Search results for: hybrid virtual clinic

Authors: Mike Wei, Mario Cedillo, Jiahui Lin, Carol Lorraine Storey-Johnson, Carla Boutin-Foster

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Purpose: The extent to which health insurance enrollment succeeds under the Affordable Care Act (ACA) rests heavily on the ability to reach the uninsured and motivate them to enroll. We sought to identify perceptions about the ACA among uninsured patients at a free clinic in New York City. Background: The ACA holds tremendous promise for reducing the number of uninsured Americans. As of April 2014, nearly 8 million people had signed up for health insurance through the Health Insurance Marketplace. Despite this early success, future and continued enrollment rests heavily on the degree of public awareness. Reaching eligible individuals and increasing their awareness and understanding remains a fundamental challenge to realizing the full potential of the ACA. Reaching out to uninsured patients who are seeking care through safety net facilities such as free clinics may provide important avenues for reaching potential enrollees. This project focuses on the experience at the free clinic at Weill Cornell Medical College, the Weill Cornell Community Clinic (WCCC), and seeks to understand perceptions about the ACA among its patient population. Methods: This was a cross-sectional study of all patients who visited the free clinic at Weill Cornell Medical College, the Weill Cornell Community Clinic, from July 2013 to May 2014. Patients who provided informed consent at their visit and completed a semi-structured questionnaire were included (N=62). The questionnaire comprised of questions about demographic characteristics and open-ended questions about their knowledge and perception of the impact of the ACA. Descriptive statistics were used to characterize the population demographics. Qualitative coding techniques were used for open-ended items. Results: Approximately one third of patients surveyed never had health insurance. Of the remaining 65%, 20% lost their insurance within the past year. Only 55% had heard about the ACA, and only 10% knew about the Health Benefits Exchange. Of those who had heard about the ACA, sentiments were tinged with optimistic misperceptions, such as “it will be free health care for all.” While optimistic, most of the responses focused on the economic implications of the ACA. Conclusions: These findings reveal the immense amount of misconception and lack of understanding with regards to the ACA. As such, the study highlights the need to educate and address the concerns of those who remain skeptical or uncertain about the implications of the ACA.

Keywords: Affordable Care Act, demographics, free clinics, underserved.

Procedia PDF Downloads 363

Authors: Amirhossein Safi

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Internet of things (IOT) is a kind of advanced information technology which has drawn societies’ attention. Sensors and stimulators are usually recognized as smart devices of our environment. Simultaneously, IOT security brings up new issues. Internet connection and possibility of interaction with smart devices cause those devices to involve more in human life. Therefore, safety is a fundamental requirement in designing IOT. IOT has three remarkable features: overall perception, reliable transmission, and intelligent processing. Because of IOT span, security of conveying data is an essential factor for system security. Hybrid encryption technique is a new model that can be used in IOT. This type of encryption generates strong security and low computation. In this paper, we have proposed a hybrid encryption algorithm which has been conducted in order to reduce safety risks and enhancing encryption's speed and less computational complexity. The purpose of this hybrid algorithm is information integrity, confidentiality, non-repudiation in data exchange for IOT. Eventually, the suggested encryption algorithm has been simulated by MATLAB software, and its speed and safety efficiency were evaluated in comparison with conventional encryption algorithm.

Keywords: internet of things, security, hybrid algorithm, privacy

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Authors: O’Day Luke

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Purpose: To validate virtual non-contrast reconstructions generated from dual-layer spectral computed tomography (DL-CT) data as an alternative for the acquisition of a dedicated true non-contrast dataset during multiphase contrast studies. Material and methods: Thirty-three patients underwent a routine multiphase clinical CT examination, using Dual-Layer Spectral CT, from March to August 2021. True non-contrast (TNC) and virtual non-contrast (VNC) datasets, generated from both portal venous and arterial phase imaging were evaluated. For every patient in both true and virtual non-contrast datasets, a region-of-interest (ROI) was defined in aorta, liver, fluid (i.e. gallbladder, urinary bladder), kidney, muscle, fat and spongious bone, resulting in 693 ROIs. Differences in attenuation for VNC and TNV images were compared, both separately and combined. Consistency between VNC reconstructions obtained from the arterial and portal venous phase was evaluated. Results: Comparison of CT density (HU) on the VNC and TNC images showed a high correlation. The mean difference between TNC and VNC images (excluding bone results) was 5.5 ± 9.1 HU and > 90% of all comparisons showed a difference of less than 15 HU. For all tissues but spongious bone, the mean absolute difference between TNC and VNC images was below 10 HU. VNC images derived from the arterial and the portal venous phase showed a good correlation in most tissue types. The aortic attenuation was somewhat dependent however on which dataset was used for reconstruction. Bone evaluation with VNC datasets continues to be a problem, as spectral CT algorithms are currently poor in differentiating bone and iodine. Conclusion: Given the increasing availability of DL-CT and proven accuracy of virtual non-contrast processing, VNC is a promising tool for generating additional data during routine contrast-enhanced studies. This study shows the utility of virtual non-contrast scans as an alternative for true non-contrast studies during multiphase CT, with potential for dose reduction, without loss of diagnostic information.

