Search results for: admission criteria

Authors: Waraporn Wimuktalop

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This research will select regions which are vulnerable to flooding in different level. Mathematical principles will be systematically and rationally utilized as a tool to solve problems of selection the regions. Therefore the method called Multiple Criteria Decision Making (MCDM) has been chosen by having two analysis standards, TOPSIS (Technique for Order Preference by Similarity to Ideal Solution) and AHP (Analytic Hierarchy Process). There are three criterions that have been considered in this research. The first criterion is climate which is the rainfall. The second criterion is geography which is the height above mean sea level. The last criterion is the land utilization which both forest and agriculture use. The study found that the South has the highest risk of flooding, then the East, the Centre, the North-East, the West and the North, respectively.

Keywords: multiple criteria decision making, TOPSIS, analytic hierarchy process, flooding

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Authors: Luis Javier Serrano Tamayo

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This research on technology makes a first approach to the selection of an amphibious landing ship with strategic capabilities, through the implementation of a multi-criteria model using Analytical Hierarchical Process (AHP), in which a significant group of alternatives of latest technology has been considered. The variables were grouped at different levels to match design and performance characteristics, which affect the lifecycle as well as the acquisition, maintenance and operational costs. The model yielded an overall measure of effectiveness and an overall measure of cost of each kind of ship that was compared each other inside the model and showed in a Pareto chart. The modeling was developed using the Expert Choice software, based on AHP method.

Keywords: analytic hierarchy process, multi-criteria decision-making, Pareto analysis, Colombian Marine Corps, projection operations, expert choice, amphibious landing ship

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Authors: Juraj Camaj, Martin Kendra, Jaroslav Masek

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The paper is focused to the evaluation railway tracks in the Slovakia by using Multi-Criteria method. Evaluation of railway tracks has important impacts for the assessment of investment in technical equipment. Evaluation of railway tracks also has an important impact for the allocation of marshalling yards. Marshalling yards are in transport model as centers for the operation assigned catchment area. This model is one of the effective ways to meet the development strategy of the European Community's railways. By applying this model in practice, a transport company can guarantee a higher quality of service and then expect an increase in performance. The model is also applicable to other rail networks. This model supplements a theoretical problem of train formation problem of new ways of looking at evaluation of factors affecting the organization of wagon flows.

Keywords: railway track, multi-criteria methods, evaluation, transportation model

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Authors: Muhammad Shahid Shah, Akram Maqbool, Samina Ashraf

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Since start of this century, world has adopted inclusion as a trend in special education. To meet the challenges of inclusion response, the Punjab government has developed a progressive policy to implement inclusive education. The objectives of this research were to analyze the administration and implementation process by consideration on the management, student’s admission process, screening and assessment, adaptations in curriculum and instruction along with an evaluation, government and nonprofit organizations support. The sample consisted of 50 schools both public and private with a total of 3000 students, 9 percent of which (270) were students with disabilities. Among all the students with disabilities, 63 percent (170) were male and 37 percent (100) were female. The concluded remarks regarding management revealed that a large number of inclusive schools was lacking in terms of developing a certain model for inclusion, including the managerial breakup of staff, the involvement of stakeholders, and conducted frequent meetings. Many of schools are not able to restructure their school organizations due to lack of financial resources, consultations, and backup. As for as student’s admission/identification/assessment was concerned, only 12 percent schools applied a selection process regarding student admission, half of which used different procedures for disable candidates. Approximately 5 percent of inclusive schools had modified their curriculum, including a variety of standards. In terms of instruction, 25 percent of inclusive schools reported that they modified their instructional process. Only a few schools, however, provided special equipment for students with visual impairment, physical impairment, speech and hearing problems, students with mild intellectual disabilities, and autism. In a student evaluation, more than 45 percent reported that test items, administration, time allocations, and students’ reports were modified. For the primary board examination conducted by the Education Department of Government of Punjab, this number decreased dramatically. Finally, government and nonprofit organizations support in the forms of funding, coaching, and facilities were mostly provided by provincial governments and by Ghazali Education Trust.

Keywords: inclusion, identification, assessment, funding, facilities, evaluation

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Authors: Nabiha Bouafia, Asma Ben Cheikh, Asma Ammar, Olfa Ezzi, Mohamed Mahjoub, Khaoula Meddeb, Imed Chouchene, Hamadi Boussarsar, Mansour Njah

