Search results for: audit opinion

Authors: Shreya Saxena

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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: Ramya P, Lino Abraham Varghese, S. Bose

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By cloud storage services, the data can be stored in the cloud, and can be shared across multiple users. Due to the unexpected hardware/software failures and human errors, which make the data stored in the cloud be lost or corrupted easily it affected the integrity of data in cloud. Some mechanisms have been designed to allow both data owners and public verifiers to efficiently audit cloud data integrity without retrieving the entire data from the cloud server. But public auditing on the integrity of shared data with the existing mechanisms will unavoidably reveal confidential information such as identity of the person, to public verifiers. Here a privacy-preserving mechanism is proposed to support public auditing on shared data stored in the cloud. It uses group signatures to compute verification metadata needed to audit the correctness of shared data. The identity of the signer on each block in shared data is kept confidential from public verifiers, who are easily verifying shared data integrity without retrieving the entire file. But on demand, the signer of the each block is reveal to the owner alone. Group private key is generated once by the owner in the static group, where as in the dynamic group, the group private key is change when the users revoke from the group. When the users leave from the group the already signed blocks are resigned by cloud service provider instead of owner is efficiently handled by efficient proxy re-signature scheme.

Keywords: data integrity, dynamic group, group signature, public auditing

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Authors: Adrian Craig, Jonathan Easaw, Rose Jordan, Ben Hall

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The prescription of intravenous fluids is a fundamental component of inpatient management, but it is one which usually lacks thought. Fluids are a drug, which like any other can cause harm when prescribed inappropriately or wrongly. However, it is well recognised that it is poorly done, especially in the acute portals. The National Institute for Health and Care Excellence (NICE) recommends 1mmol/kg of potassium, sodium, and chloride per day. With various options of fluids, clinicians tend to face difficulty in choosing the most appropriate maintenance fluid, and there is a reluctance to prescribe potassium as part of an intravenous maintenance fluid regime. The aim was to prospectively audit the prescription of the first bag of intravenous maintenance fluids, the use of urea and electrolytes results to guide the choice of fluid and the use of fluid prescription charts, in a busy emergency department of a major trauma centre in Stoke-on-Trent, United Kingdom. This was undertaken over a week in early November 2016. Of those prescribed maintenance fluid only 8.9% were prescribed a fluid which was most appropriate for their daily electrolyte requirements. This audit has helped to highlight further the issues that are faced in busy Emergency Departments within hospitals that are stretched and lack capacity for prompt transfer to a ward. It has supported the findings of NICE, that emergency admission portals such as Emergency Departments poorly prescribed intravenous fluid therapy. The findings have enabled simple steps to be taken to educate clinicians about their fluid of choice. This has included: posters to remind clinicians to consider the urea and electrolyte values before prescription, suggesting the inclusion of a suggested intravenous fluid of choice in the prescription chart of the trust and the inclusion of a session within the introduction programme revising intravenous fluid therapy and daily electrolyte requirements. Moving forward, once the interventions have been implemented then, the data will be reaudited in six months to note any improvement in maintenance fluid choice. Alongside this, an audit of the rate of intravenous maintenance fluid therapy would be proposed to further increase patient safety by avoiding unintentional fluid overload which may cause unnecessary harm to patients within the hospital. In conclusion, prescription of maintenance fluid therapy was poor within the Emergency Department, and there is a great deal of opportunity for improvement. Therefore, the measures listed above will be implemented and the data reaudited.

Keywords: chloride, electrolyte, emergency department, emergency medicine, fluid, fluid therapy, intravenous, maintenance, major trauma, potassium, sodium, trauma

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Authors: Muhammad Rehan Usman, Muhammad Arslan Usman, Soo Young Shin

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The new era of digital communication has brought up many challenges that network operators need to overcome. The high demand of mobile data rates require improved networks, which is a challenge for the operators in terms of maintaining the quality of experience (QoE) for their consumers. In live video transmission, there is a sheer need for live surveillance of the videos in order to maintain the quality of the network. For this purpose objective algorithms are employed to monitor the quality of the videos that are transmitted over a network. In order to test these objective algorithms, subjective quality assessment of the streamed videos is required, as the human eye is the best source of perceptual assessment. In this paper we have conducted subjective evaluation of videos with varying spatial and temporal impairments. These videos were impaired with frame freezing distortions so that the impact of frame freezing on the quality of experience could be studied. We present subjective Mean Opinion Score (MOS) for these videos that can be used for fine tuning the objective algorithms for video quality assessment.

Keywords: frame freezing, mean opinion score, objective assessment, subjective evaluation

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Authors: Nureni O. Adeboye, Dawud A. Agunbiade

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This research attempts to investigate the effects of heteroscedasticity and periodicity in a Panel Data Regression Model (PDRM) by extending previous works on balanced panel data estimation within the context of fitting PDRM for Banks audit fee. The estimation of such model was achieved through the derivation of Joint Lagrange Multiplier (LM) test for homoscedasticity and zero-serial correlation, a conditional LM test for zero serial correlation given heteroscedasticity of varying degrees as well as conditional LM test for homoscedasticity given first order positive serial correlation via a two-way error component model. Monte Carlo simulations were carried out for 81 different variations, of which its design assumed a uniform distribution under a linear heteroscedasticity function. Each of the variation was iterated 1000 times and the assessment of the three estimators considered are based on Variance, Absolute bias (ABIAS), Mean square error (MSE) and the Root Mean Square (RMSE) of parameters estimates. Eighteen different models at different specified conditions were fitted, and the best-fitted model is that of within estimator when heteroscedasticity is severe at either zero or positive serial correlation value. LM test results showed that the tests have good size and power as all the three tests are significant at 5% for the specified linear form of heteroscedasticity function which established the facts that Banks operations are severely heteroscedastic in nature with little or no periodicity effects.