Keywords: dual-layer spectral computed tomography, virtual non-contrast, true non-contrast, clinical comparison

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Authors: Maryam Kheirollahpour, Mahmoud Danaee, Amir Faisal Merican, Asma Ahmad Shariff

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Background: The presence of nonlinearity among the risk factors of eating behavior causes a bias in the prediction models. The accuracy of estimation of eating behaviors risk factors in the primary prevention of obesity has been established. Objective: The aim of this study was to explore the potential of a hybrid model of structural equation modeling (SEM) and Artificial Neural Networks (ANN) to predict eating behaviors. Methods: The Partial Least Square-SEM (PLS-SEM) and a hybrid model (SEM-Artificial Neural Networks (SEM-ANN)) were applied to evaluate the factors affecting eating behavior patterns among university students. 340 university students participated in this study. The PLS-SEM analysis was used to check the effect of emotional eating scale (EES), body shape concern (BSC), and body appreciation scale (BAS) on different categories of eating behavior patterns (EBP). Then, the hybrid model was conducted using multilayer perceptron (MLP) with feedforward network topology. Moreover, Levenberg-Marquardt, which is a supervised learning model, was applied as a learning method for MLP training. The Tangent/sigmoid function was used for the input layer while the linear function applied for the output layer. The coefficient of determination (R²) and mean square error (MSE) was calculated. Results: It was proved that the hybrid model was superior to PLS-SEM methods. Using hybrid model, the optimal network happened at MPLP 3-17-8, while the R² of the model was increased by 27%, while, the MSE was decreased by 9.6%. Moreover, it was found that which one of these factors have significantly affected on healthy and unhealthy eating behavior patterns. The p-value was reported to be less than 0.01 for most of the paths. Conclusion/Importance: Thus, a hybrid approach could be suggested as a significant methodological contribution from a statistical standpoint, and it can be implemented as software to be able to predict models with the highest accuracy.

Keywords: hybrid model, structural equation modeling, artificial neural networks, eating behavior patterns

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Authors: Seyyed Mohammad Hasheminia, Heoung Jae Chun, Jong Chan Park, Hong Suk Chang

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Composite joints have been getting attention recently due to their high specific mechanical strength to weight ratio that is crucial for structures such as aircrafts and automobiles. In this study on hybrid joints, quasi-static experiments and finite element analysis were performed to investigate the failure mechanism of hybrid composite joint with respect to the joint properties such as the adhesive material, clamping force, and joint geometry. The outcomes demonstrated that the stiffness of the adhesive is the most imperative design parameter. In this investigation, two adhesives with various stiffness values were utilized. Regarding the joints utilizing the adhesive with the lower stiffness modulus, it was observed that the load was exchanged promptly through the adhesive since it was shared more proficiently between the bolt and adhesive. This phenomenon permitted the hybrid joints with low-modulus adhesive to support more prominent loads before failure when contrasted with the joints that utilize the stiffer adhesive. In the next step, the stress share between the bond and bolt as a function of various design parameters was studied using a finite element model in which it was understood that the geometrical parameters such as joint overlap and width have a significant influence on the load sharing between the bolt and the adhesive.

Keywords: composite joints, composite materials, hybrid joints, single-lap joint

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Authors: Dhiraj Biswas, Chaitali Ray

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A modified refined higher order zigzag theory has been developed in this paper in order to compute the accurate interlaminar stresses within hybrid laminates. Warping has significant effect on the mechanical behaviour of the laminates. To the best of author(s)’ knowledge the stress analysis of hybrid laminates is not reported in the published literature. The present paper aims to develop a new C0 continuous element based on the refined higher order zigzag theories considering warping effect in the formulation of hybrid laminates. The eight noded isoparametric plate bending element is used for the flexural analysis of laminated composite plates to study the performance of the proposed model. The transverse shear stresses are computed by using the differential equations of stress equilibrium in a simplified manner. A computer code has been developed using MATLAB software package. Several numerical examples are solved to assess the performance of the present finite element model based on the proposed higher order zigzag theory by comparing the present results with three-dimensional elasticity solutions. The present formulation is validated by comparing the results obtained from the relevant literature. An extensive parametric study has been carried out on the hybrid laminates with varying percentage of materials and angle of orientation of fibre content.

Keywords: hybrid laminate, Interlaminar stress, refined higher order zigzag theory, warping effect

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Authors: Hana Maresova, Daniel Ecler

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The paper focuses on the use of 3D multi-user virtual environments (MUVE) in language teaching and presents the results of four years of research at the Faculty of Education, Palacký University in Olomouc (Czech Republic). In the form of an experiment, mother tongue language teaching in the 3D virtual worlds Second Life and Kitely (experimental group) and parallel traditional teaching on identical topics representing teacher's interpretation using a textbook (control group) were implemented. The didactic test, which was presented to the experimental and control groups in an identical form before and after the instruction, verified the effect of the instruction in the experimental group by comparing the results obtained by both groups. Within the three components of mother-tongue teaching (vocabulary, literature, style and communication education), the students in the literature group achieved partially better results (statistically significant in the case of items devoted to the area of visualization of the learning topic), while in the case of grammar and style education the respondents of the control group achieved better results. On the basis of the results obtained, we can conclude that the most appropriate use of MUVE can be seen in the teaching of those topics that provide the possibility of dramatization, experiential learning and group involvement and cooperation, on the contrary, with regard to the need to divide students attention between the topic taught and the control of avatar and movement in virtual reality as less suitable for teaching in the area of memorization of the topic or concepts.