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Background: Hospital acquired infections (HAI) cause significant morbidity, mortality, length of stay and hospital costs, especially in the intensive care unit (ICU), because of the debilitated immune systems of their patients and exposure to invasive devices. The aims of this study were to determine the rate and the risk factors of HAI in an ICU of a university hospital in Tunisia. Materials/Methods: A prospective study was conducted in the 8-bed adult medical ICU of a University Hospital (Sousse Tunisia) during 14 months from September 15th, 2015 to November 15th, 2016. Patients admitted for more than 48h were included. Their surveillance was stopped after the discharge from ICU or death. HAIs were defined according to standard Centers for Disease Control and Prevention criteria. Risk factors were analyzed by conditional stepwise logistic regression. The p-value of < 0.05 was considered significant. Results: During the study, 192 patients had admitted for more than 48 hours. Their mean age was 59.3± 18.20 years and 57.1% were male. Acute respiratory failure was the main reason of admission (72%). The mean SAPS II score calculated at admission was 32.5 ± 14 (range: 6 - 78). The exposure to the mechanical ventilation (MV) and the central venous catheter were observed in 169 (88 %) and 144 (75 %) patients, respectively. Seventy-three patients (38.02%) developed 94 HAIs. The incidence density of HAIs was 41.53 per 1000 patient day. Mortality rate in patients with HAIs was 65.8 %( n= 48). Regarding the type of infection, Ventilator Associated Pneumoniae (VAP) and central venous catheter Associated Infections (CVC AI) were the most frequent with Incidence density: 14.88/1000 days of MV for VAP and 20.02/1000 CVC days for CVC AI. There were 5 Peripheral Venous Catheter Associated Infections, 2 urinary tract infections, and 21 other HAIs. Gram-negative bacteria were the most common germs identified in HAIs: Multidrug resistant Acinetobacter Baumanii (45%) and Klebsiella pneumoniae (10.96%) were the most frequently isolated. Univariate analysis showed that transfer from another hospital department (p= 0.001), intubation (p < 10-4), tracheostomy (p < 10-4), age (p=0.028), grade of acute respiratory failure (p=0.01), duration of sedation (p < 10-4), number of CVC (p < 10-4), length of mechanical ventilation (p < 10-4) and length of stay (p < 10-4), were associated to high risk of HAIS in ICU. Multivariate analysis reveals that independent risk factors for HAIs are: transfer from another hospital department: OR=13.44, IC 95% [3.9, 44.2], p < 10-4, duration of sedation: OR= 1.18, IC 95% [1.049, 1.325], p=0.006, high number of CVC: OR=2.78, IC 95% [1.73, 4.487], p < 10-4, and length of stay in ICU: OR= 1.14, IC 95% [1.066,1.22], p < 10-4. Conclusion: Prevention of nosocomial infections in ICUs is a priority of health care systems all around the world. Yet, their control requires an understanding of epidemiological data collected in these units.

Keywords: healthcare associated infections, incidence, intensive care unit, risk factors

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Authors: Mariayee Doraisamy, Suhaimi bin Ibrahim, Mohd Naz’ri Mahrin

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There are several methods to monitor software projects and the objective for monitoring is to ensure that the software projects are developed and delivered successfully. A performance measurement is a method that is closely associated with monitoring and it can be scrutinized by looking at two important attributes which are efficiency and effectiveness both of which are factors that are important for the success of a software project. Consequently, a successful steering is achieved by monitoring and controlling a software project via the performance measurement criteria and metrics. Hence, this paper is aimed at identifying the performance measurement criteria and the metrics for monitoring the performance of a software project by using the Goal Question Metrics (GQM) approach. The GQM approach is utilized to ensure that the identified metrics are reliable and useful. These identified metrics are useful guidelines for project managers to monitor the performance of their software projects.

Keywords: component, software project performance, goal question metrics, performance measurement criteria, metrics

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Authors: Vineet Agrawal, Deepanjali S., Medha R., Subitha L.

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Background. Hospital malnutrition is a highly prevalent issue and is known to increase the morbidity, mortality, length of hospital stay, and cost of care. In India, studies on hospital malnutrition have been restricted to ICU, post-surgical, and cancer patients. We designed this study to assess the impact of hospital malnutrition on 30-day post-discharge and in-hospital mortality in patients admitted in the general medicine department, irrespective of diagnosis. Methodology. All patients aged above 18 years admitted in the medicine wards, excluding medico-legal cases, were enrolled in the study. Nutritional assessment was done within 72 h of admission, using Subjective Global Assessment (SGA), which classifies patients into three categories: Severely malnourished, Mildly/moderately malnourished, and Normal/well-nourished. Anthropometric measurements like Body Mass Index (BMI), Triceps skin-fold thickness (TSF), and Mid-upper arm circumference (MUAC) were also performed. Patients were followed-up during hospital stay and 30 days after discharge through telephonic interview, and their final diagnosis, comorbidities, and cause of death were noted. Multivariate logistic regression and cox regression model were used to determine if the nutritional status at admission independently impacted mortality at one month. Results. The prevalence of malnourishment by SGA in our study was 67.3% among 395 hospitalized patients, of which 155 patients (39.2%) were moderately malnourished, and 111 (28.1%) were severely malnourished. Of 395 patients, 61 patients (15.4%) expired, of which 30 died in the hospital, and 31 died within 1 month of discharge from hospital. On univariate analysis, malnourished patients had significantly higher morality (24.3% in 111 Cat C patients) than well-nourished patients (10.1% in 129 Cat A patients), with OR 9.17, p-value 0.007. On multivariate logistic regression, age and higher Charlson Comorbidity Index (CCI) were independently associated with mortality. Higher CCI indicates higher burden of comorbidities on admission, and the CCI in the expired patient group (mean=4.38) was significantly higher than that of the alive cohort (mean=2.85). Though malnutrition significantly contributed to higher mortality on univariate analysis, it was not an independent predictor of outcome on multivariate logistic regression. Length of hospitalisation was also longer in the malnourished group (mean= 9.4 d) compared to the well-nourished group (mean= 8.03 d) with a trend towards significance (p=0.061). None of the anthropometric measurements like BMI, MUAC, or TSF showed any association with mortality or length of hospitalisation. Inference. The results of our study highlight the issue of hospital malnutrition in medicine wards and reiterate that malnutrition contributes significantly to patient outcomes. We found that SGA performs better than anthropometric measurements in assessing under-nutrition. We are of the opinion that the heterogeneity of the study population by diagnosis was probably the primary reason why malnutrition by SGA was not found to be an independent risk factor for mortality. Strategies to identify high-risk patients at admission and treat malnutrition in the hospital and post-discharge are needed.

