Search results for: earnings management
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 9760

Search results for: earnings management

6400 Northern Nigeria Vaccine Direct Delivery System

Authors: Evelyn Castle, Adam Thompson

Abstract:

Background: In 2013, the Kano State Primary Health Care Management Board redesigned its Routine immunization supply chain from diffused pull to direct delivery push. It addressed issues around stockouts and reduced time spent by health facility staff collecting, and reporting on vaccine usage. The health care board sought the help of a 3PL for twice-monthly deliveries from its cold store to 484 facilities across 44 local governments. eHA’s Health Delivery Systems group formed a 3PL to serve 326 of these new facilities in partnership with the State. We focused on designing and implementing a technology system throughout. Basic methodologies: GIS Mapping: - Planning the delivery of vaccines to hundreds of health facilities requires detailed route planning for delivery vehicles. Mapping the road networks across Kano and Bauchi with a custom routing tool provided information for the optimization of deliveries. Reducing the number of kilometers driven each round by 20%, - reducing cost and delivery time. Direct Delivery Information System: - Vaccine Direct Deliveries are facilitated through pre-round planning (driven by health facility database, extensive GIS, and inventory workflow rules), manager and driver control panel customizing delivery routines and reporting, progress dashboard, schedules/routes, packing lists, delivery reports, and driver data collection applications. Move: Last Mile Logistics Management System: - MOVE has improved vaccine supply information management to be timely, accurate and actionable. Provides stock management workflow support, alerts management for cold chain exceptions/stock outs, and on-device analytics for health and supply chain staff. Software was built to be offline-first with user-validated interface and experience. Deployed to hundreds of vaccine storage site the improved information tools helps facilitate the process of system redesign and change management. Findings: - Stock-outs reduced from 90% to 33% - Redesigned current health systems and managing vaccine supply for 68% of Kano’s wards. - Near real time reporting and data availability to track stock. - Paperwork burdens of health staff have been dramatically reduced. - Medicine available when the community needs it. - Consistent vaccination dates for children under one to prevent polio, yellow fever, tetanus. - Higher immunization rates = Lower infection rates. - Hundreds of millions of Naira worth of vaccines successfully transported. - Fortnightly service to 326 facilities in 326 wards across 30 Local Government areas. - 6,031 cumulative deliveries. - Over 3.44 million doses transported. - Minimum travel distance covered in a round of delivery is 2000 kms & maximum of 6297 kms. - 153,409 kms travelled by 6 drivers. - 500 facilities in 326 wards. - Data captured and synchronized for the first time. - Data driven decision making now possible. Conclusion: eHA’s Vaccine Direct delivery has met challenges in Kano and Bauchi State and provided a reliable delivery service of vaccinations that ensure t health facilities can run vaccination clinics for children under one. eHA uses innovative technology that delivers vaccines from Northern Nigerian zonal stores straight to healthcare facilities. Helped healthcare workers spend less time managing supplies and more time delivering care, and will be rolled out nationally across Nigeria.

Keywords: direct delivery information system, health delivery system, GIS mapping, Northern Nigeria, vaccines

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6399 Accreditation and Quality Assurance of Nigerian Universities: The Management Imperative

Authors: F. O Anugom

Abstract:

