Search results for: risk assessment model
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 24665

Search results for: risk assessment model

4475 Channel Estimation for Orthogonal Frequency Division Multiplexing Systems over Doubly Selective Channels Base on DCS-DCSOMP Algorithm

Authors: Linyu Wang, Furui Huo, Jianhong Xiang

Abstract:

The Doppler shift generated by high-speed movement and multipath effects in the channel are the main reasons for the generation of a time-frequency doubly-selective (DS) channel. There is severe inter-carrier interference (ICI) in the DS channel. Channel estimation for an orthogonal frequency division multiplexing (OFDM) system over a DS channel is very difficult. The simultaneous orthogonal matching pursuit algorithm under distributed compressive sensing theory (DCS-SOMP) has been used in channel estimation for OFDM systems over DS channels. However, the reconstruction accuracy of the DCS-SOMP algorithm is not high enough in the low SNR stage. To solve this problem, in this paper, we propose an improved DCS-SOMP algorithm based on the inner product difference comparison operation (DCS-DCSOMP). The reconstruction accuracy is improved by increasing the number of candidate indexes and designing the comparison conditions of inner product difference. We combine the DCS-DCSOMP algorithm with the basis expansion model (BEM) to reduce the complexity of channel estimation. Simulation results show the effectiveness of the proposed algorithm and its advantages over other algorithms.

Keywords: OFDM, doubly selective, channel estimation, compressed sensing

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4474 The Influence of Age and Education on Patients' Attitudes Towards Contraceptives in Rural California

Authors: Shivani Thakur, Jasmin Dominguez Cervantes, Ahmed Zabiba, Fatima Zabiba, Sandhini Agarwal, Kamalpreet Kaur, Hussein Maatouk, Shae Chand, Omar Madriz, Tiffany Huang, Saloni Bansal

Abstract:

Contraceptives are an effective public health achievement, allowing for family planning and reducing the risk of sexually transmitted diseases (STDs). California’s rural Central Valley has high rates of teenage pregnancy and STDs. Factors affecting contraceptive usage here may include religious concerns, financial issues, and regional variations in the accessibility and availability of contraceptives. The increasing population and diversity of the Central Valley make the understanding of the determinants of unintended pregnancy and STDs increasingly nuanced. Patients in California’s Central Valley were surveyed at 6 surgical clinics to assess attitudes toward contraceptives. The questionnaire consisted of demographics and 14 Likert-scale statements investigating patients’ feelings regarding contraceptives. Parametric and non-parametric analysis was performed on the Likert statements. A correlation matrix for the Likert-scale statements was used to evaluate the strength of the relationship between each question. 76 patients aged 18-75 years completed the questionnaire. 90% of the participants were female, 76% Hispanic, 36% married, 44% with an income range between 30-60K, and 83% were between childbearing ages. 60% of participants stated they are currently using or had used some type of contraceptive. 25% of participants had at least one unplanned pregnancy. The most common type of contraceptives used were oral contraceptives(28%) and condoms(38%). The top reasons for patients’ contraceptive usage were: prevention of pregnancy (72%), safe sex/prevention of STDs (32%), and regulation of menstrual cycle (19%). Further analysis of Likert responses revealed that contraception usage increased due to approval of contraceptives (x̄=3.98, σ =1.02); partner approval of contraceptives (x̄=3.875, σ =1.16); and reduced anxiety about pregnancy (x̄=3.875, σ =1.23). Younger females (18-34 years old) agreed more with the statement that the cost of contraceptive supplies is too expensive than older females (35-75 years old), (x̄=3.2, σ = 1.4 vs x̄=2.8, σ =1.3, p<0.05). Younger females (44%) were also more likely to use short-acting contraceptive methods (oral and male condoms) compared to older females (64%) who use long-acting methods (implants/ intrauterine devices). 51% of Hispanic females were using some type of contraceptive. Of those Hispanic females who do not use contraceptives, 33% stated having no children, and all plan to have at least one child in the future. 35% of participants had a bachelor's degree. Those with bachelor’s degrees were more likely to use contraceptives, 58% vs 51%, p<0.05, and less likely to have unplanned pregnancy, 50% vs. 12%, p<0.01. There is increasing use and awareness among patients in rural settings concerning contraceptives. Our finding shows that younger women and women with higher educational attainment tend to have more positive attitudes towards the use of contraceptives. This work gives physicians an understanding of patients’ concerns about contraceptive methods and offers insight into culturally competent intervention programs that respect individual values.

Keywords: contraceptives, public health, rural california, women of child baring age

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4473 A Parametric Study on Lateral Torsional Buckling of European IPN and IPE Cantilevers

Authors: H. Ozbasaran

Abstract:

IPN and IPE sections, which are commonly used European I shapes, are widely used in steel structures as cantilever beams to support overhangs. A considerable number of studies exist on calculating lateral torsional buckling load of I sections. However, most of them provide series solutions or complex closed-form equations. In this paper, a simple equation is presented to calculate lateral torsional buckling load of IPN and IPE section cantilever beams. First, differential equation of lateral torsional buckling is solved numerically for various loading cases. Then a parametric study is conducted on results to present an equation for lateral torsional buckling load of European IPN and IPE beams. Finally, results obtained by presented equation are compared to differential equation solutions and finite element model results. ABAQUS software is utilized to generate finite element models of beams. It is seen that the results obtained from presented equation coincide with differential equation solutions and ABAQUS software results. It can be suggested that presented formula can be safely used to calculate critical lateral torsional buckling load of European IPN and IPE section cantilevers.

Keywords: cantilever, IPN, IPE, lateral torsional buckling

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4472 Protection and Renewal Strategies of Historical Blocks from the Perspective of “Staged Authenticity”

Authors: Xu Yingqiang, Wang Zhongde

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In the age of stock development, the contradiction between the protection and development of historical blocks in China has become increasingly prominent, among which how to reconcile the contradiction between tourists and local residents and inherit urban culture is an important proposition. Based on this, this paper introduces the theory of " staged authenticity ", combs its development process and related research progress, constructs an analysis and research model of historical blocks based on the theory of " staged authenticity ", and puts forward the protection and renewal strategy of historical blocks from the perspective of " staged authenticity ", which provides theoretical basis for coordinating the tourism-residence contradiction and protecting urban characteristics in the protection and renewal of historical blocks. The research holds that we should pay attention to the important value of "curtain" space, rationally arrange "curtain" and divide "foreground" and "background"; extract "props" from real history and culture to restore the authenticity of "stage" scenes; clever arrangement of tour streamline, so that all scenes are connected in series rhythmically; make the "actors" perform interactively in the "foreground" space, so as to enhance the "audience" sense of scene substitution.