Keywords: hospitalization outcome, length of hospital stay, mortality, malnutrition, subjective global assessment (SGA)

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Authors: Burcu Uçan

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The certification approach differs in civil and military projects in aviation. Sets of criteria and standards created by airworthiness authorities for the determination of certification basis are distinct. While the civil standards are more understandable and clear because of not only include detailed specifications but also the help of guidance materials such as Advisory Circular, military criteria do not provide this level of guidance. Therefore, specifications that are more negotiable and sometimes more difficult to reconcile arise for the certification basis of a military aircraft. This study investigates a method of how to develop a military specification set by taking advantage of civil standards, regarding the European Military Airworthiness Criteria (EMACC) that establishes the airworthiness criteria for aircraft systems. Airworthiness Certification Criteria (MIL-HDBK-516C) is a handbook published for guidance that contains qualitative evaluation for military aircrafts meanwhile Certification Specifications (CS-29) is published for civil aircrafts by European Union Aviation Safety Agency (EASA). This method intends to compare and contrast specifications that MIL-HDBK-516C and CS-29 contain within the scope of Human Factors. Human Factors supports human performance and aims to improve system performance by encompassing knowledge from a range of scientific disciplines. Human Factors focuses on how people perform their tasks and reduce the risk of an accident occurring due to human physical and cognitive limitations. Hence, regardless of whether the project is civil or military, the specifications must be guided at a certain level by taking into account human limits. This study presents an advisory method for this purpose. The method in this study develops a solution for the military certification process by identifying the CS requirement corresponding to the criteria in the MIL-HDBK-516C by means of EMACC. Thus, it eases understanding the expectations of the criteria and establishing derived requirements. As a result of this method, it may not always be preferred to derive new requirements. Instead, it is possible to add remarks to make the expectancy of the criteria and required verification methods more comprehensible for all stakeholders. This study contributes to creating a certification basis for military aircraft, which is difficult and takes plenty of time for stakeholders to agree due to gray areas in the certification process for military aircrafts.

Keywords: human factors, certification, aerospace, requirement

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Authors: Geetha Jayapathy, Lakshmi Muthukrishnan, Manoj Kumar Reddy Pulim , Radhika Raman

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Introduction: Ketones are the end products of fatty acid metabolism and a source of energy for vital organs such as the brain, heart and skeletal muscles. Ketones are produced in excess when glucose is not available as a source of energy or it cannot be utilized as in diabetic ketoacidosis. Children admitted in the emergency department often have starvation ketosis which is not clinically manifested. Decision on admission of children to the emergency room with subtle signs can be difficult at times. Point of care blood ketone testing can be done at the bedside even in a primary level care setting to supplement and guide us in our management decisions. Hence this study was done to explore the utility of this simple bedside parameter as a supplement in assessing pediatric patients presenting to the emergency department. Objectives: To estimate blood ketones of children admitted in the emergency department. To analyze the significance of blood ketones in various disease conditions. Methods: Blood ketones using point of care testing instrument (ABOTTprecision Xceed Pro meters) was done in patients getting admitted in emergency room and in out-patients (through sample collection centre). Study population: Children aged 1 month to 18 years were included in the study. 250 cases (In-patients) and 250 controls (out-patients) were collected. Study design: Prospective observational study. Data on details of illness and physiological status were documented. Blood ketones were compared between the two groups and all in patients were categorized into various system groups and analysed. Results: Mean blood ketones were high in in-patients ranging from 0 to 7.2, with a mean of 1.28 compared to out-patients ranging from 0 to 1.9 with a mean of 0.35. This difference was statistically significant with a p value < 0.001. In-patients with shock (mean of 4.15) and diarrheal dehydration (mean of 1.85) had a significantly higher blood ketone values compared to patients with other system involvement. Conclusion: Blood ketones were significantly high (above the normal range) in pediatric patients who are sick requiring admission. Patients with various forms of shock had very high blood ketone values as found in diabetic ketoacidosis. Ketone values in diarrheal dehydration were moderately high correlating to the degree of dehydration.

Keywords: admission, blood ketones, paediatric emergencies, point of care testing

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Authors: Homa Ghave, Parmis Shahmaleki

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This paper presents a new multi-criteria stochastic mathematical model for a single machine scheduling with outsourcing allowed. There are multiple jobs processing in batch. For each batch, all of job or a quantity of it can be outsourced. The jobs have stochastic processing time and lead time and deterministic due dates arrive randomly. Because of the stochastic inherent of processing time and lead time, we use the chance constrained programming for modeling the problem. First, the problem is formulated in form of stochastic programming and then prepared in a form of deterministic mixed integer linear programming. The objectives are considered in the model to minimize the maximum tardiness and outsourcing cost simultaneously. Several procedures have been developed to deal with the multi-criteria problem. In this paper, we utilize the concept of satisfaction functions to increases the manager’s preference. The proposed approach is tested on instances where the random variables are normally distributed.

