, literature review

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Authors: Thomas S. Abia II, Citlali Garcia-Saucedo

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A continuous copper precipitation treatment (CCPT) system was conceived at Intel Chandler Site to serve as a first-of-kind (FOK) facility-scale waste copper (Cu), nickel (Ni), and manganese (Mn) co-precipitation facility. The process was designed to treat highly variable wastewater discharged from a substrate packaging research factory. The paper discusses metals co-precipitation induced by internal changes for manufacturing facilities that lack the capacity for hardware expansion due to real estate restrictions, aggressive schedules, or budgetary constraints. Herein, operating parameters such as pH and oxidation reduction potential (ORP) were examined to analyze the ability of the CCPT System to immobilize various waste metals. Additionally, influential factors such as influent concentrations and retention times were investigated to quantify the environmental variability against system performance. A total of 2,027 samples were analyzed and statistically evaluated to measure the performance of CCPT that was internally retrofitted for Mn abatement to meet environmental regulations. In order to enhance the consistency of the influent, a separate holding tank was cannibalized from another system to collect and slow-feed the segregated Mn wastewater from the factory into CCPT. As a result, the baseline influent Mn decreased from 17.2+18.7 mg¹L^-1 at pre-pilot to 5.15+8.11 mg¹L^-1 post-pilot (70.1% reduction). Likewise, the pre-trial and post-trial average influent Cu values to CCPT were 52.0+54.6 mg¹L^-1 and 33.9+12.7 mg¹L^-1, respectively (34.8% reduction). However, the raw Ni content of 0.97+0.39 mg¹L^-1 at pre-pilot increased to 1.06+0.17 mg¹L^-1 at post-pilot. The average Mn output declined from 10.9+11.7 mg¹L^-1 at pre-pilot to 0.44+1.33 mg¹L^-1 at post-pilot (96.0% reduction) as a result of the pH and ORP operating setpoint changes. In similar fashion, the output Cu quality improved from 1.60+5.38 mg¹L^-1 to 0.55+1.02 mg¹L^-1 (65.6% reduction) while the Ni output sustained a 50% enhancement during the pilot study (0.22+0.19 mg¹L^-1 reduced to 0.11+0.06 mg¹L^-1). pH and ORP were shown to be significantly instrumental to the precipitative versatility of the CCPT System.

Keywords: copper, co-precipitation, industrial wastewater treatment, manganese, optimization, pilot study

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Authors: Laura Sour

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Government accounting is an essential instrument of transparency and accountability in public administration, which allows connecting internal management with the implementation of policies and their evaluation by third parties through the construction of indicators on the cost of government. Several countries have adopted the International Public Sector Accounting Standards (IPSAS) as part of their modernization strategy. This document will evaluate the quantity and harmonization of the financial information published in the financial statements of 12 Latin American countries based on what is established in IPSAS 1, 2 and 17. For this, seven types of financial statements are analyzed. published during the period from 2015 to 2019. Based on this information, it will be possible to describe the evolution in the government financial publication to carry out a detailed analysis of the items that have been most transparent in these countries. Finally, the level of harmonization of the financial statements will be studied using the Herfindahl-Hirschman index (IHH) to determine the degree of comparability of the information. To date, the results indicate that the public sector has increased the quantity and harmonization of the financial information published during the study period, but in a heterogeneous way: From the data collected, it has been found that the financial statement published with greater frequency and quantity is the Income Statement (classification of expenses by nature). On the other hand, the most complete reports were published by Costa Rica (2017 to 2019) and Mexico (2016 to 2018), periods during which these countries complied with 92.9 percent of the items analyzed. Although 2017 and 2018 are the years in which the most financial statements were reported, it is important to mention that Mexico is the country that has published the most financial information throughout the entire study period. The use of the IHH is expected to provide accurate information on the quality with which countries have adopted IPSAS within their government accounting systems to promote transparency and accountability in the continent.

Keywords: accounting and auditing, government policy and regulation, harmonization, public sector accounting and audits IPSAS

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Authors: Mahsa Shafaei Bajestani, Mahmoud Yazdani, Aliakbar Golshani

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Artificial lightweight aggregates have a wide range of applications in industry and engineering. Nowadays, the usage of this material in geotechnical activities, especially as backfill in retaining walls has been growing due to the specific characteristics which make it a competent alternative to the conventional geotechnical materials. In practice, a material with lower weight but higher shear strength parameters would be ideal as backfill behind retaining walls because of the important roles that these parameters play in decreasing the overall active lateral earth pressure. In this study, two types of Light Expanded Clay Aggregates (LECA) produced in the Leca factory are investigated. LECA is made in a rotary kiln by heating natural clay at different temperatures up to 1200 °C making quasi-spherical aggregates with different sizes ranged from 0 to 25 mm. The loose bulk density of these aggregates is between 300 and 700 kN/m³. The purpose of this research is to determine the stress-strain behavior, shear strength parameters, and the energy absorption of LECA materials. Direct shear tests were conducted at five normal stresses of 25, 50, 75, 100, and 200 kPa. In addition, conventional triaxial compression tests were operated at confining pressures of 50, 100, and 200 kPa to examine stress-strain behavior. The experimental results show a high internal angle of friction and even a considerable amount of nominal cohesion despite the granular structure of LECA. These desirable properties along with the intrinsic low density of these aggregates make LECA as a very proper material in geotechnical applications. Furthermore, the results demonstrate that lightweight aggregates may have high energy absorption that is excellent alternative material in seismic isolations.

