Prior Plans Research Articles

Exploring the reasons and factors influencing the choice of home delivery of births in rural Bangladesh: a community-based cross-sectional study

PurposeThe aim of this study was to explore the reasons for preferring home as a birth delivery place and identify the socio-economic and cultural factors influencing the choice of delivery place in rural Bangladesh.Design/methodology/approachThe data for the study come from a community-based cross-sectional study conducted among 464 mothers in a rural sub-district of Bangladesh in 2019. Respondents were selected randomly from the frame listing all mothers with inclusion criteria, using a two-stage cluster sampling design. Data were collected through a face-to-face interview. Both descriptive and inferential statistics and logistic regression models were used for data analysis.FindingsThe results indicate a very high rate (58%) of home delivery. About 20% mothers never received ANC visit. Preference for home delivery was high (63%). Mothers with no education, aged 30 and above, multi-parity, low wealth status, lack of knowledge about institutional delivery, no or <4 ANC visits, received no advice about the delivery place, no pregnancy complications, decision about health care, and prior plan for home delivery were identified as significant predictors of home delivery. Cost of services, cultural practices and attitude towards health facility, lack of a female delivery assistant, perceived fear of caesarian section, poor quality of services, and lack of knowledge about maternity services appeared as important barriers for institutional delivery.Originality/valueBased on primary data from a rural area, this study would help understand reasons and factors affecting home delivery and developing an appropriate strategy for the improvement of institutional delivery and maternity care services in Bangladesh.

Evaluation of a highly refined prediction model in knowledge-based volumetric modulated arc therapy planning for cervical cancer.

Background and purposeTo explore whether a highly refined dose volume histograms (DVH) prediction model can improve the accuracy and reliability of knowledge-based volumetric modulated arc therapy (VMAT) planning for cervical cancer.Methods and materialsThe proposed model underwent repeated refining through progressive training until the training samples increased from initial 25 prior plans up to 100 cases. The estimated DVHs derived from the prediction models of different runs of training were compared in 35 new cervical cancer patients to analyze the effect of such an interactive plan and model evolution method. The reliability and efficiency of knowledge-based planning (KBP) using this highly refined model in improving the consistency and quality of the VMAT plans were also evaluated.ResultsThe prediction ability was reinforced with the increased number of refinements in terms of normal tissue sparing. With enhanced prediction accuracy, more than 60% of automatic plan-6 (AP-6) plans (22/35) can be directly approved for clinical treatment without any manual revision. The plan quality scores for clinically approved plans (CPs) and manual plans (MPs) were on average 89.02 ± 4.83 and 86.48 ± 3.92 (p < 0.001). Knowledge-based planning significantly reduced the Dmean and V18 Gy for kidney (L/R), the Dmean, V30 Gy, and V40 Gy for bladder, rectum, and femoral head (L/R).ConclusionThe proposed model evolution method provides a practical way for the KBP to enhance its prediction ability with minimal human intervene. This highly refined prediction model can better guide KBP in improving the consistency and quality of the VMAT plans.

HighStitch: High Altitude Georeferenced Aerial Images Stitching for Rocking Telephoto Lens

A georeferenced orthophoto built from aerial images is the basic resource for various of remote sensing applications. As traditional low flight altitude aerial photographic survey is hard to handle large areas, higher altitude brings better survey efficiency, and a telephoto camera is required to maintain the resolution. Since existed structure from motion (SfM) methods are not suitable to process the low field-of-view images with high altitude, this article presents a novel georeferenced orthophoto stitching solution for telephoto images, which contain both translation and rotation movements. A mission planning strategy is designed to guarantee the consistent quality, according to the flight plan and camera intrinsic parameters. The potential matching topology is obtained by projecting images to the prior ground plan,e and overlap scores are estimated for neighbors query, followed with a feature-based keypoint matching. The ground plane and camera poses are optimized by joint considering feature matches, GPS and gimbal rotation information, while the final orthophoto is fused with a fast exposure leveling and weighted multiband-blending algorithm. The experiments show that our system is able to output novel quality orthophoto with high robustness, and we shared a trial version of our algorithm. 1