Keywords: single machine scheduling, multi-criteria mathematical model, outsourcing strategy, uncertain lead times and processing times, chance constrained programming, satisfaction function

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Authors: Bezhan Ghvaberidze

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A multiple criteria optimization approach for the solution of the Fuzzy Vehicle Routing Problem (FVRP) is proposed. For the possibility environment the levels of movements between customers are calculated by the constructed simulation interactive algorithm. The first criterion of the bi-criteria optimization problem - minimization of the expectation of total fuzzy travel time on closed routes is constructed for the FVRP. A new, second criterion – maximization of feasibility of movement on the closed routes is constructed by the Choquet finite averaging operator. The FVRP is reduced to the bi-criteria partitioning problem for the so called “promising” routes which were selected from the all admissible closed routes. The convenient selection of the “promising” routes allows us to solve the reduced problem in the real-time computing. For the numerical solution of the bi-criteria partitioning problem the -constraint approach is used. An exact algorithm is implemented based on D. Knuth’s Dancing Links technique and the algorithm DLX. The Main objective was to present the new approach for FVRP, when there are some difficulties while moving on the roads. This approach is called FVRP for extreme conditions (FVRP-EC) on the roads. Also, the aim of this paper was to construct the solving model of the constructed FVRP. Results are illustrated on the numerical example where all Pareto-optimal solutions are found. Also, an approach for more complex model FVRP with time windows was developed. A numerical example is presented in which optimal routes are constructed for extreme conditions on the roads.

Keywords: combinatorial optimization, Fuzzy Vehicle routing problem, multiple objective programming, possibility theory

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Authors: Omar Boutkhoum, Mohamed Hanine, Abdessadek Bendarag

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Sustainable economic growth is nowadays driving firms to extend toward the adoption of many green supply chain management (GSCM) solutions. However, the evaluation and selection of these solutions is a matter of concern that needs very serious decisions, involving complexity owing to the presence of various associated factors. To resolve this problem, a comparative analysis approach based on multi-criteria decision-making methods is proposed for adequate evaluation of sustainable supply chain management solutions. In the present paper, we propose an integrated decision-making model based on FAHP (Fuzzy Analytic Hierarchy Process), TOPSIS (Technique for Order of Preference by Similarity to Ideal Solution) and PROMETHEE (Preference Ranking Organisation METHod for Enrichment Evaluations) to contribute to a better understanding and development of new sustainable strategies for industrial organizations. Due to the varied importance of the selected criteria, FAHP is used to identify the evaluation criteria and assign the importance weights for each criterion, while TOPSIS and PROMETHEE methods employ these weighted criteria as inputs to evaluate and rank the alternatives. The main objective is to provide a comparative analysis based on TOPSIS and PROMETHEE processes to help make sound and reasoned decisions related to the selection problem of GSCM solution.

Keywords: GSCM solutions, multi-criteria analysis, decision support system, TOPSIS, FAHP, PROMETHEE

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Authors: Kay-Anne Haykal, Issack Biyong

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The post-traumatic stress disorder (PTSD) rises from exposure to a traumatic event and appears by a persistent experience of this event. Several psychiatric co-morbidities are associated with PTSD and include mood disorders, anxiety disorders, and substance abuse. The main objective was to compare the criteria for PTSD according to the literature to those used to diagnose a patient in a francophone hospital and to check the correspondence of these two criteria. 700 medical charts of admitted patients on the medicine or psychiatric unit at the Montfort Hospital were identified with the following diagnoses: major depressive disorder, bipolar disorder, anxiety disorder, substance abuse, and PTSD for the period of time between April 2005 and March 2006. Multiple demographic criteria were assembled. Also, for every chart analyzed, the PTSD criteria, according to the Manual of Mental Disorders (DSM) IV were found, identified, and grouped according to pre-established codes. An analysis using the receiver operating characteristic (ROC) method was elaborated for the study of data. A sample of 57 women and 50 men was studied. Age was varying between 18 and 88 years with a median age of 48. According to the PTSD criteria in the DSM IV, 12 patients should have the diagnosis of PTSD in opposition to only two identified in the medical charts. The ROC method establishes that with the combination of data from PTSD and depression, the sensitivity varies between 0,127 and 0,282, and the specificity varies between 0,889 and 0,917. Otherwise, if we examine the PTSD data alone, the sensibility jumps to 0.50, and the specificity varies between 0,781 and 0,895. This study confirms the presence of an underdiagnosed and treated PTSD that causes severe perturbations for the affected individual.

Keywords: post-traumatic stress disorder, co-morbidities, diagnosis, mental health disorders

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Authors: Pulak Swain, A. K. Ojha

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Portfolio optimization is based on dealing with the problems of efficient asset allocation. Risk and Expected return are two conflicting criteria in such problems, where the investor prefers the return to be high and the risk to be low. Using multi-objective approach we can solve those type of problems. However the information which we have for the input parameters are generally ambiguous and the input values can fluctuate around some nominal values. We can not ignore the uncertainty in input values, as they can affect the asset allocation drastically. So we use Robust Optimization approach to the problems where the input parameters comes under box uncertainty. In this paper, we solve the multi criteria robust problem with the help of  E- constraint method.

