Search results for: Clinical Application

Authors: Ankita Kushwaha, M. P. Singh

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Background: In the present investigation the efficiency of laccase (benzenediol: oxygen oxidoreductase, EC 1.10.3.2) from Pleurotus citrinopileatus was assessed for the decolorization of azo dyes. Aim: Enzyme production, characterization and kinetics of a partially purified laccase from Pleurotus citrinopileatus were determined for its application in bioremediation of azo dyes. Methods & Results: Laccase has been partially purified by using 80% ammonium sulphate solution. Total activity, total protein, specific activity and purification fold for partially purified laccase were found to be 40.38U, 293.33mg/100ml, 0.91U/mg and 2.84, respectively. The pH and temperature optima of laccase were 5.0 and 50ºC, respectively, while the enzyme was most stable at pH 4.0 and temperature 30ºC when exposed for one hour. The Km of the partially purified laccase for substrates guaiacol, DMP (2,6-dimethoxyphenol) and syringaldazine (3,5-dimethoxy-4-hydroxybenzaldehyde azine) were 60, 95 and 26, respectively. This laccase has been tested for the use in the bioremediation of azo dyes in the absence of mediator molecules. Two dyes namely congo red and bromophenol blue were tested. Discussion: It was observed that laccase enzyme was very effective in the decolorization of these two dyes. More than 80% decolorization was observed within half an hour even in the absence of mediator and their lower Km value indicates that efficiency of the enzyme is very high. The results were promising due to quicker decolorization in the absence of mediators showing that it can be used as a valuable biocatalyst for quick bioremediation of azo dyes. Conclusion: The enzymatic properties of laccase from P. citrinopileatus should be considered for a potential environmental (biodegradation and bioremediation) or industrial applications.

Keywords: azo dyes, decolorization, laccase, P.citrinopileatus

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Authors: Sara Ataei, Molouk Hadjibabaie, Amirhossein Moslehi, Maryam Taghizadeh-Ghehi, Asieh Ashouri, Elham Amini, Kheirollah Gholami, Alireza Hayatshahi, Mohammad Vaezi, Ardeshir Ghavamzadeh

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Acute kidney injury (AKI) is one of the complications of hematopoietic stem cell transplantation and is associated with increased mortality. N-acetylcysteine (NAC) is a thiol compound with antioxidant and vasodilatory properties that has been investigated for the prevention of AKI in several clinical settings. In the present study, we evaluated the effects of intravenous NAC on the prevention of AKI in allogeneic hematopoietic stem cell transplantation patients. A double-blind randomized placebo-controlled trial was conducted, and 80 patients were recruited to receive 100 mg/kg/day NAC or placebo as intermittent intravenous infusion from day -6 to day +15. AKI was determined on the basis of the Risk-Injury-Failure-Loss-Endstage renal disease and AKI Network criteria as the primary outcome. We assessed urine neutrophil gelatinase-associated lipocalin (uNGAL) on days -6, -3, +3, +9, and +15 as the secondary outcome. Moreover, transplant-related outcomes and NAC adverse reactions were evaluated during the study period. Statistical analysis was performed using appropriate parametric and non-parametric methods including Kaplan–Meier for AKI and generalized estimating equation for uNGAL. At the end of the trial, data from 72 patients were analyzed (NAC: 33 patients and placebo: 39 patients). Participants of each group were not different considering baseline characteristics. AKI was observed in 18% of NAC recipients and 15% of placebo group patients, and the occurrence pattern was not significantly different (p = 0.73). Moreover, no significant difference was observed between groups for uNGAL measures (p = 0.10). Transplant-related outcomes were similar for both groups, and all patients had successful engraftment. Three patients did not tolerate NAC because of abdominal pain, shortness of breath and rash with pruritus and were dropped from the intervention group before transplantation. However, the frequency of adverse reactions was not significantly different between groups. In conclusion, our findings could not show any clinical benefits from high-dose NAC particularly for AKI prevention in allogeneic hematopoietic stem cell transplantation patients.

Keywords: acute kidney injury, N-acetylcysteine, hematopoietic stem cell transplantation, urine neutrophil gelatinase-associated lipocalin, randomized controlled trial

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Authors: Mohd Nizam Osman

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This study explores issues and challenges of information and communication technology (ICT) adoption and application for business-related performance of Agro-based small and medium-scale enterprises (SMEs) in the state of Selangor, Malaysia. Globally, SMEs have championed the socio-economic development of nations across the globe, including Malaysia. Thus, the objectives of this study explore issues and challenges of agro-based SMEs' adoption and usage of ICT, the business-related performance of SMEs via the adoption of ICT, and the impact of incentives on SMEs' adoption and use of ICT. The study was conducted in Selangor, Malaysia. A qualitative research approach was deployed for the study. Data for the study emanated from semi-structured interviews and field note observation of 14 informants who are registered as small-scale business owners and operators. Based on thematic analysis, data were triangulated to ensure consistency and validation of findings for the study. Findings revealed that SMEs are faced with a lack of funding, low expertise, and lack of storage, leading to an unsustainable supply of goods and services. Although effective communication, ease of business activities/transactions, and information search by way of research were among the business performance experienced by SMEs' adoption of ICT. Further findings showed that loan conditions and personal and business interests hindered SMEs' reception and access to programs, schemes, and incentives geared at aiding the continuous growth and development of agro-based SMEs. The study suggests the need for policy change in terms of diversification of channels of funding and access to funds to enable credit guarantee schemes and peer or community-based financing. Consequently, the study recommends the engagement of SMEs in policy decision-making to ascertain the type of incentives relevant to their business operations. Likewise, from a technological standpoint, the study suggests the expansion of the framework of technology acceptance with focuses on affordability, type of users, and level of usage.