The general functions of the university amongst other things include teaching, research and community service. Universities are recognized as the apex of learning, accumulating and imparting knowledge and skills of all kinds to students to enable them to be productive, earn their living and to make optimum contributions to national development. This is equivalent to the production of human capital in the form of high level manpower needed to administer the educational society, be useful to the society and manage the economy. Quality has become a matter of major importance for university education in Nigeria. Accreditation is the systematic review of educational programs to ensure that acceptable standards of education, scholarship and infrastructure are being maintained. Accreditation ensures that institution maintain quality. The process is designed to determine whether or not an institution has met or exceeded the published standards for accreditation, and whether it is achieving its mission and stated purposes. Ensuring quality assurance in accreditation process falls in the hands of university management which justified the need for this study. This study examined accreditation and quality assurance: the management imperative. Three research questions and three hypotheses guided the study. The design was a correlation survey with a population of 2,893 university administrators out of which 578 Heads of department and Dean of faculties were sampled. The instrument for data collection was titled Programme Accreditation Exercise scale with high levels of reliability. The research questions were answered with Pearson ‘r’ statistics. T-test statistics was used to test the hypotheses. It was found among others that the quality of accredited programme depends on the level of funding of universities in Nigeria. It was also indicated that quality of programme accreditation and physical facilities of universities in Nigeria have high relationship. But it was also revealed that programme accreditation is positively related to staffing in Nigerian universities. Based on the findings of the study, the researcher recommend that academic administrators should be included in the team of those who ensure quality programs in the universities. Private sector partnership should be encouraged to fund programs to ensure quality of programme in the universities. Independent agencies should be engaged to monitor the activities of accreditation teams to avoid bias.

Keywords: accreditation, quality assurance, national universities commission , physical facilities, staffing

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6398 Sociocultural Context of Pain Management in Oncology and Palliative Nursing Care

Authors: Andrea Zielke-Nadkarni

Abstract:

Pain management is a question of quality of life and an indicator for nursing quality. Chronic pain which is predominant in oncology and palliative nursing situations is perceived today as a multifactorial, individual emotional experience with specific characteristics including the sociocultural dimension when dealing with migrant patients. This dimension of chronic pain is of major importance in professional nursing of migrant patients in hospices or palliative care units. Objectives of the study are: 1. To find out more about the sociocultural views on pain and nursing care, on customs and nursing practices connected with pain of both Turkish Muslim and German Christian women, 2. To improve individual and family oriented nursing practice with view to sociocultural needs of patients in severe pain in palliative care. In a qualitative-explorative comparative study 4 groups of women, Turkish Muslims immigrants (4 from the first generation, 5 from the second generation) and German Christian women of two generations (5 of each age group) of the same age groups as the Turkish women and with similar educational backgrounds were interviewed (semistructured ethnographic interviews using Spradley, 1979) on their perceptions and experiences of pain and nursing care within their families. For both target groups the presentation will demonstrate the following results in detail: Utterance of pain as well as “private” and “public” pain vary within different societies and cultures. Permitted forms of pain utterance are learned in childhood and determine attitudes and expectations in adulthood. Language, especially when metaphors and symbols are used, plays a major role for misunderstandings. The sociocultural context of illness may include specific beliefs that are important to the patients and yet seem more than far-fetched from a biomedical perspective. Pain can be an influential factor in family relationships where respect or hierarchies do not allow the direct utterance of individual needs. Specific resources are often, although not exclusively, linked to religious convictions and are significantly helpful in reducing pain. The discussion will evaluate the results of the study with view to the relevant literature and present nursing interventions and instruments beyond medication that are helpful when dealing with patients from various socio-cultural backgrounds in painful end-oflife situations.

Keywords: pain management, migrants, sociocultural context, palliative care

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6397 Performance Management in Serbian Banks: Balanced Scorecard Approach

Authors: Nela Milosevic, Sladjana Barjaktarovic Rakocevic, Sladjana Benkovic, Nemanja Milanovic

Abstract:

Nowadays, performance measurement systems play a key role in evaluating the strategic performances of an organization. On the other hand, there has been a shift towards the Balanced Scorecard (BSC), which has been recognized as a valuable managerial approach. The main goal of this paper is to analyze the main performances of Serbian banks measured at the branches level, through the usage of the Balanced Scorecard framework. Although an extensive number of practitioners have an interest in the Balanced Scorecard approach, little empirical research has been conducted on the implementation of its concept in the service sector like banks, especially within developing countries. From the beginning of August till the end of September 2015, authors have been conducting in-depth interviews among a number of experts from the most successful banks in Serbia. The results show that the non-financial measures, especially, customer oriented indicators and product/ service oriented indicators, seem to be very important factors for improving not only the financial situation within the bank, but also overall business performances. Additionally, the findings prove that there is the cause-effect relationship between non-financial and financial dimensions of the Balanced Scorecard. Having in mind that the banks are still using outdated performance evaluation systems, such as annual, quarterly and monthly reports, we hope that this paper will contribute to the knowledge of how banks in Serbia may apply the Balanced Scorecard approach to evaluate their performance on the most efficient and effective way.