Keywords: audit fee lagrange multiplier test, heteroscedasticity, lagrange multiplier test, Monte-Carlo scheme, periodicity

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Authors: Waqas Ahmad, Eisha Tahir, Shahper Aqeel, Imran Khalid Niazi, Amjad Iqbal

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Background: Breast conservation surgery applies a number of techniques for accurate localization of lesions. Wire localization remains the method of choice in non-palpable breast cancers post-neoadjuvant chemotherapy. Objective: The aim of our study was to determine the accuracy of wire localization procedures in our department and compare it with internationally set protocols as per the Royal College of Radiologists. Post wire mammography, as well as the margin status of the postoperative specimen, assessed the accuracy of the procedure. Methods: We retrospectively reviewed the data of 225 patients who presented to our department from May 2014 to June 2015 post neoadjuvant chemotherapy with non-palpable cancers. These patients are candidates for wire localized lumpectomies either under ultrasound or stereotactic guidance. Metallic marker was placed in all the patients at the time of biopsy. Post wire mammogram was performed in all the patients and the distance of the wire tip from the marker was calculated. The presence or absence of the metallic clip in the postoperative specimen, as well as the marginal status of the postoperative specimen, was noted. Results: 157 sonographic and 68 stereotactic wire localization procedures were performed. 95% of the wire tips were within 1 cm of the metallic marker. Marginal status was negative in 94% of the patients in histopathological specimen. Conclusion: Our audit report declares more than 95% accuracy of image guided wire localization in successful excision of non-palpable breast lesions.

Keywords: breast, cancer, non-palpable, wire localization

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Authors: Syed Basit Ali Shah Bukhari, Yan Qiang, Saad Abdul Rauf, Syed Saqlaina Bukhari

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Text Classification is the methodology to classify any given text into the respective category from a given set of categories. It is highly important and vital to use proper set of pre-processing , feature selection and classification techniques to achieve this purpose. In this paper we have used different ensemble techniques along with variance in feature selection parameters to see the change in overall accuracy of the result and also on some other individual class based features which include precision value of each individual category of the text. After subjecting our data through pre-processing and feature selection techniques , different individual classifiers were tested first and after that classifiers were combined to form ensembles to increase their accuracy. Later we also studied the impact of decreasing the classification categories on over all accuracy of data. Text classification is highly used in sentiment analysis on social media sites such as twitter for realizing people’s opinions about any cause or it is also used to analyze customer’s reviews about certain products or services. Opinion mining is a vital task in data mining and text categorization is a back-bone to opinion mining.

Keywords: Natural Language Processing, Ensemble Classifier, Bagging Classifier, AdaBoost

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Authors: Leila Mohammadi

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This article discusses the technology of social egg freezing in the context of existing literature on medicalization, motherhood, and marketing. The social egg freezing technique offers to preserve some healthy eggs for age-related fertility decline in the future. The study draws on a qualitative analysis and participants observation of media publications, including text, images, or audio-visual about social egg freezing technology and postpone maternity, to identify and compare their communication strategies from a framing theory perspective. Using 442 surveys and 158 pieces of publications in Spanish media, this study demonstrated that the narratives used by these publications and their structures follow a marketing objective to medicalize motherhood. Within these frames, the market of preserving fertility is cast to show compassion and concern about women. In the opinion of participants, egg freezing technology liberates, empowers, and automates women from patriarchal control, and also gives them the responsibility of taking care of their body and reproductive system. This study showed this opinion is significantly influenced by media and their communication strategies supported by providers of this business.

Keywords: motherhood, social egg freezing, medicalization, marketing, media frames, fertility, assisted reproductive system

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Authors: Rosni Lakandri

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With the development of science and technology, there has been a complete transformation in the domain of information technology. Particularly after the Second World War and Cold War period, the role of media and communication technology in shaping the political, economic, socio-cultural proceedings across the world has been tremendous. It performs as a channel between the governing bodies of the state and the general masses. As we have seen the international community constantly talking about the onset of Asian Century, India and China happens to be the major player in this. Both have the civilization history, both are neighboring countries, both are witnessing a huge economic growth and, important of all, both are considered the rising powers of Asia. Not negating the fact that both countries have gone to war with each other in 1962 and the common people and even the policy makers of both the sides view each other till now from this prism. A huge contribution to this perception of people goes to the media coverage of both sides, even if there are spaces of cooperation which they share, the negative impacts of media has tended to influence the people’s opinion and government’s perception about each other. Therefore, analysis of media’s impression in both the countries becomes important in order to know their effect on the larger implications of foreign policy towards each other. It is usually said that media not only acts as the information provider but also acts as ombudsman to the government. They provide a kind of check and balance to the governments in taking proper decisions for the people of the country but in attempting to answer this hypothesis we have to analyze does the media really helps in shaping the political landscape of any country? Therefore, this study rests on the following questions; 1.How do China and India depict each other through their respective News media? 2.How much and what influences they make on the policy making process of each country? How do they shape the public opinion in both the countries? In order to address these enquiries, the study employs both primary and secondary sources available, and in generating data and other statistical information, primary sources like reports, government documents, and cartography, agreements between the governments have been used. Secondary sources like books, articles and other writings collected from various sources and opinion from visual media sources like news clippings, videos in this topic are also included as a source of on ground information as this study is not based on field study. As the findings suggest in case of China and India, media has certainly affected people’s knowledge about the political and diplomatic issues at the same time has affected the foreign policy making of both the countries. They have considerable impact on the foreign policy formulation and we can say there is some mediatization happening in foreign policy issues in both the countries.

