Search results for: clinical decision support systems

Authors: Nadine Yehya, Chantal Maatouk

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Low energy buildings have been developed to achieve global climate commitments in reducing energy consumption. They comprise energy efficient buildings, zero energy buildings, positive buildings and passive house buildings. The reduced energy demands in Low Energy buildings call for advanced building energy modeling that focuses on studying active building systems such as heating, cooling and ventilation, improvement of systems performances, and development of control systems. Modeling and building simulation have expanded to cover different modeling approach i.e.: detailed physical model, dynamic empirical models, and hybrid approaches, which are adopted by various simulation tools. This paper uses DesignBuilder with EnergyPlus simulation engine in order to; First, study the impact of efficiency measures on building energy behavior by comparing Low energy residential model to a conventional one in Beirut-Lebanon. Second, choose the appropriate energy systems for the studied case characterized by an important cooling demand. Third, study dynamic modeling of Variable Refrigerant Flow (VRF) system in EnergyPlus that is chosen due to its advantages over other systems and its availability in the Lebanese market. Finally, simulation of different energy systems models with different modeling approaches is necessary to confront the different modeling approaches and to investigate the interaction between energy systems and building envelope that affects the total energy consumption of Low Energy buildings.

Keywords: physical model, variable refrigerant flow heat pump, dynamic modeling, EnergyPlus, the modeling approach

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Authors: Alireza Zabihi, Saeed Peyghami, Hossein Mokhtari

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With the increasing deployment of renewable power plants, such as solar and wind, it is crucial to measure the harmonic situation of the grid. This paper proposes a global voltage harmonic index to measure the harmonic situation of the power grid with a focus on power transformers. The power electronics systems used to connect these plants to the network can introduce harmonics, leading to increased losses, reduced efficiency, false operation of protective relays, and equipment damage due to harmonic intensifications. The proposed index considers the losses caused by harmonics in power transformers which are of great importance and value to the network, providing a comprehensive measure of the harmonic situation of the grid. The effectiveness of the proposed index is evaluated on a real-world distribution network, and the results demonstrate its ability to identify the harmonic situation of the network, particularly in relation to power transformers. The proposed index provides a comprehensive measure of the harmonic situation of the grid, taking into account the losses caused by harmonics in power transformers. The proposed index has the potential to support power companies in optimizing their power systems and to guide researchers in developing effective mitigation strategies for harmonics in the power grid.

Keywords: global voltage harmonic index, harmonics, power grid, power quality, power transformers, renewable energy

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Authors: Kumar Gular, Viswanathan S., Mastour Saeed Alshahrani, Ravi Shankar Reddy, Jaya Shanker Tedla, Snehil Dixit, Ajay Prasad Gautam, Venkata Nagaraj Kakaraparthi, Devika Rani Sangadala

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Background: Despite trunk control’s significant contribution to improving various functional activity components, the independent effect of trunk performance on quality of life is yet to be estimated in stroke survivors. Ascertaining the correlation between trunk control and self-reported quality of life while evaluating the effect of demographic and clinical characteristics on their relationship will guide concerned healthcare professionals in designing ideal rehabilitation protocols during the late sub-acute stroke stage of recovery. The aims of the present research were to (1) investigate the associations of trunk performance with self-rated quality of life and (2) evaluate if age, body mass index (BMI), and clinical characteristics mediate the relationship between trunk motor performance and perceived quality of life in the sub-acute stroke population. Methods: Trunk motor functions and quality of life among the late sub-acute stroke population aged 57.53 ± 6.42 years were evaluated through the trunk Impairment Scale (TIS) and Stroke specific quality of life (SSQOL) questionnaire, respectively. Pearson correlation coefficients and mediation analysis were performed to elucidate the relationship of trunk motor function with quality of life and determine the mediation impact of demographic and clinical characteristics on their association, respectively. Results: The current study observed significant correlations between trunk motor functions (TIS) and quality of life (SSQOL) with r=0.68 (p<0.001). Age, BMI, and type of stroke were detected as potential mediating factors in the association between trunk performance and quality of life. Conclusion: Validated associations between trunk motor functions and perceived quality of life among the late sub-acute stroke population emphasize the importance of comprehensive evaluation of trunk control. Rehabilitation specialists should focus on appropriate strategies to enhance trunk performance anticipating the potential effects of age, BMI, and type of stroke to improve health-related quality of life in stroke survivors.

