Search results for: China’s 14th five-year plan
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 3269

Search results for: China’s 14th five-year plan

809 Effects of Exposure to Domestic Physical Violence on Children's Behavior: A Chinese Community-Based Sample

Authors: Cao Yuping, Li Longfei, Zhao Xingfu, Zhang Yalin

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Purpose: This study examined the effects of exposure to domestic physical violence (DPV) on children’s behavior in a community sample. Method: Ninety-three 12-16 year-old adolescents exposed to DPV were matched with 54 adolescents with no exposure to DPV based on age, gender, family composition and parental age and education level. Participation included assessment with the Childhood Trauma Questionnaire (CTQ-SF) and Child Behavior Checklist (CBCL) by the adolescents and their parents respectively. Results: CBCL total score and anxiety/depression, social interaction problems, attention problems, delinquency, aggression and externalizing scores were significantly higher in adolescents exposed to DPV than those in controls (all ps<0.05).The CBCL total score and scores of anxiety/depression, social interaction problems, attention problems, delinquency, aggression and externalizing behaviors of boys were significantly higher in the research group than in the controls (all ps<0.05). Delinquency scores in abused adolescents were significantly higher than in DPV witnessed (p<0.05), but no other scores of CBCL were significant different. Different subtypes of behavioral problems were associated with different types of abuse. Conclusions: DPV exposure is associated with adverse behaviors in children, especially among boys. Children witness DPV alone have similar behavioral scores as the abused children. We recommend that both abused and DPV witness adolescents in Chinese communities need treatment to mitigate the effects on maladjusted behaviors.

Keywords: domestic violence, child, behavior, community, China

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808 Correlation Study between Clinical and Radiological Findings in Knee Osteoarthritis

Authors: Nabil A. A. Mohamed, Alaa A. A. Balbaa, Khaled E. Ayad

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Osteoarthritis (OA) of the knee is the most common form of arthritis and leads to more activity limitations (e.g., disability in walking and stair climbing) than any other disease, especially in the elderly. Recently, impaired proprioceptive accuracy of the knee has been proposed as a local factor in the onset and progression of radiographic knee OA (ROA). Purpose: To compare the clinical and radiological findings in healthy with that of knee OA. Also, to determine if there is a correlation between the clinical and radiological findings in patients with knee OA. Subjects: Fifty one patients diagnosed as unilateral or bilateral knee OA with age ranged between 35-70 years, from both gender without any previous history of knee trauma or surgery, and twenty one normal subjects with age ranged from 35 - 68 years. METHODS: peak torque/body weight (PT/BW) was recorded from knee extensors at isokinetic isometric mode at angle of 45 degree. Also, the Absolute Angular Error was recorded at 45O and 30O to measure joint position sense (JPS). They made anteroposterior (AP) plain X-rays from standing semiflexed knee position and their average score of Timed Up and Go test(TUG) and WOMAC were recorded as a measure of knee pain, stiffness and function. Comparison between the mean values of different variables in the two groups was performed using unpaired student t test. The P value less or equal to 0.05 was considered significant. Results: There were significant differences between the studied variables between the experimental and control groups except the values of AAE at 30O. Also, there were no significant correlation between the clinical findings (pain, function, muscle strength and proprioception) and the severity of arthritic changes in X-rays. CONCLUSION: From the finding of the current study we can conclude that there were a significant difference between the both groups in all studied parameters (the WOMAC, functional level, quadriceps muscle strength and the joint proprioception). Also this study did not support the dependency on radiological findings in management of knee OA as the radiological features did not necessarily indicate the level of structural damage of patients with knee OA and we should consider the clinical features in our treatment plan.

Keywords: joint position sense, peak torque, proprioception, radiological knee osteoarthritis

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807 PhenoScreen: Development of a Systems Biology Tool for Decision Making in Recurrent Urinary Tract Infections

Authors: Jonathan Josephs-Spaulding, Hannah Rettig, Simon Graspeunter, Jan Rupp, Christoph Kaleta

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Background: Recurrent urinary tract infections (rUTIs) are a global cause of emergency room visits and represent a significant burden for public health systems. Therefore, metatranscriptomic approaches to investigate metabolic exchange and crosstalk between uropathogenic Escherichia coli (UPEC), which is responsible for 90% of UTIs, and collaborating pathogens of the urogenital microbiome is necessary to better understand the pathogenetic processes underlying rUTIs. Objectives: This study aims to determine the level in which uropathogens optimize the host urinary metabolic environment to succeed during invasion. By developing patient-specific metabolic models of infection, these observations can be taken advantage of for the precision treatment of human disease. Methods: To date, we have set up an rUTI patient cohort and observed various urine-associated pathogens. From this cohort, we developed patient-specific metabolic models to predict bladder microbiome metabolism during rUTIs. This was done by creating an in silico metabolomic urine environment, which is representative of human urine. Metabolic models of uptake and cross-feeding of rUTI pathogens were created from genomes in relation to the artificial urine environment. Finally, microbial interactions were constrained by metatranscriptomics to indicate patient-specific metabolic requirements of pathogenic communities. Results: Metabolite uptake and cross-feeding are essential for strain growth; therefore, we plan to design patient-specific treatments by adjusting urinary metabolites through nutritional regimens to counteract uropathogens by depleting essential growth metabolites. These methods will provide mechanistic insights into the metabolic components of rUTI pathogenesis to provide an evidence-based tool for infection treatment.

Keywords: recurrent urinary tract infections, human microbiome, uropathogenic Escherichia coli, UPEC, microbial ecology

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806 Application Case and Result Consideration About Basic and Working Design of Floating PV Generation System Installed in the Upstream of Dam

Authors: Jang-Hwan Yin, Hae-Jeong Jeong, Hyo-Geun Jeong

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K-water (Korea Water Resources Corporation) conducted basic and working design about floating PV generation system installed above water in the upstream of dam to develop clean energy using water with importance of green growth is magnified ecumenically. PV Generation System on the ground applied considerably until now raise environmental damage by using farmland and forest land, PV generation system on the building roof is already installed at almost the whole place of business and additional installation is almost impossible. Installation space of PV generation system is infinite and efficient national land use is possible because it is installed above water. Also, PV module's efficiency increase by natural water cooling method and no shade. So it is identified that annual power generation is more than PV generation system on the ground by operating performance data. Although it is difficult to design and construct by high cost, little application case, difficult installation of floater, mooring device, underwater cable, etc. However, it has been examined cost reduction plan such as structure weight lightening, floater optimal design, etc. This thesis described basic and working design result systematically about K-water's floating PV generation system development and suggested optimal design method of floating PV generation system. Main contents are photovoltaic array location select, substation location select related underwater cable, PV module and inverter design, transmission and substation equipment design, floater design related structure weight lightening, mooring system design related water level fluctuation, grid connecting technical review, remote control and monitor equipment design, etc. This thesis will contribute to optimal design and business extension of floating PV generation system, and it will be opportunity revitalize clean energy development using water.