The Determinants of Residents’ Evacuation Behavior in the Torrential Rain in Western Japan in 2018: Examination of Survey Data of Victims in Okayama Prefecture

The torrential rain (named “the July 2018 heavy rain”) from June 28 to July 8 in 2018 resulted in tremendous human and property damage. There were 237 deaths and 7,173 cases of flooding above the floor level. During the torrential rain, the low rate of evacuation behavior of residents in the affected area was also a problem. The Okayama prefecture conducted a mail survey with residents that suffered housing damage caused by the torrential rain (valid sample n = 3,765). The survey measured what residents’ awareness and knowledge were of flooding before the torrential rain, residents’ prediction of flooding and choice and reason of evacuation behavior during the emergency heavy rain warning and the evacuation order (emergency). This study analyzed the determinants of residents’ evacuation behaviors during the torrential rain with the survey data. The results indicated that, although most residents were aware of hazard maps before the torrential rain, few predicted flooding. Most residents were aware of the evacuation shelters and had a prior evacuation plan. However, some residents made no attempt to evacuate, even when their houses were damaged. During the emergency heavy rain warning, feeling a sense of crisis was an important factor to promote evacuation behavior. And, during the evacuation order (emergency), the majority of those who took actual evacuation behaviors was those who were approached by public sectors such as the fire department and the police. Moreover, residents’ judgment based on scientific information such as hazard maps and prediction of flooding before the torrential rain had little effect on evacuation behavior during the emergency heavy rain warning and the evacuation order (emergency). Therefore, the study indicates the importance of approaching residents’ affective decision-making, instead of relying on rational decision-making, to promote evacuation behavior when people are in unusual situations.

A knowledge-based quantitative approach to characterize treatment plan quality: Application to prostate VMAT planning.

To characterize treatment plan (TP) quality, a quantitative quality control (QC) tool is proposed. The tool is validated using volumetric modulated arc therapy (VMAT) plans for treatment of prostate cancer by estimating the achievable organ at risk (OAR) sparing, based on the knowledge learned from prior plans. Prostate TP quality was investigated by evaluating the achieved OAR sparing in the rectum and bladder, based on their proximity to target surface. The knowledge base used in this work comprises 450 plans, consisting of 181 homogenous prostate plans and 269 simultaneous integrated boost (SIB) prostate plans. A knowledge-based algorithm was used to relate the absorbed doses of the OARs (rectum and bladder) and their proximity to the planning target volume (PTV). A metric (Mq,r value) was calculated to characterize the OAR sparing based on the weighted differences of the mean doses at binned distances to the PTV surface. The 90% probability ellipse of the normally distributed OARs Mq,r values was considered to define a threshold above which the treatment plan was re-optimized. Following re-optimization, 8/11 of the homogenous plans and 6/13 of the SIB plans outside the 90% probability ellipse could be re-optimized to gain better OAR sparing while achieving the same or better target coverage. However, 3/4 of the homogenous TPs and 1/9 of the SIB TPs between 80% and 90% were improved. Mq,r values of bladder and rectum after re-optimizing the plans in both groups of homogenous and SIB showed lower values compared to the corresponding values before re-optimization, which implies that better OARs sparing was achieved. This work demonstrates an effective anatomy-specific QC tool for identifying suboptimal plans and determining the achievable OAR sparing for each individual patient anatomy.

Abstract 17116: Incidence and Costs of Major Atherothrombotic Vascular Events Among Patients With Peripheral Artery Disease After Revascularization

