Search results for: medical decision

Authors: Isabelle Gobatto

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Based on an anthropological approach, this paper explores the medical profession and the construction of medical practices by considering the multiform articulations between structural poverty and the production of care from a low-resource francophone West African country, Burkina Faso. This country is considered in its exemplary dimension of culturally differentiated countries of the African continent that share the same situation of structural poverty. The objective is to expose the effects of structural poverty on the ways of constructing professional knowledge and thinking about the sense of the medical profession. If doctors are trained to have the same capacities in South and West countries, which are to treat and save lives whatever the cultural contexts of the practice of medicine, the ways of investing their role and of dealing with this context of action fracture the homogenization of the medical profession. In the line of anthropology of biomedicine, this paper outlines the complex effects of structural poverty on health care, care relations, and the moral economy of doctors. The materials analyzed are based on an ethnography including two temporalities located thirty years apart (1990-1994 and 2020-2021), based on long-term observations of care practices conducted in healthcare institutions, interviews coupled with the life histories of physicians. The findings reveal that disabilities faced by doctors to deliver care are interpreted as policy gaps, but they are also considered by physicians as constitutive of the social and cultural characteristics of patients, making their capacities and incapacities in terms of accompanying caregivers in the production of care. These perceptions have effects on know-how, structured around the need to act even when diagnoses are not made so as not to see patients desert health structures if the costs of care are too high for them. But these interpretations of highly individualizing dimensions of these difficulties place part of the blame on patients for the difficulties in using learned knowledge and delivering effective care. These situations challenge the ethics of caregivers but also of ethnologists. Firstly because the interpretations of disabilities prevent caregivers from considering vulnerabilities of care as constituting a common condition shared with their patients in these health systems, affecting them in an identical way although in different places in the production of care. Correlatively, these results underline that these professional conceptions prevent the emergence of a figure of victim, which could be shared between patients and caregivers who, together, undergo working and care conditions at the limit of the acceptable. This dimension directly involves politics. Secondly, structural poverty and its effects on care challenge the ethics of the anthropologist who observes caregivers producing, without intent to arm, experiences of care marked by an ordinary violence, by not giving them the care they need. It is worth asking how anthropologists could get doctors to think in this light in west-African societies.

Keywords: Africa, care, ethics, poverty

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Authors: Andressa dos Santos Nicolau, João P. da S.C Algusto, Claudio Márcio do N. A. Pereira, Roberto Schirru

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In case of abnormal situations, the nuclear power plant (NPP) operators must follow written procedures to check the condition of the plant and to classify the type of emergency. In this paper, we proposed a Real Time Expert System in order to improve operator’s performance in case of transient or accident with reactor shutdown. The expert system’s knowledge is based on the sequence of events (SoE) of known accident and two emergency procedures of the Brazilian Pressurized Water Reactor (PWR) NPP and uses two kinds of knowledge representation: rule and logic trees. The results show that the system was able to classify the response of the automatic protection systems, as well as to evaluate the conditions of the plant, diagnosing the type of occurrence, recovery procedure to be followed, indicating the shutdown root cause, and classifying the emergency level.

Keywords: emergence procedure, expert system, operator support, PWR nuclear power plant

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Authors: Sylwia Frydrych, Jörg Prokop, Michał Buszko

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This study investigates the complex relationship between corporate ESG (Environmental, Social, Governance) performance and stock price risk within the European market context. By analyzing a dataset of 435 companies across 19 European countries, the research assesses the impact of both combined ESG performance and its individual components on various risk measures, including volatility, idiosyncratic risk, systematic risk, and downside risk. The findings reveal that while overall ESG scores do not significantly influence stock price risk, disaggregating the ESG components uncovers significant relationships. Governance practices are shown to consistently reduce market risk, positioning them as critical in risk management. However, environmental engagement tends to increase risk, particularly in times of regulatory shifts like those introduced in the EU post-2018. This research provides valuable insights for investors and corporate managers on the nuanced roles of ESG factors in financial risk, emphasizing the need for careful consideration of each ESG pillar in decision-making processes.

Keywords: ESG performance, ESG factors, ESG pillars, ESG scores

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Authors: L. S. Chathurika

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Early prediction of student performance is an important factor to be gained academic excellence. Whatever the study stream in secondary education, students lay the foundation for higher studies during the first year of their degree or diploma program in Sri Lanka. The information technology (IT) field has certain improvements in the education domain by selecting specialization areas to show the talents and skills of students. These specializations can be software engineering, network administration, database administration, multimedia design, etc. After completing the first-year, students attempt to select the best path by considering numerous factors. The purpose of this experiment is to predict the best study path using machine learning algorithms. Five classification algorithms: decision tree, support vector machine, artificial neural network, Naïve Bayes, and logistic regression are selected and tested. The support vector machine obtained the highest accuracy, 82.4%. Then affecting features are recognized to select the best study path.

