Search results for: clinical performance assessment

Authors: Josif Figueroa, Kush Bubbar, Greg Young-Morris

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The reliability evaluation of composite generation and bulk transmission systems is crucial for ensuring a reliable supply of electrical energy to significant system load points. However, evaluating adequacy indices using probabilistic methods like sequential Monte Carlo Simulation can be computationally expensive. Despite this, it is necessary when time-varying and interdependent resources, such as renewables and energy storage systems, are involved. Recent advances in solving power network optimization problems and parallel computing have improved runtime performance while maintaining solution accuracy. This work introduces CompositeSystems, an open-source Composite System Reliability Evaluation tool developed in Julia™, to address the current deficiencies of commercial and non-commercial tools. This work introduces its design, validation, and effectiveness, which includes analyzing two different formulations of the Optimal Power Flow problem. The simulations demonstrate excellent agreement with existing published studies while improving replicability and reproducibility. Overall, the proposed tool can provide valuable insights into the performance of transmission systems, making it an important addition to the existing toolbox for power system planning.

Keywords: open-source software, composite system reliability, optimization methods, Monte Carlo methods, optimal power flow

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Authors: Euan Donley

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Emergency Departments (EDs) are heavily burdened as presentation rates continue to rise. To improve patient flow National Emergency Access Targets (NEAT) were introduced. NEAT implements timelines for ED presentations, such as discharging patients within four hours of arrival. Mental health patients use EDs more than the general population and are generally more complex in their presentations. The aim of this study is to examine the impact of NEAT on psychiatric risk assessment of mental health patients in the ED. Seventy-eight mental health clinicians from 7 Victoria, Australia, hospital EDs participated in a mixed method analysis via anonymous online survey. NEAT was considered helpful as mental health patients were seen quicker, were less likely to abscond, could improve teamwork amongst ED staff, and in some cases administrative processes were better streamlined. However, clinicians felt that NEAT was also responsible for less time with patients and relatives’, resulted in rushed assessments, placed undue pressure on mental health clinicians, was not conducive to training, and the emphasis on time was the wrong focus for patient treatment. The profile of a patient typically likely to be treated within NEAT timelines showed a perfect storm of luck and compliance. If a patient was sober, medically stable, referred early, did not require much collateral information and did not have distressed relatives, NEAT was more likely to be met. Organisationally participants reported no organisational change or training to meet NEAT. Poor mental health staffing, multiple ED presentations and a shortage of mental health beds also hamper meeting NEAT. Findings suggest participants were supportive of NEAT in principle, but a demanding workload and organisational barriers meant NEAT had an overall negative effect on psychiatric risk assessment of mental health patients in ED.

Keywords: assessment, emergency, risk, psychiatric

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Authors: Mequanent Wale Mekonen, Edoardo Otranto, Angela Alibrandi

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Diabetic kidney disease is one of the main microvascular complications caused by diabetes. Several clinical and biochemical variables are reported to be associated with diabetic kidney disease in people with type 2 diabetes. However, their interrelations could distort the effect estimation of these variables for the disease's progression. The objective of the study is to determine how the biochemical and clinical variables in people with type 2 diabetes are interrelated with each other and their effects on kidney disease progression through advanced statistical methods. First, principal component analysis was used to explore how the biochemical and clinical variables intercorrelate with each other, which helped us reduce a set of correlated biochemical variables to a smaller number of uncorrelated variables. Then, ordered logit regression models (cumulative, stage, and adjacent) were employed to assess the effect of biochemical and clinical variables on the order-level response variable (progression of kidney function) by considering the proportionality assumption for more robust effect estimation. This retrospective cross-sectional study retrieved data from a type 2 diabetic cohort in a polyclinic hospital at the University of Messina, Italy. The principal component analysis yielded three uncorrelated components. These are principal component 1, with negative loading of glycosylated haemoglobin, glycemia, and creatinine; principal component 2, with negative loading of total cholesterol and low-density lipoprotein; and principal component 3, with negative loading of high-density lipoprotein and a positive load of triglycerides. The ordered logit models (cumulative, stage, and adjacent) showed that the first component (glycosylated haemoglobin, glycemia, and creatinine) had a significant effect on the progression of kidney disease. For instance, the cumulative odds model indicated that the first principal component (linear combination of glycosylated haemoglobin, glycemia, and creatinine) had a strong and significant effect on the progression of kidney disease, with an effect or odds ratio of 0.423 (P value = 0.000). However, this effect was inconsistent across levels of kidney disease because the first principal component did not meet the proportionality assumption. To address the proportionality problem and provide robust effect estimates, alternative ordered logit models, such as the partial cumulative odds model, the partial adjacent category model, and the partial continuation ratio model, were used. These models suggested that clinical variables such as age, sex, body mass index, medication (metformin), and biochemical variables such as glycosylated haemoglobin, glycemia, and creatinine have a significant effect on the progression of kidney disease.

Keywords: diabetic kidney disease, ordered logit model, principal component analysis, type 2 diabetes

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Authors: Saad Bin Nasir

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This research will examine the impact of corporate governance on firm performance in family and non-family owned firms in Pakistan. For the purpose of this research, corporate governance mechanisms which included are board size, board composition, leadership structure, board meetings are taken as independent variable and firm performance taken as dependent variable and it will be measured with return on asset and return on equity. Firm size and firm’s age will be taken as control variables. Secondary data will collect from audited annul reports of companies and panel data regression model will applied, to check the impact of corporate governance on firm performance.

