Intelligent Transport System: Classification of Traffic Signs Using Deep Neural Networks in Real Time

Traffic control has been one of the most common and irritating problems since the time automobiles have hit the roads. Problems like traffic congestion have led to a significant time burden around the world and one significant solution to these problems can be the proper implementation of the Intelligent Transport System (ITS). It involves the integration of various tools like smart sensors, artificial intelligence, position technologies and mobile data services to manage traffic flow, reduce congestion and enhance driver's ability to avoid accidents during adverse weather. Road and traffic signs’ recognition is an emerging field of research in ITS. Classification problem of traffic signs needs to be solved as it is a major step in our journey towards building semi-autonomous/autonomous driving systems. The purpose of this work focuses on implementing an approach to solve the problem of traffic sign classification by developing a Convolutional Neural Network (CNN) classifier using the GTSRB (German Traffic Sign Recognition Benchmark) dataset. Rather than using hand-crafted features, our model addresses the concern of exploding huge parameters and data method augmentations. Our model achieved an accuracy of around 97.6% which is comparable to various state-of-the-art architectures.

Influence of Silica Surface Hydrophilicity on Adsorbed Water and Isopropanol Studied by in-situ NMR

Surface wettability is a crucial factor in oil recovery. In oil industry, the rock wettability involves the interplay between water, oil, and solid surface. Therefore, studying the interplay between adsorptions of water and hydrocarbon molecules on solid surface would be very informative for understanding rock wettability. Here we use the in-situ Nuclear Magnetic Resonance (NMR) gas isotherm technique to study competitive adsorptions of water and isopropanol, an intermediate step from hydrocarbons. This in-situ NMR technique obtains information on thermodynamic properties such as the isotherm, molecular dynamics via spin relaxation measurements, and adsorption kinetics such as how fast the system can reach thermal equilibrium after changes of vapor pressures. Using surfaces of silica glass beads, which can be modified from hydrophilic to hydrophobic, we obtained information on the influence of surface hydrophilicity on the state of surface water via obtained thermodynamic and dynamic properties.

AniMoveMineR: Animal Behavior Exploratory Analysis Using Association Rules Mining

Environmental changes and major natural disasters are most prevalent in the world due to the damage that humanity has caused to nature and these damages directly affect the lives of animals. Thus, the study of animal behavior and their interactions with the environment can provide knowledge that guides researchers and public agencies in preservation and conservation actions. Exploratory analysis of animal movement can determine the patterns of animal behavior and with technological advances the ability of animals to be tracked and, consequently, behavioral studies have been expanded. There is a lot of research on animal movement and behavior, but we note that a proposal that combines resources and allows for exploratory analysis of animal movement and provide statistical measures on individual animal behavior and its interaction with the environment is missing. The contribution of this paper is to present the framework AniMoveMineR, a unified solution that aggregates trajectory analysis and data mining techniques to explore animal movement data and provide a first step in responding questions about the animal individual behavior and their interactions with other animals over time and space. We evaluated the framework through the use of monitored jaguar data in the city of Miranda Pantanal, Brazil, in order to verify if the use of AniMoveMineR allows to identify the interaction level between these jaguars. The results were positive and provided indications about the individual behavior of jaguars and about which jaguars have the highest or lowest correlation.

Numerical Simulation of Different Configurations for a Combined Gasification/Carbonization Reactors

Gasification and carbonization are two of the most common ways for biomass utilization. Both processes are using part of the waste to be accomplished, either by incomplete combustion or for heating for both gasification and carbonization, respectively. The focus of this paper is to minimize the part of the waste that is used for heating biomass for gasification and carbonization. This will occur by combining both gasifiers and carbonization reactors in a single unit to utilize the heat in the product biogas to heating up the wastes in the carbonization reactors. Three different designs are proposed for the combined gasification/carbonization (CGC) reactor. These include a parallel combination of two gasifiers and carbonized syngas, carbonizer and combustion chamber, and one gasifier, carbonizer, and combustion chamber. They are tested numerically using ANSYS Fluent Computational Fluid Dynamics to ensure homogeneity of temperature distribution inside the carbonization part of the CGC reactor. 2D simulations are performed for the three cases after performing both mesh-size and time-step independent solutions. The carbonization part is common among the three different cases, and the difference among them is how this carbonization reactor is heated. The simulation results showed that the first design could provide only partial homogeneous temperature distribution, not across the whole reactor. This means that the produced carbonized biomass will be reduced as it will only fill a specified height of the reactor. To keep the carbonized product production high, a series combination is proposed. This series configuration resulted in a uniform temperature distribution across the whole reactor as it has only one source for heat with no temperature distribution on any surface of the carbonization section. The simulations provided a satisfactory result that either the first parallel combination of gasifier and carbonization reactor could be used with a reduced carbonized amount or a series configuration to keep the production rate high.

