Search results for: clinical outcome

Authors: Daniel Fulus Fom, Gau Patrick Damulak

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In this study, the Autoregressive Fractional Integrated Moving Average (ARFIMA) and Jordan Recurrent Neural Network (JRNN) models were employed to model the forecasting performance of the daily turbidity flow of White Clay Creek (WCC). The two methods were applied to the log difference series of the daily turbidity flow series of WCC. The measurements of error employed to investigate the forecasting performance of the ARFIMA and JRNN models are the Root Mean Square Error (RMSE) and the Mean Absolute Error (MAE). The outcome of the investigation revealed that the forecasting performance of the JRNN technique is better than the forecasting performance of the ARFIMA technique in the mean square error sense. The results of the ARFIMA and JRNN models were obtained by the simulation of the models using MATLAB version 8.03. The significance of using the log difference series rather than the difference series is that the log difference series stabilizes the turbidity flow series than the difference series on the ARFIMA and JRNN.

Keywords: auto regressive, mean absolute error, neural network, root square mean error

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Authors: P. Jayashree, S. Rajkumar

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With social networks and smart devices generating a multitude of data, effective data management is the need of the hour for networks and cloud applications. Some applications need effective storage while some other applications need effective communication over networks and data reduction comes as a handy solution to meet out both requirements. Most of the data compression techniques are based on data statistics and may result in either lossy or lossless data reductions. Though lossy reductions produce better compression ratios compared to lossless methods, many applications require data accuracy and miniature details to be preserved. A variety of data compression algorithms does exist in the literature for different forms of data like text, image, and multimedia data. In the proposed work, a generic progressive compression algorithm, based on probabilistic encoding, called PEINS is projected as an enhancement over irrational number stored coding technique to cater to storage issues of increasing data volumes as a cost effective solution, which also offers data security as a secondary outcome to some extent. The proposed work reveals cost effectiveness in terms of better compression ratio with no deterioration in compression time.

Keywords: compression ratio, generic compression, irrational number storage, probabilistic encoding

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Authors: Rajendra Kanojia

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Femoral components with inbuilt rotation require thicker flexion resection of the lateral femoral condyle and could potential risk to damage the popliteus tendon especially in the smaller Asian knees. We prospectively evaluated 10 patients with bilateral varus osteoarthritis knee to size the cuts and their location in relation to the popliteus tendon. Two different types of implant were used on either side, one side requires resection in 3° external rotation (group A) and other side femoral component with inbuilt external roation (group B). We had popliteus tendon injury in 3 knees all from group B. Risk of damaging the popliteus tendon was found higher in group B.

Keywords: popliteaus tendon injury, TKA, orthopaedic surgery, biomechanics and clinical applications

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Authors: Muhammad Waqas, Shahan Waheed, Mohsin Qadeer, Ehsan Bari, Salman Ahmed, Iqra Patoli

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Objective: To determine the value of aPTT, platelets and INR as the predictor of unfavorable outcomes in patients with blunt isolated traumatic brain injury. Methods: This was an observational cohort study conducted in a tertiary care facility from 1st January 2008 to 31st December 2012. All the patients with isolated traumatic brain injury presenting within 24 hours of injury were included in the study. Coagulation parameters at presentation were recorded and Glasgow Outcome Scale calculated on last follow up. Outcomes were dichotomized into favorable and unfavorable outcomes. Relationship of coagulopathy with GOS and unfavorable outcomes was calculated using Spearman`s correlation and area under curve ROC analysis. Results: 121 patients were included in the study. The incidence of coagulopathy was found to be 6 %. aPTT was found to a significantly associated with unfavorable outcomes with an AUC = 0.702 (95%CI = 0.602-0.802). Predictive value of platelets and INR was not found to be significant. Conclusion: Incidence of coagulopathy was found to be low in current population compared to data from the West. aPTT was found to be a good predictor of unfavorable outcomes compared with other parameters of coagulation.

Keywords: aPTT, coagulopathy, unfavorable outcomes, parameters

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Authors: Ramin Mirzada

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This research investigates the valuation of public transport importance in decreasing congestion and in introduction of bus rapid transit in Kabul city. The main concern and main problem of the Kabul city public transport is traffic congestion. When buses and trams are stuck in traffic jams, it is clear that they fall behind from the schedule and this cause lots of problem for Kabul residence. In this research, the main attention has been given to improve current public transport in Kabul city which Public transport has large share almost 50% share among all mode. The main purpose of this research is to improve public transport system, to examine the demand and the supply of public transport in Kabul city, and to improve public transport system by introducing Bus rapid transit (BRT) system in Kabul city. The data which is used in this research is gathered by Transport Ministry, Kabul Municipality and Japan Cooperation Agency in Afghanistan (JICA). Urban transportation modeling system (UTMS) which is also known as traditional four-step modeling is used as the methodology of this research. The outcome of this research shows that by improving public transport which is local bus system mostly congestion problem of Kabul city become solve, and for those lanes which has the high demand and has more congestion, it is needed to introduce bus rapid transit system.