Keywords: board size, board composition, Leadership Structure, board meetings, firm performance, family and non-family owned firms

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Authors: Shalinawati Ramli, Khairani Omar, Nurul Azmawati Mohamed, Zarini Ismail, Nur Syahrina Rahim, Nurul Hayati Chamhuri

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Medical doctors’ work to prevent, diagnose, treat diseases, disorders, and injuries as well as prescribing medication. Many people are attracted to this profession because it gives them the opportunity to help others. Doctors’ improve quality of life by providing advice, healing physical ailments and performing complex surgeries. Medicine is a profession in which dedication to the wellbeing of others is of paramount importance. Balancing the requirements of work and personal life can be a struggle as the demand of work as a doctors’ is great. Perception and expectation of medical students regarding the lifestyle of doctors’ is important to ensure that they had made the right career choice. Thus, the aim of this study is to assess the perception of pre-clinical students regarding doctors’ lifestyle. This study is a cross-sectional study involving all third-year pre-clinical medical students at University Sains Islam Malaysia. A total of 81 students participated in this study. Participants were given a set of questionnaire consisting of demographic data, open-ended questions on their perception on doctors’ lifestyle of working environment, salary expectation and family life. Thematic analysis were used to analyse the data. The participants comprised 69% female and their age range was between 20-21 years old. Majority of them were from middle-income families. Majority of the students perceived that the doctors’ lifestyle would be busy (72%). Approximately 30% of them expected that the time schedule will be unpredictable, 21% mentioned that sacrifice is required and 16% perceived it as a tiring job. Other themes emerged were ‘requiring high commitment’ (6%), challenging (7%) and risky (4%). With regards to salary expectation, 48% expected reasonable salary, 33% high salary and 12% described it as 'not worth compared to the workload'. Majority of them perceived that their family life will be restricted (62%) and time management is important (33%). Only 15% mentioned that family members have to sacrifice and spousal understanding is important (7%). About 10% of them perceived that their family will not be affected by their profession. Majority of the medical students perceived a busy doctors’ lifestyle, reasonable salary and restricted family life. However, there was a significant proportion of them who required counselling for better preparation of their future lifestyle.

Keywords: doctors lifestyle, pre-clinical students, perception, understanding

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Authors: Purna Singh, Vaibhav Tripathi, Vinayak Kalluri, Sumit Roy

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The present experimental work was carried out to investigate performance and emission characteristics of single cylinder diesel engine operating under dual-fuel mode with coconut oil blended with diesel. Coconut oil is one of the edible oil which is abundant in tropical countries and has properties like diesel. To this end, performance and emission parameters of diesel-coconut oil blends were reported in the current study. The results were drawn at different load steps of engine operation with 10% and 20% of coconut oil linearly blended with diesel. From the results, it was evident that coconut oil can be successfully replaced up to 20% of diesel without hampering the performance-emission characteristics of the existing diesel engine.

Keywords: coconut oil, alternative fuel, emissions, dual-fuel

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Authors: Sarit Rashkovits, Anat Drach- Zahavy

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The research considers the unresolved question regarding the link between nursing team accountability and team learning and the resulted team performance in nursing teams. Empirical findings reveal disappointing evidence regarding improvement in healthcare safety and quality. Therefore, there is a need in advancing managerial knowledge regarding the factors that enhance constant healthcare teams' proactive improvement efforts, meaning team learning. We first aim to identify the organizational resources that are needed for team learning in nursing teams; second, to test the moderating role of nursing teams' learning resources in the team accountability-team learning link; and third, to test the moderated mediation model suggesting that nursing teams' accountability affects team performance by enhancing team learning when relevant resources are available to the team. We point on the intervening role of three team learning resources, namely time availability, team autonomy and performance data on the relation between team accountability and team learning and test the proposed moderated mediation model on 44 nursing teams (462 nurses and 44 nursing managers). The results showed that, as was expected, there was a positive significant link between team accountability and team learning and the subsequent team performance when time availability and team autonomy were high rather than low. Nevertheless, the positive team accountability- team learning link was significant when team performance feedback was low rather than high. Accordingly, there was a positive mediated effect of team accountability on team performance via team learning when either time availability or team autonomy were high and the availability of team performance data was low. Nevertheless, this mediated effect was negative when time availability and team autonomy were low and the availability of team performance data was high. We conclude that nurturing team accountability is not enough for achieving nursing teams' learning and the subsequent improved team performance. Rather there is need to provide nursing teams with adequate time, autonomy, and be cautious with performance feedback, as the latter may motivate nursing teams to repeat routine work strategies rather than explore improved ones.

Keywords: nursing teams' accountability, nursing teams' learning, performance feedback, teams' autonomy

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Authors: Mehmet Bulent Topkaya, Mustafa Yildirim

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Wastewater treatment systems are designed and used to minimize adverse impacts of the wastewater on the environment before discharging. Various treatment options for wastewater treatment have been developed, and each of them has different performance characteristics and environmental impacts (e.g. material and land usage, energy consumption, greenhouse gas emission, water and soil emission) during construction, operation or maintenance phases. Assessing the environmental impacts during these phases are essential for the overall evaluation of the treatment systems. In this study, wastewater treatment options, such as vegetated land treatment, constructed wetland, rotating biological contactor, conventional activated sludge treatment, membrane bioreactor, extended aeration and stabilization pond are evaluated. The comparison of the environmental impacts is conducted under the assumption that the effluents will be discharged to sensitive and less sensitive areas respectively. The environmental impacts of each alternative are evaluated by life cycle assessment (LCA) approach. For this purpose, data related to energy usage, land requirement, raw material consumption, and released emissions from the life phases were collected with inventory studies based on field studies and literature. The environmental impacts were assessed by using SimaPro 7.1 LCA software. As the scale of the LCA results is global, an MS-Excel based decision support tool that includes the LCA result is developed in order to meet also the local demands. Using this tool, it is possible to assign weight factors on the LCA results according to local conditions by using Analytical Hierarchy Process and finally the most environmentally appropriate treatment option can be selected.

