Search results for: intensive case management

Authors: Bill D. Geis

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Suicide wrongful death forensic cases are the fastest rising tort in mental health law. It is estimated that suicide-related cases have accounted for 15% of U.S. malpractice claims since 2006. Most suicide-related personal injury claims fall into the legal category of “wrongful death.” Though mental health experts may be called on to address a range of forensic questions in wrongful death cases, the central consultation that most experts provide is about the negligence element—specifically, the issue of whether the clinician met the clinical standard of care in assessing, treating, and managing the deceased person’s mental health care. Standards of care, varying from U.S. state to state, are broad and address what a reasonable clinician might do in a similar circumstance. This fact leaves the issue of the suicide standard of care, in each case, up to forensic experts to put forth a reasoned estimate of what the standard of care should have been in the specific case under litigation. Because the general state guidelines for standard of care are broad, forensic experts are readily retained to provide scientific and clinical opinions about whether or not a clinician met the standard of care in their suicide assessment, treatment, and management of the case. In the past and in much of current practice, the assessment of suicide has centered on the elicitation of verbalized suicide ideation. Research in recent years, however, has indicated that the majority of persons who end their lives do not say they are suicidal at their last medical or psychiatric contact. Near-term risk assessment—that goes beyond verbalized suicide ideation—is needed. Our previous research employed structural equation modeling to predict lethal suicide risk--eight negative thought patterns (feeling like a burden on others, hopelessness, self-hatred, etc.) mediated by nine transdiagnostic clinical factors (mental torment, insomnia, substance abuse, PTSD intrusions, etc.) were combined to predict acute lethal suicide risk. This structural equation model, the Lethal Suicide Risk Pattern (LSRP), Acute model, had excellent goodness-of-fit [χ2(df) = 94.25(47)***, CFI = .98, RMSEA = .05, .90CI = .03-.06, p(RMSEA = .05) = .63. AIC = 340.25, ***p < .001.]. A further SEQ analysis was completed for this paper, adding a measure of Acute Suicide Ideation to the previous SEQ. Acceptable prediction model fit was no longer achieved [χ2(df) = 3.571, CFI > .953, RMSEA = .075, .90% CI = .065-.085, AIC = 529.550].This finding suggests that, in this additional study, immediate verbalized suicide ideation information was unhelpful in the assessment of lethal risk. The LSRP and other dynamic, near-term risk models (such as the Acute Suicide Affective Disorder Model and the Suicide Crisis Syndrome Model)—going beyond elicited suicide ideation—need to be incorporated into current clinical suicide assessment training. Without this training, the standard of care for suicide assessment is out of sync with current research—an emerging dilemma for the forensic evaluation of suicide wrongful death cases.

Keywords: forensic evaluation, standard of care, suicide, suicide assessment, wrongful death

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Authors: Hong Chen, Li Heping

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China's urbanization rate has exceeded 60%, and in the long term, China's urbanization development will enter a new stage of transformation and development focusing on quality improvement, and urban renewal has become an important part of China's urban development. In the past, many cities in the process of renewal in order to maximize the pursuit of economic interests, large-scale demolition of the old to build new, accelerating the disappearance of regional history and culture, aggravating the homogenization of the city. With the changes in the economic and social development environment, urban renewal requires a more comprehensive perspective of action. Starting from the perspective of the core of urban management theory, this paper is oriented to culture-enabled urban renewal and takes the urban renewal of Changbin Road Area in Yuzhong District of Chongqing as an example to expound the problems and renewal strategies in its urban renewal, so as to provide references for the urban renewal of other Chinese cities in the new period.

Keywords: Urban management, Urban culture, Urban renewal in mountainous areas, urban renewal

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Authors: Soumita Mitra, Santosh Kumar Sarkar

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Hooghly river estuary (HRE), situated at the north eastern part of Bay of Bengal has global significance due to its holiness. It is of immense importance to the local population as it gives perpetual water supply for various activities such as transportation, fishing, boating, bathing etc. to the local people who settled on both the banks of this estuary. This study was done to assess the dissolved and particulate trace metal in the estuary covering a stretch of about 175 Km. The water samples were collected from the surface (0-5 cm) along the salinity gradient and metal concentration were studied both in dissolved and particulate phase using Graphite Furnace Atomic Absorption Spectrophotometer (GF-AAS) along some physical characteristics such as water temperature, salinity, pH, turbidity and total dissolved solids. Although much significant spatial variation was noticed but little enrichment was found along the downstream of the estuary. The mean concentration of the metals in the dissolved and particulate phase followed the same trend and as follows: Fe>Mn>Cr>Zn>Cu>Ni>Pb. The concentration of the metals in the particulate phase were much greater than that in dissolved phase which was also depicted from the values of the partition coefficient (Kd)(ml mg-1). The Kdvalues ranged from 1.5x105 (in case of Pb) to 4.29x106 (in case of Cr). The high value of Kd for Cr denoted that the metal Cr is mostly bounded with the suspended particulate matter while the least value for Pb signified it presence more in dissolved phase. Moreover, the concentrations of all the studied metals in the dissolved phase were many folds higher than their respective permissible limits assested by WHO 2008, 2009 and 2011. On the other hand, according to Sediment Quality Guidelines (SQGs), Zn, Cu and Ni in the particulate phase lied between ERL and ERM values but Cr exceeded ERM values at all the stations confirming that the estuary is mostly contaminated with the particulate Cr and it might cause frequent adverse effects on the aquatic life. Multivariate statistics Cluster analysis was also performed which separated the stations according to the level of contamination from several point and nonpoint sources. Thus, it is found that the estuarine system is much polluted by the toxic metals and further investigation, toxicological studies should be implemented for full risk assessment of this system, better management and restoration of the water quality of this globally significant aquatic system.