Keywords: algorithm, classification, evaluation, features, testing, training

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Authors: Christine Eickhoff, Alyssa Adams, Alaine Duncan

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The Washington, DC Veterans Affairs Medical Center (DC VAMC) offers complementary and integrative health (CIH) services such as acupuncture, yoga, meditation, and nutrition education through a coordinated outpatient clinic. The primary population utilizing CIH services are veterans with chronic pain. Acupuncture is one of the most popular of the CIH services available at the DC VAMC. As interest and availability grows, it is important to measure health outcomes associated with CIH service utilization. The purpose of this study was to investigate pain and mental health outcomes for veterans with chronic pain enrolled in individual acupuncture services in the DC VAMC. Veterans at the DC VAMC with self-identified chronic pain and no prior acupuncture experience were recruited for the study (n=70). Veterans were referred for services by a medical provider and completed baseline assessments at the program orientation prior to participating in any CIH services. Veterans received four individual, full-body acupuncture appointments within four weeks of study enrollment. After the first month, participants were scheduled for six appointments that occurred every two weeks and then eight more sessions that were scheduled one month apart. Follow-up assessments were administered at 2, 4, 6, 8, and 12 months. The findings reported will include completed time points at two and four months. Measures include a demographics survey, the Measure Yourself Medical Outcome Profile-2 (MYMOP-2), The Beck Depression Inventory (BDI-II), the Defense Veterans Pain Rating Scale (DVPRS), and the Pain Disability Questionnaire (PDQ). In this sample, 67% identified a pain condition as their primary health concern. Between baseline and two-month follow-up, there were significant improvements in participants’ primary health concern (MYMOP-2 p=0.010), general wellbeing (MYMOP-2 p=0.011), and a significant decrease in the use of medication (MYMOP-2 p<0.000). Between 2 and 4-month follow-up, pain disability (PDQ p=0.035), pain rating (DVPRS p=0.027), and depression (BDI-II p=0.003) significantly improved. Preliminary findings indicate that individual acupuncture therapy can be effective at improving health outcomes, well-being, and decreasing medication use in U.S. military veterans with chronic pain. Findings also suggest that individual acupuncture therapy can improve pain ratings, pain disability, and depression in veterans with chronic pain.

Keywords: acupuncture, chronic pain, depression, integrative health, medication use, military, pain, veterans, wellbeing

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Authors: H. Erbiyik, A. Bal, M. Sirakaya, Ö. Yesildal, E. Yolcu

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The emergence of many environmental issues began with the Industrial Revolution. The depletion of natural resources and emerging environmental challenges over time requires enterprises and managers to take into consideration environmental factors while managing business. If we take notice of these causes; the design and implementation of environmentally friendly green purchasing, production and waste management systems become very important at green logistics systems. Companies can adopt green supply chain with the awareness of these facts. The concept of green supply chain constitutes from green purchasing, green production, green logistics, waste management and reverse logistics. In this study, we wanted to identify the concept of green supply chain and why green supply chain should be applied. In the practice part of the study an analytic hierarchy process (AHP) study is conducted on an aluminum production company to evaluate suppliers.

Keywords: aluminum sector, analytic hierarchy process, decision making, green logistics

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Authors: Zofia Wlodarczyk

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I study the experiences of domestic violence survivors who flee their countries of origin in times of political conflict using insight and evidence from forty-five biographical interviews with female Chechen refugees and twelve refugee resettlement professionals in Poland. Both refugees and women are often described as having less agency—that is, they lack the power to decide to migrate – refugees less than economic migrants and women less than men. In this paper, I focus on how female refugees who have been victims of domestic violence make decisions about leaving their countries of origin during times of political conflict. I use several existing migration theories to trace how the migration experience of these women is shaped by dynamics at different levels of society: the macro level, the meso level and the micro level. At the macro level of analysis, I find that political conflict can be both a source of and an escape from domestic violence. Ongoing conflict can strengthen the patriarchal cultural norms, increase violence and constrain women’s choices when it comes to marriage. However, political conflict can also destabilize families and make pathways for women to escape. At the meso level I demonstrate that other political migrants and institutions that emerge due to politically triggered migration can guide those fleeing domestic violence. Finally, at the micro level, I show that family dynamics often force domestic abuse survivors to make their decision to escape alone or with the support of only the most trusted female relatives. Taken together, my analyses show that we cannot look solely at one level of society when describing decision-making processes of women fleeing domestic violence. Conflict-related micro, meso and macro forces interact with and influence each other: on the one hand, strengthening an abusive trap, and on the other hand, opening a door to escape. This study builds upon several theoretical and empirical debates. First, it expands theories of migration by incorporating both refugee and gender perspectives. Few social scientists have used the migration theory framework to discuss the unique circumstances of refugee flows. Those who have mainly focus on “political” migrants, a designation that frequently fails to account for gender, does not incorporate individuals fleeing gender-based violence, including domestic-violence victims. The study also enriches migration scholarship, typically focused on the US and Western-European context, with research from Eastern Europe and Caucasus. Moreover, it contributes to the literature on the changing roles of gender in the context of migration. I argue that understanding how gender roles and hierarchies influence the pre-migration stage of female refugees is crucial, as it may have implications for policy-making efforts in host countries that recognize the asylum claims of those fleeing domestic violence. This study also engages in debates about asylum and refugee law. Domestic violence is normatively and often legally considered an individual-level problem whereas political persecution is recognized as a structural or societal level issue. My study challenges these notions by showing how the migration triggered by domestic violence is closely intertwined with politically motivated refuge.