Keywords: distance learning, 3D virtual environments, online teaching, language teaching

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Authors: Lalith Edirisinghe, Zhihong Jin, A.W. Wijeratne, Hansa Edirisinghe, Lakshmi Ranwala Rashika Mudunkotuwa

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A paradigm shift in container inventory management (CIM) is a long-awaited industry need. Virtual container yard (VCY) is a concept developed in 2013 and its primary objective is to minimize shipping transport cost through implementing container exchange between carriers. Shipping lines always try to maintain lower container idle time and provide higher customer satisfaction. However, it is disappointing to note that carriers turn a blind eye to the escalating cost resulted from the present inefficient CIM mechanism. The cost of empty container management is simply transferred to the importers and exporters as freight adjustments. It also creates an environmental hazard. Therefore, it has now become a problem for the society. Therefore, a paradigm shift may be required as the present CIM system is not working for common interests of human beings as it should be.

Keywords: collaboation, inventory, shipping, virtual container yard

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Authors: R. Gopakumar, G. Nagarajan

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Both DI and IDI systems possess inherent advantages as well as disadvantages. The objective of the present work is to obtain maximum advantages of both systems by implementing a hybrid design. A hybrid combustion chamber design consists of two combustion chambers viz., the main combustion chamber and an auxiliary combustion chamber. A fuel injector supplies major quantity of fuel to the auxiliary chamber. Due to the increased swirl motion in auxiliary chamber, mixing becomes more efficient which contributes to reduction in soot/particulate emissions. Also, by increasing the fuel injection pressure, NOx emissions can be reduced. The main objective of the hybrid combustion chamber design is to merge the positive features of both DI and IDI combustion chamber designs, which provides increased swirl motion and improved thermal efficiency. Due to the efficient utilization of fuel, low specific fuel consumption can be ensured. This system also aids in increasing the power output for same compression ratio and injection timing as compared with the conventional combustion chamber designs. The present system also reduces heat transfer and fluid dynamic losses which are encountered in IDI diesel engines. Since the losses are reduced, overall efficiency of the engine increases. It also minimizes the combustion noise and NOx emissions in conventional DI diesel engines.

Keywords: DI, IDI, hybrid combustion, diesel engines

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Authors: Sfiso Radebe

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The design models dealing with flawless composite structures are in abundance, where the mechanical properties of composite structures are assumed to be known a priori. However, if the worst case scenario is assumed, where material defects combined with processing anomalies in composite structures are expected, a different solution is attained. Furthermore, if the system being designed combines in series hybrid elements, individually affected by material constant variations, it implies that a different approach needs to be taken. In the body of literature, there is a compendium of research that investigates different modes of failure affecting hybrid metal-composite structures. It covers areas pertaining to the failure of the hybrid joints, structural deformation, transverse displacement, the suppression of vibration and noise. In the present study a system employing a combination of two or more hybrid power transmitting elements will be explored for the least favourable dynamic loads as well as weight minimization, subject to uncertain material properties. Elastic constants are assumed to be uncertain-but-bounded quantities varying slightly around their nominal values where the solution is determined using convex models of uncertainty. Convex analysis of the problem leads to the computation of the least favourable solution and ultimately to a robust design. This approach contrasts with a deterministic analysis where the average values of elastic constants are employed in the calculations, neglecting the variations in the material properties.

Keywords: convex modelling, hybrid, metal-composite, robust design

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Authors: Miriam Eduful

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The Electricity Company of Ghana (ECG) is under obligation, demanded by the Public Utility and Regulation Commission to meet set performance indices. However, in certain parts of the country, bamboo related power interruptions have become a challenge. Growth rate of the bamboo is such that the cost of regular vegetation maintenance along route of the overhead power lines has become prohibitive. To address the problem, several methods and techniques of bamboo eradication have being used. Some of these methods involved application of chemical compounds that are considered inimical and dangerous to the environment. In this paper, three methods of bamboo eradication along the route of the ECG overhead power lines have been investigated. A hybrid method has been found to be very effective and ecologically friendly. The method is locally available and comparatively inexpensive to apply.

Keywords: bamboo, eradication, hybrid method, gly gold

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Authors: Kazuo Kiguchi, Kouta Ikegami

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In the case of physically weak persons, not only motor abilities, but also sensory abilities are sometimes deteriorated. The concept of perception-assist has been proposed to assist the sensory ability of the physically weak persons with a power-assist robot. Since upper-limb motion is very important in daily living, perception-assist for upper-limb motion has been proposed to assist upper-limb motion in daily living. A virtual tunnel was applied to modify the user’s upper-limb motion if it was necessary. In this paper, effective shape of the virtual tunnel which is applied in the perception-assist for upper-limb motion is proposed. Not only the position of the grasped tool but also the angle of the grasped tool are modified if it is necessary. Therefore, the upper-limb motion in daily living can be effectively modified to realize certain proper daily motion. The effectiveness of the proposed virtual tunnel was evaluated by performing the experiments.

