Integrating Geographic Information into Diabetes Disease Management

Background: Traditional chronic disease management did not pay attention to effects of geographic factors on the compliance of treatment regime, which resulted in geographic inequality in outcomes of chronic disease management. This study aims to examine the geographic distribution and clustering of quality indicators of diabetes care. Method: We first extracted address, demographic information and quality of care indicators (number of visits, complications, prescription and laboratory records) of patients with diabetes for 2014 from medical information system in a medical center in Tainan City, Taiwan, and the patients’ addresses were transformed into district- and village-level data. We then compared the differences of geographic distribution and clustering of quality of care indicators between districts and villages. Despite the descriptive results, rate ratios and 95% confidence intervals (CI) were estimated for indices of care in order to compare the quality of diabetes care among different areas. Results: A total of 23,588 patients with diabetes were extracted from the hospital data system; whereas 12,716 patients’ information and medical records were included to the following analysis. More than half of the subjects in this study were male and between 60-79 years old. Furthermore, the quality of diabetes care did indeed vary by geographical levels. Thru the smaller level, we could point out clustered areas more specifically. Fuguo Village (of Yongkang District) and Zhiyi Village (of Sinhua District) were found to be “hotspots” for nephropathy and cerebrovascular disease; while Wangliau Village and Erwang Village (of Yongkang District) would be “coldspots” for lowest proportion of ≥80% compliance to blood lipids examination. On the other hand, Yuping Village (in Anping District) was the area with the lowest proportion of ≥80% compliance to all laboratory examination. Conclusion: In spite of examining the geographic distribution, calculating rate ratios and their 95% CI could also be a useful and consistent method to test the association. This information is useful for health planners, diabetes case managers and other affiliate practitioners to organize care resources to the areas most needed.

Research of the Load Bearing Capacity of Inserts Embedded in CFRP under Different Loading Conditions

Continuous carbon fiber reinforced plastics (CFRP) exhibit a high application potential for lightweight structures due to their outstanding specific mechanical properties. Embedded metal elements, so-called inserts, can be used to join structural CFRP parts. Drilling of the components to be joined can be avoided using inserts. In consequence, no bearing stress is anticipated. This is a distinctive benefit of embedded inserts, since continuous CFRP have low shear and bearing strength. This paper aims at the investigation of the load bearing capacity after preinduced damages from impact tests and thermal-cycling. In addition, characterization of mechanical properties during dynamic high speed pull-out testing under different loading velocities was conducted. It has been shown that the load bearing capacity increases up to 100% for very high velocities (15 m/s) in comparison with quasi-static loading conditions (1.5 mm/min). Residual strength measurements identified the influence of thermal loading and preinduced mechanical damage. For both, the residual strength was evaluated afterwards by quasi-static pull-out tests. Taking into account the DIN EN 6038 a high decrease of force occurs at impact energy of 16 J with significant damage of the laminate. Lower impact energies of 6 J, 9 J, and 12 J do not decrease the measured residual strength, although the laminate is visibly damaged - distinguished by cracks on the rear side. To evaluate the influence of thermal loading, the specimens were placed in a climate chamber and were exposed to various numbers of temperature cycles. One cycle took 1.5 hours from -40 °C to +80 °C. It could be shown that already 10 temperature cycles decrease the load bearing capacity up to 20%. Further reduction of the residual strength with increasing number of thermal cycles was not observed. Thus, it implies that the maximum damage of the composite is already induced after 10 temperature cycles.

Promoting Innovation Pedagogy in a Capacity Building Project in Indonesia

This study presents a project that tests and adjusts active European learning and teaching methods in Indonesian universities to increase their external impact on enterprises and other organizations; it also assesses the implementation of the Erasmus+ projects funded by the European Union. The project is based on the approach of innovation pedagogy that responds to regional development needs and integrates applied research and development projects into education to create capabilities for students to participate in development work after graduation. The assessment of the Erasmus+ project resulted in many improvements that can be made to achieve higher quality and innovativeness. The results of this study are useful for those who want to improve the applied research and development projects of higher education institutions.