Introduction: Peripheral artery disease (PAD), frequently requiring lower-extremity revascularization (LER), is associated with risk of major atherothrombotic vascular events (acute limb ischemia [ALI], major amputation of vascular etiology, myocardial infarction [MI], ischemic stroke [IS], cardiovascular [CV] death). Understanding the incidence and healthcare costs of such events in PAD patients post-revascularization may be important in translation. Methods: Patients with PAD who underwent LER were identified from Optum Clinformatics Data Mart claims database (Q1 2014 - Q2 2019). The first LER was considered index. Patients were required to be ≥50 years old at index with ≥6 months of prior health plan enrollment. Patients with IS, atrial fibrillation (AF), venous thromboembolism (VTE), intracranial hemorrhage, ESRD, or oral anticoagulant (OAC) use pre-index; or diagnoses of MI 30 days or ALI 14 days pre-index were excluded. Patients were followed until the earliest of 1) end of enrollment/data; 2) diagnosis of AF or VTE; or 3) OAC use. For each major vascular event, the incidence rate was assessed as the number of first events divided by patient-years of observation. Event-related healthcare costs per-patient-year (PPY) were also reported. Results: Of the 38,439 PAD patients meeting the study criteria, 6,675 (17.4%) had a major atherothrombotic vascular event over a median follow-up of 1.0 years (IQR: 0.4-2.1). The composite event incidence rate was 13.81 per 100 patient years [ALI: 5.51; lower-limb amputation: 5.15; MI: 3.19; IS: 2.06; CV-related death: 0.88]. PPY event-related costs ranged from $57,825 for IS to $108,302 for lower-limb amputation (Figure). Conclusions: One in six PAD patients have a major atherothrombotic vascular event within one year post-LER. Costs of these events are high, particularly for limb complications. Therefore, reducing the rate of such events could reduce the overall healthcare costs for this population.

COVID-19 and consent for research: Navigating during a global pandemic

The modern ethical framework demands informed consent for research participation that includes disclosure of material information, as well as alternatives. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic (COVID-19) results in illness that often involves rapid deterioration. Despite the urgent need to find therapy, obtaining informed consent for COVID-19 research is needed. The current pandemic presents three types of challenges for investigators faced with obtaining informed consent for research participation: (1) uncertainty over key information to informed consent, (2) time and pressure constraints, and (3) obligations regarding disclosure of new alternative therapies and re-consent. To mitigate consenting challenges, primary investigators need to work together to jointly promote urgent care and research into COVID-19. Actions they can take include (1) prior plan addressing ways to incorporate clinical research into clinical practice in emergency, (2) consider patients vulnerable with early deliberation on the consent process, (3) seek Legally Authorized Representatives (LARs), (4) create a collaborative research teams, (5) aim to consent once, despite evolving information during the pandemic, and (6) aim to match patients to a trial that will most benefit them. The COVID-19 pandemic both exacerbates existing challenges and raises unique obstacles for consent that require forethought and mindfulness to overcome. While research teams and clinician-investigators will need to be sensitive to their own contexts and adapt solutions accordingly, they can meet the challenge of obtaining genuinely informed consent during the current pandemic.

Güçlü Zayıf Yöntemi İle Proje Değerlendirme İçin Alternatif Bir Ölçek Önerisi: KOSGEB Örneği

Günümüzde gerek kamu gerekse özel sektör, öncelikli plan ve hedeflerine ulaşmak için proje çağrıları yoluyla dış paydaşlara fon sağlamaktadır. Maliyetleri hesaplanmış ve bütçelenmiş bu projelere sağlanan fonların amaçlara uygun olarak sonuçlanacağından emin olmak için kurum ve kuruluşların proje değerlendirme süreçlerini doğru bir şekilde yürütmeleri gerekmektedir. Bu çalışmada KOSGEB tarafından sağlanan destek programları incelenmiş ve Güçlü Zayıf Yöntemi kullanılarak bir destek programının puanlama tablosu uzman görüşü alınarak ağırlıklandırılmıştır. Çalışma sonucunda, proje değerlendirme sürecindeki en önemli kriterin Yatırım Projesinin Ekonomik Etkilerinin Değerlendirilmesi kriteri ve Yatırım Alanının Fiziksel ve Yapı Yeterliliğinin en zayıf kriter olarak belirlenmiştir. Elde edilen ağırlık değerleri kullanılarak yeni bir puanlama ölçeği önerilmiş ve mevcut puan tablosu ile karşılaştırılıştır.