Keywords: portfolio optimization, multi-objective optimization, ϵ - constraint method, box uncertainty, robust optimization

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Authors: Hasan Heydari

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In recent decades, locating urban services is one of the significant discussions in urban planning. Among these considerations, cities require more accurate planning in order to supply citizen needs, especially part of urban safety. In order to gain this goal, one of the main tasks of urban planners and managers is specifying suitable sites to locate firefighting stations. This study has been done to reach this purpose. Therefore effective criteria consist of coverage radius, population density, proximity to pathway network, land use (compatible and incompatible neighborhood) have been specified. After that, descriptive and local information of the criteria was provided and their layers were created in ArcGIS 9.3. Using Analytic Hierarchy Process (AHP) these criteria and their sub-criteria got the weights. These layers were classified regarding their weights and finally were overlaid by Index Overlay Model and provided the final site selection map for firefighting stations of Arak city. The results gained by analyzing in GIS environment indicate the existing fire station don’t cover the whole city sufficiently and some of the stations have established on the unsuitable sites. The output map indicates the best sites to locate firefighting stations of Arak.

Keywords: site-selection, firefighting stations, analytic hierarchy process (AHP), GIS, index overlay model

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Authors: Ali Khwaldeh, Nimer Adwan

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In this paper, a method for constructing a controlled balanced Boolean function satisfying the criterion of a Strictly Avalanche Criteria (SAC) effect is proposed. The proposed method is based on the use of three orthogonal nonlinear components which is unlike the high-order SAC functions. So, the generator synthesized by the proposed method has separate sets of control and information inputs. The proposed method proves its simplicity and the implementation ability. The proposed method allows synthesizing a SAC function generator with fixed control and information inputs. This ensures greater efficiency of the built-in oscillator compared to high-order SAC functions that can be used as a generator. Accordingly, the method is completely formalized and implemented as a software product.

Keywords: boolean function, controlled balanced boolean function, strictly avalanche criteria, orthogonal nonlinear

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Authors: Arulselvi Subramanian, Albert Venencia, Sanjeev Bhoi

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Coagulopathy of trauma is an early endogenous coagulation abnormality that occurs shortly resulting in high mortality. In emergency trauma situations, viscoelastic tests may be better in identifying the various phenotypes of coagulopathy and demonstrate the contribution of platelet function to coagulation. We aimed to determine thrombin generation and clot strength, by estimating a ratio of Maximum amplitude and R-time (MA-R ratio) for identifying trauma coagulopathy and predicting subsequent mortality. Methods: We conducted a prospective cohort analysis of acutely injured trauma patients of the adult age groups (18- 50 years), admitted within 24hrs of injury, for one year at a Level I trauma center and followed up on 3rd day and 5th day of injury. Patients with h/o coagulation abnormalities, liver disease, renal impairment, with h/o intake of drugs were excluded. Thromboelastography was done and a ratio was calculated by dividing the MA by the R-time (MA-R). Patients were further stratified into sub groups based on the calculated MA-R quartiles. First sampling was done within 24 hours of injury; follow up on 3rd and 5thday of injury. Mortality was the primary outcome. Results: 100 acutely injured patients [average, 36.6±14.3 years; 94% male; injury severity score 12.2(9-32)] were included in the study. Median (min-max) on admission MA-R ratio was 15.01(0.4-88.4) which declined 11.7(2.2-61.8) on day three and slightly rose on day 5 13.1(0.06-68). There were no significant differences between sub groups in regard to age, or gender. In the lowest MA-R ratios subgroup; MA-R1 (<8.90; n = 27), injury severity score was significantly elevated. MA-R2 (8.91-15.0; n = 23), MA-R3 (15.01-19.30; n = 24) and MA-R4 (>19.3; n = 26) had no difference between their admission laboratory investigations, however slight decline was observed in hemoglobin, red blood cell count and platelet counts compared to the other subgroups. Also significantly prolonged R time, shortened alpha angle and MA were seen in MA-R1. Elevated incidence of mortality also significantly correlated with on admission low MA-R ratios (p 0.003). Temporal changes in the MA-R ratio did not correlated with mortality. Conclusion: The MA-R ratio provides a snapshot of early clot function, focusing specifically on thrombin burst and clot strength. In our observation, patients with the lowest MA-R time ratio (MA-R1) had significantly increased mortality compared with all other groups (45.5% MA-R1 compared with <25% in MA-R2 to MA-R3, and 9.1% in MA-R4; p < 0.003). Maximum amplitude and R-time may prove highly useful to predict at-risk patients early, when other physiologic indicators are absent.