Keywords: PV generation system, clean energy, green growth, solar energy

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805 Goals, Rights and Obligations, and Moral Order: An Evaluation Approach to Chinese-Kenyan Relating Experience

Authors: Zhaohui Tian

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China’s growing and deepening engagement in Africa has attracted numerous controversial debates on Chinese-African social-racial relations both in the media and academia. Most research tends to discuss this issue and the tensions involved at the state level, but limited attention has been given to the individual relating processes of those two racial groups from an intercultural politeness evaluation angle. Thus, taking Kenya as a country focus and putting it under recent perspectives on pragmatics and politeness, this study explores the Chinese-Kenyan workplace relating experience in Chinese-owned companies with the aim to offer new insights on Chinese-African social-racial tensions. The original data were collected through 25 interviews from 29 Chinese and Kenyan participants working in different Chinese companies and industries, some of which had been later on converted into 182 short story data in order to better capture the process and content dimensions of their experiences using Spencer &Kádár’s politeness evaluation model. Both interview and story data were analysed in MAXQDA to understand the personal relating process and the criteria they were drawing from when making evaluative judgements of their relations. The result particular draws attention to tensions around goals, rights, and obligations, and social-moral dimensions that had been underrepresented in intercultural and pragmatics literature. The study offers alternative empirical insights into Chinese-Kenyan relations from an intercultural politeness management perspective and the possible mismatches of the evaluative criteria that potentially cause tension in this context.

Keywords: chinese-kenyan, evaluation, relating, workplace

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804 Global Analysis of Modern Economic Sanctions

Authors: I. L. Yakushev

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Economic sanctions are an integral part of the foreign policy repertoire of States. Increasingly, States and international organizations are resorting to sanctions to address a variety of issues -from fighting corruption to preventing the use of nuclear weapons. Over time, the ways in which economic sanctions have been used have changed, especially over the past two decades. In the late 1990s, the recognition of the humanitarian harm of economic sanctions and the "War on Terrorism" after the events of September 11, 2001, led to serious changes in the structure and mechanisms of their application. Questions about how these coercive tools work, when they are applied, what consequences they have, and when they are successful are still being determined by research conducted in the second half of the 20th century. The conclusions drawn from past cases of sanctions may not be fully applicable to the current sanctions policy. In the second half of the 20th century, most cases of sanctions were related to the United States, and it covered restrictions on international trade. However, over the past two decades, the European Union, the United Nations, and China have also been the main initiators of sanctions. Modern sanctions include targeted and financial restrictions and are applied against individuals, organizations, and companies. Changing the senders, targets, stakeholders, and economic instruments used in the sanctions policy has serious implications for effectiveness and results. The regulatory and bureaucratic infrastructure necessary to implement and comply with modern economic sanctions has become more reliable. This evolution of sanctions has provided the scientific community with an opportunity to study new issues of coercion and return to the old ones. The economic sanctions research program should be developed to be relevant for understanding the application of modern sanctions and their consequences.

Keywords: global analysis, economic sanctions, targeted sanctions, foreign policy, domestic policy, United Nations, European Union, USA, economic pressure

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803 Seroprevalence and Associated Factors of Hepatitis B and Hepatitis C Viral Infections Among Prisoners in Tigray, Northern Ethiopia

Authors: Belaynesh Tsegay, Teklay Gebrecherkos, Atsebaha Gebrekidan Kahsay, Mahmud Abdulkader

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Background: Hepatitis B and C viruses are important health and socioeconomic problem across the globe, with a remarkable number of diseases and deaths in sub-Saharan African countries. The burden of hepatitis is unknown in the prison settings of Tigray. Therefore, we aimed to describe the seroprevalence and associated factors of hepatitis B and C viruses among prisoners in Tigray, Ethiopia. Methods: A cross-sectional study was carried out from February 2020 to May 2020 at the prison facilities of Tigray. Demographics and associated factors were collected from 315 prisoners prospectively. Five milliliters of blood were collected and tested using rapid tests kits of HBsAg (Zhejiang orient Gene Biotech Co., Ltd., China) and HCV antibodies (Volkan Kozmetik Sanayi Ve Ticaret Ltd. STI, Turkey). Positive samples were confirmed using ELISA (Beijing Wantai Biological Pharmacy Enterprise Co. Ltd). Data were analyzed using the SPSS version 20, and p<0.05 was considered statistically significant. Results: The overall seroprevalence of HBV and HCV were 25 (7.9%) and 1 (0.3%), respectively. The majority of hepatitis B viral infections were identified from the age groups of 18–25 years (10.7%) and unmarried prisoners (11.8%). Prisoners greater than 100 per cell (AOR=3.95, 95% CI=1.15–13.6, p=0.029) and with a history of alcohol consumption (AOR=3.01, 95% CI=1.17–7.74, p=0.022) were significantly associated with HBV infections. Conclusion: The seroprevalence of HBV among prisoners was nearly high or borderline, with a very low HCV prevalence. HBV was most prevalent among young adults, those housed with a large number of prisoners per cell, and those who had a history of alcohol consumption. This study recommends that there should be prison-focused intervention, including regular health education, with the emphasis on the mode of transmission and introducing HBV screening policy for prisoners, especially when they enter the prison.

Keywords: seroprevalence, HBV, HCV, prisoners, tigray

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802 Identifying the Factors that Influence Water-Use Efficiency in Agriculture: Case Study in a Spanish Semi-Arid Region

Authors: Laura Piedra-Muñoz, Ángeles Godoy-Durán, Emilio Galdeano-Gómez, Juan C. Pérez-Mesa

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The current agricultural system in some arid and semi-arid areas is not sustainable in the long term. In southeast Spain, groundwater is the main water source and is overexploited, while alternatives like desalination are still limited. The Water Plan for the Mediterranean Basins 2015-2020 indicates a global deficit of 73.42 hm3 and an overexploitation of the aquifers of 205.58hm3. In order to solve this serious problem, two major actions can be taken: increasing available water, and/or improving the efficiency of its use. This study focuses on the latter. The main aim of this study is to present the major factors related to water usage efficiency in farming. It focuses on Almería province, southeast Spain, one of the most arid areas of the country, and in particular on family farms as the main direct managers of water use in this zone. Many of these farms are among the most water efficient in Spanish agriculture, but this efficiency is not generalized throughout the sector. This work conducts a comprehensive assessment of water performance in this area, using on-farm water-use, structural, socio-economic and environmental information. Two statistical techniques are used: descriptive analysis and cluster analysis. Thus, two groups are identified: the least and the most efficient farms regarding water usage. By analyzing both the common characteristics within each group and the differences between the groups with a one-way ANOVA analysis, several conclusions can be reached. The main differences between the two clusters center on the extent to which innovation and new technologies are used in irrigation. The most water efficient farms are characterized by more educated farmers, a greater degree of innovation, new irrigation technology, specialized production and awareness of water issues and environmental sustainability. The research shows that better practices and policies can have a substantial impact on achieving a more sustainable and efficient use of water. The findings of this study can be extended to farms in similar arid and semi-arid areas and contribute to foster appropriate policies to improve the efficiency of water usage in the agricultural sector.