Keywords: transportation, planning, public transport, bus rapid transit, Kabul, Afghanistan

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Authors: Neha Bhattacharyya, Soumendra Singh, Amrita Banerjee, Ria Ghosh, Oindrila Sinha, Nairit Das, Rajkumar Gayen, Somya Subhra Pal, Sahely Ganguly, Tanmoy Dasgupta, Tanusree Dasgupta, Pulak Mondal, Aniruddha Adhikari, Sharmila Sarkar, Debasish Bhattacharyya, Asim Kumar Mallick, Om Prakash Singh, Samir Kumar Pal

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Background: We aim to develop an integrated device comprised of single-probe EEG and CCD-based motion sensors for a more objective measure of Attention-deficit Hyperactivity Disorder (ADHD). While the integrated device (MAHD) relies on the EEG signal (spectral density of beta wave) for the assessment of attention during a given structured task (painting three segments of a circle using three different colors, namely red, green and blue), the CCD sensor depicts movement pattern of the subjects engaged in a continuous performance task (CPT). A statistical analysis of the attention and movement patterns was performed, and the accuracy of the completed tasks was analysed using indigenously developed software. The device with the embedded software, called MAHD, is intended to improve certainty with criterion E (i.e. whether symptoms are better explained by another condition). Methods: We have used the EEG signal from a single-channel dry sensor placed on the frontal lobe of the head of the subjects (3-5 years old pre-schoolers). During the painting of three segments of a circle using three distinct colors (red, green, and blue), absolute power for delta and beta EEG waves from the subjects are found to be correlated with relaxation and attention/cognitive load conditions. While the relaxation condition of the subject hints at hyperactivity, a more direct CCD-based motion sensor is used to track the physical movement of the subject engaged in a continuous performance task (CPT) i.e., separation of the various colored balls from one table to another. We have used our indigenously developed software for the statistical analysis to derive a scale for the objective assessment of ADHD. We have also compared our scale with clinical ADHD evaluation. Results: In a limited clinical trial with preliminary statistical analysis, we have found a significant correlation between the objective assessment of the ADHD subjects with that of the clinician’s conventional evaluation. Conclusion: MAHD, the integrated device, is supposed to be an auxiliary tool to improve the accuracy of ADHD diagnosis by supporting greater criterion E certainty.

Keywords: ADHD, CPT, EEG signal, motion sensor, psychometric test

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Authors: Majdah Alnefaie

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The ‘netnographic study’ and data mining have been used to monitor the public interaction on Social Media Sites (SMSs) to understand what the motivational factors influence the Saudi intentions regarding allowing women driving in Saudi Arabia in 2018. The netnographic study monitored the publics’ textual and visual communications in Twitter, Snapchat, and YouTube. SMSs users’ communications method is also known as electronic word of mouth (eWOM). Netnography methodology is still in its initial stages as it depends on manual extraction, reading and classification of SMSs users text. On the other hand, data mining is come from the computer and physical sciences background, therefore it is much harder to extract meaning from unstructured qualitative data. In addition, the new development in data mining software does not support the Arabic text, especially local slang in Saudi Arabia. Therefore, collaborations between social and computer scientists such as ‘netnographic study’ and data mining will enhance the efficiency of this study methodology leading to comprehensive research outcome. The eWOM communications between individuals on SMSs can promote a sense that sharing their preferences and experiences regarding politics and social government regulations is a part of their daily life, highlighting the importance of using SMSs as assistance in promoting participation in political and social. Therefore, public interactions on SMSs are important tools to comprehend people’s intentions regarding the new government regulations in the country. This study aims to answer this question, "What factors influence the Saudi Arabians' intentions of Saudi female's car-driving in 2018". The study utilized qualitative method known as netnographic study. The study used R studio to collect and analyses 27000 Saudi users’ comments from 25th May until 25th June 2018. The study has developed data collection model that support importing and analysing the Arabic text in the local slang. The data collection model in this study has been clustered based on different type of social networks, gender and the study main factors. The social network analysis was employed to collect comments from SMSs owned by governments’ originations, celebrities, vloggers, social activist and news SMSs accounts. The comments were collected from both males and females SMSs users. The sentiment analysis shows that the total number of positive comments Saudi females car driving was higher than negative comments. The data have provided the most important factors influenced the Saudi Arabians’ intention of Saudi females car driving including, culture and environment, freedom of choice, equal opportunities, security and safety. The most interesting finding indicted that women driving would play a role in increasing the individual freedom of choice. Saudi female will be able to drive cars to fulfill her daily life and family needs without being stressed due to the lack of transportation. The study outcome will help Saudi government to improve woman quality of life by increasing the ability to find more jobs and studies, increasing income through decreasing the spending on transport means such as taxi and having more freedom of choice in woman daily life needs. The study enhances the importance of using use marketing research to measure the public opinions on the new government regulations in the country. The study has explained the limitations and suggestions for future research.

Keywords: netnographic study, data mining, social media, Saudi Arabia, female driving

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Authors: Temidayo O. Omotehinwa, David O. Oyewola, Friday J. Agbo

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This study aims to gather a proper perspective of the development landscape of Computer Science research in Nigeria. Therefore, a bibliometric analysis of 4,333 bibliographic records of Computer Science research in Nigeria in the last 31 years (1991-2021) was carried out. The bibliographic data were extracted from the Scopus database and analyzed using VOSviewer and the bibliometrix R package through the biblioshiny web interface. The findings of this study revealed that Computer Science research in Nigeria has a growth rate of 24.19%. The most developed and well-studied research areas in the Computer Science field in Nigeria are machine learning, data mining, and deep learning. The social structure analysis result revealed that there is a need for improved international collaborations. Sparsely established collaborations are largely influenced by geographic proximity. The funding analysis result showed that Computer Science research in Nigeria is under-funded. The findings of this study will be useful for researchers conducting Computer Science related research. Experts can gain insights into how to develop a strategic framework that will advance the field in a more impactful manner. Government agencies and policymakers can also utilize the outcome of this research to develop strategies for improved funding for Computer Science research.

