Search results for: medication error

Authors: Anood Al-Shibli

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Designing a learner corpus is not an easy task to accomplish because dealing with learners’ language has many variables which might affect the results of any study based on learners’ language production (spoken and written). Also, it is very essential to systematically design a learner corpus especially when it is aimed to be a reference to language research. Therefore, designing the Omani Learner Corpus (OLEC) has undergone many explicit and systematic considerations. These criteria can be regarded as the foundation to design any learner corpus to be exploited effectively in language use and language learning studies. Added to that, OLEC is manually error-annotated corpus. Error-annotation in learner corpora is very essential; however, it is time-consuming and prone to errors. Consequently, a navigating tool is designed to help the annotators to insert errors’ codes in order to make the error-annotation process more efficient and consistent. To assure accuracy, error annotation procedure is followed to annotate OLEC and some preliminary findings are noted. One of the main results of this procedure is creating an error-annotation system based on the Omani learners of English language production. Because OLEC is still in the first stages, the primary findings are related to only one level of proficiency and one error type which is verb related errors. It is found that Omani learners in OLEC has the tendency to have more errors in forming the verb and followed by problems in agreement of verb. Comparing the results to other error-based studies indicate that the Omani learners tend to have basic verb errors which can found in lower-level of proficiency. To this end, it is essential to admit that examining learners’ errors can give insights to language acquisition and language learning and most errors do not happen randomly but they occur systematically among language learners.

Keywords: error-annotation system, error-annotation manual, learner corpora, verbs related errors

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Authors: Jae-Hyun Ro, Yong-Jun Kim, Chang-Bin Ha, Hyoung-Kyu Song

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In multiple input multiple output-orthogonal frequency division multiplexing (MIMO-OFDM) systems, many detection schemes have been developed to improve the error performance and to reduce the complexity. Maximum likelihood (ML) detection has optimal error performance but it has very high complexity. Thus, this paper proposes reduced complexity of ML detection combined with decision feedback equalizer (DFE). The error performance of the proposed detection scheme is higher than the conventional DFE. But the complexity of the proposed scheme is lower than the conventional ML detection.

Keywords: detection, DFE, MIMO-OFDM, ML

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Authors: A. Poukens, I. Sluyts, A. Krings, J. Swartenbroekx, D. Geeroms, J. Poukens

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Introduction and Objectives: It has been known for many years that with the administration of intravenous medication, a rather significant part of the planned to be administered infusion solution, the residual volume ( the volume that remains in the IV line and or infusion bag), does not reach the patient and is wasted. This could possibly result in under dosage and diminished therapeutic effect. Despite the important impact on the patient, the reduction of residual volume lacks attention. An optimized and clearly stated protocol concerning the reduction of residual volume in an IV line is necessary for each hospital. As described in my Master’s thesis, acquiring the degree of Master in Hospital Pharmacy, administration of intravenous medication can be optimized by reduction of the residual volume. Herewith effectiveness, user-friendliness, cost efficiency and safety were taken into account. Material and Methods: By usage of a literature study and an online questionnaire sent out to all Flemish hospitals and hospitals in the Netherlands (province Limburg), current flush methods could be mapped out. In laboratory research, possible flush methods aiming to reduce the residual volume were measured. Furthermore, a self-developed experimental method to reduce the residual volume was added to the study. The current flush methods and the self-developed experimental method were compared to each other based on cost efficiency, user-friendliness and safety. Results: There is a major difference between the Flemish and the hospitals in the Netherlands (Province Limburg) concerning the approach and method of flushing IV lines after administration of intravenous medication. The residual volumes were measured and laboratory research showed that if flushing was done minimally 1-time equivalent to the residual volume, 95 percent of glucose would be flushed through. Based on the comparison, it became clear that flushing by use of a pre-filled syringe would be the most cost-efficient, user-friendly and safest method. According to laboratory research, the self-developed experimental method is feasible and has the advantage that the remaining fraction of the medication can be administered to the patient in unchanged concentration without dilution. Furthermore, this technique can be applied regardless of the level of the residual volume. Conclusion and Recommendations: It is recommendable to revise the current infusion systems and flushing methods in most hospitals. Aside from education of the hospital staff and alignment on a uniform substantiated protocol, an optimized and clear policy on the reduction of residual volume is necessary for each hospital. It is recommended to flush all IV lines with rinsing fluid with at least the equivalent volume of the residual volume. Further laboratory and clinical research for the self-developed experimental method are needed before this method can be implemented clinically in a broader setting.

Keywords: intravenous medication, infusion therapy, IV flushing, residual volume

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Authors: Zijian Zhang, Yangyang Dong

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Synchronization is of great importance to ensure the multi-arm robot to complete the task. Therefore, a synchronous controller is designed to coordinate task space motion of the multi-arm in the paper. The position error, the synchronous position error, and the coupling position error are all considered in the controller. Besides, an adaptive control method is used to adjust parameters of the controller to improve the effectiveness of coordinated control performance. Simulation in the Matlab shows the effectiveness of the method. At last, a robot experiment platform with two 7-DOF (Degree of Freedom) robot arms has been established and the synchronous controller simplified to control dual-arm robot has been validated on the experimental set-up. Experiment results show the position error decreased 10% and the corresponding frequency is also greatly improved.