Keywords: AGENCY, DOMESTIC VIOLENCE, FEMALE REFUGEES, POLITICAL REFUGE, SOCIAL NETWORKS

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Authors: Hilya Mudrika Arini, Nur Aini Masruroh, Budi Hartono

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There are more than 20 terrorist threats from 2002 to 2012 in Indonesia. Despite of this fact, preventive solution through studies in the field of national security in Indonesia has not been conducted comprehensively. This study aims to provide a preventive solution by developing prediction model of the terrorist threat in Indonesia by using Bayesian network. There are eight stages to build the model, started from literature review, build and verify Bayesian belief network to what-if scenario. In order to build the model, four experts from different perspectives are utilized. This study finds several significant findings. First, news and the readiness of terrorist group are the most influent factor. Second, according to several scenarios of the news portion, it can be concluded that the higher positive news proportion, the higher probability of terrorist threat will occur. Therefore, the preventive solution to reduce the terrorist threat in Indonesia based on the model is by keeping the positive news portion to a maximum of 38%.

Keywords: Bayesian network, decision analysis, national security system, text mining

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Authors: Yu-Chieh Chen, Kuei-Feng Shen, Chia-Ling Chao

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The purpose of this report was to present the nursing experience and case of an unexpected cerebellar hemorrhagic stroke with acute hydrocephalus patient after lumbar spine surgery. The patient had been suffering from an emergent external ventricular drainage and stayed in the Surgical Intensive Care Unit from July 8, 2016, to July 22, 2016. During the period of the case, the data were collected for attendance, evaluation, observation, interview, searching medical record, etc. An integral evaluation of the patient's physiological 'psychological' social and spiritual states was also noted. The author noticed the following major nursing problems including ineffective cerebral perfusion 'physical activity dysfunction' family resource preparation for disability. The author provided nursing care to maintain normal intracranial pressure, along with a well-therapeutic relationship and applied interdisciplinary medical/nursing team to draft an individualized and appropriate nursing plan for them to face the psychosocial impact of the patient disabilities. We also actively participated in the rehabilitation treatments to improve daily activity and confidence. This was deemed necessary to empower them to a more positive attitude in the future.

Keywords: family resourace preparation inability, hemorrhagic sroke, ineffective tissue cerebral perfusion, lumbar spine surgery

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Authors: Moustafa Osman

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The paper describes and analyses different good practice examples of protective levels, and initiatives actions (“framework conditions”) and encourages the uptake of environmental management systems (EMSs) to small and medium-sized enterprises (SMEs). Most of industries tend to take EMS as tools leading towards sustainability planning. The application of these tools has numerous environmental obligations that neither suggests decision nor recommends what a company should achieve ultimately. These set up clearly defined criteria to evaluate environmental protective action (EEPA) into sustainability indicators. The physical integration will evaluate how to incorporate traditional knowledge into baseline information, preparing impact prediction, and planning mitigation measures in monitoring conditions. Thereby efforts between the government, industry and community led protective action to concern with present needs for future generations, meeting the goal of sustainable development. The paper discusses how to set out distinct aspects of sustainable indicators and reflects inputs, outputs, and modes of impact on the environment.

Keywords: environmental management, sustainability, indicators, protective action

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Authors: Joseph P. Mandala

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This paper examines the legal and medical ethics concerns, which proponents of human head transplantation continue to defy since the procedure was first attempted on dogs in 1908. Despite recent bioethical objections, proponents have proceeded with radical experimentation, claiming transplantation would treat incurable diseases and improve patients’ quality of life. In 2018, Italian neurosurgeon, Sergio Canavero, and Dr. Xiaoping Ren claimed to have performed a head transplant on a corpse in China. Content analysis of literature shows that the procedure failed to satisfy scientific, legal, and bioethical elements because, unlike humans, corpses cannot coordinate function. Putting a severed head onto a body that has been dead for several days is not equivalent to a transplant which would require successfully reconnecting and restoring function to a spinal cord. While reconnection without restoration of bodily function is not transplantation, the publicized procedure on animals and corpses could leapfrog to humans, sparking excitement in society likely to affect organ donors and recipients from territorial jurisdictions with varying legal and ethical regimes. As neurodiscoveries generate further excitement, the need to preemptively address the legal and medical ethics impact of head transplantation in our society cannot be overstated. A preemptive development of methods to address the impact of head transplantation will help harmonizing national and international laws on organ donations, advance directives, and laws affecting end of life.