Keywords: sub-acute stroke, quality of life, functional independence, trunk control

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Authors: Ben Khayut, Lina Fabri, Maya Avikhana

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The models of the modern Artificial Narrow Intelligence (ANI) cannot: a) independently and continuously function without of human intelligence, used for retraining and reprogramming the ANI’s models, and b) think, understand, be conscious, cognize, infer, and more in state of Uncertainty, and changes in situations, and environmental objects. To eliminate these shortcomings and build a new generation of Artificial Intelligence systems, the paper proposes a Conception, Model, and Method of Computational Psycholinguistic Cognitive Situational-Fuzzy Self-Controlled Brain and Mind System (CPCSFSCBMSUU) using a neural network as its computational memory, operating under uncertainty, and activating its functions by perception, identification of real objects, fuzzy situational control, forming images of these objects, modeling their psychological, linguistic, cognitive, and neural values of properties and features, the meanings of which are identified, interpreted, generated, and formed taking into account the identified subject area, using the data, information, knowledge, and images, accumulated in the Memory. The functioning of the CPCSFSCBMSUU is carried out by its subsystems of the: fuzzy situational control of all processes, computational perception, identifying of reactions and actions, Psycholinguistic Cognitive Fuzzy Logical Inference, Decision making, Reasoning, Systems Thinking, Planning, Awareness, Consciousness, Cognition, Intuition, Wisdom, analysis and processing of the psycholinguistic, subject, visual, signal, sound and other objects, accumulation and using the data, information and knowledge in the Memory, communication, and interaction with other computing systems, robots and humans in order of solving the joint tasks. To investigate the functional processes of the proposed system, the principles of Situational Control, Fuzzy Logic, Psycholinguistics, Informatics, and modern possibilities of Data Science were applied. The proposed self-controlled System of Brain and Mind is oriented on use as a plug-in in multilingual subject Applications.

Keywords: computational brain, mind, psycholinguistic, system, under uncertainty

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Authors: Yongxu Fu, Shaolong Wan

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We study the band degeneracy, defectiveness, as well as exceptional points of non-Hermitian systems and materials analytically. We elaborate on the energy bands, the band degeneracy, and the defectiveness of eigenstates under open boundary conditions based on developing a general theory of one-dimensional (1D) non-Hermitian systems. We research the presence of the exceptional points in a generalized non-Hermitian Su-Schrieffer-Heeger model under open boundary conditions. Beyond our general theory, there exist infernal points in 1D non-Hermitian systems, where the energy spectra under open boundary conditions converge on some discrete energy values. We study two 1D non-Hermitian models with the existence of infernal points. We generalize the infernal points to the infernal knots in four-dimensional non-Hermitian systems.

Keywords: non-hermitian, degeneracy, defectiveness, exceptional points, infernal points

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

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

Keywords: abscess, bacterial infection, bacteremia, Streptococcus anginosus

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Authors: Fabrizio Codella, Chris Parker, Samer Saab

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The Kigali Amendment is driving the adoption of low Global Warming Potential refrigerants in commercial refrigeration systems in over a hundred countries. Several refrigeration systems for the small and large retail stores at mild and hot ambient temperature climates have been compared for hydrofluorocarbons (HFC), hydrofluoroolefins (HFO), transcritical CO₂ and propane, in typical and advanced system architectures. The results of system performance, emissions and lifetime cost have been compared. The greatest benefits were found to be obtained by low global warming potential HFO advanced systems.

Keywords: commercial refrigeration, CO₂, emissions, HFO, lifetime cost, performance

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Authors: Aditi Viswanathan, Shree Ranjani, Aruna Govada

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With data sizes constantly expanding, and with classical machine learning algorithms that analyze such data requiring larger and larger amounts of computation time and storage space, the need to distribute computation and memory requirements among several computers has become apparent. Although substantial work has been done in developing distributed binary SVM algorithms and multi-class SVM algorithms individually, the field of multi-class distributed SVMs remains largely unexplored. This research seeks to develop an algorithm that implements the Support Vector Machine over a multi-class data set and is efficient in a distributed environment. For this, we recursively choose the best binary split of a set of classes using a greedy technique. Much like the divide and conquer approach. Our algorithm has shown better computation time during the testing phase than the traditional sequential SVM methods (One vs. One, One vs. Rest) and out-performs them as the size of the data set grows. This approach also classifies the data with higher accuracy than the traditional multi-class algorithms.

Keywords: distributed algorithm, MapReduce, multi-class, support vector machine

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Authors: Mahnaz Jafari, Parisa Izadpanahi, Francesco Mancini, Muhammad Qureshi