Keywords: synchronous control, space robot, task space control, multi-arm robot

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Authors: R. Vigneswaran, S. Thilakanathan

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Variable time-stepping algorithms for solving dynamical systems performed poorly for long time computations which pass close to a fixed point. To overcome this difficulty, several authors considered phase space error controls for numerical simulation of dynamical systems. In one generalized phase space error control, a step-size selection scheme was proposed, which allows this error control to be incorporated into the standard adaptive algorithm as an extra constraint at negligible extra computational cost. For this generalized error control, it was already analyzed the forward Euler method applied to the linear system whose coefficient matrix has real and negative eigenvalues. In this paper, this result was extended to the linear system whose coefficient matrix has complex eigenvalues with negative real parts. Some theoretical results were obtained and numerical experiments were carried out to support the theoretical results.

Keywords: adaptivity, fixed point, long time simulations, stability, linear system

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Authors: Dalvinder Kaur Mangal

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For the past decade, noise corrupted output measurements have been a fundamental research problem to be investigated. On the other hand, the estimation of the parameters for linear dynamic systems when also the input is affected by noise is recognized as more difficult problem which only recently has received increasing attention. Representations where errors or measurement noises/disturbances are present on both the inputs and outputs are usually called errors-in-variables (EIV) models. These disturbances may also have additive effects which are also considered in this paper. Parameter estimation of false EIV problem using equation error, output error and iterative prefiltering identification schemes with and without additive uncertainty, when only the output observation is corrupted by noise has been dealt in this paper. The comparative study of these three schemes has also been carried out.

Keywords: errors-in-variable (EIV), false EIV, equation error, output error, iterative prefiltering, Gaussian noise

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Authors: Maria Torres

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After the acknowledgment of contrastive analysis, Pit Coder’s establishment of error analysis revolutionized the way instructors analyze and examine students’ writing errors. One question that relates to error analysis with speakers of a first language, in this case, Spanish, who are learning a second language (English), is the type of errors that these learners make along with the causes of these errors. Many studies have looked at the way the native tongue influences second language acquisition, but this method does not take into account other possible sources of students’ errors. This paper examines writing samples from an advanced ESL class whose first language is Spanish at non-profit organization, Learning Quest Stanislaus Literacy Center. Through error analysis, errors in the students’ writing were identified, described, and classified. The purpose of this paper was to discover the type and origin of their errors which generated appropriate treatments. The results in this paper show that the most frequent errors in the advanced ESL students’ writing pertain to interlanguage and a small percentage from an intralanguage source. Lastly, the least type of errors were ones that originate from negative transfer. The results further solidify the idea that there are other errors and sources of errors to account for rather than solely focusing on the difference between the students’ mother and target language. This presentation will bring to light some strategies and techniques that address the issues found in this research. Taking into account the amount of error pertaining to interlanguage, an ESL teacher should provide metalinguistic awareness of the students’ errors.

Keywords: error analysis, ESL, interlanguage, intralangauge

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Authors: Man Li, Wanting Zhou, Lei Li

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Communication stability is the primary concern of communication satellites. Communication satellites are easily affected by particle radiation to generate single event effects (SEE), which leads to soft errors (SE) of the combinational logic circuit. The existing research on soft error rates (SER) of the combined logic circuit is mostly based on the assumption that the logic gates being bombarded have the same pulse width. However, in the actual radiation environment, the pulse widths of the logic gates being bombarded are different due to different linear energy transfers (LET). In order to improve the accuracy of SER evaluation model, this paper proposes a soft error rate evaluation method based on LET. In this paper, the authors analyze the influence of LET on the pulse width of combinational logic and establish the pulse width model based on the LET. Based on this model, the error rate of test circuit ISCAS'85 is calculated. The effectiveness of the model is proved by comparing it with previous experiments.

Keywords: communication satellite, pulse width, soft error rates, LET

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Authors: Mouna Hemdi, Jamel bel Hadj Tahar

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The increasing development of multimedia applications requiring the simultaneous transport of several different services contributes to the evolution of the need for very high-speed network. In this paper, we propose an effective solution to achieve the very high speed while retaining elements of the optical transmission channel. So our study focuses on error correcting codes that aim for quality improvement on duty. We present a comparison of the quality of service for single channels and integrating the code BCH, RS and LDPC in order to find the best code in the different conditions of the transmission.