Keywords: expanded clay, direct shear test, triaxial test, shear properties, energy absorption

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Authors: Kawar Salih

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It has been proven that designing sustainable buildings starts from early stages of urban design. The design of urban blocks specifically, is considered as one of the pragmatic strategies of sustainable urbanism. There have been previous studies that focused on the impact of urban block design and regulation on the outdoor thermal comfort in the semi-arid regions. However, no studies have been found that concentrated on that impact on the internal behavior of buildings of those regions specifically the daylight quality and energy performance. Further, most studies on semi-arid regions are focusing only on the cooling load reduction, neglecting the heating load. The study has focused on two parameters of urban block distribution which are the block orientation and the surface-to-volume ratio with the consideration of both heating and cooling loads of buildings. In Duhok (a semi-arid city in Kurdistan region of Iraq), energy consumption and daylight quality of different types of residential blocks have been examined using dynamic simulation. The findings suggest that there is a considerable higher energy load for heating than cooling, contradicting many previous studies about these regions. The results also highlight that the orientation of urban blocks can vary the energy consumption to 8%. Regarding the surface-to-volume ratio (S/V), it was observed that after the twice enlargement of the S/V, the energy consumption increased 15%. Though, the study demonstrates as well that there are opportunities for reducing energy consumption with the increase of the S/V which contradicts many previous research on S/V impacts on energy consumption. These results can help to design urban blocks with the bigger S/V than existing blocks in the city which it can provide better indoor daylight and relatively similar energy consumption.

Keywords: blocke orienation, building energy consumption, urban block design, semi-arid regions, surfacet-to-volume ratio

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Authors: Yuet Wah Echo Yeung

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Working with people from minority ethnic groups, refugees and asylum seeking communities who have limited proficiency in the language of the host country often presents a major challenge for social workers. Because of language differences, social workers need to work with interpreters to ensure accurate information is collected for their assessment and intervention. Drawing from social learning theory, this paper discusses how role play was used as an experiential learning exercise in a training session to help social work students develop skills when working with interpreters. Social learning theory posits that learning is a cognitive process that takes place in a social context when people observe, imitate and model others’ behaviours. The roleplay also helped students understand the role of the interpreter and the challenges they may face when they rely on interpreters to communicate with service users and their family. The first part of the session involved role play. A tutor played the role of social worker and deliberately behaved in an unprofessional manner and used inappropriate body language when working alongside the interpreter during a home visit. The purpose of the roleplay is not to provide a positive role model for students to ‘imitate’ social worker’s behaviours. Rather it aims to active and provoke internal thinking process and encourages students to critically consider the impacts of poor practice on relationship building and the intervention process. Having critically reflected on the implications for poor practice, students were then asked to play the role of social worker and demonstrate what good practice should look like. At the end of the session, students remarked that they learnt a lot by observing the good and bad example; it showed them what not to do. The exercise served to remind students how practitioners can easily slip into bad habits and of the importance of respect for the cultural difference when working with people from different cultural backgrounds.

Keywords: role play, social learning theory, social work practice, working with interpreters

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Authors: Vladimir Klepikov

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Countries of Central and Southern Europe have a typical feature: oil consumption in the region exceeds own commodity production capacity by far. So crude oil import prevails in the region’s crude oil consumption structure. Transportation using marine and pipeline transport is a common method of the imported oil delivery in the region. For certain refineries, in addition to possible transportation by oil pipelines from seaports, oil is delivered from Russian oil fields. With the view to these specific features and geographic location of the region’s refineries, three ways of imported oil delivery can be singled out: oil delivery by tankers to the port and subsequent transportation by pipeline transport of the port and the refinery; oil delivery by tanker fleet to the port and subsequent transportation by oil trunk pipeline transport; oil delivery from the fields by oil trunk pipelines to refineries. Oil is also delivered by road, internal water, and rail transport. However, the volumes transported this way are negligible in comparison to the three above transportation means. Multimodal oil transportation to refineries using the pipeline and marine transport is one of the biggest cargo flows worldwide. However, in scientific publications this problem is considered mainly for certain modes of transport. Therefore, this study is topical. To elaborate an efficient transportation policy of crude oil supply to Central and Southern Europe, in this paper the geographic concentration of oil refineries was determined and the capacities of the region’s refineries were assessed. The quantitative analysis method is used as a tool. The port infrastructure and the oil trunk pipeline system capacity were assessed in terms of delivery of raw materials to the refineries. The main groups of oil consuming countries were determined. The trends of crude oil production in the region were reviewed. The changes in production capacities and volumes at refineries in the last decade were shown. Based on the revealed refining trends, the scope of possible crude oil supplies to the refineries of the region under review was forecast. The existing transport infrastructure is able to handle the increased oil flow.