Keywords: China, foreign policy, India, media, public opinion

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Authors: B. Kenny, M. Dixon, A. Boshell

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The use of alcoholic surgical prep was recently introduced into the Royal Newcastle Center for elective procedures. In the past 3 months there have been a significant number of burns believed to be related to ‘pooling’ of this surgical prep in patients undergoing procedures where they are placed in the lateral position with hip bolsters. The aim of the audit was to determine the reason for the burns, analyze what pre-existing factors may contribute to the development of the burns and what can be changed to prevent further burns occurring. All patients undergoing a procedure performed on the hip who were placed in the lateral position with sacral and anterior, superior iliac spine (ASIS) support with ‘bolsters’ were included in the audit. Patients who developed a ‘burn’ were recorded, details of the surgery, demographics, surgical prep used and length of surgery were obtained as well as photographs taken to document the burn. Measures were then taken to prevent further burns and the efficacy was documented. Overall 14 patients developed burns over the ipsilateral ASIS. Of these, 13 were Total Hip Arthroplasty (THA) and 1 was a removal of femoral nail. All patients had Chlorhexidine 0.5% in Alcohol 70% Tinted Red surgical preparation or Betadine Alcoholic Skin Prep (70% etoh). Patients were set up in the standard lateral decubitus position with sacral and bilateral ASIS bolsters with a valband covering. 86% of patients were found to have pre-existing hypersensitivities to various substances. There is very little literature besides a few case reports on surgical prep-related burns. The case reports that do exist are related to the use of tourniquet-related burns and there is no mention in the literature examining ‘bolster’ related burns. The burns are hypothesized to be caused by pooling of the alcoholic solution which is amplified by the use of Valband.

Keywords: arthroplasty, chemical burns, wounds, rehabilitation

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Authors: Adeyinka Adesanya, Isaac Bamgboye

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There is a growing need to develop the processes to produce renewable fuels and chemicals due to the economic, political, and environmental concerns associated with fossil fuels. Lignocellulosic biomass is an excellent renewable feedstock because it is both abundant and inexpensive. This project aims at producing bioethanol from lignocellulosic plants (Sorghum Arundinacieum and Heteropogon Contortus) by biochemical means, computing the energy audit of the process and determining the fuel properties of the produced ethanol. Acid pretreatment (0.5% H2SO4 solution) and enzymatic hydrolysis (using malted barley as enzyme source) were employed. The ethanol yield of wild sorghum was found to be 20% while that of spear grass was 15%. The fuel properties of the bioethanol from wild sorghum are 1.227 centipoise for viscosity, 1.10 g/cm3 for density, 0.90 for specific gravity, 78 °C for boiling point and the cloud point was found to be below -30 °C. That of spear grass was 1.206 centipoise for viscosity, 0.93 g/cm3 for density 1.08 specific gravity, 78 °C for boiling point and the cloud point was also found to be below -30 °C. The energy audit shows that about 64 % of the total energy was used up during pretreatment, while product recovery which was done manually demanded about 31 % of the total energy. Enzymatic hydrolysis, fermentation, and distillation total energy input were 1.95 %, 1.49 % and 1.04 % respectively, the alcoholometric strength of bioethanol from wild sorghum was found to be 47 % and the alcoholometric strength of bioethanol from spear grass was 72 %. Also, the energy efficiency of the bioethanol production for both grasses was 3.85 %.

Keywords: lignocellulosic biomass, wild sorghum, spear grass, biochemical conversion

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Authors: Raja Ezman Raja Shariff

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Acute kidney injury (AKI) is commonly seen in inpatients, and places a great cost on the NHS and patients. Timely and appropriate management is both nephron sparing and potentially life-saving. Ultrasound scanning (USS) is a well-recognised method for stratifying patients. Subsequently, the NICE AKI guidance has defined groups in whom scanning is recommended within 6 hours of request (pyonephrosis), within 24 hours (obstruction/cause unknown), and in whom routine scanning isn't recommended (cause for AKI identified). The audit looks into whether Stockport NHS Trust USS practice was in line with such recommendations. The audit evaluated 92 patients with AKI who had USS, between 01/01/14 to 30/04/14. Data collection was divided into 2 parts. Firstly, radiology request cards and the online imaging software (PACS) were evaluated. Then, the electronic case notes (ADVANTIS) was evaluated further. Based on request cards, 10% of requests were for pyonephrosis. Only 33% were scanned within 6hours and a further 33% within 24hours. 75% were requested for possible obstructions and unknown cause collectively. Of those due to possible obstruction, 71% of patients were scanned within 24 hours. Of those with unknown cause, 50% were scanned within 24 hours. 15% of requests had a cause declared and so potentially did not require scanning. Evaluation of the patients’ notes suggested further interesting findings. Firstly, potentially 39% of patients had a known cause for AKI, therefore, did not need USS. Subsequently, the cohort of unknown cause and possible obstruction was collectively reduced to 45%. Alarmingly the patient cohort with possible pyonephrosis went up to 16%, suggesting an under-recognition of this life-threatening condition. We plan to highlight these findings within our institution and make changes to encourage more appropriate requesting and timely scanning. Time will tell if we manage to save or increase our costs in this cost-conscious NHS. Patient benefits, though, seem to be guaranteed.

Keywords: AKI, ARF, kidney, renal

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Authors: Emma Carr, Bilal Aslam-Pervez, David Laraway

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Litigation against surgeons and hospitals continues to increase in Western countries. While verbal consent is all that is required legally, it has for a long time been considered that written consent offers proof of discussion and interaction between the surgeon and the patient. Inadequate consenting of patients continues in the United Kingdom leaving surgeons and Health Trusts open to litigation. We present a standardised consent form which improves patient autonomy and engagement. The General Medical Council recommends that all material risks relevant to the patient are discussed and recorded prior to undergoing surgery, regardless of how likely they are to occur. Current literature was reviewed to evaluate complications associated with surgical management of mandible fractures. Analysis of risks on 52 consent forms were analysed within the Glasgow OMFS department, leading to a procedure-specific form being designed and implemented. This audit showed that the documentation of risks on consent forms was extremely variable- with uncommon risks not being recorded. Interestingly, not a single consent form was found which highlighted all the risks associated with mandible fractures. Our re-audit data confirms 100% of risks being discussed when a procedure specific form is utilised. Our hope, is to introduce further forms for inclusion on the BAOMS website and peripheral distribution. The forms are quick and easy to print and leave more time for consultation with the patient. Whilst we are under no illusion that the forms may not decrease the incidence of intended litigation, we feel confident that they will decrease the chances of it being successful.

