Factors Influencing Pre-hospital Patient Delay in Patients with Acute Myocardial Infarction

Acute myocardial infarction （AMI） is a dangerous disease with a high mortality rate. For AMI patients, the outcome of the patients depends on time to beginning of effective treatment in addition to other factors such as severity of disease and involved vessels etc. The key is whether reperfusion therapy is started early enough after the onset of symptoms, and the benefit of reperfusion therapy depends on the time, too. The delay of AMI treatment is divided into pre-hospital delay and in-hospital delay. In-hospital delay, Door-to-Balloon Time, has been well controlled. Pre-hospital delay, accounting for 75% of the total delay time, is the most important factor affect- ing AMI treatment. Patient delay （PD） time for AMI patients is summarised in this study.

Analysis on Factors Causing Project Delays in Road and Highways Sector in India Using Relative Ranking Index Technique

On-time completion of road infrastructure projects is a critical goal.When projects were not completed on schedule and real construction progress is slower than expected,the inconvenience and disruption to business access increases.On time completion is linked to economic and social welfare,as well as safety.Construction delays continue to be a typical occurrence,despite the need of prompt completion.A literature study is conducted in this context in order to learn more about the causes and factors that contribute to delays.Following a thorough review of the literature,it was determined that a questionnaire survey is the most effective and trustworthy way for gathering information about the causes and quantifying delays caused by emergent factors.The Relative Importance Index(RII)method was used to analyze the data,and the reasons for the delay were prioritized according to their importance.This study focuses on the emergent concerns/causes and reasons of concern in road infrastructure projects,as well as how to priorities these issues sequentially during the planning stage.This study survey can assist construction companies doing business in India in understanding the essential or sensitive issues that require special attention in order to conduct their businesses smoothly in this country while employing appropriate project management practices.

Stochastic Framework for Solving the Prey-Predator Delay Differential Model of Holling Type-Ⅲ

The current research aims to implement the numerical resultsfor the Holling third kind of functional response delay differential modelutilizing a stochastic framework based on Levenberg-Marquardt backpropagationneural networks (LVMBPNNs). The nonlinear model depends uponthree dynamics, prey, predator, and the impact of the recent past. Threedifferent cases based on the delay differential system with the Holling 3^(rd) type of the functional response have been used to solve through the proposedLVMBPNNs solver. The statistic computing framework is provided byselecting 12%, 11%, and 77% for training, testing, and verification. Thirteennumbers of neurons have been used based on the input, hidden, and outputlayers structure for solving the delay differential model with the Holling 3rdtype of functional response. The correctness of the proposed stochastic schemeis observed by using the comparison performances of the proposed and referencedata-based Adam numerical results. The authentication and precision ofthe proposed solver are approved by analyzing the state transitions, regressionperformances, correlation actions, mean square error, and error histograms.

Patient Delay in Patients With ST-elevation Acute Myocardial Infarction

Objectives To examine patient delay (PD) in seeking treatment among patients with ST-elevation myocardial infarction (STEMI) and to identify factors influencing PD. Methods patients with STEMI were divided into two groups based on PD: Short PD group (PD ≤ 60 minutes after onset of symptoms) and long PD group ( > 60 minutes after symptom onset). A questionnaire developed to assess demographic characteristics, clinical factors and psychological factors. Patients were interviewed within 72 hours of admission to 2 hospitals. Results 329 consecutive confirmed STEMI patients (Mean age 61years; 72.5% men) with a median PD of 90 min and a pre-hospital delay time 170 min were studied, PD was less than 1 hours in 47.4% of patients, while more than 1 hours in 52.6%, In univariate analyses, patients with short PD were witness onset, progress course of symptom, severe pain, death anxiety, knowing AMI as a deadly disease and its presentation, taking the symptom seriously. Patients with longer PD were age ≥65 year, nocturnal onset, experienced their symptoms at home, gradual onset, ’waited to see whether symptoms disappeared’, ’worried about troubling others’, ’took pain medication’ and preinfarction angina. A stepwise multiple regression analysis further suggested that the following inde-pendent contributors to a late decision to seek medical help (relative risk, 95% confidence interval): taking pain medication (15.97; 1.70～149.8 ), wanting to wait and see (6.46; 1.92～21.74), not wanting to bother anybody (6.42; 2.87～14.34), preinfarct angina (2.73; 1.20～6.19), age ≥65 years (2.51; 1.15～5.48), gradual onset (2.40; 1.05～5.44), severe pain(0.38, 0.17～0.85), witness onset (0.27, 0.10～0.70), taking symptoms seriously (0.019; 0.08～0.46). Conclusions Age ≥65 years, gradual onset, witness onset, severe pain, preinfarct angina, emotional responses and coping strategies are the independent factors associated with patient delay or decision time in patients with AMI. Emotional responses and coping strategies are the major determinants of patient delay. Modification of these emotional factors might best be achieved by patients and public education.

Luminescent properties of thermally activated delayed fluorescence molecule with intramolecular π-π interaction between donor and acceptor

Influence of intramolecular π-π interaction on the luminescent properties of thermally activated delayed fluorescence（TADF） molecule（3, 5-bis（3,6-di-tert-butyl-9 H-carbazol-9-yl）-phenyl）（pyridin-4-yl） methanone（DTCBPY） is theoretically studied by using the density functional theory（DFT） and time-dependent density functional theory（TD-DFT）.Four conformations（named as A, B, C, and D） of the DTCBPY can be found by relax scanning, and the configuration C corresponds to the luminescent molecule detected experimentally. Besides, we calculate the proportion of each conformation by Boltzmann distribution, high configuration ratios（44% and 52%） can be found for C and D. Moreover, C and D are found to exist with an intramolecular π-π interaction between one donor and the acceptor; the intramolecular interaction brings a smaller Huang-Rhys factor and reduced reorganization energy. Our work presents a rational explanation for the experimental results and demonstrates the importance of the intramolecular π-π interaction to the photophysical properties of TADF molecules.

Cost Risk Appraisal： An Application of Project RiskManagement Process in Libyan Construction Projects

Projects delay and cost overrun have become general facts in the construction industry. Project cost risk analysis considers the different costs associated with a project and focuses on the uncertainties and risks that may affect these costs. An implementation of PRM （project risk management） process on regional construction project has been carried out to maximize the likelihood of project meeting its objectives within its constraints. Qualitative and quantitative risk analyses have been carried out. The qualitative analysis is presented in a table that shows top ranked risks in Libyan construction projects based on probability-impact grid technique. In quantitative risk analyses, Mont Carlo simulation technique has been conducted to quantify and evaluate the overall level of risk exposure associated with the project completion cost. A project simulation uses a model that translates cost uncertainties into their potential impact on project objectives. A frequency curve model that represents simulation results of project completion costs has been constructed. The frequency curve model shows all possible outcomes of expected project cost at different probabilities. Project manager or decision maker can select the appropriate project budget. If a probability of 0.95 confident project budget is selected that means cost overrun risk can be minimized to a probability of 0.05. It is very helpful for project manager to take decisions based on information that shows project completion cost and its associated probability rather than usin single information of estimated cost.