Exoskeleton for Hemiplegic Patients: Mechatronic Approach to Move One Disabled Lower Limb

The number of people suffering from hemiplegia is growing each year. This lower limb disability affects all the aspects of their lives by taking away their autonomy. This implicates their close relatives, as well as the health system to provide the necessary care they need. The integration of exoskeletons in the medical field became a promising solution to resolve this issue. This paper presents an exoskeleton designed to help hemiplegic people get back the sensation and ability of normal walking. For this purpose, three step models have been created. The first step allows a simple forward movement of the leg. The second method is designed to overcome some obstacles in the patient path, and finally the third step model gives the patient total control over the device. Each of the control methods was designed to offer a solution to the challenges that the patients may face during the walking process.

Seamless MATLAB® to Register-Transfer Level Design Methodology Using High-Level Synthesis

Many designers are asking for an automated path from an abstract mathematical MATLAB model to a high-quality Register-Transfer Level (RTL) hardware description. Manual transformations of MATLAB or intermediate code are needed, when the design abstraction is changed. Design conversion is problematic as it is multidimensional and it requires many different design steps to translate the mathematical representation of the desired functionality to an efficient hardware description with the same behavior and configurability. Yet, a manual model conversion is not an insurmountable task. Using currently available design tools and an appropriate design methodology, converting a MATLAB model to efficient hardware is a reasonable effort. This paper describes a simple and flexible design methodology that was developed together with several design teams.

Drawings as a Methodical Access to Reconstruct Children's Perspective on a Horse-Assisted Intervention

In this article, the collection and analysis of drawings are implemented and discussed as a methodological approach to reconstruct children's perspective on horse-assisted interventions. For this purpose, drawings of three children (8-10 years old) were included in the research process in order to clarify the question of what insights can be derived from the drawings about the child's perspective on the intervention. The children were asked to draw a picture of themselves at the horse stable. Practical implementation considerations are disclosed. The developed analysis steps consider the work of two art historians (Erwin Panofsky and Max Imdahl) to capture the visual sense and to interpret the children's drawings. Relevant topics about the children's perspective can be inferred from the drawings. In the drawings, the following topics are important for the children: Overcoming challenges and fears in handling the horse, support from an adult in handling the horse and feeling self-confident and competent to act after completing tasks with the horse. The drawings show the main topics which are relevant for the children and can be used as a basis for conversation. All in all, the child's drawing offers a useful addition to other survey methods in order to gain further insights into the experiences of children in a horse-assisted setting.

The Price of Knowledge in the Times of Commodification of Higher Education: A Case Study on the Changing Face of Education

Current developments in the Western economies have turned some universities into corporate institutions driven by practices of production and commodity. Academia is increasingly becoming integrated into national economies as a result of students paying fees and is consequently using business practices in student retention and engagement. With these changes, pedagogy status as a priority within the institution has been changing in light of these new demands. New strategies have blurred the boundaries that separate a student from a client. This led to a change of the dynamic, disrupting the traditional idea of the knowledge market, and emphasizing the corporate aspect of universities. In some cases, where students are seen primarily as a customer, the purpose of academia is no longer to educate but sell a commodity and retain fee-paying students. This paper considers opposing viewpoints on the commodification of higher education, reflecting on the reality of maintaining a pedagogic grounding in an increasingly commercialized sector. By analysing a case study of the Student Success Festival, an event that involved academic and marketing teams, the differences are considered between the respective visions of the pedagogic arm of the university and the corporate. This study argues that the initial concept of the event, based on the principles of gamification, independent learning, and cognitive criticality, was more clearly linked to a grounded pedagogic approach. However, when liaising with the marketing team in a crucial step in the creative process, it became apparent that these principles were not considered a priority in terms of their remit. While the study acknowledges in the power of pedagogy, the findings show that a pact of concord is necessary between different stakeholders in order for students to benefit fully from their learning experience. Nevertheless, while issues of power prevail and whenever power is unevenly distributed, reaching a consensus becomes increasingly challenging and further research should closely monitor the developments in pedagogy in the UK higher education.