Keywords: ICT adoption, business related performance, agro-based SMEs, ICT application for SMEs

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Authors: A. Mihoc, K. Cater

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On the bridge of a ship the officers are looking for visual aids to guide navigation in order to reconcile the outside world with the position communicated by the digital navigation system. Aids to navigation include: Lighthouses, lightships, sector lights, beacons, buoys, and others. They are designed to help navigators calculate their position, establish their course or avoid dangers. In poor visibility and dense traffic areas, it can be very difficult to identify these critical aids to guide navigation. The paper presents the usage of Augmented Reality (AR) as a means to present digital information about these aids to support navigation. To date, nautical navigation related mobile AR applications have been limited to the leisure industry. If proved viable, this prototype can facilitate the creation of other similar applications that could help commercial officers with navigation. While adopting a user centered design approach, the team has developed the prototype based on insights from initial research carried on board of several ships. The prototype, built on Nexus 9 tablet and Wikitude, features a head-up display of the navigational aids (lights) in the area, presented in AR and a bird’s eye view mode presented on a simplified map. The application employs the aids to navigation data managed by Hydrographic Offices and the tablet’s sensors: GPS, gyroscope, accelerometer, compass and camera. Sea trials on board of a Navy and a commercial ship revealed the end-users’ interest in using the application and further possibility of other data to be presented in AR. The application calculates the GPS position of the ship, the bearing and distance to the navigational aids; all within a high level of accuracy. However, during testing several issues were highlighted which need to be resolved as the prototype is developed further. The prototype stretched the capabilities of Wikitude, loading over 500 objects during tests in a major port. This overloaded the display and required over 45 seconds to load the data. Therefore, extra filters for the navigational aids are being considered in order to declutter the screen. At night, the camera is not powerful enough to distinguish all the lights in the area. Also, magnetic interference with the bridge of the ship generated a continuous compass error of the AR display that varied between 5 and 12 degrees. The deviation of the compass was consistent over the whole testing durations so the team is now looking at the possibility of allowing users to manually calibrate the compass. It is expected that for the usage of AR in professional maritime contexts, further development of existing AR tools and hardware is needed. Designers will also need to implement a user-centered design approach in order to create better interfaces and display technologies for enhanced solutions to aid navigation.

Keywords: compass error, GPS, maritime navigation, mobile augmented reality

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Authors: Joshua Russell, Omar Zubair, Reuben Ndegwa

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Introduction: Mesenteric ischemia is an uncommon condition that can be challenging to diagnose in the acute setting, with the potential for significant morbidity and mortality. Very rarely has acute acalculous cholecystitis been described in the setting of mesenteric ischemia. Case: This was the case in a 78-year-old male, who initially presented with clinical and radiological evidence of small bowel obstruction, thought likely secondary to malignancy. The patient had a 6-week history of anorexia, worsening lower abdominal pain, and ~30kg of unintentional weight loss over a 12-month period and a CT- scan demonstrated a transition point in the distal ileum. The patient became increasingly hemodynamically unstable and peritonitic, and an emergency laparotomy was performed. Intra-operatively, however, no obvious transition point was identified, and instead, the gallbladder was markedly gangrenous and oedematous, consistent with acalculous cholecystitis. An open total cholecystectomy was subsequently performed. The patient was admitted to the Intensive Care Unit post-operatively and continued to deteriorate over the proceeding 48 hours, with two re-look laparotomies demonstrating progressively worsening bowel ischemia, initially in the distribution of the superior mesenteric artery and then the coeliac trunk. On review, the patient was found to have an aberrant right hepatic artery arising from the superior mesenteric artery. The extent of ischemia was considered non-survivable, and the patient was palliated. Discussion: Multiple theories currently exist for the underlying pathophysiology of acalculous cholecystitis, including biliary stasis, sepsis, and ischemia. This case lends further support to ischemia as the underlying etiology of acalculous cholecystitis. This is particularly the case when considered in the context of the patient’s aberrant right hepatic artery arising from the superior mesenteric artery, which occurs in 11-14% of patients. Conclusion: This case report adds further insight to the debate surrounding the pathophysiology of acalculous cholecystitis. It also presents acalculous cholecystitis as a complication of mesenteric ischemia that should always be considered, especially in the elderly patient and in the context of relatively common anatomical variations. Furthermore, the case brings to attention the importance of maintaining dynamic working diagnoses in the setting of evolving pathophysiology and clinical presentations.

Keywords: acalculous cholecystitis, anatomical variation, general surgery, mesenteric ischemia

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Authors: Francisco J. Cedano, Laura M. Pinzón, Camila I. Castro, Felipe Salcedo, Juan P. Casas, Juan C. Briceño

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Complex fractures located in articular surfaces are challenging to treat and their reduction with conventional treatments could compromise the functionality of the affected limb. An adhesive material to treat those fractures is desirable for orthopedic surgeons. This adhesive must be biocompatible and have a high adhesion to bone surface in an aqueous environment. The proposed adhesive is based on chitosan, given its adhesive and biocompatibility properties. Chitosan is mixed with calcium carbonate and hydroxyapatite, which contribute to structural support and a gel like behavior, and glutaraldehyde is used as a cross-linking agent to keep the adhesive mechanical performance in aqueous environment. This work aims to evaluate the rheological, adhesion strength and biocompatibility properties of the proposed adhesive using in vitro tests. The gelification process of the adhesive was monitored by oscillatory rheometry in an ARG-2 TA Instruments rheometer, using a parallel plate geometry of 22 mm and a gap of 1 mm. Time sweep experiments were conducted at 1 Hz frequency, 1% strain and 37°C from 0 to 2400 s. Adhesion strength is measured using a butt joint test with bovine cancellous bone fragments as substrates. The test is conducted at 5 min, 20min and 24 hours after curing the adhesive under water at 37°C. Biocompatibility is evaluated by a cytotoxicity test in a fibroblast cell culture using MTT assay and SEM. Rheological results concluded that the average gelification time of the adhesive is 820±107 s, also it reaches storage modulus magnitudes up to 106 Pa; The adhesive show solid-like behavior. Butt joint test showed 28.6 ± 9.2 kPa of tensile bond strength for the adhesive cured for 24 hours. Also there was no significant difference in adhesion strength between 20 minutes and 24 hours. MTT showed 70 ± 23 % of active cells at sixth day of culture, this percentage is estimated respect to a positive control (only cells with culture medium and bovine serum). High vacuum SEM observation permitted to localize and study the morphology of fibroblasts presented in the adhesive. All captured fibroblasts presented in SEM typical flatted structure with filopodia growth attached to adhesive surface. This project reports an adhesive based on chitosan that is biocompatible due to high active cells presented in MTT test and these results were correlated using SEM. Also, it has adhesion properties in conditions that model the clinical application, and the adhesion strength do not decrease between 5 minutes and 24 hours.