Keywords: code error correction, high speed broadband, optical transmission, information systems security

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Authors: Tijing Cai, Qimeng Xu, Daijin Zhou

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This paper puts forward a short-baseline dual-antenna BDS/MEMS-IMU integrated navigation, constructs the carrier phase double difference model of BDS (BeiDou Navigation Satellite System), and presents a 2-position initial orientation method on BDS. The Extended Kalman-filter has been introduced for the integrated navigation system. The differences between MEMS-IMU and BDS position, velocity and carrier phase indications are used as measurements. To show the performance of the short-baseline dual-antenna BDS/MEMS-IMU integrated navigation system, the experiment results show that the position error is less than 1m, the pitch angle error and roll angle error are less than 0.1°, and the heading angle error is about 1°.

Keywords: MEMS-IMU (Micro-Electro-Mechanical System Inertial Measurement Unit), BDS (BeiDou Navigation Satellite System), dual-antenna, integrated navigation

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Authors: Salisu ibrahim, Abdalla Rababah

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In this research, we use Weighted G2-Multi-degree reduction of Bezier curve of degree n to a Bezier curve of degree m, m < n. The degree reduction of Bezier curves is used to represent a given Bezier curve of n by a Bezier curve of degree m, m < n. Exact degree reduction is not possible, and degree reduction is approximate process in nature. We derive a weighted degree reducing method that is geometrically continuous at the end points. Different norms will be considered, several error minimizations will be given. The proposed methods produce error function that are less than the errors of existing methods.

Keywords: Bezier curves, multiple degree reduction, geometric continuity, error function

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Authors: Albert Acheampong, Tamer Elshandidy

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We investigate the extent to which sustainability disclosure from the narrative section of European banks’ annual reports improves analyst forecast accuracy. We capture sustainability disclosure using a machine learning approach and use forecast error to proxy analyst forecast accuracy. Our results suggest that sustainability disclosure significantly improves analyst forecast accuracy by reducing the forecast error. In a further analysis, we also find that the induction of Directive 2014/95/European Union (EU) is associated with increased disclosure content, which then reduces forecast error. Collectively, our results suggest that sustainability disclosure improves forecast accuracy, and the induction of the new EU directive strengthens this improvement. These results hold after several further and robustness analyses. Our findings have implications for market participants and policymakers.

Keywords: sustainability disclosure, machine learning, analyst forecast accuracy, forecast error, European banks, EU directive

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Authors: Young Hee Geum

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In this paper, we present the iterative method and determine the control parameters to converge cubically for solving nonlinear equations. In addition, we derive the asymptotic error constant.

Keywords: asymptotic error constant, iterative method, multiple root, root-finding, order of convergent

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Authors: B. Siva Kumar Reddy, B. Lakshmi

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WiMAX has adopted an Adaptive Modulation and Coding (AMC) in OFDM to endure higher data rates and error free transmission. AMC schemes employ the Channel State Information (CSI) to efficiently utilize the channel and maximize the throughput and for better spectral efficiency. This CSI has given to the transmitter by the channel estimators. In this paper, LSE (Least Square Error) and MMSE (Minimum Mean square Error) estimators are suggested and BER (Bit Error Rate) performance has been analyzed. Channel equalization is also integrated with with AMC-OFDM system and presented with Constant Modulus Algorithm (CMA) and Least Mean Square (LMS) algorithms with convergence rates analysis. Simulation results proved that increment in modulation scheme size causes to improvement in throughput along with BER value. There is a trade-off among modulation size, throughput, BER value and spectral efficiency. Results also reported the requirement of channel estimation and equalization in high data rate systems.

Keywords: AMC, CSI, CMA, OFDM, OFDMA, WiMAX

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Authors: Mia Schneeweiss, Joseph Merola