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The advancement in Information Technology (IT) has been an intrinsic element in the developments of the 21st century bringing benefits such as increased economic productivity. However, its widespread application has also been associated with inadvertent negative impacts on society and the environment necessitating selective interventions to mitigate these impacts. This study responded to this need by developing a Green IT Rating Tool (GIRT) for higher education institutions (HEI) in Australia to evaluate the sustainability of IT-related practices from an environmental, social, and economic perspective. Each dimension must be considered equally to achieve sustainability. The development of the GIRT was informed by the views of interviewed IT professionals whose opinions formed the basis of a framework listing Green IT initiatives in order of their importance as perceived by the interviewed professionals. This framework formed the base of the GIRT, which identified Green IT initiatives (such as videoconferencing as a substitute for long-distance travel) and the associated weighting of each practice. The proposed sustainable Green IT model could be integrated into existing IT systems, leading to significant reductions in carbon emissions and e-waste and improvements in energy efficiency. The development of the GIRT and the findings of this study have the potential to inspire other organizations to adopt sustainable IT practices, positively impact the environment, and be used as a reference by IT professionals and decision-makers to evaluate IT-related sustainability practices. The GIRT could also serve as a benchmark for HEIs to compare their performance with other institutions and to track their progress over time. Additionally, the study's results suggest that virtual and cloud-based technologies could reduce e-waste and energy consumption in the higher education sector. Overall, this study highlights the importance of incorporating Green IT practices into the IT systems of HEI to contribute to a more sustainable future.

Keywords: green information technology, international higher-educational institution, sustainable solutions, environmentally friendly IT systems

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Authors: Deok Hyun Han

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Objective: To explore outcomes of UventaTM metallic ureteral stent between malignant and benign ureteral obstruction. Methods: We reviewed the medical records of 90 consecutive patients who underwent Uventa stent placement for benign or malignant ureteral obstruction from December 2009 to June 2013. We evaluated the clinical outcomes, complications, and reasons and results for unexpected stent removals. Results: The median follow-up was 10.7 (0.9 – 41) months. From a total of 125 ureter units, there were 24 units with benign obstructions and 101 units with malignant obstructions. Initial technical successes were achieved in all patients. The overall success rate was 70.8% with benign obstructions and 84.2% with malignant obstructions. The major reasons for treatment failure were stent migration (12.5%) in benign and tumor progression (11.9%) in malignant obstructions. The overall complication rate was similar between benign and malignant obstructions (58.3% and 42.6%), but severe complications, which are Clavien grade 3 or more, occurred in 41.7% of benign and 6.9% of malignant obstructions. The most common complications were stent migration (25.0%) in benign obstructions and persistent pain (14.9%) in malignant obstructions. The stent removal was done in 16 units; nine units that were removed by endoscopy and seven units were by open surgery. Conclusions: In malignant ureteral obstructions, the Uventa stent showed favorable outcomes with high success rate and acceptable complication rate. However, in benign ureteral obstructions, overall success rate and complication rate were less favorable. Malignant ureteral obstruction seems to be appropriate indication of Uventa stent placement. However, in chronic diffuse benign ureteral obstructions the decision of placement of Uventa stent has to be careful.

Keywords: cause, complication, ureteral obstruction, metal stent

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

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

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

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Authors: Sameh Ibrahim Ghali Hanna

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Information system (IS) are fairly crucial in the operation of private and public establishments in growing and developed international locations. Growing countries are saddled with many project failures throughout the implementation of records systems. However, successful information systems are greatly wished for in developing nations in an effort to decorate their economies. This paper is extraordinarily critical in view of the high failure fee of data structures in growing nations, which desire to be decreased to minimal proper levels by means of advocated interventions. This paper centers on a review of IS development in developing international locations. The paper gives evidence of the IS successes and screw-ups in developing nations and posits a version to deal with the IS failures. The proposed model can then be utilized by means of growing nations to lessen their IS mission implementation failure fee. A contrast is drawn between IS improvement in growing international locations and evolved international locations. The paper affords valuable records to assist in decreasing IS failure, and growing IS models and theories on IS development for developing countries.

Keywords: research information systems (RIS), research information, heterogeneous sources, data quality, data cleansing, science system, standardization artificial intelligence, AI, enterprise information system, EIS, integration developing countries, information systems, IS development, information systems failure, information systems success, information systems success model

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Authors: Walid Moudani

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The healthcare environment is generally perceived as being information rich yet knowledge poor. However, there is a lack of effective analysis tools to discover hidden relationships and trends in data. In fact, valuable knowledge can be discovered from application of data mining techniques in healthcare system. In this study, a proficient methodology for the extraction of significant patterns from the coronary heart disease warehouses for heart attack prediction, which unfortunately continues to be a leading cause of mortality in the whole world, has been presented. For this purpose, we propose to enumerate dynamically the optimal subsets of the reduced features of high interest by using rough sets technique associated to dynamic programming. Therefore, we propose to validate the classification using Random Forest (RF) decision tree to identify the risky heart disease cases. This work is based on a large amount of data collected from several clinical institutions based on the medical profile of patient. Moreover, the experts’ knowledge in this field has been taken into consideration in order to define the disease, its risk factors, and to establish significant knowledge relationships among the medical factors. A computer-aided system is developed for this purpose based on a population of 525 adults. The performance of the proposed model is analyzed and evaluated based on set of benchmark techniques applied in this classification problem.