Keywords: dissolved and particulate phase, Hooghly river estuary, partition coefficient, surface water, toxic metals

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Authors: Seyed Mazyar Mortazavi, Masod Memari, Hasan Ali Ahmadi, Zhaleh Abed

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Introduction: VACTERL association is a rare disorder with various congenital malformations. The aetiology remains unknown. Combination of at least three congenital anomalies of the following criteria is required for diagnosis: vertebral defects, anal atresia, cardiac anomalies, tracheo-esophageal fistula, renal anomalies, and limb defects. Case presentation: The first case was 1-day old male neonate with multiple congenital anomalies was bore from 28 years old mother. The mother had history of pregnancy with lymphocyte therapy. His anomalies included: defects in thoracic and lumbar vertebral, anal atresia, bilateral hydronephrosis, atrial septal defect, and lower limb abnormality. Other anomalies were cryptorchidism and nasal canal narrowing. The second case was born with 32 weeks gestational age from mother with history of pregnancy with lymphocyte therapy. He had thoracic vertebral defect, cardiac anomalies and renal defect. Conclusion: diagnosis based on clinical finding is VACTERL association. Early diagnosis is very important to investigation and treatment of other coexistence anomalies. VACTERL association in mothers with history of pregnancy with lymphocyte therapy has suggested possibly of relationship between VACTERL association and this method of pregnancy.

Keywords: anal atresia, tracheo-esophageal fistula, atrial septal defect, lymphocyte therapy

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Authors: Rukhsana Kausar, Issam Malki

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The integration and assimilation of ethnic minority immigrants (EMIs) and their subsequent generations remains a serious unsettled issue in most of the host countries. This study conducts the labour market gender analysis to investigate specifically whether second generation of ethnic minority immigrants in the UK is gaining access to professional and managerial employment and advantaged occupational positions on par with their native counterparts. The data used to examine the labour market achievements of EMIs is taken from Labour Force Survey (LFS) for the period 2014-2018. We apply a multivalued treatment under ignorability as proposed by Cattaneo (2010), which refers to treatment effects under the assumptions of (i) selection – on – observables and (ii) common support. We report estimates of Average Treatment Effect (ATE), Average Treatment Effect on the Treated (ATET), and Potential Outcomes Means (POM) using three estimators, including the Regression Adjustment (RA), Augmented Inverse Probability Weighting (AIPW) and Inverse Probability Weighting- Regression Adjustment (IPWRA). We consider two cases: the case with four categories where the first-generation natives are the base category, the second case combine all natives as a base group. Our findings suggest the following. Under Case 1, the estimated probabilities and differences across groups are consistently similar and highly significant. As expected, first generation natives have the highest probability for higher career attainment among both men and women. The findings also suggest that first generation immigrants perform better than the remaining two groups, including the second-generation natives and immigrants. Furthermore, second generation immigrants have higher probability to attain higher professional career, while this is lower for a managerial career. Similar conclusions are reached under Case 2. That is to say that both first – generation and second – generation immigrants have a lower probability for higher career and managerial attainment. First – generation immigrants are found to perform better than second – generation immigrants.

Keywords: immigrnats, second generation, occupational attainment, ethnicity

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Authors: M. Boumaiza, S. Mohamadi, B. Moussai

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In this article the study of the seismic response of an earth dam with sealing walls has been made by introducing the effect of the change of position and depth of the sealing wall and the effect of non-linear behavior of soil of the foundation by taking into account the variation of the viscous damping and shear modulus in each layer of soil on the seismic response of the dam. As a case study, we take the Algerian dam Kef-Eddir which lies in the far west of the territory of the Wilaya of Tipaza (wadi Eddamous), classified according to the RPA 2003 as a high seismicity zone (zone III). With a height of 71m above the foundation and a width of 478m. The seismic event applied to the rock, is the earthquake of Chenoua (29 October, 1989), with a magnitude Mw=6 that hit the region.

Keywords: earth dam, earthquake, sealing walls, viscous damping

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Authors: Mara Balestrieri, Clara Pusceddu

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Issues relating to the destructive phenomena that can damage people and goods have returned to the centre of debate in Italy with the increase in catastrophic episodes in recent years in a country which is highly vulnerable to hydrological risk. Environmental factors and geological and geomorphological territorial characteristics play an important role in determining the level of vulnerability and the natural tendency to risk. However, a territory has also been subjected to the requirements of and transformations of society, and this brings other relevant factors. The reasons for the increase in destructive phenomena are often to be found in the territorial development models adopted. Stewardship of the landscape and management of risk are related issues. This study aims to summarize the most relevant elements about this connection and at the same time to clarify the role of environmental risk assessment as a tool to aid in the sustainable management of landscape. How planners relate to this problem and which aspects should be monitored in order to prepare responsible and useful interventions?