Keywords: bibliometric analysis, biblioshiny, computer science, Nigeria, science mapping

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Authors: Shaghayegh Mirshekari, Atiyeh Ghorbani

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EThe Iranian system of education has been politically influenced by the thoughts of the governing religious party. It has brought many religious books into the educational system from grade one up to graduation from high school, and therefore, teaching English as a non-Islamic language has been put aside the system, focusing on the Islamic language of Arabic. Teaching English has been widely talked about in international academia, but the Iranian educational system has not brought in any of its outcomes due to the general policy of keeping people away from international Western thoughts. Because of the increasing interest among Iranians in learning English, this language is being taught and studied in public and private schools, commercial and adult schools, language institutes, colleges, universities, and numerous homes throughout the country. Methods and techniques of teaching English, the attitude of the teachers and learners towards the language, and the availability of textbooks and other language materials are quite different in any one of the different institutions. This paper has evaluated the outcome of the Iranian educational system in teaching English in terms of their methods of teaching, as well as the policies regarding the educational system. The results show that not only has there been no progress in the system in terms of teaching English, rather there is backwardness in this regard due to the political policy of preventing people from learning English. Therefore, we see the majority of the youth not speaking English properly at the age where they need to enter the international arena.

Keywords: English, public school, language, Iran, teaching

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Authors: Shafaq Rana, Hina Ansar

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Projectification is an emerging phenomenon in Western economies. The projects have become the key driver of the economic actions. The impact of projectification is understudy for over a decade. A methodology was developed to measure the degree of projectification at economical level, which was later adapted to measure the degree of projectification in Germany, Norway, and Iceland; and compared the differences in these project societies, considering their industrial structure, organizational size, and the share of project work. Using the same methodology, this study aims to provide empirical evidence of the project work in the context of Pakistan –a developing nation, keeping into consideration the macroeconomic measures, qualitative and quantitative measures of the project i/c GDP, monetary measures, and project success. The research includes a qualitative pre-study to define these macro-measures in the country-specific context and a quantitative study to measure the project work w.r.t hours working in the organizations on projects. The outcome of this study provides the key data on the projectification in a developing economy, which will help industry practitioners and decision-makers to examine the consequences of projectification and strategize, respectively. This study also provides a foundation for further research in individual sectors of the country while exploring different macroeconomic questions, including the effect of projectification on project productivity, income effects, and labor market.

Keywords: developing economy, Pakistan, project work, projectification

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Authors: Habsah Mohamad Sabli, Mohammad Fardillah Wahi

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The main aim of this research study is to better understand and measure students' perceptions towards the effectiveness of mobile learning. This paper reports on the results of a survey of three hundred nineteen students at Polytechnic Mukah Sarawak (PMU) about their perception to the use of mobile technology in education. An analysis of the quantitative survey findings is presented focusing on the ramification for mobile-learning (m-learning) practices in higher learning and teaching environments. In this paper we present our research findings about the level of perception and gender correlations with perceived ease of use and perceived usefulness using M-Learning in learning activities among students in Polytechnic Mukah (PMU). Based on gender respondent, were 150 female (47.0%) and 169 male (53.0%). The survey findings further revealed that perception of students are in moderately high and agree for using m-learning. The perceived ease of use and perceived usefulness is significant with weak correlations between students to adapt m-learning for active learning activities. The outcome of this research can benefit the decision makers of higher institution in Mukah Sarawak regard to way to enhance m-learning and promote effective teaching and learning activities as well as strengthening the quality of learning delivery.

Keywords: M-learning, student attitudes, student perception, mobile technology

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Authors: J. Luché-Thayer, C. Perronne, C. Meseko

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We reviewed how certain institutional policies and practices, as well as questionable research, are creating obstacles to care and informed consent for Lyme and relapsing fever Borreliosis patients. The interference is denying access to treatments that meet the internationally accepted standards as set by the Institute of Medicine. This obstruction to care contributes to significant human suffering, disability and negative economic effect across many nations and in many regions of the world. We note how evidence based medicine emphasizes the importance of clinical experience and patient-centered care and how these patients benefit significantly when their rights to choose among treatment options are upheld.  

Keywords: conflicts of interest, obstacles to healthcare accessibility, patient-centered care, the right to informed consent

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Authors: Lucie Mrackova, Helena Kisvetrova