Keywords: consent, litigation, mandible fracture, surgery

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Authors: Lee Artz

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Based on content analyses of major US media, immediately following the George Floyd killing in May 2020, some mayors and local, state, and national officials offered favorable representations of protests against police violence. As the protest movement grew to historic proportions with 26 million joining actions in large cities and small towns, dominant representations of racism by elected officials and leading media shifted—replacing both the voices and demands of protestors with representations by elected officials. Major media quoted Black mayors and Congressional representatives who emphasized concerns about looting and the disruption of public safety. Media coverage privileged elected officials who criticized movement demands for defunding police and deplored isolated instances of property damaged by protestors. Subsequently, public opinion polls saw an increase in concern for law and order tropes and a decrease in support for protests against police violence. Black Lives Matter and local organizations had no coordinated response and no effective means of communication to counter dominant representations voiced by politicians and globally disseminated by major media. Politician and media-instigated public opinion shifts indicate that social movements need their own means of communication and collective decision-making--both of which were largely missing from Black Lives Matter leaders, leading to disaffection and a political split by more than 20 local affiliates. By itself, social media by myriad individuals and groups had limited purchase as a means for social movement communication and organization. Lacking a collaborative, coordinated strategy, organization, and independent media, the loose network of Black Lives Matter groups was unable to offer more accurate, democratic, and favorable representations of protests and their demands for more justice and equality. The fight for equality was diverted by the fight for representation.

Keywords: black lives matter, public opinion, racism, representations, social movements

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Authors: jihen ayadi sellami

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The rapid evolution of the global financial landscape has led to increased attention to corporate tax policies and the need to understand the factors that influence their tax behavior. In order to mitigate any residual loss for shareholders resulting from tax aggressiveness and resolve the agency problem, appropriate systems that separate the function of management from that of controlling are needed. In this context of growing concerns to limit aggressive corporate taxation practices through governance, this study discusses. Its aims is to examine the influence of six key characteristics of the board of directors (board size, diligence, CEO duality, presence of audit committees, gender diversity and independence of directors), given a governance mechanism, on the tax decisions of non-financial corporations in the United State. In fact, using a sample of 90 non-financial US firms from S&P 500 over a period of 4 years going from 2014 to 2017, the results based on a multivariate linear regression highlight significant associations between these characteristics and corporate tax policy. Notably, larger board, gender diversity, diligence and increased director independence appear to play an important role in reducing aggressive taxation. While duality has a positive and significant correlation with tax aggressiveness, that can be explained by the fact that the manager did properly exploit his specific position within the company. These findings contribute to a deeper understanding of how board characteristics can influence corporate tax management, providing avenues for more effective corporate governance and more responsible tax decision-making

Keywords: tax aggressiveness, board of directors, board size, CEO duality, audit committees, gender diversity, director independence, diligence, corporate governance, united states

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Authors: Nani Manvelishvili

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Soviet propaganda tried to shape common public opinion through Soviet Press. The activation of propaganda gained special importance to increase the fighting ability of the military and people behind the front During the Great Patriotic war (1941-1945). The state propaganda used unnecessary intervention in Press and created characters who were supposed to be role models for society. The new female role models were identified, which were supported by the authorities. The representation of the mother, warrior woman, working woman, victim, feminine woman, etc., in the works aimed to raise the fighting ability of the Soviet citizen and incite patriotism. This paper analyzes the soviet Press (The newspaper “Komunisti”) that was written and published during the Great Patriotic war in Soviet Georgia. The study aims to find propagandistic content in Press that used Soviet ideology during the Great Patriotic war. We analyzed the Soviet Newspaper "Komunisti," published during wartime. Soviet Press had the most significant impact on the formation of public opinion. The Soviet government actively used this resource to increase combat capability. While at the beginning of the war, women were supposed to replace men, propaganda by the end of the war moved to reassert conservative gender politics. Women returned to their traditional roles.

Keywords: Great Patriotic War, Soviet Georgia, women in war, women's history, Soviet press

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Authors: Asma Ameur, Dhafer Malouche

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Nowadays, user comments on the Internet have an important impact on hotel bookings. This confirms that the e-reputation issue can influence the likelihood of customer loyalty to a hotel. In this way, e-reputation has become a real differentiator between hotels. For this reason, we have a unique opportunity in the opinion mining field to analyze the comments. In fact, this field provides the possibility of extracting information related to the polarity of user reviews. This sentimental study (Opinion Mining) represents a new line of research for analyzing the unstructured textual data. Knowing the score of e-reputation helps the hotelier to better manage his marketing strategy. The score we then obtain is translated into the image of hotels to differentiate between them. Therefore, this present research highlights the importance of hotel satisfaction ‘scoring. To calculate the satisfaction score, the sentimental analysis can be manipulated by several techniques of machine learning. In fact, this study treats the extracted textual data by using the Artificial Neural Networks Approach (ANNs). In this context, we adopt the aforementioned technique to extract information from the comments available in the ‘Trip Advisor’ website. This actual paper details the description and the modeling of the ANNs approach for the scoring of online hotel reviews. In summary, the validation of this used method provides a significant model for hotel sentiment analysis. So, it provides the possibility to determine precisely the polarity of the hotel users reviews. The empirical results show that the ANNs are an accurate approach for sentiment analysis. The obtained results show also that this proposed approach serves to the dimensionality reduction for textual data’ clustering. Thus, this study provides researchers with a useful exploration of this technique. Finally, we outline guidelines for future research in the hotel e-reputation field as comparing the ANNs with other technique.