Keywords: coagulopathy, trauma, thromboelastography, mortality

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Authors: Neda Valizadeh, Mani Mofidi, Sama Haghighi, Ali Hashemaghaee, Soudabeh Shafiee Ardestani

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Background: There are many systems and parameters to evaluate trauma patients in the emergency department. Most of these evaluations are to distinguish patients with worse conditions so that the care systems have a better prediction of condition for a better care-giving. The purpose of this study is to determine the relationship between axillary body temperature and mortality in patients hospitalized in the intensive care unit (ICU) with multiple traumas and with other clinical and para-clinical factors. Methods: All patients between 16 and 75 years old with multiple traumas who were admitted into Emergency Department then hospitalized in the ICU were included in our study. An axillary temperature in the first and the second day of admission, Glasgow cola scale (GCS), systolic blood pressure, Serum glucose levels, and white blood cell counts of all patients at the admission day were recorded and their relationship with mortality were analyzed by SPSS software with suitable statistical tests. Results: Axillary body temperatures in the first and second day were statistically lower in expired traumatic patients (p=0.001 and p<0,001 respectively). Patients with lower GCS had a significantly lower first-day temperature and a significantly higher mortality. (p=0.006 and p=0.006 respectively). Furthermore, the first-day axillary temperature was significantly lower in patients with a lower first-day systolic blood pressure (p=0.014). Conclusion: Our results showed that lower axillary body temperature in the first day is associated with higher mortality, lower GCS, and lower systolic blood pressure. Thus, this could be used as a predictor of mortality in evaluation of traumatic patients in emergency settings.

Keywords: fever, trauma, mortality, emergency

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Authors: Sonam Kelzang

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Background: Penetrating injuries as a result of traditional sports (Archery and Khuru) are commonly seen in Bhutan. To our knowledge, there is no study carried out looking into the data of penetrating injuries due to traditional sports. Aim: This is a retrospective analysis of cases of penetrating injuries as a result of traditional sports admitted to JDWNRH over the last 3 years to draw an inference on the pattern of injury and associated morbidity and mortality. Method: Data on penetrating injuries related to traditional sports (Archery and Khuru) were collected and reviewed over the period of 3 years. Assault cases were excluded. For each year we analysed age, sex, parts of the body affected, agent of injury and whether admission was required or not. Results: Out of the total 44 victims of penetrating injury by traditional sports (Archery and Khuru) between 2013 and 2015 (average of 15 cases of penetrating injuries per year). Eighty-five percent were male and 15% were female. Their age ranged from 4 yrs to 62 years. Sixty-one percent of the victims were in the working age group of 19-58 years; 30% of the victims were referred from various district hospitals; 38% of the victims needed admission; 42 % of the victims suffered injury to the head; and 54% of the injuries were caused by Khuru. Conclusion: Penetrating injuries due to traditional sports admitted to JDWNRH, Thimphu, remained same over the three years period despite safety regulations in place. Although there were no deaths during the last three years, morbidity still remains high.

Keywords: archery, Bhutan, Khuru, darts

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Authors: Eylem Koç, Hasan Arda Burhan

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Location selection presents a crucial decision problem in today’s business world where strategic decision making processes have critical importance. Thus, location selection has strategic importance for companies in boosting their strength regarding competition, increasing corporate performances and efficiency in addition to lowering production and transportation costs. A right choice in location selection has a direct impact on companies’ commercial success. In this study, a store location selection problem of Carglass Turkey which operates in vehicle glass branch is handled. As this problem includes both tangible and intangible criteria, Analytic Network Process (ANP) was accepted as the main methodology. The model consists of control hierarchy and BOCR subnetworks which include clusters of actors, alternatives and criteria. In accordance with the management’s choices, five different locations were selected. In addition to the literature review, a strict cooperation with the actor group was ensured and maintained while determining the criteria and during whole process. Obtained results were presented to the management as a report and its feasibility was confirmed accordingly.

Keywords: analytic network process (ANP), BOCR, multi-actor decision making, multi-criteria decision making, real-life problem, location selection

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Authors: Hong-Nam Choi, Hyeong-Wook Song, Sungwan Hong, Hong-Kyu Kim

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In Korea, elements that decide the quality of residential environment are not only diverse, but show deviation as well. However, people do not consider these elements and instead, they try to settle the uniformed style of residential environment, which focuses on the construction development of apartment housing and business based plans. Recently, block-unit redevelopment is becoming the standout alternative plan of standardize redevelopment projects, but constructions become inefficient because of indefinite planning criteria. In conclusion, the following research is about analyzing and categorizing the development method and legal ground of redevelopment project district, plan determinant and applicable standard. The purpose of this study is to become a basis in compatible analysis of planning standards that will happen in the future.

Keywords: shape restrictions, improvement of regulation, diversity of residential environment, classification of redevelopment project, planning criteria of redevelopment, special architectural district (SAD)

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Authors: Imene Skhakhfa, Lahbaci Ouerdachi

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To ensure the overall coherence of simulated results, it is necessary to develop a robust validation process. In many applications, it is no longer content to calibrate and validate the model only in relation to the hydro graph measured at the outlet, but we try to better simulate the functioning of the watershed in space. Therefore the timing also performs compared to other variables such as water level measurements in intermediate stations or groundwater levels. As part of this work, we limit ourselves to modeling flood of short duration for which the process of evapotranspiration is negligible. The main parameters to identify the models are related to the method of unit hydro graph (HU). Three different models were tested: SNYDER, CLARK and SCS. These models differ in their mathematical structure and parameters to be calibrated while hydrological data are the same, the initial water content and precipitation. The models are compared on the basis of their performance in terms six objective criteria, three global criteria and three criteria representing volume, peak flow, and the mean square error. The first type of criteria gives more weight to strong events whereas the second considers all events to be of equal weight. The results show that the calibrated parameter values are dependent and also highlight the problems associated with the simulation of low flow events and intermittent precipitation.

