Characteristics of Infertile Clientele Attending a Public in Vitro Fertilization Clinic: Appraising Priorities in a Low-Income Country

Introduction: Infertilityaffects one in six couples, and it is an important public health issue largely due to thepervasive effects on the emotional and psychological wellbeing of affected couples. In many developing nations emphasis is placed on childbirth and inability to fulfill this role can be very distressing. There is an unmet need for assisted reproductive technology (ART) in many developing countries and where facilities exist, they are mostly privately owned, expensive and concentrated in urban areas. To bridge this gap, public fertility clinics have been established to provide subsidized care. Evaluating the characteristics and peculiarities of clientele presenting at these public facilities will aid planning and prioritization of care. Methodology: A descriptive retrospective study of 116 infertile patients presenting to the fertility clinic of the University College Hospital, Ibadan, Nigeria from inception on the 14th of February 2019 and 31st of December 2022.Data was analyzed using the Statical Package for Social Sciences (IBM, SPSS, New York) version 23. Descriptive statistics were used to summarize the results which were presented with the aid of bar charts and frequency tables. Result: The mean age of the patients was 40.70 ± 6.62 years. Post-menopausal patients accounted for about one-fifth of the study population while 80.2% (93 women) were older than 35 years. The mean duration of infertility was 9.39 ± 6.11years and nine patients (7.8%) had a duration greater than 2 decades. Secondary infertility occurred in 67.2% of the women. Twenty-nine women (25%) had undergone myomectomy prior to presentation. Hypertension (11.2%) was the most prevalent comorbidity. Nineteen patients (16.4%) had used contraceptives in the past with the male condom (36.8%)being the most preponderant. Sixty-seven patients had experienced pregnancy losses before 28 weeks of gestation while just 16 patients (13.8%) had undergone ART, and none was successful. Conclusion: Secondary infertility was the prevalent type of infertility and may not be unconnected with the low contraceptive usage and high risk of sexually transmitted infection. Late presentation coupled with a large proportion of post-menopausal clientele suggests delayed health-seeking behavior most probably due to the prohibitive cost of ART. The need to streamline services offered in public fertility clinics is paramount in low-income countries grappling with scarce resources. A pragmatic approach will involve the provision of low-cost ART, while enhancing gamete donation programs through the implementation of gamete sharing policies. This will invariably bridge the unmet need and skewed access to ART in developing countries.

Applying an Ordinal Priority Approach Based Neutrosophic Fuzzy Axiomatic Design Approach to Develop Sustainable Geothermal Energy Source

Geothermal energy is considered a renewable,environmentally friendly,especially carbon-free,sustainable energy source that can solve the problem of climate change.In general,countries with geothermal energy resources are the ones going through the ring of fire.Therefore,not every country is lucky enough to own this resource.As a country with 117 active volcanoes and within the world’s ring of fire,it is a country whose geothermal resources are estimated to be about 40%of the world’s geothermal energy potential.However,the percentage used compared to the geothermal potential is too small.Therefore,this is the main energy source that Indonesia is aiming to exploit and use.However,the deployment and development of this energy source are still facing many obstacles due to many aspects from budget sources due to high capital costs,factory construction location,quality of resources,and conflicts of the local community.In this context,determining the optimal locations for geothermal energy sites(GES)is one of the most important and necessary issues.To strengthen the selection methods,this study applies a two-layer fuzzy multi-criteria decision-making method.Through the layers,the Ordinal Priority Approach(OPA)is proposed to weight the sub-criteria,the main criterion,and the sustainability factors.In layer 2,the Neutrosophic Fuzzy Axiomatic Design(NFAD)is applied to rank and evaluate potential locations for geothermal plant construction.Choosing the right geothermal energy site can bring low-cost efficiency,no greenhouse gas emissions,and quickly become the main energy source providing electricity for Indonesia.The final ranking shows Papua,Kawah Cibuni,and Moluccas as the three most suitable cities to build geothermal energy systems.Kawah Cibuni was identified as the most potential GES in Indonesia,with a score of 0.46.Papua is the second most promising GES with a score of 0.45.Next is the Moluccas,with a score of 0.39.However,the three least potential sites among the 15 studied sites are Lumut Balai,Moluccas and Patuha,with scores of 0.08,0.11 and 0.17,respectively.The conclusion of this study also classifies positions into groups to aid in decision-making.

