Search results for: expected value
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2859

Search results for: expected value

2709 Low Energy Mechanism in Pelvic Trauma at Elderly

Authors: Ravid Yinon

Abstract:

Introduction: Pelvic trauma causes high mortality, particularly among the elderly population. Pelvic injury ranges from low-energy incidents such as falls to high-energy trauma like motor vehicle accidents. The mortality rate among high-energy trauma patients is higher, as can be expected. The elderly population is more vulnerable to pelvic trauma even at low energy mechanisms due to the fragility and diminished physiological reserve of these patients. The aim of this study is to examine whether there is a higher long-term mortality in pelvic injuries in the elderly from the low-energy mechanism than those injured in high energy. Methods: A retrospective cohort study was conducted in a level 1 trauma center with injured patients aged 65 years and over with pelvic trauma. The patients were divided into two groups of low and high-energy mechanisms of injury. Multivariate analysis was conducted to characterize the differences between the groups. Results: There were 585 consecutive injured patients over the age of 65 with a documented pelvic injury who were treated at the primary trauma center between 2008-2020. The injured in the high energy group were younger (mean HE- 75.18, LE-80.73), with fewer comorbidities (mean 0.78 comorbidities at HE and 1.28 at LE), more men (52.6% at HE and 27.4% at LE), were consumed more treatments facilities such as angioembolization, ICU admission, emergency surgeries and blood products transfusion and higher mortality rate at admission (HE- 19/133, 14.28%, LE- 10/452, 2.21%) compared to the low energy group. However, in a long-term follow-up of one year after the injury, mortality in the low-energy group was significantly higher (HE- 14/114, 12.28%, LE- 155/442, 35.06%). Discussion: Although it can be expected that in the mechanism of high energy, the mortality rate in the long term would be higher, it was found that mortality at the low energy patient was higher. Apparently, low-energy pelvic injury in geriatric patients is a measure of frailty in these patients, causes injury to more frail and morbid patients, and is a predictor of mortality in this population in the long term. Conclusion: The long-term follow-up of injured elderly with pelvic trauma should be more intense, and the healthcare provider should put more emphasis on the rehabilitation of these special patient populations in an attempt to prevent long-term mortality.

Keywords: pelvic trauma, elderly trauma, high energy trauma, low energy trauma

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2708 Sexual Health in the Over Forty-Fives: A Cross-Europe Project

Authors: Tess Hartland, Moitree Banerjee, Sue Churchill, Antonina Pereira, Ian Tyndall, Ruth Lowry

Abstract:

Background: Sexual health services and policies for middle-aged and older adults are underdeveloped, while global sexually transmitted infections in this age group are on the rise. The Interreg cross-Europe Sexual Health In Over 45s (SHIFT) project aims to increase participation in sexual health services and improve sexual health and wellbeing in people aged over 45, with an additional focus on disadvantaged groups. Methods: A two-pronged mixed-methodology is being used to develop a model for good service provision in sexual health for over 45s. (1) Following PRISMA-ScR guidelines, a scoping review is being conducted, using the databases PsychINFO, Web of Science, ERIC and PubMed. A key search strategy using terms around sexual health, good practice, over 45s and disadvantaged groups. The initial search for literature yielded 7914 results. (2) Surveys (n=1000) based on the Theory of Planned Behaviour are being administered across the UK, Belgium and Netherlands to explore current sexual health knowledge, awareness and attitudes. Expected results: It is expected that sexual health needs and potential gaps in service provision will be identified in order to inform good practice for sexual health services for the target population. Results of the scoping review are being analysed, while focus group and survey data is being gathered. Preliminary analysis of the survey data highlights barriers to access such as limited risk awareness and stigma. All data analysis will be completed by the time of the conference. Discussion: Findings will inform the development of a model to improve sexual health and wellbeing for among over 45s, a population which is often missed in sexual health policy improvement.

Keywords: adult health, disease prevention, health promotion, over 45s, sexual health

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2707 Cloud Computing Impact on e-Government Adoption

Authors: Ali Elshabrawy

Abstract:

Cloud computing is expected to be important for e Government in near future. Governments need it for solving some of its e Government, financial, infrastructure, legacy systems and integration problems. It reduces information technology (IT) infrastructure needs and support costs, and offers on-demand infrastructure and computational power, improved collaboration capabilities, which are important for e Government projects start up and sustainability. Budget pressures will continue to drive more and more government IT to hybrid and even public clouds, and more cooperation between cloud service providers and governmental agencies are expected, Or developing governmental private, community clouds. Motivation to convince governments to use cloud computing services, will create a pressure on cloud service providers to cope with government's requirements for interoperability, security standards, open data and integration between their cloud systems There will be significant legal action arising out of governmental uses of cloud computing, and legislation addressing both IT and business needs and consumer fears and protections. Cloud computing is a considered a revolution for IT and E business in general and e commerce, e Government in particular. As governments faces increasing challenges regarding IT infrastructure required for e Government projects implementation. As a result of Lack of required financial resources allocated for e Government projects in developed and developing countries. Cloud computing can play a major role to solve some of e Government projects challenges such as, lack of financial resources, IT infrastructure, Human resources trained to manage e Government applications, interoperability, cost efficiency challenges. If we could solve some security issues related to cloud computing usage which considered critical for e Government projects. Pretty sure it’s Just a matter of time before cloud service providers will find out solutions to attract governments as major customers for their business.

Keywords: cloud computing, e-government, adoption, supply side barriers, e-government requirements, challenges

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2706 Analysis of Two-Echelon Supply Chain with Perishable Items under Stochastic Demand

Authors: Saeed Poormoaied

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Perishability and developing an intelligent control policy for perishable items are the major concerns of marketing managers in a supply chain. In this study, we address a two-echelon supply chain problem for perishable items with a single vendor and a single buyer. The buyer adopts an aged-based continuous review policy which works by taking both the stock level and the aging process of items into account. The vendor works under the warehouse framework, where its lot size is determined with respect to the batch size of the buyer. The model holds for a positive and fixed lead time for the buyer, and zero lead time for the vendor. The demand follows a Poisson process and any unmet demand is lost. We provide exact analytic expressions for the operational characteristics of the system by using the renewal reward theorem. Items have a fixed lifetime after which they become unusable and are disposed of from the buyer's system. The age of items starts when they are unpacked and ready for the consumption at the buyer. When items are held by the vendor, there is no aging process which results in no perishing at the vendor's site. The model is developed under the centralized framework, which takes the expected profit of both vendor and buyer into consideration. The goal is to determine the optimal policy parameters under the service level constraint at the retailer's site. A sensitivity analysis is performed to investigate the effect of the key input parameters on the expected profit and order quantity in the supply chain. The efficiency of the proposed age-based policy is also evaluated through a numerical study. Our results show that when the unit perishing cost is negligible, a significant cost saving is achieved.