Keywords: motion modification, power-assist robots, perception-assist, upper-limb motion

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Authors: Ilirian Laçi, Alketa Spahiu

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Modality of treatment in hepatocellular carcinoma (HCC) patients depends on the stage of the disease. The Barcelona Clinic Liver Cancer Classification (BCLC) is the preferred staging system. There are many patients initially present with intermediate-stage disease. For these patients, transarterial chemoembolization (TACE) is the treatment of choice. The differences in individual factors that are not captured by the BCLC framework, such as the tumor growth pattern, degree of hypervascularity, and vascular supply, complicate further evaluation of these patients. Because of these differences, not all patients benefit equally from TACE. Several tools have been devised to aid the decision-making process, which have shown promising initial results but have failed external evaluation and have not been translated to the clinic aspects. Criteria for treatment decisions in daily clinical practice are needed in all stages of the disease.

Keywords: hepatocellular carcinoma, transarterial chemoembolization, TACE, liver

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Authors: Satya Pradhan, Venky Nanniyur

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As the software industry transitions from a license-based model to a subscription-based Software-as-a-Service (SaaS) model, many software development groups are using a hybrid development model that incorporates Agile and Waterfall methodologies in different parts of the organization. The traditional metrics used for measuring software quality in Waterfall or Agile paradigms do not apply to this new hybrid methodology. In addition, to respond to higher quality demands from customers and to gain a competitive advantage in the market, many companies are starting to prioritize quality as a strategic differentiator. As a result, quality metrics are included in the decision-making activities all the way up to the executive level, including board of director reviews. This paper presents key challenges associated with measuring software quality in organizations using the hybrid development model. We introduce a framework called Prevention-Inspection-Evaluation-Removal (PIER) to provide a comprehensive metric definition for hybrid organizations. The framework includes quality measurements, quality enforcement, and quality decision points at different organizational levels and project milestones. The metrics framework defined in this paper is being used for all Cisco systems products used in customer premises. We present several field metrics for one product portfolio (enterprise networking) to show the effectiveness of the proposed measurement system. As the results show, this metrics framework has significantly improved in-process defect management as well as field quality.

Keywords: quality management system, quality metrics framework, quality metrics, agile, waterfall, hybrid development system

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Authors: Juliana Bom-Tempo

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The proposed composition occurs between images, performances, clinics and philosophies. For this enterprise we depart for what is not known beforehand, so with a question as a compass: "would it be in the creation, production and implementation of images in a performance a 'when' for the event of a poetic clinic?” In light of this, there are, in order to think a 'when' of the event of a poetic clinic, images in performances created, produced and executed in partnerships with the author of this text. Faced with this composition, we built four indicators to find spatiotemporal coordinates that would spot that "when", namely: risk zones; the mobilizations of the signs; the figuring of the flesh and an education of the affections. We dealt with the images in performances; Crútero; Flesh; Karyogamy and the risk of abortion; Egg white; Egg-mouth; Islands, threads, words ... germs; Egg-Mouth-Debris, taken as case studies, by engendering risks areas to promote individuations, which never actualize thoroughly, thus always something of pre-individual and also individuating a environment; by mobilizing the signs territorialized by the ordinary, causing them to vary the language and the words of order dictated by the everyday in other compositions of sense, other machinations; by generating a figure of flesh, disarranging the bodies, isolating them in the production of a ground force that causes the body to leak out and undo the functionalities of the organs; and, finally, by producing an education of affections, by placing the perceptions in becoming and disconnecting the visible in the production of small deserts that call for the creation of a people yet to come. The performance is processed as a problematizing of the images fixed by the ordinary, producing gestures that precipitate the individuation of images in performance, strange to the configurations that gather bodies and spaces in what we call common. Lawrence proposes to think of "people" who continually use umbrellas to protect themselves from chaos. These have the function of wrapping up the chaos in visions that create houses, forms and stabilities; they paint a sky at the bottom of the umbrella, where people march and die. A chaos, where people live and wither. Pierce the umbrella for a desire of chaos; a poet puts himself as an enemy of the convention, to be able to have an image of chaos and a little sun that burns his skin. The images in performances presented, thereby, were moving in search for the power of producing a spatio-temporal "when" putting the territories in risk areas, mobilizing the signs that format the day-to-day, opening the bodies to a disorganization and the production of an education of affections for the event of a poetic clinic.

