Search results for: schedule risk management

Authors: Nevruz Zogu, Shpetim Rezniqi

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In the framework of transformational economic development social pluralism and the free, market health systems operating in the countries of our region are naturally involved in a process of profound change and reform. Health systems actually represent complex ensembles centers and public and private institutions (domestic and foreign), who administer substantial amounts of human, technological, material, financial, information and scientific facts • The goal of health systems is much more than medical care. It includes the promotion, protection, treatment and rehabilitation of health of the population. • Meeting the needs of increasingly diverse broader health services efficient, secure the quality and affordability of their increasing cost of unstoppable, requires the necessary reform of health systems and implementing policies and new management methods, to ensure effectiveness and health benefits as higher population.

Keywords: health, management, economy, finance

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Authors: Peri Harish Kumar, Sai Sharan Dwarka, Tajbinder Singh Bains, Suneet John Joseph, Chaitanya Kiran, Sambhu Dutta, Sarah Makram, Mohamed Sayed Zaazouee, Alaa Ahmed Elshanbary

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Objective: To identify cancer and non-cancer causes of death in hepatocellular carcinoma (HCC) patients over different time periods after diagnosis and to compare the mortality risk of each cause in HCC patients with the general population. Methods: In this retrospective cohort study, data of 67,637 HCC patients from 1975 to 2016 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. We investigated the association between different causes of death and the following variables: age, race, tumor stage at diagnosis, and treatment (surgery, chemotherapy, and radiotherapy); each according to the periods of <1 year, 1-5 years, 5-10 years, and >10 years following the diagnosis. Standardized mortality ratios (SMRs) and their 95% confidence intervals (CIs) were calculated for cancer and non-cancer deaths in each of the mentioned periods following diagnosis. Results: Data of 67,637 patients, of whom 50,571 patients died during the follow-up period, were analyzed. Most deaths were due to HCC itself (35,535, 70.3%), followed by other cancers (3,983, 7.9%). Common causes of non-cancer mortality included infectious and parasitic diseases including HIV (2,823 patients, SMR=105.68, 95% CI: 101.82-109.65), chronic liver disease (2,719 patients, SMR=76.56, 95% CI: 73.71,79.5), and heart diseases (1,265 patients, SMR=2.26, 95% CI: 2.14-2.39), with higher mortality risk in HCC patients than in the general population. Conclusion: Cancers stand for most deaths in patients with HCC. Besides, infectious, and parasitic diseases including HIV represent the commonest non-cancer cause of mortality.

Keywords: hepatocellular carcinoma, seer, causes of death, mortality

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Authors: Eleni Giouli

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Distance learning provides a flexible approach to education, enabling busy learners to complete their coursework at their own pace, on their own schedule, and from a convenient location. This flexibility combined with a series of other issues; make the benefits of lifelong distance learning numerous. The purpose of the paper is to investigate whether distance education can contribute to the improvement of adult skills in Greece, highlighting in this way the necessity of the lifelong distance learning. To investigate this goal, a questionnaire is constructed and analyzed based on responses from 3,016 attendees of lifelong distance learning programs in the e-learning of the National and Kapodistrian University of Athens in Greece. In order to do so, a series of relationships is examined including the effects of a) the gender, b) the previous educational level, c) the current employment status, and d) the method used in the distance learning program, on the development of new general, technical, administrative, social, cultural, entrepreneurial and green skills. The basic conclusions that emerge after using a binary logistic framework are that the following factors are critical in order to develop new skills: the gender, the education level and the educational method used in the lifelong distance learning program. The skills more significantly affected by those factors are the acquiring new skills in general, as well as acquiring general, language and cultural, entrepreneurial and green skills, while for technical and social skills only gender and educational method play a crucial role. Moreover, routine skills and social skills are not affected by the four factors included in the analysis.

Keywords: adult skills, distance learning, education, lifelong learning

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Authors: Abigail Kusi Amponsah, Evans Frimpong Kyei, John Bright Agyemang, Hanson Boakye, Joana Kyei-Dompim, Collins Kwadwo Ahoto, Evans Oduro

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Staff shortages, deficient knowledge, inappropriate attitudes, demanding workloads, analgesic shortages, and low prioritization of pain management have been identified in earlier studies as the nursing-related barriers to optimal children’s pain management. These studies have mainly been undertaken in developed countries, which have different healthcare dynamics than those in developing countries. The current study, therefore, sought to identify and understand the nursing-related barriers to children’s pain management in the Ghanaian context. A descriptive qualitative study was conducted among 28 purposively sampled nurses working in the pediatric units of five hospitals in the Ashanti region of Ghana. Over the course of three months, participants were interviewed on the barriers which prevented them from optimally managing children’s pain in practice. Recorded interviews were transcribed verbatim and deductively analysed based on a conceptual interest in pain assessment and management-related barriers. NVivo 12 plus software guided data management and analyses. The mean age of participating nurses was 30 years, with majority being females (n =24). Participants had worked in the nursing profession for an average of five years and in the pediatric care settings for an average of two years. The nursing-related barriers identified in the present study included communication difficulties in assessing and evaluating pain management interventions with children who have nonfunctional speech, insufficient training, misconceptions on the experience of pain in children, lack of assessment tools, and insufficient number of nurses to manage the workload and nurses’ inability to prescribe analgesics. The present study revealed some barriers which prevented Ghanaian nurses from optimally managing children’s pain. Nurses should be educated, empowered, and supported with the requisite material resources to effectively manage children’s pain and improve outcomes for families, healthcare systems, and the nation. Future studies should explore the facilitators and barriers from other stakeholders involved in pediatric pain management