Keywords: assessment, landscape, risk, planning

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Authors: S. Ping Ho, R. Dahal

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The global economy has drastically changed how firms operate and compete. Although the construction industry is ‘local’ by its nature, the internationalization of the construction industry has become an inevitable reality. As a result of global competition, staying domestic is no longer safe from competition and, on the contrary, to grow and become an MNE (multi-national enterprise) becomes one of the important strategies for a firm to survive in the global competition. For the successful entrance into competing markets, the firms need to re-define their competitive advantages and re-identify the sources of the competitive advantages. A firm’s initiation of internationalization is not necessarily a result of strategic planning but also involves certain idiosyncratic events that pave the path leading to a firm’s internationalization. For example, a local firm’s incidental or unintentional collaboration with an MNE can become the initiating point of its internationalization process. However, because of the intensive competition in today’s global movement, many firms were compelled to initiate their internationalization as a strategic response to the competition. Understandingly stepping in in the process of internationalization and appropriately implementing the strategies (in the process) at different stages lead the construction firms to a successful internationalization journey. This study is carried out to develop a model of the internationalization process, which derives appropriate strategies that the construction firms can implement at each stage. The proposed model integrates two major and complementary views of internationalization and expresses the dynamic process of internationalization in three stages, which are the pre-international (PRE) stage, the foreign direct investment (FDI) stage, and the multi-national enterprise (MNE) stage. The strategies implied in the proposed model are derived, focusing on capability building, market locations, and entry modes based on the resource-based views: value, rareness, imitability, and substitutability (VRIN). With the proposed dynamic process model the potential construction firms which are willing to expand their business market area can be benefitted. Strategies for internationalization, such as core competence strategy, market selection, partner selection, and entry mode strategy, can be derived from the proposed model. The internationalization process is expressed in two different forms. First, we discuss the construction internationalization process, identify the driving factor/s of the process, and explain the strategy formation in the process. Second, we define the stages of internationalization along the process and the corresponding strategies in each stage. The strategies may include how to exploit existing advantages for the competition at the current stage and develop or explore additional advantages appropriate for the next stage. Particularly, the additionally developed advantages will then be accumulated and drive forward the firm’s stage of internationalization, which will further determine the subsequent strategies, and so on and so forth, spiraling up the stages of a higher degree of internationalization. However, the formation of additional strategies for the next stage does not happen automatically, and the strategy evolution is based on the firm’s dynamic capabilities.

Keywords: construction industry, dynamic capabilities, internationalization process, internationalization strategies, strategic management

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Authors: Tamas Madl

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Sudden cardiac death (SCD) constitutes a large proportion of cardiovascular mortalities, provides little advance warning, and the risk is difficult to recognize based on ubiquitous, low cost medical equipment such as the standard, 12-lead, ten second ECG. Autonomic abnormalities have been shown to be strongly predictive of SCD risk; yet current methods are not trivially applicable to the brevity and low temporal and electrical resolution of standard ECGs. Here, we build horizontal visibility graph representations of very short inter-beat interval time series, and perform unsuper- vised representation learning in order to convert these variable size objects into fixed-length vectors preserving similarity rela- tions. We show that such representations facilitate classification into healthy vs. at-risk patients on two different datasets, the Mul- tiparameter Intelligent Monitoring in Intensive Care II and the PhysioNet Sudden Cardiac Death Holter Database. Our results suggest that graph representation learning of heartbeat interval time series facilitates robust classification even in sequences as short as ten seconds.

Keywords: sudden cardiac death, heart rate variability, ECG analysis, time series classification

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Authors: Mumtaz Ali, Hamzullah Khan, Khalid Khanzada, Shahid Ayub, Aurangzeb Wazir

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Objective: To analyse the death of patients treated in neuro-surgical ICU for severe head injuries from different perspectives. The evaluation of the data so obtained to help improve the health care delivery to this group of patients in ICU. Study Design: It is a descriptive study based on retrospective analysis of patients presenting to neuro-surgical ICU in Lady Reading Hospital, Peshawar. Study Duration: It covered the period between 1st January 2009 to 31st December 2009. Material and Methods: The Clinical record of all the patients presenting with the clinical radiological and surgical features of severe head injuries, who expired in neuro-surgical ICU was collected. A separate proforma which mentioned age, sex, time of arrival and death, causes of head injuries, the radiological features, the clinical parameters, the surgical and non surgical treatment given was used. The average duration of stay and the demographic and domiciliary representation of these patients was noted. The record was analyzed accordingly for discussion and recommendations. Results: Out of the total 112 (n-112) patients who expired in one year in the neuro-surgical ICU the young adults made up the majority 64 (57.14%) followed by children, 34 (30.35%) and then the elderly age group: 10 (8.92%). Road traffic accidents were the major cause of presentation, 75 (66.96%) followed by history of fall; 23 (20.53%) and then the fire arm injuries; 13 (11.60%). The predominant CT scan features of these patients on presentation was cerebral edema, and midline shift (diffuse neuronal injuries). 46 (41.07%) followed by cerebral contusions. 28 (25%). The correctable surgical causes were present only in 18 patients (16.07%) and the majority 94 (83.92%) were given conservative management. Of the 69 (n=69) patients in which CT scan was repeated; 62 (89.85%) showed worsening of the initial CT scan abnormalities while in 7 cases (10.14%) the features were static. Among the non surgical cases both ventilatory therapy in 7 (6.25%) and tracheostomy in 39 (34.82%) failed to change the outcome. The maximum stay in the neuro ICU leading upto the death was 48 hours in 35 (31.25%) cases followed by 31 (27.67%) cases in 24 hours; 24 (21.42%) in one week and 16 (14.28%) in 72 hours. Only 6 (5.35%) patients survived more than a week. Patients were received from almost all the districts of NWFP except. The Hazara division. There were some Afghan refugees as well. Conclusion: Mortality following the head injuries is alarmingly high despite repeated claims about the professional and administrative improvement. Even places like ICU could not change the out come according to the desired aims and objectives in the present set up. A rethinking is needed both at the individual and institutional level among the concerned quarters with a clear aim at the more scientific grounds. Only then one can achieve the desired results.