Keywords: two-echelon supply chain, perishable items, age-based policy, renewal reward theorem

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2705 Looking beyond Corporate Social Responsibility to Sustainable Development: Conceptualisation and Theoretical Exploration

Authors: Mercy E. Makpor

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Traditional Corporate Social Responsibility (CSR) idea has gone beyond just ensuring safety environments, caring about global warming and ensuring good living standards and conditions for the society at large. The paradigm shift is towards a focus on strategic objectives and the long-term value creation for both businesses and the society at large for a realistic future. As an important approach to solving social and environment issues, CSR has been accepted globally. Yet the approach is expected to go beyond where it is currently. So much is expected from businesses and governments at every level globally and locally. This then leads to the original idea of the concept, that is, how it originated and how it has been perceived over the years. Little wonder there has been a lot of definitions surrounding the concept without a major globally acceptable definition of it. The definition of CSR given by the European Commission will be considered for the purpose of this paper. Sustainable Development (SD), on the other hand, has been viewed in recent years as an ethical concept explained in the UN-Report termed “Our Common Future,” which can also be referred to as the Brundtland report. The report summarises the need for SD to take place in the present without comprising the future. However, the recent 21st-century framework on sustainability known as the “Triple Bottom Line (TBL)” framework, has added its voice to the concepts of CSR and sustainable development. The TBL model is of the opinion that businesses should not only report on their financial performance but also on their social and environmental performances, highlighting that CSR has gone beyond just the “material-impact” approach towards a “Future-Oriented” approach (sustainability). In this paper, the concept of CSR is revisited by exploring the various theories therein. The discourse on the concepts of sustainable development and sustainable development frameworks will also be indicated, thereby inducing these into how CSR can benefit both businesses and their stakeholders as well as the entirety of the society, not just for the present but for the future. It does this by exploring the importance of both concepts (CSR and SD) and concludes by making recommendations for a more empirical research in the near future.

Keywords: corporate social responsibility, sustainable development, sustainability, triple bottom line model

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2704 The Perspective of Health Care Professionals of Pediatric Palliative Care

Authors: Eunkyo Kang, Jihye Lee, Jiyeon Choo

Abstract:

Background: Pediatric palliative care has been increasing, and the number of studies has focused on the age at which pediatric patient can be notified their terminal illness, pediatric advanced care planning (ACP) and palliative care. However, there is a lack of research on health professionals’ perception. Aim: We aimed to investigate the perceptions of healthcare professionals about appropriate age disclosing terminal illness, awareness of ACP, and the relationship between ACP knowledge and the preference for palliative care for children. Methods: We administered nationwide questionnaires to 928 physicians from the 12 hospitals and the Korean Medical Association and 1,241 individuals of the general Korean population. We asked about the age at which the pediatric patients could be notified of their terminal illness, by 4 groups; 4 years old or older, 12 years old or older, 15 years old or older, or not. In addition, we surveyed the questionnaires about the knowledge of ACP of the medical staff, the preference of the pediatric hospice palliative care, aggressive treatment, and life-sustaining treatment preference. Results: In the appropriate age disclosing terminal illness, there were more respondents in the physicians than in the general population who thought that it was possible even at a younger age. Palliative care preference in pediatric patients who were expected to expire within months was higher when health care professionals had knowledge of ACPs compared to those without knowledge. The same results were obtained when deaths were expected within weeks or days. The age of the terminal status notification, the health care professionals who thought to be available at a lower age have a higher preference for palliative care and has less preference for aggressive treatment and life-sustaining treatment. Conclusion: Despite the importance of pediatric palliative care, our study confirmed that there is a difference in the preference of the health care professionals for pediatric palliative care according to the ACP knowledge of the medical staff or the appropriate age disclosing terminal illness. Future research should focus on strategies for inducing changes in perceptions of health care professionals and identifying other obstacles for the pediatric palliative care.

Keywords: pediatric palliative care, disclosing terminal illness, palliative care, advanced care planning

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2703 Students’ Opinions Related to Virtual Classrooms within the Online Distance Education Graduate Program

Authors: Secil Kaya Gulen

Abstract:

Face to face and virtual classrooms that came up with different conditions and environments, but similar purposes have different characteristics. Although virtual classrooms have some similar facilities with face-to-face classes such as program, students, and administrators, they have no walls and corridors. Therefore, students can attend the courses from a distance and can control their own learning spaces. Virtual classrooms defined as simultaneous online environments where students in different places come together at the same time with the guidance of a teacher. Distance education and virtual classes require different intellectual and managerial skills and models. Therefore, for effective use of virtual classrooms, the virtual property should be taken into consideration. One of the most important factors that affect the spread and effective use of the virtual classrooms is the perceptions and opinions of students -as one the main participants-. Student opinions and recommendations are important in terms of providing information about the fulfillment of expectation. This will help to improve the applications and contribute to the more efficient implementations. In this context, ideas and perceptions of the students related to the virtual classrooms, in general, were determined in this study. Advantages and disadvantages of virtual classrooms expected contributions to the educational system and expected characteristics of virtual classrooms have examined in this study. Students of an online distance education graduate program in which all the courses offered by virtual classrooms have asked for their opinions. Online Distance Education Graduate Program has totally 19 students. The questionnaire that consists of open-ended and multiple choice questions sent to these 19 students and finally 12 of them answered the questionnaire. Analysis of the data presented as frequencies and percentages for each item. SPSS for multiple-choice questions and Nvivo for open-ended questions were used for analyses. According to the results obtained by the analysis, participants stated that they did not get any training on virtual classes before the courses; but they emphasize that newly enrolled students should be educated about the virtual classrooms. In addition, all participants mentioned that virtual classroom contribute their personal development and they want to improve their skills by gaining more experience. The participants, who mainly emphasize the advantages of virtual classrooms, express that the dissemination of virtual classrooms will contribute to the Turkish Education System. Within the advantages of virtual classrooms, ‘recordable and repeatable lessons’ and ‘eliminating the access and transportation costs’ are most common advantages according to the participants. On the other hand, they mentioned ‘technological features and keyboard usage skills affect the attendance’ is the most common disadvantage. Participants' most obvious problem during virtual lectures is ‘lack of technical support’. Finally ‘easy to use’, ‘support possibilities’, ‘communication level’ and ‘flexibility’ come to the forefront in the scope of expected features of virtual classrooms. Last of all, students' opinions about the virtual classrooms seems to be generally positive. Designing and managing virtual classrooms according to the prioritized features will increase the students’ satisfaction and will contribute to improve applications that are more effective.