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Atopic dermatitis (AD) is a chronic inflammatory skin condition with a prevalence of 9.6 million in children under the age of 18 in the US, 3.2 million of those suffer severe AD. AD has significant effects on the quality of life and psychiatric comorbidity in affected patients. We sought to quantify the use of psychotropic medications and mental health services in children. We used longitudinal claims data form commercially insured patients in the US between 2003 and 2016 to identify children aged 18 or younger with a diagnosis of AD associated with an outpatient or inpatient encounter. A 180-day enrollment period was required before the first diagnosis of AD. Among those diagnosed, we computed the use of psychiatric services and dispensing of psychotropic medications during the following 6 months. Among 1.6 million children <18 years with a diagnosis of AD, most were infants (0-1 years: 17.6%), babies (1-2 years: 12.2%) and young children (2-4 years: 15.4). 5.1% were in age group 16-18 years. Among younger children 50% of patients were female, after the age of 14 about 60% were female. In 16-18 years olds 6.4% had at least one claim with a recorded psychopathology during the 6-month baseline period; 4.6% had depression, 3.3% anxiety, 0.3% panic disorder, 0.6% psychotic disorder, 0.1% anorexia. During the 6 months following the physician diagnosis of AD, 66% used high-potency topical corticosteroids, 3.5% used an SSRI, 0.3% used an SNRI, 1.2% used a tricyclic antidepressant, 1.4% used an antipsychotic medication, and 5.2% used an anxiolytic agent. 4.4% had an outpatient visit with a psychiatrist and 0.1% had been hospitalized with a psychiatric diagnosis. In 14-16 years olds, 4.7% had at least one claim with a recorded psychopathology during the 6-month baseline period; 3.3% had depression, 2.5% anxiety, 0.2% panic disorder, 0.5% psychotic disorder, 0.1% anorexia. During the 6 months following the physician diagnosis of AD, 68% used high-potency topical corticosteroids, 4.6% used an SSRI, 0.6% used an SNRI, 1.5% used a tricyclic antidepressant, 1.4% used an antipsychotic medication, and 4.6% used an anxiolytic agent. 4.7% had an outpatient visit with a psychiatrist and 0.1% had been hospitalized with a psychiatric diagnosis. In 12-14 years olds, 3.3% had at least one claim with a recorded psychopathology during the 6-month baseline period; 1.9% had depression, 2.2% anxiety, 0.1% panic disorder, 0.7% psychotic disorder, 0.0% anorexia. During the 6 months following the physician diagnosis of AD, 67% used high-potency topical corticosteroids, 2.1% used an SSRI, 0.1% used an SNRI, 0.7% used a tricyclic antidepressant, 0.9 % used an antipsychotic medication, and 4.1% used an anxiolytic agent. 3.8% had an outpatient visit with a psychiatrist and 0.05% had been hospitalized with a psychiatric diagnosis. In younger children psychopathologies were decreasingly common: 10-12: 2.8%; 8-10: 2.3%; 6-8: 1.3%; 4-6: 0.6%. In conclusion, there is substantial psychiatric comorbidity among children, <18 years old, with diagnosed atopic dermatitis in a US commercially insured population. Meaningful psychiatric medication use (>3%) starts as early as 12 years old.

Keywords: pediatric atopic dermatitis, phychotropic medication use, psychiatric comorbidity, claims database

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Authors: Yinggang Guo, Zongchun Li

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In order to decrease the accumulated survey error of tunnel installation control network of particle accelerator, a sectional control method is proposed. Firstly, the accumulation rule of positional error with the length of the control network is obtained by simulation calculation according to the shape of the tunnel installation-control-network. Then, the RMS of horizontal positional precision of tunnel backbone control network is taken as the threshold. When the accumulated error is bigger than the threshold, the tunnel installation control network should be divided into subsections reasonably. On each segment, the middle survey station is taken as the datum for independent adjustment calculation. Finally, by taking the backbone control points as faint datums, the weighted partial parameters adjustment is performed with the adjustment results of each segment and the coordinates of backbone control points. The subsections are jointed and unified into the global coordinate system in the adjustment process. An installation control network of the linac with a length of 1.6 km is simulated. The RMS of positional deviation of the proposed method is 2.583 mm, and the RMS of the difference of positional deviation between adjacent points reaches 0.035 mm. Experimental results show that the proposed sectional control method can not only effectively decrease the accumulated survey error but also guarantee the relative positional precision of the installation control network. So it can be applied in the data processing of tunnel installation control networks, especially for large particle accelerators.

Keywords: alignment, tunnel installation control network, accumulated survey error, sectional control method, datum

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Authors: Selam Mulugeta, Barkot Milkias, Mesfin Araya, Abel Worku, Eyasu Mulugeta

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In Ethiopia, there is inadequate information on non-adherence to antidepressant treatment in patients with depressive disorders. Having awareness of the pattern of adherence is important in future prognosis, quality of life, and functionality in these patients. This hospital-based cross-sectional quantitative study was done on a sample of 216 consecutive outpatients with depressive disorders. Data were collected using questionnaires through in-person and phone call interviews. The 8-item Morisky scale was used to assess the pattern of medication adherence. Other specially developed tools were used to obtain sociodemographic and clinical information from electronic medical records and patient interviews. Data were analyzed using the Statistical Package for the Social Sciences Version - 25. Univariate and multivariable analyses were carried out to assess factors associated with non-adherence. 90% of the participants had a primary diagnosis of major depressive disorder. Based on the 8-item Morisky Medication Adherence Scale, the prevalence of non-adherence was found to be 84.7%. Living distance between 11 to 50 km from the hospital (AOR= 11, 95% CI (29,46.6)), post-secondary level of education (AOR= 8.3, 95% CI (1, 64.4)) and taking multiple medications (AOR= 6.1, 95% CI (1, 34.9)) were found to have significantly increased odds of non-adherence. Non-adherence was significantly associated with factors such as increased living distance from the hospital, relatively higher educational level, and polypharmacy. Proper and patient-centered psychoeducation, addressing the communication gap between patients and doctors, adherence to prescribing guidelines, avoiding polypharmacy unless indicated & working on accessibility of treatment is essential to decrease non-adherence.