The Significance of Cultural Risks for Western Consultants Executing Gulf Cooperation Council Megaprojects

Differences in commercial, professional and personal cultural traditions between western consultants and project sponsors in the Gulf Cooperation Council (GCC) region are potentially significant in the workplace, and this can impact on project outcomes. These cultural differences can, for example, result in conflict amongst senior managers, which can negatively impact the megaproject. New entrants to the GCC often experience ‘culture shock’ as they attempt to integrate into their unfamiliar environments. Megaprojects are unique ventures with individual project characteristics, which need to be considered when managing their associated risks. Megaproject research to date has mostly ignored the significance of the absence of cultural congruence in the GCC, which is surprising considering that there are large volumes of megaprojects in various stages of construction in the GCC. An initial step to dealing with cultural issues is to acknowledge culture as a significant risk factor (SRF). This paper seeks to understand the criticality for western consultants to address these risks. It considers the cultural barriers that exist between GCC sponsors and western consultants and examines the cultural distance between the key actors. Initial findings suggest the presence to a certain extent of ethnocentricity. Other cultural clashes arise out of a lack of appreciation of the customs, practices and traditions of ‘the Other’, such as the need for avoiding public humiliation and the hierarchal significance rankings. The concept and significance of cultural shock as part of the integration process for new arrivals are considered. Culture shock describes the state of anxiety and frustration resulting from the immersion in a culture distinctly different from one's own. There are potentially substantial project risks associated with underestimating the process of cultural integration. This paper examines two distinct but intertwined issues: the societal and professional culture differences associated with expatriate assignments. A case study examines the cultural congruences between GCC sponsors and American, British and German consultants, over a ten-year cycle. This provides indicators as to which nationalities encountered the most profound cultural issues and the nature of these. GCC megaprojects are typically intensive fast track demanding ventures, where consultant turnover is high. The study finds that building trust-filled relationships is key to successful project team integration and therefore, to successful megaproject execution. Findings indicate that both professional and social inclusion processes have steep learning curves. Traditional risk management practice is to approach any uncertainty in a structured way to mitigate the potential impact on project outcomes. This research highlights cultural risk as a significant factor in the management of GCC megaprojects. These risks arising from high staff turnover typically include loss of project knowledge, delays to the project, cost and disruption in replacing staff. This paper calls for cultural risk to be recognised as an SRF, as the first step to developing risk management strategies, and to reduce staff turnover for western consultants in GCC megaprojects.

A Surrealist Play of Associations: Neoliberalism, Critical Pedagogy and Surrealism in Secondary English Language Arts

This project utilizes principles derived from the Surrealist movement to prioritize creative and critical thinking in secondary English Language Arts (ELA). The implementation of Surrealist-style pedagogies within an ELA classroom will be rooted in critical, radical pedagogy, which addresses the injustices caused by economic-oriented educational systems. The use of critical pedagogy will enable the subversive artistic and political aims of Surrealism to be transmitted to a classroom context. Through aesthetic reading strategies, appreciative questioning and dialogue, students will actively critique the power dynamics which structure (and often restrict) their lives. Within the ELA domain, cost-effective approaches often replace the actual “arts” of ELA. This research will therefore explore how Surrealist-oriented pedagogies could restore imaginative freedom and deconstruct conceptual barriers (normative standards, curricular constraints, and status quo power relations) in secondary ELA. This research will also examine how Surrealism can be used as a political and pedagogical model to treat societal problems mirrored in ELA classrooms. The stakeholders are teachers, as they experience constant pressure within their practices. Similarly, students encounter rigorous, results-based pressures. These dynamics contribute to feelings of powerlessness, thus reinforcing a formulaic model of ELA. The ELA curriculum has potential to create laboratories for critical discussion and active movement towards social change. This proposed research strategy of Surrealist-oriented pedagogies could enable students to experiment with social issues and develop senses of agency and voice that reflect awareness of contemporary society while simultaneously building their ELA skills.