Performance Evaluation of a ‘Priority-Controlled’ Intersection Converted to Signal-Controlled Intersection

There is a call to ensure that the issues of safety and efficient throughput are considered during design; the solutions to these issues can also be retrofitted at locations where they were not captured during design, but have become problems to road users over time. This paper adopts several methods to analyze the performance of an intersection which was formerly a ‘priority-controlled’ intersection, but has now been converted to a ‘signal-controlled’ intersection. Extensive review of literature helped form the basis for result analysis and discussion. The Ikot-Ekpene/Anagha-Ezikpe intersection, located at the heart of Umuahia was adopted as case study; considering the high traffic volume on the route. Anecdotal evidence revealed that traffic signals imposed enormous delays at the intersection, especially for traffic on the major road. The major road has arrival flow which surpasses the saturation flow obtained from modelling of the isolated signalized intersection. Similarly, there were several geometric elements that did not agree with the specific function of the road. A roundabout, particularly flower roundabout was recommended as a better traffic control measure.

The Determination of Aflatoxins in Paddy and Milled Fractions of Rice in Guyana: Preliminary Results

A survey was conducted in the five rice-growing regions in Guyana to determine the presence of aflatoxins in multiple fractions of rice in June/October 2015 growing season. The fractions were paddy, steamed paddy, cargo rice, white rice and parboiled rice. Samples were analyzed by High Performance Liquid Chromatography. A subset of the samples was further analyzed by enzyme-linked immunosorbent assay (ELISA) for concurrence. All analyses were conducted at the University of Missouri, USA. Of the 186 samples tested, 16 had aflatoxin concentrations greater than 20 ppb the recommended limit for aflatoxins in food according to the United States Food and Drug Administration. An additional three samples had aflatoxin B1 concentrations greater than the European Union Commission maximum levels for aflatoxin B1 in rice at 5 µg/kg and total aflatoxins (B1, B2, G1 and G2) at 10 µg/kg. The survey indicates that there is no widespread aflatoxin problem in rice in Guyana. The incidence of aflatoxins appears to be localized.

Poststreptococcal Reactive Arthritis in Children: A Serial Case

Infection by group A streptococci (GAS) can trigger an autoantibody that cause a poststreptococcal reactive arthritis (PSRA). Four patients with PSRA aged 10 years to 14 years old with the main complaint of joint pain for five days to 10 days after suffering a fever and sore throat. The joint pain was persistent, additive, and non migratory. All patients revealed an increase in erythrocyte sedimentation rate (ESR) and anti-streptolysin O (ASLO), but the chest x-ray, electrocardiography, and echocardiography were normal. Bone imaging showed no destruction on the affected joint. Jones Criteria were not fulfilled in all patients. Erythromycin and ibuprofen were given in all patients and an improvement was shown. Erythromycin was continued for one year and routine controls were conducted for cardiac evaluation. The prognosis of all the patients was good.

Stabilizing Effects of Deep Eutectic Solvents on Alcohol Dehydrogenase Mediated Systems

This study explored the effects of different organic solvents, temperature, and the amount of glycerol on the alcohol dehydrogenase (ADH)-catalysed stereoselective reduction of different ketones. These conversions were then analyzed by gas chromatography. It was found that when the amount of deep eutectic solvents (DES) increases, it can improve the stereoselectivity of the enzyme although reducing its ability to convert the substrate into the corresponding alcohol. Moreover, glycerol was found to have a strong stabilizing effect on the ADH from Ralstonia sp. (E. coli/ RasADH). In the case of organic solvents, it was observed that the best conversions into the alcohols were achieved with DMSO and hexane. It was also observed that temperature decreased the ability of the enzyme to convert the substrates into the products and also affected the selectivity. In addition to that, the recycling of DES up to three times gave good conversions and enantiomeric excess results and glycerol showed a positive effect in the stability of various ADHs. Using RasADH, a good conversion and enantiomeric excess into the S-alcohol were obtained. It was found that an enhancement of the temperature disabled the stabilizing effect of glycerol and decreased the stereoselectivity of the enzyme. However, for other ADHs a temperature increase had an opposite positive effect, especially with ADH-T from Thermoanaerobium sp. One of the objectives of this study was to see the effect of cofactors such as NAD(P) on the biocatlysis activities of ADHs.