Keywords: depressive disorders, Ethiopia, medication adherence, Addis Ababa

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Authors: Nurullah Buker, Ezgi Karagoz, Yesim Salik Sengul, Sevay Alsen Guney, Gokhan Yoyler, Aylin Ozbek

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Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders with heterogeneous clinical features such as inattention, hyperactivity, and impulsivity. Many different types of exercise interventions were employed for children with ADHD. However, previous studies have usually examined the effects of non-specific exercise programs or short-term effects of exercise. The aim of this study is to investigate the effect of the Neurocognitive Exercise Program (NEP), which is a structured exercise program derived from Life Kinetik, and a relatively new for children with ADHD, on symptoms, attention, and dynamic balance in medication-naïve children with ADHD. Fourteen medication-naive children (7-12 years) with ADHD were included in the intervention group. NEP was performed once a week for ten weeks. The intervention group also performed a structured home exercise program for another six days, for ten weeks. The children in the intervention group were assessed at baseline, in the third month, in the sixth month, and in the twelfth month regarding ADHD-related symptoms, attention, and dynamic balance. Fifteen age-matched typically developing children were assessed once for establishing normative values. Hyperactivity-Impulsivity score and dynamic balance were found to improve after NEP in the ADHD group in the 3rd month (p<0.05). In addition, these results were similar for both groups after NEP and at the end of the 12th month (p>0.05). The NEP may provide beneficial effects on hyperactivity-impulsivity, oppositional defiant, and dynamic balance in children with ADHD, and the improvements may be maintained in the long term.

Keywords: ADHD, attention problems, dynamic balance, neurocognitive exercise

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Authors: Zainab Almukhtar, Adel Merabet

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In this paper, a method for maximum power point tracking of a photovoltaic energy conversion system is presented. This method is based on using the difference between the power from the solar panel and an estimated power value to control the DC-DC converter of the photovoltaic system. The difference is continuously compared with a preset error permitted value. If the power difference is more than the error, the estimated power is multiplied by a factor and the operation is repeated until the difference is less or equal to the threshold error. The difference in power will be used to trigger a DC-DC boost converter in order to raise the voltage to where the maximum power point is achieved. The proposed method was experimentally verified through a PV energy conversion system driven by the OPAL-RT real time controller. The method was tested on varying radiation conditions and load requirements, and the Photovoltaic Panel was operated at its maximum power in different conditions of irradiation.

Keywords: control system, error, solar panel, MPPT tracking

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Authors: Ranitha Guna Selvi D, Ramakrishnan R, Mohideen Abdul Kader

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Purpose: To study the role of Vision centers in managing preventable blindness through refractive error correction in Rural South India. Methods: A retrospective analysis of patients attending 15 Vision centers in Rural South India from a period of January 2021 to December 2021 was done. Medical records of 10,85,81 patients both new and reviewed, 79,562 newly registered patients and 29,019 review patient’s from15 Vision centers were included for data analysis. All the patients registered at the vision center underwent basic eye examination, including visual acuity, IOP measurement, Slit-lamp examination, retinoscopy, Fundus examination etc. Results: A total of 1,08,581 patients were included in the study. Of the total 1,08,581 patients, 79,562 were newly registered patients at Vision center and 29,019 were review patients. Males were 52,201(48.1%) and Females were 56,308(51.9) among them. The mean age of all examined patients was 41.03 ± 20.9 years (Standard deviation) and ranged from 01 – 113 years. Presenting mean visual acuity was 0.31 ± 0.5 in the right eye and 0.31 ± 0.4 in the left eye. Of the 1,08,581 patients 22,770 patients had refractive error in right eye and 22,721 patients had uncorrected refractive error in left eye. Glass prescription was given to 17,178 (15.8%) patients. 8,109 (7.5%) patients were referred to the base hospital for specialty clinic expert opinion or for cataract surgery. Conclusion: Vision center utilizing teleconsultation for comprehensive eye screening unit is a very effective tool in reducing the avoidable visual impairment caused due to uncorrected refractive error. Vision Centre model is believed to be efficient as it facilitates early detection and management of uncorrected refractive errors.

Keywords: refractive error, uncorrected refractive error, vision center, vision technician, teleconsultation

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Authors: Kathleen Joy Hingan, Jessiraye Luienne Catubigan, Carlo Mercado, Janisse RañEses

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In this research, the researchers wanted to explore how specialists and resident doctors in the fields of surgery, and obstetrics and gynecology handle their medical errors. They are interested in understanding the factors that contributed to the disclosure of medical error, the feelings after the occurrence of an error, and the way they coped with it given the power relations in place. The researchers conducted semi-structured interviews, transcribed the recordings, and analyzed the transcripts using thematic analysis. They found that doctors disclosed to their superiors and co-residents to cope with and to learn from the errors. In terms of disclosure to patients, the participants told them about the adverse event, but not about the error because of fear for themselves, their colleagues, their institution, and their patient. Doctors also performed compensatory actions to make up for the error and the nondisclosure of its occurrence. These actions functioned as a form of damage control too. Resident doctors and specialists receive different sanctions because of the power structures in the system.