Keywords: clustering, consumer behavior, data mining, e-reputation, machine learning, neural network, online hotel ‘reviews, opinion mining, scoring

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Authors: Aarati Susan Mathew, Radhika Narendra Patel, Jiji Mathew

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A retrospective study conducted at Christian Medical College (CMC) Teaching Hospital, Vellore, India on 14th August 2014 to assess the accuracy of clinically estimated foetal weight upon labour admission. Estimating foetal weight is a crucial factor in assessing maternal and foetal complications during and after labour. Medical notes of ninety-eight postnatal women who fulfilled the inclusion criteria were studied to evaluate the correlation between their recorded Estimated Foetal Weight (EFW) on admission and actual birth weight (ABW) of the newborn after delivery. Data concerning maternal and foetal demographics was also noted. Accuracy was determined by absolute percentage error and proportion of estimates within 10% of ABW. Actual birth weights ranged from 950-4080g. A strong positive correlation between EFW and ABW (r=0.904) was noted. Term deliveries (≥40 weeks) in the normal weight range (2500-4000g) had a 59.5% estimation accuracy (n=74) compared to pre-term (<40 weeks) with an estimation accuracy of 0% (n=2). Out of the term deliveries, macrosomic babies (>4000g) were underestimated by 25% (n=3) and low birthweight (LBW) babies were overestimated by 12.7% (n=9). Registrars who estimated foetal weight were accurate in babies within normal weight ranges. However, there needs to be an improvement in predicting weight of macrosomic and LBW foetuses. We have suggested the use of an amended version of the Johnson’s formula for the Indian population for improvement and a need to re-audit once implemented.

Keywords: clinical palpation, estimated foetal weight, pregnancy, India, Johnson’s formula

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Authors: Arista Mayang Sari Slamet

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This study was conducted to see the shape or behavior that shows the attitude of confidence in the practice of debate on science program students in Senior High School. This research is a descriptive qualitative study by explaining the forms of behavior of each indicator (there are ten indicators) confidence of Santrock. Data collection using interviews with Indonesian language teachers, direct observation, and documents. In this study, it was found that there is one item that is not visible indicator of the high school students of class X, which is the fourth item ‘Sitting with others in social activities’. This is caused by the forum examined are debating forum, so there is a social activity can’t be seen. The result of this study there are two students who do not show the behavior of confidence, their name is Dea and Audria (from the pro team). This indicates that the head of a pro team dominated the debate. The time for the debate is 45 minutes. Therefore all students in both of team can’t demonstrate their debate skill. In each team is only dominated by one student. The most common forms of confidence behavior are expressing opinion, look at the other person (speaker), and keeping eye contact with the other person. This indicates that the attitude of confidence by looking at the other person makes them more confident about their opinion. The most uncommon indicators is to direct or instruct to the other person. This shows that the attitude of self-confidence shown by the students isn’t lead.

Keywords: confidence, debate, senior high school, Jakarta

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Authors: Rizwan Iqbal

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Introduction: Re-TURBT has been recommended by international guidelines for patients with non-muscle invasive bladder cancer (NMIBC) who are deemed high-risk. Indications for re-TURBTs remain controversial and studies show mixed outcomes. It should be performed when the initial TURBT specimen lacks detrusor muscle, has tumor stage pT1 or G3/high-grade, or where resection is deemed incomplete. This ensures complete resection of tumors that have a high risk of recurrence as well as accurately identifying any tumors which have been upstaged. The aim of this audit was to evaluate the quality of re-TURBTs in a district general hospital. Method: Data were retrospectively collected from 31 patients who had re-TURBTs between April 2021 and September 2022. Data included baseline demographics, time from initial to re-TURBT, quality of operation note, presence of residual tumor, complications, and administration of chemotherapy within 24 hours of the initial TURBT. Data collection remains ongoing at the time of writing. Results: The mean age was 76 years old and 71.0% of patients were male. 32.3% of patients had their re-TURBT within six weeks and 32.3% had intravesical chemotherapy administered within 24 hours of the initial TURBT. 74.2% of initial TURBTs had detrusor muscle present in the specimen. 48.4% of patients had residual disease following re-TURBT. Just one patient had their pathology upstaged at re-TURBT. The use of the TURBT proforma on the operation note was variable, with 51.6% and 38.7% of surgeons using the proforma after the initial and re-TURBT. Conclusion: Re-TURBT improves bladder cancer staging and is necessary in patients who are deemed high-risk in order to identify any upstaging or recurrence of the disease.

Keywords: urology, bladder cancer, turbt, cancer

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Authors: Ashfaq M. Naikwadi

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Decided cases of medical negligence, mostly are not settled in the lower courts. Majority of them reach up to the apex courts. This is mostly due to different interpretations of the term medical negligence. After studying various cases of medical negligence it is found that in most of the cases the doctors/hospitals are not held liable. There are different interpretations of law concerning medical services. Globally the principles deciding medical negligence are same, viz. Legal duty of care - breach of that duty - direct causation resulting in damages. Since ordinary negligence is not punishable by law, doctors/hospitals have defenses to save themselves from liability. Complaints of negligence come to the courts whose judges mostly are not oriented with medical services or health sciences. Matters of medical negligence are decided on the basic principles of reasonableness and prudence or by relying on the expert’s opinion. Deciding reasonableness or prudence is a complex issue in case of medical services. Again expert opinion is also questionable as an expert in case of medical negligence is appointed from the same field and same faculty. There is a chance of favoritism to the doctor/hospital. The concept of vicarious liability is not widely applied to in many of the medical negligence cases. Established cases used as precedents were studied to understand the basic principles in deciding medical negligence. This paper evaluates the present criteria in interpreting medical negligence and concludes with suggesting reforms required to be made in deciding matters of medical negligence under the consumer laws.