Keywords: European region, infrastructure, oil terminal capacity, pipeline capacity, refinery capacity, tanker draft

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Authors: Policarpio Jr. Joves

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Physicians in most teaching hospitals are commonly promoted into managerial roles, yet their training is mostly in clinical and scientific skills but not in leadership competencies. When they shift into roles of physician leadership, the majority hold on to their primary identity of physicians. These conflicting roles affect their identity and eventually their work. The physician leaders also face additional challenges related to academics which include incorporation of new knowledge into the existing curriculum, use of technology in the delivery of teaching, the need to train medical students outside of hospital wards, etc. The study aims to explore how physician leaders in teaching hospitals of private medical schools enact their leadership roles and how they face the challenges as physician leaders. The study setting shall be teaching hospitals of three private medical schools situated in the National Capital Region, Philippines. A multiple case study design shall be adopted in this research. Physicians shall be eligible to participate in the study if they are practicing clinicians limited to the five major clinical specialty: Internal Medicine, Pediatrics, Family Medicine, Surgery, Obstetrics and Gynecology. They must be teaching in the College of Medicine prior to their appointments as physician leaders in both medical school and teaching hospital. Semi-structured face-to-face interviews shall be utilized as a means of data collection, with open-ended questions, enabling physician leaders to present narratives about their identity, role enactment, conflicts, reaction of colleagues, and the challenges encountered in their day-to-day work as physician leaders. Interviews shall be combined with observations and review of records to gain more insights into how the physician leaders are 'doing' management. Within-case analysis shall be done initially followed by a thematic analysis across the cases, referred to as cross–case analysis or cross-case synthesis.

Keywords: academic leaders, academic managers, physician leaders, physician managers

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Authors: Radovan Čobanović, Milica Rankov Šicar

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The meat is in the group of perishable food which can be spoiled very rapidly if stored at room temperature. Salting in combination with smoke is intended to extend shelf life, and also to form the specific taste, odor and color. The smoke do not affect only on taste and flavor of the product, it has a bactericidal and oxidative effect and that is the reason because smoked products are less susceptible to oxidation and decay processes. According to mentioned the goal of this study was to evaluate shelf life of smoked ham, which is stored in conditions of high temperature (+15 °C). For the purposes of this study analyzes were conducted on eight samples of smoked ham every 7th day from the day of reception until 21st day. During this period, smoked ham is subjected to sensory analysis (appearance, odor, taste, color, aroma) and bacteriological analyzes (Listeria monocytogenes, Salmonella spp. and yeasts and molds) according to Serbian state regulation. All analyses were tested according to ISO methodology: sensory analysis ISO 6658, Listeria monocytogenes ISO 11 290-1, Salmonella spp ISO 6579 and yeasts and molds ISO 21527-2. Results of sensory analysis of smoked ham indicating that the samples after the first seven days of storage showed visual changes at the surface in the form of allocations of salt, most likely due to the process of drying out the internal parts of the product. The sample, after fifteen days of storage had intensive exterior changes, but the taste was still acceptable. Between the fifteenth and twenty-first day of storage, there is an unacceptable change on the surface and inside of the product and the occurrence of molds and yeasts but neither one analyzed pathogen was found. Based on the obtained results it can be concluded that this type of product cannot be stored for more than seven days at an elevated temperature of +15°C because there are a visual changes that would certainly have influence on decision of customers when purchase of this product is concerned.

Keywords: sustainability, smoked meat products, food engineering, agricultural process engineering

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Authors: Trunov V.O., Ryabov A. B., Poddubny I.V

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Introduction: cystic and solid pancreatic tumors have a relevant and disruptive position in many positions. The results of the treatment of children with tumors and pancreatic cysts aged 3 to 17 years for the period from 2008 to 2019 on the basis of the Morozov State Children's Clinical Hospital in Moscow were analyzed. The total number of children with solid tumors was 17, and 31 with cysts. In all children, the diagnosis was made on the basis of ultrasound, followed by CT and MRI. In most patients with solid tumors, they were located in the area of the pancreas tail - 58%, in the body area - 14%, in the area of the pancreatic head - 28%. In patients with pancreatic cysts, the distribution of patients by topography was as follows: head of the pancreas - 10%, body of the pancreas - 16%, tail of the pancreas - 68%, total cystic transformation of the Wirsung duct - 6%. In pancreatic cysts, the method of surgical treatment was based on the results of MRCP, the level of amylase in the contents of the cyst, and the localization of the cyst. Thus, pathogenetically substantiated treatment included: excision of cysts, internal drainage on an isolated loop according to Ru, the formation of pancreatojejunoanastomosis in a child with the total cystic transformation of the Wirsung duct. In patients with solid pancreatic lesions, pancretoduodenalresection, central resection of the pancreas, and distal resection from laparotomy and laparoscopic access were performed. In the postoperative period, in order to prevent pancreatitis, all children underwent antisecretory therapy, parenteral nutrition, and drainage of the omental bursa. Results: hospital stay ranged from 7 to 12 days. The duration of postoperative fermentemia in patients with solid formations lasted from 3 to 6 days. In all cases, according to the histological examination, a pseudopapillary tumor of the pancreas was revealed. In the group of children with pancreatic cysts, fermentemia was observed from 2 to 4 days, recurrence of cysts in the long term was detected in 3 children (10%). Conclusions: the treatment of cystic and solid pancreatic neoplasms is a difficult task in connection with the anatomical and functional features of the organ.