Keywords: analytical hierarchy process, decision support system, life cycle assessment, wastewater treatment

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Authors: Boldin Roman, Liliana Analía Diaz

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As the hydrogen economy continues to expand, reducing energy consumption and emissions while stimulating economic growth, the development of efficient and cost-effective hydrogen production technologies is critical. Among various methods, anion exchange membrane (AEM) water electrolysis stands out due to its potential for using non-noble metal catalysts. The exploration and enhancement of non-noble metal catalysts, such as NiFe-type catalysts, are pivotal for the advancement of AEM technology, ensuring its commercial viability and environmental sustainability. NiFe-type catalysts were synthesized through electrodeposition and characterized both electrochemically and physico-chemically. Various supports, including Ni foam and Ni mesh, were used as porous transport layers (PTLs) to evaluate the effective catalyst thickness and the influence of the PTL in a 5 cm² AEM electrolyzer. This methodological approach allows for a detailed assessment of catalyst performance under operational conditions typical of industrial hydrogen production. The study revealed that electrodeposited non-noble multi-metallic catalysts maintain stable performance as anodes in AEM water electrolysis. NiFe-type catalysts demonstrated superior activity, with the NiFeCoP alloy outperforming others by delivering the lowest overpotential and the highest current density. Furthermore, the use of different PTLs showed significant effects on the electrochemical behavior of the catalysts, indicating that PTL selection is crucial for optimizing performance and efficiency in AEM electrolyzers. Conclusion: The research underscores the potential of non-noble metal catalysts in enhancing efficiency and reducing the costs of AEM electrolysers. The findings highlight the importance of catalyst and PTL optimization in developing scalable and economically viable hydrogen production technologies. Continued innovation in this area is essential for supporting the growth of the hydrogen economy and achieving sustainable energy solutions.

Keywords: AEMWE, electrocatalyst, hydrogen production, water electrolysis.

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Authors: Mohammed Ahmed Ahmed Odah

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DNA barcoding is a crucial method for assessing and monitoring species diversity amidst escalating threats to global biodiversity. The author explores DNA barcoding's potential as a robust and reliable tool for biodiversity assessment. It begins with a comprehensive review of existing literature, delving into the theoretical foundations, methodologies and applications of DNA barcoding. The suitability of various DNA regions, like the COI gene, as universal barcodes is extensively investigated. Additionally, the advantages and limitations of different DNA sequencing technologies and bioinformatics tools are evaluated within the context of DNA barcoding. To evaluate the efficacy of DNA barcoding, diverse ecosystems, including terrestrial, freshwater and marine habitats, are sampled. Extracted DNA from collected specimens undergoes amplification and sequencing of the target barcode region. Comparison of the obtained DNA sequences with reference databases allows for the identification and classification of the sampled organisms. Findings demonstrate that DNA barcoding accurately identifies species, even in cases where morphological identification proves challenging. Moreover, it sheds light on cryptic and endangered species, aiding conservation efforts. The author also investigates patterns of genetic diversity and evolutionary relationships among different taxa through the analysis of genetic data. This research contributes to the growing knowledge of DNA barcoding and its applicability for biodiversity assessment. The advantages of this approach, such as speed, accuracy and cost-effectiveness, are highlighted, along with areas for improvement. By unlocking the genetic code, DNA barcoding enhances our understanding of biodiversity, supports conservation initiatives and informs evidence-based decision-making for the sustainable management of ecosystems.

Keywords: DNA barcoding, biodiversity assessment, genetic code, species identification, taxonomic resolution, next-generation sequencing

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Authors: James Hilton Williams

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Recent tsunami events, including the 2011 Tohoku Tsunami, Japan, and the 2015 Illapel Tsunami, Chile, have highlighted the potential for tsunami impacts on the built environment. International research in the tsunami impacts domain has been largely focused toward impacts on buildings and casualty estimations, while only limited attention has been placed on the impacts on infrastructure which is critical for the recovery of impacted communities. New Zealand, with 75% of the population within 10 km of the coast, has a large amount of coastal infrastructure exposed to local, regional and distant tsunami sources. To effectively manage tsunami risk for New Zealand critical infrastructure, including energy, transportation, and communications, the vulnerability of infrastructure networks and components must first be determined. This research develops infrastructure asset vulnerability, functionality and repair- cost functions based on international post-event tsunami impact assessment data from technologically similar countries, including Japan and Chile, and adapts these to New Zealand. These functions are then utilized within a New Zealand based impact framework, allowing for cost benefit analyses, effective tsunami risk management strategies and mitigation options for exposed critical infrastructure to be determined, which can also be applied internationally.

Keywords: impact assessment, infrastructure, tsunami impacts, vulnerability functions

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Authors: Laiba Amin, Rashna H. Sukhia, Mubassar Fida

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Introduction: This study evaluates the accuracy of responses from ChatGPT, Google Bard, and Microsoft Copilot regarding dentofacial orthopedic appliances. As artificial intelligence (AI) increasingly enhances various fields, including healthcare, understanding its reliability in specialized domains like orthodontics becomes crucial. By comparing the accuracy of different AI models, this study aims to shed light on their effectiveness and potential limitations in providing technical insights. Materials and Methods: A total of 110 questions focused on dentofacial orthopedic appliances were posed to each AI model. The responses were then evaluated by five experienced orthodontists using a modified 5-point Likert scale to ensure a thorough assessment of accuracy. This structured approach allowed for consistent and objective rating, facilitating a meaningful comparison between the AI systems. Results: The results revealed that Google Bard demonstrated the highest accuracy at 74%, followed by Microsoft Copilot, with an accuracy of 72.2%. In contrast, ChatGPT was found to be the least accurate, achieving only 52.2%. These results highlight significant differences in the performance of the AI models when addressing orthodontic queries. Conclusions: Our study highlights the need for caution in relying on AI for orthodontic insights. The overall accuracy of the three chatbots was 66%, with Google Bard performing best for removable Class II appliances. Microsoft Copilot was more accurate than ChatGPT, which, despite its popularity, was the least accurate. This variability emphasizes the importance of human expertise in interpreting AI-generated information. Further research is necessary to improve the reliability of AI models in specialized healthcare settings.