Keywords: cluster analysis, family farms, Spain, water-use efficiency

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801 Drawbacks of Second Generation Urban Re-Development in Addis Ababa

Authors: Ezana Haddis Weldeghebrael

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Addis Ababa City Administration is engaged in a massive facelift of the inner-city. The paper, therefore, aims to analyze the challenges of the current urban regeneration effort by paying special attention to Lideta and Basha Wolde Chilot projects. To this end, the paper has adopted a documentary research strategy to collect the data and Institutionalist perspective as well as the concept of urban regeneration to analyze the data. The sources were selected based on relevance and recency. Academic research outputs were used primarily. However, where much scholastic publications are not available institutional reports, newspaper articles, and expert presentations were used. The major findings of the research revealed that although the second generation of urban redevelopment projects have attempted to involve affected groups and succeeded in designing better neighborhoods, they are riddled with three major drawbacks. The first one is institutional constraints, i.e. absence of urban redevelopment strategy as well as housing policy, broad definition of ‘public purpose’, little regard for informal businesses, limitation on rights groups, negotiation power not devolved at sub-city level and no plan for groups that cannot afford to pay the down payment for low-cost apartments. The second one is planning limitation, i.e. absence of genuine affected group participation as well as consultative level of public engagement. The third one is implementation failure, i.e. no regard to maintaining social bond, non-participatory and ill-informed resettlement, interference from senior government officials, failure to protect the poor from speculators, corruption and disregard to heritage buildings. Based on the findings, the paper concluded that the current inner-city redevelopment has failed to be socially sustainable and calls for enactment of housing policy as well as redevelopment strategy, affected group participation, on-site resettlement, empowering the Sub-city to manage the project and allowing housing rights groups to advocate for the poor slum dwellers.

Keywords: participation, redevelopment, planning, implementation, consultation

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800 Enhancing Teaching of Engineering Mathematics

Authors: Tajinder Pal Singh

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Teaching of mathematics to engineering students is an open ended problem in education. The main goal of mathematics learning for engineering students is the ability of applying a wide range of mathematical techniques and skills in their engineering classes and later in their professional work. Most of the undergraduate engineering students and faculties feels that no efforts and attempts are made to demonstrate the applicability of various topics of mathematics that are taught thus making mathematics unavoidable for some engineering faculty and their students. The lack of understanding of concepts in engineering mathematics may hinder the understanding of other concepts or even subjects. However, for most undergraduate engineering students, mathematics is one of the most difficult courses in their field of study. Most of the engineering students never understood mathematics or they never liked it because it was too abstract for them and they could never relate to it. A right balance of application and concept based teaching can only fulfill the objectives of teaching mathematics to engineering students. It will surely improve and enhance their problem solving and creative thinking skills. In this paper, some practical (informal) ways of making mathematics-teaching application based for the engineering students is discussed. An attempt is made to understand the present state of teaching mathematics in engineering colleges. The weaknesses and strengths of the current teaching approach are elaborated. Some of the causes of unpopularity of mathematics subject are analyzed and a few pragmatic suggestions have been made. Faculty in mathematics courses should spend more time discussing the applications as well as the conceptual underpinnings rather than focus solely on strategies and techniques to solve problems. They should also introduce more ‘word’ problems as these problems are commonly encountered in engineering courses. Overspecialization in engineering education should not occur at the expense of (or by diluting) mathematics and basic sciences. The role of engineering education is to provide the fundamental (basic) knowledge and to teach the students simple methodology of self-learning and self-development. All these issues would be better addressed if mathematics and engineering faculty join hands together to plan and design the learning experiences for the students who take their classes. When faculties stop competing against each other and start competing against the situation, they will perform better. Without creating any administrative hassles these suggestions can be used by any young inexperienced faculty of mathematics to inspire engineering students to learn engineering mathematics effectively.

Keywords: application based learning, conceptual learning, engineering mathematics, word problem

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799 Spontaneous Eruption of Impacted Teeth While Awaiting Surgical Intervention

Authors: Alison Ryan, Himani Chhabra, Mohammed Dungarwalla, Judith Jones

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Background: Impacted and ectopic teeth present in 1-2% of orthodontic patients and often require joint surgical and orthodontic management. The authors present two patients undergoing orthodontic treatment, where the impacted teeth, in a hopeless position, spontaneously erupted during the period of cessation of general anaesthetic lists during the COVID-19 pandemic. Patient information: A healthy 11-year-old boy was referred to the Department of Oral and Maxillofacial Surgery for the management of a mesioangular impacted LR7. The patient was seen by the joint oral surgery/orthodontic team, who planned for the removal of the LR7 under general anaesthetic. A healthy 13-year-old boy was referred to the same Department and team for surgical extraction of unerupted and buccally impacted UL3 and UR3 under general anaesthetic. Management and outcome: The majority of elective dental-alveolar work ceased as a result of the global pandemic. On resumption of activity, the first patient was reviewed in July 2021. The LR7 had spontaneously erupted in a favourable position, and following MDT review, a decision was made to forgo any further surgical intervention. The second patient was reviewed in July 2021. The UL3 had clinically erupted, and there was radiographic evidence of favourable movement of UR3. Due to the nature of the patient’s malocclusion, the decision was made to proceed with the extractions as previously planned. Key Learning Points: Severely impacted teeth do have a prospect of spontaneous eruption or alignment without clinical intervention, and current literature states the initial location, axial inclination, degree of root formation, and relation of the impacted tooth to adjacent teeth roots may influence spontaneous eruption. There is potential to introduce a period of observation to account for this possibility in the developing dentition, with the aim of reducing the unnecessary need for surgical intervention. This could help prevent episodes of general anaesthetic and allocate theatre space more appropriately.