Keywords: distance education, virtual classrooms, higher education, e-learning

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2702 Adequacy of Advanced Earthquake Intensity Measures for Estimation of Damage under Seismic Excitation with Arbitrary Orientation

Authors: Konstantinos G. Kostinakis, Manthos K. Papadopoulos, Asimina M. Athanatopoulou

Abstract:

An important area of research in seismic risk analysis is the evaluation of expected seismic damage of structures under a specific earthquake ground motion. Several conventional intensity measures of ground motion have been used to estimate their damage potential to structures. Yet, none of them was proved to be able to predict adequately the seismic damage of any structural system. Therefore, alternative advanced intensity measures which take into account not only ground motion characteristics but also structural information have been proposed. The adequacy of a number of advanced earthquake intensity measures in prediction of structural damage of 3D R/C buildings under seismic excitation which attacks the building with arbitrary incident angle is investigated in the present paper. To achieve this purpose, a symmetric in plan and an asymmetric 5-story R/C building are studied. The two buildings are subjected to 20 bidirectional earthquake ground motions. The two horizontal accelerograms of each ground motion are applied along horizontal orthogonal axes forming 72 different angles with the structural axes. The response is computed by non-linear time history analysis. The structural damage is expressed in terms of the maximum interstory drift as well as the overall structural damage index. The values of the aforementioned seismic damage measures determined for incident angle 0° as well as their maximum values over all seismic incident angles are correlated with 9 structure-specific ground motion intensity measures. The research identified certain intensity measures which exhibited strong correlation with the seismic damage of the two buildings. However, their adequacy for estimation of the structural damage depends on the response parameter adopted. Furthermore, it was confirmed that the widely used spectral acceleration at the fundamental period of the structure is a good indicator of the expected earthquake damage level.

Keywords: damage indices, non-linear response, seismic excitation angle, structure-specific intensity measures

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2701 Context-Aware Recommender Systems Using User's Emotional State

Authors: Hoyeon Park, Kyoung-jae Kim

Abstract:

The product recommendation is a field of research that has received much attention in the recent information overload phenomenon. The proliferation of the mobile environment and social media cannot help but affect the results of the recommendation depending on how the factors of the user's situation are reflected in the recommendation process. Recently, research has been spreading attention to the context-aware recommender system which is to reflect user's contextual information in the recommendation process. However, until now, most of the context-aware recommender system researches have been limited in that they reflect the passive context of users. It is expected that the user will be able to express his/her contextual information through his/her active behavior and the importance of the context-aware recommender system reflecting this information can be increased. The purpose of this study is to propose a context-aware recommender system that can reflect the user's emotional state as an active context information to recommendation process. The context-aware recommender system is a recommender system that can make more sophisticated recommendations by utilizing the user's contextual information and has an advantage that the user's emotional factor can be considered as compared with the existing recommender systems. In this study, we propose a method to infer the user's emotional state, which is one of the user's context information, by using the user's facial expression data and to reflect it on the recommendation process. This study collects the facial expression data of a user who is looking at a specific product and the user's product preference score. Then, we classify the facial expression data into several categories according to the previous research and construct a model that can predict them. Next, the predicted results are applied to existing collaborative filtering with contextual information. As a result of the study, it was shown that the recommended results of the context-aware recommender system including facial expression information show improved results in terms of recommendation performance. Based on the results of this study, it is expected that future research will be conducted on recommender system reflecting various contextual information.

Keywords: context-aware, emotional state, recommender systems, business analytics

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2700 Financial Liberalization, Exchange Rates and Demand for Money in Developing Economies: The Case of Nigeria, Ghana and Gambia

Authors: John Adebayo Oloyhede

Abstract:

This paper examines effect of financial liberalization on the stability of the demand for money function and its implication for exchange rate behaviour of three African countries. As the demand for money function is regarded as one of the two main building blocks of most exchange rate determination models, the other being purchasing power parity, its stability is required for the monetary models of exchange rate determination to hold. To what extent has the liberalisation policy of these countries, for instance liberalised interest rate, affected the demand for money function and what has been the consequence on the validity and relevance of floating exchange rate models? The study adopts the Autoregressive Instrumental Package (AIV) of multiple regression technique and followed the Almon Polynomial procedure with zero-end constraint. Data for the period 1986 to 2011 were drawn from three developing countries of Africa, namely: Gambia, Ghana and Nigeria, which did not only start the liberalization and floating system almost at the same period but share similar and diverse economic and financial structures. Its findings show that the demand for money was a stable function of income and interest rate at home and abroad. Other factors such as exchange rate and foreign interest rate exerted some significant effect on domestic money demand. The short-run and long-run elasticity with respect to income, interest rates, expected inflation rate and exchange rate expectation are not greater than zero. This evidence conforms to some extent to the expected behaviour of the domestic money function and underscores its ability to serve as good building block or assumption of the monetary model of exchange rate determination. This will, therefore, assist appropriate monetary authorities in the design and implementation of further financial liberalization policy packages in developing countries.

Keywords: financial liberalisation, exchange rates, demand for money, developing economies

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2699 A Pilot Study of Influences of Scan Speed on Image Quality for Digital Tomosynthesis

Authors: Li-Ting Huang, Yu-Hsiang Shen, Cing-Ciao Ke, Sheng-Pin Tseng, Fan-Pin Tseng, Yu-Ching Ni, Chia-Yu Lin

Abstract:

Chest radiography is the most common technique for the diagnosis and follow-up of pulmonary diseases. However, the lesions superimposed with normal structures are difficult to be detected in chest radiography. Chest tomosynthesis is a relatively new technique to obtain 3D section images from a set of low-dose projections acquired over a limited angular range. However, there are some limitations with chest tomosynthesis. Patients undergoing tomosynthesis have to be able to hold their breath firmly for 10 seconds. A digital tomosynthesis system with advanced reconstruction algorithm and high-stability motion mechanism was developed by our research group. The potential for the system to perform a bidirectional chest scan within 10 seconds is expected. The purpose of this study is to realize the influences of the scan speed on the image quality for our digital tomosynthesis system. The major factors that lead image blurring are the motion of the X-ray source and the patient. For the fore one, an experiment of imaging a chest phantom with three different scan speeds, which are 6 cm/s, 8 cm/s, and 15 cm/s, was proceeded to understand the scan speed influences on the image quality. For the rear factor, a normal SD (Sprague-Dawley) rat was imaged with it alive and sacrificed to assess the impact on the image quality due to breath motion. In both experiments, the profile of the ROIs (region of interest) and the CNRs (contrast-to-noise ratio) of the ROIs to the normal tissue of the reconstructed images was examined to realize the degradations of the qualities of the images. The preliminary results show that no obvious degradation of the image quality was observed with increasing scan speed, possibly due to the advanced designs for the hardware and software of the system. It implies that higher speed (15 cm/s) than that of the commercialized tomosynthesis system (12 cm/s) for the proposed system is achieved, and therefore a complete chest scan within 10 seconds is expected.