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Authors: Mahsa Pishdar

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Food traceability through the supply chain is facing increased demand. IoT and blockchain are among the tools under consideration in the Industry 4.0 era that could be integrated to help implementation of the Circular Economy (CE) principles while enhancing food traceability solutions. However, such tools need intellectual system, and infrastructureto be settled as guidance through the way, helping overcoming obstacles. That is why the critical success factors for implementing Industry 4.0 and circular economy principles in food traceability concept are analyzed in this paper by combination of interval type 2 fuzzy Worst Best Method and Measurement Alternatives and Ranking according to Compromise Solution (Interval Type 2 fuzzy WBM-MARCOS). Results indicate that “Knowledge of Industry 4.0 obligations and CE principle” is the most important factor that is the basis of success following by “Management commitment and support”. This will assist decision makers to seize success in gaining a competitive advantage while reducing costs through the supply chain.

Keywords: food traceability, industry 4.0, internet of things, block chain, best worst method, marcos

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Authors: Javad Jozaei, Rob G. Bell, Paula Blackett, Scott A. Stephens

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In the last few decades, Social Vulnerability Assessment (SVA) has been a favoured means in evaluating the susceptibility of social systems to drivers of change, including climate change and natural disasters. However, the application of SVA to inform responsive and practical strategies to deal with uncertain climate change impacts has always been challenging, and typically agencies resort back to conventional risk/vulnerability assessment. These challenges include complex nature of social vulnerability concepts which influence its applicability, complications in identifying and measuring social vulnerability determinants, the transitory social dynamics in a changing environment, and unpredictability of the scenarios of change that impacts the regime of vulnerability (including contention of when these impacts might emerge). Research suggests that the conventional quantitative approaches in SVA could not appropriately address these problems; hence, the outcomes could potentially be misleading and not fit for addressing the ongoing uncertain rise in risk. The second phase of New Zealand’s Resilience to Nature’s Challenges (RNC2) is developing a forward-looking vulnerability assessment framework and methodology that informs the decision-making and policy development in dealing with the changing coastal systems and accounts for complex dynamics of New Zealand’s coastal systems (including socio-economic, environmental and cultural). Also, RNC2 requires the new methodology to consider plausible drivers of incremental and unknowable changes, create mechanisms to enhance social and community resilience; and fits the New Zealand’s multi-layer governance system. This paper aims to analyse the conventional approaches and methodologies in SVA and offer recommendations for more responsive approaches that inform adaptive decision-making and policy development in practice. The research adopts a qualitative research design to examine different aspects of the conventional SVA processes, and the methods to achieve the research objectives include a systematic review of the literature and case study methods. We found that the conventional quantitative, reductionist and deterministic mindset in the SVA processes -with a focus the impacts of rapid stressors (i.e. tsunamis, floods)- show some deficiencies to account for complex dynamics of social-ecological systems (SES), and the uncertain, long-term impacts of incremental drivers. The paper will focus on addressing the links between resilience and vulnerability; and suggests how resilience theory and its underpinning notions such as the adaptive cycle, panarchy, and system transformability could address these issues, therefore, influence the perception of vulnerability regime and its assessment processes. In this regard, it will be argued that how a shift of paradigm from ‘specific resilience’, which focuses on adaptive capacity associated with the notion of ‘bouncing back’, to ‘general resilience’, which accounts for system transformability, regime shift, ‘bouncing forward’, can deliver more effective strategies in an era characterised by ongoing change and deep uncertainty.

Keywords: complexity, social vulnerability, resilience, transformation, uncertain risks

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Authors: Arati Siddharth Petkar, Joel E. M. Macwan

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Preferences for residential location are of a diverse nature. Primarily they are based on the socio-economic, socio-cultural, socio-demographic characteristics of the household. It also depends on character, and the growth potential of different areas in a city. In the present study, various criteria affecting residential location preferences from the Urban Dwellers’ perspective have been analyzed. The household survey has been conducted in two parts: Existing Buyers’ survey and Future Buyers’ survey. The analysis reveals that workplace location is the most governing criterion in deciding residential location from the majority of the urban dwellers perspective. For analyzing the importance of varied criteria, Analytical Hierarchy Process approach has been explored. The suggested approach will be helpful for urban planners, decision makers and developers, while designating a new residential area or redeveloping an existing one.

Keywords: analytical hierarchy process (AHP), household, preferences, residential location preferences, residential land use, urban dwellers

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Authors: Mais Khader, Xingjie Wei

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This research sheds light on female entrepreneurs by providing new insights on the survival predictions of companies led by females in the UK. This study aims to build a predictive machine learning model of the survival of female-led & co-led small & medium enterprises (SMEs) in the UK over the period 2000-2020. The predictive model built utilised a combination of financial and non-financial features related to both companies and their directors to predict SMEs' survival. These features were studied in terms of their contribution to the resultant predictive model. Five machine learning models are used in the modelling: Decision tree, AdaBoost, Naïve Bayes, Logistic regression and SVM. The AdaBoost model had the highest performance of the five models, with an accuracy of 73% and an AUC of 80%. The results show high feature importance in predicting companies' survival for company size, management experience, financial performance, industry, region, and females' percentage in management.