Keywords: Glasgow Coma Scale, pediatrics, geriatrics, Peshawar

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Authors: Kwasi Sarfo, Bernard Okoampah Otu

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The 1992 constitution of the Republic of Ghana recognises the authority and roles of traditional leaders and considers them as being entrusted with fiduciary responsibility over land in their respective territories. The new land act, Act 1036 of 2020, in buttressing the fiduciary role of traditional leaders in land matters, inserted the traditional leaders’ accountability clause. Many traditional leaders have expressed their misgivings about the insertion of this clause. Therefore, there appears to be a misunderstanding of the concept of fiduciary in land management in Ghana. The objective of this study is to examine the concept of fiduciary in respect of allodial rights holders in land management and administration and how this concept is perceived and applied by traditional leaders. The study seeks to provide insights into the discrepancy between fiduciary theory and its practical implementation in Ghana. The study is based on a qualitative empirical research approach and adopts in-depth interviews as a primary method of data collection. The study also adopts the theory of New Institutionalism of social anthropology in analysing and interpreting the findings. The data for this study was collected over a period of one year, from July 2022 to July 2023, as part of one of the author's PhD dissertation. The collected data were carefully analysed using the principles of thematic analysis, identifying key themes and patterns. This study does not seek to pursue the discussions from a legal standpoint but from a social anthropological perspective and argues that the concept of fiduciary in theory is far different from what pertains in practice and that traditional leaders’ assumptions and application of this concept contribute to the alienation of customary and communal land at the expense of their subjects. This study deepens our understanding of the continuous expropriation of communal landholders in many rural communities in Africa in the era of global land grabbing, which worsens their poverty levels. It also explains further the theory of new institutionalism of social anthropology by highlighting how the theory manifests in practice in the case of Ghana.

Keywords: fiduciary, customary land tenure, allodial rights, land alienation, communal land, Ghana

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Authors: Mohammed Hassan Alshaikhi

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Teaching vocabulary is a fundamental step in helping students to develop a good grasp of language. Exploring new strategies is an essential part of improving the teaching of vocabulary. The study aimed to explore the teaching vocabulary strategies in Saudi primary classrooms (aged 11 and 12 years old) in Jeddah, Saudi Arabia. The study was based on qualitative data collected from a large-scale case study, which utilised observations at eight male state and private primary schools during the academic year 2016-2017. The observations were transcribed, coded and entered into Nvivo software to be organised and analysed. Varying teaching vocabulary strategies were explored, and then they were circulated to many English teachers to be used in their classes.

Keywords: case study, English language, Saudi teachers, teaching vocabulary strategies

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Authors: Pradip Baishya, D. K. Mahanta

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Rapid and unplanned urbanisation in most cities of India has progressively increased the problem of managing municipal waste in the past few years. With insufficient infrastructure and funds, Municipalities in most cities are struggling to cope with the pace of waste generated. Open dumping is widely in practice as a cheaper option. Scientific disposal of waste in such a large scale with the elements of segregation, recycling, landfill, and incineration involves sophisticated and expensive plants. In an effort to finding affordable and simple solutions to address this burning issue of waste disposal, a semi-mechanized plant has been designed underlying the concept of a zero waste community. The fabrication work of the waste management unit is carried out by local skills from locally available materials. A resident colony in the city of Guwahati has been chosen, which is seen as a typical representative of most cities in India in terms of size and key issues surrounding waste management. Scientific management and disposal of waste on site is carried out on the principle of reduce, reuse and recycle from segregation to compositing. It is a local community participatory model, which involves all stakeholders in the process namely rag pickers, residents, municipality and local industry. Studies were conducted to testify the plant as revenue earning self-sustaining model in the long term. Current working efficiency of plant for segregation was found to be 1kg per minute. Identifying bottlenecks in the success of the model, data on efficiency of the plant, economics of its fabrication were part of the study. Similar satellite waste management plants could potentially be a solution to supplement the waste management system of municipalities of similar sized cities in India or South East Asia with similar issues surrounding waste disposal.

Keywords: affordable, rag pickers, recycle, reduce, reuse, segregation, zero waste

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Authors: Mohammad Yousefikia, Sara Moridpour, Ehsan Mazloumi

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Perceiving track geometry deterioration decisively influences the optimization of track maintenance operations. The effective management of this deterioration and increasingly utilized system with limited financial resources is a significant challenge. This paper provides a review of degradation models relevant for railroad tracks. Furthermore, due to the lack of long term information on the condition development of tram infrastructures, presents the methodology which will be used to derive degradation models from the data of Melbourne tram network.