Keywords: coping, disclosure, doctors, interviews, medical errors, thematic analysis

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Authors: Anan Jarab, Riham Almrayat, Salam Alqudah, Maher Khdour, Tareq Mukattash, Sharell Pinto

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Background: The prevalence of diabetes in Jordan is among the highest in the world, making it a particularly alarming health problem there. It has been indicated that poor adherence to the prescribed therapy lead to poor glycemic control and enhance the development of diabetes complications and unnecessary hospitalization. Purpose: To explore factors associated with medication non-adherence in patients with type 2 diabetes in Jordan. Materials and Methods: Variables including socio-demographics, disease and therapy factors, diabetes knowledge, and health-related quality of life in addition to adherence assessment were collected for 171 patients with type 2 diabetes using custom-designed and validated questionnaires. Logistic regression was performed to develop a model with variables that best predicted medication non-adherence in patients with type 2 diabetes in Jordan. Results: The majority of the patients (72.5%) were non-adherent. Patients were found four times less likely to adhere to their medications with each unit increase in the number of prescribed medications (OR = 0.244, CI = 0.08-0.63) and nine times less likely to adhere to their medications with each unit increase in the frequency of administration of diabetic medication (OR = 0.111, CI = 0.04-2.01). Patients in the present study were also approximately three times less likely (OR = 0.362, CI = 0.24-0.87) to adhere to their medications if they reported having concerns about side effects and twice more likely to adhere to medications (OR = 0.493, CI = 0.08-1.16) if they had one or more micro-vascular complication. Conclusion: The current study revealed low adherence rate to the prescribed therapy among Jordanians with type 2 diabetes. Simplifying dosage regimen, selecting treatments with lower side effects along with an emphasis on diabetes complications should be taken into account when developing care plans for patients with type 2 diabetes.

Keywords: type 2 diabetes, adherence, glycemic control, clinical pharmacist, Jordan

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Authors: A. Shirazibeheshti, T. Radwan, A. Ettefaghian, G. Wilson, C. Luca, Farbod Khanizadeh

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Anticholinergic medication has been associated with events such as falls, delirium, and cognitive impairment in older patients. To further assess this, anticholinergic burden scores have been developed to quantify risk. A risk model based on clustering was deployed in a healthcare management system to cluster patients into multiple risk groups according to anticholinergic burden scores of multiple medicines prescribed to patients to facilitate clinical decision-making. To do so, anticholinergic burden scores of drugs were extracted from the literature, which categorizes the risk on a scale of 1 to 3. Given the patients’ prescription data on the healthcare database, a weighted anticholinergic risk score was derived per patient based on the prescription of multiple anticholinergic drugs. This study was conducted on over 300,000 records of patients currently registered with a major regional UK-based healthcare provider. The weighted risk scores were used as inputs to an unsupervised learning algorithm (mean-shift clustering) that groups patients into clusters that represent different levels of anticholinergic risk. To further evaluate the performance of the model, any association between the average risk score within each group and other factors such as socioeconomic status (i.e., Index of Multiple Deprivation) and an index of health and disability were investigated. The clustering identifies a group of 15 patients at the highest risk from multiple anticholinergic medication. Our findings also show that this group of patients is located within more deprived areas of London compared to the population of other risk groups. Furthermore, the prescription of anticholinergic medicines is more skewed to female than male patients, indicating that females are more at risk from this kind of multiple medications. The risk may be monitored and controlled in well artificial intelligence-equipped healthcare management systems.

Keywords: anticholinergic medicines, clustering, deprivation, socioeconomic status

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Authors: Longxiang Guo, Haoyan Hao, Xueli Sheng, Hanjun Yu, Jingwei Yin

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In order to prevent target splitting and ensure the accuracy of fusion, system error registration is an important step in multi-static sonar fusion detection system. To eliminate the inherent system errors including distance error and angle error of each sonar in detection, this paper uses offline estimation method for error registration. Suppose several sonars from different platforms work together to detect a target. The target position detected by each sonar is based on each sonar’s own reference coordinate system. Based on the two-dimensional stereo projection method, this paper uses real-time quality control (RTQC) method and least squares (LS) method to estimate sensor biases. The RTQC method takes the average value of each sonar’s data as the observation value and the LS method makes the least square processing of each sonar’s data to get the observation value. In the underwater acoustic environment, matlab simulation is carried out and the simulation results show that both algorithms can estimate the distance and angle error of sonar system. The performance of the two algorithms is also compared through the root mean square error and the influence of measurement noise on registration accuracy is explored by simulation. The system error convergence of RTQC method is rapid, but the distribution of targets has a serious impact on its performance. LS method can not be affected by target distribution, but the increase of random noise will slow down the convergence rate. LS method is an improvement of RTQC method, which is widely used in two-dimensional registration. The improved method can be used for underwater multi-target detection registration.