Environmental Decision Making Model for Assessing On-Site Performances of Building Subcontractors

Buildings cause a variety of loads on the environment due to activities performed at each stage of the building life cycle. Construction is the first stage that affects both the natural and built environments at different steps of the process, which can be defined as transportation of materials within the construction site, formation and preparation of materials on-site and the application of materials to realize the building subsystems. All of these steps require the use of technology, which varies based on the facilities that contractors and subcontractors have. Hence, environmental consequences of the construction process should be tackled by focusing on construction technology options used in every step of the process. This paper presents an environmental decision-making model for assessing on-site performances of subcontractors based on the construction technology options which they can supply. First, construction technologies, which constitute information, tools and methods, are classified. Then, environmental performance criteria are set forth related to resource consumption, ecosystem quality, and human health issues. Finally, the model is developed based on the relationships between the construction technology components and the environmental performance criteria. The Fuzzy Analytical Hierarchy Process (FAHP) method is used for weighting the environmental performance criteria according to environmental priorities of decision-maker(s), while the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method is used for ranking on-site environmental performances of subcontractors using quantitative data related to the construction technology components. Thus, the model aims to provide an insight to decision-maker(s) about the environmental consequences of the construction process and to provide an opportunity to improve the overall environmental performance of construction sites.

Grief and Repenting: The Engaging Remembrance in Thomas Hardy’s ‘Poems of 1912-13’

Nostalgia, to some people, may seem foolhardy in a way. However, nostalgia is a completely and intensely private but social, collective emotion. It has continuing consequence and outgrowth for our lives as social actions. It leads people to hunt and explore remembrance of persons and places of our past in an effort to confer meaning of persons and places of present. In the ‘Poems of 1912-13’ Thomas Hardy, a British poet, composed a series of poems after the unexpected death of his long-disaffected wife, Emma. The series interprets the cognitive and emotional concussion of Emma’s death on Hardy, concerning his mind and real visit to the landscape in Cornwall, England. Both spaces perform the author’s innermost in thought to his late wife and to the landscape. They present an apparent counterpart of the poet and his afflicted conscience. After Emma had died, Hardy carried her recollections alive by roaming about in the real visit and whimsical land (space) they once had drifted and meandered. This paper highlights the nostalgias and feds that seem endlessly to crop up.

Optimal Bayesian Control of the Proportion of Defectives in a Manufacturing Process

In this paper, we present a model and an algorithm for the calculation of the optimal control limit, average cost, sample size, and the sampling interval for an optimal Bayesian chart to control the proportion of defective items produced using a semi-Markov decision process approach. Traditional p-chart has been widely used for controlling the proportion of defectives in various kinds of production processes for many years. It is well known that traditional non-Bayesian charts are not optimal, but very few optimal Bayesian control charts have been developed in the literature, mostly considering finite horizon. The objective of this paper is to develop a fast computational algorithm to obtain the optimal parameters of a Bayesian p-chart. The decision problem is formulated in the partially observable framework and the developed algorithm is illustrated by a numerical example.