Shape Analysis of Agricultural Parcels for Land Consolidation Priorities in Tekirdag Province,Turkey

Shape irregularity,a sub-factor of parcel fragmentation is a problem that hinders sustainable agriculture and is solved using land consolidation projects.Determination of the parcel shape degree contributes significantly to spatial prioritization where there is also a high probability of achieving positive effects of consolidation projects.This study aims to determine the shape degree of the agricultural parcels both at singular and rural county scales in Tekirdag Province,Turkey in 2020 by combining the parcel shape index(PSI) with the minimum bounding geometry index(MBG) to improve parcel scores.Hot-spot zones of the highly irregular and near optimum parcels were also determined using Getis-Ord G_(i)^(*) statistic.The parcel degrees were classified into four categories,namely highly irregular,irregular,regular and near optimum.The obtained unweighted scores of the parameters exhibit deviations from the expected values.After weighting by pairwise comparison,the values approached ideal scores.Among 346 740 parcels,53% were highly irregular and irregular and 47% were regular and near optimum shapes after weighting whereas these were 70% and 30%,respectively before weighting.The average parcel degree of 63 rural counties was regular while the average parcel degree of the remaining 264 rural counties was irregular.The combined use of PSI and MBG index improved the correctness of the parcel shape score.It could be suggested to use as a tool in land consolidation prioritization.

Prioritizing the efforts:lived experiences of family when taking care of people with cancer

Objective:Cancer has one of the highest disease mortality rates.Families are very important in the treatment of people with cancer.By using a phenomenological design,this study aimed to explore the experience of families in caring for a person with cancer and to identify the needs of these families.Methods:First,eight interviews were under taken with family members selected through a purposive sampling method.Then,another three interviews were conducted for data validation.The collected data were analyzed using the framework method of analysis.Results:The core theme,“Prioritizing the efforts:Being aware of the best we could do for our family,”reflected family’s experiences of caring for a person with cancer and was underpinned by five themes:“Decisions to make,”“Keeping up the good support,”“Acknowledging the others’contributions,”“Assisting my family to alleviate the disease,”and“Adapting to the current situation.”Conclusions:The results suggest that building mutual trust and communication between family and healthcare professionals is vital in decision-making for people with cancer.Family may also work with the person in fulfilling their needs,without disregarding the needs of the family.When suppor ting the needs of people with diabetes,the family requires appropriate information,and thus,healthcare professionals wisely select which information can help the family make a decision regarding the treatment.After administering the treatment and providing information for people with cancer and their family,asking for feedback is required for evaluation.

Boundedness and liveness enforcement for labeled Petri nets using transition priority

This paper deals with the supervisory control problem of discrete event systems modeled by labeled Petri nets. The system is originally unbounded. First, the solvability of the problem is confirmed. A necessary condition is given and proven for the existence of a feasible priority-based controller based on the notions of liveness and transition invariants. Next, a cyclic behavior graph is constructed, which shows the reachable markings that guarantee the maximum liveness of the system within a given bound vector. Finally, an on-line control strategy is proposed to enforce boundedness and liveness to the given system by appending priority relations to transitions. The dynamic priority relation changes flexibly according to the current state of the system and enforces the system evolving in a bounded and live manner. In addition, numerical examples are studied to verify the validity of the proposed approach that remains the structure of the plant net and is efficient for on-line control.

Prevalence of Some World Health Organization Priority Organisms from an Abattoir at Kwata, Anambra State, Nigeria

The abattoir is one of the important sectors in the food industry, therefore the need for close monitoring of everything concerning it to minimize microbial contamination. The aim of the study is to identify bacteria listed as WHO priority organisms associated with meat from Kwata abattoir in Awka, Anambra state. The study was carried out over a three (3) months period from September to December 2022. Thirteen samples were collected from the floor, table, water, meat, knife and soil in the abattoir. The samples were cultured using streak and spread plate methods on MacConkey and Cetrimide agar. The isolates were identified with the following biochemical tests: catalase, oxidase, citrate and indole tests. Ampiclox levofloxacin, gentamicin, ofloxacin impenem ceftraixone, cefixime, cefuroxime and nitrofurantoin were used for sensitivity test following Kirby Bauer disc diffusion method and biofilm formation was determined using the tube method. The 75 isolates obtained were identified as follows;29.3% E. coli, 26.7% Klebsiella spp., 16% Proteus spp., and 28% Pseudomonas spp. The result of antibiotics sensitivity test interpreted using the European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints showed that (98%) of the isolates were resistant to the antibiotics used. Test for biofilm formation with 52 isolates showed 31 strong, 12 moderate and 9 weak biofilm formers. The result of this study confirms the presence of bacteria contaminants within the WHO priority list in the abattoir, as such there is need for improved handling of animals. Slaughtering, cleaning and distribution of meat should be done using aseptic procedures. .