Keywords: consumer, doctors, laws, medical negligence

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Authors: Prashant Neupane, Asmi Pandey, Mumna Ehsan, Katie Davies, Richard Lowsby

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Introduction/Background & aims: Safe and effective prescribing in hospitals, directly and indirectly, impacts the health of the patients. Even though digital prescribing in the National Health Service (NHS), UK has been used in lots of tertiary centers along with district general hospitals, a significant number of NHS trusts are still using paper prescribing. We came across lots of irregularities in our daily clinical practice when we are doing paper prescribing. The main aim of the study was to assess how safely and effectively are we prescribing at our hospital where there is no access to digital prescribing. Method/Summary of work: We conducted a prospective audit in the critical care department at Mid Cheshire Hopsitals NHS Foundation Trust in which 20 prescription charts from different patients were randomly selected over a period of 1 month. We assessed 16 multiple categories from each prescription chart and compared them to the standard trust guidelines on prescription. Results/Discussion: We collected data from 20 different prescription charts. 16 categories were evaluated within each prescription chart. The results showed there was an urgent need for improvement in 8 different sections. In 85% of the prescription chart, all the prescribers who prescribed the medications were not identified. Name, GMC number and signature were absent in the required prescriber identification section of the prescription chart. In 70% of prescription charts, either indication or review date of the antimicrobials was absent. Units of medication were not documented correctly in 65% and the allergic status of the patient was absent in 30% of the charts. The start date of medications was missing and alternations of the medications were not done properly in 35%of charts. The patient's name was not recorded in all desired sections of the chart in 50% of cases and cancellations of the medication were not done properly in 45% of the prescription charts. Conclusion(s): From the audit and data analysis, we assessed the areas in which we needed improvement in prescription writing in the Critical care department. However, during the meetings and conversations with the experts from the pharmacy department, we realized this audit is just a representation of the specialized department of the hospital where access to prescribing is limited to a certain number of prescribers. But if we consider bigger departments of the hospital where patient turnover is much more, the results could be much worse. The findings were discussed in the Critical care MDT meeting where suggestions regarding digital/electronic prescribing were discussed. A poster and presentation regarding safe and effective prescribing were done, awareness poster was prepared and attached alongside every bedside in critical care where it is visible to prescribers. We consider this as a temporary measure to improve the quality of prescribing, however, we strongly believe digital prescribing will help to a greater extent to control weak areas which are seen in paper prescribing.

Keywords: safe prescribing, NHS, digital prescribing, prescription chart

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Authors: Ernest Nweke

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The work of Professional Accountants and Corporate governance are synonymous and cannot be divorced from each other. Organizations, profit and non-profit alike cannot implement sound corporate practices without inputs from Professional Accountants. In today’s dynamic corporate world, good corporate governance practice is a sine qua non. More so, following the corporate failures of the past decades like Enron and WorldCom, governments around the world, including Mongolia are becoming more proactive in ensuring sound corporate governance mechanisms. In the past fifteen years, the Mongolian government has taken several measures to establish and strengthen internal corporate governance structures in firms. This paper highlights the role of professional accountants and auditors play in ensuring that good corporate governance mechanisms are entrenched in listed companies in Mongolia. Both primary and secondary data are utilized in this research. In collection of primary data, Delphi method was used, securing responses from only knowledgeable senior employees, top managers, and some CEOs. Using this method, a total of 107 top-level company employees and executives randomly selected from 22 companies were surveyed; maximum of 5 and minimum of 4 from each company. These companies cut across several sectors. It was concluded that Professional Accountants play key roles in setting and maintaining firm governance. They do this by ensuring full compliance with all the requirements of good and sound corporate governance, establishing reporting, monitoring and evaluating standards, assisting in the setting up of proper controls, efficient and effective audit systems, sound fraud risk management and putting in place an overall vision for the enterprise. Companies with effective corporate governance mechanisms are usually strong and fraud-resilient. It was also discovered that companies with big 4 audit firms tend to have better governance structures in Mongolia.

Keywords: accountants, corporate disclosure, corporate failure, corporate governance

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Authors: Petchpong Mayukhachot

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The purposes of this research were (1) to develop a distance training package on topic of Production of Handbook and Report writing for innovative learning and teaching for Vocational Teachers of Office of The Vocational Education Commission; (2) to study the effects of using the distance training package on topic Production of Handbook and Report writing for innovative learning and teaching for Vocational Teachers of Office of The Vocational Education Commission. and (3) to study the samples’ opinion on the distance training package on topic Production of Handbook and Report writing for innovative learning and teaching for Vocational Teachers of Office of The Vocational Education Commission Research and Development was used in this research. The purposive sampling group of this research was 39 Vocational Teachers of Office of The Vocational Education Commission. Instruments were; (1) the distance training package, (2) achievement tests on understanding of Production of Handbook and Report writing for innovative learning and teaching and learning activities to develop practical skills, and (3) a questionnaire for sample’s opinion on the distance training package. Percent, Mean, Standard Deviation, the E1/E2 efficiency index and t-test were used for data analysis. The findings of the research were as follows: (1) The efficiency of the distance training package was established as 80.90 / 81.90. The distance training package composed of the distance training package document and a manual for the distance training package. The distance training package document consisted of the name of the distance training package, direction for studying the distance training package, content’s structure, concepts, objectives, and activities after studying the distance training package. The manual for the distance training package consisted of the explanation of the distance training package and objectives, direction for using the distance training package, training schedule, documents as a manual of speech, and evaluations. (2) The effects of using the distance training package on topic Production of Handbook and Report writing for innovative learning and teaching for Vocational Teachers of Office of The Vocational Education Commission were the posttest average scores of achievement on understanding of Technology and Occupations teaching for development of critical thinking of the sample group were higher than the pretest average scores. (3) The most appropriate of trainees’ opinion were contents of the distance training package is beneficial to performance. That can be utilized in Teaching or operations. Due to the content of the two units is consistent and activities assigned to the appropriate content.