Keywords: data fusion, multi-static sonar detection, offline estimation, sensor registration problem

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Authors: Frederick Huie, Lauren Fusfeld, William Burchenal, Scott Howell, Alyssa McVey, Thomas F. Goss

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Alzheimer’s Disease (AD) is a degenerative brain disease characterized by memory loss and cognitive decline that presents a substantial economic burden for patients and health insurers in the US. This study evaluates the payer budget impact of the DISCERN™ test in the diagnosis and management of patients with symptoms of dementia evaluated for AD. DISCERN™ comprises three assays that assess critical factors related to AD that regulate memory, formation of synaptic connections among neurons, and levels of amyloid plaques and neurofibrillary tangles in the brain and can provide a quicker, more accurate diagnosis than tests in the current diagnostic pathway (CDP). An Excel-based model with a three-year horizon was developed to assess the budget impact of DISCERN™ compared with CDP in a Medicare Advantage plan with 1M beneficiaries. Model parameters were identified through a literature review and were verified through consultation with clinicians experienced in diagnosis and management of AD. The model assesses direct medical costs/savings for patients based on the following categories: •Diagnosis: costs of diagnosis using DISCERN™ and CDP. •False Negative (FN) diagnosis: incremental cost of care avoidable with a correct AD diagnosis and appropriately directed medication. •True Positive (TP) diagnosis: AD medication costs; cost from a later TP diagnosis with the CDP versus DISCERN™ in the year of diagnosis, and savings from the delay in AD progression due to appropriate AD medication in patients who are correctly diagnosed after a FN diagnosis.•False Positive (FP) diagnosis: cost of AD medication for patients who do not have AD. A one-way sensitivity analysis was conducted to assess the effect of varying key clinical and cost parameters ±10%. An additional scenario analysis was developed to evaluate the impact of individual inputs. In the base scenario, DISCERN™ is estimated to decrease costs by $4.75M over three years, equating to approximately $63.11 saved per test per year for a cohort followed over three years. While the diagnosis cost is higher with DISCERN™ than with CDP modalities, this cost is offset by the higher overall costs associated with CDP due to the longer time needed to receive a TP diagnosis and the larger number of patients who receive a FN diagnosis and progress more rapidly than if they had received appropriate AD medication. The sensitivity analysis shows that the three parameters with the greatest impact on savings are: reduced sensitivity of DISCERN™, improved sensitivity of the CDP, and a reduction in the percentage of disease progression that is avoided with appropriate AD medication. A scenario analysis in which DISCERN™ reduces the utilization for patients of computed tomography from 21% in the base case to 16%, magnetic resonance imaging from 37% to 27% and cerebrospinal fluid biomarker testing, positive emission tomography, electroencephalograms, and polysomnography testing from 4%, 5%, 10%, and 8%, respectively, in the base case to 0%, results in an overall three-year net savings of $14.5M. DISCERN™ improves the rate of accurate, definitive diagnosis of AD earlier in the disease and may generate savings for Medicare Advantage plans.

Keywords: Alzheimer’s disease, budget, dementia, diagnosis.

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Authors: Larissa Burruano, Sergey Grabovyj, Irina Nguen

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The study aimed to assess the level of adherence to anti retroviral therapy (ART) and to examine the relationship between adherence and risk behavior factor (drug use) among patients infected with HIV. The patients with newly diagnosed or established HIV infection under follow-up at the Sumskij Regional Centre for AIDS Prevention in Ukraine were eligible for this study. Medical records were used to measure the patient’s adherence to medication. Measurements were obtained at month 6 and at month 12 to calculate the number of medication omission during the past 30 days: (on a 2-point scale – once until three in a month – were considered adherent, three and more in a month – were considered non-adherent). Of the 50 study participants, 27 (54.0%) were men and 23 (46.0%) women. The mean age is 35.2 years (SD= 5.1). A majority of the patients (82.0%) is in the age group of 25-30 years. The main level of adherence was 74.0% and 66.0% at 6 and 12 months, respectively. The main routes of HIV transmission were drug injection among men 12 (44.4%) and sexual contact among women 11 (47.8%). Univariate analyses indicated that patients who had lower level of education were more likely to have been non-adherent at month 6- (X2 =5.1, n=50, p < .05) and at month 12 (X2 = 4.34, n=50, p < .05). Multivariate tests showed that only age (OR= 1.163 [95% CI 0.98–1.370]) was significant independent predictor of treatment adherence, while gender, education, employment status were not predictive for the risk of developing non-compliance. There was not a significant interaction between non-adherence and intravenous drug use. Consistent with these findings, younger people were more likely to have missed a dose of their medication because they had a greater sense of invulnerability than older patients. The study indicates that the socio demographic characteristic should be taken into an account in the future research regarding adherence in the case of HIV infection. If the patient anti retroviral adherence can be improved by qualitatively better medical care in all regions of the Ukraine, behavioral changes in the population can to be expected in the long term.