Keywords: spontaneous eruption, impaction, observation, hopeless position, surgical, orthodontic, change in treatment plan

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798 Best Practical Technique to Drain Recoverable Oil from Unconventional Deep Libyan Oil Reservoir

Authors: Tarek Duzan, Walid Esayed

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Fluid flow in porous media is attributed fundamentally to parameters that are controlled by depositional and post-depositional environments. After deposition, digenetic events can act negatively on the reservoir and reduce the effective porosity, thereby making the rock less permeable. Therefore, exploiting hydrocarbons from such resources requires partially altering the rock properties to improve the long-term production rate and enhance the recovery efficiency. In this study, we try to address, firstly, the phenomena of permeability reduction in tight sandstone reservoirs and illustrate the implemented procedures to investigate the problem roots; finally, benchmark the candidate solutions at the field scale and recommend the mitigation strategy for the field development plan. During the study, two investigations have been considered: subsurface analysis using ( PLT ) and Laboratory tests for four candidate wells of the interested reservoir. Based on the above investigations, it was obvious that the Production logging tool (PLT) has shown areas of contribution in the reservoir, which is considered very limited, considering the total reservoir thickness. Also, Alcohol treatment was the first choice to go with for the AA9 well. The well productivity has been relatively restored but not to its initial productivity. Furthermore, Alcohol treatment in the lab was effective and restored permeability in some plugs by 98%, but operationally, the challenge would be the ability to distribute enough alcohol in a wellbore to attain the sweep Efficiency obtained within a laboratory core plug. However, the Second solution, which is based on fracking wells, has shown excellent results, especially for those wells that suffered a high drop in oil production. It is suggested to frac and pack the wells that are already damaged in the Waha field to mitigate the damage and restore productivity back as much as possible. In addition, Critical fluid velocity and its effect on fine sand migration in the reservoir have to be well studied on core samples, and therefore, suitable pressure drawdown will be applied in the reservoir to limit fine sand migration.

Keywords: alcohol treatment, post-depositional environments, permeability, tight sandstone

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797 The Precarious Chinese Ecology of Financial Expertise: Discontent in the Mix

Authors: Giulia Dal Maso

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Within the contemporary financial capitalist configuration, the interplay of Chinese statecraft and financialization has shaped a new ‘ecology of financial expertise.’ This indicates the emergence of a new financial technocratic governance; that is increasingly changing the Chinese economy, reducing the state’s administrative and fiscal functions and increasing state assets in accordance with a new shareholder logic. In this shift, the creation of the stock market by the state was conceived not only as a new redistributor of wealth but as a ‘clearing house’ for social discontent resulting from work casualization, wage repression and a lack of social welfare. Since its inception in the wake of Deng Xiaoping’s reforms, the Chinese state has used the stock market as a means of securing social legitimation by providing a prearranged space where the disaggregated and vulnerable subjects left behind by the dismantlement of the collective work units of the Maoist period (danwei) can congregate. However, fieldwork which included both participant observation as well as interviews with investors in brokerage rooms in Shanghai (where one of only two mainland Chinese stock exchanges is situated) reveals that both new formal and informal financial experts—namely the haigui (Chinese returnees with a financial degree abroad) and sanhu (individual Chinese scattered players), are equally dissatisfied with their investing activities. They express discontent with the state, which they hold responsible for the summer 2015 financial crisis and for the financial turmoil that jeopardizes China’s financial and political project. What the investors want is a state that will guarantee the continuation of the current gupiaore ‘stock fever’. This paper holds that, by embracing financialization, the state is undermining the contract at the base of its legitimacy.

Keywords: Chinese state, Deng Xiaoping, financial capitalism, individual investors

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796 Community Involvement and Willingness To Pay for Municipal Solid Waste Management Activities in Rapid Urbanized Region: A Case Study of Mnadani and Madukani Wards-Dodoma Urban

Authors: Isabela Thomas Mkude

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This research was done to assess how the community is involved in waste management activities and their willingness to pay for services. Mnadani and Madukani are among the old wards in Dodoma urban. These two areas are similar and face numerous environmental problems, poor solid waste management practices being among them. People realize problems because they live with them daily but the study advice that the only way to stay off problems is to find appropriate measures. The findings recognized some problems that led to poor community involvement solid waste management the study areas. Lack of community education on how to deal with solid wastes, poor responsibility of ward leaders in issues concerning the environment and in active participation of communities in environmental meeting are among other major problems found during the research. The research also revealed that there is low willingness to pay for waste collection among communities and financial problems that make environmental committee inactive; that leading to a poor disposal and unavailable collection facilities in urban area. Although the municipal improves disposal activities by increasing amount of waste to be disposed off by 11% in three years, the amount of waste that collected is also increasing by 41% each day. It is advised that some corrective measures need to be put in place so that the communities are well involved in managing solid wastes as the best way to attain achievement in keeping the urban free from solid waste. Environmental education dissemination to the communities is needed so that they become responsible and dedicated citizen on the environment. There should be some incentives from government to the wards local government and CBOs so that they can practically implement solid waste management programs and to attract formation of more groups and motivate the present groups. Capacity building programs to the ward leaders need to be given priority so that leaders are well organized and able to plan, coordinate and cooperate with various governmental institutions, and NGOs responsible for development and environmental management.

Keywords: solid waste, waste management, public involvement, rapid urbanized region

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795 Exploration of Professional Skepticism among Entry-level Auditors in China from Psychological and Cultural Perspectives

Authors: Sammy Xiaoyan Ying

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Professional skepticism remains one of the most important and controversial topics in auditing. This study examines the influence of client cooperativeness and fraud risk on judgments of professional skepticism among Chinese entry-level auditors in the context of evaluation of client-provided audit evidence. Given that the essence of auditors’ PS rests on distrust of clients, this study invokes trust-related theories from psychological and cultural perspectives. Specifically, invoking psychology theories of trust concerning positive relationship between risk and distrust, this study hypothesizes that professional skepticism is likely to be positively associated with client fraud risk. The results support the hypothesis and show that lower (higher) levels of client fraud risk lead to lower (higher) levels of professional skepticism. Furthermore, drawing on analysis of relationship between cooperation and trust, with particular reference to guanxi dynamics in the Chinese culture, this study hypothesizes that professional skepticism is likely to be negatively associated with client cooperativeness. The results support the hypothesis and show that higher (lower) levels of client cooperativeness lead to lower (higher) levels of professional skepticism. The findings may assist audit firms and auditing educators in improving training and education programs and enhancing entry-level auditors’ abilities to maintain professional skepticism. Also, practitioners and regulators may benefit from increasing awareness of psychological factors in influencing professional skepticism.