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Spirituality is an integral part of human life. In a secular environment, spiritual needs are often overlooked, especially in acute nursing care. Spiritual needs assessment for patients (SNAP), which also exists in the Czech version (SNAP-CZ), can be used for objective evaluation. The aim of this study was to measure the psychometric properties of SNAP-CZ and to find correlations between SNAP-CZ and sociodemographic and clinical variables. A cross-sectional study with tools assessing spiritual needs (SNAP-CZ), anxiety (Beck Anxiety Inventory; BAI), depression (Beck Depression Inventory; BDI), pain (Visual Analogue Scale; VAS), self-sufficiency (Barthel Index; BI); cognitive function (Montreal Cognitive Test; MoCa) and selected socio-demographic data was performed. The psychometric properties of SNAP-CZ were tested using factor analysis, reliability and validity tests, and correlations between the questionnaire and sociodemographic data and clinical variables. Internal consistency was established with Cronbach’s alfa for the overall score, respective domains, and individual items. Reliability was assessed by test-retest by Interclass correlation coefficient (ICC). Data for correlation analysis were processed according to Pearson's correlation coefficient. The study included 172 trauma patients (the mean age = 40.6 ± 12.1 years) who experienced polytrauma or severe monotrauma. There were a total of 106 (61.6%) male subjects, 140 (81.4%) respondents identified themselves as non-believers. The full-scale Cronbach's alpha was 0.907. The test-retest showed the reliability of the individual domains in the range of 0.924 to 0.960 ICC. Factor analysis resulted in a three-factor solution (psychosocial needs (alfa = 0.788), spiritual needs (alfa = 0.886) and religious needs (alfa = 0.841)). Correlation analysis using Pearson's correlation coefficient showed that the domain of psychosocial needs significantly correlated only with gender (r = 0.178, p = 0.020). Males had a statistically significant lower average value in this domain (mean = 12.5) compared to females (mean = 13.8). The domain of spiritual needs significantly correlated with gender (r = 0.199, p = 0.009), social status (r = 0.156, p = 0.043), faith (r = -0.250, p = 0.001), anxiety (r = 0.194, p = 0.011) and depression (r = 0.155, p = 0.044). The domain of religious needs significantly correlated with age (r = 0,208, p = 0,007), education (r = -0,161, p = 0,035), faith (r = -0,575, p < 0,0001) and depression (r = 0,179, p = 0,019). Overall, the whole SNAP scale significantly correlated with gender (r = 0.219, p = 0.004), social status (r = 0.175, p = 0.023), faith (r = -0.334, p <0.0001), anxiety (r = 0.177, p = 0.022) and depression (r = 0.173, p = 0.025). The results of this study corroborate the reliability of the SNAP-CZ and support its future use in the nursing care of trauma patients in a secular society. Acknowledgment: The study was supported by grant nr. IGA_FZV_2020_003.

Keywords: acute nursing care, assessment of spiritual needs, patient, psychometric validation, spirituality

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Authors: Mustarakh Gelfi, Poonam Taneja, Tiedo Vellinga, Delon Hamonangan

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The initial masterplan of New Priok in the Port of Tanjung Priok was developed in 2012 is being updated to cater to new developments and new demands. In the new masterplan (2017), Phase II of development will start from 2035-onwards, depending on the future conditions. This study is about creating a robust masterplan for Phase II, which will remain functional under future uncertainties. The methodology applied in this study is scenario-based planning in the framework of Adaptive Port Planning (APP). Scenario-based planning helps to open up the perspective of the future as a horizon of possibilities. The scenarios are built around two major uncertainties in a 2x2 matrix approach. The two major uncertainties for New Priok port are economics and sustainability awareness. The outcome is four plausible scenarios: Green Port, Business As Usual, Moderate Expansion, and No Expansion. Terminal needs in each scenario are analyzed through traffic analysis and identifying the key cargos and commodities. In conclusion, this study gives the wide perspective for Port of Tanjung Priok for the planning Phase II of the development. The port has to realize that uncertainties persevere and are very likely to influence the decision making as to the future layouts. Instead of ignoring uncertainty, the port needs to make the action plans to deal with these uncertainties.

Keywords: Indonesia Port, port's layout, port planning, scenario-based planning

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Authors: Aedah Abd Rahman

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Software organisations may implement single or multiple frameworks in order to remain competitive. There are wide selection of generic Software Process Improvement (SPI) frameworks, best practices and standards implemented with different focuses and goals. Issues and difficulties emerge in the SPI practices from the context of software development and IT Service Management (ITSM). This research looks into the integration of multiple frameworks from the perspective of software development and ITSM. The research question of this study is how to define steps of methodology to solve the multi model software process improvement problem. The objective of this study is to define the research approach and methodologies to produce a more integrated and efficient Multi Model Process Improvement (MMPI) solution. A multi-step methodology is used which contains the case study, framework mapping and Delphi study. The research outcome has proven the usefulness and appropriateness of the proposed framework in SPI and quality practice in Malaysian software industries. This mixed method research approach is used to tackle problems from every angle in the context of software development and services. This methodology is used to facilitate the implementation and management of multi model environment of SPI frameworks in multiple domains.

Keywords: Delphi study, methodology, multi model software process improvement, service management

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Authors: Nilgun Kuskonmaz, Zeynep Taslıcukur Ozturk, Cem Sahin

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In this study, Si3N4-SiC composites were synthesized by using different raw materials. In the first method, Si3N4 and C black powder mixtures were used to fabricate Si3N4-SiC composites by in-situ carbothermal reduction process. The percentage of C black was only changed. The effects of carbon black percentage in the mixtures were analysed by characterization of SiC particles which were obtained in the Si3N4 matrix. In the second method, SiC particles were added to the matrix in different weight ratios. The composites were pressed by cold isostatic method under 150 MPa pressure and pressureless sintered at 1700-1850 °C during 1 hour in the argon atmosphere. AlN and Y2O3 were used as sintering additives. Sintering temperature, time and all the effects on in-situ reaction were studied. The densification and microstructure properties of the produced ceramics were analysed. Density was one of the main subjects in these reactions. It is very important during porous SiC sintering. Green density and relative density were measured higher for CIP samples. Samples which were added carbon black were more porous than SiC added samples. The increase in the carbon black, makes increase in porosity. The outcome of the experiments was SiC powders which were obtained at the grain boundries of β-Si3N4 particles.