Priority Detector and Classifier Techniques Based on ML for the IoMT

Emerging telemedicine trends,such as the Internet of Medical Things(IoMT),facilitate regular and efficient interactions between medical devices and computing devices.The importance of IoMT comes from the need to continuously monitor patients’health conditions in real-time during normal daily activities,which is realized with the help of various wearable devices and sensors.One major health problem is workplace stress,which can lead to cardiovascular disease or psychiatric disorders.Therefore,real-time monitoring of employees’stress in the workplace is essential.Stress levels and the source of stress could be detected early in the fog layer so that the negative consequences can be mitigated sooner.However,overwhelming the fog layer with extensive data will increase the load on fog nodes,leading to computational challenges.This study aims to reduce fog computation by proposing machine learning(ML)models with two phases.The first phase of theMLmodel assesses the priority of the situation based on the stress level.In the second phase,a classifier determines the cause of stress,which was either interruptions or time pressure while completing a task.This approach reduced the computation cost for the fog node,as only high-priority records were transferred to the fog.Low-priority records were forwarded to the cloud.Four MLapproaches were compared in terms of accuracy and prediction speed:Knearest neighbors(KNN),a support vector machine(SVM),a bagged tree(BT),and an artificial neural network(ANN).In our experiments,ANN performed best in both phases because it scored an F1 score of 99.97% and had the highest prediction speed compared with KNN,SVM,and BT.

A-Kano模型下全过程工程咨询业主需求实证研究

我国全过程工程咨询实践正处于多种模式并存、咨询内容差异较大的探索性阶段。以业主需求为导向,合理确定咨询服务内容,提升全过程工程咨询企业服务能力,是推进全过程工程咨询健康发展的关键。通过梳理相关文献,识别出12种全过程工程咨询业主需求,进而借助A-Kano模型开展正、负向满意度与重要度问卷调查,并计算出各类需求的优先级。实证分析结果表明:工程监理和造价咨询属于基本型需求;项目管理、设计及勘察属于期望型需求;招标代理、前期策划和BIM咨询为兴奋型需求;后期运营、建筑节能与绿色建筑咨询、工程检测服务以及工程保险咨询为无差异需求。基于上述结果为工程咨询企业提出转型建议,使其更好地满足业主集成化、个性化的咨询需求。

The value rationality and tool rationality of Health Priority

Health Priority is increasingly becoming a human need and an international consensus.In addition to the basic value judgment and direction-leading function,Health Priority also has a clear,practical meaning and distinct tool attributes.The text adheres to the organic unity of regularity and purpose,follows the modern medical model and the philosophy of system theory,combines the characteristic facts,and discusses the value rationality and tool rationality of Health Priority based on the whole process management,and tries to refine the Health Priority governance model with Chinese characteristics,so as to provide a reference for global health governance.

以新质生产力赋能中国式现代化的重点与任务

发展新质生产力是中国式现代化的主要推动力,以新质生产力赋能中国式现代化是适应我国社会主要矛盾变化背景下推动中国式现代化的新要求,是打造中国式现代化质量版的客观要求,是实现中国式现代化目标转型的必然要求。以新质生产力赋能中国式现代化的战略重点在于构建现代经济体系、培育现代化新动能、提高供给体系质量。以新质生产力赋能中国式现代化新发展的战略任务是形成以新质生产力赋能中国式现代化的内生驱动力,推动供给侧的产业结构升级,以新质生产力形成中国式现代化新优势;推动动力转换,形成中国式现代化新动力;实现数字经济赋能中国式现代化,以数字新质生产力打造中国式现代化的升级版;以新质生产力推动新型工业化,形成新型工业化的新优势。