Keywords: Experimentations , Images in Performances, Poetic Clinic, Risk

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Authors: Wasiu Olaniyi, Ofelia Omitogun

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Hybridization has been of importance in both research and commercial aquaculture due to its benefits such as increased growth rate, sex ratio manipulation, production of sterile species and many other desirable economic traits. In this study, we successfully produced hybrids between crosses of Clariid catfish species of Clarias gariepinus and Heterobranchus bidorsalis for stock improvement. Milt and eggs from parent broodstock of C. gariepinus and H. bidorsalis were collected for both intrageneric and interspecific hybridization, viz: same parent species crosses (♀C. gariepinus ×♂C. gariepinus; ♀H. bidorsalis × ♂H. bidorsalis) and inter-specific crosses (♀H. bidorsalis × ♂C. gariepinus; ♀C. gariepinus × ♂H. bidorsalis). These crosses were made in triplicates whereby the data on latency period, fertility, hatchability, deformity, and survival were recorded. A phenotypic form of distinction was registered in the hybrid ♀C. gariepinus × ♂H. bidorsalis that was smooth-greyed while its reciprocal cross was marpatic. The parent species C. gariepinus had greyed-marpatic color while the H. bidorsalis was yellowish-brown. Fertility data revealed the significant difference (p < 0.05) between the hybrid cross ♀C. gariepinus × ♂H. bidorsalis (88.00 ± 1.00%) compared to its reciprocal ♀H. bidorsalis × ♂C. gariepinus (71.67 ± 10.41%) which further had carried over effects to hatchability. The reciprocal ♀H. bidorsalis × ♂C. gariepinus recorded the highest deformity (11.67 ± 3.06%) that was significantly different (p < 0.05) from the rest of the crosses. Also, an outcome of equal sex ratio in the hybrids compared with the two parent species was shown. Specific growth rate (SGR) data revealed highest significant difference (p < 0.05) in the hybrid ♀C. gariepinus × ♂H. bidorsalis (2.64 ± 0.09%), followed by the cross of ♀C. gariepinus × ♂ C. gariepinus (1.91 ± 0.02%) while there were no significant differences (p > 0.05) between the reciprocal hybrid ♀H. bidorsalis × ♂C. gariepinus (2.20 ± 0.57%) and ♀H. bidorsalis × ♂H. bidorsalis (2.19 ± 0.19%). The SGR analysis proved that the crosses ♀C. gariepinus × ♂C. gariepinus had slow growth performance compared to its hybrid ♀C. gariepinus × ♂H. bidorsalis. Critical evaluation based on survival and specific growth performance showed the superiority of the hybrid ♀C. gariepinus × ♂H. bidorsalis. The least survival in reciprocal hybrid ♀H. bidorsalis × ♂C. gariepinus (27.33%) can be explained by significant deformity (11.67%) recorded due to maternal effects. Hence, the survival of hybrid ♀C. gariepinus × ♂H. bidorsalis was better.

Keywords: aquaculture, hybridization, Clarias gariepinus, Heterobranchus bidorsalis

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Authors: Dipti Patra, Guguloth Uma, Smita Pradhan

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Registration is a fundamental task in image processing. It is used to transform different sets of data into one coordinate system, where data are acquired from different times, different viewing angles, and/or different sensors. The registration geometrically aligns two images (the reference and target images). Registration techniques are used in satellite images and it is important in order to be able to compare or integrate the data obtained from these different measurements. In this work, mutual information is considered as a similarity metric for registration of satellite images. The transformation is assumed to be a rigid transformation. An attempt has been made here to optimize the transformation function. The proposed image registration technique hybrid PSO-GA incorporates the notion of Particle Swarm Optimization and Genetic Algorithm and is used for finding the best optimum values of transformation parameters. The performance comparision obtained with the experiments on satellite images found that the proposed hybrid PSO-GA algorithm outperforms the other algorithms in terms of mutual information and registration accuracy.

Keywords: image registration, genetic algorithm, particle swarm optimization, hybrid PSO-GA algorithm and mutual information

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Authors: Doaa M. Atia, Faten H. Fahmy, Ninet M. A. El-Rahman, Hassan T. Dorra

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In this paper, the optimum design for renewable energy system powered an aquaculture pond was determined. Hybrid Optimization Model for Electric Renewable (HOMER) software program, which is developed by U.S National Renewable Energy Laboratory (NREL), is used for analyzing the feasibility of the stand-alone and hybrid system in this study. HOMER program determines whether renewable energy resources satisfy hourly electric demand or not. The program calculates energy balance for every 8760 hours in a year to simulate operation of the system. This optimization compares the demand for the electrical energy for each hour of the year with the energy supplied by the system for that hour and calculates the relevant energy flow for each component in the model. The essential principle is to minimize the total system cost while HOMER ensures control of the system. Moreover the feasibility analysis of the energy system is also studied. Wind speed, solar irradiance, interest rate and capacity shortage are the parameters which are taken into consideration. The simulation results indicate that the hybrid system is the best choice in this study, yielding lower net present cost. Thus, it provides higher system performance than PV or wind stand-alone systems.