Keywords: chest radiography, digital tomosynthesis, image quality, scan speed

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2698 Significant Growth in Expected Muslim Inbound Tourists in Japan Towards 2020 Tokyo Olympic and Still Incipient Stage of Current Halal Implementations in Hiroshima

Authors: Kyoko Monden

Abstract:

Tourism has moved to the forefront of national attention in Japan since September of 2013 when Tokyo won its bid to host the 2020 Summer Olympics. The number of foreign tourists has continued to break records, reaching 13.4 million in 2014, and is now expected to hit 20 million sooner than initially targeted 2020 due to government stimulus promotions; an increase in low cost carriers; the weakening of the Japanese yen, and strong economic growth in Asia. The tourism industry can be an effective trigger in Japan’s economic recovery as foreign tourists spent two trillion yen ($16.6 million) in Japan in 2014. In addition, 81% of them were all from Asian countries, and it is essential to know that 68.9% of the world’s Muslims, about a billion people, live in South and Southeast Asia. An important question is ‘Do Muslim tourists feel comfortable traveling in Japan?’ This research was initiated by an encounter with Muslim visitors in Hiroshima, a popular international tourist destination, who said they had found very few suitable restaurants in Hiroshima. The purpose of this research is to examine halal implementation in Hiroshima and suggest the next steps to be taken to improve current efforts. The goal will be to provide anyone, Muslims included, with first class hospitality in the near future in preparation for the massive influx of foreign tourists in 2020. The methods of this research were questionnaires, face-to-face interviews, phone interviews, and internet research. First, this research aims to address the significance of growing inbound tourism in Japan, especially the expected growth in Muslim tourists. Additionally, it should address the strong popularity of eating Japanese foods in Asian Muslim countries and as ranked no. 1 thing foreign tourists want to do in Japan. Secondly, the current incipient stage of Hiroshima’s halal implementation at hotels, restaurants, and major public places were exposed, and the existing action plans by Hiroshima Prefecture Government were presented. Furthermore, two surveys were conducted to clarify basic halal awareness of local residents in Hiroshima, and to gauge the inconveniences Muslims living in Hiroshima faced. Thirdly, the reasons for this lapse were observed and compared to the benchmarking data of other major tourist sites, Hiroshima’s halal implementation plans were proposed. The conclusion is, despite increasing demands and interests in halal-friendly businesses, overall halal actions have barely been applied in Hiroshima. 76% of Hiroshima residents had no idea what halal or halaal meant. It is essential to increase halal awareness and its importance to the economy and to launch further actions to make Muslim tourists feel welcome in Hiroshima and the entire country.

Keywords: halaal, halal implementation, Hiroshima, inbound tourists in Japan

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2697 Saudi Arabia and the Yemen War: A Fruitless Struggle

Authors: Majid Dashtgerd, Eisa Moradi Afrapoli

Abstract:

The “Yemen War” is one of the longest wars of the recent century, which was launched on 26 March 2015 after the Saudi Arabia-led alliance's military intervention in Yemen. The war began with the aim of fighting Yemen's Houthis and preventing Iranian influence in the region, and Saudi leaders expected a quick victory; However, the “Yemen War” lasted about seven years and is still going on (May 2022), and Saudi Arabia has not been able to achieve its strategic objectives. This study seeks to examine some of the most important reasons for Saudi Arabia's protracted war and failure in Yemen.

Keywords: Saudi Arabia, yemen war, houthis, Iran

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2696 Terahertz Glucose Sensors Based on Photonic Crystal Pillar Array

Authors: S. S. Sree Sanker, K. N. Madhusoodanan

Abstract:

Optical biosensors are dominant alternative for traditional analytical methods, because of their small size, simple design and high sensitivity. Photonic sensing method is one of the recent advancing technology for biosensors. It measures the change in refractive index which is induced by the difference in molecular interactions due to the change in concentration of the analyte. Glucose is an aldosic monosaccharide, which is a metabolic source in many of the organisms. The terahertz waves occupies the space between infrared and microwaves in the electromagnetic spectrum. Terahertz waves are expected to be applied to various types of sensors for detecting harmful substances in blood, cancer cells in skin and micro bacteria in vegetables. We have designed glucose sensors using silicon based 1D and 2D photonic crystal pillar arrays in terahertz frequency range. 1D photonic crystal has rectangular pillars with height 100 µm, length 1600 µm and width 50 µm. The array period of the crystal is 500 µm. 2D photonic crystal has 5×5 cylindrical pillar array with an array period of 75 µm. Height and diameter of the pillar array are 160 µm and 100 µm respectively. Two samples considered in the work are blood and glucose solution, which are labelled as sample 1 and sample 2 respectively. The proposed sensor detects the concentration of glucose in the samples from 0 to 100 mg/dL. For this, the crystal was irradiated with 0.3 to 3 THz waves. By analyzing the obtained S parameter, the refractive index of the crystal corresponding to the particular concentration of glucose was measured using the parameter retrieval method. Refractive indices of the two crystals decreased gradually with the increase in concentration of glucose in the sample. For 1D photonic crystals, a gradual decrease in refractive index was observed at 1 THz. 2D photonic crystal showed this behavior at 2 THz. The proposed sensor was simulated using CST Microwave studio. This will enable us to develop a model which can be used to characterize a glucose sensor. The present study is expected to contribute to blood glucose monitoring.

Keywords: CST microwave studio, glucose sensor, photonic crystal, terahertz waves

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2695 Evaluation of Four Different DNA Targets in Polymerase Chain Reaction for Detection and Genotyping of Helicobacter pylori

Authors: Abu Salim Mustafa

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Polymerase chain reaction (PCR) assays targeting genomic DNA segments have been established for the detection of Helicobacter pylori in clinical specimens. However, the data on comparative evaluations of various targets in detection of H. pylori are limited. Furthermore, the frequencies of vacA (s1 and s2) and cagA genotypes, which are suggested to be involved in the pathogenesis of H. pylori in other parts of the world, are not well studied in Kuwait. The aim of this study was to evaluate PCR assays for the detection and genotyping of H. pylori by targeting the amplification of DNA targets from four genomic segments. The genomic DNA were isolated from 72 clinical isolates of H. pylori and tested in PCR with four pairs of oligonucleotides primers, i.e. ECH-U/ECH-L, ET-5U/ET-5L, CagAF/CagAR and Vac1F/Vac1XR, which were expected to amplify targets of various sizes (471 bp, 230 bp, 183 bp and 176/203 bp, respectively) from the genomic DNA of H. pylori. The PCR-amplified DNA were analyzed by agarose gel electrophoresis. PCR products of expected size were obtained with all primer pairs by using genomic DNA isolated from H. pylori. DNA dilution experiments showed that the most sensitive PCR target was 471 bp DNA amplified by the primers ECH-U/ECH-L, followed by the targets of Vac1F/Vac1XR (176 bp/203 DNA), CagAF/CagAR (183 bp DNA) and ET-5U/ET-5L (230 bp DNA). However, when tested with undiluted genomic DNA isolated from single colonies of all isolates, the Vac1F/Vac1XR target provided the maximum positive results (71/72 (99% positives)), followed by ECH-U/ECH-L (69/72 (93% positives)), ET-5U/ET-5L (51/72 (71% positives)) and CagAF/CagAR (26/72 (46% positives)). The results of genotyping experiments showed that vacA s1 (46% positive) and vacA s2 (54% positive) genotypes were almost equally associated with VaCA+/CagA- isolates (P > 0.05), but with VacA+/CagA+ isolates, S1 genotype (92% positive) was more frequently detected than S2 genotype (8% positive) (P< 0.0001). In conclusion, among the primer pairs tested, Vac1F/Vac1XR provided the best results for detection of H. pylori. The genotyping experiments showed that vacA s1 and vacA s2 genotypes were almost equally associated with vaCA+/cagA- isolates, but vacA s1 genotype had a significantly increased association with vacA+/cagA+ isolates.