Keywords: company survival, entrepreneurship, females, machine learning, SMEs

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Authors: Yang Zhang, Jian He

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Heart disease is one of the leading causes of death in the world, and coronary heart disease (CHD) is one of the major heart diseases. Electrocardiogram (ECG) is widely used in the detection of heart diseases, but the traditional manual method for CHD prediction by analyzing ECG requires lots of professional knowledge for doctors. This paper introduces sliding window and continuous wavelet transform (CWT) to transform ECG signals into images, and then ResNet and Bi-LSTM are introduced to build the ECG feature extraction network (namely ECGNet). At last, an auxiliary system for coronary heart disease prediction was developed based on modified ResNet18 and Bi-LSTM, and the public ECG dataset of CHD from MIMIC-3 was used to train and test the system. The experimental results show that the accuracy of the method is 83%, and the F1-score is 83%. Compared with the available methods for CHD prediction based on ECG, such as kNN, decision tree, VGGNet, etc., this method not only improves the prediction accuracy but also could avoid the degradation phenomenon of the deep learning network.

Keywords: Bi-LSTM, CHD, ECG, ResNet, sliding window

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Authors: E. Behmanesh, J. Pannek

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The distribution-allocation problem is known as one of the most comprehensive strategic decision. In real-world cases, it is impossible to solve a distribution-allocation problem in traditional ways with acceptable time. Hence researchers develop efficient non-traditional techniques for the large-term operation of the whole supply chain. These techniques provide near-optimal solutions particularly for large scales test problems. This paper, presents an integrated supply chain model which is flexible in the delivery path. As the solution methodology, we apply a memetic algorithm with a novelty in population presentation. To illustrate the performance of the proposed memetic algorithm, LINGO optimization software serves as a comparison basis for small size problems. In large size cases that we are dealing with in the real world, the Genetic algorithm as the second metaheuristic algorithm is considered to compare the results and show the efficiency of the memetic algorithm.

Keywords: integrated logistics network, flexible path, memetic algorithm, genetic algorithm

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Authors: Baluku Nathan

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Infection prevention and control (IPC) is a practical, evidence-based approach that prevents patients and emergency health workers from being harmed by avoidable infections as a result of antimicrobial resistance; all hospital infection control programs put together various practices which, when used appropriately, restrict the spread of infection. A breach in these control practices facilitates the transmission of infections from patients to health workers, other patients, and attendants. It is, therefore important for all emergency medical technicians (EMTs) and patients to strictly adhere to them. It is also imperative for administrators to ensure the implementation of the infection control programme for their facilities. Purpose: The purpose of this study was to investigate the influencing factors of prevention practices against infection exposure among emergency medical technicians (EMTs) in the emergency department at Mbarara hospital. Methodology: This was a descriptive cross-sectional study that employed a self-reported questionnaire that was filled out by 32 EMTs in the emergency department from 12th February to 3rd march 2022. The questionnaire consisted of items concerning the defensive environment and other factors influencing infection prevention and control practices in the accident and emergency department of Mbarara hospital. Results: From the findings, the majority 16 (50%) always used protective gear when doing clinical work, 14 (43.8%) didn’t use protective gear, citing they were only assisting those performing resuscitations, gumboots were the least used protective gear with only3(9.4%) usage. About disposal techniques of specific products like blood and sharps, results showed 10 (31.3%) said blood is disposed of in red buckets, 5 (15.6%) in yellow buckets, and only 5(15.6%) in black buckets, and 12(37.5%) didn’t respond, however, 28(87.5%) said sharps were disposed of in a sharps container. The majority, 17 (53.1%), were not aware of the infection control guidelines even though they were pinned on walls of the emergency rooms, 15(46.9%) said they have never had quality assurance monitoring events, 14(43.8%) said monitoring was continuous while 15(46.9 %) said it was discrete. Conclusions: The infection control practices at the emergency department were inadequate in view of less than 100% of the EMTs observing the five principles of infection prevention, such as the use of personal protective equipment and proper waste disposal in appropriate color-coded bins. Dysfunctional infection prevention and control committees accompanied by inadequate supervision to ensure infection control remained a big challenge.

Keywords: emergency medical technician, infection prevention, influencing factors, infection control

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Authors: C. Kuoh, C. Lucas, T. Lopes, I. Mechie, J. Yoong, W. Yoong

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For all surgeons, there is one preventable but still highly occurring complication – wrong site surgeries. They can have potentially catastrophic, irreversible, or even fatal consequences on patients. With the exponential development of microsurgery and the use of advanced technological tools, the consequences of operating on the wrong side, anatomical part, or even person is seen as the most visible and destructive of all surgical errors and perhaps the error that is dreaded by most clinicians as it threatens their licenses and arouses feelings of guilt. Despite the implementation of the WHO surgical safety checklist more than a decade ago, the incidence of wrong-site surgeries remains relatively high, leading to tremendous physical and psychological repercussions for the clinicians involved, as well as a financial burden for the healthcare institution. In this presentation, the authors explore various factors which can lead to wrong site surgery – a combination of environmental and human factors and evaluate their impact amongst patients, practitioners, their families, and the medical industry. Major contributing factors to these “never events” include deviations from checklists, excessive workload, and poor communication. Two real-life cases are discussed, and systems that can be implemented to prevent these errors are highlighted alongside lessons learnt from other industries. The authors suggest that reinforcing speaking-up, implementing medical professional trainings, and higher patient’s involvements can potentially improve safety in surgeries and electrosurgeries.