Keywords: wind stand-alone system, photovoltaic stand-alone system, hybrid system, optimum system sizing, feasibility, cost analysis

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Authors: Christina Tran, Lu Khoo, Andrea Waylen

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Introduction: The evolution of the dental consultation from paternalism to partnership has been well documented in developed Western countries. Great emphasis is now placed on the importance of empowering patients to make decisions regarding their care, obtaining informed consent, and maintaining patient privacy and confidentiality. With the majority of communication occurring non-verbally, clinicians often adopt behaviours which suggest an approachable and positive attitude. However, evidence indicates that in Asia, a paternalistic model may be favored in medicine. The power imbalance occurring in doctor-patient relationships worldwide may be exacerbated by various factors in Southeast Asia: the strong hierarchical culture, and the large education gap between doctor and patient. Further insight into this matter can be gained by observing patient-dentist communication in Cambodia. The dentist:population ratio in Cambodia is approximately 1:33,000, with rural areas remaining extremely underserviced. We have carried out an observational study of communication in a voluntary dental clinic in Cambodia with the aim of describing whether the patient-dentist relationship follows a paternalistic or patient-centred model. Method: Over a period of two weeks, two clinicians provided dental care as part of a voluntary program in two Cambodian settings: a temporary, rural clinic and a permanent clinic in Phnom Penh. The clinicians independently recorded their experiences in diaries, making observations on the verbal and non-verbal communication between patients and staff. General observations such as the clinic environment were also made. The diaries were then compared and analyzed using a thematic approach. Results: The overall themes that emerged were regarding the clinic environment, verbal communication, and non-verbal communication. Regarding the clinic environment, the rural clinic was arranged in order to easily direct patients from one dentist to another, with little emphasis on continuous patient care. There was also little consideration for patient privacy: patients were often treated in the presence of many observers, including other waiting patients. However, the permanent clinic was structured to allow greater patient privacy, with continuous patient care occurring throughout the appointment. Regarding verbal communication, there was a strongly paternalistic approach to gaining consent and giving instruction. Patients rarely asked questions regarding their treatment, with dentists doing little to encourage patient involvement. Non-verbal communication between patients and dentists was generally paternalistic, with the dentist often addressing the supine patient from above. Patients often avoided making eye-contact, which may have indicated discomfort or lack of engagement. Both adult and paediatric patients rarely raised verbal concerns regarding pain during treatment, despite displaying non-verbal signs of experiencing pain. Anxious paediatric patients were sometimes managed with physical restraint by their mothers to facilitate treatment. Conclusion: Patient-professional communication in the Cambodian dental setting was observed to be generally paternalistic in nature, although more patient-centred aspects were observed in the established, urban setting. However, it should be noted that these observations are subjective in nature, and that the patients’ actual perceptions of their communication experience were unexplored. Further observations in variety of dental settings in Cambodia are needed before any definitive conclusions can be made.

Keywords: patient-dentist communication, paternalism, patient-centered, non-verbal communication

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Authors: P.Kiruthika, K. Ramani

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This paper presented the design and advancement of a single-phase 27-level Hybrid Multilevel DC-AC Converter interfacing with Photo Voltaic. In this context, the Multicarrier Pulse Width Modulation method can be implemented in 27-level Hybrid Multilevel Inverter for generating a switching pulse. Perturb & Observer algorithm can be used in the Maximum Power Point Tracking method for the Photo Voltaic system. By implementing Maximum Power Point Tracking with three separate solar panels as an input source to the 27-level Hybrid Multilevel Inverter. This proposed method can be simulated by using MATLAB/simulink. The result shown that the proposed method can achieve silky output wave forms, more flexibility in voltage range, and to reduce Total Harmonic Distortion in medium-voltage drives.

Keywords: Multi Carrier Pulse Width Modulation Technique (MCPWM), Multi Level Inverter (MLI), Maximum Power Point Tracking (MPPT), Perturb and Observer (P&O)

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Authors: Jia-Shiun Chen, Hsiu-Ying Hwang

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Hybrid electric vehicles can reduce pollution and improve fuel economy. Power-split hybrid electric vehicles (HEVs) provide two power paths between the internal combustion engine (ICE) and energy storage system (ESS) through the gears of an electrically variable transmission (EVT). EVT allows ICE to operate independently from vehicle speed all the time. Therefore, the ICE can operate in the efficient region of its characteristic brake specific fuel consumption (BSFC) map. The two-mode powertrain can operate in input-split or compound-split EVT modes and in four different fixed gear configurations. Power-split architecture is advantageous because it combines conventional series and parallel power paths. This research focuses on input-split and compound-split modes in the two-mode power-split powertrain. Fuzzy Logic Control (FLC) for an internal combustion engine (ICE) and PI control for electric machines (EMs) are derived for the urban driving cycle simulation. These control algorithms reduce vehicle fuel consumption and improve ICE efficiency while maintaining the state of charge (SOC) of the energy storage system in an efficient range.

Keywords: hybrid electric vehicle, fuel economy, two-mode hybrid, fuzzy control

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Authors: Mina Mortazavi, Hamid Ronagh, Pezhman Sharafi

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The new concept of a cold formed-hot rolled hybrid steel wall panel system is introduced to overcome the deficiency in lateral load resisting capacity of cold-formed steel structures. The hybrid system is composed of a cold-formed steel part laterally connected to hot rolled part. The hot rolled steel part is responsible for carrying the whole lateral load; while the cold formed steel part is only required to transfer the lateral load to the hot rolled part without any local failure. The vertical load is beared by both hot rolled, and cold formed steel part, proportionally. In order to investigate the lateral performance of the proposed system, it should be tested under simultaneous lateral and vertical load. The main concern is to deliver the loads to each part during the test to simulate the real load distribution in the structure. In this paper, a detailed description of the proposed wall panel system and the designed testing rig is provided.