Keywords: bioadhesive, bone adhesive, calcium carbonate, chitosan, hydroxyapatite, glutaraldehyde

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Authors: Mikailzade Parvin, Gurbanova Jamila, Alizade Samaya, Hasanova Afat

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It is known that in March 2020, the World Health Organization (WHO) declared a global pandemic of the 2019 coronovirus disease COVID-19, caused by the severe acute respiratory syndrome coronovirus (SARS-CoV-2). In this period, ensuring the safety of pregnancy and childbirth has become one of the necessary issues. The measures taken in this direction naturally consisted of strengthening and improving preventive measures among pregnant women. It should be noted that the lethality of SARS-CoV-2 infection among women reached 25%. The relevance of studying the effect of COVID-19 on reproductive health in women is due to its wide spread worldwide, severe clinical course, and the occurrence of numerous complications or lethality. It is of urgent importance to study the impact of the mentioned coronavirus infection on the health of pregnant women and the serious complications caused by it.Taking these into account, 230 pregnant women infected with the COVID-19 virus infection were registered. The average age of the pregnant women included in the study was: 29.24±6.0. The diagnosis of corona virus infection was made on the basis of polymerase chain reaction (PCR), serological tests (IgG, IgM). In 57.4% of cases, bilateral pneumonia was recorded in pregnant women and confirmed on the basis of radiological (RH) examination. RH examination revealed pneumonia with infiltrate in the lungs. Among clinical symptoms in pregnant women infected with COVID-19 virus infection: in 86 (37.4%) cases, symptoms such as high fever (t-39.0oC), shortness of breath, fatigue, and hypoxia were noted in pregnant women. A decrease in SpO2 to a minimal level was recorded. Laboratory-instrumental examinations were carried out. The obtained results showed: the average limit of D-dimer was 0.8±0.5; prothrombin time 13.2±1.1 seconds; INR 0.98±0.08, prothrombin index 104.3±19.5%, EHS - 34.8±13.6 mm/s. It should be noted that respiratory distress syndrome (RDS), premature birth, malformed and extremely malformed newborns, asphyxia or hypoxia have been reported in infants born to pregnant women infected with the coronavirus disease.Thus, from the obtained indicators, it is known that pregnant women infected with the virus have a high risk of serious illness and death for both themselves and their babies. It has been proven that the majority of babies born to SARS-CoV-2 positive mothers have a negative impact on their health.

Keywords: Covid 19, reproductive health, preqnancy, premature birth

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Authors: Aleksandra Zysk, Pawel Badura

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Recognizing and controlling vocal registers during singing is a difficult task for beginner vocalist. It requires among others identifying which part of natural resonators is being used when a sound propagates through the body. Thus, an application has been designed allowing for sound recording, automatic vocal register recognition (VRR), and a graphical user interface providing real-time visualization of the signal and recognition results. Six spectral features are determined for each time frame and passed to the support vector machine classifier yielding a binary decision on the head or chest register assignment of the segment. The classification training and testing data have been recorded by ten professional female singers (soprano, aged 19-29) performing sounds for both chest and head register. The classification accuracy exceeded 93% in each of various validation schemes. Apart from a hard two-class clustering, the support vector classifier returns also information on the distance between particular feature vector and the discrimination hyperplane in a feature space. Such an information reflects the level of certainty of the vocal register classification in a fuzzy way. Thus, the designed recognition and training application is able to assess and visualize the continuous trend in singing in a user-friendly graphical mode providing an easy way to control the vocal emission.

Keywords: classification, singing, spectral analysis, vocal emission, vocal register

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Authors: Chong-Yang Qiao, Teeravarunyou Sakol

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Current production-oriented factories need maintenance operators to work in shifts monitoring and inspecting complex systems and different equipment in the situation of mechanical breakdown. Augmented reality (AR) is an emerging technology that embeds data into the environment for situation awareness to help maintenance operators make decisions and solve problems. An application was designed to identify the problem of steam generators and inspection centrifugal pumps. The objective of this research was to find the best medium of AR and type of problem solving strategies among analogy, focal object method and mean-ends analysis. Two scenarios of inspecting leakage were temperature and vibration. Two experiments were used in usability evaluation and future innovation, which included decision-making process and problem-solving strategy. This study found that maintenance operators prefer build-in magnifier to zoom the components (55.6%), 3D exploded view to track the problem parts (50%), and line chart to find the alter data or information (61.1%). There is a significant difference in the use of analogy (44.4%), focal objects (38.9%) and mean-ends strategy (16.7%). The marked differences between maintainers and operators are of the application of a problem solving strategy. However, future work should explore multimedia information retrieval which supports maintenance operators for decision-making.

Keywords: augmented reality, situation awareness, decision-making, problem-solving

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Authors: Juei-Hsin Wang, Yen-Ting Chen

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The paper examines teacher professional learning community theory and implementation by using technology and media tools in Taiwan. After literature review, the researcher concluded in five elements of teacher professional learning community theory. They are ‘sharing the vision and value', ‘collaborative cooperation’, ‘ to support the situation', ‘to share practice' and 'Pay Attention to Student Learning Effectiveness' five levels by using technology and media in flipped education. Teacher professional learning community is one kind of models for teacher professional development in flipped education. Due to Taiwan education culture, there is no summative evaluation for teachers. So, there are multiple kinds of ways and education practice in teacher professional learning community nowadays. This study used literature review and quality analysis to analyze the connection theory and practice and discussed the official and non‐official strategies on teacher professional learning community by using technology and media in flipped education. The tablet is used as a camera tool for classroom students to solve problems. The students can instantly see and enable other students to watch the whole class discussion by operating the tablet. This would allow teachers and students to focus on discussing the connotation of subjects, especially bottom‐up and non‐official cases from teachers become an important influence in Taiwan.

Keywords: professional learning community, collaborative cooperation, flipped education, technology application, media application

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Authors: Jaeseo Lim, Jooyong Park

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Although there is ample evidence that student involvement enhances learning, college education is still mainly centered on lectures. However, in recent years, the effectiveness of discussions and the use of collective intelligence have attracted considerable attention. This study intends to examine the empirical effects of discussions on learning outcomes in various conditions. Eighty eight college students participated in the study and were randomly assigned to three groups. Group 1 was told to review material after a lecture, as in a traditional lecture-centered class. Students were given time to review the material for themselves after watching the lecture in a video clip. Group 2 participated in a discussion in groups of three or four after watching the lecture. Group 3 participated in a discussion after studying on their own. Unlike the previous two groups, students in Group 3 did not watch the lecture. The participants in the three groups were tested after studying. The test questions consisted of memorization problems, comprehension problems, and application problems. The results showed that the groups where students participated in discussions had significantly higher test scores. Moreover, the group where students studied on their own did better than that where students watched a lecture. Thus discussions are shown to be effective for enhancing learning. In particular, discussions seem to play a role in preparing students to solve application problems. This is a preliminary study and other age groups and various academic subjects need to be examined in order to generalize these findings. We also plan to investigate what kind of support is needed to facilitate discussions.