Dose-Toxicity Relationship Algorithm for Reirradiation: A Novel Tool for ‘How to Treat in a ‘No-Treatment’ Zone’

Reirradiation is an increasing problem. Due to longer-life expectancies with better anti-cancer therapies, larger numbers of patients are candidates for reirradiation because of delayed recurrence. Patients are also more commonly undergoing multiple treatment courses within the same body site as part of subsequent metastatic local consolidation (LCT). However, little is known about the safety of reirradiation throughout the body. Given the wide-range of dose/fractionation schedules, and lack of a common conversion format for dose-toxicity relationship assessment, a void has existed for physicians wishing to pursue reirradiation. This is most commonly observed at the time of planning directive placement and knowledge of toxicity thresholds for organs at risk (OARs) in the reirradiation setting. To address this, we created a novel algorithm to convert nominal dose (Gy) from prior treatment plans to corresponding BED and EQD2 values, at voxel size of 2.5mm. Using this algorithm, and an alpha/beta of 3 for normal tissues, a proof of principle analysis was performed on 4 reirradiation NSCLC patients receiving 1) 50Gy in 4 fraction therapy followed by 70Gy in 10, 2) 50Gy in 4 followed by 50Gy in 4, 3) 70Gy in 10 followed by 70Gy in 10, and 4) 50Gy in 4 followed by 60Gy in 30. All cases were in the lung and same lobe. Following the conversion of each plan to its corresponding BED and EQD2 map, deformable registration was used to create a summed composite reirradiation BED/EQD2 plan for each patient. This allowed for composite – and anatomically accurate -- dosimetric EQD2 and BED assessment for each OAR. Evaluation of the algorithm-generated maps revealed accurate conversion of Gy to BED/EQD2 at each voxel. This enabled evaluation of dose summation received by organs at risk in the reirradiation setting (e.g. mean heart BED dose, max BED dose to major vessels, mean esophageal and lung BED). These dose characteristics were then compared to the toxicities experienced by patients following reirradiation to understand what dose thresholds might exist for OARs, regardless of fractionation scheme(s) chosen by physicians. To this end, the novel BED/EQD2 algorithm was successfully used to assess toxicity relationships in OARs for 15 patients receiving re-SABR after initial SABR, and 26 patients receiving curative chemoradiation (CRT) after initial SABR. This relatively simple, but highly clinically relevant, algorithm allows for assessment of dose-toxicity relationships using a common format in the reirradiation setting. Using this algorithm, multiple cohorts of reirradiation patients are being analyzed at our center to characterize dose-thresholds for reirradiation. Using BED/EQD2 reirradiation thresholds, physicians everywhere can calculate dose received to OARs during the first radiation course and, after selecting fractionation for the second, be able to generate evidence-based planning directives for organs at risk in the reirradiation setting.

A deep learning model to predict dose-volume histograms of organs at risk in radiotherapy treatment plans.

To develop a deep learning-based model to predict achievable dose-volume histograms (DVHs) of organs at risk (OARs) for automation of inverse planning. The model was based on a connected residual deconvolution network (CResDevNet) and compared with UNet as a baseline. The DVHs of OARs are dependent on patient anatomical features of the planning target volumes and OARs, and these spatial relationships can be learned automatically from prior high-quality plans. The contours of planning target volumes and OARs were parsed from the plan database and used as the input to the model, and the dose-area histograms (DAHs) of the OARs were output from the model. The model was trained from scratch by correlating anatomical features with DAHs of OARs, then accumulating these histograms to obtain the final predicted DVH for each OAR. Helical tomotherapy plans for 170 nasopharyngeal cancer patients were used to train and validate the model. An additional 60 patient treatment plans were used to test the predictive accuracy of the model. The DVHs and dose-volume indices (DVIs) of clinical interest for each OAR in the testing dataset were predicted to evaluate the accuracy of the models. The mean absolute errors in the DVIs for each OAR were calculated using each model and statistically compared using a paired-samples t-test. Dice similarity coefficients for areas of the DVHs were also evaluated. Dose-volume histograms of 21 OARs in nasopharyngeal cancer were predicted using the models. For each patient, 63 DVIs for all OARs were calculated. Using the 60 patient treatment plans in the testing dataset, 79% and 73% of the DVIs predicted using the CResDevNet and UNet models, respectively, were within 5% of the clinical values. The median value of the DVIs' mean absolute errors was 3.2±2.5% and 3.7±2.9% for the CResDevNet and UNet models, respectively. The average dice similarity coefficient for all OARs was 0.965 using the CResDevNet model and 0.958 using the UNet model. A deep learning model was developed for predicting achievable DVHs of OARs. The prediction accuracy of the CResDevNet model was evaluated using a planning database of nasopharyngeal cancer cases and shown to be more accurate than the UNet model. Prediction accuracy was also higher for larger-volume OARs. The model can be used for automation of inverse planning and quality assessment of individual treatment plans.