Keywords: silicon nitride, silicon carbide, carbon black, cold isostatic press, sintering

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Authors: Melikulov A. A., Toshpulotov Sh. G., Akhmedova M. F., Beshimov A. S., Rakhimov M. K. Zokirov N. K.

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Postinfarction ventricular septal defect (PVSD) is a rare but life-threatening complication of acute myocardial infarction. Currently, an alternative direction of minimally invasive treatment of postinfarction ventricular septal defect (PVSD) is being developed - transcatheter closure of the defect using an occluder, but surgical closure of the defect remains the <> correction of post-infarction VSD. Our article presents a case of successful surgical treatment of a patient with a large post-infarction rupture of the interventricular septum (IVS) and post-infarction LV aneurysm under cardiopulmonary bypass and parallel perfusion.

Keywords: echocardiography, myocardial infarction, ventricular septal defect, parallel perfusion

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Authors: Tan Hui Ying Renee, Stella Rizalina Sasha, Farah Safdar Husain

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Introduction: Menopause Hormone Therapy (MHT) is an effective drug indicated for the treatment of menopausal symptoms and as replacement therapy in women who undergo premature menopause. In 2020, less than 8.8% of perimenopausal Singaporean women are on hormonal therapy, as compared to the Western population, where up to 50% may be on MHT. Factors associated with MHT utilization have been studied from patient characteristics, but the impact of locally prescribing physicians resulting in low MHT utilization has yet to be evaluated. The aim of the study is to determine the level of knowledge physicians in the Obstetrics and Gynaecology specialty have and their attitudes toward MHT. We believe that knowledge of MHT is lacking and that negative attitudes towards MHT may influence its use and undermine the benefits MHT may have for women. This paper is a part of a larger study on Singaporean physicians’ knowledge and attitudes towards MHT. Methods: This is a cross-sectional study intended to assess the knowledge and attitudes of physicians toward Menopausal Hormone Therapy. An anonymous questionnaire was disseminated via institutional internal circulations to optimize reach to physicians who may prescribe MHT, particularly in the fields of Gynaecology, Family Medicine and Endocrinology. Responses were completed voluntarily. Physicians had the option for each question to declare that they were ‘unsure’ or that the question was ‘beyond their expertise’. 21 knowledge questions tested factual recall on indications, contraindications, and risks of MHT. The remaining 6 questions were clinical scenarios crafted with the intention of testing specific principles related to the use of MHT. These questions received face validation from experts in the field. 198 responses were collected, 79 of which were from physicians in the Obstetrics and Gynaecology specialty. The data will be statistically analyzed to investigate areas that can be improved to increase the overall benefits of MHT for the Singaporean population. Results: Preliminary results show that the prevailing factors that limit Singaporean gynecologists and obstetricians from prescribing MHT are a lack of knowledge of MHT and a lack of confidence in prescribing MHT. Risks and indications of MHT were not well known by many physicians, with the majority of the questions having more than 25% incorrect and ‘unsure’ as their reply. The clinical scenario questions revealed significant shortcomings in knowledge on how to navigate real-life challenges in MHT use, with 2 of 6 questions with more than 50% incorrect or ‘beyond their expertise’ as their reply. The portion of the questionnaire that investigated the attitudes of physicians showed that though a large majority believed MHT to be an effective drug, only 40.5% were confident in prescribing it. Conclusion: Physicians in the Obstetrics and Gynaecology specialty lack knowledge and confidence in MHT. Therefore, it is imperative to formulate solutions on both the individual and institutional levels to fill these gaps and ensure that MHT is used appropriately and prescribed to the patients who need it.

Keywords: menopause, menopause hormone therapy, physician factors, obstetrics and gynecology, menopausal symptoms, Singapore

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Authors: Abosede Mosunmola Odeseye

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The sustainability of nations’ economies today have proven to be unrealistic in a constantly changing world without appropriate accordance to entrepreneurship role and its processes. This role has therefore proven to be a product of the available and discoverable opportunities by an individual/organisation in any pattern – innovation, discovery, diffusion, imitation amidst possible challenges. In light of these, this paper examined the relationship between opportunity development and entrepreneurial processes as well as the factors determining individual’s opportunity development and the success of entrepreneurial processes. Systematic review method was adopted for selecting relevant academic materials. The theoretical base of this paper was anchored on Schumpeter’s entrepreneurial innovation model and Drucker and Stevenson’s opportunity-based entrepreneurship theory. Based on the reviewed literature, it was discovered that rough business idea “opportunity” in any form – techniques/product encounter various obstacles to achieve its development, acceptability and sustainability. In essence, the findings revealed that the birth of every opportunity is as a result of the individual/organisation and environmental factors to be able to scale through the whole process successfully. Due to the outcome of this paper, it was recommended that the organisations/government should endeavour to create an enabling environment for a rough business idea to come to life amidst the hurdles of the entrepreneurial process.