Keywords: discussions, education, learning, lecture, test

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Authors: Jee-Young Lee, Joaquim J. Ferreira, Hyeo-il Ma, José-Francisco Rocha, Beomseok Jeon

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The effective management of wearing-off is a key driver of medication changes for patients with Parkinson’s disease (PD) treated with levodopa (L-DOPA). While L-DOPA is well tolerated and efficacious, its clinical utility over time is often limited by the development of complications such as dyskinesia. Still, common first-line option includes adjusting the daily L-DOPA dose followed by adjunctive therapies usually counting for the L-DOPA equivalent daily dose (LEDD). The LEDD conversion formulae are a tool used to compare the equivalence of anti-PD medications. The aim of this work is to compare the effects of opicapone (OPC) 50 mg, a catechol-O-methyltransferase (COMT) inhibitor, and an additional 100 mg dose of L-DOPA in reducing the off time in PD patients with early motor fluctuations receiving different daily L-DOPA doses. OPC was found to be well tolerated and efficacious in advanced PD population. This work utilized patients' home diary data from a 4-week Phase 2 pharmacokinetics clinical study. The Korean ADOPTION study randomized (1:1) patients with PD and early motor fluctuations treated with up to 600 mg of L-DOPA given 3–4 times daily. The main endpoint was change from baseline in off time in the subgroup of patients receiving 300–400 mg/day L-DOPA at baseline plus OPC 50 mg and in the subgroup receiving >300 mg/day L-DOPA at baseline plus an additional dose of L-DOPA 100 mg. Of the 86 patients included in this subgroup analysis, 39 received OPC 50 mg and 47 L-DOPA 100 mg. At baseline, both L-DOPA total daily dose and LEDD were lower in the L-DOPA 300–400 mg/day plus OPC 50 mg group than in the L-DOPA >300 mg/day plus L-DOPA 100 mg. However, at Week 4, LEDD was similar between the two groups. The mean (±standard error) reduction in off time was approximately three-fold greater for the OPC 50 mg than for the L-DOPA 100 mg group, being -63.0 (14.6) minutes for patients treated with L-DOPA 300–400 mg/day plus OPC 50 mg, and -22.1 (9.3) minutes for those receiving L-DOPA >300 mg/day plus L-DOPA 100 mg. In conclusion, despite similar LEDD, OPC demonstrated a significantly greater reduction in off time when compared to an additional 100 mg L-DOPA dose. The effect of OPC appears to be LEDD independent, suggesting that caution should be exercised when employing LEDD to guide treatment decisions as this does not take into account the timing of each dose, onset, duration of therapeutic effect and individual responsiveness. Additionally, OPC could be used for keeping the L-DOPA dose as low as possible for as long as possible to avoid the development of motor complications which are a significant source of disability.

Keywords: opicapone, levodopa, pharmacokinetics, off-time

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Authors: Krasimir Ivanov, Tonyo Tonev, Nguyen Nguyen, Alexander Peltekov, Anyo Mitkov

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Maize is among the most economically important crops and at the same time one of the most sensitive to soil deficiency in zinc. In this paper, the impact of the foliar zinc application in the form of zinc hydroxy nitrate suspension on the micro and macro elements partitioning in maize leaves and grain was studied during spring maize season, 2017. The impact of the foliar zinc fertilization on the grain yield and quality was estimated too. The experiment was performed by the randomized block design with 8 variants in 3 replications. Seven suspension solutions whit different Zn concentration were used, including ZnO suspension and zinc hydroxyl nitrate alone or nixed with other nutrients. Fertilization and irrigation were the same for all variants. The Zn content and the content of selected micro (Cu, Fe) and macro (Ca, Mg, P and K) elements in maize leaves were determined two weeks after the first spraying (5-6 sheets), two weeks after the second spraying (9-10 sheets) and after harvesting. It was concluded that the synthesized zinc hydroxy nitrate demonstrates potential as the long-term foliar fertilizer. A significant (p < 0.05) effect of zinc accumulation in maize leaves by foliar zinc application during the first growth stage was found, followed by its reutilization to other plants organs during the second growth stage. Significant export of Cu, P, and K from lower and middle leaves was observed. The content of Ca and Mg remains constant in the whole longevity period, while the content of Fe decreases sharply.

Keywords: foliar fertilization, zinc hydroxy nitrate, maize, zinc

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Authors: Rui Liu, Pengyu Cui, Nan Jiang

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At present, there is much research on the application of centralized management and cross-integration application of basic geographic information. However, the idea of information integration and sharing between land, sea, and air navigation targets is not deeply applied into the research of navigation information service, especially in the information expression. Targeting at this problem, the paper carries out works about the expression pattern of navigation electronic map for ground vehicles under air and land united navigation mechanism. At first, with the support from multi-source information fusion of GIS vector data, RS data, GPS data, etc., an air and land united information expression pattern is designed aiming at specific navigation task of emergency rescue in the earthquake. And then, the characteristics and specifications of the united expression of air and land navigation information under the constraints of map load are summarized and transferred into expression rules in the rule bank. At last, the related navigation experiment is implemented to evaluate the effect of the expression pattern. The experiment selects evaluation factors of the navigation task accomplishment time and the navigation error rate as the main index, and make comparisons with the traditional single information expression pattern. To sum up, the research improved the theory of navigation electronic map and laid a certain foundation for the design and realization of united navigation system in the aspect of real-time navigation information delivery.