Keywords: audit judgment, Chinese culture, entry-level auditor, professional skepticism

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794 Investigating Chinese Students' Engagement with Teacher Feedback: Multiple Case Studies in a UK University

Authors: Fangfei Li

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This research was conducted to explore how Chinese overseas students, who rarely received teacher feedback during their undergraduate studies in China, engaged in a different feedback provision context in the UK universities. In particular, this research provides some insights into Chinese students’ perspectives on how they made sense of the teacher feedback they obtained and how they took it on board in their assignments. Research questions in this study are 1) What are Chinese overseas students’ perceptions of teacher feedback on courses in UK higher education? 2) How do they respond to the teacher feedback they obtained? 3) What factors might influence their engagement with teacher feedback? Multiple case studies of five Chinese overseas students in a UK university have been carried out to address the research questions. The main data collection instruments are various types of semi-structured interviews, consisting of background interviews, scenario-based activities, stimulated recall sessions and retrospective interviews. Research findings indicate that student engagement with teacher feedback is a complex learning process incorporating several stages: from initial teacher input to ultimate transformational learning. Apart from students interpreting teachers’ comments/suggestions by themselves, students’ understandings of and responses to teacher feedback could also be influenced by pre-submission guidance, peer discussion, use of exemplars and post-submission discussion with teachers. These are key factors influencing students to make use of teacher feedback. Findings also reveal that the level of students’ reflections on tutor feedback influences the quality of their assignments and even their future learning. To sum up, this paper will discuss the current concepts of teacher feedback in existing studies and research findings of this study from which reconceptualization of teacher feedback has occurred.

Keywords: Chinese students, student engagement, teacher feedback, the UK higher education

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793 The Relationship between Creative Imagination and Curriculum

Authors: Faride Hashemiannejad, Shima Oloomi

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Imagination is one of the important elements of creative thinking which as a skill needs attention by the educational system. Although most students learn reading, writing, and arithmetic skills well, they lack high level thinking skills like creative thinking. Therefore, in the information age and in the beginning of entry to knowledge-based society, the educational system needs to think over its goals and mission, and concentrate on creativity-based curriculum. From among curriculum elements-goals, content, method and evaluation “method” is a major domain whose reform can pave the way for fostering imagination and creativity. The purpose of this study was examining the relationship between creativity development and curriculum. Research questions were: (1) is there a relationship between the cognitive-emotional structure of the classroom and creativity development? (2) Is there a relationship between the environmental-social structure of the classroom and creativity development? (3) Is there a relationship between the thinking structure of the classroom and creativity development? (4) Is there a relationship between the physical structure of the classroom and creativity development? (5) Is there a relationship between the instructional structure of the classroom and creativity development? Method: This research is a applied research and the research method is Correlational research. Participants: The total number of participants in this study included 894 students from High school through 11th grade from seven schools of seven zones in Mashad city. Sampling Plan: Sampling was selected based on Random Multi State. Measurement: The dependent measure in this study was: (a) the Test of Creative Thinking, (b) The researcher-made questionnaire includes five fragments, cognitive, emotional structure, environmental social structure, thinking structure, physical structure, and instructional structure. The Results Show: There was significant relationship between the cognitive-emotional structure of the classroom and student’s creativity development (sig=0.139). There was significant relationship between the environmental-social structure of the classroom and student’s creativity development (sig=0.006). There was significant relationship between the thinking structure of the classroom and student’s creativity development (sig=0.004). There was not significant relationship between the physical structure of the classroom and student’s creativity development (sig=0.215). There was significant relationship between the instructional structure of the classroom and student’s creativity development (sig=0.003). These findings denote if students feel secure, calm and confident, they can experience creative learning. Also the quality of coping with students’ questions, imaginations and risks can influence on their creativity development.

Keywords: imagination, creativity, curriculum, bioinformatics, biomedicine

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792 Associations between Parental Marital Quality and Sexual Behaviors among 50,000 Chinese University Students

Authors: Jiashu Shen

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With the increase in the prevalence of divorce, the impact of divorce on children’s sexual and reproductive health has received wide attention, while few studies have investigated parent marital relationship. This study aims to study the relation of both parent divorce and perceived parental marital relationship with children’s sexual behaviors among Chinese university or vocational college students. The study used data from “National College Student Survey on Sexual and Reproductive Health 2019”, an internet-based survey conducted from November 2019 to February 2020, in 241 universities or vocational colleges in China. Statistical analyses were conducted to assess the relationship of perceived parental marital relationship and parents’ divorce of distinct occurrence time with sexual intercourse, risky sexual behaviors, unintended health outcomes and sexual abuse. Among 51,124 university or vocational college students, those whose parents had divorced accounted for 10.72%. Better perceived parental relationship was associated with a lower likelihood to have sexual intercourse (male: OR: 0.83, 95%CI: 0.80-0.86; female: OR: 0.73, 95%CI: 0.70-0.75), sexual abuse, risky sexual behaviors and unintended health outcomes. Divorce was also found to be associated with higher risk of sexual abuse, risky sexual behaviors and unintended health outcomes. The findings highlight the importance of parental marital relationship and divorce in risky sexual behavior among young adults. The findings may provide implications on intervention programs targeting at children with divorced parents from an early stage.

Keywords: college students, divorce, family relationship, sexual behavior

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791 Indian Emigration to Gulf Countries: Opportunities and Challenges

Authors: Sudhaveni Naresh

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International migration is an important subject and gaining more significance andinterest among scholars in recent years. It is defined as crossing of the boundaries of political or administrative units for a certain minimum period for reasons such as education, employment, etc.International migration is not new for India because it has a long history with the Gulf region since ancient period. India is also one of the largest migrant-sending countries after China in the world. Migration towards the Gulf region became more prominent during early 1970s due to oil boom which led to rapid increase in the demand for foreign labour. Of 25 million Indian emigrants are living across the world, about six million Indian emigrants working in the Gulf. Most of these migrants were either unskilled or semi-skilled. Both the pull and push factors behind labour emigrate to Gulf countries. India is world’s leading receiver of remittances and the flow of remittances to India has been increasing steadily since the 1970s. In 2011-12, it was about 4 percent of GDP.Emigrants play a significant role in the economic development and growth of the country via the remittances and knowledge and skill transfer. Scholars see remittances as vital tool in the development for origin country. This paper examines the recent trend and pattern of migration from India to Gulf countries and explores impact of remittances on emigrants’ families at home country. It also highlights opportunities, challenges and the need for strengthening multilateral cooperation to transform migration into an efficient, orderly and humane process.The study propose to undertake a primary survey for this purpose. Both quantitative and qualitative research methods will be used to study the above issues.