Keywords: Nursing-Related Barriers, Children, Pain Management, Ghana

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Authors: Henrie Yunianto, Dermawan Wibisono

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PT. XYZ is a family business (private company) in Indonesia that provide an educational program and consultation services. Since its establishment in 2011, the company has run without any strategic management system implemented. Though the company could survive until now. The management of PT. XYZ sees the business opportunity for such product is huge, even though the targeted market is very specific (niche), the volume is large (due to large population of Indonesia) and numbers of competitors are low (now). It can be said if the product life cycle is in between ‘Introduction stage’ and ‘growth’ stage. It is observed that nowadays the new entrants (competitors) are increasing, thus PT. XYZ consider reacting in facing the intense business rivalry by conducting the business in an appropriate manner. A Performance Management System is important to be implemented in accordance with the business sustainability and growth. The framework of Performance Management System chosen is Integrated Performance Management System (IPMS). IPMS framework has the advantages of its simplicity, linkage between its business variables and indicators where the company can see the connections between all factors measured. IPMS framework consists of perspectives: (1) Business Result, (2) Internal Processes, (3) Resource Availability. Variables and indicators were examined through deep analysis of the business external and internal environments, Strength-Weakness-Opportunity-Threat (SWOT) analysis, Porter’s five forces analysis. Analytical Hierarchy Process (AHP) analysis was then used to quantify the weight of each variable/indicators. AHP is needed since in this study, PT. XYZ, the data of existing performance indicator was not available. Later, where the IPMS is implemented, the real data measured can be examined to determine the weight factor of each indicators using correlation analysis (or other methods). In this study of IPMS design for PT. XYZ, the analysis shows that with current company goals, along with the AHP methodology, the critical indicators for each perspective are: (1) Business results: Customer satisfaction and Employee satisfaction, (2) Internal process: Marketing performance, Supplier quality, Production quality, Continues improvement; (3) Resources Availability: Leadership and company culture & value, Personal Competences, Productivity. Company and/or organization require performance management system to help them in achieving their vision and mission. Company strategy will be effectively defined and addressed by using performance management system. Integrated Performance Management System (IPMS) framework and AHP analysis help us in quantifying the factors which influence the business output expected.

Keywords: analytical hierarchy process, business strategy, differentiation strategy, integrated performance management system

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Authors: Yen Ling Liu, Shu-Fen Wu, Chen-Fuh Lam, I-Ling Tsai, Chia-Yu Chen

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Purpose: Nurse anesthetists are confronting extraordinarily high job stress in their daily practice, deriving from the fast-track anesthesia care, risk of perioperative complications, routine rotating shifts, teaching programs and interactions with the surgical team in the operating room. This study investigated the influence of work stress on the burnout and turnover intention of nurse anesthetists in a regional general hospital in Southern Taiwan. Methods: This was a descriptive correlational study carried out in 66 full-time nurse anesthetists. Data was collected from March 2017 to June 2017 by in-person interview, and a self-administered structured questionnaire was completed by the interviewee. Outcome measurements included the Practice Environment Scale of the Nursing Work Index (PES-NWI), Maslach Burnout Inventory (MBI) and nursing staff turnover intention. Numerical data were analyzed by descriptive statistics, independent t test, or one-way ANOVA. Categorical data were compared using the chi-square test (x²). Datasets were computed with Pearson product-moment correlation and linear regression. Data were analyzed by using SPSS 20.0 software. Results: The average score for job burnout was 68.7916.67 (out of 100). The three major components of burnout, including emotional depletion (mean score of 26.32), depersonalization (mean score of 13.65), and personal(mean score of 24.48). These average scores suggested that these nurse anesthetists were at high risk of burnout and inversely correlated with turnover intention (t = -4.048, P < 0.05). Using linear regression model, emotional exhaustion and depersonalization were the two independent factors that predicted turnover intention in the nurse anesthetists (19.1% in total variance). Conclusion/Implications for Practice: The study identifies that the high risk of job burnout in the nurse anesthetists is not simply derived from physical overload, but most likely resulted from the additional emotional and psychological stress. The occurrence of job burnout may affect the quality of nursing work, and also influence family harmony, in turn, may increase the turnover rate. Multimodal approach is warranted to reduce work stress and job burnout in nurse anesthetists to enhance their willingness to contribute in anesthesia care.

Keywords: anesthesia nurses, burnout, job, turnover intention

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Authors: Khlif Hamadi

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Customer Relationship Management has become the main interest of researchers and practitioners especially in the domains of Management and Information Systems (IS). This paper is an overview of success factors that could facilitate successful adoption of CRM. There are 2 factors: the organizational climate and the capacity for innovation. The survey was developed with 200 CRM users. Empirical research is in the positivist paradigm based on the hypothetico-deductive method. Indeed, the approach adopted is the quantitative approach based on a questionnaire complied by Tunisian companies operating in different sectors of activity. For the data analyses, the structural equations method was used to conduct our exploratory and confirmatory analysis. The results revealed that the creative organizational climate and high innovation capacity positively influence the success of CRM practice.

Keywords: CRM practices, innovation capacity, organizational climate, the structural equation

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Authors: Malaiphan Pansap, Surasit Vithayarat

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The purpose of this study was to study the relationship between internal organization communications’ effectiveness and employee’s performance of Faculty of Management Science, Suan Sunandha Rajabhat University. Study on solutions of communication were carried out within the organization. Questionnaire was used to collect information from 136 people of staff and instructor and data were analyzed by using frequency, percentage, mean and standard deviation and then data processing statistic programs. The result found that organization communication that affects their employee’s performance is sender which lack the skills for speaking and writing to convince audiences ready before taking message and the message which organizations are not always informed. The employees believe the behavior of good organization communication has a positive impact on the development of organization because the employees feel involved and be a part of the organization, by the cooperation in working to achieve the goal, the employees can work in the same direction and meet goal quickly.