Keywords: historic block, protection and renewal, staged authenticity, curtain

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4471 Blockchain for IoT Security and Privacy in Healthcare Sector

Authors: Umair Shafique, Hafiz Usman Zia, Fiaz Majeed, Samina Naz, Javeria Ahmed, Maleeha Zainab

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The Internet of Things (IoT) has become a hot topic for the last couple of years. This innovative technology has shown promising progress in various areas, and the world has witnessed exponential growth in multiple application domains. Researchers are working to investigate its aptitudes to get the best from it by harnessing its true potential. But at the same time, IoT networks open up a new aspect of vulnerability and physical threats to data integrity, privacy, and confidentiality. It's is due to centralized control, data silos approach for handling information, and a lack of standardization in the IoT networks. As we know, blockchain is a new technology that involves creating secure distributed ledgers to store and communicate data. Some of the benefits include resiliency, integrity, anonymity, decentralization, and autonomous control. The potential for blockchain technology to provide the key to managing and controlling IoT has created a new wave of excitement around the idea of putting that data back into the hands of the end-users. In this manuscript, we have proposed a model that combines blockchain and IoT networks to address potential security and privacy issues in the healthcare domain. Then we try to describe various application areas, challenges, and future directions in the healthcare sector where blockchain platforms merge with IoT networks.

Keywords: IoT, blockchain, cryptocurrency, healthcare, consensus, data

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4470 How to “Eat” without Actually Eating: Marking Metaphor with Spanish Se and Italian Si

Authors: Cinzia Russi, Chiyo Nishida

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Using data from online corpora (Spanish CREA, Italian CORIS), this paper examines the relatively understudied use of Spanish se and Italian si exemplified in (1) and (2), respectively. (1) El rojo es … el que se come a los demás. ‘The red (bottle) is the one that outshines/*eats the rest.’(2) … ebbe anche la saggezza di mangiarsi tutto il suo patrimonio. ‘… he even had the wisdom to squander/*eat all his estate.’ In these sentences, se/si accompanies the consumption verb comer/mangiare ‘to eat’, without which the sentences would not be interpreted appropriately. This se/si cannot readily be attributed to any of the multiple functions so far identified in the literature: reflexive, ergative, middle/passive, inherent, benefactive, and complete consumptive. In particular, this paper argues against the feasibility of a recent construction-based analysis of sentences like (1) and (2), which situates se/si within a prototype-based network of meanings all deriving from the central meaning of 'COMPLETE CONSUMPTION' (e.g., Alice se comió toda la torta/Alicesi è mangiata tutta la torta ‘John ate the whole cake’). Clearly, the empirical adequacy of such an account is undermined by the fact that the events depicted in the se/si-sentences at issue do not always entail complete consumption because they may lack an INCREMENTAL THEME, the distinguishing property of complete consumption. Alternatively, it is proposed that the sentences under analysis represent instances of verbal METAPHORICAL EXTENSION: se/si represents an explicit marker of this cognitive process, which has independently developed from the complete consumptive se/si, and the meaning extension is captured by the general tenets of Conceptual Metaphor Theory (CMT). Two conceptual domains, Source (DS) and target (DT), are related by similarity, assigning an appropriate metaphorical interpretation to DT. The domains paired here are comer/mangiare (DS) and comerse/mangiarsi (DT). The eating event (DS) involves (a) the physical process of xEATER grinding yFOOD-STUFF into pieces and swallowing it; and (b) the aspect of xEATER savoring yFOOD-STUFF and being nurtured by it. In the physical act of eating, xEATER has dominance and exercises his force over yFOOD-STUFF. This general sense of dominance and force is mapped onto DT and is manifested in the ways exemplified in (1) and (2), and many others. According to CMT, two other properties are observed in each pair of DS & DT. First, DS tends to be more physical and concrete and DT more abstract, and systematic mappings are established between constituent elements in DS and those in DT: xEATER corresponds to the element that destroys and yFOOD-STUFF to the element that is destroyed in DT, as exemplified in (1) and (2). Though the metaphorical extension marker se/si appears by far most frequently with comer/mangiare in the corpora, similar systematic mappings are observed in several other verb pairs, for example, jugar/giocare ‘to play (games)’ and jugarse/giocarsi ‘to jeopardize/risk (life, reputation, etc.)’, perder/perdere ‘to lose (an object)’ and perderse/perdersi ‘to miss out on (an event)’, etc. Thus, this study provides evidence that languages may indeed formally mark metaphor using means available to them.

Keywords: complete consumption value, conceptual metaphor, Italian si/Spanish se, metaphorical extension.

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4469 Home Environment and Self-Efficacy Beliefs among Native American, African American and Latino Adolescents

Authors: Robert H. Bradley

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Many minority adolescents in the United States live in adverse circumstances that pose long-term threats to their well-being. A strong sense of personal control and self-efficacy can help youth mitigate some of those risks and may help protect youth from influences connected with deviant peer groups. Accordingly, it is important to identify conditions that help foster feelings of efficacy in areas that seem critical for the accomplishment of developmental tasks during adolescence. The purpose of this study is to examine two aspects of the home environment (modeling and encouragement of maturity, family companionship and investment) and their relation to three components of self efficacy (self efficacy in enlisting social resources, self efficacy for engaging in independent learning, and self-efficacy for self-regulatory behavior) in three groups of minority adolescents (Native American, African American, Latino). The sample for this study included 54 Native American, 131 African American, and 159 Latino families, each with a child between 16 and 20 years old. The families were recruited from four states: Arizona, Arkansas, California, and Oklahoma. Each family was administered the Late Adolescence version of the Home Observation for Measurement of the Environment (HOME) Inventory and each adolescent completed a 30-item measure of perceived self-efficacy. Three areas of self-efficacy beliefs were examined for this study: enlisting social resources, independent learning, and self-regulation. Each of the three areas of self-efficacy was regressed on the two aspects of the home environment plus overall household risk. For Native Americans, modeling and encouragement were significant for self-efficacy pertaining to enlisting social resources and independent learning. For African Americans, companionship and investment was significant in all three models. For Latinos, modeling and encouragement was significant for self-efficacy pertaining to enlisting social resources and companionship and investment were significant for the other two areas of self-efficacy. The findings show that even as minority adolescents are becoming more individuated from their parents, the quality of experiences at home continues to be associated with their feelings of self-efficacy in areas important for adaptive functioning in adult life. Specifically, individuals can develop a sense that they are efficacious in performing key tasks relevant to work, social relationships, and management of their own behavior if they are guided in how to deal with key challenges and they have been exposed and supported by others who are competent in dealing with such challenges. The findings presented in this study would seem useful given that there is so little current research on home environmental factors connected to self-efficacy beliefs among adolescents in the three groups examined. It would seem worthwhile that personnel from health, human service and juvenile justice agencies give attention to supporting parents in communicating with adolescents, offering expectations to adolescents in mutually supportive ways, and in engaging with adolescents in productive activities. In comparison to programs for parents of young children, there are few specifically designed for parents of children in middle childhood and adolescence.