Patterns of emergency shelters in coastal plains a case study after the great east Japan Earthquake and Tsunami in Higashi‐Matsushima City

AbstractIt has been pointed out that during large‐scale disasters, some evacuees cannot receive necessary support since they evacuate to places other than the shelters pre‐designated by the government. This is due to the fact that prior evacuation plans do not match the actual evacuation situation, and that the information collection and support system are not examined thoroughly beforehand. This research aims to contribute to the provision of measures on how to prepare for the occurrence of non‐designated shelters and evacuees and provide immediate support activities for evacuees after a disaster. From a case study of events in Higashi‐Matsushima during the Great East Japan Earthquake, we examined the occurrence and causes of evacuation within the coastal plains and showed that non‐designated shelters were also found in flooded areas of coastal plains.

Online-adaptive versus robust IMPT for prostate cancer: How much can we gain?

Background/purposeIntensity-modulated proton therapy (IMPT) is highly sensitive to anatomical variations which can cause inadequate target coverage during treatment. Available mitigation techniques include robust treatment planning and online-adaptive IMPT. This study compares a robust planning strategy to two online-adaptive IMPT strategies to determine the benefit of online adaptation. Materials/methodsWe derived the robustness settings and safety margins needed to yield adequate target coverage (V95%≥98%) for >90% of 11 patients in a prostate cancer cohort (88 repeat CTs). For each patient, we also adapted a non-robust prior plan using a simple restoration and a full adaptation method. The restoration uses energy-adaptation followed by a fast spot-intensity re-optimization. The full adaptation uses energy-adaptation followed by the addition of new spots and a range-robust spot-intensity optimization.Dose was prescribed as 55 Gy(RBE) to the low-dose target (lymph nodes and seminal vesicles) with a boost to 74 Gy(RBE) to the high-dose target (prostate). Daily patient set-up was simulated using implanted intra-prostatic markers. ResultsMargins of 4 and 8 mm around the high- and low-dose target regions, a 6 mm setup error and a 3% range error were found to obtain adequate target coverage for all repeat CTs of 10/11 patients (94.3% of all 88 repeat CTs).Both online-adaptive strategies yielded V95%≥98% and better OAR sparing in 11/11 patients. Median OAR improvements up to 11%-point and 16%-point were observed when moving from robust planning to respectively restoration and full adaption. ConclusionBoth full plan adaptation and simple dose restoration can increase OAR sparing besides better conforming to the target criteria compared to robust treatment planning.

Analysis of Batam District Court Decision Number: 35 / Pid.B / 2012 compared to the Supreme Court Decision Number: 1691 / K / Pid / 2012

This study aims to analyze the interpretation of judges through the decision of the Batam District Court Number: 35/Pid.B/2012/PN.BTM which has been reconstructed through the Supreme Court Decision Number: 1691K/Pid/2012 in the murder case on behalf of Defendant MindoTampubolon, S.Ik. This research is a normative legal research, because it is based on library research that takes excerpts from reading books, literature, or supporting books that have relation to the problem to be studied, assisted with primary, secondary and tertiary data sources. This study uses qualitative data analysis and produces descriptive data.The results showed that the Judicial Consideration of the Panel of Judges in Batam District Court Decree Number 35/Pid.B/2012/PN.BTM was the indictment of the Public Prosecutor who stated that the defendant MindoTampubolon, S.Ik did, who ordered and did and participated in the act, intentionally and with prior plans to take the lives of others in their proof related to the elements in Articles 338 and 340 Jo. Article 55 paragraph (1) 1 of the Criminal Code. While the non-juridical consideration of the Panel of Judges in Batam District Court Decree Number 35/Pid.B/2012/PN.BTM is that the evidence of the involvement of the accused is only based on the statement of TumpalManik, SH, and always states that the perpetrators of the killings are witnesses GugunGunawan alias Ujang bin Ade. Decision of the Supreme Court Number 1691K/Pid/2012 is in accordance with the sense of justice in accordance with the purpose of criminalization and realized in the form of the application of the principle of Equality Before the Law, the principle of Presumption of Innocence and imprisonment of the defendant MindoTampubolon, S. Ik for a lifetime.