Keywords: artificial intelligence, large language models, orthodontics, dentofacial orthopaedic appliances, accuracy assessment.

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Authors: Madiha Zahid, Afifa Khanam

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The present study aims to investigate the effect of reflective teaching practices on prospective teachers’ performance. Reflective teaching practice helps teachers to plan, implement and improve their performance by rethinking about their strengths and weaknesses. An action research was conducted by the researcher. All prospective teachers of sixth semester in a women university’s teacher education program were the population of the study. From 40 students, 20 students were taken as experimental group, and the rest of 20 students were taken as control group. During the action research a cyclic process of producing a module, training teachers for the reflective practices and then observing them during their class for reflective practice was done by the researchers. The research used a set of rubrics and checklists for assessing prospective teachers’ performance during their class. Finally, the module was modified with the help of findings. It was found that the training has improved the performance of teachers as they revised and modified their teaching strategies through reflective practice. However, they were not able to train their students for reflective practice as per expectation. The study has implications for teacher training programs to include reflective practice modules as part of their course work for making them better teachers.

Keywords: reflective practices, prospective teacher, effect, performance

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Authors: Ladda Thiamwong, Renata Komalasari

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Falls are the leading cause of disability and hospitalization in low-income older adults. Fear of falling is present in 20% to 85 % of older adults and has been identified as an independent risk factor of fall risk, activity restriction, and loss of independence. About 12% of American older adults have subjective cognitive decline. Cognitive impairment is also an established factor of fall risk. However, it is unclear whether measures of fear of falling and subjective cognitive decline have the greatest association with fall risk in low-income older adults. The aim of this study was to evaluate the association between fear of falling, subjective cognitive decline-functional performance (SCD-FP), and fall risk using simple screening tools. In this cross-section study, we collected data from community-dwelling older adults 60 years or older in low-income settings in Central Florida, and 86 participants were included in the data analysis. Fear of falling was assessed by the Short Fall Efficacy Scale- International (Short FES-I) with seven items. Subjective cognitive decline-functional performance (SCD-FP) was assessed by a self-reported experience of worsening or more frequent confusion or memory loss in the past 12 months and its functional implications. Fall risk was evaluated by the Centers for Disease Control and Prevention (CDC)'s Stay Independent checklist with 12 items. The majority of participants were female, and more than half of the participants were African American. More than half of the participants had a higher school degree or higher, and less than 20% had no financial problems. Less than 30% of the participants perceived their general health as very good- excellent. More than half of the participants lived alone, and less than 15% lived with a partner or spouse. About 60% of the participants had hypertension, 40% had diabetes, 16% had cancer, and 50% had arthritis. About 30% of the participants had difficulty walking up ten steps without resting, more than 40% felt unsteady when walking, and 30% had been advised to use a cane or walker to get around safely. Regression analysis showed that fall risk was associated with fear of falling ( = .524, p <.001) and subjective cognitive decline-functional performance ( = .465, p =.027). The structure coefficient showed that fear of falling (rs2 = .922) was a stronger predictor of fall risk than subjective cognitive decline-functional performance (rs2= .200). Fear of falling and subjective cognitive decline-functional performance are growing public health issues, and addressing those issues is a public priority. Proactive screening for fear of falling and subjective cognitive decline-functional performance is critical in fall prevention. A combination of all three self-reported tools (Short FES-I, SCD-FP, and CDC's Stay Independent checklist) takes less than 5 minutes to complete. Primary care providers or public health professionals should consider including these tools to screen fear of falling and subjective cognitive decline-functional performance as part of fall risk assessment, especially in low-income settings. Thus, encouraging older adults and healthcare professionals to discuss fear of falling, subjective cognitive decline, and fall risk during routine medical office visits.

Keywords: falls, fall risk, fear of falling, cognition, subjective cognitive decline, low-income, older adults, community, screening, nursing, primary care

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Authors: Seongryong Kang, Woonjin Kim, Sungjoo Lee

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Under the environment of fierce competition and globalized economy, international technology collaboration has gained increasing attention as a way to improve innovation efficiency. While international technology transfer helps a firm to acquire necessary technology in a short period of time, it also has a risk; embedding external technology from overseas partners may cause a transaction cost due to the regional, cultural and language barriers, which tend to offset the benefits of such transfer. Though a number of previous studies have focused on the effects of technology in-transfer on firm performance, few have conducted in the context of international technology transfer. To fill this gap, this study aims to investigate the impact of international technology in-transfer on firm performance – both innovation and financial performance, with a particular emphasis on the diversity and intensity of such transfer. To do this, we adopted technology balance payment (TBP) data of Korean firms from 2010 to 2011, where an intermediate regression analysis was used to identify the intermediate effects of absorptive capacity. The analysis results indicate that i) the diversity and intensity of international technology transfer influence innovation performance by improving R&D capability positively; and ii) the diversity has a positive impact but the intensity has a negative impact on financial performance through the intermediation of R&D intensity. The research findings are expected to provide meaningful implications for establishing global technology strategy and developing policy programs to facilitate technology transfer.

Keywords: diversity, intensity, international technology acquisition, performance, technology transfer

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Authors: E. A. Tkachenko, E. M. Rogova, V. V. Klimov

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One of the basic issues of development management is connected with performance measurement as a prerequisite for identifying the achievement of development objectives. The aim of our research is to develop an improved model of assessing a company’s development results. The model should take into account the cyclical nature of development and the high degree of uncertainty in dealing with numerous management tasks. Our hypotheses may be formulated as follows: Hypothesis 1. The cycle of a company’s development may be studied from the standpoint of a project cycle. To do that, methods and tools of project analysis are to be used. Hypothesis 2. The problem of the uncertainty when justifying managerial decisions within the framework of a company’s development cycle can be solved through the use of the mathematical apparatus of fuzzy logic. The reasoned justification of the validity of the hypotheses made is given in the suggested article. The fuzzy logic toolkit applies to the case of technology shift within an enterprise. It is proven that some restrictions in performance measurement that are incurred to conventional methods could be eliminated by implementation of the fuzzy logic apparatus in performance measurement models.