Keywords: family companionship, home environment, household income, modeling, self-efficacy

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4468 Revolutionizing Accounting: Unleashing the Power of Artificial Intelligence

Authors: Sogand Barghi

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The integration of artificial intelligence (AI) in accounting practices is reshaping the landscape of financial management. This paper explores the innovative applications of AI in the realm of accounting, emphasizing its transformative impact on efficiency, accuracy, decision-making, and financial insights. By harnessing AI's capabilities in data analysis, pattern recognition, and automation, accounting professionals can redefine their roles, elevate strategic decision-making, and unlock unparalleled value for businesses. This paper delves into AI-driven solutions such as automated data entry, fraud detection, predictive analytics, and intelligent financial reporting, highlighting their potential to revolutionize the accounting profession. Artificial intelligence has swiftly emerged as a game-changer across industries, and accounting is no exception. This paper seeks to illuminate the profound ways in which AI is reshaping accounting practices, transcending conventional boundaries, and propelling the profession toward a new era of efficiency and insight-driven decision-making. One of the most impactful applications of AI in accounting is automation. Tasks that were once labor-intensive and time-consuming, such as data entry and reconciliation, can now be streamlined through AI-driven algorithms. This not only reduces the risk of errors but also allows accountants to allocate their valuable time to more strategic and analytical tasks. AI's ability to analyze vast amounts of data in real time enables it to detect irregularities and anomalies that might go unnoticed by traditional methods. Fraud detection algorithms can continuously monitor financial transactions, flagging any suspicious patterns and thereby bolstering financial security. AI-driven predictive analytics can forecast future financial trends based on historical data and market variables. This empowers organizations to make informed decisions, optimize resource allocation, and develop proactive strategies that enhance profitability and sustainability. Traditional financial reporting often involves extensive manual effort and data manipulation. With AI, reporting becomes more intelligent and intuitive. Automated report generation not only saves time but also ensures accuracy and consistency in financial statements. While the potential benefits of AI in accounting are undeniable, there are challenges to address. Data privacy and security concerns, the need for continuous learning to keep up with evolving AI technologies, and potential biases within algorithms demand careful attention. The convergence of AI and accounting marks a pivotal juncture in the evolution of financial management. By harnessing the capabilities of AI, accounting professionals can transcend routine tasks, becoming strategic advisors and data-driven decision-makers. The applications discussed in this paper underline the transformative power of AI, setting the stage for an accounting landscape that is smarter, more efficient, and more insightful than ever before. The future of accounting is here, and it's driven by artificial intelligence.

Keywords: artificial intelligence, accounting, automation, predictive analytics, financial reporting

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4467 Implementation of an Online-Platform at the University of Freiburg to Help Medical Students Cope with Stress

Authors: Zoltán Höhling, Sarah-Lu Oberschelp, Niklas Gilsdorf, Michael Wirsching, Andrea Kuhnert

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A majority of medical students at the University of Freiburg reported stress-related psychosomatic symptoms which are often associated with their studies. International research supports these findings, as medical students worldwide seem to be at special risk for mental health problems. In some countries and institutions, psychologically based interventions that assist medical students in coping with their stressors have been implemented. It turned out that anonymity is an important aspect here. Many students fear a potential damage of reputation when being associated with mental health problems, which may be due to a high level of competitiveness in classes. Therefore, we launched an online-platform where medical students could anonymously seek help and exchange their experiences with fellow students and experts. Medical students of all semesters have access to it through the university’s learning management system (called “ILIAS”). The informative part of the platform consists of exemplary videos showing medical students (actors) who act out scenes that demonstrate the antecedents of stress-related psychosomatic disorders. These videos are linked to different expert comments, describing the exhibited symptoms in an understandable and normalizing way. The (inter-)active part of the platform consists of self-help tools (such as meditation exercises or general tips for stress-coping) and an anonymous interactive forum where students can describe their stress-related problems and seek guidance from experts and/or share their experiences with fellow students. Besides creating an immediate proposal to help affected students, we expect that competitiveness between students might be diminished and bondage improved through mutual support between them. In the initial phase after the platform’s launch, it was accessed by a considerable number of medical students. On a closer look it appeared that platform sections like general information on psychosomatic-symptoms and self-treatment tools were accessed far more often than the online-forum during the first months after the platform launch. Although initial acceptance of the platform was relatively high, students showed a rather passive way of using our platform. While user statistics showed a clear demand for information on stress-related psychosomatic symptoms and its possible remedies, active engagement in the interactive online-forum was rare. We are currently advertising the platform intensively and trying to point out the assured anonymity of the platform and its interactive forum. Our plans, to assure students their anonymity through the use of an e-learning facility and promote active engagement in the online forum, did not (yet) turn out as expected. The reasons behind this may be manifold and based on either e-learning related issues or issues related to students’ individual needs. Students might, for example, question the assured anonymity due to a lack of trust in the technological functioning university’s learning management system. However, one may also conclude that reluctance to discuss stress-related psychosomatic symptoms with peer medical students may not be solely based on anonymity concerns, but could be rooted in more complex issues such as general mistrust between students.