Keywords: model calibration, intensity, runoff, hydrograph

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Authors: Boussoualim Nacira, Aklouf Youcef

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Software as a Service (SaaS) is a software delivery paradigm in which the product is not installed on-premise, but it is available on Internet and Web. The customers do not pay to possess the software itself but rather to use it. This concept of pay per use is very attractive. Hence, we see increasing number of organizations adopting SaaS. However, each customer is unique, which leads to a very large variation in the requirements off the software. As several suppliers propose SaaS products, the choice of this latter becomes a major issue. When multiple criteria are involved in decision making, we talk about a problem of «Multi-Criteria Decision-Making» (MCDM). Therefore, this paper presents a method to help customers to choose a better SaaS product satisfying most of their conditions and alternatives. Also, we know that a good method of adaptive selection should be based on the correct definition of the different parameters of choice. This is why we started by extraction and analysis the various parameters involved in the process of the selection of a SaaS application.

Keywords: cloud computing, business operation, Multi-Criteria Decision-Making (MCDM), Software as a Service (SaaS)

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Authors: Ajit Kumar Sah, Rajesh Kumar Jha, Phoolgen Sah, Dev Kumar Shah

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Older individuals often suffer from multiple systemic diseases and are particularly more vulnerable to potentially inappropriate medicine prescribing. Inappropriate medication can cause serious medical problem for the elderly. The purpose of this study was to determine the prevalence of potentially inappropriate medicine (PIM) prescribing in older Nepalese patients in a medicine outpatient department. Beers’ criteria are the most widely used tools to assess PIM to elderly patients. Prospective observational analysis of drugs prescribed in medicine out-patient department (OPD) of a hospital of Bharatpur, Chitwan, Nepal during November 2011 to October 2012 to 869 older adults aged 65 years and above. The use of potentially inappropriate medications (PIM) in elderly patients was analyzed using Beers Criteria updated to 2013. In the 869 patients included the average number of drugs prescribed per prescription was 5.56. The most commonly used drugs were atenolol (24.3%), amlodipine (23.16%), paracetamol (17.6%), salbutamol (15.72%) and vitamin B complex (13.26%). The total number of medications prescribed was 4833. At least one instance of PIM was experienced by approximately 26.3% of patients when evaluated using the Beers criteria. Potentially inappropriate medications are highly prevalent among older patients attending medical OPD and are associated with a number of medications prescribed. Further research is warranted to study the impact of PIMs towards health-related outcomes in these elderly.

Keywords: Beers criteria, elderly, polypharmacy, potentially inappropriate medicines

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Authors: Neda Najafi, Mehran Allalhesabi

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At present, the natural, geographical, physical contexts of the rural textures, which play a crucial role in making the concept behind their body, are not considered in the new designs. Despite the fundamental differences in contexts, this issue has caused that, the new rural textures in our country become similar to each other and the cohesive structure of many villages in the development of rural areas are exposed to deterioration. The villages of northern Iran are not immune from this situation and nothing have remained from their physical characteristic, and the new sections of rural areas are designed heterogeneously and regardless to the concepts behind the region's architecture, which destroys the originality of the environment. The purpose of this study is to extract the concepts and criteria that differentiate the body of the village and reveal its similarity with the same structures. In this way, understanding the underlying values is extremely useful and is considered very important to approach the new model. In the first part, the subject matters of the research (context, village and rural architecture) are defined and then the characteristics of context-oriented rural architecture and criteria that can be examined from the perspective of contextualism approach are presented. In the second part, by selecting 3 samples from the houses of Baliran village, these concepts and criteria have been evaluated in the houses of the village. The results of this study show that the characteristics of contextual rural architecture have the ability to adapt to the body of the village and can be the best model to achieve contextual architecture in this area. Therefore, by using these concepts and criteria, it is possible to achieve a type of architecture that is located along with the past architecture and, with the help of the modern facilities and environmental potentials, creates a logical and correct flow in the physical development of the rural textures.

Keywords: context, village, rural architecture, concepts and criteria of physical contextualism

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Authors: Jamal A. Radaideh, Ziad N. Shatnawi

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Both indoor and outdoor air quality is investigated throughout residential areas of Al Hofuf city/ Eastern province of Saudi Arabia through a multi‐week multiple sites measurement and sampling survey. Concentration levels of five criteria air pollutants, including carbon dioxide (CO2), carbon monoxide (CO), nitrous dioxide (NO2), sulfur dioxide (SO2) and total volatile organic compounds (TVOC) were measured and analyzed during the study period from January to May 2014. For this survey paper, three different sites, roadside RS, urban UR, and rural RU were selected. Within each site type, six locations were assigned to carryout air quality measurements and to study varying indoor/outdoor air quality for each pollutant. Results indicate that a strong correlation between indoor and outdoor air exists. The I/O ratios for the considered criteria pollutants show that the strongest relationship between indoor and outdoor air is found by analyzing of carbon dioxide, CO2 (0.88), while the lowest is found by both NO2 and SO2 (0.7).