Keywords: wrong side surgery, never events, checklist, workload, communication

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Authors: Nael Y. Zabel, Maged E. Georgy, Moheeb E. Ibrahim

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A knowledge-based expert system with the acronym RASPE is developed as an application tool to help decision makers in construction companies make informed decisions about managing risks in pipeline construction projects. Choosing to use expert systems from all available artificial intelligence techniques is due to the fact that an expert system is more suited to representing a domain’s knowledge and the reasoning behind domain-specific decisions. The knowledge-based expert system can capture the knowledge in the form of conditional rules which represent various project scenarios and potential risk mitigation/response actions. The built knowledge in RASPE is utilized through the underlying inference engine that allows the firing of rules relevant to a project scenario into consideration. This paper provides an overview of the knowledge acquisition process and goes about describing the knowledge structure which is divided up into four major modules. The paper shows one module in full detail for illustration purposes and concludes with insightful remarks.

Keywords: expert system, knowledge management, pipeline projects, risk mismanagement

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Authors: Itai Kohavi, Wojciech Nowiak

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This article explores the stagnation of the Israeli -Palestinian peace negotiation process, and the reasons behind the failure of more than 12 international initiatives to resolve the conflict. Twenty-seven top members of the Israeli national security elite (INSE) were interviewed, including heads of the negotiation teams, the National Security Council, the Mossad, and other intelligence and planning arms. The interviewees provided their insights on the Israeli challenges in reaching a sustainable and stable peace agreement and in dealing with the international pressure on Israel to negotiate a peace agreement while preventing anti-Israeli UN decisions and sanctions. The findings revealed a decision tree, with red herring deception strategies implemented to postpone the negotiation process and to delay major decisions during the negotiation process. Beyond the possible applications for the Israeli – Palestinian conflict, the findings shed more light on the phenomenon of rational deception of allies in a negotiation process, a subject less frequently researched as compared with deception of rivals.

Keywords: deception, Israeli-Palestinian conflict, negotiation, red herring, terrorist state, treadmill negotiation

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Authors: Alexander Dolin

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In the practice of Faith-based counseling, the clinician frequently faces multifaceted issues that come together when theological directives meet professional ethics to create a special set of dilemmas. The study narrates one working through the professional dilemmas of these Faith-based counselors, thereby looking into the tensions between the necessity of fidelity to faith and the requirements to follow the American Counseling Association Code of Ethics. Through a qualitative analysis of interviews with practitioners from various denominational backgrounds, the study has identified common ethical challenges and best practices that enable the integration of faith and ethics in practice. The findings provide insight into how faith-based counselors would reconcile a situation of conflict between religious belief and professional obligations but are striving to provide care that honors both their spiritual convictions and ethical responsibilities. This will add to existing discussions related to ethical decision-making in faith-based counseling by providing practical ways of dealing with these dilemmas in support of the counselor's professional integrity and spiritual mission.

Keywords: ethics, faith, common challenges, practical tools, counseling

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Authors: Leen Al Kassab, Sarah Johns, Helen Noble, Nawal Nour, Elizabeth Janiak, Sarrah Shahawy

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Introduction: Immigrant and refugee women experience disparities in sexual and reproductive health (SRH) outcomes, partially as a result of barriers to SRH literacy and to regular healthcare access and engagement. Despite the existing data highlighting growing needs for culturally relevant and structurally competent care, interventions are scarce and not well-documented. Methods: In this IRB-approved study, we used a community-based participatory research approach, with the assistance of a community advisory board, to conduct a qualitative needs assessment of SRH knowledge and service engagement with immigrant and refugee women from Africa or the Middle East and currently residing in Boston. We conducted a total of nine focus group discussions (FGDs) in partnership with medical, community, and religious centers, in six languages: Arabic, English, French, Somali, Pashtu, and Dari. A total of 44 individuals participated. We explored migrant and refugee women’s current and evolving SRH care needs and gaps, specifically related to the development of interventions and clinical best practices targeting SRH literacy, healthcare engagement, and informed decision-making. Recordings of the FGDs were transcribed verbatim and translated by interpreter services. We used open coding with multiple coders who resolved discrepancies through consensus and iteratively refined our codebook while coding data in batches using Dedoose software. Results: Participants reported immigrant adaptation experiences, discrimination, and feelings of trust, autonomy, privacy, and connectedness to family, community, and the healthcare system as factors surrounding SRH knowledge and needs. The context of previously learned SRH knowledge was commonly noted to be in schools, at menstruation, before marriage, from family members, partners, friends, and online search engines. Common themes included empowering strength drawn from religious and cultural communities, difficulties bridging educational gaps with their US- born daughters, and a desire for more SRH education from multiple sources, including family, health care providers, and religious experts & communities. Regarding further SRH education, participants’ preferences varied regarding ideal platform (virtual vs. in-person), location (in religious and community centers or not), smaller group sizes, and the involvement of men. Conclusions: Based on these results, empowering SRH initiatives should include both community and religious center-based, as well as clinic-based, interventions. Interventions should be composed of frequent educational workshops in small groups involving age-grouped women, daughters, and (sometimes) men, tailored SRH messaging, and the promotion of culturally, religiously, and linguistically competent care.