Keywords: employee’s performance, faculty of management science, internal organization communications’ effectiveness, management accounting, Suan Sunandha Rajabhat University

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Authors: Katie Wood

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Cyber criminals are constantly on the lookout for new opportunities to exploit organisation and cause destruction. This could lead to significant cause of economic loss for organisations in the form of destruction in finances, reputation and even the overall survival of the organization. Additionally, this leads to serious consequences on national security. The threat of possible cyber attacks places further pressure on organisations to ensure they are secure, at a time where international scale cyber attacks have occurred in a range of sectors. Stakeholders are wanting confidence that their data is protected. This is only achievable if a business fosters a resilient supply chain strategy which is implemented throughout its supply chain by having a strong cyber leadership culture. This paper will discuss the essential role and need for organisations to adopt a cyber leadership culture and direction to learn about own internal processes to ensure mitigating systemic vulnerability of its supply chains. This paper outlines that to protect national security there is an urgent need for cyber awareness culture change. This is required in all organisations, regardless of their sector or size, to implementation throughout the whole supplier chain to support and protect economic prosperity to make the UK more resilient to cyber-attacks. Through businesses understanding the supply chain and risk management cycle of their own operates has to be the starting point to ensure effective cyber migration strategies.

Keywords: cyber leadership, cyber migration strategies, resilient supply chain strategy, cybersecurity

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Authors: M. Wisnu Pamungkas, Patrianef Darwis

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Introduction: Critical limb ischemia (CLI) is a vascular disease that has a significant amputation and mortality risk with diabetes mellitus, the most significant risk factor in CLI, is very common among Indonesian. Endovascular intervention (EVI) is preferred in treating CLI because it is noninvasive and effective. Balloon angioplasty and stent angioplasty are the most common method of EVI in Indonesia. This study aims to compare the effectiveness of balloon angioplasty and stent angioplasty on wound healing in CLI. Method: A cross-sectional study enrolled 90 subjects of CLI who underwent endovascular intervention using balloon angioplasty and stent angioplasty from January 2013 to July 2017 in dr. Cipto Mangunkusumo General Hospital, Jakarta. The wound healing period between balloon angioplasty dan stent angioplasty was analyzed using unpaired T-test with p<0,05 considered as statistically significant. Data of intervention method wound healing period, and subjects characteristic data (age, amputation, BMI, smoking habit, DM, occlusion site, and blood profile) were obtained. Result: The wound healing period in balloon angioplasty and stent angioplasty distributed normally. Mean value of wound healing period in balloon angioplasty and stent angioplasty are 84,8+/-2,423 and 59,93 +/- 2,423 days with a mean difference of 25 days. The difference in wound healing period in both groups is statically significant (p<0,05). The amputation event in balloon angioplasty and stent angioplasty is 22 and 16 event with no difference statistically. Conclusion: Stent angioplasty is a better method than balloon angioplasty for wound healing in patients with CLI.

Keywords: critical limb ischemia, endovascular intervention, wound healing, angioplasty

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Authors: Moon-Tak Oh, Kyung-Min Park, Tae-Eun Yoon, Hoon Choi, Chil-Woo Lee

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This paper is about middle-ware which enables group-user applications on mobile devices in physical proximity to interact with other devices without intervention of a central server. Requirements of the middle-ware are identified from service usage scenarios, and the functional architecture of the middle-ware is specified. These requirements include group management, synchronization, and resource management. Group Management needs to provide various capabilities to such applications with respect to managing multiple users (e.g., creation of groups, discovery of group or individual users, member join/leave, election of a group manager and service-group association) using D2D communication technology. We designed the middle-ware for the above requirements on the Android platform.

Keywords: group user, middleware, mobile service, physical proximity

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Authors: Vesna Karapetkovska Hristova, M. Ayaz Ahmad, Julijana Tomovska, Biljana Bogdanova Popov, Blagojce Najdovski

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The average total concentrations of heavy metals; (cadmium [Cd], copper [Cu], nickel [Ni], lead [Pb], and zinc [Zn]) were analyzed in soil and vegetables samples collected from the different region of Macedonia during the years 2010-2012. Basic soil properties such as pH, organic matter and clay content were also included in the study. The average concentrations of Cd, Cu, Ni, Pb, Zn in the A horizon (0-30 cm) of agricultural soils were as follows, respectively: 0.25, 5.3, 6.9, 15.2, 26.3 mg kg-1 of soil. We have found that neural networking model can be considered as a tool for prediction and spatial analysis of the processes controlling the metal transfer within the soil-and vegetables. The predictive ability of such models is well over 80% as compared to 20% for typical regression models. A radial basic function network reflects good predicting accuracy and correlation coefficients between soil properties and metal content in vegetables much better than the back-propagation method. Neural Networking / soft computing can support the decision-making processes at different levels, including agro ecology, to improve crop management based on monitoring data and risk assessment of metal transfer from soils to vegetables.