Keywords: cold-formed steel, hybrid system, wall panel system, testing rig design

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Authors: Deli Mona, Rafika Husni

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The aim of this research is to evaluate the effect of lighting distance on surface hardness of light composite resin. We held laboratory experimental research with post-test only group design. The samples used are 30 disc-like hybrid composite resins with the diameter is 6 mm and the thickness is 2 mm, lighted by an LED for 20 seconds. They were divided into 3 groups, and every group was consisted by 10 samples, which were 0 mm, 2 mm, and 5 mm lighting distance group. Every samples group was treated with hardness test, Vicker Hardness Test, then analyzed with one-way ANOVA test to evaluate the effect of lighting distance differences on surface hardness of light composite resin. Statistic test result shown hardness mean change of composite renin between 0 mm and 2 mm lighting distance with 0.00 significance (p<0.05), between 0 mm and 5 mm lighting distance with 0.00 significance (p<0.05), and 2 mm and 5 mm lighting distance with 0.05 significance (p<0.05). According to the result of this research, we concluded that the further lighting distance, the more surface hardness decline of hybrid composite resin.

Keywords: composite resin hybrid, tip distance, microhardness, light curing LED

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Authors: Jason Ceavers, Travis Thompson, Juan Torres, Ramanakumar Anam, Alan Wong, Andrei Carvalho, Shane Quo, Shawn Alonso, Moises Cintron, Ricardo C. Carrero, German Lopez, Vamsi Garimella, German Giese

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Introduction: Advance directives (AD) are essential for patients to communicate their wishes when they are not able to. Ideally, these discussions should not occur for the first time when a patient is hospitalized with an acute life-threatening illness. There is a large number of patients who do not have clearly documented ADs, resulting in the misutilization of resources and additional patient harm. This is a nationwide issue, and the Joint Commission has it as one of its national quality metrics. Presented here is a proposed protocol to increase the number of documented AD discussions in a community-based, internal medicine residency primary care clinic in South Florida. Methods: The SMART Aim for this quality improvement project is to increase documentation of AD discussions in the outpatient setting by 25% within three months in medicare patients. A survey was sent to stakeholders (clinic attendings, residents, medical assistants, front desk staff, and clinic managers), asking them for three factors they believed contributed most to the low documentation rate of AD discussions. The two most important factors were time constraints and systems issues (such as lack of a standard method to document ADs and ADs not being uploaded to the chart) which were brought up by 25% and 21.2% of the 32 survey responders, respectively. Pre-intervention data from clinic patients in 2020-2021 revealed 17.05% of patients had clear, actionable ADs documented. To address these issues, an AD pocket card was created to give to patients. One side of the card has a brief explanation of what ADs are. The other side has a column of interventions (cardiopulmonary resuscitation, mechanical ventilation, dialysis, tracheostomy, feeding tube) with boxes patients check off if they want the intervention done, do not want the intervention, do not want to discuss the topic, or need more information. These cards are to be filled out and scanned into their electronic chart to be reviewed by the resident before their appointment. The interventions that patients want more information on will be discussed by the provider. If any changes are made, the card will be re-scanned into their chart. After three months, we will chart review the patients seen in the clinic to determine how many medicare patients have a pocket card uploaded and how many have advance directives discussions documented in a progress note or annual wellness note. If there is not enough time for an AD discussion, a follow-up appointment can be scheduled for that discussion. Discussion: ADs are a crucial part of patient care, and failure to understand a patient’s wishes leads to improper utilization of resources, avoidable litigation, and patient harm. Time constraints and systems issues were identified as two major factors contributing to the lack of advance directive discussion in our community-based resident primary care clinic. Our project aims at increasing the documentation rate for ADs through a simple pocket card intervention. These are self-explanatory, easy to read and allow the patients to clearly express what interventions they desire or what they want to discuss further with their physician.

Keywords: advance directives, community-based, pocket card, primary care clinic

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Authors: Mahdi Zolfaghari, Seyed Hossein Hosseinian, Hossein Askarian Abyaneh, Mehrdad Abedi

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This paper presents a virtual active power filter (VAPF) using vehicle to grid (V2G) technology to maintain power quality requirements. The optimal discrete operation of the power converter of electric vehicle (EV) is based on recognizing desired switching states using the model predictive control (MPC) algorithm. A fast dynamic response, lower total harmonic distortion (THD) and good reference tracking performance are realized through the presented control strategy. The simulation results using MATLAB/Simulink validate the effectiveness of the scheme in improving power quality as well as good dynamic response in power transferring capability.

Keywords: electric vehicle, model predictive control, power quality, V2G technology, virtual active power filter

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Authors: Alaa Koaik, Bruno Jurkiewiez, Sylvain Bel

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Recently, the use of GFRP pultruded profiles increased in the domain of civil engineering especially in the construction of sandwiched slabs and footbridges. However, under heavy loads, the risk of using these profiles increases due to their high deformability and instability as a result of their weak stiffness and orthotropic nature. A practical solution proposes the assembly of these profiles with concrete slabs to create a stiffer hybrid element to support higher loads. The connection of these two elements is established either by traditional means of steel studs (bolting in our case) or bonding technique. These two techniques have their advantages and disadvantages regarding the mechanical behavior and in-situ implementation. This paper presents experimental results of interface characterization and bending behavior of two hybrid beams, PB7 and PB8, designed and constructed using both connection techniques. The results obtained are exploited to design and build a hybrid footbridge BPBP1 which is tested within service limits (elastic domain). Analytical methods are also developed to analyze the behavior of these structures in the elastic range and the ultimate phase. Comparisons show acceptable differences mainly due to the sensitivity of the GFRP moduli as well as the non-linearity of concrete elements.