Public Economic Efficiency and Case-Based Reasoning: A Theoretical Framework to Police Performance

At present, public efficiency is a concept that intends to maximize return on public investment focus on minimizing the use of resources and maximizing the outputs. The concept takes into account statistical criteria drawn up according to techniques such as DEA (Data Envelopment Analysis). The purpose of the current work is to consider, more precisely, the theoretical application of CBR (Case-Based Reasoning) from economics and computer science, as a preliminary step to improving the efficiency of law enforcement agencies (public sector). With the aim of increasing the efficiency of the public sector, we have entered into a phase whose main objective is the implementation of new technologies. Our main conclusion is that the application of computer techniques, such as CBR, has become key to the efficiency of the public sector, which continues to require economic valuation based on methodologies such as DEA. As a theoretical result and conclusion, the incorporation of CBR systems will reduce the number of inputs and increase, theoretically, the number of outputs generated based on previous computer knowledge.

Assessing the Impact of Underground Cavities on Buildings with Stepped Foundations on Sloping Lands

The use of sloping lands is increasing due to the reduction of suitable lands for the construction of buildings. In the design and construction of buildings on sloping lands, the foundation has special loading conditions that require the designer and executor to use the slopped foundation. The creation of underground cavities, including urban and subway tunnels, sewers, urban facilities, etc., inside the ground, causes the behavior of the foundation to be unknown. In the present study, using Abacus software, a 45-degree stepped foundation on the ground is designed. The foundations are placed on the ground in a cohesive (no-hole) manner with circular cavities that show the effect of increasing the cross-sectional area of ​​the underground cavities on the foundation's performance. The Kobe earthquake struck the foundation and ground for two seconds. The underground cavities have a circular cross-sectional area with a radius of 5 m, which is located at a depth of 22.54 m above the ground. The results showed that as the number of underground cavities increased, von Mises stress (in the vertical direction) increased. With the increase in the number of underground cavities, the plastic strain on the ground has increased. Also, with the increase in the number of underground cavities, the change in location and speed in the foundation has increased.

Sediment Wave and Cyclic Steps as Mechanism for Sediment Transport in Submarine Canyons Thalweg

Seismic analysis of bedforms has proven to be one of the best ways to study deepwater sedimentary features. Canyons are known to be sediment transportation conduit. Sediment wave are large-scale depositional bedforms in various parts of the world's oceans formed predominantly by suspended load transport. These undulating objects usually have tens of meters to a few kilometers in wavelength and a height of several meters. Cyclic steps have long long-wave upstream-migrating bedforms confined by internal hydraulic jumps. They usually occur in regions with high gradients and slope breaks. Cyclic steps and migrating sediment waves are the most common bedform on the seafloor. Cyclic steps and related sediment wave bedforms are significant to the morpho-dynamic evolution of deep-water depositional systems architectural elements, especially those located along tectonically active margins with high gradients and slope breaks that can promote internal hydraulic jumps in turbidity currents. This report examined sedimentary activities and sediment transportation in submarine canyons and provided distinctive insight into factors that created a complex seabed canyon system in the Ceara Fortaleza basin Brazilian Equatorial Margin (BEM). The growing importance of cyclic steps made it imperative to understand the parameters leading to their formation, migration, and architecture as well as their controls on sediment transport in canyon thalweg. We extracted the parameters of the observed bedforms and evaluated the aspect ratio and asymmetricity. We developed a relationship between the hydraulic jump magnitude, depth of the hydraulic fall and the length of the cyclic step therein. It was understood that an increase in the height of the cyclic step increases the magnitude of the hydraulic jump and thereby increases the rate of deposition on the preceding stoss side. An increase in the length of the cyclic steps reduces the magnitude of the hydraulic jump and reduces the rate of deposition at the stoss side. Therefore, flat stoss side was noticed at most preceding cyclic step and sediment wave.

European Environmental Policy for Road Transport: Analysis of the Perverse Effects Generated and Proposals for a Good Practice Guide

The aim of this paper is to analyse the different environmental policies adopted in Europe for car emissions, to comment on some of the possible perverse effects generated and point out these policies which are considered more efficient under the environmental perspective. This paper is focused on passenger cars as this category is the most significant in road transport. The utility of this research lies in this being the first step or basis to improve and optimise actual policies. The methodology applied in this paper refers to a comparative analysis from a practical and theoretical point of view of European environmental policies in road transport. This work describes an overview of the road transport industry in Europe pointing out some relevant aspects such as the contribution of road transport to total emissions and the vehicle fleet in Europe. Additionally, we propose a brief practice guide with the combined policies in order to optimise their aim.