Characterisation of Fractions Extracted from Sorghum Byproducts

Sorghum byproducts, namely bran, stalk, and panicle are examples of lignocellulosic biomass. These raw materials contain large amounts of polysaccharides, in particular hemicelluloses, celluloses, and lignins, which if efficiently extracted, can be utilised for the development of a range of added value products with potential applications in agriculture and food packaging sectors. The aim of this study was to characterise fractions extracted from sorghum bran and stalk with regards to their physicochemical properties that could determine their applicability as food-packaging materials. A sequential alkaline extraction was applied for the isolation of cellulosic, hemicellulosic and lignin fractions from sorghum stalk and bran. Lignin content, phenolic content and antioxidant capacity were also investigated in the case of the lignin fraction. Thermal analysis using differential scanning calorimetry (DSC) and X-Ray Diffraction (XRD) revealed that the glass transition temperature (Tg) of cellulose fraction of the stalk was ~78.33 oC at amorphous state (~65%) and water content of ~5%. In terms of hemicellulose, the Tg value of stalk was slightly lower compared to bran at amorphous state (~54%) and had less water content (~2%). It is evident that hemicelluloses generally showed a lower thermal stability compared to cellulose, probably due to their lack of crystallinity. Additionally, bran had higher arabinose-to-xylose ratio (0.82) than the stalk, a fact that indicated its low crystallinity. Furthermore, lignin fraction had Tg value of ~93 oC at amorphous state (~11%). Stalk-derived lignin fraction contained more phenolic compounds (mainly consisting of p-coumaric and ferulic acid) and had higher lignin content and antioxidant capacity compared to bran-derived lignin fraction.

An Intelligent Transportation System for Safety and Integrated Management of Railway Crossings

Railway crossings are complex entities whose optimal management cannot be addressed unless with the help of an intelligent transportation system integrating information both on train and vehicular flows. In this paper, we propose an integrated system named SIMPLE (Railway Safety and Infrastructure for Mobility applied at level crossings) that, while providing unparalleled safety in railway level crossings, collects data on rail and road traffic and provides value-added services to citizens and commuters. Such services include for example alerts, via variable message signs to drivers and suggestions for alternative routes, towards a more sustainable, eco-friendly and efficient urban mobility. To achieve these goals, SIMPLE is organized as a System of Systems (SoS), with a modular architecture whose components range from specially-designed radar sensors for obstacle detection to smart ETSI M2M-compliant camera networks for urban traffic monitoring. Computational unit for performing forecast according to adaptive models of train and vehicular traffic are also included. The proposed system has been tested and validated during an extensive trial held in the mid-sized Italian town of Montecatini, a paradigmatic case where the rail network is inextricably linked with the fabric of the city. Results of the tests are reported and discussed.

Mechanical Behavior of Sandwiches with Various Glass Fiber/Epoxy Skins under Bending Load

While the polymeric foam cored sandwiches have been realized for many years, recently there is a growing and outstanding interest on the use of sandwiches consisting of aluminum foam core because of their some of the distinct mechanical properties such as high bending stiffness, high load carrying and energy absorption capacities. These properties make them very useful in the transportation industry (automotive, aerospace, shipbuilding industry), where the "lightweight design" philosophy and the safety of vehicles are very important aspects. Therefore, in this study, the sandwich panels with aluminum alloy foam core and various types and thicknesses of glass fiber reinforced polymer (GFRP) skins produced via Vacuum Assisted Resin Transfer Molding (VARTM) technique were obtained by using a commercial toughened epoxy based adhesive with two components. The aim of this contribution was the analysis of the bending response of sandwiches with various glass fiber reinforced polymer skins. The three point bending tests were performed on sandwich panels at different values of support span distance using a universal static testing machine in order to clarify the effects of the type and thickness of the GFRP skins in terms of peak load, energy efficiency and absorbed energy values. The GFRP skins were easily bonded to the aluminum alloy foam core under press machine with a very low pressure. The main results of the bending tests are: force-displacement curves, peak force values, absorbed energy, collapse mechanisms and the influence of the support span length and GFRP skins. The obtained results of the experimental investigation presented that the sandwich with the skin made of thicker S-Glass fabric failed at the highest load and absorbed the highest amount of energy compared to the other sandwich specimens. The increment of the support span distance made the decrease of the peak force and absorbed energy values for each type of panels. The common collapse mechanism of the panels was obtained as core shear failure which was not affected by the skin materials and the support span distance.