Keywords: soft computing approach, total concentrations, heavy metals, agricultural soils

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Authors: Federica Di Marcantonio, Antoine Leblois, Wolfgang Göbel, Hervè Kerdiles

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Weather-related shocks can threaten the ability of farmers to maintain their agricultural output and food security levels. Informal coping mechanisms (i.e. migration or community risk sharing) have always played a significant role in mitigating the negative effects of weather-related shocks in Ethiopia, but they have been found to be an incomplete strategy, particularly as a response to covariate shocks. Particularly, as an alternative to the traditional risk pooling products, an innovative form of insurance known as Index-based Insurance has received a lot of attention from researchers and international organizations, leading to an increased number of pilot initiatives in many countries. Despite the potential benefit of the product in protecting the livelihoods of farmers and pastoralists against climate shocks, to date there has been an unexpectedly low uptake. Using information from current pilot projects on index-based insurance in Ethiopia, this paper discusses the determinants of uptake that have so far undermined the scaling-up of the products, by focusing in particular on weather data availability, price affordability and willingness to pay. We found that, aside from data constraint issues, high price elasticity and low willingness to pay represent impediments to the development of the market. These results, bring us to rethink the role of index insurance as products for enhancing smallholders’ response to covariate shocks, and particularly for improving their food security.

Keywords: index-based insurance, willingness to pay, satellite information, Ethiopia

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Authors: Geraldine G. Granados Vazquez

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Every human being is exposed to the risk of dying; wherein some of them are more susceptible than others depending on the cause. Therefore, the cause could be the hazard to die that a group or individual has, making this irreversible damage the condition of vulnerability. Risk is a dynamic concept; which means that it depends on the environmental, social, economic and political conditions. Thus vulnerability may only be evaluated in terms of relative parameters. This research is focusing specifically on building a model that evaluate the risk or propensity of death in past urban societies in connection with the everyday life of individuals, considering that death can be a consequence of two coexisting issues: hazard and the deterioration of the resistance to destruction. One of the most important discussions in bioarchaeology refers to health and life conditions in ancient groups; the researchers are looking for more flexible models that evaluate these topics. In that way, this research proposes a theoretical-methodological model that assess the vulnerability of death in past urban groups. This model pretends to be useful to evaluate the risk of death, considering their sociohistorical context, and their intrinsic biological features. This theoretical and methodological model, propose four areas to assess vulnerability. The first three areas use statistical methods or quantitative analysis. While the last and fourth area, which corresponds to the embodiment, is based on qualitative analysis. The four areas and their techniques proposed are a) Demographic dynamics. From the distribution of age at the time of death, the analysis of mortality will be performed using life tables. From here, four aspects may be inferred: population structure, fertility, mortality-survival, and productivity-migration, b) Frailty. Selective mortality and heterogeneity in frailty can be assessed through the relationship between characteristics and the age at death. There are two indicators used in contemporary populations to evaluate stress: height and linear enamel hypoplasias. Height estimates may account for the individual’s nutrition and health history in specific groups; while enamel hypoplasias are an account of the individual’s first years of life, c) Inequality. Space reflects various sectors of society, also in ancient cities. In general terms, the spatial analysis uses measures of association to show the relationship between frail variables and space, d) Embodiment. The story of everyone leaves some evidence on the body, even in the bones. That led us to think about the dynamic individual's relations in terms of time and space; consequently, the micro analysis of persons will assess vulnerability from the everyday life, where the symbolic meaning also plays a major role. In sum, using some Mesoamerica examples, as study cases, this research demonstrates that not only the intrinsic characteristics related to the age and sex of individuals are conducive to vulnerability, but also the social and historical context that determines their state of frailty before death. An attenuating factor for past groups is that some basic aspects –such as the role they played in everyday life– escape our comprehension, and are still under discussion.

Keywords: bioarchaeology, frailty, Mesoamerica, vulnerability

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Authors: Jaroslav Masek, Juraj Camaj, Eva Nedeliakova

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The aim of optimization of store management is not only designing the situation of store management itself including its equipment, technology and operation. In optimization of store management we need to consider also synchronizing of technological, transport, store and service operations throughout the whole process of logistic chain in such a way that a natural flow of material from provider to consumer will be achieved the shortest possible way, in the shortest possible time in requested quality and quantity and with minimum costs. The paper deals with the application of the queuing theory for optimization of warehouse processes. The first part refers to common information about the problematic of warehousing and using mathematical methods for logistics chains optimization. The second part refers to preparing a model of a warehouse within queuing theory. The conclusion of the paper includes two examples of using queuing theory in praxis.

Keywords: queuing theory, logistics system, mathematical methods, warehouse optimization

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Authors: Henry Kiptum Yatich, Ronald Chepkilot, Aquilars Mutuku Kalio

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Studies on energy management have focused on environmental conservation, reduction in production and operation expenses. However, transferring gains of energy management practices to competitive advantage is importance to manufacturers in Kenya. Success in managing competitive advantage arises out of a firm’s ability in identifying and implementing actions that can give the company an edge over its rivals. Manufacturing firms in Kenya are the highest consumers of both electricity and petroleum products. In this regard, the study posits that transfer of the gains of energy management practices to competitive advantage is imperative. The study was carried in Nairobi and its environs, which hosts the largest number of manufacturers. The study objectives were; to determine the level of implementing energy management regulations on sustaining competitive advantage, to determine the level of implementing company energy management policy on competitive advantage, to examine the level of implementing energy efficient technology on sustaining competitive advantage, and to assess the percentage energy expenditure on sustaining competitive advantage among manufacturing firms. The study adopted a survey research design, with a study population of 145,987. A sample of 384 respondents was selected randomly from 21 proportionately selected firms. Structured questionnaires were used to collect data. Data analysis was done using descriptive statistics (mean and standard deviations) and inferential statistics (correlation, regression, and T-test). Data is presented using tables and diagrams. The study found that Energy Management Regulations, Company Energy Management Policies, and Energy Expenses are significant predictors of Competitive Advantage (CA). However, Energy Efficient Technology as a component of Energy Management Practices did not have a significant relationship with Competitive Advantage. The study revealed that the level of awareness in the sector stood at 49.3%. Energy Expenses in the sector stood at an average of 10.53% of the firm’s total revenue. The study showed that gains from energy efficiency practices can be transferred to competitive strategies so as to improve firm competitiveness. The study recommends that manufacturing firms should consider energy management practices as part of its strategic agenda in assessing and reviewing their energy management practices as possible strategies for sustaining competitiveness. The government agencies such as Energy Regulatory Commission, the Ministry of Energy and Petroleum, and Kenya Association of Manufacturers should enforce the energy management regulations 2012, and with enhanced stakeholder involvement and sensitization so as promote sustenance of firm competitiveness. Government support in providing incentives and rebates for acquisition of energy efficient technologies should be pursued. From the study limitation, future experimental and longitudinal studies need to be carried out. It should be noted that energy management practices yield enormous benefits to all stakeholders and that the practice should not be considered a competitive tool but rather as a universal practice.