Keywords: logic, fuzzy sets, performance measurement, project analysis

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Authors: Adila Shaukat, Hussam Al Soub, Muna Al Maslamani, Abdullatif Al Khal

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Background: The aim of this study was to assess clinical presentation and antimicrobial susceptibility of Streptococcus (S.) anginosus group infections in Hamad General Hospital, a tertiary care hospital in the state of Qatar, which is a multinational community. The S. anginosus group is a subgroup of viridans streptococci that consist of 3 different species: S. anginosus, S. constellatus, and S. intermedius. Although a part of the human bacteria flora, they have potential to cause suppurative infections. Method: We studied a total of 101 patients with S. anginosus group infections from January 2006 until March 2012 by reviewing medical records and identification of organisms by VITEK 2 and MALDI-TOF. Results: The most common sites of infection were skin and soft tissue, intra-abdominal, and bacteremia (28.7%, 24.8%, and 22.7%, respectively). Abscess formation was seen in approximately 30% of patients. Streptococcus constellatus was the most common isolated species (40%) followed by S. anginosus(30%) and S. intermedius(7%). In 23% of specimens, the species was unidentified. The most common type of specimen for organism isolation was blood followed by pus and tissue (50%, 22%, and 8%, respectively). Streptococcus constellatus was more frequently associated with abdominal and skin and soft tissue infections than the other 2 species, whereas S. anginosus was isolated more frequently from blood. All isolates were susceptible to penicillin, ceftriaxone, and vancomycin. Susceptibility to erythromycin and clindamycin was also good, reaching 91% and 95%, respectively. Forty percent of patients needed surgical drainage along with antibiotic therapy. Conclusions: Identification of S. anginosus group to species level is helpful in clinical practice because different species exhibit different pathogenic potentials.

Keywords: abscess, bacterial infection, bacteremia, Streptococcus anginosus

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Authors: Ahmed R. Z. Baghdadi,  Mona H. Gamal Eldein

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Background: With the perceived pain and poor function experienced following knee arthroplasty, patients usually feel unsatisfied. Yet, a controversy still persists on the appropriate operative technique that doesn’t affect proprioception much. Purpose: This study compared the effects of Cruciate Retaining (CR) and Posterior Stabilized (PS) total knee arthroplasty (TKA on dynamic balance, pain and functional performance following rehabilitation. Methods: Thirty patients with CRTKA (group I), thirty with PSTKA (group II) and fifteen indicated for arthroplasty but weren’t operated on yet (group III) participated in the study. The mean age was 54.53±3.44, 55.13±3.48 and 55.33±2.32 years and BMI 35.7±3.03, 35.7±1.99 and 35.73±1.03 kg/m2 for group I, II, and III respectively. The Berg Balance Scale (BBS), WOMAC pain subscale and Timed-Up-and-Go (TUG) and Stair-Climbing (SC) tests were used for assessment. Assessments were conducted four weeks pre- and post-operatively, three, six and twelve months post-operatively with the control group being assessed at the same time intervals. The post-operative rehabilitation involved hospitalization (1st week), home-based (2nd-4th weeks), and outpatient clinic (5th-12th weeks) programs, follow-up to all groups for twelve months. Results: The Mixed design MANOVA revealed that group I had significantly lower pain scores and SC time compared with group II three, six and twelve months post-operatively. Moreover, the BBS scores increased significantly and the pain scores and TUG and SC time decreased significantly six months post-operatively compared with four weeks pre- and post-operatively and three months post-operatively in group I and II with the opposite being true four weeks post-operatively. But no significant differences in BBS scores, pain scores and TUG and SC time between six and twelve months post-operatively in group I and II. Interpretation/Conclusion: CRTKA is preferable to PSTKA, possibly due to the preserved human proprioceptors in the un-excised PCL.

Keywords: dynamic balance, functional performance, knee arthroplasty, long-term

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Authors: Steffen Schieweck, Johannes Dregger, Sascha Kaczmarek, Michael ten Hompel

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Logistics distributors face the issue of having to provide increasing service levels while being forced to reduce costs at the same time. Same-day delivery, quick order processing and rapidly growing ranges of articles are only some of the prevailing challenges. One key aspect of the performance of an intra-logistics system is how often and in which amplitude congestions and dysfunctions affect the processing operations. By gaining knowledge of the so called ‘performance availability’ of such a system during the planning stage, oversizing and wasting can be reduced whereas planning transparency is increased. State of the art for the determination of this KPI are simulation studies. However, their structure and therefore their results may vary unforeseeably. This article proposes a concept for the establishment of ‘certified’ and hence reliable and comparable simulation models.