Digital Library Evaluation by SWARA-WASPAS Method

Since the discovery of the manuscript, mechanical methods for storing, transferring and using the information have evolved into digital methods over the time. In this process, libraries that are the center of the information have also become digitized and become accessible from anywhere and at any time in the world by taking on a structure that has no physical boundaries. In this context, some criteria for information obtained from digital libraries have become more important for users. This paper evaluates the user criteria from different perspectives that make a digital library more useful. The Step-Wise Weight Assessment Ratio Analysis-Weighted Aggregated Sum Product Assessment (SWARA-WASPAS) method is used with flexibility and easy calculation steps for the evaluation of digital library criteria. Three different digital libraries are evaluated by information technology experts according to five conflicting main criteria, ‘interface design’, ‘effects on users’, ‘services’, ‘user engagement’ and ‘context’. Finally, alternatives are ranked in descending order.

Normal and Peaberry Coffee Beans Classification from Green Coffee Bean Images Using Convolutional Neural Networks and Support Vector Machine

The aim of this study is to develop a system which can identify and sort peaberries automatically at low cost for coffee producers in developing countries. In this paper, the focus is on the classification of peaberries and normal coffee beans using image processing and machine learning techniques. The peaberry is not bad and not a normal bean. The peaberry is born in an only single seed, relatively round seed from a coffee cherry instead of the usual flat-sided pair of beans. It has another value and flavor. To make the taste of the coffee better, it is necessary to separate the peaberry and normal bean before green coffee beans roasting. Otherwise, the taste of total beans will be mixed, and it will be bad. In roaster procedure time, all the beans shape, size, and weight must be unique; otherwise, the larger bean will take more time for roasting inside. The peaberry has a different size and different shape even though they have the same weight as normal beans. The peaberry roasts slower than other normal beans. Therefore, neither technique provides a good option to select the peaberries. Defect beans, e.g., sour, broken, black, and fade bean, are easy to check and pick up manually by hand. On the other hand, the peaberry pick up is very difficult even for trained specialists because the shape and color of the peaberry are similar to normal beans. In this study, we use image processing and machine learning techniques to discriminate the normal and peaberry bean as a part of the sorting system. As the first step, we applied Deep Convolutional Neural Networks (CNN) and Support Vector Machine (SVM) as machine learning techniques to discriminate the peaberry and normal bean. As a result, better performance was obtained with CNN than with SVM for the discrimination of the peaberry. The trained artificial neural network with high performance CPU and GPU in this work will be simply installed into the inexpensive and low in calculation Raspberry Pi system. We assume that this system will be used in under developed countries. The study evaluates and compares the feasibility of the methods in terms of accuracy of classification and processing speed.

Granting Saudi Women the Right to Drive in the Eyes of Qatari Media

This research attempts to evaluate the treatment provided by the Qatari media to the decision to allow Saudi women to drive, and then activate this decision after a few months, that is, within the time frame between September 26, 2017 until June 30, 2018. This is through asking several questions, including whether the political dispute between Qatar and Saudi Arabia has cast a shadow over this handling, and if these Qatari media handlings are used to criticize the Saudi regime for delaying this step. Here emerges one of the research hypotheses that says that the coverage did not have the required professionalism, due to the fact that the decision and its activation took place in light of the political stalemate between Qatar and the Kingdom of Saudi Arabia, which requires testing the media framing and agenda theories to know to what extent they apply to this case. The research dealt with a sample of five Qatari media read in this sample: Al-Jazeera Net, The New Arab Newspaper, Al-Sharq Newspaper, The Arab Newspaper, and Al-Watan Newspaper. The results showed that most of the authors who covered the decision to allow Saudi women to drive a car did not achieve a balance in their writing, and that almost half of them did not have objectivity, and this indicates the proof of the hypothesis that there is a defect in the professional competence in covering the decision to allow Saudi women to drive cars by means of Qatari media, and the researcher attributes this result to the political position between Qatar and Saudi Arabia, in addition to the fact that the Arab media in most of them are characterized by a low ceiling of freedom, and most of them are identical in their position with the position of the regime’s official view.