Keywords: development, international migration, remittances, unskilled labour

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790 Business Model Innovation and Firm Performance: Exploring Moderation Effects

Authors: Mohammad-Ali Latifi, Harry Bouwman

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Changes in the business environment accelerated dramatically over the last decades as a result of changes in technology, regulation, market, and competitors’ behavior. Firms need to change the way they do business in order to survive or maintain their growth. Innovating business model (BM) can create competitive advantages and enhance firm performance. However, many companies fail to achieve expected outcomes in practice, mostly due to irreversible fundamental changes in key components of the company’s BM. This leads to more ambiguity, uncertainty, and risks associated with business performance. However, the relationship among BM Innovation, moderating factors, and the firm’s overall performance is by and large ignored in the current literature. In this study, we identified twenty moderating factors from our comprehensive literature review. We categorized these factors based on two criteria regarding the extent to which: the moderating factors can be controlled and managed by firms, and they are generic or specific changes to the firms. This leads to four moderation groups. The first group is BM implementation, which includes management support, employees’ commitment, employees’ skills, communication, detailed plan. The second group is called BM practices, which consists of BM tooling, BM experimentation, the scope of change, speed of change, degree of novelty. The third group is Firm characteristics, including firm size, age, and ownership. The last group is called Industry characteristics, which considers the industry sector, competitive intensity, industry life cycle, environmental dynamism, high-tech vs. low-tech industry. Through collecting data from 508 European small and medium-sized enterprises (SMEs) and using the structural equation modeling technique, the developed moderation model was examined. Results revealed that all factors highlighted through these four groups moderate the relation between BMI and firm performance significantly. Particularly, factors related to BM-Implementation and BM-Practices are more manageable and would potentially improve firm overall performance. We believe that this result is more important for researchers and practitioners since the possibility of working on factors in Firm characteristics and Industry characteristics groups are limited, and the firm can hardly control and manage them to improve the performance of BMI efforts.

Keywords: business model innovation, firm performance, implementation, moderation

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789 Examining Fertility Desires and Reproductive Planning among Low-Income Black Fathers: A Mixed-Methods Approach

Authors: Adaobi Anakwe, Wilson Majee, Kari White, Rhonda BeLue

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Background: Black men in the U.S. have overall poorer health, are more likely to experience unintended pregnancies, and have pregnancies (with their partner) at younger ages than other racial/ethnic groups. These factors increase the likelihood that pregnancies among Black fathers will occur at suboptimal paternal health. Although several community-based programs exist to support low-income Black fathers’ involvement with their families, little is known about the sexual and reproductive health, and family planning needs of fathers enrolled in these programs. The objective of this study was to quantitatively examine the relationship between Black fathers’ fertility desires and pregnancy prevention strategies and qualitatively explore the nuances of this relationship. Methods: A concurrent mixed-methods approach was used to survey 36 and interview 13 Black fathers from low-income backgrounds, who were participating in a community-based fatherhood program in a Midwestern urban area. Fathers in this study were ≥18 years old with at least one child. Differences between groups were compared using Fisher’s Exact tests and thematic analyses to examine the relationship between participants' fertility desires and reproductive planning practices. Results: Participants had a median age of 33 years, and 72% were non-residential biological parents. About 40% of men desired pregnancy, and 69% reported they or their partner always used contraception. In bivariate analysis, participants’ fertility desires were not associated with pregnancy prevention (p=0.251). Although most interview participants desired pregnancies, several factors contributed to their ability to plan for a pregnancy. Men felt that using contraception to prevent pregnancies was dependent on navigating trust with a partner. Health before pregnancy and financial stability were also important. Overall, participants thought that using an adult mindset, in which they considered the consequences of unprotected sex, was key to family planning. Conclusion: Black fathers may not desire pregnancy and consider a variety of factors, but this does not always result in active pregnancy prevention/contraceptive use. Community-based organizations already working with Black fathers can be leveraged to increase reproductive health awareness and facilitate reproductive planning for fathers.

Keywords: reproductive planning, reproductive health, preconception health, Black fathers, fertility desires, pregnancy

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788 Examining the Influences of Exchange Programmes on Youths' National Identity: A Hong Kong Case Study

Authors: Annie Y. N. Cheng

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Since the handover of Hong Kong to China, 'National Identity' has become a vital focus promoted by the HKSAR government. According to the poll by the University of Hong Kong’s Public Opinion Programme (2010 – 2015), young people aged between 18 and 29 have the least and decreasing recognition, an average 5.5%, of their Chinese identity. Past research has shown that student participation in exchange programmes and study tours provides the possibility of new formulations of national identity. Since the Policy Address 2008, the HKSAR government has been actively expanding and exploring the feasibility of Mainland exchange programmes to enhance our youths’ understanding of Chineseness and to strengthen their national identity. Schools have been sponsored or subsidized with the costs of Mainland exchange activities through various grants and channels. Considering the significantly increasing number of Hong Kong youths who have participated in these Mainland exchange programmes and study tours, however, the effectiveness of these activities is understudied. At present, there is the lack of systematic research on the impacts of these activities and the ways in which they influence our students’ perceptions of national identity. Using case study approach, this study aims to examine students’ perceptions of their national identity; and evaluate whether the Mainland exchange programmes or study tours have influences on students’ perceptions of national identity. Results show that the influences on national identity varied which were dependent on the objectives and destinations of the programmes. The findings of this study can provide significant feedback for schools to organize meaningful Mainland exchange activities or study tours and inform policy makers how to formulate effective strategies for promoting such exchange activities.

Keywords: Hong Kong youth, mainland exchange programme, national identity, study tours

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787 The Effect of Using Levels of Red Tiger Shrimp Meal in Starter Broiler Diet upon Growth Performance

Authors: Mohammed I.A. Al-Neemi, Mohammed S.B., Al-Hlawee, Ilham N. Ezaddin, Soz A. Faris, Omer E. Fakhry, Heemen S. Mageed

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This objective of this study was to measure the effect of replacing different levels of animal protein concentrate with Red Tiger shrimp meal (RTSM: 60 % crude protein, 2400 M.E kcal/kg and the source of RTSM was imported from china) in the broiler starter diets. A total 300 broiler chicks (Ross-308) were randomly assigned in treatments dietary contained three different levels of RTSM (0.00, 4.16 and 8.32 %) in experimental diet with a completely randomized design (CRD). Each treatment included four replicates (floor pens) and 25 broilers in each replication (Pen). Therefore, floor space for each boilers was 900 cm2. Initially, the broilers where exposed to a continues lighting of 23:30 hours and dark period of 30 minutes in each 24 hours. Feed and water were supplied ad libitum to the broilers throughout the experimental period (1-21 days). The results of this study indicated that body weight (B.W.), body weight gain (B.W.G), conversion ratio of feed, protein and energy (F.CR, P.C.R and E.C.R) were significantly (p ≤ 0.05) decreased by complete substituting (RTSM) for animal protein concentration (third treatment). Mortality percentage significantly (p ≤ 0.05) increased for third dietary treatment. No significant differences were found for feed, protein and energy intake among treatments during the experimental period (three weeks). In conclusion, (RTSM) could be included to 4.16% in the broiler starter diet or substitute the protein Red Tiger shrimp as alternative of protein animal protein concentrate as much as 50%.