Keywords: community, immigrant, religion, sexual & reproductive health, women's health

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Authors: Shirazu Issahaku, Isaac Kwesi Acquah, Simon Mensah Amoh, George Nunoo

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Introduction: Diagnostic Reference Levels are important indicators for monitoring and optimizing protocol and procedure in medical imaging between facilities and equipment. This helps to evaluate whether, in routine clinical conditions, the median value obtained for a representative group of patients within an agreed range from a specified procedure is unusually high or low for that procedure. This study aimed to propose Diagnostic Reference Levels for Computed Tomography examination of the most common routine examination of the head, chest and abdominal pelvis regions at the University of Ghana Medical Centre. Methods: The Diagnostic Reference Levels were determined based on the investigation of the most common routine examinations, including head Computed Tomography examination with and without contrast, abdominopelvic Computed Tomography examination with and without contrast, and chest Computed Tomography examination without contrast. The study was based on two dose indicators: the volumetric Computed Tomography Dose Index and Dose-Length Product. Results: The estimated median distribution for head Computed Tomography with contrast for volumetric-Computed Tomography dose index and Dose-Length Product were 38.33 mGy and 829.35 mGy.cm, while without contrast, were 38.90 mGy and 860.90 mGy.cm respectively. For an abdominopelvic Computed Tomography examination with contrast, the estimated volumetric-Computed Tomography dose index and Dose-Length Product values were 40.19 mGy and 2096.60 mGy.cm. In the absence of contrast, the calculated values were 14.65 mGy and 800.40 mGy.cm, respectively. Additionally, for chest Computed Tomography examination, the estimated values were 12.75 mGy and 423.95 mGy.cm for volumetric-Computed Tomography dose index and Dose-Length Product, respectively. These median values represent the proposed diagnostic reference values of the head, chest, and abdominal pelvis regions. Conclusions: The proposed Diagnostic Reference Level is comparable to the recommended International Atomic Energy Agency and International Commission Radiation Protection Publication 135 and other regional published data by the European Commission and Regional National Diagnostic Reference Level in Africa. These reference levels will serve as benchmarks to guide clinicians in optimizing radiation dose levels while ensuring accurate diagnostic image quality at the facility.

Keywords: diagnostic reference levels, computed tomography dose index, computed tomography, radiation exposure, dose-length product, radiation protection

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Authors: Yasmine Aridi, Lara Nasreddine, Maya Khalil, Arafat Tfayli, Anas Mugharbel, Farah Naja

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Breast cancer is the most commonly diagnosed cancer site among women worldwide and the second most common cause of cancer mortality. Breast cancer rates differ vastly between geographical areas, countries, and within the same country. In Lebanon, the proportion of breast cancer to all other sites of tumor is 38.2%; these rates are still lower than those observed worldwide, but remain the highest among Arab countries. Studies and evidence based reviews show a strong association between breast cancer development and prognosis and dietary habits, specifically the Mediterranean diet (MD). As such, the aim of this study is to examine dietary patterns and adherence to the MD among a sample of 182 breast cancer female patients in Beirut, Lebanon. Subjects were recruited from two major hospitals; a private medical center and a public hospital. All subjects were administered two questionnaires: socio- demographics and Mediterranean diet adherence. Five Mediterranean scores were calculated: MS, MSDPS, PMDI, PREDIMED and DDS. The mean age of the participants was 53.78 years. The overall adherence to the Mediterranean diet (MD) was low since the sample means of 3 out of the 5 calculated scores were less than the scores’ medians. Given that 4 out of the 5 Mediterranean scores significantly varied between the recruitment sites, women in the private medical center were found to adhere more to the MD. Our results also show that the majority of the sample population’s intakes are exceeding the recommendations for total and saturated fat, while meeting the requirements for fiber, EPA, DHA and Linolenic Acid. Participants in the private medical center were consuming significantly more calories, carbohydrates, fiber, sugar, Lycopene, Calcium, Iron and Folate and less fat. After conducting multivariate linear regression analyses, the following significant results were observed: positive associations between MD (CPMDI, PREDIMED) and monthly income & current state of health, while negative associations between MD (MSDPS, PREDIMED) and age & employment status. Our findings indicated a low overall adherence to the MD and identified factors associated with it; which suggests a need to address dietary habits among BC patients in Lebanon, specifically encouraging them to adhere to their traditional Mediterranean diet.