Keywords: H. pylori, PCR, detection, genotyping

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2694 Equality in Higher Education: A Library and Learning Collaborative Project to Support Teachers

Authors: Ika Jorum

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The aim of this collaborative project was to develop library support that contributes in a long-term way to a technical university’s work on increased equality in education. The background was an assessment made by the Higher Education Authority that showed the need for improvement regarding equality in several programs at the university. The university’s Vice President for equality and Vice President for sustainability announced funds for projects that supported the improvement of equality in education. The library was granted funding for a one-year project that aimed both to support teachers in order to embed equality in education and to support the library staff and improve the organization’s own work. The part of the project that was directed to teachers was performed as activities in different areas and forms, such as acquisition and collections, teaching, exhibitions and book discussions. Besides the activities and support that was offered to teachers, the education team had journal clubs in order to develop and embed equality in their own teaching. The part that was directed to library staff and management was performed as workshops in collaboration with Equality Office in order to identify areas where the library could make improvements on work with equality and inclusion. The expectation was that the activities would be well attended since the project team had got indications that the content would be relevant. The outcome of this project was that some activities turned out to be more attended than others and what is expected to be found relevant, for example, a workshop on information searching from a gender and equality perspective for teachers, might still not attract participants. On the other hand, Ph.D. students and students participated in the book discussions and wanted them to continue after the project had ended. Results will be shared both on what was successful and what was challenging. Some reflections will be given on what can be done to attract participants to activities in the area of gender equality that is most likely relevant for the expected attendants and how results from a project on gender equality can be integrated into an organization’s daily work.

Keywords: equality, higher education, critical information literacy, collaboration

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2693 Changes in Temperature and Precipitation Extremes in Northern Thailand

Authors: Chakrit Chotamonsak

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This study was analyzed changes in temperature and precipitation extremes in northern Thailand for the period 1981-2011.The study includes an analysis of the average and trends of changes in temperature and precipitation using 22 climate indices, related to the intensity, frequency and duration of extreme climate events. The results showed that the averaged trend of maximum, minimum and mean temperature is likely to increase over the study area in rate of 0.5, 0.9 and 0.7 °C in last 30 years. Changes in temperature at nighttime, then rising at a rate higher daytime is resulting to decline of diurnal temperature range throughout the area. Trend of changes in average precipitation during the year 1981-2011 is expected to increase at an average rate of 21%. The intensity of extreme temperature events is increasing almost all station. In particular, the changes of the night were unusually hot has intensified throughout the region. In some provinces such as Chiang Mai and Lampang are likely be faced with the severity of hot days and hot nights in increasing rate. Frequency of extreme temperature events are likely to increase each station, especially hot days, and hot nights are increasing at a rate of 2.38 and 3.58 days per decade. Changes in the cold days and cold nights are declining at a rate of 0.82 and 3.03 days per decade. The duration of extreme temperature events is expected to increase the events hot in every station. An average of 17.8 days per decade for the number of consecutive cold winter nights likely shortens the rate of 2.90 days per decade. The analysis of the precipitation indices reveals the intensity of extreme precipitation is increasing almost across the region. The intensify expressed the heavy rain in one day (Rx1day) and very heavy rain accumulated in 5 days (RX5day) which is likely to increase, and very heavy rainfall is likely to increase in intensity. Frequency of extreme precipitation events is likely to increase over the station. The average frequency of heavy precipitation events increased xxx days per decade. The duration of extreme precipitation events, such as the consecutive dry days are likely to reduce the numbers almost all station while the consecutive wet days tends to increase and decrease at different numbers in different areas.

Keywords: climate extreme, temperature extreme, precipitation extreme, Northern Thailand

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2692 Landslide and Liquefaction Vulnerability Analysis Using Risk Assessment Analysis and Analytic Hierarchy Process Implication: Suitability of the New Capital of the Republic of Indonesia on Borneo Island

Authors: Rifaldy, Misbahudin, Khalid Rizky, Ricky Aryanto, M. Alfiyan Bagus, Fahri Septianto, Firman Najib Wibisana, Excobar Arman

Abstract:

Indonesia is a country that has a high level of disaster because it is on the ring of fire, and there are several regions with three major plates meeting in the world. So that disaster analysis must always be done to see the potential disasters that might always occur, especially in this research are landslides and liquefaction. This research was conducted to analyze areas that are vulnerable to landslides and liquefaction hazards and their relationship with the assessment of the issue of moving the new capital of the Republic of Indonesia to the island of Kalimantan with a total area of 612,267.22 km². The method in this analysis uses the Analytical Hierarchy Process and consistency ratio testing as a complex and unstructured problem-solving process into several parameters by providing values. The parameters used in this analysis are the slope, land cover, lithology distribution, wetness index, earthquake data, peak ground acceleration. Weighted overlay was carried out from all these parameters using the percentage value obtained from the Analytical Hierarchy Process and confirmed its accuracy with a consistency ratio so that a percentage of the area obtained with different vulnerability classification values was obtained. Based on the analysis results obtained vulnerability classification from very high to low vulnerability. There are (0.15%) 918.40083 km² of highly vulnerable, medium (20.75%) 127,045,44815 km², low (56.54%) 346,175.886188 km², very low (22.56%) 138,127.484832 km². This research is expected to be able to map landslides and liquefaction disasters on the island of Kalimantan and provide consideration of the suitability of regional development of the new capital of the Republic of Indonesia. Also, this research is expected to provide input or can be applied to all regions that are analyzing the vulnerability of landslides and liquefaction or the suitability of the development of certain regions.