Keywords: e-tutoring, stress-coping, student support, online forum

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4466 Real Estate Rigidities: The Effect of Cash Transactions and the Impact of Demonetisation on Them

Authors: Dishant Shahi, Aradhya Shandilya, Nand Kumar

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We study here the impact of the black component referred to as X component in the text on Real estate transactions. The X component involved not only acts as friction in transaction but also leads to dysfunctionality in the capital market of real estate. The effect of the component is presented by using a model of economy which seeks resemblance with that of India involving property deals. The rigidities which hinder smooth transactions in property or land deals are depicted and their impact on the economy as a whole has been modelled. The effect of subprime crisis (2007) on Indian housing capital market and the role which the X component played during it, is also included in one of the sections. In the entire text, we have utilised 4 Quadrant graphs to study supply and demand causalities involved in commercial real estate. At the end we have included the impact of demonetisation as a move to counter the problem of overvaluation in the property assets arising due to the X component. The case of Demonetisation which has been the latest move by the Indian Government to control huge amount of black money in circulation has been included along with its impact on the housing and rent as well as the capital market.

Keywords: X-component, 4Q graph, real estate, capital markets, demonetisation, consumer sentiments

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4465 A Study on the Annual Doses Received by the Workers of Some Medical Practices

Authors: Eltayeb Hamad Elneel Yousif

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This paper describes occupational radiation doses of workers in non-destructive testing (NDT) and some medical practices during the year 2007. The annual doses received by the workers of a public hospital are presented in this report. The Department is facilitated with HARSHAW Reader model 6600 and assigned the rule of personal monitoring to contribute in controlling and reducing the doses received by radiation workers. TLD cards with two TLD chips type LiF: Mg, Ti (TLD-100) were calibrated to measure the personal dose equivalent Hp(10). Around 150 medical radiation workers were monitored throughout the year. Each worker received a single TLD card worn on the chest above lead apron and returned for laboratory reading every two months. The average annual doses received by the workers of radiotherapy, nuclear medicine and diagnostic radiology were evaluated. The annual doses for individual radiation workers ranged between 0.55-4.42 mSv, 0.48-1.86 mSv, and 0.48-0.91 mSv for the workers of radiotherapy, nuclear medicine and diagnostic radiology, respectively. The mean dose per worker was 1.29±1, 1.03±0.4, and 0.69±0.2 mSv, respectively. The results showed compliance with international dose limits. Our results reconfirm the importance of personal dosimetry service in assuring the radiation protection of medical staff in developing countries.

Keywords: radiation medicine, non-destructive testing, TLD, public hospital

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4464 Rheology Study of Polyurethane (COAPUR 6050) For Composite Materials Usage

Authors: Sabrina Boutaleb, Kouider Halim Benrahou, François Schosseler, Abdelouahed Tounsi, El Abbas Adda Bedia

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The use of polyurethane in different areas becomes more frequent. This is due to significant advantages they have including their lightness and resistance. However, their use requires a mastery of their mechanical performance. We will present in this work, a COAPUR 6050 which can be used to develop composite materials. COAPUR 6050 is an associative polyurethane thickener allowing fine rheological adjustment of flat or semi-gloss paints. COAPUR 6050 is characterised by its thickening efficiency at low shear rate. It is a solvent-free liquid product. It promotes good paint pick up, while maintaining a low yield point after shearing, and consequently a good levelling. We will then determine its rheological behaviour experimentally using different annular gaps. The rheological properties of COAPUR 6050 were researched by rotational rheometer (Rheometer-Mars III) using different annular gaps. There is the influence of the size of the annular gap on the behaviour as well as on the rheological parameters of the COAPUR 6050. The rheological properties data of COAPUR 6050 were regressed by nonlinear regression method and their rheological models were established, are characterized by yield pseudoplastic model. In this case, it is essential to make a viscometric correction. The latter was developed and presented in the experimental results.

Keywords: COAPUR 6050, flow’s couette, polyurethane, rheological behaviours

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4463 Kinetics and Adsorption Studies of Tetracycline from Aqueous Solution Using Melon Husk

Authors: Ungwanen John Ahile, Sylvester Obaike Adejo, Simon Terver Ubwa, Raymond Lubem Tyohemba, Pius Utange, Mnena G. Ikyagh

Abstract:

The adsorption of tetracycline from aqueous solution was carried out using melon husk as a low-cost adsorbent. The adsorption was characterized using standard methods and values obtained were; pH = 7.80, bulk density = 0.43 g/mL, ash content = 2.2 %, moisture content = 8.27 %, attrition = 1%, and iodine number = 552 mg/g. Adsorption capacity was found to vary with initial concentration, adsorbent dosage, pH, contact time and temperature, the maximum adsorption capacity in each case was found to be at; 30 mg/L for concentration, 0.8 g for adsorbent dose, 5 for pH, 60 minutes for time and 30 °C for temperature. FTIR analysis was done to analyses the surface functional groups which shows the presence of O-H stretch, at 3743.92 corresponding to alcohol, phenols, C-H stretch at 2923.27 indicative of alkanes, H-C=O: C-H stretch at 2725.76 corresponding to aldehyde, C-C stretch at 1462.72 corresponding to aromatic, SEM analysis carried out revealed a rough and smooth morphology of the uncontacted and contacted adsorbent respectively. The experimental data judging from the R2 values fitted best into the Temkin isotherm. The fitting of tetracycline adsorption into the pseudo second order kinetic model (R2 of 0.9992) is suggestive of chemisorption for the adsorbent.

Keywords: adsorption, adsorbent isotherm, antibiotics, tertracycline

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4462 Mathematical Modelling of a Low Tip Speed Ratio Wind Turbine for System Design Evaluation

Authors: Amir Jalalian-Khakshour, T. N. Croft

Abstract:

Vertical Axis Wind Turbine (VAWT) systems are becoming increasingly popular as they have a number of advantages over traditional wind turbines. The advantages are reliability, ease of transportation and manufacturing. These attributes could make these technologies useful in developing economies. The performance characteristics of a VAWT are different from a horizontal axis wind turbine, which can be attributed to the low tip speed ratio operation. To unlock the potential of these VAWT systems, the operational behaviour in a number of system topologies and environmental conditions needs to be understood. In this study, a non-linear dynamic simulation method was developed in Matlab and validated against in field data of a large scale, 8-meter rotor diameter prototype. This simulation method has been utilised to determine the performance characteristics of a number of control methods and system topologies. The motivation for this research was to develop a simulation method which accurately captures the operating behaviour and is computationally inexpensive. The model was used to evaluate the performance through parametric studies and optimisation techniques. The study gave useful insights into the applications and energy generation potential of this technology.