Keywords: entrepreneurial process, entrepreneurship, opportunity, opportunity development, organisation, sustainability

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Authors: Markus Bredel, Sindhu Nair, Hoa Q. Trummell, Rajani Rajbhandari, Christopher D. Willey, Lewis Z. Shi, Zhuo Zhang, William J. Placzek, James A. Bonner

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Purpose: EGFR-targeted monoclonal antibodies (mAbs) provide clinical benefit in some patients with H&N squamous cell carcinoma (HNSCC), but others progress with minimal response. Missense mutations in the EGFR ectodomain (ECD) can be acquired under mAb therapy by mimicking the effect of large deletions on receptor untethering and activation. Little is known about the contribution of EGFR ECD mutations to EGFR activation and anti-EGFR response in HNSCC. Methods: We selected patient-derived HNSCC cells (UM-SCC-1) for resistance to mAb Cetuximab (CTX) by repeated, stepwise exposure to mimic what may occur clinically and identified two concurrent EGFR ECD mutations (UM-SCC-1R). We examined the competence of the mutants to bind EGF ligand or CTX. We assessed the potential impact of the mutations through visual analysis of space-filling models of the native sidechains in the original structures vs. their respective side-chain mutations. We performed CRISPR in combination with site-directed mutagenesis to test for the effect of the mutants on ligand-independent EGFR activation and sorting. We determined the effects on receptor internalization, endocytosis, downstream signaling, and radiation sensitivity. Results: UM-SCC-1R cells carried two non-synonymous missense mutations (G33S and N56K) mapping to domain I in or near the EGF binding pocket of the EGFR ECD. Structural modeling predicted that these mutants restrict the adoption of a tethered, inactive EGFR conformation while not permitting association of EGFR with the EGF ligand or CTX. Binding studies confirmed that the mutant, untethered receptor displayed a reduced affinity for both EGF and CTX but demonstrated sustained activation and presence at the cell surface with diminished internalization and sorting for endosomal degradation. Single and double-mutant models demonstrated that the G33S mutant is dominant over the N56K mutant in its effect on EGFR activation and EGF binding. CTX-resistant UM-SCC-1R cells demonstrated cross-resistance to mAb Panitumuab but, paradoxically, remained sensitive to the reversible receptor tyrosine kinase inhibitor Erlotinib. Conclusions: HNSCC cells can select for EGFR ECD mutations under EGFR mAb exposure that converge to trap the receptor in an open, constitutively activated state. These mutants impede the receptor’s competence to bind mAbs and EGF ligand and alter its endosomal trafficking, possibly explaining certain cases of clinical mAb and radiation resistance.

Keywords: head and neck cancer, EGFR mutation, resistance, cetuximab

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Authors: Aparajita Bhattacharya, Mousumi Dutta, Zakir Husain, Dionne Sequeira, Asima Mukhopadhyay

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Background: Tata Medical Centre (TMC), Kolkata is a major cancer referral centre in Eastern India and neighbouring countries providing state of the art facilities; however, it is a non-profit organisation with patients requiring to pay at subsidised rates. Although a system for social assessment and applying for governmental/ non-governmental (NGO) funds is in place, access is challenging. Amongst gynaecological cancers (GC), ovarian cancer (OC) is associated with the highest treatment cost; majority of which is required at the beginning when complex surgery is performed and funding arrangements cannot be made in time. We therefore appointed a dedicated Medical Social Worker (MSW) in 2016, supported by NGO for GC patients in order to assist patients/family members to access/avail these funds more readily and assist in economic evaluation for both direct and opportunity costs. Objectives: To reflect on our experience and challenges in collecting data on economic evaluation of cancer patients and compare success rates in achieving fund mobilization after introduction of MSW. Methods: A Retrospective survey. Patients with OC and their relatives were seen by the MSW during the initial outpatients department visit and followed though till discharge from the hospital and during follow-up visits. Assistance was provided in preparing the essential documents/paperwork/contacts for the funding agencies including both governmental (Chief-Minister/Prime-Minister/President) and NGO sources. In addition, a detailed questionnaire was filled up for economic assessment of direct/opportunity costs during the entire treatment and 12 months follow up period which forms a part of the study called HEPTROC (Health economic evaluation of primary treatment for ovarian cancer) developed in collaboration with economics departments of Universities. Results: In 2015, 102 patients were operated for OC; only 16 patients (15.68 %) had availed funding of a total sum of INR 1640000 through the hospital system for social assessment. Following challenges were faced by majority of the relatives: 1. Gathering important documents/proper contact details for governmental funding bodies and difficulty in following up the current status 3. Late arrival of funds. In contrast in 2016, 104 OC patients underwent surgery; the direct cost of treatment was significantly higher (median, INR 300000- 400000) compared to other GCs (n=274). 98/104 (94.23%) OC patients could be helped to apply for funds and 90/104(86.56%) patients received funding amounting to a total of INR 10897000. There has been a tenfold increase in funds mobilized in 2016 after the introduction of dedicated MSW in GC. So far, in 2017 (till June), 46/54(85.18%) OC patients applied for funds and 37/54(68.51%) patients have received funding. In a qualitative survey, all patients appreciated the role of the MSW who subsequently became the key worker for patient follow up and the chief portal for patient reported outcome monitoring. Data collection quality for the HEPTROC study was improved when questionnaires were administered by the MSW compared to researchers. Conclusion: Introduction of cancer specific MSW can expedite the availability of funds required for cancer patients and it can positively impact on patient satisfaction and outcome reporting. The economic assessment will influence fund allocation and decision for policymaking in ovarian cancer. Acknowledgement: Jivdaya Foundation Dallas, Texas.