Keywords: distance training package, handbook writing for innovative learning, teaching report writing for innovative learning, teaching

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Authors: Felix O. Omosele

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Several studies have established that electronic voting machines are prone to multi-faceted challenges. One of which is their capacity to lose votes after the ballots might have been cast. Therefore, the international consensus appears to favour the use of electronic voting machines that are accompanied with verifiable audit paper audit trail (VVPAT). At present, there is no known study that has evaluated the impacts (or otherwise) of this verification and auditing on the authentication, admissibility and evidential weight of electronically-obtained electoral data. This legal inquiry is important as elections are sometimes won or lost in courts and on the basis of such data. This gap will be filled by the present research work. Using the United States of America as a case study, this paper employed a qualitative legal analysis of several of its appellate courts’ judicial opinions. This analysis equally unearths the necessary statutory rules and regulations that are important to the research problem. The objective of the research is to highlight the roles played by VVPAT on electoral evidence- as seen from the eyes of the court. The preliminary outcome of this qualitative analysis shows that the admissibility and weight attached to ‘Computer Evidence from e-voting machines (CEEM)’ are often treated with general standards applied to other computer-stored evidence. These standards sometimes fail to embrace the peculiar challenges faced by CEEM, particularly with respect to their tabulation and transmission. This paper, therefore, argues that CEEM should be accorded unique consideration by courts. It proposes the development of a legal standard which recognises verification and auditing as ‘weight enhancers’ for electronically-obtained electoral data.

Keywords: admissibility of computer evidence, electronic voting, qualitative legal analysis, voting machines in the USA

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Authors: Diab Z., Hamad A., Dixit A., Al-Rikabi M., Keshaverzi F.

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Introduction: According to the NICE guidelines, 2020Prasugrel is the recommended first line treatment in adults with acute coronary syndromes (ACS) in patients with ST-segment-elevation myocardial infarction (STEMI), defined as ST elevation or new left bundle branch block on ECG , that cardiologists intend to treat with primary percutaneous coronary intervention (PCI). The current literature suggests that this is largely due to safety and efficacy, and cost effectiveness. We wanted to do an audit to examine the adherence of the MRI hospital with guidelines in using prasugrel as first-line therapy in patients with STEMI and undergoing PPCI. AIM: To examine the adherence of the MRI hospital with guidelines in using prasugrel as first-line therapy in patients with STEMI and undergoing PPCI Methods: We looked at the patients presented to MRI during1^st of January 2022 to 28th February 2022. We included all the people who were above 18 and were brought to the hospital through the PPCI pathway and diagnosed as ACS and underwent PPCI. We excluded Patients who were brought to the hospital through the PPCI pathway and underwent coronary angiography and their diagnosis was found other than STEMI or if the outcome was death before discharge or they were above age >75 (as per guideline increase bleeding risk of prasugrel in a person aged 75 or older). Results: The total number of patients was 100. There were a total of seventy patients who had STEMI and fit the criteria for inclusion. Out of these, only 72.9% (51) were given Prasugrel as a first line. Seventeen (17) 24.3% STEMI patients were candidates for prasugrel as first-line therapy but were instead offered (clopidogrel/ticagrelor). Two 2 (2.9%) STEMI patients were not given prasugrel as first-line therapy because of C/I (CVA) or the use of anticoagulant Nine 9 (9%) of them died before discharge. Eleven 11 (11%) were above the age of 75. Ten 10 (10%) of patients had a diagnosis other than STEMI. Conclusions and recommendations: Our audit has shown the need to increase awareness amongst staff re: the first line use of Prasugrel as per NICE guidelines. We aim to arrange awareness sessions for staff and increase visibility of the guidelines for the staff to encourage them to adhere to the guideline. Further research is needed to find the optimum treatment in patients above 75.

Keywords: pasurgrel, PCI, NICE, STEMI

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Authors: Jummalla Aashrith, N. L. Shiva Sai, K. Bhavya Sri

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The swift progress of web technology has not only amassed a vast reservoir of internet data but also triggered a substantial surge in data generation. The internet has metamorphosed into one of the dynamic hubs for online education, idea dissemination, as well as opinion-sharing. Notably, the widely utilized social networking platform Twitter is experiencing considerable expansion, providing users with the ability to share viewpoints, participate in discussions spanning diverse communities, and broadcast messages on a global scale. The upswing in online engagement has sparked a significant curiosity in subjective analysis, particularly when it comes to Twitter data. This research is committed to delving into sentiment analysis, focusing specifically on the realm of Twitter. It aims to offer valuable insights into deciphering information within tweets, where opinions manifest in a highly unstructured and diverse manner, spanning a spectrum from positivity to negativity, occasionally punctuated by neutrality expressions. Within this document, we offer a comprehensive exploration and comparative assessment of modern approaches to opinion mining. Employing a range of machine learning algorithms such as Naive Bayes and Logistic Regression, our investigation plunges into the domain of Twitter data streams. We delve into overarching challenges and applications inherent in the realm of subjectivity analysis over Twitter.