Keywords: intra-logistics, performance availability, simulation, warehousing

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Authors: Jack Nash, Chris Simpson, Holly Hurn, Ronel Terblanche, Alan Mistlin

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There is an increasing incidence of mild traumatic brain injury (mTBI) cases throughout sport and with this, a growing interest from governing bodies to ensure these are managed appropriately and player welfare is prioritised. The Berlin consensus statement on concussion in sport recommends a multidisciplinary approach when managing those patients who do not have full resolution of mTBI symptoms. There are as of yet no standardised guideline to follow in the treatment of complex cases mTBI in athletes. The aim of this project was to analyse the outcomes, both clinical and vocational, of all patients admitted to the mild Traumatic Brain Injury (mTBI) service at the UK’s Defence Military Rehabilitation Centre Headley Court between 1st June 2008 and 1st February 2017, as a result of a sport induced injury, and evaluate potential predictive indicators of outcome. Patients were identified from a database maintained by the mTBI service. Clinical and occupational outcomes were ascertained from medical and occupational employment records, recorded prospectively, at time of discharge from the mTBI service. Outcomes were graded based on the vocational independence scale (VIS) and clinical documentation at discharge. Predictive indicators including referral time, age at time of injury, previous mental health diagnosis and a financial claim in place at time of entry to service were assessed using logistic regression. 45 Patients were treated for sport-related mTBI during this time frame. Clinically 96% of patients had full resolution of their mTBI symptoms after input from the mTBI service. 51% of patients returned to work at their previous vocational level, 4% had ongoing mTBI symptoms, 22% had ongoing physical rehabilitation needs, 11% required mental health input and 11% required further vestibular rehabilitation. Neither age, time to referral, pre-existing mental health condition nor compensation seeking had a significant impact on either vocational or clinical outcome in this population. The vast majority of patients reviewed in the mTBI clinic had persistent symptoms which could not be managed in primary care. A consultant-led, multidisciplinary approach to the diagnosis and management of mTBI has resulted in excellent clinical outcomes in these complex cases. High levels of symptom resolution suggest that this referral and treatment pathway is successful and is a model which could be replicated in other organisations with consultant led input. Further understanding of both predictive and individual factors would allow clinicians to focus treatments on those who are most likely to develop long-term complications following mTBI. A consultant-led, multidisciplinary service ensures a large number of patients will have complete resolution of mTBI symptoms after sport-related mTBI. Further research is now required to ascertain the key predictive indicators of outcome following sport-related mTBI.

Keywords: brain injury, concussion, neurology, rehabilitation, sports injury

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Authors: Lucia Billeci, Gennaro Tartarisco, Maurizio Varanini

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Fetal cardiac monitoring by fetal electrocardiogram (fECG) can provide significant clinical information about the healthy condition of the fetus. Despite this potentiality till now the use of fECG in clinical practice has been quite limited due to the difficulties in its measuring. The recovery of fECG from the signals acquired non-invasively by using electrodes placed on the maternal abdomen is a challenging task because abdominal signals are a mixture of several components and the fetal one is very weak. This paper presents an approach for fECG extraction from abdominal maternal recordings, which exploits the characteristics of pseudo-periodicity of fetal ECG. It consists of devising a quality index (fQI) for fECG and of finding the linear combinations of preprocessed abdominal signals, which maximize these fQI (quality index optimization - QIO). It aims at improving the performances of the most commonly adopted methods for fECG extraction, usually based on maternal ECG (mECG) estimating and canceling. The procedure for the fECG extraction and fetal QRS (fQRS) detection is completely unsupervised and based on the following steps: signal pre-processing; maternal ECG (mECG) extraction and maternal QRS detection; mECG component approximation and canceling by weighted principal component analysis; fECG extraction by fQI maximization and fetal QRS detection. The proposed method was compared with our previously developed procedure, which obtained the highest at the Physionet/Computing in Cardiology Challenge 2013. That procedure was based on removing the mECG from abdominal signals estimated by a principal component analysis (PCA) and applying the Independent component Analysis (ICA) on the residual signals. Both methods were developed and tuned using 69, 1 min long, abdominal measurements with fetal QRS annotation of the dataset A provided by PhysioNet/Computing in Cardiology Challenge 2013. The QIO-based and the ICA-based methods were compared in analyzing two databases of abdominal maternal ECG available on the Physionet site. The first is the Abdominal and Direct Fetal Electrocardiogram Database (ADdb) which contains the fetal QRS annotations thus allowing a quantitative performance comparison, the second is the Non-Invasive Fetal Electrocardiogram Database (NIdb), which does not contain the fetal QRS annotations so that the comparison between the two methods can be only qualitative. In particular, the comparison on NIdb was performed defining an index of quality for the fetal RR series. On the annotated database ADdb the QIO method, provided the performance indexes Sens=0.9988, PPA=0.9991, F1=0.9989 overcoming the ICA-based one, which provided Sens=0.9966, PPA=0.9972, F1=0.9969. The comparison on NIdb was performed defining an index of quality for the fetal RR series. The index of quality resulted higher for the QIO-based method compared to the ICA-based one in 35 records out 55 cases of the NIdb. The QIO-based method gave very high performances with both the databases. The results of this study foresees the application of the algorithm in a fully unsupervised way for the implementation in wearable devices for self-monitoring of fetal health.

Keywords: fetal electrocardiography, fetal QRS detection, independent component analysis (ICA), optimization, wearable

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Authors: Daya Weerasinghe

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Parental expectations often differ to that of their children and the influence and involvement of parents, at home, may affect the student performance in the classroom. This paper presents results from a survey of Asian and European background secondary school mathematics students (N=128) in Melbourne, Australia. Student responses to survey questions were analysed using confirmatory factor analysis, followed by t-tests and ANOVA. The aim of the analysis was to identify similarities and differences in parental expectations in relation to ethnicity, gender, and the year level of the students. The notable findings from the analysis showed no significant difference (at 0.05 level) in parental expectations and student performance, in relation to ethnicity or gender. Conversely, there was a significant difference in both parental expectations and student performance between year 7 and year 12 students. Further, whilst there was a significant difference in parental expectations between year 7 and year 11 students, the students’ performances were not significantly different. The results suggest further research may be needed to understand the parental expectations and student performance between the lower and upper secondary school mathematics students.