Keywords: analytic hierarchy process, Borneo Island, landslide and liquefaction, vulnerability analysis

Procedia PDF Downloads 134
2691 Examining College Students’ Attitudes toward Diversity Environments in a Physical Activity Course

Authors: Young Ik Suh, Sanghak Lee, Tae Wook Chung

Abstract:

In recent year, cultural diversity has acquired increasing attentions in our society due to the cultural pluralism and globalization. With the emphasis of diversity in our society, higher education has played a significant role in preparing people to be successful in a diverse world. A number of colleges and universities provide various diversity-related courses that enhance students to recognize the importance of diversity and multiculturalism. However, little research has been conducted with diversity environments in physical activity and sports-related courses to appreciate students’ attitudes toward multiculturalism. Physical activity courses can be regarded as an essential and complementary part of general education. As well, playing and watching certain sports plays a critical role to foster mutual understanding between different races and to help social integration for minority communities. Therefore, it is expected that the appropriate diverse environments in physical activity courses may have a positive impact to the understandings of different cultures and races. The primary purpose of this study is to examine attitudes toward cultural diversity in a physical activity course among undergraduate students. In building on the scholarly foundation in this area, this study applies the established survey scale (e.g., Pluralism and Diversity Attitude Assessment [PADAA]) developed by Stanley (1996) and previous literature related to cultural diversity. The PADAA includes 19 questions. The following two research hypotheses were proposed. H1: Students who take a diversity-related physical course (i.e., Taekwondo) will provide positive attitude changes toward their cultural diversity. H2: Students who take a general physical activity course (i.e., Weight Training) will provide no significant attitude changes toward their cultural diversity. To test the research hypotheses, subjects will be selected from the both Taekwondo and Weight Training class at University of West Georgia. In the Taekwondo class, students will learn the history, meaning, basic terminology, and physical skills, which is a Korean martial art and the national sport of Korea. In the Weight Training class, students will not be exposed to any cultural diversity topics. Regarding data analysis, Doubly Multivariate Analysis of Covariance (Doubly MANCOVA), 2 (time period: pre and after) X 2 (diversity-related content exposure: Taekwondo and Weight Training), will be conducted on attitudes toward the cultural diversity with control variables such as gender and age. The findings of this study will add to the body of literature in cultural diversity because this will be the first known attempt to explain the college students’ attitudes toward cultural diversity in a physical activity courses. The expected results will state that the physical activity course focusing on diversity issues will have a positive impact on college students’ attitude toward cultural diversity. This finding will indicate that Universities need to create diverse programs (e.g., study abroad, exchange program, second language courses) and environments so that students can have positive interactions with other groups of races and different cultures. It is also expected that the positive perceptions and attitudes toward cultural diversity will break down cultural barriers and make students be ready for meeting several challenges in a multicultural and global society.

Keywords: cultural diversity, physical activity course, attitude, Taekwondo

Procedia PDF Downloads 238
2690 Time, Uncertainty, and Technological Innovation

Authors: Xavier Everaert

Abstract:

Ever since the publication of “The Problem of Social” cost, Coasean insights on externalities, transaction costs, and the reciprocal nature of harms, have been widely debated. What has been largely neglected however, is the role of technological innovation in the mitigation of negative externalities or transaction costs. Incorporating future uncertainty about negligence standards or expected restitution costs and the profit opportunities these uncertainties reveal to entrepreneurs, allow us to frame problems regarding social costs within the reality of rapid technological evolution.

Keywords: environmental law and economics, entrepreneurship, commons, pollution, wildlife

Procedia PDF Downloads 395
2689 Energy Interaction among HVAC and Supermarket Environment

Authors: Denchai Woradechjumroen, Haorong Li, Yuebin Yu

Abstract:

Supermarkets are the most electricity-intensive type of commercial buildings. The unsuitable indoor environment of a supermarket provided by abnormal HVAC operations incurs waste energy consumption in refrigeration systems. This current study briefly describes significantly solid backgrounds and proposes easy-to-use analysis terminology for investigating the impact of HVAC operations on refrigeration power consumption using the field-test data obtained from building automation system (BAS). With solid backgrounds and prior knowledge, expected energy interactions between HVAC and refrigeration systems are proposed through Pearson’s correlation analysis (R value) by considering correlations between equipment power consumption and dominantly independent variables (driving force conditions). The R value can be conveniently utilized to evaluate how strong relations between equipment operations and driving force parameters are. The calculated R values obtained from field data are compared to expected ranges of R values computed by energy interaction methodology. The comparisons can separate the operational conditions of equipment into faulty and normal conditions. This analysis can simply investigate the condition of equipment operations or building sensors because equipment could be abnormal conditions due to routine operations or faulty commissioning processes in field tests. With systematically solid and easy-to-use backgrounds of interactions provided in the present article, the procedures can be utilized as a tool to evaluate the proper commissioning and routine operations of HVAC and refrigeration systems to detect simple faults (e.g. sensors and driving force environment of refrigeration systems and equipment set-point) and optimize power consumption in supermarket buildings. Moreover, the analysis will be used to further study FDD research for supermarkets in future.

Keywords: energy interaction, HVAC, R-value, supermarket buildings

Procedia PDF Downloads 398
2688 Family Quality of Life in the Context of Pediatric Sickle Cell Disease in Oman

Authors: Wafa Al Jabri

Abstract:

Sickle cell disease (SCD) is a genetic blood disorder that is characterized by a severe painful crisis. SCD among children requires long term dependencies and high caregiving demands that increase the overall family burdens. It is, therefore, essential to examine, support, and promote the well-being of families of children with SCD. Although there has been considerable progress in the international research on family quality of life (FQOL) in recent years; however, research in this field is relatively recent and diverse. Oman is a country in which family quality of life has definitely been under-researched. Therefore, the purpose of the study is to describe the FQOL in families of children with SCD in Oman. The study will also examine the relationships between child, mother, and family-related factors that may influence the overall FQOL. Theoretical Framework: The study is guided by the unified theory of family quality of life to help in understanding the concept of FQOL and the factors that shape it. Method:A convenience sample of 98 mothers of children with SCD will be recruited from the pediatric hematology clinic at Sultan Qaboos University Hospital in Oman to participate in this descriptive, cross sectional, correlational study. Data will be obtained using a self-administered questionnaire that includes child and mother socio-demographic data, questions about the number of visits and admissions to health care facilities for vaso- occlusive crises (VOCs), the Perceived Stress Scale-10, and the Beachcenter-FQOL scale. Anticipated Results: It is expected to find an association among frequency of VOCs, mother’s perceived stress level, and FQOL in families of children with SCD in Oman. Family type, socio-economic status, and number of SCD children in the family are also expected to influence the overall FQOL. Conclusion: The findings of the study might be pivotal in designing and implementing tailored family-based interventions to improve families’ wellbeing.