Keywords: navigation electronic map, united navigation, multi-element expression pattern, multi-source information fusion

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Authors: C. M. Choi, H. C. Tsang, W. K. Fong, Y. K. Cheng, T. K. Chui, L. Y. Chan, K. W. Lee, C. K. Yuen, P. W. Lau, Y. L. To, K. C. Chow

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Six-minute walk test (6MWT) is a sub-maximal exercise test to assess aerobic capacity and exercise tolerance of patients with chronic respiratory disease and heart failure. This has been proven to be a reliable and valid tool and commonly used in clinical situations. Traditional 6MWT is labour-intensive and time-consuming especially for patients who require assistance in ambulation and oxygen use. When performing the test with these patients, one staff will assist the patient in walking (with or without aids) while another staff will need to manually record patient’s oxygen saturation, heart rate and walking distance at every minute and/or carry oxygen cylinder at the same time. Physiotherapist will then have to document the test results in bed notes in details. With the use of electronic 6MWT (E-6MWT), patients wear a wireless oximeter that transfers data to a tablet PC via Bluetooth. Real-time recording of oxygen saturation, heart rate, and distance are displayed. No manual work on recording is needed. The tablet will generate a comprehensive report which can be directly attached to the patient’s bed notes for documentation. Data can also be saved for later patient follow up. This study was carried out in North District Hospital. Patients who followed commands and required 6MWT assessment were included. Patients were assigned to study or control groups. In the study group, patients adopted the E-6MWT while those in control group adopted the traditional 6MWT. Manpower and time consumed were recorded. Physiotherapists also completed a questionnaire about the use of E-6MWT. Total 12 subjects (Study=6; Control=6) were recruited during 11-12/2017. An average number of staff required and time consumed in traditional 6MWT were 1.67 and 949.33 seconds respectively; while in E-6MWT, the figures were 1.00 and 630.00 seconds respectively. Compared to traditional 6MWT, E-6MWT required 67.00% less manpower and 50.10% less in time spent. Physiotherapists (n=7) found E-6MWT is convenient to use (mean=5.14; satisfied to very satisfied), requires less manpower and time to complete the test (mean=4.71; rather satisfied to satisfied), has better data management (mean=5.86; satisfied to very satisfied) and is recommended to be used clinically (mean=5.29; satisfied to very satisfied). It is proven that E-6MWT requires less manpower input with higher efficiency and better data management. It is welcomed by the clinical frontline staff.

Keywords: electronic, physiotherapy, six-minute walk test, 6MWT

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Authors: Omar Ameir, Jakub Chlopecký, Jaroslav Hubáček

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Behavioral aspects are very important for successful human resource management. This fact is becoming more and more apparent. Therefore, the paperdeals with behaviora leconomics, human resource management, and theenterpriseswith 100+ employees. More precisely, thepaperfocuses on the degree of the anchoring effect, i.e. the degree of the use of the instruments for influencing and persuasionthatmanagersapply to manage their employees. This paper builds on the results of previous researches and further develops these results. The authors used the questionnaire to identify how much the anchoring effect is applied in enterprise with 100+ employees. The main goal of the paper is to compare the anchoring effect application in employee management in SilesianVoivodeship (Polish region) with three Czech regions which are Prague, Moravian-Silesian region, and Vysočina region. The comparison applies to enterprises with 100+ employees. The second goal of the paper is to find out how tentheanchoring effectisused in the SilesianVoivodeship. The authors set one hypothesis and the result soft the paper rejected it. The basic assumption led the authors of this paper to this research. The authors predicted that managers of SilesianVoivodeshipcompanies use anchoring methods less often than the three regions mentioned above, i.ethemanagersof Prague companies, themanagersofMoravian-Silesian region companies, and themanagersofVysočina region companies. Confirmation or rejection of the above mentioned assumptions discussed in more detail.

Keywords: anchoring effect, behavioral economics, enterprises with 100+ employees, nescience of the anchoring

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Authors: Alisha M. Ebrahim, Bijoy K. Menon, Eddy Lang, Shelagh B. Coutts, Katie Lin

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Introduction: Frontline emergency physicians require clear and evidence-based approaches to guide neuroimaging investigations for patients presenting with suspected acute stroke or transient ischemic attack (TIA). Various forms of computed tomography (CT) are currently available for initial investigation, including non-contrast CT (NCCT), CT angiography head and neck (CTA), and CT perfusion (CTP). However, there is uncertainty around optimal imaging choice for cost-effectiveness, particularly for minor or resolved neurological symptoms. In addition to the cost of CTA and CTP testing, there is also a concern for increased incidental findings, which may contribute to the burden of overdiagnosis. Methods: In this cross-sectional observational study, analysis was conducted on 586 anonymized triage and diagnostic imaging (DI) reports for neuroimaging orders completed on patients presenting to adult emergency departments (EDs) with a suspected stroke or TIA from January-December 2019. The primary outcome of interest is the diagnostic yield of NCCT+CTA compared to NCCT alone for patients presenting to urban academic EDs with Canadian Emergency Department Information System (CEDIS) complaints of “symptoms of stroke” (specifically acute stroke and TIA indications). DI reports were coded into 4 pre-specified categories (endorsed by a panel of stroke experts): no abnormalities, clinically significant findings (requiring immediate or follow-up clinical action), incidental findings (not meeting prespecified criteria for clinical significance), and both significant and incidental findings. Standard descriptive statistics were performed. A two-sided p-value <0.05 was considered significant. Results: 75% of patients received NCCT+CTA imaging, 21% received NCCT alone, and 4% received NCCT+CTA+CTP. The diagnostic yield of NCCT+CTA imaging for prespecified clinically significant findings was 24%, compared to only 9% in those who received NCCT alone. The proportion of incidental findings was 30% in the NCCT only group and 32% in the NCCT+CTA group. CTP did not significantly increase the yield of significant or incidental findings. Conclusion: In this cohort of patients presenting with suspected stroke or TIA, an NCCT+CTA neuroimaging strategy had a higher diagnostic yield for clinically significant findings than NCCT alone without significantly increasing the number of incidental findings identified.

Keywords: stroke, diagnostic yield, neuroimaging, emergency department, CT

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Authors: Mohd Asim, K. Nageswara Rao

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The present work was carried out on River Yamuna passing through Delhi- National Capital Region (Delhi-NCR) of India for a stretch of about 130 km to assess the anthropogenic impact on the channel migration process for a period of 200 years with the help of satellite data and topographical maps with integration of geographic information system environment. Digital Shoreline Analysis System (DSAS) application was used to quantify river channel migration in ArcGIS environment. The average river channel migration was calculated to be 22.8 m/year for the entire study area. River channel migration was found to be moving in westward and eastward direction. Westward migration is more than 4 km maximum in length and eastward migration is about 4.19 km. The river has migrated a total of 32.26 sq. km of area. The results reveal that the river is being impacted by various human activities. The impact indicators include engineering structures, sand mining, embankments, urbanization, land use/land cover, canal network. The DSAS application was also used to predict the position of river channel in future for 2032 and 2042 by analyzing the past and present rate and direction of movement. The length of channel in 2032 and 2042 will be 132.5 and 141.6 km respectively. The channel will migrate maximum after crossing Okhla Barrage near Faridabad for about 3.84 sq. km from 2022 to 2042 from west to east.