Keywords: ethnic background, gender, parental expectations, student performance, year level

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Authors: Masaki Yamaguchi, Daimei Sasayama, Shinsuke Washizuka

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The goal of this study was to examine the possibility of salivary cytokines for the screening of attention deficit hyperactivity disorder (ADHD) in children. We carried out a case-control study, including 19 children with ADHD and 17 healthy children (controls). A multiplex bead array immunoassay was used to conduct a multi-analysis of 27 different salivary cytokines. Six salivary cytokines (interleukin (IL)-1β, IL-8, IL12p70, granulocyte colony-stimulating factor (G-CSF), interferon gamma (IFN-γ), and vascular endothelial growth factor (VEGF)) were significantly associated with the presence of ADHD (p < 0.05). An informative salivary cytokine panel was developed using VEGF by logistic regression analysis (odds ratio: 0.251). Receiver operating characteristic analysis revealed that assessment of a panel using VEGF showed “good” capability for discriminating between ADHD patients and controls (area under the curve: 0.778). ADHD has been hypothesized to be associated with reduced cerebral blood flow in the frontal cortex, due to reduced VEGF levels. Our study highlights the possibility of utilizing differential salivary cytokine levels for point-of-care testing (POCT) of biomarkers in children with ADHD.

Keywords: cytokine, saliva, attention deficit hyperactivity disorder, child

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Authors: Bassem Boshra Thabet, Mohammed Ibrahim Elsabagh, Mohammad Adly Talaat

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The number of cellular mobile phone users has increased enormously worldwide over the last two decades. Consequently, the monitoring of the performance of the Mobile Network Operators (MNOs) in terms of network coverage and broadband signal strength has become vital for both of the MNOs and regulators. This monitoring helps telecommunications operators and regulators keeping the market playing fair and most beneficial for users. However, the adopted methodologies to facilitate this continuous monitoring process are still problematic regarding cost, effort, and reliability. This paper introduces My Operator Coverage (MOC) system that is using Internet of Things (IoT) concepts and tools to monitor the MNOs performance using a crowd-sourced real-time methodology. MOC produces robust and reliable geographical maps for the user-perceived quality of the MNOs performance. MOC is also meant to enrich the telecommunications regulators with concrete, and up-to-date information that allows for adequate mobile market management strategies as well as appropriate decision making.

Keywords: mobile performance monitoring, crowd-sourced applications, mobile broadband performance, cellular networks monitoring

Procedia PDF Downloads 396

Authors: Madhavi-Priya Singh, Liam Lowe, Farouk Arnaout, Ludmilla Pillay, Giordan Perez, Luke Mischker, Steve Costa

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An Emergency Department consultant identified the failure of medical students to complete the task of clerking a patient in its entirety. As six medical students on our first clinical placement, we recognised our own failure and endeavoured to examine why this failure was consistent among all medical students that had been given this task, despite our best motivations as adult learner. Our aim is to understand and investigate the elements which impeded our ability to learn and perform as medical students in the clinical environment, with reference to the prescribed task. We also aim to generate a discussion around the delivery of medical education with potential solutions to these barriers. Six medical students gathered together to have a comprehensive reflective discussion to identify possible factors leading to the failure of the task. First, we thoroughly analysed the delivery of the instructions with reference to the literature to identify potential flaws. We then examined personal, social, ethical, and cultural factors which may have impacted our ability to complete the task in its entirety. Through collation of our shared experiences, with support from discussion in the field of medical education and ethics, we identified two major areas that impacted our ability to complete the set task. First, we experienced an ethical conflict where we believed the inconvenience and potential harm inflicted on patients did not justify the positive impact the patient interaction would have on our medical learning. Second, we identified a lack of confidence stemming from multiple factors, including the conflict between preclinical and clinical learning, perceptions of perfectionism in the culture of medicine, and the influence of upward social comparison. After discussions, we found that the various factors we identified exacerbated the fears and doubts we already had about our own abilities and that of the medical education system. This doubt led us to avoid completing certain aspects of the tasks that were prescribed and further reinforced our vulnerability and perceived incompetence. Exploration of philosophical theories identified the importance of the role of doubt in education. We propose the need for further discussion around incorporating both pedagogic and andragogic teaching styles in clinical medical education and the acceptance of doubt as a driver of our learning. Doubt will continue to permeate our thoughts and actions no matter what. The moral or psychological distress that arises from this is the key motivating factor for our avoidance of tasks. If we accept this doubt and education embraces this doubt, it will no longer linger in the shadows as a negative and restrictive emotion but fuel a brighter dialogue and positive learning experience, ultimately assisting us in achieving our full potential.

Keywords: medical education, clinical education, andragogy, pedagogy

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Authors: Hae-Yeoun Lee

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Quantification of cardiac function is performed by calculating blood volume and ejection fraction in routine clinical practice. However, these works have been performed by manual contouring,which requires computational costs and varies on the observer. In this paper, an automatic left ventricle segmentation algorithm on cardiac magnetic resonance images (MRI) is presented. Using knowledge on cardiac MRI, a K-mean clustering technique is applied to segment blood region on a coil-sensitivity corrected image. Then, a graph searching technique is used to correct segmentation errors from coil distortion and noises. Finally, blood volume and ejection fraction are calculated. Using cardiac MRI from 15 subjects, the presented algorithm is tested and compared with manual contouring by experts to show outstanding performance.

Keywords: cardiac MRI, graph searching, left ventricle segmentation, K-means clustering

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Authors: Mahtab Davari, Charles Edward Okon, Somayeh Aghanavesi

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Every institute of learning is usually interested in the performance of enrolled students. The level of these performances determines the approach an institute of study may adopt in rendering academic services. The focus of this paper is to evaluate students' academic performance in given courses of study using machine learning methods. This study evaluated various supervised machine learning classification algorithms such as Logistic Regression (LR), Support Vector Machine, Random Forest, Decision Tree, K-Nearest Neighbors, Linear Discriminant Analysis, and Quadratic Discriminant Analysis, using selected features to predict study performance. The accuracy, precision, recall, and F1 score obtained from a 5-Fold Cross-Validation were used to determine the best classification algorithm to predict students’ performances. SVM (using a linear kernel), LDA, and LR were identified as the best-performing machine learning methods. Also, using the LR model, this study identified students' educational habits such as reading and paying attention in class as strong determinants for a student to have an above-average performance. Other important features include the academic history of the student and work. Demographic factors such as age, gender, high school graduation, etc., had no significant effect on a student's performance.