Keywords: pancreas, tumors, cysts, resection, laparoscopy, children

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Authors: Javier Ascanio Villabona, Brayan Eduardo Tarazona Romero, Camilo Leonardo Sandoval Rodriguez, Arly Dario Rincon, Omar Lengerke Perez

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Efficient energy consumption in the housing sector in relation to refrigeration is a concern in the construction and rehabilitation of houses in tropical areas. Thermal comfort is aggravated by heat gain on the roof surface by heat gains. Thus, in the group of passive cooling techniques, one of the practices and technologies in solar control that provide improvements in comfortable conditions are thermal insulation or geometric changes of the roofs. On the other hand, methods with reflection and radiation are the methods used to decrease heat gain by facilitating the removal of excess heat inside a building to maintain a comfortable environment. Since the potential of these techniques varies in different climatic zones, their application in different zones should be examined. This research is based on the experimental study of a prototype of a roof radiator as a method of passive cooling in homes, which was developed through an experimental research methodology making measurements in a prototype built by means of the paradigm of appropriate technology, with the aim of establishing an initial behavior of the internal temperature resulting from the climate of the external environment. As a starting point, a selection matrix was made to identify the typologies of passive cooling systems to model the system and its subsequent implementation, establishing its constructive characteristics. Step followed by the measurement of the climatic variables (outside the prototype) and microclimatic variables (inside the prototype) to obtain a database to be analyzed. As a final result, the decrease in temperature that occurs inside the chamber with respect to the outside temperature was evidenced. likewise, a linearity in its behavior in relation to the variations of the climatic variables.

Keywords: appropriate technology, enveloping, energy efficiency, passive cooling

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Authors: Juan A. Ferriz-Papi, Allan L. Nantel, Talib E. Butt

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Buildings are thought to consume about 50% of the total energy in the UK. The use stage in a building life cycle has the largest energy consumption, although different assessments are showing that the construction can equal several years of maintenance and operations. The selection of materials with lower embodied energy is very important to reduce this consumption. For this reason, timber is one adequate material due to its low embodied energy and the capacity to be used as carbon storage. The use of timber in the construction industry is very significant. Sawn wood, for example, is one of the top 5 construction materials consumed in the UK according to National Statistics. Embodied energy for building products considers the energy consumed in extraction and production stages. However, it is not the same consideration if this product is produced locally as when considering the resource produced further afield. Transport is a very relevant matter that profoundly influences in the results of embodied energy. The case of timber use in the UK is important because the balance between imports and exports is far negative, industry consuming more imported timber than produced. Nearly 80% of sawn softwood used in construction is imported. The imports-exports deficit for sawn wood accounted for more than 180 million pounds during the first four-month period of 2016. More than 85% of these imports come from Europe (83% from the EU). The aim of this study is to analyze climate change impact due to transport for timber products consumed in the UK. An approximate estimation of energy consumed and carbon emissions are calculated considering the timber product’s import origin. The results are compared to the total consumption of each product, estimating the impact of transport on the final embodied energy and carbon emissions. The analysis of these results can help deduce that one big challenge for climate change is the reduction of external dependency, with the associated improvement of internal production of timber products. A study of different types of timber products produced in the UK and abroad is developed to understand the possibilities for this country to improve sustainability and self-management. Reuse and recycle possibilities are also considered.

Keywords: embodied energy, climate change, CO2 emissions, timber, transport

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Authors: Kunio Yoshikawa, Ding Lu

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Small-scale, distributed and low-cost biomass power generation technologies are highly required in the modern society. There are big needs for these technologies in the disaster areas of developed countries and un-electrified rural areas of developing countries. This work aims to present a technical feasibility of the portable ultra-small power generation system based on the gasification of carbonized wood pellets/briquettes. Our project is designed for enabling independent energy production from various kinds of biomass resources in the open-field. The whole process mainly consists of two processes: biomass and waste pretreatment; gasification and power generation. The first process includes carbonization, densification (briquetting or pelletization), and the second includes updraft fixed bed gasification of carbonized pellets/briquettes, syngas purification, and power generation employing an internal combustion gas engine. A combined pretreatment processes including carbonization without external energy and densification were adopted to deal with various biomass. Carbonized pellets showed a better gasification performance than carbonized briquettes and their mixture. The 100-hour continuous operation results indicated that pelletization/briquetting of carbonized fuel realized the stable operation of an updraft gasifier if there were no blocking issues caused by the accumulation of tar. The cold gas efficiency and the carbon conversion during carbonized wood pellets gasification was about 49.2% and 70.5% with the air equivalence ratio value of around 0.32, and the corresponding overall efficiency of the gas engine was 20.3% during the stable stage. Moreover, the maximum output power was 21 kW at the air flow rate of 40 Nm³·h⁻¹. Therefore, the comprehensive system covering biomass carbonization, densification, gasification, syngas purification, and engine system is feasible for portable, ultra-small power generation. This work has been supported by Innovative Science and Technology Initiative for Security (Ministry of Defence, Japan).