Keywords: analytical model, concrete, flexural behavior, GFRP pultruded profile, hybrid structure, interconnection slip, push-out

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Authors: Dianxun Zheng, Wuxing Jing, Lin Hetong

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Optical remote sensing satellite, always running on the Sun-synchronous orbit, equipped laser warning equipment to alert CCD camera from laser attack. There have three ways to protect the CCD camera, closing the camera cover satellite attitude maneuver and satellite orbit avoidance. In order to enhance the safety of optical remote sensing satellite in orbit, this paper explores the strategy of satellite avoidance. The avoidance strategy is expressed as the evasion of pre-determined target points in the orbital coordinates of virtual satellite. The so-called virtual satellite is a passive vehicle which superposes a satellite at the initial stage of avoidance. The target points share the consistent cycle time and the same semi-major axis with the virtual satellite, which ensures the properties of the Sun-synchronous orbit remain unchanged. Moreover, to further strengthen the avoidance capability of satellite, it can perform multi-object avoid maneuvers. On occasions of fulfilling the orbit tasks of the satellite, the orbit can be restored back to virtual satellite through orbit maneuvers. There into, the avoid maneuvers adopts pulse guidance. and the fuel consumption is also optimized. The avoidance strategy discussed in this article is applicable to avoidance for optical remote sensing satellite when encounter the laser hostile attacks.

Keywords: optical remote sensing satellite, always running on the sun-synchronous

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Authors: Mohammad Muntasir Maruf, Muhammad Zillur Rahman Khan, Nasim Jahan, Md. Waziul Alam Chowdhury, Satparkash, Md. Nozrul Islam

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Background: Substance use disorders have become a major public health problem in Bangladesh. Objectives: The present study was designed to assess the pattern of substance use and factors related to it among the hospitalized patients. Methods: This was a cross-sectional study. All the patients who were admitted in a private drug de-addiction clinic in the capital city (Dhaka) of Bangladesh during 1 July-31 December, 2013 and diagnosed as a case of substance use disorder by applying Structured Clinical Interview for DSM- Clinician Version were enrolled in the study. Data were collected through face to face interview by a semi-structured questionnaire and the information was complemented by the case-notes. Study subjects were 105 in number. Data analysis was performed using Statistical Package for Social Sciences (SPSS). Results: Most (90.5%) of the respondents were male. The mean age of the respondents was 28.8 (± 8.0) years. Majority (91.4%) were poly-substance users. Most (27.6%) respondents used 3 types of substances. Smoking or inhalation was the route used by most (90.5%) respondents. More than three-fourth (81%) of the respondents used nicotine. Among the other substances, majority (79%) used opiates group, followed by cannabinoids group (55.2%) and alcohol (41%). Curiosity, peer pressure and to have enjoyment or fun were identified as the common reasons for initiating substance use. Conclusions: A high proportion of poly-substance use was found. The study findings would help in management and prevention strategy of substance use in Bangladesh.

Keywords: Bangladesh, de-addiction clinic, poly-substance users, substance use disorder

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Authors: Kang Zijian, Zhang Tingyu, Burra Venkata Durga Kumar

Abstract:

This article investigates the challenges in memory migration during the live migration of virtual machines. We found three challenges probably existing in pre-copy technology. One of the main challenges is the challenge of downtime migration. Decrease the downtime could promise the normal work for a virtual machine. Although pre-copy technology is greatly decreasing the downtime, we still need to shut down the machine in order to finish the last round of data transfer. This paper provides an optimization scheme for the problems existing in pro-copy technology, mainly the optimization of the dirty page migration mechanism. The typical pre-copy technology copy n-1th’s dirty pages in nth turn. However, our idea is to create a double iteration method to solve this problem.

Keywords: virtual machine, pre-copy technology, memory migration process, downtime, dirty pages migration method

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Authors: Mojtaba Ghodsi, Hamidreza Ziaifar, Morteza Mohammadzaheri, Payam Soltani

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In this paper, the performance of a medium power (25 kW/25 kHz) hybrid inverter with a reactive transformer is investigated. To analyze the sensitivity of the inverster, the RSM technique is employed to manifest the effective factors in the inverter to minimize current passing through the Insulated Bipolar Gate Transistors (IGBTs) (current stress). It is revealed that the ratio of the axillary inductor to the effective inductance of resonant inverter (N), is the most effective parameter to minimize the current stress in this type of inverter. In practice, proper selection of N mitigates the current stress over IGBTs by five times. This reduction is very helpful to keep the IGBTs at normal temperatures.

Keywords: analytical analysis, hybrid resonant inverter, reactive transformer, response surface method

Procedia PDF Downloads 179