Keywords: student performance, supervised machine learning, classification, cross-validation, prediction

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Authors: Anna Ching-Yu Wong

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This study aims to identify the quality and effectiveness of the adult programs provided by the public library using the ServQUAL Method and the National Library Public Programs Assessment guidelines (NIPPA, June 2019). ServQUAl covers several variables, namely: tangible, reliability, responsiveness, assurance, and empathy. NIPPA guidelines focus on program characteristics, particularly on the outcomes – the level of satisfaction from program participants. The reached populations were adults who participated in library adult programs at a small-town public library in Kansas. This study was designed as quantitative evaluative research which analyzed the quality and effectiveness of the library adult programs by analyzing the role of each factor based on ServQUAL and the NIPPA's library program assessment guidelines. Data were collected from November 2019 to January 2020 using a questionnaire with a Likert Scale. The data obtained were analyzed in a descriptive quantitative manner. The impact of this research can provide information about the quality and effectiveness of existing programs and can be used as input to develop strategies for developing future adult programs. Overall the result of ServQUAL measurement is in very good quality, but still, areas need improvement and emphasis in each variable: Tangible Variables still need improvement in indicators of the temperature and space of the meeting room. Reliability Variable still needs improvement in the timely delivery of the programs. Responsiveness Variable still needs improvement in terms of the ability of the presenters to convey trust and confidence from participants. Assurance Variables still need improvement in the indicator of knowledge and skills of program presenters. Empathy Variable still needs improvement in terms of the presenters' willingness to provide extra assistance. The result of program outcomes measurement based on NIPPA guidelines is very positive. Over 96% of participants indicated that the programs were informative and fun. They learned new knowledge and new skills and would recommend the programs to their friends and families. They believed that together, the library and participants build stronger and healthier communities.

Keywords: ServQual model, ServQual in public libraries, library program assessment, NIPPA library programs assessment

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Authors: Eashwar V. Somasundaram, Raoul R. Wadhwa, Jacob G. Scott

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The use of radiomics in measuring geometric properties of tumor images such as size, surface area, and volume has been invaluable in assessing cancer diagnosis, treatment, and prognosis. In addition to analyzing geometric properties, radiomics would benefit from measuring topological properties using persistent homology. Intuitively, features uncovered by persistent homology may correlate to tumor structural features. One example is necrotic cavities (corresponding to 2D topological features), which are markers of very aggressive tumors. We develop a data pipeline in R that clusters tumors images based on persistent homology is used to identify meaningful clinical distinctions between tumors and possibly new relationships not captured by established clinical categorizations. A preliminary analysis was performed on 16 Magnetic Resonance Imaging (MRI) breast tissue segments downloaded from the 'Investigation of Serial Studies to Predict Your Therapeutic Response with Imaging and Molecular Analysis' (I-SPY TRIAL or ISPY1) collection in The Cancer Imaging Archive. Each segment represents a patient’s breast tumor prior to treatment. The ISPY1 dataset also provided the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status data. A persistent homology matrix up to 2-dimensional features was calculated for each of the MRI segmentation. Wasserstein distances were then calculated between all pairwise tumor image persistent homology matrices to create a distance matrix for each feature dimension. Since Wasserstein distances were calculated for 0, 1, and 2-dimensional features, three hierarchal clusters were constructed. The adjusted Rand Index was used to see how well the clusters corresponded to the ER/PR/HER2 status of the tumors. Triple-negative cancers (negative status for all three receptors) significantly clustered together in the 2-dimensional features dendrogram (Adjusted Rand Index of .35, p = .031). It is known that having a triple-negative breast tumor is associated with aggressive tumor growth and poor prognosis when compared to non-triple negative breast tumors. The aggressive tumor growth associated with triple-negative tumors may have a unique structure in an MRI segmentation, which persistent homology is able to identify. This preliminary analysis shows promising results in the use of persistent homology on tumor imaging to assess the severity of breast tumors. The next step is to apply this pipeline to other tumor segment images from The Cancer Imaging Archive at different sites such as the lung, kidney, and brain. In addition, whether other clinical parameters, such as overall survival, tumor stage, and tumor genotype data are captured well in persistent homology clusters will be assessed. If analyzing tumor MRI segments using persistent homology consistently identifies clinical relationships, this could enable clinicians to use persistent homology data as a noninvasive way to inform clinical decision making in oncology.

Keywords: cancer biology, oncology, persistent homology, radiomics, topological data analysis, tumor imaging

Procedia PDF Downloads 135

Authors: M. S. Rodríguez, F. Cadaveira, M. F. Páramo

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First year university students comprise one of the groups most likely to indulge in hazardous alcohol consumption. The transition from secondary school to university presents a range of academic, social and developmental challenges requiring new responses that will meet the demands of this highly competitive environment. The main purpose of this research was to analyze the influence of gender and hazardous alcohol consumption on academic performance of 300 university students in Spain in a three-year follow-up study. Alcohol consumption was measured using the Alcohol Use Identification Test (AUDIT), and the average university grades were provided by the Academic Management Services of the University. Analysis of variance showed that the level of alcohol consumption significantly affected academic performance. Students undertaking hazardous alcohol consumption obtained the lowest grades during the first three years at university. These effects were particularly marked in the sample of women with a hazardous pattern of alcohol consumption, although the interaction between gender and this type of consumption was not significant. The study highlights the impact of hazardous alcohol consumption on the academic trajectory of university students. The findings confirm that alcohol consumption predicts poor academic performance in first year students and that the low level of performance is maintained throughout the university career.

Keywords: academic performance, alcohol consumption, gender, university students

Procedia PDF Downloads 311