Decontamination of Chromium Containing Ground Water by Adsorption Using Chemically Modified Activated Carbon Fabric

Chromium in the environment is considered as one of the most toxic elements probably next only to mercury and arsenic. It is acutely toxic, mutagenic and carcinogenic in the environment. Chromium contamination of soil and underground water due to industrial activities is a very serious problem in several parts of India covering Karnataka, Tamil Nadu, Andhra Pradesh etc. Functionally modified Activated Carbon Fabrics (ACF) offer targeted chromium removal from drinking water and industrial effluents. Activated carbon fabric is a light weight adsorbing material with high surface area and low resistance to fluid flow. We have investigated surface modification of ACF using various acids in the laboratory through batch as well as through continuous flow column experiments with a view to develop the optimum conditions for chromium removal. Among the various acids investigated, phosphoric acid modified ACF gave best results with a removal efficiency of 95% under optimum conditions. Optimum pH was around 2 – 4 with 2 hours contact time. Continuous column experiments with an effective bed contact time (EBCT) of 5 minutes indicated that breakthrough occurred after 300 bed volumes. Adsorption data followed a Freundlich isotherm pattern. Nickel adsorbs preferentially and sulphate reduces chromium adsorption by 50%. The ACF could be regenerated up to 52.3% using 3 M NaOH under optimal conditions. The process is simple, economical, energy efficient and applicable to industrial effluents and drinking water.

Role-Specific Target-Systems in Professional Bureaucracies: A Qualitative Analysis in the OR

This paper firstly discusses the initial situation and problems. Afterward, it defines professional bureaucracies and shows their impact for the OR-work. The OR-center and its actors are shown. Finally, the paper provides the empiric design for detecting the target systems of the different work groups within the OR, the quality criteria in qualitative research and empirical results. It is shown that different groups have different targets in their daily work and that helps for a better understanding. More precisely, by detecting the target systems of these experts, we can ‘bridge’ the different points of view to create a common basis for the work in the OR. One of the aims was to find bridges to overcome separating factors. This paper describes the situation in Germany focusing the Hannover Medical School. It can be assumed that the results can be transferred to other countries using the DRG-System (Diagnosis Related Groups).

Numerical Analysis of Laminar Flow around Square Cylinders with EHD Phenomenon

In this research, a numerical simulation of an Electrohydrodynamic (EHD) actuator’s effects on the flow around a square cylinder by using a finite volume method has been investigated. This is one of the newest ways for controlling the fluid flows. Two plate electrodes are flush-mounted on the surface of the cylinder and one wire electrode is placed on the line with zero angle of attack relative to the stagnation point and excited with DC power supply. The discharge produces an electric force and changes the local momentum behaviors in the fluid layers. For this purpose, after selecting proper domain and boundary conditions, the electric field relating to the problem has been analyzed and then the results in the form of electrical body force have been entered in the governing equations of fluid field (Navier-Stokes equations). The effect of ionic wind resulted from the Electrohydrodynamic actuator, on the velocity, pressure and the wake behind cylinder has been considered. According to the results, it is observed that the fluid flow accelerates in the nearest wall of the frontal half of the cylinder and the pressure difference between frontal and hinder cylinder is increased.

Effect of Flour Concentration and Retrogradation Treatment on Physical Properties of Instant Sinlek Brown Rice