教育优先发展视域下学校体育高质量育人的理论意涵与实践路径

教育优先发展是党和国家提出并长期坚持的重大方针,高质量发展是教育优先发展在新阶段的重要表征。学校体育高质量育人作为教育高质量发展的重要构成,体现出育人目标的素养导向、育人过程的生本导向和要素导向以及育人功效的多元导向等特征。新时期推进学校体育高质量育人需要坚持把立德树人作为根本任务,着力培养青少年的核心素养;提升学生体育学习的实际获得感,提高体育师资培养质量,推进体育家校合作;科学认识学校体育促进青少年全面发展的育人价值,充分发挥学校体育的育体功能和育心功能。

考虑电动汽车优先级需求的两阶段优化调度策略

随着光伏发电渗透率的升高,光伏出力的不确定性会影响电网的安全稳定运行。而利用电动汽车(EV)移动储能的特性可以实现EV和光伏的协同增效。本文基于EV能量调度的灵活性,构建了考虑用户充电需求的EV两阶段优化调度模型:在日前预调度阶段,建立光伏的就地消纳偏差最小、EV充电完成率最大、EV用户出行成本最小的多目标优化函数,并引入充放电系数对EV的充电行为进行优化;在实时调度阶段,负荷聚合商结合各时段EV的实际充电需求,根据调度优先级对优化后的充放电系数修正,保证EV充电的公平性,制定出最优的充放电策略。通过综合考虑EV用户对于充电完成度和充电成本的不同需求,对不同充电模式、不同权重系数进行分析,同时考虑了用户改变充电需求的情况,验证本文所提策略在降低光伏消纳偏差量、满足用户充电需求方面具有明显效果。

基于公交优先的干线协调信号控制改进模型

基于公交信号优先策略,对MULTIBAND模型进行改进,重新定义了权重系数、车道清空时间和最小绿波带宽,结合不同相位放行方式实施红灯早断或绿灯延长控制策略,并在此基础上考虑公交车辆的车速与停靠时间,建立对公交车辆的约束,提出基于公交优先的干线协调信号控制改进模型。通过VISSIM仿真,将该模型与传统干线协调信号控制模型对比分析,结果表明:与传统协调控制模型相比,模型使社会车辆平均延误降低了4.77%,停车次数降低了3.77%,公交车辆平均延误降低了11.35%,停车次数降低了2.06%,人均延误降低了7.22%,且在不同的公交流量下均有较好的效果。

河北衡水湖自然保护区水鸟多样性分布格局及其保护优先区

水鸟是反映湿地生态系统状况的指示物种,水鸟多样性保护优先区识别对自然保护区功能区划和湿地保护修复具有重要意义。于2020年5月—2021年4月,开展了衡水湖自然保护区水鸟群落的调查监测,采用GIS软件和结构方程模型等分析其不同区域水鸟群落结构和季节性变化、水鸟多样性分布格局及其驱动因素。结果表明:(1)衡水湖自然保护区不同区域均表现出以雁鸭类等游禽为优势种的水鸟群落特征,衡水湖西湖和滏东排河的水鸟物种丰富度和Shannon多样性指数最高,衡水湖东湖的水鸟种群数量最大,滏阳新河的鸻鹬类种群数量相对较大。(2)不同区域水鸟群落具有明显的季节性变化特征,春夏季涉禽数量明显增多,但仅在衡水湖自然保护区东湖、西湖和滏阳新河成为水鸟群落的优势种;9月之后各区域游禽种数和种群数量占比均明显上升,雁鸭类成为优势种群。(3)水鸟物种丰富度和种群数量较高的区域主要在自然保护区的湿地恢复区、滏东排河和小湖隔堤两侧等地;不同类群水鸟的空间分布格局差异较大,雁鸭类分布较为分散,鸻鹬类、鹤鹳类水鸟分布更为集中;栖息地状况是影响衡水湖水鸟多样性的主要因素。(4)衡水湖水鸟保护优先区包括湿地恢复区及周边区域、南李庄鱼塘、良心庄鱼塘及周边区域、东湖的姊妹东岛、小湖隔堤两侧等5个区域,占保护区总面积的8.94%。研究结果为衡水湖自然保护区的功能区划、水鸟保护策略制定、栖息地保护修复提供了相关依据。