The Alliance for Grassland Renewal: A Model for Teaching Endophyte Technology

To the author’s best knowledge, there are no published reports of effective methods for teaching fescue toxicosis and grass endophyte technology in the USA. To address this need, a group of university scientists, industry representatives, government agents, and livestock producers formed an organization called the Alliance for Grassland Renewal. One goal of the Alliance was to develop a teaching method that could be employed across all regions in the USA and all sectors of the agricultural community. The first step in developing this method was identification of experts who were familiar with the science and management of fescue toxicosis. The second step was curriculum development. Experts wrote a curriculum that addressed all aspects of toxicosis and management, including toxicology, animal nutrition, pasture management, economics, and mycology. The curriculum was created for presentation in lectures, laboratories, and in the field. The curriculum was in that it could be delivered across state lines, regardless of peculiar, in-state recommendations. The curriculum was also unique as it was unanimously supported by private companies otherwise in competition with each other. The final step in developing this teaching method was formulating a delivery plan. All experts, including university, industry, government, and production, volunteered to travel from any state in the USA, converge in one location, teach a 1-day workshop, then travel to the next location. The results of this teaching method indicate widespread success. Since 2012, experts across the entire USA have converged to teach Alliance workshops in Kansas, Oklahoma, Missouri, Kentucky, Georgia, South Carolina, North Carolina, and Virginia, with ongoing workshops in Arkansas and Tennessee. Data from post-workshop surveys indicate that instruction has been effective, as at least 50% of the participants stated their intention to adopt the endophyte technology presented in these workshops. The teaching method developed by the Alliance for Grassland Renewal has proved to be effective, and the Alliance continues to expand across the USA.

A Corpus-Based Study on the Styles of Three Translators

The present paper is preoccupied with the different styles of three translators in their translating a Chinese classical novel Shuihu Zhuan. Based on a parallel corpus, it adopts a target-oriented approach to look into whether and what stylistic differences and shifts the three translations have revealed. The findings show that the three translators demonstrate different styles concerning their word choices and sentence preferences, which implies that identification of recurrent textual patterns may be a basic step for investigating the style of a translator.

A Study to Evaluate the Effectiveness of Simulation on Anaesthetic Non-Technical Skills in the Management of Major Trauma Patients

Background: Dynamic, challenging instances during the management of major trauma patients requires optimal team intervention to ensure patient safety and effective crisis management. These factors highlight the importance of increased awareness in both technical and non-technical skills (NTS) training. Simulation based training (SBT) is an effective tool that replicates and teaches the required clinical skills, resulting in teamwork improvement, better patient safety, and care. Aims: This study investigates change in NTS, during the management of major trauma patients, using SBT. We also investigated the relationship between NTS performance and participation in previous NTS workshop (NTSW), years of experience, previous simulation (PS), previous exposure to major trauma patient management (MTPM) and group size. Methods: NTS behaviours were assessed by a single rater using previously validated framework for observing and rating Anaesthetists’ Non-Technical Skills (ANTS) for anaesthetists and Anaesthetic Non-Technical Skills for Anaesthetic Practitioners (ANTS-AP) for anaesthetic nurses during SBT. Two anaesthetists (one senior, one junior) together with one to four registered anaesthetic nurses formed 17 teams. The SBT consisted of 3 major trauma scenarios: 1) Major haemorrhage following multiple stab wounds to the torso, 2) Traumatic brain injury complicated by unanticipated difficult intubation, and 3) Penetrating neck injury with major haemorrhage, complicated by a failed intubation. The scores of each NTS category for each scenario are evaluated for significance in change and used to correlate whether NTS during the simulation were affected by previous NTSW, PS, previous exposure to MTPM and group size. Results: The resulting anaesthetists and anesthetic nurses’ p-values were < 0.05 indicating a significant improvement in all NTS resulting from score differences between scenarios 1 & 2 and 1 & 3. Anaesthetists’ NTS categories were not influenced by PS, previous NTSW, and exposure to MTPM. However, anaesthetic nurses NTS categories were influenced by PS, exposure to MTPM but not by NTSW. Conclusions: SBT has shown to be effective in improving the NTS for both anaesthetists and anaesthetic nurses. This enhances safety and team performance for MTPM. The impact of SBT in the clinical environment for patient management and safety warrants further research.