Keywords: family quality of life, sickle cell disaes, children, family well-being

Procedia PDF Downloads 103
2687 Prediction of Seismic Damage Using Scalar Intensity Measures Based on Integration of Spectral Values

Authors: Konstantinos G. Kostinakis, Asimina M. Athanatopoulou

Abstract:

A key issue in seismic risk analysis within the context of Performance-Based Earthquake Engineering is the evaluation of the expected seismic damage of structures under a specific earthquake ground motion. The assessment of the seismic performance strongly depends on the choice of the seismic Intensity Measure (IM), which quantifies the characteristics of a ground motion that are important to the nonlinear structural response. Several conventional IMs of ground motion have been used to estimate their damage potential to structures. Yet, none of them has been proved to be able to predict adequately the seismic damage. Therefore, alternative, scalar intensity measures, which take into account not only ground motion characteristics but also structural information have been proposed. Some of these IMs are based on integration of spectral values over a range of periods, in an attempt to account for the information that the shape of the acceleration, velocity or displacement spectrum provides. The adequacy of a number of these IMs in predicting the structural damage of 3D R/C buildings is investigated in the present paper. The investigated IMs, some of which are structure specific and some are nonstructure-specific, are defined via integration of spectral values. To achieve this purpose three symmetric in plan R/C buildings are studied. The buildings are subjected to 59 bidirectional earthquake ground motions. The two horizontal accelerograms of each ground motion are applied along the structural axes. The response is determined by nonlinear time history analysis. The structural damage is expressed in terms of the maximum interstory drift as well as the overall structural damage index. The values of the aforementioned seismic damage measures are correlated with seven scalar ground motion IMs. The comparative assessment of the results revealed that the structure-specific IMs present higher correlation with the seismic damage of the three buildings. However, the adequacy of the IMs for estimation of the structural damage depends on the response parameter adopted. Furthermore, it was confirmed that the widely used spectral acceleration at the fundamental period of the structure is a good indicator of the expected earthquake damage level.

Keywords: damage measures, bidirectional excitation, spectral based IMs, R/C buildings

Procedia PDF Downloads 298
2686 A Location-Based Search Approach According to Users’ Application Scenario

Authors: Shih-Ting Yang, Chih-Yun Lin, Ming-Yu Li, Jhong-Ting Syue, Wei-Ming Huang

Abstract:

Global positioning system (GPS) has become increasing precise in recent years, and the location-based service (LBS) has developed rapidly. Take the example of finding a parking lot (such as Parking apps). The location-based service can offer immediate information about a nearby parking lot, including the information about remaining parking spaces. However, it cannot provide expected search results according to the requirement situations of users. For that reason, this paper develops a “Location-based Search Approach according to Users’ Application Scenario” according to the location-based search and demand determination to help users obtain the information consistent with their requirements. The “Location-based Search Approach based on Users’ Application Scenario” of this paper consists of one mechanism and three kernel modules. First, in the Information Pre-processing Mechanism (IPM), this paper uses the cosine theorem to categorize the locations of users. Then, in the Information Category Evaluation Module (ICEM), the kNN (k-Nearest Neighbor) is employed to classify the browsing records of users. After that, in the Information Volume Level Determination Module (IVLDM), this paper makes a comparison between the number of users’ clicking the information at different locations and the average number of users’ clicking the information at a specific location, so as to evaluate the urgency of demand; then, the two-dimensional space is used to estimate the application situations of users. For the last step, in the Location-based Search Module (LBSM), this paper compares all search results and the average number of characters of the search results, categorizes the search results with the Manhattan Distance, and selects the results according to the application scenario of users. Additionally, this paper develops a Web-based system according to the methodology to demonstrate practical application of this paper. The application scenario-based estimate and the location-based search are used to evaluate the type and abundance of the information expected by the public at specific location, so that information demanders can obtain the information consistent with their application situations at specific location.

Keywords: data mining, knowledge management, location-based service, user application scenario

Procedia PDF Downloads 86
2685 Providing Healthy Food in Primary and Secondary Schools of Saudi Arabia to Significantly Reduce Obesity and Improve Health by Using the Star Rating System for a Healthier Diet

Authors: Emran M. Badghish

Abstract:

Overweight and obesity have now become an epidemic around the globe, both in high-, as well as low-income regions. It is important to use preventive measures that are cost-effective. Schools are the essence of building societies and engaging them in healthy nutrition will offer a way to reach individuals at an early stage in life, with many positive and significant impacts. Aim: Provide healthy food in schools of children aged 5 to 18 years old. Methods: Distributing healthy food to a school and implementation of a star rating system for healthier foods, with five stars for the healthiest option to a half a star for the unhealthiest. The stars system was developed in Australia and should motivate children to consume the healthier nutritional options. Each canteen should be allowed a minimum of 3.5 stars rating for the food provided. Outcome Measurement: Body-mass-index as an indicator of overweight and obesity should be checked at the beginning of the study annually for five years for all children. Another side measurement is the performance by checking the grades and a questionnaire on eating habits at the start of the study and yearly. Expected Outcome: A lower health-risk behaviour and assistance to children in reaching their potentials as they will adapt to eating healthier. Nutrition during childhood has the potential to prevent obesity, type 2 diabetes, dental diseases, hypertension and, in later life, cardiovascular disease, osteoporosis and a variety of cancers. In Australia NSW starting from 2016 is expecting a 5% reduction of childhood overweight and obesity by 2025. As for Saudi-Arabia, it is expected to have an, even more, reduction by 2023 as a lot of our children are canteen-dependent. Conclusion: Introducing healthy food in schools is a preventative method that would have significant influence on the reduction of the prevalence of obesity in Saudi-Arabia and improves its general health.

Keywords: food, healthy, children, obesity, schools

Procedia PDF Downloads 161
2684 Review of Vehicle to Grid Applications in Recent Years

Authors: Afsane Amiri

Abstract:

Electric Vehicle (EV) technology is expected to take a major share in the light-vehicle market in the coming decades. Charging of EVs will put an extra burden on the distribution grid and in some cases adjustments will need to be made. In this paper a review of different plug-in and vehicle to grid (V2G) capable vehicles are given along with their power electronics topologies. The economic implication of charging the vehicle or sending power back to the utility is described in brief.