Keywords: power generation, renewable energy, rotordynamics, wind energy

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4461 The Digital Transformation of Life Insurance Sales in Iran With the Emergence of Personal Financial Planning Robots; Opportunities and Challenges

Authors: Pedram Saadati, Zahra Nazari

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Anticipating and identifying future opportunities and challenges facing industry activists for the emergence and entry of new knowledge and technologies of personal financial planning, and providing practical solutions is one of the goals of this research. For this purpose, a future research tool based on receiving opinions from the main players of the insurance industry has been used. The research method in this study was in 4 stages; including 1- a survey of the specialist salesforce of life insurance in order to identify the variables 2- the ranking of the variables by experts selected by a researcher-made questionnaire 3- holding a panel of experts with the aim of understanding the mutual effects of the variables and 4- statistical analyzes of the mutual effects matrix in Mick Mac software is done. The integrated analysis of influencing variables in the future has been done with the method of Structural Analysis, which is one of the efficient and innovative methods of future research. A list of opportunities and challenges was identified through a survey of best-selling life insurance representatives who were selected by snowball sampling. In order to prioritize and identify the most important issues, all the issues raised were sent to selected experts who were selected theoretically through a researcher-made questionnaire. The respondents determined the importance of 36 variables through scoring, so that the prioritization of opportunity and challenge variables can be determined. 8 of the variables identified in the first stage were removed by selected experts, and finally, the number of variables that could be examined in the third stage became 28 variables, which, in order to facilitate the examination, were divided into 6 categories, respectively, 11 variables of organization and management. Marketing and sales 7 cases, social and cultural 6 cases, technological 2 cases, rebranding 1 case and insurance 1 case were divided. The reliability of the researcher-made questionnaire was confirmed with the Cronbach's alpha test value of 0.96. In the third stage, by forming a panel consisting of 5 insurance industry experts, the consensus of their opinions about the influence of factors on each other and the ranking of variables was entered into the matrix. The matrix included the interrelationships of 28 variables, which were investigated using the structural analysis method. By analyzing the data obtained from the matrix by Mic Mac software, the findings of the research indicate that the categories of "correct training in the use of the software, the weakness of the technology of insurance companies in personalizing products, using the approach of equipping the customer, and honesty in declaring no need Customer to Insurance", the most important challenges of the influencer and the categories of "salesforce equipping approach, product personalization based on customer needs assessment, customer's pleasant experience of being consulted with consulting robots, business improvement of the insurance company due to the use of these tools, increasing the efficiency of the issuance process and optimal customer purchase" were identified as the most important opportunities for influence.

Keywords: personal financial planning, wealth management, advisor robots, life insurance, digital transformation

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4460 Multiscale Computational Approach to Enhance the Understanding, Design and Development of CO₂ Catalytic Conversion Technologies

Authors: Agnieszka S. Dzielendziak, Lindsay-Marie Armstrong, Matthew E. Potter, Robert Raja, Pier J. A. Sazio

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Reducing carbon dioxide, CO₂, is one of the greatest global challenges. Conversion of CO₂ for utilisation across synthetic fuel, pharmaceutical, and agrochemical industries offers a promising option, yet requires significant research to understanding the complex multiscale processes involved. To experimentally understand and optimize such processes at that catalytic sites and exploring the impact of the process at reactor scale, is too expensive. Computational methods offer significant insight and flexibility but require a more detailed multi-scale approach which is a significant challenge in itself. This work introduces a computational approach which incorporates detailed catalytic models, taken from experimental investigations, into a larger-scale computational flow dynamics framework. The reactor-scale species transport approach is modified near the catalytic walls to determine the influence of catalytic clustering regions. This coupling approach enables more accurate modelling of velocity, pressures, temperatures, species concentrations and near-wall surface characteristics which will ultimately enable the impact of overall reactor design on chemical conversion performance.

Keywords: catalysis, CCU, CO₂, multi-scale model

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4459 Driver Behavior Analysis and Inter-Vehicular Collision Simulation Approach

Authors: Lu Zhao, Nadir Farhi, Zoi Christoforou, Nadia Haddadou

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The safety test of deploying intelligent connected vehicles (ICVs) on the road network is a critical challenge. Road traffic network simulation can be used to test the functionality of ICVs, which is not only time-saving and less energy-consuming but also can create scenarios with car collisions. However, the relationship between different human driver behaviors and the car-collision occurrences has been not understood clearly; meanwhile, the procedure of car-collisions generation in the traffic numerical simulators is not fully integrated. In this paper, we propose an approach to identify specific driver profiles from real driven data; then, we replicate them in numerical traffic simulations with the purpose of generating inter-vehicular collisions. We proposed three profiles: (i) 'aggressive': short time-headway, (ii) 'inattentive': long reaction time, and (iii) 'normal' with intermediate values of reaction time and time-headway. These three driver profiles are extracted from the NGSIM dataset and simulated using the intelligent driver model (IDM), with an extension of reaction time. At last, the generation of inter-vehicular collisions is performed by varying the percentages of different profiles.

Keywords: vehicular collisions, human driving behavior, traffic modeling, car-following models, microscopic traffic simulation

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4458 Functionalization of Sanitary Pads with Probiotic Paste

Authors: O. Sauperl, L. Fras Zemljic

Abstract:

The textile industry is gaining increasing importance in the field of medical materials. Therefore, presented research is focused on textile materials for external (out-of-body) use. Such materials could be various hygienic textile products (diapers, tampons, sanitary napkins, incontinence products, etc.), protective textiles and various hospital linens (surgical covers, masks, gowns, cloths, bed linens, etc.) wound pillows, bandages, orthopedic socks, etc. Function of tampons and sanitary napkins is not only to provide protection during the menstrual cycle, but their function can be also to take care of physiological or pathological vaginal discharge. In general, women's intimate areas are against infection protected by a low pH value of the vaginal flora. High pH inhibits the development of harmful microorganisms, as it is difficult to be reproduced in an acidic environment. The normal vaginal flora in healthy women is highly colonized by lactobacilli. The lactic acid produced by these organisms maintains the constant acidity of the vagina. If the balance of natural protection breaks, infections can occur. In the market, there exist probiotic tampons as a medical product supplying the vagina with beneficial probiotic lactobacilli. But, many users have concerns about the use of tampons due to the possible dry-out of the vagina as well as the possible toxic shock syndrome, which is the reason that they use mainly sanitary napkins during the menstrual cycle. Functionalization of sanitary napkins with probiotics is, therefore, interesting in regard to maintain a healthy vaginal flora and to offer to users added value of the sanitary napkins in the sense of health- and environmentally-friendly products. For this reason, the presented research is oriented in functionalization of the sanitary napkins with the probiotic paste in order to activate the lactic acid bacteria presented in the core of the functionalized sanitary napkin at the time of the contact with the menstrual fluid. In this way, lactobacilli could penetrate into vagina and by maintaining healthy vaginal flora to reduce the risk of vaginal disorders. In regard to the targeted research problem, the influence of probiotic paste applied onto cotton hygienic napkins on selected properties was studied. The aim of the research was to determine whether the sanitary napkins with the applied probiotic paste may assure suitable vaginal pH to maintain a healthy vaginal flora during the use of this product. Together with this, sorption properties of probiotic functionalized sanitary napkins were evaluated and compared to the untreated one. The research itself was carried out on the basis of tracking and controlling the input parameters, currently defined by Slovenian producer (Tosama d.o.o.) as the most important. Successful functionalization of sanitary pads with the probiotic paste was confirmed by ATR-FTIR spectroscopy. Results of the methods used within the presented research show that the absorption of the pads treated with probiotic paste deteriorates compared to non-treated ones. The coating shows a 6-month stability. Functionalization of sanitary pads with probiotic paste is believed to have a commercial potential for lowering the probability of infection during the menstrual cycle.

Keywords: functionalization, probiotic paste, sanitary pads, textile materials

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4457 Simulation of Fiber Deposition on Molded Fiber Screen Using Multi-Sphere Discrete Element Method

Authors: Kim Quy Le, Duan Fei, Jia Wei Chew, Jun Zeng, Maria Fabiola Leyva

Abstract:

In line with the sustainable development goal, molded fiber products play important roles in reducing plastic-based packaging. To fabricate molded fiber products, besides using conventional meshing tools, 3D printing is employed to manufacture the molded fiber screen. 3D printing technique allows printing molded fiber screens with complex geometry, flexible in pore size and shape. The 3D printed molded fiber screens are in the progress of investigation to improve the de-watering efficiency, fiber collection, mechanical strength, etc. In addition, the fiber distribution on the screen is also necessary to access the quality of the screen. Besides using experimental methods to capture the fiber distribution on screen, simulation also offers using tools to access the uniformity of fiber. In this study, the fiber was simulated using the multi-sphere model to simulate the fibers. The interaction of the fibers was able to mimic by employing the discrete element method. The fiber distribution was captured and compared to the experiment. The simulation results were able to reveal the fiber deposition layer upon layer and explain the formation of uneven thickness on the tilted area of molded fiber screen.

Keywords: 3D printing, multi-jet fusion, molded fiber screen, discrete element method

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4456 A Machine Learning Approach for Intelligent Transportation System Management on Urban Roads

Authors: Ashish Dhamaniya, Vineet Jain, Rajesh Chouhan

Abstract:

Traffic management is one of the gigantic issue in most of the urban roads in al-most all metropolitan cities in India. Speed is one of the critical traffic parameters for effective Intelligent Transportation System (ITS) implementation as it decides the arrival rate of vehicles on an intersection which are majorly the point of con-gestions. The study aimed to leverage Machine Learning (ML) models to produce precise predictions of speed on urban roadway links. The research objective was to assess how categorized traffic volume and road width, serving as variables, in-fluence speed prediction. Four tree-based regression models namely: Decision Tree (DT), Random Forest (RF), Extra Tree (ET), and Extreme Gradient Boost (XGB)are employed for this purpose. The models' performances were validated using test data, and the results demonstrate that Random Forest surpasses other machine learning techniques and a conventional utility theory-based model in speed prediction. The study is useful for managing the urban roadway network performance under mixed traffic conditions and effective implementation of ITS.

Keywords: stream speed, urban roads, machine learning, traffic flow

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4455 Improved Blood Glucose-Insulin Monitoring with Dual-Layer Predictive Control Design

Authors: Vahid Nademi

Abstract:

In response to widely used wearable medical devices equipped with a continuous glucose monitor (CGM) and insulin pump, the advanced control methods are still demanding to get the full benefit of these devices. Unlike costly clinical trials, implementing effective insulin-glucose control strategies can provide significant contributions to the patients suffering from chronic diseases such as diabetes. This study deals with a key role of two-layer insulin-glucose regulator based on model-predictive-control (MPC) scheme so that the patient’s predicted glucose profile is in compliance with the insulin level injected through insulin pump automatically. It is achieved by iterative optimization algorithm which is called an integrated perturbation analysis and sequential quadratic programming (IPA-SQP) solver for handling uncertainties due to unexpected variations in glucose-insulin values and body’s characteristics. The feasibility evaluation of the discussed control approach is also studied by means of numerical simulations of two case scenarios via measured data. The obtained results are presented to verify the superior and reliable performance of the proposed control scheme with no negative impact on patient safety.

Keywords: blood glucose monitoring, insulin pump, predictive control, optimization

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4454 Walmart Sales Forecasting using Machine Learning in Python

Authors: Niyati Sharma, Om Anand, Sanjeev Kumar Prasad

Abstract:

Assuming future sale value for any of the organizations is one of the major essential characteristics of tactical development. Walmart Sales Forecasting is the finest illustration to work with as a beginner; subsequently, it has the major retail data set. Walmart uses this sales estimate problem for hiring purposes also. We would like to analyzing how the internal and external effects of one of the largest companies in the US can walk out their Weekly Sales in the future. Demand forecasting is the planned prerequisite of products or services in the imminent on the basis of present and previous data and different stages of the market. Since all associations is facing the anonymous future and we do not distinguish in the future good demand. Hence, through exploring former statistics and recent market statistics, we envisage the forthcoming claim and building of individual goods, which are extra challenging in the near future. As a result of this, we are producing the required products in pursuance of the petition of the souk in advance. We will be using several machine learning models to test the exactness and then lastly, train the whole data by Using linear regression and fitting the training data into it. Accuracy is 8.88%. The extra trees regression model gives the best accuracy of 97.15%.