Sinlek rice flour beverage or instant product is a dietary supplement for dysphagia, or difficulty swallowing. It is also consumed by individuals who need to consume supplements to maintain their calorific needs. This product provides protein, fat, iron, and a high concentration of carbohydrate from rice flour. However, the application of native flour is limited due to its high viscosity. Starch modification by controlling starch retrogradation was used in this study. The research studies the effects of rice flour concentration and retrogradation treatment on the physical properties of instant Sinlek brown rice. The native rice flour, gelatinized rice flour, and flour gels retrograded under 4 °C for 3 and 7 days were investigated. From the statistical results, significant differences between native and retrograded flour were observed. The concentration of rice flour was the main factor influencing the swelling power, solubility, and pasting properties. With the increase in rice flour content from 10 to 15%, swelling power, peak viscosity, trough, and final viscosity decreased; but, solubility, pasting temperature, peak time, breakdown, and setback increased. The peak time, pasting temperature, peak viscosity, trough, and final viscosity decreased as the storage period increased from 3 to 7 days. The retrograded rice flour powders had lower pasting temperature, peak viscosity, breakdown, and final viscosity than the gelatinized and native flour powders. Reduction of starch viscosity by gelatinization and controlling starch retrogradation could allow for increased quantities of rice flour in instant rice beverages. Also, the treatment could increase the energy and nutrient densities of rice beverages without affecting the viscosity of this product.

A Comparative Analysis of Heuristics Applied to Collecting Used Lubricant Oils Generated in the City of Pereira, Colombia

Currently, in Colombia is arising a problem related to collecting used lubricant oils which are generated by the increment of the vehicle fleet. This situation does not allow a proper disposal of this type of waste, which in turn results in a negative impact on the environment. Therefore, through the comparative analysis of various heuristics, the best solution to the VRP (Vehicle Routing Problem) was selected by comparing costs and times for the collection of used lubricant oils in the city of Pereira, Colombia; since there is no presence of management companies engaged in the direct administration of the collection of this pollutant. To achieve this aim, six proposals of through methods of solution of two phases were discussed. First, the assignment of the group of generator points of the residue was made (previously identified). Proposals one and four of through methods are based on the closeness of points. The proposals two and five are using the scanning method and the proposals three and six are considering the restriction of the capacity of collection vehicle. Subsequently, the routes were developed - in the first three proposals by the Clarke and Wright's savings algorithm and in the following proposals by the Traveling Salesman optimization mathematical model. After applying techniques, a comparative analysis of the results was performed and it was determined which of the proposals presented the most optimal values in terms of the distance, cost and travel time.

Sensitivity and Reliability Analysis of Masonry Infilled Frames

The seismic performance of buildings with irregular distribution of mass, stiffness and strength along the height may be significantly different from that of regular buildings with masonry infill. Masonry infilled reinforced concrete (RC) frames are very common structural forms used for multi-storey building construction. These structures are found to perform better in past earthquakes owing to additional strength, stiffness and energy dissipation in the infill walls. The seismic performance of a building depends on the variation of material, structural and geometrical properties. The sensitivity of these properties affects the seismic response of the building. The main objective of the sensitivity analysis is to found out the most sensitive parameter that affects the response of the building. This paper presents a sensitivity analysis by considering 5% and 95% probability value of random variable in the infills characteristics, trying to obtain a reasonable range of results representing a wide number of possible situations that can be met in practice by using pushover analysis. The results show that the strength-related variation values of concrete and masonry, with the exception of tensile strength of the concrete, have shown a significant effect on the structural performance and that this effect increases with the progress of damage condition for the concrete. The seismic risk assessments of the selected frames are expressed in terms of reliability index.

Numerical Analysis of Cold-Formed Steel Shear Wall Panels Subjected to Cyclic Loading

Shear walls made of cold formed steel are used as lateral force resisting components in residential and low-rise commercial and industrial constructions. The seismic design analysis of such structures is often complex due to the slenderness of members and their instability prevalence. In this context, a simplified modeling technique across the panel is proposed by using the finite element method. The approach is based on idealizing the whole panel by a nonlinear shear link element which reflects its shear behavior connected to rigid body elements which transmit the forces to the end elements (studs) that resist the tension and the compression. The numerical model of the shear wall panel was subjected to cyclic loads in order to evaluate the seismic performance of the structure in terms of lateral displacement and energy dissipation capacity. In order to validate this model, the numerical results were compared with those from literature tests. This modeling technique is particularly useful for the design of cold formed steel structures where the shear forces in each panel and the axial forces in the studs can be obtained using spectrum analysis.