Keywords: energy, efficiency, management, guidelines, policy, technology, competitive advantage

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Authors: I. Caldas, T. Duarte

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Avoidant Restrictive Food Intake Disorder (ARFID) was included for the first time in DSM-5, replacing the old diagnosis of DSM-4 'Early Childhood Eating Disorder'. An ARFID is characterized by a restrictive/avoidant eating pattern that can lead to severe nutritional deficiency, weight loss, nutritional supplementation dependence, and poor psychosocial functioning. This eating pattern is associated with decreased interest in food, worries about food characteristics or the act of ingestion, and lack of concern with weight or body image. This paper aims to understand the impact of this new diagnosis in other Eating Disorders (ED) prevalence, as well as to compare their therapeutic approaches. Methodology: Literature reviewed by PubMed with the following keywords: 'ARFID', 'Prevalence', and 'Eating Disorders'. We selected articles related to this theme, written since 2016. Results: In a population of children hospitalized with ED, 5% to 14% was diagnosed with ARFID, and, as outpatient treatment, the prevalence was 22%. People diagnosed with ARFID have more prevalence of other comorbidities, especially autism spectrum, are younger, and are more often male. Regarding the treatment of ARFID, it most often required nasogastric feeding, and with less suffering associated with this procedure, compared to AN. Despite these differences, 12% of patients diagnosed with ARFID transited to AN during treatment, suggesting that the first pathology may be a risk factor for the development of AN. Conclusions: The differences identified between ARFID and the other EDs are important when analyzed as differential diagnostic hypotheses and therapeutic approaches. Further study is necessary regarding its prevalence, risk factors, and treatment.

Keywords: avoidant restrictive food intake disorder, ARFID, differential diagnoses, eating disorders, prevalence

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Authors: Mehtab Alam, Mudiarasan Kuppusamy, Puvaneswaran Kunaserkaran

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The purpose of this paper is to bridge the gap and complete the relationship between tourism destinations and image branding as a choice of edifice foreign policy. Such options became a crucial component for individuals interested in leisure and travel activities. The destination management factors have been evaluated and analyzed using the primary and secondary data in a mixed-methods approach (quantitative sample of 384 and qualitative 8 semi-structured interviews at saturated point). The study chose the Environmental Management Accounting (EMA) and Image Restoration (IR) theories, along with a schematic diagram and an analytical framework supported by NVivo software 12, for two locations in Abbottabad, KPK, Pakistan: Shimla Hill and Thandiani. This incorporates the use of PLS-SEM model for assessing validity of data while SPSS for data screening of descriptive statistics. The results show that destination management's promotion of tourism has significantly improved Pakistan's state image. The use of institutional setup, environmental drivers, immigration, security, and hospitality as well as recreational initiatives on destination management is encouraged. The practical ramifications direct the heads of tourism projects, diplomats, directors, and policymakers to complete destination projects before inviting people to Pakistan. The paper provides the extent of knowledge for academic tourism circles to use tourism destinations as brand ambassadors.

Keywords: tourism, management, state image, foreign policy, image branding

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Authors: Kennedy Zinn, Chris Anderson

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Chronic Covid syndrome (CCS) is a condition in which individuals who test positive for Covid-19 experience persistent symptoms after recovering from the virus. CCS affects every organ system, including the central nervous system. Neurological “long-haul” symptoms last from a few weeks to several months and include brain fog, chronic fatigue, dyspnea, mood dysregulation, and headaches. Data suggest that 10-30% of individuals testing positive for Covid-19 develop CCS. Current literature indicates a decreased quality of life in persistent symptoms. CCS is a pervasive and pernicious COVID-19 sequelae. More research is needed to understand risk factors, impact, and possible interventions. Research frequently cites cytokine storming as noteworthy etiology in CCS. Cytokine storming is a malfunctional immune response and facilitates multidimensional interconnected physiological responses. The most prominent responses include abnormal blood flow, hypoxia/hypoxemia, inflammation, and endothelial damage. Neurological impairments and pathogenesis in CCS parallel that of traumatic brain injury (TBI). Both exhibit impairments in memory, cognition, mood, sustained attention, and chronic fatigue. Evidence suggests abnormal blood flow, inflammation, and hypoxemia as shared causal factors. Cytokine storming is also typical in mTBI. The shared characteristics in symptoms and etiology suggest potential parallel routes of investigation that allow for better understanding of CCS. Research on the effect of altitude in mTBI varies. Literature finds decreased rates of concussions at higher altitudes. Other studies suggest that at a higher altitude, pre-existing mTBI symptoms are exacerbated. This may mean that in CCS, the geographical location where individuals live and the location where individuals experienced acute Covid-19 symptoms may influence the severity and risk of developing CCS. It also suggests that clinics which treat mTBI patients could also provide benefits for those with CCS. This study aims to examine the relationships between altitude and CCS as a risk factor and investigate the longevity and severity of symptoms in different altitudes. Existing patient data from a concussion clinic using fMRI scans and self-reported symptoms will be used for approximately 30 individuals with CCS symptoms. The association between acclimated altitude and CCS severity will be analyzed. Patients will be classified into low, medium, and high altitude groups and compared for differences on fMRI severity scores and self-reported measures. It is anticipated that individuals living in lower altitudes are at higher risk of developing more severe neuropsychological symptoms in CCS. It is also anticipated that a treatment approach for mTBI will also be beneficial to those with CCS.