Keywords: red tiger shrimp, broiler, starter diet, growth performance, animal protein concentrate

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786 Assessment of Isatin as Surface Recognition Group: Design, Synthesis and Anticancer Evaluation of Hydroxamates as Novel Histone Deacetylase Inhibitors

Authors: Harish Rajak, Kamlesh Raghuwanshi

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Histone deacetylase (HDAC) are promising target for cancer treatment. The panobinostat (Farydak; Novartis; approved by USFDA in 2015) and chidamide (Epidaza; Chipscreen Biosciences; approved by China FDA in 2014) are the novel HDAC inhibitors ratified for the treatment of patients with multiple myeloma and peripheral T cell lymphoma, respectively. On the other hand, two other HDAC inhibitors, Vorinostat (SAHA; approved by USFDA in 2006) and Romidepsin (FK228; approved by USFDA in 2009) are already in market for the treatment of cutaneous T-cell lymphoma. Several hydroxamic acid based HDAC inhibitors i.e., belinostat, givinostat, PCI24781 and JNJ26481585 are in clinical trials. HDAC inhibitors consist of three pharmacophoric features - an aromatic cap group, zinc binding group (ZBG) and a linker chain connecting cap group to ZBG. Herein, we report synthesis, characterization and biological evaluation of HDAC inhibitors possessing substituted isatin moiety as cap group which recognize the surface of active enzyme pocket and thiosemicarbazide moiety incorporated as linker group responsible for connecting cap group to ZBG (hydroxamic acid). Several analogues were found to inhibit HDAC and cellular proliferation of Hela cervical cancer cells with GI50 values in the micro molar range. Some of the compounds exhibited promising results in vitro antiproliferative studies. Attempts were also made to establish the structure activity relationship among synthesized HDAC inhibitors.

Keywords: HDAC inhibitors, hydroxamic acid derivatives, isatin derivatives, antiproliferative activity, docking

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785 Improving the Weekend Handover in General Surgery: A Quality Improvement Project

Authors: Michael Ward, Eliana Kalakouti, Andrew Alabi

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Aim: The handover process is recognized as a vulnerable step in the patient care pathway where errors are likely to occur. As such, it is a major preventable cause of patient harm due to human factors of poor communication and systematic error. The aim of this study was to audit the general surgery department’s weekend handover process compared to the recommended criteria for safe handover as set out by the Royal College of Surgeons (RCS). Method: A retrospective audit of the General Surgery department’s Friday patient lists and patient medical notes used for weekend handover in a London-based District General Hospital (DGH). Medical notes were analyzed against RCS's suggested criteria for handover. A standardized paper weekend handover proforma was then developed in accordance with guidelines and circulated in the department. A post-intervention audit was then conducted using the same methods for cycle 1. For cycle 2, we introduced an electronic weekend handover tool along with Electronic Patient Records (EPR). After a one-month period, a second post-intervention audit was conducted. Results: Following cycle 1, the paper weekend handover proforma was only used in 23% of patient notes. However, when it was used, 100% of them had a plan for the weekend, diagnosis and location but only 40% documented potential discharge status and 40% ceiling of care status. Qualitative feedback was that it was time-consuming to fill out. Better results were achieved following cycle 2, with 100% of patient notes having the electronic proforma. Results improved with every patient having documented ceiling of care, discharge status and location. Only 55% of patients had a past surgical history; however, this was still an increase when compared to paper proforma (45%). When comparing electronic versus paper proforma, there was an increase in documentation in every domain of the handover outlined by RCS with an average relative increase of 1.72 times (p<0.05). Qualitative feedback was that the autofill function made it easy to use and simple to view. Conclusion: These results demonstrate that the implementation of an electronic autofill handover proforma significantly improved handover compliance with RCS guidelines, thereby improving the transmission of information from week-day to weekend teams.

Keywords: surgery, handover, proforma, electronic handover, weekend, general surgery

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784 The role of Financial Development and Institutional Quality in Promoting Sustainable Development through Tourism Management

Authors: Hashim Zameer

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Effective tourism management plays a vital role in promoting sustainability and supporting ecosystems. A common principle that has been in practice over the years is “first pollute and then clean,” indicating countries need financial resources to promote sustainability. Financial development and the tourism management both seems very important to promoting sustainable development. However, without institutional support, it is very difficult to succeed. In this context, it seems prominently significant to explore how institutional quality, tourism development, and financial development could promote sustainable development. In the past, no research explored the role of tourism development in sustainable development. Moreover, the role of financial development, natural resources, and institutional quality in sustainable development is also ignored. In this regard, this paper aims to investigate the role of tourism development, natural resources, financial development, and institutional quality in sustainable development in China. The study used time-series data from 2000–2021 and employed the Bayesian linear regression model because it is suitable for small data sets. The robustness of the findings was checked using a quantile regression approach. The results reveal that an increase in tourism expenditures stimulates the economy, creates jobs, encourages cultural exchange, and supports sustainability initiatives. Moreover, financial development and institution quality have a positive effect on sustainable development. However, reliance on natural resources can result in negative economic, social, and environmental outcomes, highlighting the need for resource diversification and management to reinforce sustainable development. These results highlight the significance of financial development, strong institutions, sustainable tourism, and careful utilization of natural resources for long-term sustainability. The study holds vital insights for policy formulation to promote sustainable tourism.

Keywords: sustainability, tourism development, financial development, institutional quality

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783 An Empirical Study of Performance Management System: Implementation of Performance Management Cycle to Achieve High-Performance Culture at Pertamina Company, Indonesia

Authors: Arif Budiman

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Any organization or company that wishes to achieve vision, mission, and goals of the organization is required to implement a performance management system or known as the Performance Management System (PMS) in every part of the whole organization. PMS is a tool to help visualize the direction and work program of the organization to achieve the goal. The challenge is PMS should not stop merely as a visualization tool to achieve the vision and mission of the organization, but PMS should also be able to create a high-performance culture that is inherent in each individual of the organization. Establishment of a culture within an organization requires the support of top leaders and also requires a system or governance that encourages every individual in the organization to be involved in any work program of the organization. Keywords of creating a high-performance culture are the formation of communication pattern involving the whole individual, either vertically or horizontally, and performed consistently and persistently by all individuals in each line of the organization. PT Pertamina (Persero) as the state-owned national energy company holds a system to internalize the culture of high performance through a system called Performance Management System Cycle (PMS Cycle). This system has 7 stages of the cycle, those are: (1) defining vision, mission and strategic plan of the company, (2) defining key performance indicator of each line and the individual (‘expectation setting conversation’), (3) defining performance target and performance agreement, (4) monitoring performance on a monthly regular basis (‘pulse check’), (5) implementing performance dialogue between leaders and staffs periodically every 3 months (‘performance dialogue’), (6) defining rewards and consequences based on the achievement of the performance of each line and the individual, and (7) calculating the final performance value achieved by each line and individual from one period of the current year. Perform PMS is a continual communication running throughout the year, that is why any three performance discussion that should be performed, include expectation setting conversations, pulse check and performance dialogue. In addition, another significant point and necessary undertaken to complete the assessment of individual performance assessment is soft competencies through 360-degree assessment by leaders, staffs, and peers.