Keywords: river migration, remote sensing, river Yamuna, anthropogenic impacts, DSAS, Delhi-NCR

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Authors: Thaminda Liyanage, Chamila Shamika Kurukulasuriya

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Introduction: Morbid obesity has been successfully treated with bariatric surgery for over 60 years. Although operative procedures have improved and associated complications have reduced substantially, surgery still carries the risk of post-operative malabsorption, malnutrition and a range of gastrointestinal disorders. Overweight by itself can impair libido in both sexes and cause erectile dysfunction in males by inducing a state of hypogonadotropic hypogonadism, proportional to the degree of obesity. Impact of weight reduction on libido and sexual activity remains controversial, however it is broadly accepted that weight loss improves sexual drive. Zinc deficiency, subsequent to malabsorption, may lead to impaired testosterone synthesis in men while excessive and/or rapid weight loss in females may result in reversible amenorrhoea leading to sub-fertility. Methods: We describe a 37 year old male, 6 years post Roux-en-Y gastric bypass surgery, who presented with erectile dysfunction, loss of libido, worsening fatigue and generalized weakness for 4 months. He also complained of constipation and frequent muscle cramps but denied having headache, vomiting or visual disturbances. Patient had lost 38 kg of body weight post gastric bypass surgery over four years {135kg (BMI 42.6 kg/m2) to 97 kg (BMI 30.6 kg/m2)} and the weight had been stable for past two years. He had no recognised co-morbidities at the time of the surgery and noted marked improvement in general wellbeing, physical fitness and psychological confident post surgery, up until four months before presentation. Clinical examination revealed dry pale skin with normal body hair distribution, no thyroid nodules or goitre, normal size testicles and normal neurological examination with no visual field defects or diplopia. He had low serum testosterone, follicular stimulating hormone (FSH), luteinizing hormone (LH), T3, T4, thyroid stimulating hormone (TSH), insulin like growth factor 1 (IGF-1) and 24-hour urine cortisol levels. Serum cortisol demonstrated an appropriate rise to ACTH stimulation test but growth hormone (GH) failed increase on insulin tolerance test. Other biochemical and haematological studies were normal, except for low zinc and folate with minimally raised liver enzymes. MRI scan of the head confirmed a solid pituitary mass with no mass effect on optic chiasm. Results: In this patient clinical, biochemical and radiological findings were consistent with anterior pituitary dysfunction. However, there were no features of raised intracranial pressure or neurological compromise. He was commenced on appropriate home replacement therapy and referred for neurosurgical evaluation. Patient reported marked improvement in his symptoms, specially libido and erectile dysfunction, on subsequent follow up visits. Conclusion: Sexual dysfunction coupled with non specific constitutional symptoms has multiple aetiologies. Clinical symptoms out of proportion to nutritional deficiencies post bariatric surgery should be thoroughly investigated. Close long term follow up is crucial for overall success.

Keywords: obesity, bariatric surgery, erectile dysfunction, loss of libido

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Authors: Qin Dai

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The renovation of existing interior space is big issue for architects in today’s China. However the traditional way of space renovation in China mostly focuses on the object itself, and the method also focuses on subjective level without the support of specific data. This research focuses the application of renovation of existing interior space based on post occupancy evaluation by a case study of a typical interior space. The research hopes to give a more scientific method of interior space renovation for architects and help promoting and guiding renovation practice. This research studies the post occupancy evaluation of the atrium space of Zhejiang University Library including subjective satisfaction and physical environmental satisfaction. The result provides necessary data support to conclude the design principles and strategies of renovation. Then the research uses simulation software to verify the availability of the strategy given based on the study. In conclusion, the research summarizes the application process of design methods of renovation of existing interior space based on the post-occupancy evaluation, and testifies to the practical significance of the renovation of existing interior space.

Keywords: existing interior space, physical environmental satisfaction, post occupancy evaluation, renovation of space, subjective satisfaction of space

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Authors: Dalia El Hadi, Alaa Bou Ghannam, Hala Mostafa, Hana Mansour, Ibrahim Hashim, Soubhi Tahhan, Tharwat El Zahran

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Introduction: Neuro-ophthalmological emergencies require prompt assessment and management to avoid vision or life-threatening sequelae. Some would require neuroimaging. Most commonly used are the CT and MRI of the Brain. They can be over-used when not indicated. Their yield remains dependent on multiple factors relating to the clinical scenario. Methods: A retrospective cross-sectional study was conducted by reviewing the electronic medical records of patients presenting to the Emergency Department (ED) with isolated neuro-ophthalmologic complaints. For each patient, data were collected on the clinical presentation, whether neuroimaging was performed (and which type), and the result of neuroimaging. Analysis of the performed neuroimaging was made, and its yield was determined. Results: A total of 211 patients were reviewed. The complaints or symptoms at presentation were: blurry vision, change in the visual field, transient vision loss, floaters, double vision, eye pain, eyelid droop, headache, dizziness and others such as nausea or vomiting. In the ED, a total of 126 neuroimaging procedures were performed. Ninety-four imagings (74.6%) were normal, while 32 (25.4%) had relevant abnormal findings. Only 2 symptoms were significant for abnormal imaging: blurry vision (p-value= 0.038) and visual field change (p-value= 0.014). While 4 physical exam findings had significant abnormal imaging: visual field defect (p-value= 0.016), abnormal pupil reactivity (p-value= 0.028), afferent pupillary defect (p-value= 0.018), and abnormal optic disc exam (p-value= 0.009). Conclusion: Risk indicators for abnormal neuroimaging in the setting of neuro-ophthalmological emergencies are blurred vision or changes in the visual field on history taking. While visual field irregularities, abnormal pupil reactivity with or without afferent pupillary defect, or abnormal optic discs, are risk factors related to physical testing. These findings, when present, should sway the ED physician towards neuroimaging but still individualizing each case is of utmost importance to prevent time-consuming, resource-draining, and sometimes unnecessary workup. In the end, it suggests a well-structured patient-centered algorithm to be followed by ED physicians.