Keywords: biomass carbonization, densification, distributed power generation, gasification

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Authors: Byl Farney Cunha Junior

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In this work the dynamic three-dimensional analysis of a 47-story building located in Goiania city when subjected to wind loads generated using both the Wind Brazilian code, NBR6123 (ABNT, 1988) and the Synthetic-Wind method is realized. To model the frames three different methodologies are used: the shear building model and both bi and three-dimensional finite element models. To start the analysis, a plane frame is initially studied to validate the shear building model and, in order to compare the results of natural frequencies and displacements at the top of the structure the same plane frame was modeled using the finite element method through the SAP2000 V10 software. The same steps were applied to an idealized 20-story spacial frame that helps in the presentation of the stiffness correction process applied to columns. Based on these models the two methods used to generate the Wind loads are presented: a discrete model proposed in the Wind Brazilian code, NBR6123 (ABNT, 1988) and the Synthetic-Wind method. The method uses the Davenport spectrum which is divided into a variety of frequencies to generate the temporal series of loads. Finally, the 47- story building was analyzed using both the three-dimensional finite element method through the SAP2000 V10 software and the shear building model. The models were loaded with Wind load generated by the Wind code NBR6123 (ABNT, 1988) and by the Synthetic-Wind method considering different wind directions. The displacements and internal forces in columns and beams were compared and a comparative study considering a situation of a full elevated reservoir is realized. As can be observed the displacements obtained by the SAP2000 V10 model are greater when loaded with NBR6123 (ABNT, 1988) wind load related to the permanent phase of the structure’s response.

Keywords: finite element method, synthetic wind, tall buildings, shear building

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Authors: Qijiao He, Lin Ye

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To evaluate the effect of the ribs on internal structure in film hole and the film cooling performance on outer surface, the numerical study investigates on the effects of rib configuration on the film cooling performance with ribbed cross-flow coolant channel. The base smooth case and three ribbed cases, including the continuous rib case and two cross-truncated rib cases with different arrangement, are studied. The distributions of adiabatic film cooling effectiveness and heat transfer coefficient are obtained under the blowing ratios with the value of 0.5 and 1.0, respectively. A commercial steady RANS (Reynolds-averaged Navier-Stokes) code with realizable k-ε turbulence model and enhanced wall treatment were performed for numerical simulations. The numerical model is validated against available experimental data. The two cross-truncated rib cases produce approximately identical cooling effectiveness compared with the smooth case under lower blowing ratio. The continuous rib case significantly outperforms the other cases. With the increase of blowing ratio, the cases with ribs are inferior to the smooth case, especially in the upstream region. The cross-truncated rib I case produces the highest cooling effectiveness among the studied the ribbed channel case. It is found that film cooling effectiveness deteriorates with the increase of spiral intensity of the cross-flow inside the film hole. Lower spiral intensity leads to a better film coverage and thus results in better cooling effectiveness. The distinct relative merits among the cases at different blowing ratios are explored based on the aforementioned dominant mechanism. With regard to the heat transfer coefficient, the smooth case has higher heat transfer intensity than the ribbed cases under the studied blowing ratios. The laterally-averaged heat transfer coefficient of the cross-truncated rib I case is higher than the cross-truncated rib II case.

Keywords: cross-flow, cross-truncated rib, film cooling, numerical simulation

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Authors: Toshitaka Higashino, Naoki Wakamiya

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Human beings perform a task by perceiving information from outside, recognizing them, and responding them. There have been various attempts to analyze and understand internal processes behind the reaction to a given stimulus by conducting psychological experiments and analysis from multiple perspectives. Among these, we focused on Model Human Processor (MHP). However, it was built based on psychological experiments and thus the relation with brain activity was unclear so far. To verify the validity of the MHP and propose our model from a viewpoint of neuroscience, EEG (Electroencephalography) measurements are performed during experiments in this study. More specifically, first, experiments were conducted where Latin alphabet characters were used as visual stimuli. In addition to response time, ERPs (event-related potentials) such as N100 and P300 were measured by using EEG. By comparing cycle time predicted by the MHP and latency of ERPs, it was found that N100, related to perception of stimuli, appeared at the end of the perceptual processor. Furthermore, by conducting an additional experiment, it was revealed that P300, related to decision making, appeared during the response decision process, not at the end. Second, by experiments using Japanese Hiragana characters, i.e. Japan's own phonetic symbols, those findings were confirmed. Finally, Japanese Kanji characters were used as more complicated visual stimuli. A Kanji character usually has several readings and several meanings. Despite the difference, a reading-related task and a meaning-related task exhibited similar results, meaning that they involved similar information processing processes of the brain. Based on those results, our model was proposed which reflects response time and ERP latency. It consists of three processors: the perception processor from an input of a stimulus to appearance of N100, the cognitive processor from N100 to P300, and the decision-action processor from P300 to response. Using our model, an application system which reflects brain activity can be established.