Keywords: deterioration modeling, asset management, railway, tram

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Authors: Mohammad Yousuf Khan, Bhavya Alankar

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Blockchain is a promising technology with its features such as immutability and decentralized database. It has applications in various fields such as pharmaceutical, finance, & the food industry. At the core of its heart lies its feature, traceability which is the most desired key in supply chains. However, supply chains have always been hit rock bottom by scandals and controversies. In this review paper, we have explored the advancement and research gaps of blockchain technology (BT) in supply chain management (SCM). We have used the Prisma framework for systematic literature review (SLR) and included a minuscule amount of grey literature to reduce publication bias. We found that supply chain traceability and transparency is the most researched objective in SCM. There was hardly any research in supply chain resilience. Further, we found that 40 % of the papers were application based. Most articles have focused on the advantages of BT, rather than analyzing it critically. This study will help identify gaps and suitable actions to be followed for an efficient implementation of BT in SCM.

Keywords: blockchain technology, supply chain management, supply chain transparency, supply chain resilience

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Authors: Shereen Ismail Fawaz, Shin-Ichi Izumi, Nouran Mohamed Salah, Heba G. Saber, Ibrahim Mohamed Roushdi

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Background: Multiple sclerosis (MS) is a chronic, inflammatory, mainly demyelinating disease of the central nervous system, more common in young adults. Cerebellar involvement is one of the most disabling lesions in MS and is usually a sign of disease progression. It plays a major role in the planning, initiation, and organization of movement via its influence on the motor cortex and corticospinal outputs. Therefore, it contributes to controlling movement, motor adaptation, and motor learning, in addition to its vast connections with other major pathways controlling balance, such as the cerebellopropriospinal pathways and cerebellovestibular pathways. Hence, trying to stimulate the cerebellum by facilitatory protocols will add to our motor control and balance function. Non-invasive brain stimulation, both repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), has recently emerged as effective neuromodulators to influence motor and nonmotor functions of the brain. Anodal tDCS has been shown to improve motor skill learning and motor performance beyond the training period. Similarly, rTMS, when used at high frequency (>5 Hz), has a facilitatory effect on the motor cortex. Objective: Our aim was to determine the effect of high-frequency rTMS over the cerebellum in improving balance and functional ambulation of multiple sclerosis patients with Ataxia. Patients and methods: This was a randomized single-blinded placebo-controlled prospective trial on 40 patients. The active group (N=20) received real rTMS sessions, and the control group (N=20) received Sham rTMS using a placebo program designed for this treatment. Both groups received 12 sessions of high-frequency rTMS over the cerebellum, followed by an intensive exercise training program. Sessions were given three times per week for four weeks. The active group protocol had a frequency of 10 Hz rTMS over the cerebellar vermis, work period 5S, number of trains 25, and intertrain interval 25s. The total number of pulses was 1250 pulses per session. The control group received Sham rTMS using a placebo program designed for this treatment. Both groups of patients received an intensive exercise program, which included generalized strengthening exercises, endurance and aerobic training, trunk abdominal exercises, generalized balance training exercises, and task-oriented training such as Boxing. As a primary outcome measure the Modified ICARS was used. Static Posturography was done with: Patients were tested both with open and closed eyes. Secondary outcome measures included the expanded Disability Status Scale (EDSS) and 8 Meter walk test (8MWT). Results: The active group showed significant improvements in all the functional scales, modified ICARS, EDSS, and 8-meter walk test, in addition to significant differences in static Posturography with open eyes, while the control group did not show such differences. Conclusion: Cerebellar high-frequency rTMS could be effective in the functional improvement of balance in MS patients with ataxia.

Keywords: brain neuromodulation, high frequency rTMS, cerebellar stimulation, multiple sclerosis, balance rehabilitation

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Authors: Abdikarim Barqadle Igale

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The main objective of this study is to find out the indicators of excellent supply chain management based on game theory. The study employed a survey design to collect data. A total of 268 respondents participated in this research. The results indicate that both companies (Coca-cola & Yousran International) managed to effectively use the physical and information flows but were different from the focus on the items in the two key areas. The Coca-cola, for instance, sustained to utilize the flows of excellent planning, starting from row materials, timing, transformation, transportation, and storage of goods to reach consumer’s hands on one side and solid linkage to strategic partners to plan and work together for long-term control of better day-to-day supply chains of goods and materials down to customers’ consumption on the other. Meanwhile, the Yousran International heavily concentrated on the physical side with moderate rapports with strategic partners for long-term improvement on supply chain. The study proposes that strong combination of effective use of both physical and information flows are good indicators of better supply chain management in today’s emerging companies.

Keywords: game theory, physical flow, supply chain management, indicators

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Authors: N. Reza Pour, S. Chuah, T. Vo