Keywords: emergency department, neuro-ophthalmology, neuroimaging, risk indicators

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Authors: Musa H. Arslan

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Strengthening of the existing seismically deficient reinforced concrete (RC) buildings is an important issue in earthquake prone regions. Addition of RC shear wall as infill or external walls into the structural system has been a commonly preferred strengthening technique since the Big Erzincan Earthquake occurred in Turkey, 1992. The newly added rigid infill walls act primarily as shear walls and relieve the non-ductile existing frames from being subjected to large shear demands providing that new RC inner or external walls are adequately anchored to the existing weak RC frame. The performance of the RC shear walls-RC weak frame connections by steel anchor dowels depends on some parameters such as compressive strength of the existing RC frame concrete, diameter and embedment length of anchored rebar, type of rebar, yielding stress of bar, properties of used chemicals, position of the anchor bars in RC. In this study, application problems of the steel anchor dowels have been checked with some field studies such as tensile test. Two different RC buildings which will be strengthened were selected, and before strengthening, some tests have been performed in the existing RC buildings. According to the field observation and experimental studies, if the concrete compressive strength is lower than 10 MPa, the performance of the anchors is reduced by 70%.

Keywords: anchor dowel, concrete, damage, reinforced concrete, shear wall, frame

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Authors: Eny Syatriana

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English proficiency of Indonesian secondary school students is below standard. The low proficiency may come from poor teaching materials that do not meet the students’ need. The main objective for English teachers is to improve the English proficiency of the students. The purpose of this study is to explore the application Mapping, Practicing, Using (MPU) strategy with Instructional Materials Based on the School Curriculum toward the English achievement of Indonesian EFL Students. This paper is part my dissertation entitles 'Designing instructional materials for secondary school students based on the school curriculum' consisting of need analysis, design, development, implementation, and evaluation; this paper discusses need analysis and creates a model of creating instructional materials through deep discussion among teachers of secondary schools. The subject consisted of six English teachers and students of three classes at three different secondary schools in Makassar, South Sulawesi, Indonesia. Pretest and posttest design were administered to see the effectiveness of the MPU strategy. Questionnaires were administered to see the teachers and students’ perception toward the instructional materials. The result indicates that the MPU strategy is effective in improving the English achievement; instructional materials with different strategies improve the English achievement of the students. Both teachers and students argue that the presented instructional materials are effective to be used in the teaching and learning process to increase the English proficiency of the students.

Keywords: proficiency, development, English for secondary school students, instructional materials

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Authors: Yusuf Ali Abdulle, Azhar Uddin Keerio

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Background: Protein elicitors play a key role in signaling or displaying plant defense mechanisms and emerging as vital tools for bio-control of insects. This study was aimed at the characterization of the novel protein elicitor isolated from entomopathogenic fungi Lecanicillium lecanii (V3) strain and its activity against Whitefly, Bemisia tabaci in cotton. The sequence of purified elicitor protein showed 100% similarity with hypothetical protein LEL_00878 [Cordyceps confragosa RCEF 1005], GenBank no (OAA81333.1). This novel protein elicitor has 253 amino acid residues and 762bp with a molecular mass of 29 kDa. The protein recombinant was expressed in Escherichia coli using pET‐28a (+) plasmid. Effects of purified novel protein elicitor on Bemisia tabaci were determined at three concentrations of protein (i.e., 58.32, 41.22, 35.41 μg mL⁻¹) on cotton plants and were exposed to newly molted adult B.tabaci. Bioassay results showed a significant effect of the exogenous application of novel protein elicitor on B. tabaci in cotton. In addition, the gene expression analysis found a significant up-regulation of the major genes associated with salicylic acid (SA) and jasmonic acid (JA) linked plant defense pathways in elicitor protein-treated plants. Our results suggested the potential application of a novel protein elicitor derived from Lecanicillium lecanii as a future bio-intensive controlling approach against the whitefly, Bemisia tabaci.

Keywords: resistance, Lecanicillium lecanii, secondary metabolites, whitefly

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Authors: Gurbanova J., Majidova N., Ali-Zade S., Hasanova A., Mikailzade P.

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Currently, the problem of oncogynecological diseases is widespread and remains relevant in terms of quantitative growth. It is known that due to the increase in the number of benign diseases of the cervix, the development of precancerous conditions occurs. Benign diseases of the cervix represent the most common gynecological problem, which are often precursors of malignant neoplasms, especially cervical cancer. According to statistics, benign diseases of the cervix cover 25-45% of all gynecological diseases. Among women's oncogynecological diseases, cervical cancer ranks second in the world after breast cancer and ranks first in the mortality rate among oncological diseases in economically underdeveloped countries. We performed a comprehensive clinical and laboratory examination of 130 women aged 18 to 73 with benign cervical diseases. 59 (38.5%) women of reproductive age, as well as 39 (30%) premenopausal and 41 (31.5%) menopausal patients, participated in the study. Detailed anamnesis was collected from all patients, objective and gynecological examination was performed, laboratory and instrumental examinations (USM, IPV DNA, smear microscopy, and PCR bacteriological examination of sexually transmitted infections), simple and extended colposcopy, liquid-based РАР-smear smear and РАР-classic smear examinations were conducted. As a result of the research, the following nosological forms were found in women with benign diseases of the cervix: non-specific vaginitis in 10 (7.7%) cases; ectopia, endocervicitis - 60(46.2%); cervical ectropion - 7(5.4%); cervical polyp - 9(6.9%); cervical leukoplakia - 15(11.5%); atrophic vaginitis - 7(5.4%); condyloma - 12(9.2%); cervical stenosis - 2(1.5%); endometriosis of the cervix - was noted in 8 (6.2%) cases (p<0.001), respectively. Characteristics of the menstrual cycle among the examined women: normal cycle in 97 (74.6%) cases; oligomenorrhea – 23 (17.7%); polymenorrhea – 4(3.1%); algomenorrhea – noted in 6 (4.6%) cases (p<0.001). Cytological examination showed that: the specificity of liquid-based cytology was 76.2%, and the traditional PAP test was set at 70.6%. The overall diagnostic value was calculated to be 86% in liquid-based cytology and 78.5% in conventional PAP tests. Treatment of women with benign diseases of the cervix was carried out by diathermocoagulation method and "FOTEK EA 141M" device. It should be noted that 6 months after the treatment, after treatment with the "FOTEK EA 141M" device, there was no relapse in any patient. Recurrence was found in 23.7% of patients after diathermoelectrocoagulation. Thus, it is clear from the above that the study of cervical pathologies, the determination of optimal examinations, and effective treatment methods is one of the urgent problems facing obstetrics and gynecology.

Keywords: cervical cancer, cytological examination, PAP-smear, non-specific vaginitis

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Authors: Enoch Kudoahor, Nan Zheng

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We describe the use of readily available self-doped TiO2 and visible light, under a mild condition to synthesize a class of monocyclic, bicyclic, and benzocyclobutene amino compounds containing the endoperoxide bridges; their derivatives and further test their effective clinical activities against malaria, cancer, and their resistances. Considering their stable under photooxidation conditions and recyclability, we use a self-doped TiO2 under a visible condition to synthesize these classes of amino endoperoxides. These amino endoperoxides are stable over a period compared to classes of endoperoxides.