Keywords: random forest algorithm, linear regression algorithm, extra trees classifier, mean absolute error

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4453 Comparing Skill, Employment, and Productivity of Industrial City Case Study: Bekasi Industrial Area and Special Economic Zone Sei Mangkei

Authors: Auliya Adzillatin Uzhma, M. Adrian Rizky, Puri Diah Santyarini

Abstract:

Bekasi Industrial Area in Kab. Bekasi and SEZ (Special Economic Zone) Sei Mangkei in Kab. Simalungun are two areas whose have the same main economic activity that are manufacturing industrial. Manufacturing industry in Bekasi Industrial Area contributes more than 70% of Kab. Bekasi’s GDP, while manufacturing industry in SEZ Sei Mangkei contributes less than 20% of Kab. Simalungun’s GDP. The dependent variable in the research is labor productivity, while the independent variable is the amount of labor, the level of labor education, the length of work and salary. This research used linear regression method to find the model for represent actual condition of productivity in two industrial area, then the equalization using dummy variable on labor education level variable. The initial hypothesis (Ho) in this research is that labor productivity in Bekasi Industrial Area will be higher than the productivity of labor in SEZ Sei Mangkei. The variable that supporting the accepted hypothesis are more labor, higher education, longer work and higher salary in Bekasi Industrial Area.

Keywords: labor, industrial city, linear regression, productivity

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4452 The Urgent Quest for an Alliance between the Global North and Global South to Manage the Risk of Refugees and Asylum Seekers

Authors: Mulindwa Gerald

Abstract:

Forced Migration is believed to be the most pressing issue in migration studies today, it therefore makes it of paramount importance that we examine the efficacy of the prevailing laws, treaties, conventions and global policies of refugee management. It suffices to note that the existing policies are vague and ambiguous encouraging the hospitality but not assessing the social economic impact to not only the refugees but also their host communities. The commentary around the Off-shore arrangements like one of UK-Rwanda and the legal implications of the same, make it even more fascinating. These are issues that need to be amplified and captured in the Migration Policies. In Uganda, a small landlocked country in East Africa, there always appeared new faces who were refugees from the Congo and Rwanda the neighboring countries to the West and South West respectively. The refugees would migrate to Uganda with absolutely no idea whatsoever how they were going to meet the daily needs of life, no food, no shelter, no clothing. It interest’s one’s mind to conscientiously interrogate the policy issues surrounding refugee management. The 1951 convention sets a number of obligations to states and the conundrum, faced by citizens of the universe interested in Migration studies is ensuring maximum compliance to these obligations considering the resource challenges. States have a duty to protect refugees in accordance with Article 14 of the Universal Declaration for Human Rights which was adopted by the 1951 convention, these speak to rights like the most important right of refugees known as the Principle of Non-Refoulement, which prohibits expulsion or return of refugees or asylum seekers The International Organization for Migrations projection of the number of migrants globally by 2050 was overwhelmingly surpassed by 2019 due to wars, conflicts that have been experienced in different parts of the globe. This is also due natural calamities and tough economic conditions. It is a descriptive analysis that encompasses a qualitative design research based on a case study involving both desk research and field study. The use of qualitative research approaches like interview guides, document review and direct observation methods helped to bring in the experience, social, behavioral and cultural aspects of the respondents into the study, and since qualitative research uses subjective information and not limited to the rigidly definable variables, thus it helped to explore the research area of the study. it therefore verily believe that this paper is going to trigger perspectives and spark a conversation on this really pressing global issue of refugees and asylum seekers, it is suggesting viable solutions to the management challenges while making recommendations like the ensuring that no refugees or asylum seekers are closed at any borders on the globe for instance a concerted effort of all global players to ensure that refugees are protected efficiently.

Keywords: management, migration, refugees, rights

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4451 Blind Channel Estimation for Frequency Hopping System Using Subspace Based Method

Authors: M. M. Qasaymeh, M. A. Khodeir

Abstract:

Subspace channel estimation methods have been studied widely. It depends on subspace decomposition of the covariance matrix to separate signal subspace from noise subspace. The decomposition normally is done by either Eigenvalue Decomposition (EVD) or Singular Value Decomposition (SVD) of the Auto-Correlation matrix (ACM). However, the subspace decomposition process is computationally expensive. In this paper, the multipath channel estimation problem for a Slow Frequency Hopping (SFH) system using noise space based method is considered. An efficient method to estimate multipath the time delays basically is proposed, by applying MUltiple Signal Classification (MUSIC) algorithm which used the null space extracted by the Rank Revealing LU factorization (RRLU). The RRLU provides accurate information about the rank and the numerical null space which make it a valuable tool in numerical linear algebra. The proposed novel method decreases the computational complexity approximately to the half compared with RRQR methods keeping the same performance. Computer simulations are also included to demonstrate the effectiveness of the proposed scheme.

Keywords: frequency hopping, channel model, time delay estimation, RRLU, RRQR, MUSIC, LS-ESPRIT

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4450 Regionalism or Ladder-Up: A Theoretical Perspective of Association of Southeast Asian Nations’ Reactions to Belt and Road Initiative

Authors: Yunqi Wang

Abstract:

As a vital region to the Chinese Belt and Road Initiative (BRI), members of the Association of Southeast Asian Nations (ASEAN) have responded to the grand strategy differently. Some expressed fervent support, while others played the 'hedging' card between great powers. This paper explores the underlying rationale behind such complexity by proposing two theoretical explanations: a Regionalism Hypothesis, where countries respond with hedging, balancing, and bandwagoning behaviours in line with national interests and norm-based 'ASEAN-Way'; and a Ladder-up Hypothesis, where countries consider the initiative as an incentive to remove bottlenecks of climbing up the economic ladder in Rostow's stage of the growth model. By analysing reactions from Myanmar, Laos, Indonesia, and Singapore, two patterns are observed. On an empirical note, the more developed economies are more inclined to the Regionalist explanation. On a theoretical note, there has been a gradual convergence between the two explanations, given the impact of economic globalisation on ASEAN. This paper will contribute to the current theoretical vacancy in the study of ASEAN and BRI by capturing the particular norms shared by this regional entity.