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Background: Vertebral artery dissection (VAD) is a rare complication of pregnancy. It can occur spontaneously or following a traumatic event. The pathogenesis is unclear. Predisposing factors include chronic hypertension, Marfan’s syndrome, fibromuscular dysplasia, vasculitis and cystic medial necrosis. Physiological changes of pregnancy have also been proposed as potential mechanisms of injury to the vessel wall. The clinical presentation varies and it can present as a headache, neck pain, diplopia, transient ischaemic attack, or an ischemic stroke. Isolated cases of VAD in pregnancy and puerperium have been reported in the literature. One case was found to have posterior circulation stroke as a result of bilateral VAD and labour was induced at 37 weeks gestation for preeclampsia. Another patient at 38 weeks with severe neck pain that persisted after induction for elevated blood pressure and arteriography showed right VAD postpartum. A single case of lethal VAD in pregnancy with subsequent massive subarachnoid haemorrhage has been reported which was confirmed by the autopsy. Case Presentation: We report two cases of vertebral artery dissection in pregnancy. The first patient was a 32-year-old primigravida presented at the 38th week of pregnancy with the onset of early labour and blood pressure (BP) of 130/70 on arrival. After 2 hours, the patient developed a severe headache with blurry vision and BP was 238/120. Despite treatment with an intravenous antihypertensive, she had eclamptic fit. Magnesium solfate was started and Emergency Caesarean Section was performed under the general anaesthesia. On the second day after the operation, she developed left-sided neck pain. Magnetic Resonance Imaging (MRI) angiography confirmed a short segment left vertebral artery dissection at the level of C3. The patient was treated with aspirin and remained stable without any neurological deficit. The second patient was a 33-year-old primigavida who was admitted to the hospital at 36 weeks gestation with BP of 155/105, constant headache and visual disturbances. She was medicated with an oral antihypertensive agent. On day 4, she complained of right-sided neck pain. MRI angiogram revealed a short segment dissection of the right vertebral artery at the C2-3 level. Pregnancy was terminated on the same day with emergency Caesarean Section and anticoagulation was started subsequently. Post-operative recovery was complicated by rectus sheath haematoma requiring evacuation. She was discharged home on Aspirin without any neurological sequelae. Conclusion: Because of collateral circulation, unilateral vertebral artery dissections may go unrecognized and may be more common than suspected. The outcome for most patients is benign, reflecting the adequacy of the collateral circulation in young patients. Spontaneous VAD is usually treated with anticoagulation or antiplatelet therapy for a minimum of 3-6 months to prevent future ischaemic events, allowing the dissection to heal on its own. We had two cases of VAD in the context of hypertensive disorders of pregnancy with an acceptable outcome. A high level of vigilance is required particularly with preeclamptic patients presenting with head/neck pain to allow an early diagnosis. This is as we hypothesize, early and aggressive management of vertebral artery dissection may potentially prevent further complications.

Keywords: eclampsia, preeclampsia, pregnancy, Vertebral Artery Dissection

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Authors: Saeed Vahidifar, Mohammad Nakhaee Sharif, Mohammad Ghaffari

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Few people would dispute the fact that one of the most common applications of energy is creating comfort in buildings, so it is probably true to say that management of energy consumption is required due to the environmental issues and increasing the efficiency of mechanical systems. From the geographical point of view, Iran is located in a warm and semi-arid region; therefore, air-cooled chillers are usually used for cooling residential buildings, commercial buildings, medical buildings, etc. In this study, a heat exchanger was designed for providing laundry hot water by utilizing condenser heat lost base on analytical results of a 540-bed hospital in the city of Mashhad in Iran. In this paper, by using the analytical method, energy consumption reduces about 13%, and coefficient of performance increases a bit. Results show that this method can help in the management of energy consumption a lot.

Keywords: air cooled chiller, energy management, environmental issues, heat exchanger, hospital laundry system

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Authors: Shazia Ali, Yves Mard, Éric Severin

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To the best of our knowledge, this is the first study to have analyzed the impact of a) firm-specific product-market power and b) industry competition on earnings management behavior of European firms in distress versus healthy years while controlling for firm-level characteristics. We predicted a significant relationship between firms’ product market power and earnings management tools and their trade-off under the moderation effect of financial distress. We found that the firm-level market power hereinafter referred to as MP (proxied by the industry-adjusted Lerner Index) is positively associated with both real and accrual earnings management. However, MP is associated with a higher level of real earnings management compared to accrual earnings management in distress years compared to healthy years. On the other hand, industry product market power (representing low competition and proxied by the inverse of the total number of firms in an industry hereinafter referred to as NUMB) and firms product market power (proxied by firm market share hereinafter referred to as MS) are associated with lower inflationary accruals and higher deflationary accruals respectively. On the other hand, they are found to be linked with higher real earnings management in distress versus healthy years. When we divided the sample into small and big firms based on their respective industry-year median total assets, we found that all three measures of industry competition (Industry Median Lerner Index (hereinafter referred to as IMLI), NUMB, and Herfindahl–Hirschman Index (hereinafter referred to as HHI) indicate that small firms in low-competitive industries in financial distress are more likely to inflate their earnings through discretionary accruals. While big firms in this situation are more likely to lower the use of both inflationary and deflationary discretionary accruals as indicated by IMLI and HHI and trade-off accruals earnings management for real earnings management as indicated by NUMB. Moreover, IMLI and HHI did not show any interesting results when we divided the sample based on the firm Lerner Index/Market Power. However, the distressed firms with high market power (MP>industry median) are found to engage in income-decreasing discretionary accruals in low-competitive industries (high NUMB). Whereas firms with low market power in the same industry use downward discretionary accruals but inflate income using real activities (abnCFO). Our findings are robust across alternate measures of discretionary accruals and financial distress, such as the Altman Z-Score. The finding of the study is valuable for accounting standard setters, competition authorities, policymakers, and investors alike to help in informed decision-making.