Keywords: brain activity, EEG, information processing model, model human processor

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Authors: Lanlan Xiao, Yang Liu, Shuo Chen, Bingmei Fu

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Most cancer-related deaths are due to metastasis. Metastasis is a complex, multistep processes including the detachment of cancer cells from the primary tumor and the migration to distant targeted organs through blood and/or lymphatic circulations. During hematogenous metastasis, the emigration of tumor cells from the blood stream through the vascular wall into the tissue involves arrest in the microvasculature, adhesion to the endothelial cells forming the microvessel wall and transmigration to the tissue through the endothelial barrier termed as extravasation. The narrow slit between endothelial cells that line the microvessel wall is the principal pathway for tumor cell extravasation to the surrounding tissue. To understand this crucial step for tumor hematogenous metastasis, we used Dissipative Particle Dynamics method to investigate an individual cell passing through a narrow slit numerically. The cell membrane was simulated by a spring-based network model which can separate the internal cytoplasm and surrounding fluid. The effects of the cell elasticity, cell shape and cell surface area increase, and slit size on the cell transmigration through the slit were investigated. Under a fixed driven force, the cell with higher elasticity can be elongated more and pass faster through the slit. When the slit width decreases to 2/3 of the cell diameter, the spherical cell becomes jammed despite reducing its elasticity modulus by 10 times. However, transforming the cell from a spherical to ellipsoidal shape and increasing the cell surface area only by 3% can enable the cell to pass the narrow slit. Therefore the cell shape and surface area increase play a more important role than the cell elasticity in cell passing through the narrow slit. In addition, the simulation results indicate that the cell migration velocity decreases during entry but increases during exit of the slit, which is qualitatively in agreement with the experimental observation.

Keywords: dissipative particle dynamics, deformability, surface area increase, cell migration

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Authors: Fiona Gibson

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This study is on sustainable capacity building in tourism management of the touristic destination of forts and castles within the Accra Metropolis, of the Greater Accra Region of Ghana, notably, the Christianbough Castle, the James and Ussher Forts. These forts and castle mentioned above have a rich colonial historical past that emerged from the 17th century onwards on the Gulf Coast of Guinea of the West Africa Sub-Region. Unfortunately, apart from the Christianbough Castle, which used to be the seat of government until recently, the environment of James and Ussher Forts are in a deployable state of decay due to years of neglect. Jamestown and Usshertown fishing communities with historical colonial past of a rich touristic heritage sites are predominantly indigenous Gas who speak only the Ga language, one of the languages of the six local languages spoken in Ghana, as a medium for sustainable tourism management. The purpose of this study is to investigate the reasons for years of decay and neglect, using both qualitative and quantitative research approach for individual interviews, to develop a rich picture of life situational story of the people of James and Ussher Forts environs and finding solutions to their predicaments through internal generated funds for sustainability of tourism management within the communities. The study recommends nation-wide educational campaigns and programmes on culture of maintenance and management for sustainable tourism development and management at all historical heritage sites in the country, specifically with the aim of promoting tourism in Ghana, using the indigenous local languages. The study also recommends formal and informal education for the residents, especially the youth to help them learn skills, either through local training or the formal education and this call for collaboration between the government of Ghana and other local and international bodies.

Keywords: sustainable capacity building, tourism management, forts, castles

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Authors: Cristina Costa-Lobo, Priscila Martins, Silvia Amado Cordeiro, Ana Campina

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Behavior directed toward high levels of sports performance and excellence implies task-focused processes, processes of cognitive and emotional regulation. This research aims to understand if subjective well-being, emotional regulation, and motivational orientation influence the performance of competitive athletes. The sample of this study is a non-probabilistic convenience sample, consisting of 50 male athletes, aged 14 to 15 years, who belong to training teams integrated in the pedagogical department of a sports club in the North of Portugal. In terms of performance, the distinction between team A and team B is due to the championships in which the respective athletes participate. Team A participates in national championships where the levels of demand and challenge are more pronounced and the team B only participates in championships at the district level. Was verified the internal consistency of the subjective happiness scale, the emotional regulation scale, and the motivational orientation questionnaire. SPSS, version 22.0, was used in the data treatment. When comparing the dimensions of emotional regulation with performance, it can be seen that athletes with lower sports scores have higher levels of emotional control and emotional self-awareness. As far as situational responsiveness is concerned, only the emotional self-control dimension and the emotional self-awareness dimension show an influence on the income, although, contrary to what would be expected, they appear to be associated with lower incomes. When comparing the motivational orientation with the athletic performance, it is verified that the athletes with the highest performance present an ego-oriented motivation, evidencing the athletes with a lower performance athletic tendency towards the task orientation. Only the ego-oriented dimension seems to be associated with high sport performance. The motivational orientation for the ego and the dimensions emotional control and emotional self-awareness are presented in this study as having influence on sports performance. Following these studies that have shown concern with the characterization of the best athletes and the promotion of higher sports performances, this work contributes to the signaling of psychological variables associated with high sports income.

Keywords: subjective well-being, emotional regulation, motivational orientation, sports performance

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Authors: Tomasz Komornicki

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The primary aim of the presentation is to try to model border traffic and, at the same time to explain on which economic variables the intensity of border traffic depended in the long term. For this purpose, long series of traffic data on the Polish borders were used. Models were estimated for three variants of explanatory variables: a) for total arrivals and departures (total movement of Poles and foreigners), b) for arrivals and departures of Poles, and c) for arrivals and departures of foreigners. Each of the defined explanatory variables in the models appeared as the logarithm of the natural number of persons. Data from 1994-2017 were used for modeling (for internal Schengen borders for the years 1994-2007). Information on the number of people arriving in and leaving Poland was collected for a total of 303 border crossings. On the basis of the analyses carried out, it was found that one of the main factors determining border traffic is generally differences in the level of economic development (GDP) and the condition of the economy (level of unemployment) and the degree of border permeability. Also statistically significant for border traffic are differences in the prices of goods (fuels, tobacco, and alcohol products) and services (mainly basic ones, e.g., hairdressing services). Such a relationship exists mainly on the eastern border (border traffic determined largely by differences in the prices of goods) and on the border with Germany (in the first analysed period, border traffic was determined mainly by the prices of goods, later - after Poland's accession to the EU and the Schengen area - also by the prices of services). The models also confirmed differences in the set of factors shaping the volume and structure of border traffic on the Polish borders resulting from general geopolitical conditions, with the year 2007 being an important caesura, after which the classical population mobility factors became visible. The results obtained were additionally related to changes in traffic that occurred as a result of the CPOVID-19 pandemic and as a result of the Russian aggression against Ukraine.