Keywords: multi-classifier decisions tree, features reduction, dynamic programming, rough sets

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Authors: Norazlan Alias, Mohd. Hasimi Yaacob

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This study examines the impact of governance structure via corporate restructuring decision on selected firm characteristics and performance. Results of selected ratios that represent corporate decision, governance structure and performance in pre and post restructuring are analyzed for some conclusions. This study uses annual data of companies that are consistently listed on the Main Board of Bursa Malaysia and announced completed corporate restructuring. The results show that only debt ratio is significantly different before and after asset restructuring. This study concludes that firms do not view corporate restructuring namely asset restructuring as an opportunity to simultaneous enhance governance structure that could also contribute enhance firm performance and board of directors’ structure subsequent to asset restructuring only has significantly influence on changing capital structure but not on firm performance.

Keywords: board of directors, capital structure, corporate restructuring, performance

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Authors: Rebecca Hafner, Daniel Read, David Elmes

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The persuasive potential of normative and feedback (financial vs. environmental) information in ‘nudging’ people towards making environmentally sound decisions was explored in a hypothetical choice experiment. The research was specifically focused on determining how subtle variations in the decision frame could be used to increase the selection of energy efficient vs. standard technologies, using the context of home heating choice. Participants were given a choice of a standard heating system (a gas boiler) and a relatively more-energy efficient option (a heat pump). The experiment had a 2 (normative vs. no normative information) by 3 feedback type (financial, environmental, none) design. The last group constituted the control. Half of the participants were given normative information about what the majority of others in their neighbourhood had opted to do when faced with the same choice set, prior to making their decision. The other half received no such information. Varying feedback frames were incorporated by providing participants with information on either financial or environmental savings that could be achieved by choosing the heat pump. No such information was provided in the control group. A significant interaction was found between normative information and feedback frame type. Specifically, the impact of feedback frames was found to be reduced when normative information was provided; illustrating the overriding influence of normative information on option preference. Participants were significantly more likely to select the heat pump if they were vs. were not given normative information. Yet when no normative information was provided, the persuasive influence of the financial frame was increased – highlighting this as an effective means of encouraging uptake of new technologies in this instance. Conversely, the environmental frame was not found to differ significantly from the control. Marginal carryover effects were also found for stated future real-life decision-making behaviour, with participants who were versus were not given normative information being marginally more likely to state they would consider installing a heat pump when they next need to replace their heating system in real life. We conclude that normative and financial feedback framing techniques are highly effective in increasing uptake of new, energy efficient heating technologies involving significant upfront financial outlay. The implications for researchers looking to promote ‘green’ choice in the context of new technology adoption are discussed.

Keywords: energy-efficient technology adoption, environmental decision making, financial vs. environmental feedback framing techniques, social norms

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Authors: Kimberley Kennedy

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The major findings of this study discuss the importance of understanding and applying Systems thinking concepts to ensure an effective Project-Based Learning environment. A pilot project study of a major pedagogical change was conducted over a five year period with the goal to give students real world, hands-on learning experiences and the opportunity to apply what they had learned over the past two years of their business program. The first two weeks of the fifteen week semester utilized teaching methods of lectures, guest speakers and design thinking workshops to prepare students for the project work. For the remaining thirteen weeks of the semester, the students worked with actual business owners and clients on projects and challenges. The first three years of the five year study focused on student feedback to ensure a quality learning experience and continuous improvement process was developed. The final two years of the study, examined the conceptual understanding and perception of learning and teaching by faculty using Project-Based Learning pedagogy as compared to lectures and more traditional teaching methods was performed. Relevant literature was reviewed and data collected from program faculty participants who completed pre-and post-semester interviews and surveys over a two year period. Systems thinking concepts were applied to better understand the challenges for faculty using Project-Based Learning pedagogy as compared to more traditional teaching methods. Factors such as instructor and student fatigue, motivation, quality of work and enthusiasm were explored to better understand how to provide faculty with effective support and resources when using Project-Based Learning pedagogy as the main teaching method. This study provides value by presenting generalizable, foundational knowledge by offering suggestions for practical solutions to assure student and teacher engagement in Project-Based Learning courses.

Keywords: continuous improvement, project-based learning, systems thinking, teacher engagement

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Authors: Amanda Silva Parra, Dayra Yisel García Ramirez

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In developing countries, agricultural "modernization" has led to a loss of biodiversity and inefficiency of agricultural systems, manifested in increases in Greenhouse Gas Emissions (GHG) and the C footprint, generating the susceptibility of systems agriculture to environmental problems, loss of biodiversity, depletion of natural resources, soil degradation and loss of nutrients, and a decrease in the supply of products that affect food security for peoples and nations. Each year agriculture emits 10 to 12% (5.1 to 6.1 Gt CO2eq per year) of the total estimated GHG emissions (51 Gt CO2 eq per year). The FAO recommends that countries that have not yet done so consider declaring sustainable agriculture as an essential or strategic activity of public interest within the framework of green economies to better face global climate change. The objective of this research was to estimate the balance of GHG in agricultural systems of Cumaral, Meta (Colombia), to contribute to the recovery and sustainable operation of agricultural systems that guarantee food security and face changes generated by the climate in a more intelligent way. To determine the GHG balances, the IPCC methodologies were applied with a Tier 1 and 2 level of use. It was estimated that all the silvopastoral systems evaluated play an important role in this reconversion compared to conventional systems such as improved pastures. and degraded pastures due to their ability to capture C both in soil and in biomass, generating positive GHG balances, guaranteeing greater sustainability of soil and air resources.