Keywords: Adherence, Breast cancer, Dietary patterns, Mediterranean diet, Nutrition

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Authors: Asma Ben Yaghlane, Mohamed Naceur Azaiez

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In this paper, we briefly introduce the concept of Poisson attacks in the case of defense/attack strategies where attacks are assumed to be continuous. We suggest a game model in which the attacker will combine both criteria of a sufficient confidence level of a successful attack and a reasonably small size of the estimation error in order to launch an attack. Here, estimation error arises from assessing the system failure upon attack using aggregate data at the system level. The corresponding error is referred to as aggregation error. On the other hand, the defender will attempt to deter attack by making one or both criteria inapplicable. The defender will build his/her strategy by both strengthening the targeted system and increasing the size of error. We will formulate the defender problem based on appropriate optimization models. The attacker will opt for a Bayesian updating in assessing the impact on the improvement made by the defender. Then, the attacker will evaluate the feasibility of the attack before making the decision of whether or not to launch it. We will provide illustrations to better explain the process.

Keywords: attacker, defender, game theory, information

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Authors: Elias K. Maragos, Petros E. Maravelakis

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In Dynamic Data Envelopment Analysis (DDEA), which is a subfield of Data Envelopment Analysis (DEA), the productivity of Decision Making Units (DMUs) is considered in relation to time. In this case, as it is accepted by the most of the researchers, there are outputs, which are produced by a DMU to be used as inputs in a future time. Those outputs are known as intermediates. The common models, in DDEA, do not take into account the shape of the distribution of those inputs, outputs or intermediates data, assuming that the distribution of the virtual value of them does not deviate from linearity. This weakness causes the limitation of the accuracy of the analytical power of the traditional DDEA models. In this paper, the authors, using the concept of piecewise linear inputs and outputs, propose an extended DDEA model. The proposed model increases the flexibility of the traditional DDEA models and improves the measurement of the dynamic performance of DMUs.

Keywords: Dynamic Data Envelopment Analysis, DDEA, piecewise linear inputs, piecewise linear outputs

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Authors: Hsin-Yi Lo, Huang-Ju Jiun, Yu-Chiao Chu

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Hemodynamic monitoring is an important in the intensive care unit. Advances in medical technology in recent years, more diversification of intensive care equipment, there are many kinds of instruments available for monitoring of hemodynamics, Edwards Lifesciences Hemodynamic Monitoring (FloTrac) is one of them. The recent medical safety incidents in parameters were changed, nurses have not to notify doctor in time, therefore, it is hoped to analyze the current problems and find effective improvement strategies. In August 2021, the survey found that only 74.0% of FloTrac correctness of operation, reasons include lack of education, the operation manual is difficulty read, lack of audit mechanism, nurse doesn't know those numerical changes need to notify doctor, work busy omission, unfamiliar with operation and have many nursing records then omissions. Improvement methods include planning professional nurse education, formulate the secret arts of FloTrac, enacting an audit mechanism, establish FloTrac action learning, make「follow the sun」care map, hold simulated training and establish monitoring data automatically upload nursing records. After improvement, FloTrac correctness of operation increased to 98.8%. The results are good, implement to the ICU of the hospital.

Keywords: hemodynamic monitoring, edwards lifesciences hemodynamic monitoring, multiple strategies, intensive care

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Authors: Laura Bishop, Isabel Jones, Linn Halvorsen, Angela Smith

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Phishing emails are a form of social engineering where attackers deceive email users into revealing sensitive information or installing malware such as ransomware. Scammers often use persuasion techniques to influence email users to interact with malicious content. This study will use eye-tracking equipment to analyze how participants respond to and process Cialdini’s persuasion principles when utilized within phishing emails. Eye tracking provides insights into what is happening on the subconscious level of the brain that the participant may not be aware of. An experiment is conducted to track participant eye movements, whilst interacting with and then filing a series of persuasive emails delivered at random. Eye tracking metrics will be analyzed in relation to whether a malicious email has been identified as phishing (filed as ‘suspicious’) or not phishing (filed in any other folder). This will help determine the most influential persuasion techniques and those 'areas of interest' within an email that require intervention. The results will aid further research on how to reduce the effects of persuasion on human decision-making when interacting with phishing emails.

Keywords: cybersecurity, human-centric, phishing, psychology

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Authors: Sakul Jariyachamsit

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The objectives of this research were to study the behaviour of inbound tourist who visited Ratanakosin Island and to study their needs concerning support facilities. The independent variables included gender, age, levels of education, occupation, and income while the dependent variables were classified into two groups: tourists’ behaviour variables and tourists’ need of supporting facilities. A simple random sampling method was utilized to get 225 respondents. The majority of respondents were both male and female in the same proportion but most were between 21-30 years old. Most were married with a graduated degree. The average income of the respondents was between $20,000-30,000. The findings revealed that the majority of respondents came to Thailand for the first time and spent about 8 days in Thailand and preferred to travel in small groups. Their decision to come to Thailand was influenced by word of mouth. When they first thought of Thailand, they thought of Thai food. In terms of the needs for tourists around the Ratanakosin Island, and ranked in importance, are as follows: a tourist centre, somebody who can speak English, a trustable agency, police patrol, and the availability of maps and brochures.

Keywords: Rattanakosin Island, tourist, travelling behaviour, media engineering

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