Keywords: HIV, antiretroviral therapy, adherence, Ukraine, Eastern Europe

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Authors: Nabil Ahmed Kamal Badawy, Ali Falah Alhajraf, Mawaheb Falah Alsamdan

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Objectives: To estimate the prevalence of self-medication with over-the-counter pain relievers (acetaminophen, ibuprofen, and aspirin) among Kuwaiti citizens above the age of 16 years old and describe their patterns of use, perceived awareness of, and concerns about the drugs’ potential side effects. Design: A descriptive cross-sectional questionnaire-based survey. Setting: Samples were selected from the six Kuwaiti governorates. Subjects: The data were collected over a four-month period in 2012, from 850 subjects who identified as Kuwaiti citizens. These subjects were recruited using stratified random sampling. Results: Overall, a 67% response rate was obtained. In total, 68% (573) of the respondents reported the use of over-the-counter pain relievers. Women, middle-aged or single individuals, and those who had completed higher education used these drugs more than any other subgroup (p<0.05). We found evidence of inappropriate use of these drugs, with 15% (88) of the consumers using them almost daily. Further, 19% (111) of the consumers exceeded the recommended dosage at least once. Not only were 81% of the consumers unaware of the potential side effects, but also more than 61% were not concerned about them. Women were more knowledgeable than men regarding the maximum dose (p=0.036, OR 1.49, CI 1.03–2.17). Consumers with higher levels of education did not show distinct knowledge regarding the maximum allowed dose of the drugs (p=0.252, OR 1.71, CI 0.68-4.25). Conclusion: The results showed a high prevalence of self-medication with over-the-counter pain relievers among Kuwaiti citizens. The subjects showed marked unawareness and a lack of concern regarding the potential complications resulting from the inappropriate use of these analgesics. This demonstrates the need for educational interventions directed toward both patients and health care workers.

Keywords: awareness of side effects, concern, patterns of use, prevalence

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Authors: Adil Balla Elkrail

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Visual MODFLOW computer codes were selected to simulate head distribution, calculate the groundwater budgets of the area, and evaluate the effect of external stresses on the groundwater head and to demonstrate how the groundwater model can be used as a comparative technique in order to optimize utilization of the groundwater resource. A conceptual model of the study area, aquifer parameters, boundary, and initial conditions were used to simulate the flow model. The trial-and-error technique was used to calibrate the model. The most important criteria used to check the calibrated model were Root Mean Square error (RMS), Mean Absolute error (AM), Normalized Root Mean Square error (NRMS) and mass balance. The maps of the simulated heads elaborated acceptable model calibration compared to observed heads map. A time length of eight years and the observed heads of the year 2004 were used for model prediction. The predictive simulation showed that the continuation of pumping will cause relatively high changes in head distribution and components of groundwater budget whereas, the low deficit computed (7122 m3/d) between inflows and outflows cannot create a significant drawdown of the potentiometric level. Hence, the area under consideration may represent a high permeability and productive zone and strongly recommended for further groundwater development.

Keywords: aquifers, model simulation, groundwater, calibrations, trail-and- error, prediction

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Authors: Domingos Vita, Patrick Brady

Abstract:

Background: There is a tuberculosis (TB) epidemic in Angola that has been getting worse for more than a decade despite the active implementation of the DOTS strategy. The aim of this study was to directly interrogate healthcare workers involved in TB control on what they consider to be the drivers of the TB epidemic in Angola. Methods: Twenty four in-depth qualitative interviews were conducted with medical staff working in this field in the provinces of Luanda and Benguela. Results: The healthcare professionals see the migrant working poor as a particular problem for the control of TB. These migrants are constructed as ‘Rural People’ and are seen as non-compliant and late-presenting. This is a stigmatized and marginal group contending with the additional stigma associated with TB infection. The healthcare professionals interviewed also see the interruption of treatment and self medication generally as a better explanation for the TB epidemic than urbanization or lack of medication. Conclusions: The local narrative is in contrast to previous explanations used elsewhere in the developing world. To be effective policy must recognize the local issues of the migrant workforce, interruption of treatment and the stigma associated with TB in Angola.

Keywords: Africa, Angola, migrants, qualitative, research, tuberculosis

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Authors: Himayatullah Khan

Abstract:

This study estimates supply response function of sugarcane in Pakistan from 1980-81 to 2012-13. The study uses co-integration approach and error correction mechanism. Sugarcane production, area and price series were tested for unit root using Augmented Dickey Fuller (ADF). The study found that these series were stationary at their first differenced level. Using the Augmented Engle-Granger test and Cointegrating Regression Durbin-Watson (CRDW) test, the study found that “production and price” and “area and price” were co-integrated suggesting that the two sets of time series had long-run or equilibrium relationship. The results of the error correction models for the two sets of series showed that there was disequilibrium in the short run there may be disequilibrium. The Engle-Granger residual may be thought of as the equilibrium error which can be used to tie the short-run behavior of the dependent variable to its long-run value. The Granger-Causality test results showed that log of price granger caused both the long of production and log of area whereas, the log of production and log of area Granger caused each other.

Keywords: co-integration, error correction mechanism, Granger-causality, sugarcane, supply response

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