Keywords: economic evaluation, funding, medical social worker, ovarian cancer

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Authors: Vivek Bhat, Rohini Kelkar, Sanjay Biswas

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Introduction: Cancer patients are at increased risk of bacterial infections. This may due to the disease process itself, the effect of chemotherapeutic drugs or invasive procedures such as catheterization. A wide variety of bacteria including some emerging pathogens are increasingly being reported from these patients. The incidence of multidrug-resistant organisms particularly in the Gram negative group is also increasing, with higher resistance rates seen to cephalosporins, β-lactam/β-lactam inhibitor combinations, and the carbapenems. This study documents the bacteriological spectrum of infections and their resistance patterns in cancer patients. Methods: This study includes all bacterial isolates recovered from infections cancer patients over a period of 18 months. Samples included Blood cultures, Pus/wound swabs, urine, tissue biopsies, body fluids, catheter tips and respiratory specimens such as sputum and bronchoalveolar lavage (BAL). All samples were processed in the microbiology laboratory as per standard laboratory protocols. Organisms were identified to species level and antimicrobial susceptibility testing was performed manually by the disc diffusion technique or in the Vitek-2 (Biomereux, France) instrument. Interpretations were as per Clinical laboratory Standards Institute (CLSI) guidelines. Results: A total of 1150 bacterial isolates were cultured from 884 test samples during the study period. Of these 227 were Gram-positive and 923 were Gram-negative organisms. Staphylococcus aureus (99 isolates) was the commonest Gram-positive isolate followed by Enterococcus (79) and Gr A Streptococcus (30). Among the Gram negatives, E. coli (304), Pseudomonas aeruginosa (201) and Klebsiella pneumoniae (190) were the most common. Of the Staphylococcus aureus isolates 27.2% were methicillin resistant. Only 5.06% enterococci were vancomycin resistant. High rates of resistance to cefotaxime and ciprofloxacin were seen amongst E. coli (84.8% & 83.55%) and Klebsiella pneumoniae (71 & 62.1%) respectively. Resistance to carbapenems (meropenem) was high at 70% in Acinetobacter spp.; however all isolates were sensitive to colistin. Among the aminoglycosides, amikacin retained good efficacy against Escherichia coli (82.9%) and Pseudomonas aeruginosa (78.1%). Occasional isolates of emerging pathogens such as Chryseobacterium indologens, Roseomonas, and Achromobacter xyloxidans were also recovered. Conclusion: The common infections in cancer patients include respiratory, wound, tract infections and sepsis. The commonest isolates include Staphylococcus aureus, Enterococci, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. There is a high level of resistance to the commonly used antibiotics among Gram-negative organisms.

Keywords: bacteria, resistance, infection, cancer

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Authors: Jingyuan Hu, Zhandong Liu

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CRISPR genome editing technology has transformed molecular biology by accurately targeting and altering an organism’s DNA. Despite the state-of-art precision of CRISPR genome editing, the imprecise mutation outcome and off-target effects present considerable risk, potentially leading to unintended genetic changes. Targeted deep sequencing, combined with bioinformatics sequence alignment, can detect such unwanted mutations. Nevertheless, the classical method, Needleman-Wunsch (NW) algorithm may produce false alignment outcomes, resulting in inaccurate mutation identification. The key to precisely identifying CRISPR-induced mutations lies in determining optimal parameters for the sequence alignment algorithm. Hidden Markov models (HMM) are ideally suited for this task, offering flexibility across CRISPR systems by leveraging forward-backward algorithms for parameter estimation. In this study, we introduce CRISPR-HMM, a statistical software to precisely call CRISPR-induced mutations. We demonstrate that the software significantly improves precision in identifying CRISPR-induced mutations compared to NW-based alignment, thereby enhancing the overall understanding of the CRISPR gene-editing process.

Keywords: CRISPR, HMM, sequence alignment, gene editing

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Authors: Catherine Bernard

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The maldistribution of clinicians within countries is well documented. It is a common theme throughout the world that rural areas often struggle to recruit and retain health workers resulting in inadequate healthcare for many. This paper will concentrate on the responsibilities that medical schools may have in addressing this shortage of rural health workers. Recommendations are made with regards to targeted rural student admissions, rurally-based medical schools, rural clinical rotations and a curriculum orientated towards rural health issues. The evidence gathered suggests that individual factors are positive in encouraging health workers to practice in rural locations. However, there is strength in numbers, and combining all the recommendations will likely result in a synergistic effect, thereby increasing numbers of rural health workers and achieving accessible healthcare for those living in rural populations.

Keywords: medical education, medical education design, public health, rural health

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Authors: Muhammad Farooq Baig

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Objective: The purpose of this study was to compare results obtained using a single fecal specimen for O&P examination, direct immunofluorescence assay (DFA), and two conventional staining methods. Design: Hundred and fifty children fecal specimens were collected and examined by each method. The O&P and the DFA were used as the reference method. Setting: The study was performed at the laboratory in the Basic Medical Science Institute JPMC Karachi. Patients or Other Participants: The fecal specimens were collected from children with a suspected Giardia lamblia infection. Main Outcome Measures: The amount of agreement and disagreement between methods.1) Presence of giardiasis in our population. 2) The sensitivity and specificity of each method. Results: There was 45(30%) positive 105 (70%) negative on DFA, 41 (27.4%) positive 109 (72.6%) negative on iodine and 34 (22.6%) positive 116(77.4%) on saline method. The sensitivity and specificity of DFA in comparision to iodine were 92.2%, 92.7% respectively. The sensitivity and specificity of DFA in comparisoin to saline method were 91.2%, 87.9% respectively. The sensitivity of iodine method and saline method in compariosn to DFA were 82.2%, 68.8% respectively. There is mark diffrence in sensitivity of DFA to conventional method. Conclusion: The study supported findings of other investigators who concluded that DFA method have the greater sensitivity. The immunologic methods were more efficient and quicker than the conventional O&P method.