Keywords: climate change, carbon capture, environmental sustainability, GHG mitigation, silvopastoral systems

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Authors: Yuguang Gao, Qiang Yang, Yanpeng Zhang, Mingtao Deng

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To enhance the safety, quality and efficiency of healthcare services provided by surgical doctors, we propose a comprehensive approach to the performance evaluation of individual doctors by incorporating insights from performance data as well as views of different stakeholders in the hospital. Exploratory factor analysis was first performed on collective multidimensional performance data of surgical doctors, where key factors were extracted that encompass assessment of professional experience and service performance. A two-level indicator system was then constructed, for which we developed a weighted interval-valued spherical fuzzy analytic hierarchy process to analyze the relative importance of the indicators while handling subjectivity and disparity in the decision-making of multiple parties involved. Our analytical results reveal that, for the key factors identified as instrumental for evaluating surgical doctors’ performance, the overall importance of clinical workload and complexity of service are valued more than capacity of service and professional experience, while the efficiency of resource consumption ranks comparatively the lowest in importance. We also provide a retrospective case study to illustrate the effectiveness and robustness of our quantitative evaluation model by assigning meaningful performance ratings to individual doctors based on the weights developed through our approach.

Keywords: analytic hierarchy processes, factor analysis, fuzzy logic, performance evaluation

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Authors: Maciej Zaręba, Sławomir Lasota

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Understanding the dependencies between the input signal, that controls the production system and signals, that capture its output, is of a great importance in intelligent systems. The method for identification of the relationship between signals in continuous monitoring of production systems is described in the paper. The method discovers the correlation between changes in the states derived from input signals and resulting changes in the states of output signals of the production system. The method is able to handle system inertia, which determines the time shift of the relationship between the input and output.

Keywords: manufacturing operation management, signal relationship, continuous monitoring, production systems

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Authors: Karina Peron, Ricardo Ghelman, Monica Taminato, Katia R. Oliveira, Debora C. A. Rodrigues, Juliana R. C. Mumme, Olga K. M. Sunakozaua, Georg Seifert, Vicente O. Filho

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The nurse is the most available health professional for the interventions of support in the integrative approach in hospital environment, therefore a professional group key to changes in the model of care. The central components in the performance of anthroposophic nursing procedures are direct physical contact, promotion of proper rhythm, thermal regulation and the construction of a calm and empathic atmosphere, safe for patients and their caregivers. The procedures of anthroposophic external therapies (AET), basically composed of the application of compresses and the use of natural products, provide an opportunity to intensify the therapeutic results through an innovative, complementary and integrative model in the university hospital. The objective of this work is to report the implementation of a program of nursing techniques (AET) through a partnership between the Pediatric Oncology Sector of the Department of Pediatrics of the Faculty of Medicine of the University of Sao Paulo and Charite University of Berlin, with lecturers from Berlin's Integrative Hospital Havelhöhe and Witten-Herdecke Integrative Hospital, both in Germany. Intensive training activities of the Hospital's nursing staff and a survey on AET needs were developed based on the most prevalent complaints in pediatric oncology patients in the three environments of the Hospital of Pediatric Oncology: Bone Marrow Transplantation Unit, Intensive Care Unit and Division of Internal Patients. We obtained the approval of the clinical protocol of external anthroposophic therapies for nursing care by the Ethics Committee and the Academic Council of the Hospital. With this project, we highlight the key AET needs that will be part of the standard program of pediatric oncology care with appropriate scientific support. The results of the prevalent symptoms were: vomiting, nausea, pain, difficulty in starting sleep, constipation, cold extremities, mood disorder and psychomotor agitation. This project was the pioneer within the Integrative Pediatrics Program, as an innovative concept of Medicine and Integrative Health presented at scientific meetings.

Keywords: integrative health care, integrative nursing, pediatric nursing, pediatric oncology

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Authors: Jai Prakash Verma, Khushboo Verma

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In the present paper, a pair of Mond-Weir type non-differentiable multiobjective second-order programming problems, involving two kernel functions, where each of the objective functions contains support function, is formulated. We prove weak, strong and converse duality theorem for the second-order symmetric dual programs under η-pseudoinvexity conditions.