Keywords: catalysis, endoperoxides, titanium dioxide, visible light

Procedia PDF Downloads 146

Authors: Maria Stepankova, Lucie Vistejnova, Pavel Klein, Tereza Blassova, Marketa Slajerova, Radek Sedlacek, Martin Bartos, Jaroslav Chlupac

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Background: Clinical outcome benefits of the segment rib fracture surgical therapy are well known and follow from better stabilization of the chest wall. Despite this, some authors still incline to conservative therapy and point out to possible rib fracture healing failure in connection with the bone vascular supply disturbance caused by metal plate implantation. This suggestion met neither experimental nor clinical verification and remains the object of discussion. In our pilot study we investigated the titanium plate fixation effect on the rib fracture healing in porcine model and its histological, biomechanical and radiological aspects. Materials and Method: Two porcine models (experimental group) underwent the operative chest wall stabilization with a titanium plate implantation after osteotomy. Two other porcine models (control group) were treated conservatively after osteotomy. Three weeks after surgery, all animals were sacrificed, treated ribs were explanted and the histological analysis, µCT imaging and biomechanical testing of the calluses tissue were performed. Results: In µCT imaging, experimental group showed a higher cortical bone volume compared to the control group. Histological analysis using the non-decalcified bone tissue blocks demonstrated more maturated callus with higher newly-formed osseous tissue ratio in experimental group in comparison to controls. In contrast, no significant differences in bone blood vessels supply in both groups were observed. This finding suggests that the bone blood supply in experimental group was not impaired. Biomechanical analysis using 3-point bending test demonstrated significantly higher bending stiffness and the maximum force in experimental group. Conclusion: Based on our observation, it could be concluded, that the titanium plate fixation of the rib fractures leads to faster bone callus maturation whereas does not cause the vascular supply impairment after 3 weeks and thus has a beneficial effect on the rib fracture healing.

Keywords: bone vascular supply, chest wall stabilization, fracture healing, histological analysis, titanium plate implantation

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Authors: M. Amrita, R. R. Srikant, A. V. Sita Rama Raju

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Water miscible cutting fluids are conventionally used to lubricate and cool the machining zone. But issues related to health hazards, maintenance and disposal costs have limited their usage, leading to application of Minimum Quantity Lubrication (MQL). To increase the effectiveness of MQL, nanocutting fluids are proposed. In the present work, water miscible nanographite cutting fluids of varying concentration are applied at cutting zone by two systems A and B. System A utilizes high pressure air and supplies cutting fluid at a flow rate of 1ml/min. System B uses low pressure air and supplies cutting fluid at a flow rate of 5ml/min. Their performance in machining is evaluated by measuring cutting temperatures, tool wear, cutting forces and surface roughness and compared with dry machining and flood machining. Application of nano cutting fluid using both systems showed better performance than dry machining. Cutting temperatures and cutting forces obtained by both techniques are more than flood machining. But tool wear and surface roughness showed improvement compared to flood machining. Economic analysis has been carried out in all the cases to decide the applicability of the techniques.

Keywords: economic analysis, machining, minimum quantity lubrication, nanofluid

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Authors: Mustafa M. Donma, Orkide Donma

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Obesity and weight gain are associated with increased risk of developing cardiovascular diseases and the progression of liver fibrosis. Aspartate transaminase–to-platelet count ratio index (AST-to-PLT, APRI) and fibrosis-4 (FIB-4) were primarily considered as the formulas capable of differentiating hepatitis from cirrhosis. Recently, they have found clinical use as measures of liver fibrosis and cardiovascular risk. However, their status in children has not been evaluated in detail yet. The aim of this study is to determine APRI and FIB-4 status in obese (OB) children and compare them with values found in children with normal body mass index (N-BMI). A total of sixty-eight children examined in the outpatient clinics of the Pediatrics Department in Tekirdag Namik Kemal University Medical Faculty were included in the study. Two groups were constituted. In the first group, thirty-five children with N-BMI, whose age- and sex-dependent BMI indices vary between 15 and 85 percentiles, were evaluated. The second group comprised thirty-three OB children whose BMI percentile values were between 95 and 99. Anthropometric measurements and routine biochemical tests were performed. Using these parameters, values for the related indices, BMI, APRI, and FIB-4, were calculated. Appropriate statistical tests were used for the evaluation of the study data. The statistical significance degree was accepted as p<0.05. In the OB group, values found for APRI and FIB-4 were higher than those calculated for the N-BMI group. However, there was no statistically significant difference between the N-BMI and OB groups in terms of APRI and FIB-4. A similar pattern was detected for triglyceride (TRG) values. The correlation coefficient and degree of significance between APRI and FIB-4 were r=0.336 and p=0.065 in the N-BMI group. On the other hand, they were r=0.707 and p=0.001 in the OB group. Associations of these two indices with TRG have shown that this parameter was strongly correlated (p<0.001) both with APRI and FIB-4 in the OB group, whereas no correlation was calculated in children with N-BMI. Triglycerides are associated with an increased risk of fatty liver, which can progress to severe clinical problems such as steatohepatitis, which can lead to liver fibrosis. Triglycerides are also independent risk factors for cardiovascular disease. In conclusion, the lack of correlation between TRG and APRI as well as FIB-4 in children with N-BMI, along with the detection of strong correlations of TRG with these indices in OB children, was the indicator of the possible onset of the tendency towards the development of fatty liver in OB children. This finding also pointed out the potential risk for cardiovascular pathologies in OB children. The nature of the difference between APRI vs FIB-4 correlations in N-BMI and OB groups (no correlation versus high correlation), respectively, may be the indicator of the importance of involving age and alanine transaminase parameters in addition to AST and PLT in the formula designed for FIB-4.

Keywords: APRI, children, FIB-4, obesity, triglycerides

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Authors: Florian Engel

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Only with a radical change to an intrinsically motivated project team, through giving the employees the freedom for autonomy, mastery and purpose, it is then possible to develop excellent products. With these changes, combined with using a rapid application development approach, the group of users serves as an important indicator to test the market needs, rather than only as the stakeholders for requirements.

Keywords: intrinsic motivation, requirements elicitation, self-directed work, stakeholder participation

Procedia PDF Downloads 331