Pixel classification for automated diabetic foot diagnosis

Worldwide, more than 180 million people suffer from diabetes mellitus. Approximately 50% of these patients will develop complications to their feet. Neuropathy, combined with poor blood supply and biomechanical changes results in a high risk for foot ulcers, which is a key problem in the diabetic foot; when these wounds become infected, this can ultimately result in lower extremity amputation, which has a serious effect on the quality of life of the patient, and causes a large economic burden on society.\ud \ud This was the motivation for a collaborate project (Vincent50) in which a photographic foot imaging device was developed. The system allows scanning of the foot soles on a daily basis which may lead to early recognition of foot problems. The goal of the present study is to determine whether pixel classification is a useful intermediate step towards automatically assessing the images of the foot soles for signs of diabetic foot disease. If successful, this approach will further relief health care professionals in assessing the foot and enable the placement of more devices in the future. \ud \ud The best agreement between automated recognition and expert diagnosis was achieved with a combination of RGB and derived features, proves that the RGB data is informative with respect to detection of ulcers. However, the automatic detection of pre-signs of ulcers and other anomalies needs more sophistication than pixel classification alone. Firstly, other physical features, such as hyperspectral data, infrared and/or textural features are expected to be more informative. Secondly, we expect to be able to boost the performance by using the context between neighboring pixels. Thirdly, an individualized and normalized classification process might help with the large variability in foot soles between individuals. \u

Tourism and religion: an uneasy relationship?

The interrelationship of religion and tourism has barely been touched upon in research (Vukonić, 1996). Smart (1996) distinguishes various dimensions of religion, but not in terms of cultural meaning and identity. Changes take place, for instance in Islamic beliefs, from relatively tolerant to extremely intolerant (Bauer, 2011), or in terms of secularisation in Christianity (Giddens, 1993). This paper questions how hosts and host societies perceive tourists’ behaviour while relating their perception to religious (or cultural) convictions. How far does this perception lead to condemnation through disapproval, bans, resistance, or violence? Nevertheless, Cavanaugh (2009) warns against the myth of religious violence

Rural Tourism : A Gender Approach

Research on the subject of rural tourism and agritourism in the Netherlands has shown that most of the work in this field is done by women. Moreover, without the consent and initiative of the women, no agritourist activities would have been started. In the paper the position of women in agritourist enterprises is understood within the framework of family enterprises. Findings of research are presented on the position of women in tourism enterprises, of which agritourist enterprises are specific examples. The women's position in the enterprise and in the branch organisation are discussed with help of the power relation theory (Giddens, 1981; Komter, 1985), and the `tokenism' theory of Kanter (1977). The findings indicate that the challenge of the renewal of the countryside, plays a major role in the independency and control rural women face when setting up an own enterprise related to the farm

Institutions and the regulation of business:An international firm-level study of regulatory compliance costs

Prior work has established the negative effects of many regulations on business and policy.These negative effects have been a key driver for many of the so-called better regulation programmes. Despite all efforts, however, deregulation programmes have had inconclusive results and their success remains the subject of ongoing debate. We suggest that the public policy efforts have largely overlooked a business perspective of regulation and its institutional determinants. We argue that the institutional determinants of regulation include the regulation stock, the quality of regulation and the predictability of regulation application. This study is among the first to examine the impact of these institutional determinants on regulatory compliance costs for firms using a unique dataset from companies in OECD countries. Our results convincingly support our approach to the study of regulation

Psychological distress among frontline workers during the COVID-19 pandemic:A mixed-methods study

BACKGROUND: Novel virus outbreaks, such as the COVID-19 pandemic, may increase psychological distress among frontline workers. Psychological distress may lead to reduced performance, reduced employability or even burnout. In the present study, we assessed experienced psychological distress during the COVID-19 pandemic from a self-determination theory perspective. METHODS: This mixed-methods study, with repeated measures, used surveys (quantitative data) combined with audio diaries (qualitative data) to assess work-related COVID-19 experiences, psychological need satisfaction and frustration, and psychological distress over time. Forty-six participants (nurses, junior doctors, and consultants) completed 259 surveys and shared 60 audio diaries. Surveys and audio diaries were analysed separately. RESULTS: Quantitative results indicated that perceived psychological distress during COVID-19 was higher than pre-COVID-19 and fluctuated over time. Need frustration, specifically autonomy and competence, was positively associated with psychological distress, while need satisfaction, especially relatedness, was negatively associated with psychological distress. In the qualitative, thematic analysis, we observed that especially organisational logistics (rostering, work-life balance, and internal communication) frustrated autonomy, and unfamiliarity with COVID-19 frustrated competence. Despite many need frustrating experiences, a strong connection with colleagues and patients were important sources of relatedness support (i.e. need satisfaction) that seemed to mitigate psychological distress. CONCLUSION: The COVID-19 pandemic resulted in an increase of psychological distress among frontline workers. Both need frustration and need satisfaction explained unique variance of psychological distress, but seemed to originate from different sources. Challenging times require healthcare organisations to better support their professionals by tailored formal and informal support. We propose to address both indirect (e.g. organisation) and direct (e.g. colleagues) elements of the clinical and social environment in order to reduce need frustration and enhance need satisfaction