Keywords: criteria air pollutants, indoor/outdoor air pollution, indoor/outdoor ratio, Saudi Arabia

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Authors: Shreya Saxena

Abstract:

Background: Choledocholithiasis is a common complication of gallstone disease. Risk scoring systems exist to guide the need for further imaging or endoscopy in managing choledocholithiasis. We completed an audit to review the American Society for Gastrointestinal Endoscopy (ASGE) scoring system for prediction and management of choledocholithiasis against the current practice at a tertiary hospital to assess its utility in resource optimisation. We have now conducted a cost focused sub-analysis on patients categorized high-risk for choledocholithiasis according to the guidelines to determine any associated cost benefits. Method: Data collection from our prior audit was used to retrospectively identify thirteen patients considered high-risk for choledocholithiasis. Their ongoing management was mapped against the guidelines. Individual costs for the key investigations were obtained from our hospital financial data. Total cost for the different management pathways identified in clinical practice were calculated and compared against predicted costs associated with recommendations in the guidelines. We excluded the cost of laparoscopic cholecystectomy and considered a set figure for per day hospital admission related expenses. Results: Based on our previous audit data, we identified a77% positive predictive value for the ASGE risk stratification tool to determine patients at high-risk of choledocholithiasis. 47% (6/13) had an magnetic resonance cholangiopancreatography (MRCP) prior to endoscopic retrograde cholangiopancreatography (ERCP), whilst 53% (7/13) went straight for ERCP. The average length of stay in the hospital was 7 days, with an additional day and cost of £328.00 (£117 for ERCP) for patients awaiting an MRCP prior to ERCP. Per day hospital admission was valued at £838.69. When calculating total cost, we assumed all patients had admission bloods and ultrasound done as the gold standard. In doing an MRCP prior to ERCP, there was a 130% increase in cost incurred (£580.04 vs £252.04) per patient. When also considering hospital admission and the average length of stay, it was an additional £1166.69 per patient. We then calculated the exact costs incurred by the department, over a three-month period, for all patients, for key investigations or procedures done in the management of choledocholithiasis. This was compared to an estimate cost derived from the recommended pathways in the ASGE guidelines. Overall, 81% (£2048.45) saving was associated with following the guidelines compared to clinical practice. Conclusion: MRCP is the most expensive test associated with the diagnosis and management of choledocholithiasis. The ASGE guidelines recommend endoscopy without an MRCP in patients stratified as high-risk for choledocholithiasis. Our audit that focused on assessing the utility of the ASGE risk scoring system showed it to be relatively reliable for identifying high-risk patients. Our cost analysis has shown significant cost savings per patient and when considering the average length of stay associated with direct endoscopy rather than an additional MRCP. Part of this is also because of an increased average length of stay associated with waiting for an MRCP. The above data supports the ASGE guidelines for the management of high-risk for choledocholithiasis patients from a cost perspective. The only caveat is our small data set that may impact the validity of our average length of hospital stay figures and hence total cost calculations.

Keywords: cost-analysis, choledocholithiasis, risk stratification tool, general surgery

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Authors: Andrés C. Cuervo Pinilla, Christian G. Quintero M., Chinthaka Premachandra

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This paper considers people’s driving skills diagnosis under real driving conditions. In that sense, this research presents an approach that uses GPS signals which have a direct correlation with driving maneuvers. Besides, it is presented a novel expert-driving-criteria approximation using fuzzy logic which seeks to analyze GPS signals in order to issue an intelligent driving diagnosis. Based on above, this works presents in the first section the intelligent driving diagnosis system approach in terms of its own characteristics properties, explaining in detail significant considerations about how an expert-driving-criteria approximation must be developed. In the next section, the implementation of our developed system based on the proposed fuzzy logic approach is explained. Here, a proposed set of rules which corresponds to a quantitative abstraction of some traffics laws and driving secure techniques seeking to approach an expert-driving- criteria approximation is presented. Experimental testing has been performed in real driving conditions. The testing results show that the intelligent driving diagnosis system qualifies driver’s performance quantitatively with a high degree of reliability.

Keywords: driver support systems, intelligent transportation systems, fuzzy logic, real time data processing

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Authors: Rita SahaRay, Ganesh Dutta

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In this article, experimental situations are considered where a main effects plan is to be used to study m two-level factors using n runs which are partitioned into b blocks, not necessarily of same size. Assuming the block sizes to be even for all blocks, for the case n ≡ 2 (mod 4), optimal designs are obtained with respect to type 1 and type 2 optimality criteria in the class of designs providing estimation of all main effects orthogonal to the block effects. In practice, such orthogonal estimation of main effects is often a desirable condition. In the wider class of all available m two level even sized blocked main effects plans, where the factors do not occur at high and low levels equally often in each block, E-optimal designs are also characterized. Simple construction methods based on Hadamard matrices and Kronecker product for these optimal designs are presented.

Keywords: design matrix, Hadamard matrix, Kronecker product, type 1 criteria, type 2 criteria

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Authors: Antanas Žiliukas, Mindaugas Kukis

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The work deals with cellular pressure vessels subjected to internal pressure. Their cellular insert can be used for placing liquids or gases, which is necessary to carry out technological processes, and the vessel itself has a good bearing capacity. Numerical calculations of the three core structures, which measure the influence of the inner cylinder thickness on maximum bearing capacity are presented. The calculations are compared using strength criteria and they show the different strength safety level.

Keywords: pressure, strength criterion, sandwich plate, cellular vessel

Procedia PDF Downloads 282