RCEP框架下海南与东盟十国经贸合作的优先梯度与重点领域研究

随着区域全面经济伙伴关系(RCEP)框架的建立,海南与东盟十国之间的经贸合作迎来了新的发展机遇,本文主要探讨在RCEP框架下海南与东盟十国经贸合作的优先梯度与重点领域。通过文献回顾和分析,本文结合海南与东盟经贸合作的发展现状,从外部环境、营商环境出发,分析了合作的优先梯度,并提出了重点合作领域的建议,根据分析结果提出相应的对策建议,旨在促进海南与东盟十国之间经贸合作的深入发展,推动区域经济一体化进程。

考虑柔性设备加工能力的综合调度算法

现有柔性综合调度研究中,没有考虑设备系统的协同加工能力,从而降低了设备系统高密加工和快速加工能力。针对此问题,文章将柔性设备可进行加工的工序数作为优化对象、以竞争资源较为紧张的设备资源为优化要素,提出了考虑柔性设备加工能力的综合调度算法(ISA-CPCFE):首先,采用优先调度层级较高与加工时长较短的工序的策略,提高了工序并行调度的力度;其次,提出一种最小化调度标尺与动态调整柔性设备优先级的策略,进一步提高了设备紧凑调度的力度。最后,将ISA-CPCFE算法与基于剪枝分层、基于设备驱动、基于实际路径、基于逆序层优先的算法进行对比实验。结果表明:ISA-CPCFE算法实现了复杂产品加工时间更短、柔性设备系统整体利用率更高的优化目标,调度效果更优。

国际承包商合规体系的有效性度量研究

为响应廉洁“一带一路”号召,助力国际承包商开展有效的合规管理,采用文献分析法、德尔菲法构建企业层面的合规指标体系,并基于Fuzzy-OPA形成合规体系的有效性度量模型,通过调研某国际承包商的合规体系验证模型的合理性。研究结果表明:合规指标体系包含合规准则、措施及最佳实践,基于Fuzzy-OPA构建的度量模型能够评价企业合规体系的有效性,为诊断合规薄弱环节、完善合规体系提供参考。

优先权之反思与重述

优先权的概念范畴有狭义和广义之分。源自法国民法的狭义优先权长期游离于我国债物二分体系之中,已造成权利性质难辨、公示机制阙如和其他衍生的学理弊端。广义优先权谱系的创设存在语境虚假、效果无益、集合异类等显著缺陷。在狭义优先权中,一般优先权实为债权,特别优先权实为法定抵押权。此种法定抵押权与受其担保的主债权相区分,具有债法和物法的双重面相。其他所谓的“优先权”子项主要包括竞争中享有优待地位的资格和对因顺位判定原则或规则所生结果的描述。

基于措施优先级的失效模式和效应分析在结直肠术手术部位感染防控中的应用

目的评估结直肠手术后手术部位感染(SSI)防控措施执行的过程风险,探讨基于措施优先级的失效模式和效应分析(FMEA)的应用效果。方法应用基于措施优先级的FMEA评估结直肠手术后SSI防控措施执行的整个流程,对是否采取优化措施进行优先级排序,比较FMEA实施前后结直肠手术SSI防控措施依从项达标率、SSI发病率。结果评估后SSI高优先级防控措施7项,中优先级22项,对中优先级措施加强控制,重点对高优先级措施制定进一步的预防和可探测措施。改进后再评价结果显示,7项高优先级措施降至中优先级;16项中优先级措施降至低优先级。SSI防控措施执行达标率由77.15%(2566/3326)提高至92.47%(3096/3348),SSI发病率由6.04%(58/960)降至2.54%(60/2364)。结论运用基于措施优先级的FMEA可对结直肠手术SSI防控过程进行有效风险评估,并结合现状针对性采用预防性风险控制措施,可降低结直肠手术SSI发病率。

公交专用车道规划管理思辨及公共汽电车交通发展纾困

2023年上半年,公安部推出10项公安交管新措施,其中包括优化城市公交专用车道管理。北京、深圳、青岛、南通等地陆续发布公交专用车道相关管理措施,引发广泛讨论与关注。围绕公交专用车道管理措施背后的原因与调整的依据,公交专用车道本身的规划、管理与使用问题,以及公共汽电车交通运营困境,特邀城市交通行业专家学者和公共汽电车运营管理研究的一线工作人员以笔谈的形式交流观点。在此基础上,探索在城市存量发展阶段如何建立常态化路权变更规则和评估机制,以及公共汽电车交通纾困之路。