POSITIVE EMOTION MEMEDIASI SALES PROMOTION DAN STORE ENVIRONMENT TERHADAP IMPULSE BUYING

Impulse buying is the behavior to make purchases directly, without prior plan, done quickly and without much evaluation. Companies need to pay attention to factors that influence the creation of impulse buying to increase revenue. Purpose of this study is to determine Positive Emotion in mediating sales promotion and store environments in impulse buying. Study is conducted in Denpasar and Alfamart as research objects. 112 are used as respondents who had shopped at Alfamart with purposive sampling. Data collected through questionnaires and analyzed using path analysis. Based on the results, sales promotion and store environment have a positive and significant effect on Positive Emotion, Positive Emotion has a positive and significant effect on impulse buying, sales promotion and store environment has a positive and significant effect on impulse buying, and Positive Emotion is able to mediate the influence of sales promotion and store environment for impulse buying.&#x0D; Keywords: sales promotion, store environment, Positive Emotion, impulse buying.

Switching Costs in Medicare Advantage.

This paper estimates the magnitude of switching costs in the Medicare Advantage program. Consumers are generally assumed to pick plans that provide the combination of benefits and premiums that maximize their individual utility. However, the plan choice literature has generally omitted prior choices from choice models. The analysis is based on five years of the Medicare Current Beneficiary Survey, a nationally representative longitudinal dataset. The MCBS data were combined with data on Medicare Advantage Part C plan benefits and premiums. Individual choices are modeled as a function of individual characteristics, plan characteristics and prior year plan choices using a mixed logit model. We found relatively high rates of switching between plans within insurer (20%), although less switching between insurers. Prior year plan choices were highly significant at both the contract and plan level. Premium was negative and significant. Loyalty (contract and plan), premium and plan structure were found to be heterogeneous in preferences. We found a statistically significant willingness to pay for a lower prescription drug deductible and lower copays. Switching costs were higher for sicker individuals. Switching costs between plans offered by the same insurer are far lower than switching costs between insurers; beneficiaries will switch plans if an alternative is perceived as $233 a month better than the current choice and switch insurers if the alternative is perceived as $944 better than the current plan/contract, on average. Premium elasticities would be 34% greater in magnitude if prior choices were irrelevant. We provide evidence that the state dependence is structural rather than spurious.

107 Increased Hospitalisation Associated with Nasogastric Feeding in Advanced Dementia: Experience of A Geriatric Unit in Singapore

Abstract Introduction Tube feeding is not recommended in persons with advanced dementia and dysphagia; it does not improve nutrition, reduce infections or mortality. In Singapore, limited data exists on the prevalence of oral versus tube feeding in persons with advanced dementia, and the alignment between the mode of administering food and fluids and a prior advanced care plan (ACP) discussion. Methods Retrospective review of 120 patients from January to October 2017 was conducted to examine the prevalence of oral and tube feeding in advanced dementia patients with ACP, and the alignment of the chosen mode of intake with their ACP. Outcomes include rates of readmission, pneumonia, ACP revisions and mortality at six months. Results 42 subjects fulfilling criteria were analysed. 81.0% continued oral feeding. There was a statistically significant difference in the decision for tube insertion between oral and tube feeding groups (p=0.02), which was influenced by the ACP discussion. Concordance with ACP discussion in the tube feeding group was mixed, with 50% agreeing for tube insertion and 33.3% who were clinically guided. Surrogates made the decisions in 90.5% of the discussions. Six-month readmission rate was 32.4% for orally-fed patients versus 75% for tube-fed patients (p=0.045). 52.9% of admissions were attributed to pneumonia. 8.8% of orally fed patients revised their ACP to opt for a trial of treatment in their own home instead of readmission to the hospital. There was no difference in 6-month mortality (p=0.123). Conclusions Oral feeding was continued for most advanced dementia patients. Tube feeding does not offer survival benefit or prevent aspiration at 6 months, yet is associated with increased hospitalisations. ACP discussion should be initiated earlier to provide persons with dementia the opportunity to express their preferences for the mode of food and fluid intake.