Keywords: direct immunofluorescence assay (DFA), ova and parasite (O&P), Giardia lamblia, children, medical science

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Authors: A. Elsariti, T. Evans

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An understanding of the interaction between acoustic waves and cancellous bone is needed in order to realize the full clinical potential of ultrasonic bone measurements. Scattering is likely to be of central importance but has received little attention to date. Few theoretical approaches have been described to explain scattering of ultrasound from bone. In this study, a scattering model based on velocity and density fluctuations in a binary mixture (marrow fat and cortical matrix) was used to estimate the ultrasonic attenuation in cancellous bone as a function of volume fraction. Predicted attenuation and backscatter coefficient were obtained for a range of porosities and scatterer size. At 600 kHZ and for different scatterer size the effect of velocity and density fluctuations in the predicted attenuation was approximately 60% higher than velocity fluctuations.

Keywords: ultrasound scattering, sound speed, density fluctuations, attenuation coefficient

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Authors: Girum Tedla Assefa

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Background: Granulomatous mycosis fungoides is an extremely rare type of cutaneous T-cell lymphoma (<55 cases reported worldwide). Case report: A 36-year-old female presented with soft tissue atrophy of right lower limb (dermis + hypodermis) of 22 years and plaques over trunk of 3 years duration. Histological examination of a biopsy taken from the atrophied tissue showed a granulomatous reaction with epidermotropic atypical lymphocytes. However, in other areas there were only findings of conventional MF without granuloma. Conclusion: The diagnosis of a granulomatous mycosis fungoides depends exclusively on the histological demonstration of granulomas. Distinct clinical characteristics are not present. This case highlights the importance of thorough investigation of lipoatrophic skin changes in the adult to exclude underlying causes, including MF.

Keywords: cutaneous lymphoma, granulomatous skin lymphoma, mycoses fungoides, skin atrophy

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Authors: Tikumporn Rodkhunmuang

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The importance of ‘international law of governance’ is the means and end to deal with international affairs. This research paper seeks to first study the historical development of international law of governance from the classical period of the international legal framework of global governance until the contemporary period of its framework. Second, the international law of governance is extremely turning into the crucial point in its long history because of the changing of China's foreign policies towards ‘One Belt One Road Initiative’. Third, the proposing model of the existing international law of governance within Chinese characteristics will be the new rules and modalities of modern diplomacy and governed international affairs. Methodologically speaking, this research paper is conducting under mixed methods research, which are also included numerical analysis and theoretical considerations. As a result, this research paper is the critical point of the international legal framework of global governance that changing the diplomatic paradigm as well as turning China into a great-power in international politics. So, this research paper is useful for international legal scholars and diplomats for slightly changing their understanding of the rapidly changing their norms from western norms to the eastern norms of international law. Therefore, the outcome of the research is the modern model of China to make a diplomatic relationship with other countries in the global society.

Keywords: global governance, international law, landscape, one belt one road

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Authors: Kritin K. Verma, Bailey Duhon, Patrick W. Slater

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Objective: To introduce the possible etiological role that the Labyrinthine Venous Vasculature (LVV) has in venous congestion of the cochlear system in Sudden Sensorineural Hearing Loss (SSNHL) patients. Patients: Two patients (62-year-old female, 50-year-old male) presented within twenty-four hours of onset of SSNHL. Intervention: Following failed conservative and salvage techniques, the patients underwent ablation of the labyrinthine venous vasculature ipsilateral to the side of the loss. Main Outcome Measures: Improvement of sudden SSNHL based on an improvement of pure-tone audiometric (PTA) low-tone scoring averages at 250, 500, and 1000 Hz. Word recognition scoring using the NU-6 word list was used to assess quality of life. Results: Case 1 experienced a 51.7 dB increase in low-tone PTA and an increased word recognition scoring of 90%. Case 2 experienced a 33.4 dB increase in low-tone PTA and 60% increase in word recognition score. No major complications noted. Conclusion: Two patients experienced significant improvement in their low-tone PTA and word recognition scoring following the labyrinthine venous vasculature ablation.

Keywords: case report, sudden sensorineural hearing loss, venous congestion, vascular ablation

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Authors: Maria Laura Alzua, Maria Adelaida Lopera

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This paper measures the relative importance of conditional cooperation and unconditional cooperation in a large public goods experiment conducted in Mali. We use expectations about total public goods provision to estimate a structural choice model with heterogeneous preferences. While unconditional cooperation can be captured by common preferences shared by all participants, conditional cooperation is much more heterogeneous and depends on unobserved individual factors. This structural model, in combination with two experimental treatments, suggests that leadership and group communication incentivize public goods provision through different channels. First, We find that participation of local leaders effectively changes individual choices through unconditional cooperation. A simulation exercise predicts that even in the most pessimistic scenario in which all participants expect zero public good provision, 60% would still choose to cooperate. Second, allowing participants to communicate fosters conditional cooperation. The simulations suggest that expectations are responsible for around 24% of the observed public good provision and that group communication does not necessarily ameliorate public good provision. In fact, communication may even worsen the outcome when expectations are low.

Keywords: conditional cooperation, discrete choice model, expectations, public goods game, random coefficients model

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