Keywords: border, modal structure, transport, Ukraine

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Authors: Maryam Parsian, Pelin Mutlu, Ufuk Gunduz

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Two-dimensional cell culture affords simplicity and low cost, but it has serious limitations; lacking cell-cell and cell-matrix interactions that are present in tissues. Cancer cells grown in 3D culture systems have distinct phenotypes of adhesion, growth, migration, invasion as well as profiles of gene and protein expression. These interactions cause the 3D-cultured cells to acquire morphological and cellular characteristics relevant to in vivo tumors. Palbociclib is a chemotherapeutic agent for the treatment of ER-positive and HER-negative metastatic breast cancer. Poly-amidoamine (PAMAM) dendrimer is a well-defined, special three-dimensional structure and has a multivalent surface and internal cavities that can play an essential role in drug delivery systems. In this study, palbociclib is loaded onto the magnetic PAMAM dendrimer. Hanging droplet method was used in order to form 3D spheroids. The possible toxic effects of both free drug and drug loaded nanoparticles were evaluated in 2D and 3D MCF-7, MD-MB-231 and SKBR-3 breast cancer cell culture models by performing MTT cell viability and Alamar Blue assays. MTT analysis was performed with six different doses from 1000 µg/ml to 25 µg/ml. Drug unloaded PAMAM dendrimer did not demonstrate significant toxicity on all breast cancer cell lines. The results showed that 3D spheroids are clearly less sensitive than 2D cell cultures to free palbociclib. Also, palbociclib loaded PAMAM dendrimers showed more toxic effect than free palbociclib in all cell lines at 2D and 3D cultures. The results suggest that the traditional cell culture method (2D) is insufficient for mimicking the actual tumor tissue. The response of the cancer cells to anticancer drugs is different in the 2D and 3D culture conditions. This study showed that breast cancer cells are more resistant to free palbociclib in 3D cultures than in 2D cultures. However, nanoparticle loaded drugs can be more cytotoxic when compared to free drug.

Keywords: 2D and 3D cell culture, breast cancer, palbociclibe, PAMAM magnetic nanoparticles

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Authors: Junaid Mahmood Alam

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Revalidating and harmonizing clinical chemistry analytical principles and optimizing methods through quality control programs and assessments is the preeminent means to attain optimal outcome within the clinical laboratory services. Present study reports revalidation of our existing IFCC regularized analytical methods, particularly hepatic and thyroid function tests, by optimization of precision analyses and processing through external and internal quality assessments and regression determination. Parametric components of hepatic (Bilirubin ALT, γGT, ALP), cardiac (LDH, AST, Trop I) and thyroid/pituitary (T3, T4, TSH, FT3, FT4) function tests were used to validate analytical techniques on automated chemistry and immunological analyzers namely Hitachi 912, Cobas 6000 e601, Cobas c501, Cobas e411 with UV kinetic, colorimetric dry chemistry principles and Electro-Chemiluminescence immunoassay (ECLi) techniques. Process of validation and revalidation was completed with evaluating and assessing the precision analyzed Preci-control data of various instruments plotting against each other with regression analyses R2. Results showed that: Revalidation and optimization of respective parameters that were accredited through CAP, CLSI and NEQAPP assessments depicted 99.0% to 99.8% optimization, in addition to the methodology and instruments used for analyses. Regression R2 analysis of BilT was 0.996, whereas that of ALT, ALP, γGT, LDH, AST, Trop I, T3, T4, TSH, FT3, and FT4 exhibited R2 0.998, 0.997, 0.993, 0.967, 0.970, 0.980, 0.976, 0.996, 0.997, 0.997, and R2 0.990, respectively. This confirmed marked harmonization of analytical methods and instrumentations thus revalidating optimized precision standardization as per IFCC recommended guidelines. It is concluded that practices of revalidating and harmonizing the existing or any new services should be followed by all clinical laboratories, especially those associated with tertiary care hospital. This is will ensure deliverance of standardized, proficiency tested, optimized services for prompt and better patient care that will guarantee maximum patients’ confidence.