Keywords: altitude, chronic covid syndrome, concussion, covid brain, EPIC treatment, fMRI, traumatic brain injury

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Authors: Thanooja Naushad, Meena Natarajan, Tushar Vasant Kulkarni

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Background: The Lacey Assessment of Preterm Infants (LAPI) is used in clinical practice to identify premature babies at risk of neuromotor impairments, especially cerebral palsy. This study attempted to find the validity of the Lacey assessment of preterm infants to predict neuromotor outcomes of premature babies at 12 months corrected age and to compare its predictive ability with the brain ultrasound. Methods: This prospective cohort study included 89 preterm infants (45 females and 44 males) born below 35 weeks gestation who were admitted to the neonatal intensive care unit of a government hospital in Dubai. Initial assessment was done using the Lacey assessment after the babies reached 33 weeks postmenstrual age. Follow up assessment on neuromotor outcomes was done at 12 months (± 1 week) corrected age using two standardized outcome measures, i.e., infant neurological international battery and Alberta infant motor scale. Brain ultrasound data were collected retrospectively. Data were statistically analyzed, and the diagnostic accuracy of the Lacey assessment of preterm infants (LAPI) was calculated -when used alone and in combination with the brain ultrasound. Results: On comparison with brain ultrasound, the Lacey assessment showed superior specificity (96% vs. 77%), higher positive predictive value (57% vs. 22%), and higher positive likelihood ratio (18 vs. 3) to predict neuromotor outcomes at one year of age. The sensitivity of Lacey assessment was lower than brain ultrasound (66% vs. 83%), whereas specificity was similar (97% vs. 98%). A combination of Lacey assessment and brain ultrasound results showed higher sensitivity (80%), positive (66%), and negative (98%) predictive values, positive likelihood ratio (24), and test accuracy (95%) than Lacey assessment alone in predicting neurological outcomes. The negative predictive value of the Lacey assessment was similar to that of its combination with brain ultrasound (96%). Conclusion: Results of this study suggest that the Lacey assessment of preterm infants can be used as a supplementary assessment tool for premature babies in the neonatal intensive care unit. Due to its high specificity, Lacey assessment can be used to identify those babies at low risk of abnormal neuromotor outcomes at a later age. When used along with the findings of the brain ultrasound, Lacey assessment has better sensitivity to identify preterm babies at particular risk. These findings have applications in identifying premature babies who may benefit from early intervention services.

Keywords: brain ultrasound, lacey assessment of preterm infants, neuromotor outcomes, preterm

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Authors: Magdalena Korytowska, Gunnar Lengstrand, Cecilia Larsson Wexell

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Background: Breast cancer (BC) is the most common cancer among women worldwide, and cases are continuing to increase in Sweden. Bone is the most common metastatic site in breast cancer patients, where > 65-75% of women with advanced breast cancer develop bone metastases during their disease. To prevent the skeletal-related events of metastases (e.g., pathological fractures, bone loss, cancer-induced bone pain, and hypercalcemia bone), two different classes of antiresorptive medications (AR), bisphosphonate and denosumab are typically administered every 3 to 4 weeks. Since 2015, adjuvant bisphosphonate treatment has been used every six months for three to five years in postmenopausal women for the prevention of skeletal metastases and improved survival. Methods: A case-control study was conducted to test the hypotheses that patients treated with high-dose AR are at higher risk of developing MRONJ than breast cancer patients with adjuvant bisphosphonate treatment at a lower dose. Medical and odontological data was collected between 2015-2020. Assessment of oral health and dental care before and during oncological treatment took place at the specialist clinic for Orofacial medicine linked to the specific hospital. Results: In total, 220 patients were included, 101 patients in the high-dose group and 119 patients in the adjuvant BP-treatment group. MRONJ was diagnosed in 13 patients (14%) in the high-dose group. The mandible was affected in most of the cases (84.6%), with a mean duration of high-dose treatment of 19.7 months. In 46.2% of cases, no dental cause of MRONJ could be identified. Overall, estrogen receptor-positive (ER+) BC was the most representative type in 172 patients (78.2%). However, this was 83.9% in the high-dose cases group. The most used drug was denosumab. Twenty-five patients (26.9%) switched their medication from ZOL to denosumab during their oncological treatment. Patients with ER+ breast cancer were reported in 88 patients (87.8%) in the adjuvant group that was treated with ZOL. Conclusions: MRONJ was diagnosed only in the high-dose AR group. Dental assessment and care of patients in the adjuvant group should be considered, with a recommendation to potentially prolong ZOL treatment from 3 to 5 years, with concomitant use of hormonal therapy in patients diagnosed with ER+ breast cancer to prevent bone loss induced by oncological treatment. A new referral for dental assessment is very important in the case of bone metastases when treatment with high dose AR will be required since it is associated with a higher risk of MRONJ.