Keywords: non-differentiable multiobjective programming, second-order symmetric duality, efficiency, support function, eta-pseudoinvexity

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Authors: Ezeni Brzovska, Durdana Ozretic-Dosen

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The purpose of this paper is to deepen the understanding of the product cues that influence purchase decision for a specific product category – chocolate, and to identify demographic differences in the buying behavior. ANOVA was employed for analyzing the significance level for nine product cues, and the survey showed statistically significant differences among different age and gender groups, and between respondents with different levels of education. From the theoretical perspective, the study adds to the existing knowledge by contributing with the research results from the new environment (Southeast Europe, Macedonia), which has been neglected so far. Establishing the level of significance for the product cues that affect buying behavior in the chocolate consumption context might help managers to improve marketing decision-making, and better meet consumer needs through identifying opportunities for packaging innovations and/or personalization toward different target groups.

Keywords: chocolate consumption context, chocolate selection, demographic characteristics, product cues

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Authors: Wheyming Song, Hung-Hsiang Lin, Scott Lian

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In this research, we investigate the optimal dispatching rule for machines and manpower allocation in the solar ingot-wafer systems. The performance of the method is measured by the sales profit for each dollar paid to the operators in a one week at steady-state. The decision variables are identification-number of machines and operators when each job is required to be served in each process. We propose a rule which is a function of operator’s ability, corresponding salary, and standing location while in the factory. The rule is named ‘Multi-nominal distribution dispatch rule’. The proposed rule performs better than many traditional rules including generic algorithm and particle swarm optimization. Simulation results show that the proposed Multi-nominal distribution dispatch rule improvement on the sales profit dramatically.

Keywords: dispatching, solar ingot, simulation, flexsim

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Authors: A. Fordham, A. Hudson

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Background: Studies have suggested 16-25% of normotensive trauma patients with no clinical signs of shock have abnormal lactate and BD readings evidencing shock; a phenomenon known as occult hypoperfusion (OH). In light of the scarce quantity of evidence currently documenting OH, this study aimed to identify the prevalence of OH in the pre-hospital setting and explore ways to improve its identification and management. Methods: A quantitative retrospective data analysis was carried out on 75 sets of patient records for trauma patients treated by Kent Surrey Sussex Air Ambulance Trust between November 2013 and October 2014. The KSS HEMS notes and subsequent ED notes were collected. Trends between patients’ SBP on the scene, whether or not they received PRBCs on the scene as well as lactate and BD readings in the ED were assessed. Patients’ KSS HEMS notes written by the HEMS crew were also reviewed and recorded. Results: -Suspected OH was identified in 7% of the patients who did not receive PRBCs in the pre-hospital phase. -SBP heavily influences the physicians’ decision of whether or not to transfuse PRBCs in the pre-hospital phase. Preliminary conclusions: OH is an under-studied and underestimated phenomenon. We suggest a prospective trial is carried out to evaluate whether detecting trauma patients’ tissue perfusion status in the pre-hospital phase using portable devices capable of measuring serum BD and/or lactate could aid more accurate detection and management of all haemorrhaging trauma patients, including patients with OH.

Keywords: occult hypoperfusion, PRBC transfusion, point of care testing, pre-hospital emergency medicine, trauma

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Authors: Ali Taher Othman Ali

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The aim of this research is to provide a draft proposal for the professional development of mathematics teachers in accordance with the orientation of science, technology, engineering and mathematics which is known by the abbreviation STEM, as a modern and contemporary orientation in the teaching and learning of mathematics and in order to achieve the objective of the research, the researcher used the theoretical descriptive method through the induction of the literature of education and the previous studies and experiments related to the topic. The researcher concluded by providing the proposal according to five basic axes, the first axe: professional development as a system, and its requirements include: development of educational systems, and allocate sufficient budgets to support the requirements of teaching STEM, identifying mechanisms for incentives and rewards for teachers attending professional development programs based on STEM; the second: development of in-depth knowledge content and its requirements include: basic sciences content development for STEM, linking the scientific understanding of teachers with real-world issues and problems, to provide the necessary resources to expand teachers' knowledge in this area; the third: the necessary pedagogical skills of teachers in the field of STEM, and its requirements include: identification of the required training and development needs and the mechanism of determining these needs, the types of professional development programs and the mechanism of designing it, the mechanisms and places of execution, evaluation and follow-up; the fourth: professional development strategies and mechanisms in the field of STEM, and its requirements include: using a variety of strategies to enable teachers to design and transfer effective educational experiences which reflect their scientific mastery in the fields of STEM, provide learning opportunities, and developing the skills of procedural research to generate new knowledge about the STEM; the fifth: to support professional development in the area of STEM, and its requirements include: support leadership within the school, provide a clear and appropriate opportunities for professional development for teachers within the school through professional learning communities, building partnerships between the Ministry of education and the local and international community institutions. The proposal includes other factors that should be considered when implementing professional development programs for mathematics teachers in the field of STEM.