Keywords: ASEAN, belt and road initiative, hedging, Rostow's stages of growth, regionalism

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4449 Set-point Performance Evaluation of Robust ‎Back-Stepping Control Design for a Nonlinear ‎Electro-‎Hydraulic Servo System

Authors: Maria Ahmadnezhad, Seyedgharani Ghoreishi ‎

Abstract:

Electrohydraulic servo system have been used in industry in a wide ‎number of applications. Its ‎dynamics are highly nonlinear and also ‎have large extent of model uncertainties and external ‎disturbances. ‎In this thesis, a robust back-stepping control (RBSC) scheme is ‎proposed to overcome ‎the problem of disturbances and system ‎uncertainties effectively and to improve the set-point ‎performance ‎of EHS systems. In order to implement the proposed control ‎scheme, the system ‎uncertainties in EHS systems are considered as ‎total leakage coefficient and effective oil volume. In ‎addition, in ‎order to obtain the virtual controls for stabilizing system, the ‎update rule for the ‎system uncertainty term is induced by the ‎Lyapunov control function (LCF). To verify the ‎performance and ‎robustness of the proposed control system, computer simulation of ‎the ‎proposed control system using Matlab/Simulink Software is ‎executed. From the computer ‎simulation, it was found that the ‎RBSC system produces the desired set-point performance and ‎has ‎robustness to the disturbances and system uncertainties of ‎EHS systems.‎

Keywords: electro hydraulic servo system, back-stepping control, robust back-‎stepping control, Lyapunov redesign‎

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4448 An Adaptive Neuro-Fuzzy Inference System (ANFIS) Modelling of Bleeding

Authors: Seyed Abbas Tabatabaei, Fereydoon Moghadas Nejad, Mohammad Saed

Abstract:

The bleeding prediction of the asphalt is one of the most complex subjects in the pavement engineering. In this paper, an Adaptive Neuro Fuzzy Inference System (ANFIS) is used for modeling the effect of important parameters on bleeding is trained and tested with the experimental results. bleeding index based on the asphalt film thickness differential as target parameter,asphalt content, temperature depth of two centemeter, heavy traffic, dust to effective binder, Marshall strength, passing 3/4 sieves, passing 3/8 sieves,passing 3/16 sieves, passing NO8, passing NO50, passing NO100, passing NO200 as input parameters. Then, we randomly divided empirical data into train and test sections in order to accomplish modeling. We instructed ANFIS network by 72 percent of empirical data. 28 percent of primary data which had been considered for testing the approprativity of the modeling were entered into ANFIS model. Results were compared by two statistical criterions (R2, RMSE) with empirical ones. Considering the results, it is obvious that our proposed modeling by ANFIS is efficient and valid and it can also be promoted to more general states.

Keywords: bleeding, asphalt film thickness differential, Anfis Modeling

Procedia PDF Downloads 258
4447 Competition and Cooperation of Prosumers in Cournot Games with Uncertainty

Authors: Yong-Heng Shi, Peng Hao, Bai-Chen Xie

Abstract:

Solar prosumers are playing increasingly prominent roles in the power system. However, its uncertainty affects the outcomes and functions of the power market, especially in the asymmetric information environment. Therefore, an important issue is how to take effective measures to reduce the impact of uncertainty on market equilibrium. We propose a two-level stochastic differential game model to explore the Cournot decision problem of prosumers. In particular, we study the impact of punishment and cooperation mechanisms on the efficiency of the Cournot game in which prosumers face uncertainty. The results show that under the penalty mechanism of fixed and variable rates, producers and consumers tend to take conservative actions to hedge risks, and the variable rates mechanism is more reasonable. Compared with non-cooperative situations, prosumers can improve the efficiency of the game through cooperation, which we attribute to the superposition of market power and uncertainty reduction. In addition, the market environment of asymmetric information intensifies the role of uncertainty. It reduces social welfare but increases the income of prosumers. For regulators, promoting alliances is an effective measure to realize the integration, optimization, and stable grid connection of producers and consumers.

Keywords: Cournot games, power market, uncertainty, prosumer cooperation

Procedia PDF Downloads 90
4446 Tracking Patient Pathway for Assessing Public Health and Financial Burden to Community for Pulmonary Tuberculosis: Pointer from Central India

Authors: Ashish Sinha, Pushpend Agrawal

Abstract:

Background: Patients with undiagnosed pulmonary TB predominantly act as reservoirs for its transmission through 10-15 secondary infections in the next 1-5 Yrs. Delays in the diagnosis and treatment may worsen the disease with increase the risk of death. Factors responsible for such delays by tracking patient pathways to treatment may help in planning better interventions. The provision of ‘free diagnosis and treatment’ forms the cornerstone of the National Tuberculosis Elimination Programme (NTEP). OOPE is defined as the money spent by the patient during TB care other than public health facilities. Free TB care at all health facilities could reduce out-of-pocket expenses to the minimum possible levels. Material and Methods: This cross-sectional study was conducted among randomly selected 252 TB patients from Nov – Oct 2022 by taking in-depth interviews following informed verbal consent. We documented their journey from initial symptoms until they reached the public health facility, along with their ‘out-of-pocket expenditure’ (OOPE) pertaining to TB care. Results: Total treatment delay was 91±72 days on average (median: 77days, IQR: 45-104 days), while the isolated patient delay was 31±45 days (median: 15 days, IQR: 0 days to 43 days); diagnostic delay; 57±60 days (median: 42days, IQR 14-78 days), treatment delay 19 ± 18 days (median: 15days, IQR: 11-19 days). A patient delay (> 30 days) was significantly associated with ignorance about classic symptoms of pulmonary TB, adoption of self-medication, illiteracy, and middle and lower social class. Diagnostic delay was significantly higher among those who contacted private health facilities, were unaware of signs and symptoms, had >2 consultations, and not getting an appropriate referral for TB care. Most (97%) of the study participants interviewed claimed to have incurred some expenditure.Median total expenses were 6155(IQR: 2625-15175) rupees. More than half 141 (56%) of the study participants had expenses >5000 rupees. Median transport expenses were 525(IQR: 200-1012) rupees; Median consultation expenses were 700(IQR: 200-1600) rupees; Median investigation expenses were 1000(IQR: 0-3025) rupees and the Median medicine expenses were 3350(IQR: 1300-7525).OOPE for consultation, investigation, and medicine was observed to be significantly higher among patients who ignored classical signs& symptoms of TB, repeated visits to private health facilities, and due to self-medication practices. Transport expenses and delays in seeking care at facilities were observed to have an upward trend with OOP Expenses (r =1). Conclusion: Delay in TB care due to low awareness about signs and symptoms of TB and poor seeking care, lack of proper consultation, and appropriate referrals reported by the study subjects indicate the areas which need proper attention by the program managers. Despite a centrally sponsored programme, the financial burden on TB patients is still in the unacceptable range. OOPE could be reduced as low as possible by addressing the responsible factors linked to it.

Keywords: patient pathway, delay, pulmonary tuberculosis, out of pocket expenses

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