Keywords: antiresorptive therapy, breast cancer, dental care, MRONJ

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Authors: Oumayma Tajouri

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The relationship between total quality management (TQM) practices and innovation is conflictual. Some scholars suggest that TQM has an effect on incremental improvement and would not lead to innovation and creativity. The purpose of this paper is to analyse the association between TQM and different types of innovation. Our goal is to examine to what extent the implementation of TQM practices is indeed supporting innovation in the Tunisian ISO 9001 certified industries. Using a self-administered survey to sample ISO9001 certified industry companies, this study examines five hypotheses and tests the relation between TQM practices and innovation. The principal finding of this study is that TQM has significant and positive effects on innovation in the Tunisian context. The results support that TQM has an influence on incremental, radical, and administrative innovation.

Keywords: total quality management, incremental innovation product and/service, radical innovation product/service, incremental innovation process, radical innovation process, administrative innovation

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Authors: Pushkar Lal Sharma, Sanjana Singh, Umesh Kumar Sahu

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This paper helps to understand the need of Customer Relationship Management in Libraries and why Librarians should implement the marketing concept of Customer Relationship Management in their libraries. As like any industry, libraries too face growing challenges to continuously meet customer expectations, and attract and retain users in light of overflowing competition. The ability to understand customers, build relationships and market diverse services is essential when considering ways to expand service offerings and improve Return on Investment. Since Library is service oriented Enterprise, hence the Customer/User/ Reader/Patron are the most important element of Library & Information System to whom and for whom library offers various services. How to provide better and most efficient services to its users is the main concern of every Library & Information centre in the present era. The basic difference between Business Enterprise and Library Information System is that ‘in Business System ‘the efficiency is measured in terms of ’profit’ or ‘monetary gains’; whereas in a Library & Information System, the efficiency is measured in terms of ‘services’ and therefore the goals that are set in Business Enterprise are’ profit oriented’ whereas goals set in the Library & Information Centre are ‘Service-oriented’. With the explosion of information and advancement of technology readers have so many choices to get information rather than visiting a library. Everything is available at the click of a mouse, library customers have become more knowledgeable and demanding in an era marked by abundance of information resources and services. With this explosion of information in every field of knowledge and choice in selection of service, satisfying user has become a challenge now a day for libraries. Accordingly, Libraries have to build good relationship with its users by adopting Customer relationship Management. CRM refers to the methods and tools which help an organization to manage its relationship with its customers in an organized way. The Customer Relationship Management (CRM) combines business strategy and technology to identify, acquire and retain good customer relationship. The goal of CRM is to optimize management of customer information needs & interests and increase customer satisfaction and loyalty. Implementing CRM in Libraries can improve customer data and process management, customer loyalty, retention and satisfaction.

Keywords: customer relationship management, CRM, CRM tools, customer satisfaction

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Authors: Margaret S. Wright

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Background/Significance: During many recent public health emergencies/disasters, public health nursing data has been missing or delayed, potentially impacting the decision-making and response. Data used as evidence for decision-making in response, planning, and mitigation has been erratic and slow, decreasing the ability to respond. Methodology: Applying best practices in data management and data use in public health settings, and guided by the concepts outlined in ‘Disaster Standards of Care’ models leads to the development of recommendations for a model of best practices in data management and use in public health disasters/emergencies by public health nurses. As the ‘patient’ in public health disasters/emergencies is the community (local, regional or national), guidelines for patient documentation are incorporated in the recommendations. Findings: Using model public health nurses could better plan how to prepare for, respond to, and mitigate disasters in their communities, and better participate in decision-making in all three phases bringing public health nursing data to the discussion as part of the evidence base for decision-making.

Keywords: data management, decision making, disaster planning documentation, public health nursing

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Authors: Mwenya Mubanga, Sula Mazimba

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Background: In Zambia, much of the focus on nutrition and health has been on reducing micronutrient deficiencies, wasting and underweight malnutrition and not on the rising global projections of trends in obesity and type 2 diabetes. The aim of this review was to identify and collate studies on the prevalence of obesity, diabetes and diabetes-related cardiovascular disease conducted in Zambia, to summarize their findings and to identify areas that need further research. Methods: The Medical Literature Analysis and Retrieval System (MEDLINE) database was searched for peer-reviewed articles on the prevalence of, and factors associated with obesity, type 2 diabetes, and diabetes-related cardiovascular disease amongst Zambian residents using a combination of search terms. The period of search was from 1 January 2000 to 31 December 2016. We expanded the search terms to include all possible synonyms and spellings obtained in the search strategy. Additionally, we performed a manual search for other articles and references of peer-reviewed articles. Results: In Zambia, the current prevalence of Obesity and Type 2 diabetes is estimated at 13%-16% and 2.0 – 3.0% respectively. Risk factors such as the adoption of western dietary habits, the social stigmatization associated with rapid weight loss due to Tuberculosis and/ or the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and rapid urbanization have all been blamed for fueling the increased risk of obesity and type 2 diabetes. However, unlike traditional Western populations, those with no formal education were less likely to be obese than those who attained secondary or tertiary level education. Approximately 30% of those surveyed were unaware of their diabetes diagnosis and more than 60% were not on treatment despite a known diabetic status. Socio-demographic factors such as older age, female sex, urban dwelling, lack of tobacco use and marital status were associated with an increased risk of obesity, impaired glucose tolerance and type 2 diabetes. We were unable to identify studies that specifically looked at diabetes-related cardiovascular disease. Conclusion: Although the prevalence of Obesity and Type 2 diabetes in Zambia appears low, more representative studies focusing on parts of the country outside of the main industrial zone need to be conducted. There also needs to be research on diabetes-related cardiovascular disease. National surveillance, monitoring and evaluation on all non-communicable diseases need to be prioritized and policies that address underweight, obesity and type 2 diabetes developed.