Keywords: professional development, mathematics teachers, the orientation of science, technology, engineering and mathematics (STEM)

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Authors: Nautiyal Ruchira, Nautiyal Hemant, Chaudhury Devnanda, Bhargava Surbhi, Chauhan Nidhi

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Introduction: South East Asian region contributes 2.5 million cases of malaria each year to the global burden of 300 to 500 million of which 76% is reported from India. Government of India launched a national program almost half a century ago, still malaria remains a major public health challenge. Pregnant women are more susceptible to severe malaria and its fetomaternal complications. Inadequate surveillance and under-reporting underestimates the problem. Aim: Present study aimed to analyze the clinical course and pattern of malaria during pregnancy and to study the feto-maternal outcome. Methodology: This is a prospective observational study carried out at Himalayan Institute of Medical Sciences – a tertiary care center in the sub-Himalayan state of Uttarakhand, Northern India. All the pregnant women with malaria and its complications were recruited in the study during 2009 to 2014 which included referred cases from the state of western Uttar Pradesh. A thorough history and clinical examination were carried out to assess maternal and fetal condition. Relevant investigations including haemogram, platelet count, LFT, RFT, and USG was done. Blood slides and rapid diagnostic tests were done to diagnose the type of malaria.The primary outcomes measured were the type of malaria infection, maternal complications associated with malaria, outcome of pregnancy and effect on the fetus. Results: 67 antenatal cases with malaria infection were studied. 71% patients were diagnosed with plasmodium vivax infection, 25% cases were plasmodium falciparum positive and in 3% cases mixed infection was found. 38(56%) patients were primigravida and 29(43%) were multiparous. Most of the patients had already received some treatment from their local doctors and presented with severe malaria with the complications. Thrombocytopenia was the commonest manifestation seen in 35(52%) patients, jaundice in 28%, severe anemia in 18%, and severe oligohydramnios in 10% and renal failure in 6% cases. Regarding pregnancy outcome there were 44 % preterm deliveries, 22% had IUFD and abortions in 6% cases.20% of newborn were low birth weight and 6% were IUGR. There was only one maternal death which occurred due to ARDS in falciparum malaria. Although Plasmodium vivax was the main parasite considering the severity of clinical presentation, all the patients received intensive care. As most of the patients had received chloroquine therapy hence they were treated with IV artesunate followed by oral artemesinin combination therapy. Other therapies in the form of packed RBC’s and platelet transfusions, dialysis and ventilator support were provided when required. Conclusion: Even in areas with annual parasite index (API) less than 2 like ours, malaria in pregnancy could be an alarming problem. Vivax malaria cannot be considered benign in pregnancy because of high incidence of morbidity. Prompt diagnosis and aggressive treatment can reduce morbidity and mortality significantly. Increased community level research, integrating ANC checkups with the distribution of insecticide-treated nets in areas of high endemicity, imparting education and awareness will strengthen the existing control strategies.

Keywords: severe malaria, pregnancy, plasmodium vivax, plasmodium falciparum

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Authors: Jochen Edmund Kerschenbauer, Roman Salinger, Daniel Strametz

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Insufficient informal communication systems can lead to the first crisis (‘Crisis of Leadership’) for start-ups. Management Control Systems (MCS) are one way for high-technology start-ups to successfully overcome these problems. So far the literature has investigated the incubation of a start-up, but focused less on the post-incubation stage. This paper focuses on the use of MCS in post-incubation and, if failed start-ups agree, on how MCS are used. We conducted 14 semi-structured interviews for this purpose, to obtain our results. The overall conclusion is that the majority of the companies were closed down due to a combination of strategic, operative and financial reasons.

Keywords: closed down, high-technology, incubation, levers of control, management control systems, post-incubation, start-ups

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Authors: Omneya M. Helmy, Mona T. Kashef

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Aminoglycosides are used in treating a wide range of infections caused by both Gram-negative and Gram positive bacteria. The presence of 16S rRNA methyl transferases (16S-RMTase) is among the newly discovered resistance mechanisms that confer high resistance to clinically useful aminoglycosides. Cephalosporins are the most commonly used antimicrobials in Egypt; therefore, this study was conducted to determine the isolation frequency of 16S rRNA methyl transferases among third generation cephalosporin-resistant clinical isolates in Egypt. One hundred and twenty three cephalosporin resistant Gram-negative clinical isolates were screened for aminoglycoside resistance by the Kirby Bauer disk diffusion method and tested for possible production of 16S-RMTase. PCR testing and sequencing were used to confirm the presence of 16S-RMTase and the associated antimicrobial resistance determinants, as well as the genetic region surrounding the armA gene. Out of 123 isolates, 66 (53.66%) were resistant to at least one aminoglycoside antibiotic. Only one Escherichia coli isolate (E9ECMO) which was totally resistant to all tested aminoglycosides, was confirmed to have the armA gene in association with blaTEM-1, blaCTX-M-15, blaCTX-M-14 and aac(6)-Ib genes. The armA gene was found to be carried on a large A/C plasmid. Genetic mapping of the armA surrounding region revealed, for the first time, the association of armA with aac(6)-Ib on the same transposon. In Conclusion, the isolation frequency of 16S-RMTase was low among the tested cephalosporin-resistant clinical samples. However, a novel composite transposon has been detected conferring high-level aminoglycosides resistance.