Keywords: financial distress, earnings management, market competition

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Authors: Youcef Lakhdar Hamina

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In order to tame the ecological damage specificity, it is imperative to assert the procedural and objective liability aspect, which leads us to analyse current trends based on the development of preventive civil liability based on the precautionary principle. Our research focuses on the instruments of the environment protection in urban areas based on two complementary aspects appearing contradictory and refer directly to the institutional dimensions: - The preventive aspect: considered as a main objective of the environmental policy which highlights the different legal mechanisms for the environment protection by highlighting the role of administration in its implementation (environmental planning, tax incentives, modes of participation of all actors, etc.). - The healing-repressive aspect: considered as an approach for the identification of ecological damage and the forms of reparation (spatial and temporal-responsibility) to the impossibility of predicting with rigor and precision, the appearance of ecological damage, which cannot be avoided.

Keywords: environmental law, environmental taxes, environmental damage, eco responsibility, precautionary principle, environmental management

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Authors: Muhammad Ejaz1

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Rework has been defined as: "The unnecessary effort of re-doing a process or activity that was incorrectly implemented the first time." A great threat to the construction industry is rework. By and large due attention has not been given to avoid the causes of reworks, resulting time and cost over runs, in civil engineering projects. Besides these direct consequences, there might also be indirect consequences, such as stress, de-motivation or loss of future clients. When delivered products do not meet the requirements or expectations, work often has to be redone. Rework occurs in various phases of the construction process or in various divisions of a company. Rework can occur on the construction site or in a management department due to for example bad materials management. Rework can also have internal or external origins. Changes in clients’ expectations are an example of an external factor that might lead to rework. Rework can cause many costs to be higher than calculated at the start of the project. Rework events can have many different origins and for this research they have been categorized into four categories; changes, errors, omissions, and damages. The research showed that the major source of reworks were non professional attitude from technical hands and ignorance of total quality management principals by stakeholders. It also revealed that sources of reworks have not major differences among project categories. The causes were further analyzed by interviewing employees. Based on existing literature an extensive list of rework causes was made and during the interviews the interviewees were asked to confirm or deny statements regarding rework causes. The causes that were most frequently confirmed can be grouped into the understanding categories. 56% (max) of the causes are change-related, 30% (max) is error-related and 18% (max) falls into another category. Therefore, by recognizing above mentioned factors, reworks can be reduced to a great extent.

Keywords: total quality management, construction industry, cost overruns, rework, material management, client’s expectations

Procedia PDF Downloads 293

Authors: A. H. Shaikat, M. B. Hossain, S. K. M. A. Islam, M. M. Hassan, S. A. Khan, A. K. M. Saifuddin, M. N. Islam, M. A. Hoque

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A total of eighteen (18) sex reversed chickens with unusual phenotypic characteristics of male birds were identified over 2000 Hyline layer chickens at Motaher Poultry Farm, Ramu, Cox’s Bazar. Chickens were subdivided into two groups (case = 18, control = 20) based on the appearance of sex-reversed secondary sexual characteristics. Phenotypic traits of studied chickens were measured with farm management details. Hormone assay using ELISA, autopsy followed by gross examination of viscera was performed. The study found higher body weight (gm) (1579.3; 95% CI: 1561.7-1596.8), comb length (cm) (12.2; 11.5-12.8), comb width (cm) (7.9; 7.7-8.2), wattle length (cm) (4.9; 4.8-5.1) distinct spur, and shortened pubic bones distance, suggesting decrease oviposition in sex-reversed chickens. Testosterone concentration (ng/ml) (8.5; 6.4-10.6) was significantly higher (p<0.001) along with decrease estrogen (pg/ml) (5.1; 4.9-5.5) and progesterone concentration (pg/ml) (310.9; 289.4-332.5) in sex-reversed chickens. Mass abdominal fat deposition with atrophied ovary was found upon exploration of viscera.

Keywords: ovary, phenotypic traits, sex hormone, sex reversal

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Authors: Siri-Orn Champatong

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This research aimed to study the relationship between attitudes toward marketing mix and customers’ repurchase intention of Thai dessert in case of Ekachai Salee Suphan’s shop in Thailand. This study employed by survey and quantitative research and the questionnaire was used to collect the data from 385 sampled of customers who visited at Ekachai Salee Suphan's shop in Thailand. The descriptive statistics and Pearson’s correlation coefficient analysis was used to analyze data. The research found that the customers’ perception on the overall and individual aspects of attitudes toward marketing mix include products, prices, promotions, and physical characteristics were at very good level, but distribution channels, staffs, and management process were at good level. Furthermore, the hypothesis tests found that attitudes toward overall marketing mix had relationship with individual aspects of intention that were the repurchase intention, willingness to recommend others to repurchase, and possibility to repurchase with statistical significance level of 0.01.

Keywords: intention, repurchase, service marketing mix, Thai dessert

Procedia PDF Downloads 254

Authors: Sandra So, Mohd Roslan Ismail, Safurah Jaafar

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With the rapid proliferation of data in healthcare has provided an opportune platform creation of Artificial Intelligence (AI). AI has brought a paradigm shift for healthcare professionals, promising improvement in delivery and quality. This study aims to determine the perception of healthcare personnel on perceived ease of use, perceived usefulness, and subjective norm toward attitude for artificial intelligence acceptance. A cross-sectional single institutional study of employees’ perception of adopting AI in the hospital was conducted. The survey was conducted using a questionnaire adapted from Technology Acceptance Model and a four-point Likert scale was used. There were 96 or 75.5% of the total population responded. This study has shown the significant relationship and the importance of ease of use, perceived usefulness, and subjective norm to the acceptance of AI. In the study results, it concluded that the determining factor to the strong acceptance of AI in their practices is mostly those respondents with the most interaction with the patients and clinical management.