Keywords: revalidation, standardized, IFCC, CAP, harmonized

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Authors: Lidija R. Jevrić, Sanja O. Podunavac-Kuzmanović, Strahinja Z. Kovačević

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Quantitative structure-retention relationship (QSRR) analysis was used to predict the chromatographic behavior of s-triazine derivatives by using theoretical descriptors computed from the chemical structure. Fundamental basis of the reported investigation is to relate molecular topological descriptors with chromatographic behavior of s-triazine derivatives obtained by reversed-phase (RP) thin layer chromatography (TLC) on silica gel impregnated with paraffin oil and applied ethanol-water (φ = 0.5-0.8; v/v). Retention parameter (RM0) of 14 investigated s-triazine derivatives was used as dependent variable while simple connectivity index different orders were used as independent variables. The best QSRR model for predicting RM0 value was obtained with simple third order connectivity index (3χ) in the second-degree polynomial equation. Numerical values of the correlation coefficient (r=0.915), Fisher's value (F=28.34) and root mean square error (RMSE = 0.36) indicate that model is statistically significant. In order to test the predictive power of the QSRR model leave-one-out cross-validation technique has been applied. The parameters of the internal cross-validation analysis (r2CV=0.79, r2adj=0.81, PRESS=1.89) reflect the high predictive ability of the generated model and it confirms that can be used to predict RM0 value. Multivariate classification technique, hierarchical cluster analysis (HCA), has been applied in order to group molecules according to their molecular connectivity indices. HCA is a descriptive statistical method and it is the most frequently used for important area of data processing such is classification. The HCA performed on simple molecular connectivity indices obtained from the 2D structure of investigated s-triazine compounds resulted in two main clusters in which compounds molecules were grouped according to the number of atoms in the molecule. This is in agreement with the fact that these descriptors were calculated on the basis of the number of atoms in the molecule of the investigated s-triazine derivatives.

Keywords: s-triazines, QSRR, chemometrics, chromatography, molecular descriptors

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Authors: Chih-Wen Fan

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Backgrounds/ Research goals : School improvement requires change leadership, which often means discomfort. Principals are the key people that determine the effectiveness of schools. In an era of organization’s pursuit of speed and effectiveness, school administration has to be accountable and innovative. Effective principals work to improve achievement by focusing on the administrative and teaching quality of improvement. However, there is a lack of literature addressing the relevant case studies on school change leadership. This article explores how principals can use change leadership to drive school change. It analyze the driving factors of principal changes in the case school, the beliefs of change leadership, specific methods, and what impact they have. Methods: This study applies the case study research method to the selected primary school located in an urban area for case study, which has achieved excellent performance after reform and innovation. The researchers selected an older primary school located in an urban area that was transformed into a high-performance primary school after changes were enacted by the principal. The selected case was recommended by three supervisors of the Education Department. The case school underwent leadership change by the new principal during his term, and won an award from the Ministry of Education. Total of 8 teachers are interviewed. The data encoding includes interviews and documents. Expected results/ conclusions: The conclusions of the study are, as follows: (1) The influence for Principal Lin's change leadership is from internal and external environmental development and change pressures. (2) The principal's belief in change leadership is to recognize the sense of crisis, and to create a climate of change and demand for change. (3) The principal's specific actions are intended to identify key members, resolve resistance, use innovative thinking, and promote organizational learning. (4) Principal Lin's change leadership can enhance the professional functions of all employees through appropriate authorization. (5) The effectiveness of change leadership lies in teachers' participation in decision-making; the school's reputation has been enhanced through featured courses.

Keywords: change leadership, empowerment, crisis awareness, case study

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Authors: Sung Hee Ahn, Ju Rang Han

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Background: With increasing importance in healthcare organization on patient satisfaction and nurses’ job satisfaction, many studies have been conducted. But no research has been administered how nurses’ satisfaction with healthcare organization influence patient satisfaction and loyalty. Purpose: This study aims to conceptualize nurses‘ satisfaction, patient satisfaction with and patient loyalty to hospitals using a hypothetical linear structural equation model, and to identify the significance of path coefficients and goodness of fit index of the structural equation model as well. Method: A total of 2,079 nurses and 6,776 patients recruited from 5 university hospitals in South Korea participated in this study. The data on nurses, including ward nurses and outpatient nurses, were collected from June 24th to July 12th, at the 204 departments of the 5 hospitals through an on-line survey. The data on the patients, including both inpatients and outpatients, were collected from September 30th to October 24th, 2013 at the 5 hospitals using a structured questionnaire. The variable of nurses’ satisfaction was measured using a scale evaluating internal client satisfaction, which is used in SSM Health Care System in the US. Patient satisfaction with the hospital and nurses and patient loyalty were measured by assessing the patient’s intention to revisit and to recommending the hospital to others using a visual analogue scale. The data were analyzed using SPSS version 21.0 and AMOS version 21.0. Result: The hypothetical model was fairly good in terms of goodness of fit (χ2= 64.897 (df=24, p <. 001), GFI=. 906, AGFI=.823, CFI=.921, NFI=.951, NNFI=.952. RMSEA=.114). The significance of path coefficients includes followings 1)The nurses’ satisfaction has significant influence on the patient satisfaction with nurses. 2)The patient satisfaction with nurses has significant influence on the patient satisfaction with the hospital. 3)The patient satisfaction with the hospital has significant influence on the patients’ revisit intention. 4)The patient satisfaction with the hospital has significant influence on the patients’ intention to the recommendations of the hospital. Conclusion: These results provide several practical implications to hospital administrators, who should incorporate ways of improving nurses' and patients' satisfaction with the hospital into their health care marketing strategies.

Keywords: linear structural equation model, loyalty, nurse, patient satisfaction

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