Keywords: energy storage system, battery unit, cost, optimal sizing, plug-in electric vehicles (PEVs), smart grid

Procedia PDF Downloads 573
2683 Pavement Management for a Metropolitan Area: A Case Study of Montreal

Authors: Luis Amador Jimenez, Md. Shohel Amin

Abstract:

Pavement performance models are based on projections of observed traffic loads, which makes uncertain to study funding strategies in the long run if history does not repeat. Neural networks can be used to estimate deterioration rates but the learning rate and momentum have not been properly investigated, in addition, economic evolvement could change traffic flows. This study addresses both issues through a case study for roads of Montreal that simulates traffic for a period of 50 years and deals with the measurement error of the pavement deterioration model. Travel demand models are applied to simulate annual average daily traffic (AADT) every 5 years. Accumulated equivalent single axle loads (ESALs) are calculated from the predicted AADT and locally observed truck distributions combined with truck factors. A back propagation Neural Network (BPN) method with a Generalized Delta Rule (GDR) learning algorithm is applied to estimate pavement deterioration models capable of overcoming measurement errors. Linear programming of lifecycle optimization is applied to identify M&R strategies that ensure good pavement condition while minimizing the budget. It was found that CAD 150 million is the minimum annual budget to good condition for arterial and local roads in Montreal. Montreal drivers prefer the use of public transportation for work and education purposes. Vehicle traffic is expected to double within 50 years, ESALS are expected to double the number of ESALs every 15 years. Roads in the island of Montreal need to undergo a stabilization period for about 25 years, a steady state seems to be reached after.

Keywords: pavement management system, traffic simulation, backpropagation neural network, performance modeling, measurement errors, linear programming, lifecycle optimization

Procedia PDF Downloads 431
2682 Pulse Generator with Constant Pulse Width

Authors: Rozita Borhan, Hanif Che Lah, Wee Leong Son

Abstract:

This paper is about method to produce a stable and accurate constant output pulse width regardless of the amplitude, period and pulse width variation of the input signal source. The pulse generated is usually being used in numerous applications as the reference input source to other circuits in the system. Therefore, it is crucial to produce a clean and constant pulse width to make sure the system is working accurately as expected.

Keywords: amplitude, Constant Pulse Width, frequency divider, pulse generator

Procedia PDF Downloads 362
2681 Post Occupancy Evaluation of Thermal Comfort and User Satisfaction in a Green IT Commercial Building

Authors: Shraddha Jadhav

Abstract:

We are entering a new age in the built environment where we expect our buildings to deliver far more than just a place to work or live. It is widely believed that sustainable building design strategies create improved occupants’ comfort & satisfaction with respect to thermal comfort & indoor environmental quality. Yet this belief remains a hypothesis with little empirical support. IT buildings cater to more than 3000 users at a time. Nowadays people spend 90% of the time inside offices. These sustainable IT office buildings should provide the occupants with maximum comfort for better work productivity. Such green rated buildings fulfill all the criteria at the designing stage, but do they really work as expected at the occupancy stage. The aim of this paper is to evaluate whether green IT buildings provide the required comfort level as expected at the design stage. Building Occupants are a rich source of information for evaluating their comfort level in the building and to find out the solutions for their discomfort. This can be achieved by carrying out Post Occupancy Evaluation after the building has been occupied for more than a year or two. The technique consists of qualitative methods like questionnaire surveys & observations and quantitative methods like field measurements, photographs. Post Occupancy Evaluation was carried out in a Green (Platinum rated) IT building in Pune. 30 samples per floor were identified for the questionnaire survey. The core questions access occupant satisfaction with thermal comfort in the work area and measures adopted for making it comfortable were identified. The Mean Radiant Temperature of the same samples was taken to compare the quantitative and qualitative results. The survey was used to evaluate the occupant thermal comfort in a green office building and identify areas needing improvement. The survey has been designed in reference to ASHRAE standard 55-2010 & ISHRAE 10001:2017 IEQ and was further refined to suit the user of the building.

Keywords: green office building, building occupant, thermal comfort, POE, user satisfaction, survey

Procedia PDF Downloads 45
2680 Budget Impact Analysis of a Stratified Treatment Cascade for Hepatitis C Direct Acting Antiviral Treatment in an Asian Middle-Income Country through the Use of Compulsory and Voluntary Licensing Options

Authors: Amirah Azzeri, Fatiha H. Shabaruddin, Scott A. McDonald, Rosmawati Mohamed, Maznah Dahlui

Abstract:

Objective: A scaled-up treatment cascade with direct-acting antiviral (DAA) therapy is necessary to achieve global WHO targets for hepatitis C virus (HCV) elimination in Malaysia. Recently, limited access to Sofosbuvir/Daclatasvir (SOF/DAC) is available through compulsory licensing, with future access to Sofosbuvir/Velpatasvir (SOF/VEL) expected through voluntary licensing due to recent agreements. SOF/VEL has superior clinical outcomes, particularly for cirrhotic stages, but has higher drug acquisition costs compared to SOF/DAC. It has been proposed that a stratified treatment cascade might be the most cost-efficient approach for Malaysia whereby all HCV patients are treated with SOF/DAC except for patients with cirrhosis who are treated with SOF/VEL. This study aimed to conduct a five-year budget impact analysis from the provider perspective of the proposed stratified treatment cascade for HCV treatment in Malaysia. Method: A disease progression model that was developed based on model-predicted HCV epidemiology data in Malaysia was used for the analysis, where all HCV patients in scenario A were treated with SOF/DAC for all disease stages while in scenario B, SOF/DAC was used only for non-cirrhotic patients and SOF/VEL was used for the cirrhotic patients. The model projections estimated the annual numbers of patients in care and the numbers of patients to be initiated on DAA treatment nationally. Healthcare costs associated with DAA therapy and disease stage monitoring was included to estimate the downstream cost implications. For scenario B, the estimated treatment uptake of SOF/VEL for cirrhotic patients were 25%, 50%, 75%, 100% and 100% for 2018, 2019, 2020, 2021 and 2022 respectively. Healthcare costs were estimated based on standard clinical pathways for DAA treatment described in recent guidelines. All costs were reported in US dollars (conversion rate US$1=RM4.09, the price year 2018). Scenario analysis was conducted for 5% and 10% reduction of SOF/VEL acquisition cost anticipated from the competitive market pricing of generic DAA in Malaysia. Results: The stratified treatment cascade with SOF/VEL in Scenario B was found to be cost-saving compared to Scenario A. A substantial portion of the cost reduction was due to the costs associated with DAA therapy which resulted in USD 40 thousand (year 1) to USD 443 thousand (year 5) savings annually, with cumulative savings of USD 1.1 million after 5 years. Cost reductions for disease stage monitoring were seen in year three onwards which resulted in cumulative savings of USD 1.1 thousand. Scenario analysis estimated cumulative savings of USD 1.24 to USD 1.35 million when the acquisition cost of SOF/VEL was reduced. Conclusion: A stratified treatment cascade with SOF/VEL was expected to be cost-saving and can results in a budget impact reduction in overall healthcare expenditure in Malaysia compared to treatment with SOF/DAC. The better clinical efficacy with SOF/VEL is expected to halt patients’ HCV disease progression and may reduce downstream costs of treating advanced disease stages. The findings of this analysis may be useful to inform healthcare policies for HCV treatment in Malaysia.

Keywords: Malaysia, direct acting antiviral, compulsory licensing, voluntary licensing

Procedia PDF Downloads 141