Keywords: aminoglcosides, armA gene, β lactmases, 16S rRNA methyl transferases

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Authors: Rhiannon Barker, Gregory Hartwell, Matt Egan, Karen Lock

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Background: Evidence suggests that mental health (MH) issues in children and young people (CYP) in the UK are on the rise. Of particular concern is data that indicates that the pandemic, together with the impact of school closures, have accentuated already pronounced inequalities; children from families on low incomes or from black and minority ethnic groups are reportedly more likely to have been adversely impacted. This study aimed to help identify specific support which may facilitate the building of a positive school climate and protect student mental health, particularly in the wake of school closures following the pandemic. It has important implications for integrated working between schools and statutory health services. Methods: The research comprised of three parts; scoping, case studies, and a stakeholder workshop to explore and consolidate results. The scoping phase included a literature review alongside interviews with a range of stakeholders from government, academia, and the third sector. Case studies were then conducted in two London state schools. Results: Our research identified how student MH was being impacted by a range of factors located at different system levels, both internal to the school and in the wider community. School climate, relating both to a shared system of beliefs and values, as well as broader factors including style of leadership, teaching, discipline, safety, and relationships -all played a role in the experience of school life and, consequently, the MH of both students and staff. Participants highlighted the importance of a whole school approach and ensuring that support for student MH was not separated from academic achievement, as well as the importance of identifying and applying universal measuring systems to establish levels of MH need. Our findings suggest that a school’s climate is influenced by the style and strength of its leadership, while this school climate - together with mechanisms put in place to respond to MH needs (both statutory and non-statutory) - plays a key role in supporting student MH. Implications: Schools in England have a responsibility to decide on the nature of MH support provided for their students, and there is no requirement for them to report centrally on the form this provision takes. The reality on the ground, as our study suggests, is that MH provision varies significantly between schools, particularly in relation to ‘lower’ levels of need which are not covered by statutory requirements. A valid concern may be that in the huge raft of possible options schools have to support CYP wellbeing, too much is left to chance. Work to support schools in rebuilding their cultures post-lockdowns must include the means to identify and promote appropriate tools and techniques to facilitate regular measurement of student MH. This will help establish both the scale of the problem and monitor the effectiveness of the response. A strong vision from a school’s leadership team that emphasises the importance of student wellbeing, running alongside (but not overshadowed by) academic attainment, should help shape a school climate to promote beneficial MH outcomes. The sector should also be provided with support to improve the consistency and efficacy of MH provision in schools across the country.

Keywords: mental health, schools, young people, whole-school culture

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Authors: Ronald L. Kaunda

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The education system in Zambia still bears scars of colonialism in the area of policy, curriculum and implementation. This historical context resulted in the failure by the Government of the Republic of Zambia to achieve literacy goals expected among school going children. Specifically, research shows that the use of English for initial literacy and Western based teaching methods to engage learners in literacy activities at lower levels of education including preschool has exacerbated this situation. In 2014, the Government of the Republic of Zambia implemented a new curriculum that, among others things, required preschool teachers to use local and cultural materials and familiar languages for early literacy teaching from preschool to grade 4. This paper presents findings from a study that sought to establish ways in which preschool teachers use Zambian Indigenous knowledge systems and Indigenous teaching strategies to support literacy development among preschool children. The study used Indigenous research methodology for data collection and iterative feature of Constructivist Grounded Theory (CGT) in the data collection process and analysis. This study established that, as agents of education, preschool teachers represented community adult educators because of some roles which they played beyond their academic mandate. The study further found that classrooms as venues of learning were equipped with learning corners reflecting Indigenous literacy materials and Indigenous ways of learning. Additionally, the study found that learners were more responsive to literacy lessons because of the use of familiar languages and local contextualized environments that supported their own cultural ways of learning. The study recommended that if the education system in Zambia is to be fully inclusive of Indigenous knowledge systems and cultural ways of learning, the education policy and curriculum should include conscious steps on how this should be implemented at the classroom level. The study further recommended that more diverse local literacy materials and teaching aids should be produced for use in the classroom.

Keywords: agents of learning, early literacy, indigenous knowledge systems, venues of education

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