Keywords: type 2 diabetes, Zambia, obesity, cardiovascular disease

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Authors: Ted Gournelos

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Marketing approaches in practice and academic literature usually foreground the importance of product and brand awareness in strategy. Decisions emphasize justifications and promotions of existing projects, which has the unintended consequence of pushing marketing, public relations, and other communications to secondary strategies and tactics rather than as inherent pieces of organizational development. In other words, marketers implement what others have already decided. This is a challenge not only for the communications field, but also for the organizations themselves, since integrated communications employees are often the primary, if not the only, touchpoints for client/customer/user research and interaction. Organizations thus become increasingly out of touch, raising the risk of public or human resources crisis and decreasing the focus on opportunities for development and growth. This paper will discuss the potential for social entrepreneurship to refocus marketing and communications professionals on primary strategy, and suggest best practices for developing initiatives not only to impact marketing efforts themselves, but also the guiding organizational approaches to project management, human resources, corporate social responsibility, and research. It will provide a comparative analysis of social media marketing efforts conducted by food security non-governmental organizations from several countries, pointing out both flaws and areas of opportunity for integration with for-profit organizational strategy, and discuss the implications of descriptive, proactive, and interactive messaging.

Keywords: social enterprise, strategy, innovation, social media

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Authors: Hadeer Hegazy, Wael Ewieda, Ranin Soliman, Samah Elway, Asmaa Tawfik, Ragaa Sayed, Sahar Mousa

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The current healthcare system is facing major challenges in terms of cost, quality of care, and access to services. In response, the concept of value-based healthcare has emerged as a new approach to healthcare delivery. This concept puts the focus on patient values rather than on the traditional medical model of care. To achieve this, healthcare organizations must be agile and able to anticipate and respond quickly to changing needs. Agile management is essential for healthcare organizations to achieve value-based care, as it allows them to rapidly adjust their strategies to changing circumstances. Additionally, it is argued that agile management can help healthcare organizations gain a better understanding of the needs of their patients and develop better care delivery models. Besides, it can help healthcare organizations develop new services, innovate, and become more efficient. The authors provide evidence to support their argument, drawing on examples from successful value-based healthcare initiatives at children’s cancer hospital Egypt-57357. The paper offers insight into how agile management can be used to facilitate the shift towards value-based healthcare and how it can be used to maximize value in the healthcare system.

Keywords: value-based healthcare, agility in healthcare, nursing department, patients outcomes

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Authors: Shadab Shishegar, Sophie Duchesne, Genevieve Pelletier

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Sustainability as one of the key elements of Smart cities, can be realized by employing Real Time Control Strategies for city’s infrastructures. Nowadays Stormwater management systems play an important role in mitigating the impacts of urbanization on natural hydrological cycle. These systems can be managed in such a way that they meet the smart cities standards. In fact, there is a huge potential for sustainable management of urban stormwater and also its adaptability to global challenges like climate change. Hence, a dynamically managed system that can adapt itself to instability of the environmental conditions is desirable. A Global Predictive Real Time Control approach is proposed in this paper to optimize the performance of stormwater management basins in terms of flooding prevention. To do so, a mathematical optimization model is developed then solved using Genetic Algorithm (GA). Results show an improved performance at system-level for the stormwater basins in comparison to static strategy.

Keywords: environmental sustainability, optimization, real time control, storm water management

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Authors: Elias Kodjo Kekesi

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This study seeks to investigate a critical but neglected area in disaster and emergency management in Ghana. It explores aspects of work within one of the safety-critical work environments that expose workers to psychological, social and physical harm. With much attention to crises’ survivors, deceased and their families, this research attempts to answer a key question: ‘What happens to the rescuer’? Emergency response is associated with immense and unprecedented pressure that puts responders’ physical, mental and social well-being at risk. Despite the negative psychological outcomes, scholars argue that being in a traumatic situation may trigger positive outcomes for some people. Thus, the study also focuses on the positive impact of working in a risky crisis environment. Additionally, people’s interpretation of negative experiences or exposure to adverse conditions differ owing to their personal resources which explains why some people may be negatively affected whiles others are positively impacted. To examine these complex nuances, an exploratory sequential mixed method design is adopted. This paper will highlight the findings of study one, which explores the underlying themes emerging from the Ghanaian disaster and emergency response environment regarding psychosocial hazard exposures and the corresponding outcomes.

Keywords: psychosocial hazards, organisational outcomes, qualitative research, Ghana

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Authors: Won Man Park, Dae Kyung Choi, Kyungsoo Kim, Yoon Hyuk Kim

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Traction therapy has been used in the treatment of spinal pain for decades. However, a case study reported the occurrence of large disc protrusion during motorized traction therapy. In this study, we hypothesized that additional local decompression with a global axial traction could be helpful for risk reduction of intervertebral disc damage. A validated three dimensional finite element model of the lumbar spine was used. Two-step traction therapy using the axial global traction (the first step) with 1/3 body weight and the additional local decompression (the second step) with 7 mm translation of L4 spinal bone was determined for the traction therapy. During two-step traction therapy, the sacrum was constrained in all translational directions. Reduced lordosis angle by the global axial traction recovered with the additional local decompression. Stress on fibers of the annulus fibrosus by the axial global traction decreased with the local decompression by 17%~96% in the posterior region of intervertebral disc. Stresses on ligaments except anterior longitudinal ligaments in all motion segments decreased till 4.9 mm~5.6 mm translation of L4 spinal bone. The results of this study showed that the additional local decompression is very useful for reducing risk of damage in the intervertebral disc and ligaments caused by the global axial traction force. Moreover, the local decompression could be used to enhance reduction of intradiscal pressure.

Keywords: lumbar spine, traction-therapy, biomechanics, finite element analysis

Procedia PDF Downloads 474