Keywords: artificial intelligence, machine learning, perceived ease of use, perceived usefulness, subjective norm

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Authors: W. Ling, Mohamed Saufi Bin Awang

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Introduction: Mycobacterium tuberculosis post a major health problem worldwide. Central nervous system (CNS) infection by mycobacterium tuberculosis is one of the most devastating complications of tuberculosis. Although with advancement in medical fields, we are yet to understand the pathophysiology of how mycobacterium tuberculosis was able to cross the blood-brain barrier (BBB) and infect the CNS. CNS TB may present with nonspecific clinical symptoms which can mimic other diseases/conditions; this is what makes the diagnosis relatively difficult and challenging. Public health has to be informed and educated about the spread of TB, and early identification of TB is important as it is a curable disease. Case Report: A young 21-year-old Malay gentleman was initially presented to us with symptoms of ear discharge, tinnitus, and right-sided headache for the past one year. Further history reveals that the symptoms have been mismanaged and neglected over the period of 1 year. Initial investigation reveals features of inflammation of the ear. Further imaging showed the feature of chronic inflammation of the otitis media and atypical right cerebral abscess, which has the same characteristic features and consistency. He further underwent a biopsy, and results reveal positive Mycobacterium tuberculosis of the otitis media. With the results and the available imaging, we were certain that this is likely a case of disseminated tuberculosis causing CNS TB. Conclusion: We aim to highlight the challenge and difficult face in our health care system and public health in early identification and treatment.

Keywords: central nervous system tuberculosis, intracranial tuberculosis, tuberculous encephalopathy, tuberculous meningitis

Procedia PDF Downloads 189

Authors: Marlin Killen

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The American Association of University Professors (AAUP) describes academic freedom as essential to the purposes of research and teaching. The importance of academic freedom as a bedrock foundation that supports the work of the professoriate cannot be overstated, and there have been innumerable challenges that have attempted to curtail it. These challenges come from a variety of sources that span legal, ethical, cultural, institutional, and professional perspective and are amplified by social media, traditional media, and political action efforts. Because of these challenges, the development of a comprehensive institutional policy on academic freedom that addresses the principles, practices, and appropriate responses to modern challenges can be a daunting task. This presentation will focus on a case study of a university’s effort to develop an updated, evolving policy on academic freedom that provides a framework and remedies for contemporary challenges to this critical function in higher education.

Keywords: academic freedom, academic freedom policy, higher education policy

Procedia PDF Downloads 199

Authors: Eleonora Di Mario

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This paper describes the application of ground improvement to replace a typical piled foundation scheme in a power plant in Singapore. Several buildings within the plant were founded on vibro-compacted sand, including a turbine unit which had extremely stringent requirements on the allowable settlement. The achieved savings in terms of cost and schedule are presented. The monitoring data collected during the operation of the turbine are compared to the design predictions to validate the design approach, and the quality of the ground improvement works. In addition, the calculated carbon footprint of the ground improvement works are compared to the piled solution, showing that the vibro-compaction has a significantly lower carbon footprint.

Keywords: ground improvement, vibro-compaction, case study, sustainability, carbon footprint

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Authors: Alabi Odunayo Mayowa, Ajayi Oluwasola Felix

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Solid waste such as “garbage” “trash” “refuse” “slug” and “rubbish” is disposed off or is required to be disposed off in accordance with national law. The study relies on primary and secondary sources of information. The primary sources include the Constitution, statutes and subsidiary legislation. The secondary sources of information include books, journals, conference proceedings, newspapers, magazines and internet materials. The information obtained from these sources is subjected to content and contextual analysis. The study examines the Kwara State Environmental Protection Agency Law, 1992 and other laws on waste disposal and management in Kwara State, Nigeria. The study also examines the regulations and the agency i.e. the Kwara State Environmental Protection Agency created by the law with a view to determine the inadequacies in the law.

Keywords: solid waste, waste disposal, waste management, domestic waste

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Authors: Joseph Berlin P. Juanzon, Manuel M. Muhi

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Motivating SME-based construction firms to adopt different management systems is not a simple task, especially if they are not aware of the benefits that they will gain from the new process-based management system. The implementation of ISO 9001:2008, Quality Management System in the construction industry is an ongoing trend, more so in the Small and Medium Enterprise. However, the level of awareness and readiness of the construction industry in the Philippines is still low as compared to the neighboring countries in Asia and in the western countries where ISO 9001:2008 originated. The purpose of this research is to determine the significant factors that will motivate SME-based construction firms in the Philippines to implement ISO 9001:2008. A field study was conducted on SME based construction firms in the Philippines, wherein a total of 139 respondents out of the 613 SME-based construction firms in CALABARZON areas were surveyed. Results reveal that the three main factors that will motivate SME-based construction firms to implement ISO 9001:2008 are: - if required by their clients, - to qualify for bidding, and - to increase customer satisfaction. Therefore, based on the results and findings, a certification of ISO 9001:2008 from an accredited auditor shall be required by clients as a constituent in accrediting SME-based construction firms and to qualify for bidding.

Keywords: construction, ISO 9001:2008, quality management systems (QMS), small medium enterprise (SME)

Procedia PDF Downloads 395