Keywords: machine learning, sentiment analysis, visualisation, python

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Authors: Naser Shagerdi Esmaeli, Mohsen Hamidpour, Parisa Hasankhani Tehrani

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Background And Objective: Haematopoietic stem cell transplant is a potentially curative treatment option in various benign and malignant haematological diseases. Patients undergoing stem cell transplant procedure require blood transfusion on a daily basis. Currently, there is paucity of data from developing countries on transfusion practices. This audit was undertaken to determine the consumption of packed red blood cells (PRBCs) transfusion in the bone marrow transplant unit of the Shahid Ghazi Tabatabaei Hospital, Tabriz, Iran. Subjects And Methods: A retrospective audit was conducted for packed red cell transfusion ordering practice over a period from March 2017 to march 2018. All consecutive patients admitted for stem cell transplant procedure for various underlying diseases were included. Outcome measures used in this study were (i) cross match to transfusion (C: T) ratio and (ii) transfusion trigger. Results: During the study period, n=13 patients underwent a haematopoietic stem cell transplant. There were n=10 males and n=3 females. One patient was less than 15 years of age, while rests were adults. Median age±SD was 26.5±14.5 years (12∼54 years). The underlying diagnosis included Aplastic anemia (n=4), Thalassemia major (n=1), Multiple Myeloma (n=3), Acute leukemia (n=3), Hodgkin's lymphoma (n=1), PRCA (n=1). Grand total consumption of PRBCs during the study period was 204, while 258 products were crossmatch. The C:T ratio was 1.26. The transfusion trigger was Hb level of less than 8 gr/dl. Conclusion: The results of our BMT unit indicate that the C:T ratio and transfusion trigger is comparable to the international criteria and pioneer country in BMT transplantation. Also, we hope that our blood consumption become less than it is now.

Keywords: blood consumption, C: T ratio, PRBCs, stem cell transplant, tabriz, Iran

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Authors: Jibran Abbasy, Rizwan Sultan, Ammar Humayun, Tabish Chawla

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Background: Hydatid disease caused by Echinococcus Granulosus affects liver in 70-90% of cases. Dogs are the definitive host while humans are the accidental host. Modalities used for its treatment are especially important for our population as the disease is endemic in many Asian countries. The aim of the study was to perform an audit of the various modalities used for treatment of hydatid disease of liver and the response to each modality in tertiary care center of Pakistan. Materials and Methods: Retrospective audit of patients diagnosed and treated for Hydatid disease of the liver at Aga Khan University Hospital from 1st January 2007 to 31st December 2014 was completed. All patients aged 16 and above were included. Patients who had extra hepatic disease and missing records were excluded. Outcome measures were morbidity, mortality and recurrence of the disease. Results: During the study period 56 patients were treated for isolated hepatic hydatid disease and were included. Mean age was 39 years with 48% being females and 52% males. Most common presenting complaint was abdominal pain seen in 53% of patients(n=41). Duration of symptoms was less than 6 months in 74% (n=38). Mostly right lobe was involved in 69% (n=38).Most common treatment modality used was surgery in 34 patients followed by PAIR in 14 patients while 8 patients were treated medically. At a median follow up of 34 months recurrence was seen in 2 patients treated with PAIR while no patient treated with surgery had recurrence with the median follow up of 20 months. While no morbidity and mortality were observed in PAIR, but in surgery 5 patients had morbidity while 1 patient had mortality. Conclusion: Our data is comparative to other studies in terms of morbidity, mortality, and recurrence. We had adequate follow up. In our study PAIR and surgery both are effective and have less complications and recurrence rate. Surgery is still the gold standard in terms of recurrence.

Keywords: echinococcous granulosus, puncture aspiration irrigation reaspiration (PAIR), surgery, hydatid disease

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Authors: Andrew White, Abigail Lowe, Kory Watkins, Hamed Akhlaghi, Nicole Winter

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The timing and appropriateness of diagnostic imaging are critical to the evaluation and management of traumatic injuries. Within the subclass of trauma patients, the prevalence of c-spine injury is less than 4%. However, the incidence of delayed diagnosis within this cohort has been documented as up to 20%, with inadequate radiological examination most cited issue. In order to assess those in which c-spine injury cannot be fully excluded based on clinical examination alone and, therefore, should undergo diagnostic imaging, a set of criteria is used to provide clinical guidance. The NEXUS (National Emergency X-Radiography Utilisation Study) criteria is a validated clinical decision-making tool used to facilitate selective c-spine radiography. The criteria allow clinicians to determine whether cervical spine imaging can be safely avoided in appropriate patients. The NEXUS criteria are widely used within the Emergency Department setting given their ease of use and relatively straightforward application and are used in the Victorian State Trauma System’s guidelines. This audit utilized retrospective data collection to examine the concordance of c-spine imaging in trauma patients to that of the NEXUS criteria and assess compliance with state guidance on diagnostic imaging in trauma. Of the 183 patients that presented with trauma to the head, neck, or face (244 excluded due to incorrect triage), 98 did not undergo imaging of the c-spine. Out of those 98, 44% fulfilled at least one of the NEXUS criteria, meaning the c-spine could not be clinically cleared as per the current guidelines. The criterion most met was intoxication, comprising 42% (18 of 43), with midline spinal tenderness (or absence of documentation of this) the second most common with 23% (10 of 43). Intoxication being the most met criteria is significant but not unexpected given the cohort of patients seen at St Vincent’s and within many emergency departments in general. Given these patients will always meet NEXUS criteria, an element of clinical judgment is likely needed, or concurrent use of the Canadian C-Spine Rules to exclude the need for imaging. Midline tenderness as a met criterion was often in the context of poor or absent documentation relating to this, emphasizing the importance of clear and accurate assessments. The distracting injury was identified in 7 out of the 43 patients; however, only one of these patients exhibited a thoracic injury (T11 compression fracture), with the remainder comprising injuries to the extremities – some studies suggest that C-spine imaging may not be required in the evaluable blunt trauma patient despite distracting injuries in any body regions that do not involve the upper chest. This emphasises the need for standardised definitions for distracting injury, at least at a departmental/regional level. The data highlights the currently poor application of the NEXUS guidelines, with likely common themes throughout emergency departments, highlighting the need for further education regarding implementation and potential refinement/clarification of criteria. Of note, there appeared to be no significant differences between levels of experience with respect to inappropriately clearing the c-spine clinically with respect to the guidelines.

Keywords: imaging, guidelines, emergency medicine, audit

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