The "Carmen de Bolívar event" in HPV vaccination in Colombia. Cause or outcome?

To open the "black box" of the "Carmen de Bolívar event". Search for literature in Medline, Lilacs and Redalyc with the terms "vaccine", "HPV", and "Colombia"; review of national ends surveys and policy documents published on the website of the Colombian Ministry of Health. Low knowledge of the vaccine by Colombian women before its introduction, no articulation to the sexual and reproductive health policy, lack of prior training of health workers at all levels of care and non-specific communication plans for HPV vaccine. There could be a new list of responsibles to assess "Carmen de Bolívar" more as an outcome. Such as the introduction of the non-integrated vaccine to sexual and reproductive health programs, the absence of prior strengthening of knowledge and skills about HPV and the vaccine in health workers, especially in primary care, the absence of a specific prior communication plan at the start of vaccination, guided by the indications of problems of acceptability in the population and knowledge gaps in women in deep Colombia, the implementation of an operational strategy identical to vaccines for communicable diseases that did not assess the unique characteristics of the vaccine against HPV. But also, the handling of the crisis in El Carmen de Bolívar that did not comply with the WHO recommendations for these cases could operate as an aggravating circumstance, and not as a determining cause of the current problem.

EVOLUTION OF HISTORICAL URBAN STRUCTURE: A CASE OF GANJA CITY, AZERBAIJAN

Time and people life transform urban structure according to their needs, principles and mentality. This process occurs either as entirely evaluate the space, or as build the remaining texture. Thus, several layers of heritage generate structural mosaic within the same urban cores. The purpose of this study is to reconstruct the evaluation structural stage of Ganja’s urban structure. The history of Azerbaijan in the 18th century is riddled with internal clashes and outside invasions. The cities of Azerbaijan were ravaged and devastated to a varying extent, and there was a significant reduction in productive forces, foreign and domestic trade. Characteristic of the period was prolonged political instability with permanent infighting and economic stagnation. With the determinations obtained by previous masterplans, the transformation ratio in morphological structure has been examined comparatively via urban fabric and its elements. This research collect archive data and emphasize major edition of prior city plans.

Attribute Ibase Cloudidata Iintegrity I Check Out Ifor Isecure I Outsourced Istorage

Property based Encryption (ABE) is viewed as a promising cryptographic leading instrument to ensure information proprietors’ immediate authority over their information in open distributed storage. The prior ABE plans include just a single position to keep up the entire trait set, which can bring a solitary point bottleneck on both security and execution. Accordingly, some multi-authority plans are proposed, in which different specialists independently keep up disjoint trait subsets. Be that as it may, the single-point bottleneck issue stays unsolved. In this paper, from another viewpoint, we direct an edge multi-authority CP-ABE access control conspire for open distributed storage, named SMAAC, in which various specialists together deal with a uniform quality set. In SMAAC, exploiting (t; in) edge mystery sharing, the ace key can be shared among various specialists, and a legitimate client can create his/her mystery key by associating with any it specialists. Security and execution investigation results show that SMAAC isn’t just obvious secure when not as much as it specialists are undermined, yet in addition strong when no not as much as it specialists are alive in the framework. Besides, by productively consolidating the customary multi-authority conspire with SMAAC, we build a half and half one, which fulfills the situation of properties originating from various specialists just as accomplishing security and framework level strength

Slowdown in Indian Economy and MGNREGA

It is not that MGNREGA is altogether a bad scheme and cannot be utilized to long term benefits to the economy. It can easily be done by changing some of the features of the present form of this inclusive scheme. Government is required to make it compulsory that the fund of MGNREGA scheme is spent as wages to skilled, semi-skilled and unskilled labour only for infrastructure projects in every development block of every district. In this pursuit a prior annual plan of Prime Minister Gramin Sadak Yojana and MPLADS for regular employment opportunities can play vital role. This will not only provide income source to unprivileged sections of society but also help to build large numbers of infrastructures for civic as well as development purpose. This asset backed scheme will make MGNREGA not only desirable but economically viable and sustainable.