Keywords: 360-degree assessment, expectation setting conversation, performance management system cycle, performance dialogue, pulse check

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782 Preventative Maintenance, Impact on the Optimal Replacement Strategy of Secondhand Products

Authors: Pin-Wei Chiang, Wen-Liang Chang, Ruey-Huei Yeh

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This paper investigates optimal replacement and preventative maintenance policies of secondhand products under a Finite Planning Horizon (FPH). Any consumer wishing to replace their product under FPH would have it undergo minimal repairs. The replacement provided would be required to undergo periodical preventive maintenance done to avoid product failure. Then, a mathematical formula for disbursement cost for products under FPH can be derived. Optimal policies are then obtained to minimize cost. In the first of two segments of the paper, a model for initial product purchase of either new or secondhand products is used. This model is built by analyzing product purchasing price, surplus value of product, as well as the minimal repair cost. The second segment uses a model for replacement products, which are also secondhand products with no limit on usage. This model analyzes the same components as the first as well as expected preventative maintenance cost. Using these two models, a formula for the expected final total cost can be developed. The formula requires four variables (optimal preventive maintenance level, preventive maintenance frequency, replacement timing, age of replacement product) to find minimal cost requirement. Based on analysis of the variables using the expected total final cost model, it was found that the purchasing price and length of ownership were directly related. Also, consumers should choose the secondhand product with the higher usage for replacement. Products with higher initial usage upon acquisition require an earlier replacement schedule. In this case, replacements should be made with a secondhand product with less usage. In addition, preventative maintenance also significantly reduces cost. Consumers that plan to use products for longer periods of time replace their products later. Hence these consumers should choose the secondhand product with lesser initial usage for replacement. Preventative maintenance also creates significant total cost savings in this case. This study provides consumers with a method of calculating both the ideal amount of usage of the products they should purchase as well as the frequency and level of preventative maintenance that should be conducted in order to minimize cost and maintain product function.

Keywords: finite planning horizon, second hand product, replacement, preventive maintenance, minimal repair

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781 Reflecting Socio-Political Needs in Education Policy-Making: An Exploratory Study of Vietnam's Key Education Reforms (1945-2017)

Authors: Linh Tong

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This paper aims to contribute to the understanding of key education reforms in Vietnam from 1945 to 2017, which reflects an evolution of socio-political needs of the Socialist Republic of Vietnam throughout this period. It explores the contextual conditions, motivations and ambitions influencing the formation of the education reforms in Vietnam. It also looks, from an applied practical perspective, at the influence of politics on education policy-making. The research methodology includes a content analysis of curriculum designs proposed by the Ministry of Education and Training, relevant resolutions and executive orders passed by the National Assembly and the Prime Minister, as well as interviews with experts and key stakeholders. The results point to a particular configuration of factors which have been inspiring the shape and substance of these reforms and which have most certainly influenced their implementation. This configuration evolves from the immediate needs to erase illiteracy and cultivate socialist economic model at the beginning of Vietnam’s independence in 1945-1975, to a renewed urge to adopt market-oriented economy in 1986 and cautiously communicate with the outside world until 2000s, and to currently a demonstrated desire to fully integrate into the global economy and tackle with rising concerns about national security (the South China Sea Dispute), environmental sustainability, construction of a knowledge economy, and a rule-of-law society. Overall, the paper attempts to map Vietnam’s socio-political needs with the changing sets of goals and expected outcomes in teaching and learning methodologies and practices as introduced in Vietnamese key education reforms.

Keywords: curriculum development, knowledge society, national security, politics of education policy-making, Vietnam's education reforms

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780 Diagnostic Accuracy in the Detection of Cervical Lymph Node Metastases in Head and Neck Squamous Cell Carcinoma Patients: A Comparison of Sonography, CT, PET/CT and MRI

Authors: Di Luo, Maria Buchberger, Anja Pickhard

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Objectives: The purpose of this study was to assess and compare the diagnostic accuracy of four common morphological approaches, including sonography, computed tomography (CT), positron emission tomography/computed tomography (PET/CT), and magnetic resonance imaging (MRI) for the evaluation of cervical lymph node metastases in head and neck squamous cell carcinoma (HNSCC) patients. Material and Methods: Included in this retrospective study were 26 patients diagnosed with HNSCC between 2010 and 2011 who all underwent sonography, CT, PET/CT, and MRI imaging before neck dissection. Morphological data were compared to the corresponding histopathological results. Statistical analysis was performed with SPSS statistic software (version 26.0), calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for detection of cervical lymph node metastases. Results: The 5-year survival rate of the patient collective was 55.5%.Risk factors for survival included initial primary tumor stage, initial lymph node stage, initial metastasis status, and therapeutic approaches. Cox regression showed initial metastasis status(HR 8.671, 95%CI 1.316-57.123, p=0.025) and therapeutic approaches(HR 6.699, 95%CI 1.746-25.700, p=0.006)to be independent predictive risk factors for survival. Sensitivity was highest for MRI (96% compared to 85% for sonography and 89% for CT and PET/CT). Specificity was comparable with 95 % for CT and 98 % for sonography and PET/CT, but only 68% for MRI. While the MRI showed the least PPV (34%) compared to all other methods (85% for sonography,75% for CT, and 86% for PET/CT), the NPV was comparable in all methods(98-99%). The overall accuracy of cervical lymph node metastases detection was comparable for sonography, CT, and PET/CT with 96%,97%,94%, respectively, while MRI had only 72% accuracy. Conclusion: Since the initial status of metastasis is an independent predictive risk factor for patients’ survival, efficient detection is crucial to plan adequate therapeutic approaches. Sonography, CT, and PET/CT have better diagnostic accuracy than MRI for the evaluation of cervical lymph node metastases in HNSCC patients.

Keywords: cervical lymph node metastases, diagnostic accuracy, head and neck squamous carcinoma, risk factors, survival

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