Keywords: balanced scorecard approach, bank management, performance measurement systems, strategic performances

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6396 A Sustainable Energy Portfolio for Greater Kampala Metropolitan Area by the Mid-Century

Authors: Ismail Kimuli

Abstract:

With a steadfast economic development, the Greater Kampala metropolitan area (GKMA) faces increasing pressures to increasetheshare of low-carbon electricity in the energy balance, abate CO2 emissions and also restructure the transportation sector for a sustainable 2050. GKMA, is Uganda’s commercial, political, social, and industrial hub with a population of 4.1 million, contributing 60% tothe nation’s GDP and accounts for 80% of Uganda’s industrial sector.However, with the rampant anthropogenic interference that causes climate change, CO2 emissions in the metropolitan are contributing to global warming. Many economies across the globe are addressing this challengethrough development and analysis of sustainable energy portfolios.A sustainable energy portfolio is a low-carbon scenario. The study reviews the literature to establish the current energy management situation of GKMA and finds it wanting in addressing the immediate challenges associated with energy management of the metropolitan. Then, the study develops and examines a sustainable energy portfolio for GKMA using TIMES-VEDA and then presents it as an investigative low-carbon energy scenario that could propel the metropolitan sustainably towards 2050.Sustainability is plausible by optimizing the total primary energy supply, generating low-carbon electricity from hydropower and PV-solar renewables, improving heating technologies for residential & commercial sectors, and switching 90% of land passengers from road to a Kampala metro for a sustainable mid-century.

Keywords: GKMA, sustainability, TIMES-VEDA, low-carbon scenario

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6395 A Framework Factors Influencing Accounting Information Systems Adoption Success

Authors: Manirath Wongsim

Abstract:

AIS plays an important role in business management, strategic and can provide assistance in all phases of decision making. Thus, many organisations needs to be seen as well adopting AIS, which is critical to a company in order to organise, manage and operate process in all sections. In order to implement AIS successfully, it is important to understand the underlying factors that influence the AIS adoption. Therefore, this research intends to study this perspective of factors influence and impact on AIS adoption’s success. The model has been designed to illustrate factors influences in AIS adoption. It also attempts to identify the critical success factors that organisations should focus on, to ensure the adoption on accounting process. This framework will be developed from case studies by collecting qualitative and quantitative data. Case study and survey methodology were adopted for this research. Case studies in two Thai- organisations were carried out. The results of the two main case studies suggested 9 factors that may have impact on in AIS adoption. Survey instrument was developed based on the findings from case studies. Two large-scale surveys were sent to selected members of Thailand Accountant, and Thailand Computer Society to further develop and test the research framework. The top three critical factors for ensuring AIS adoption were: top management commitment, steering committees, and Technical capability of AIS personnel. That is, it is now clear which factors impact in AIS adoption, and which of those factors are critical success factors for ensuring AIS adoption successes

Keywords: accounting information system, accounting information systems adoption, and inflecting AIS adoption

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6394 Effectiveness of Jute Geotextiles for Hill Slope Stabilization in Adverse Climatic Condition

Authors: Pradip Choudhury, Tapobrata Sanyal

Abstract:

Effectiveness of Jute Geotextiles (JGT) in hill slope management now stands substantiated. The reasons of its efficacy are attributed to its bio-degradability, hygroscopic property and its thickness. Usually open weave JGT is used for slope management. Thickness of JGT helps in reducing the velocity of surface run-off, thus curbing the extent of migration of soil particles detached as a result of kinetic energy of rain-drops and also of wind effects. Initially JGT acts as cover of the surface of slope thus protect movement of loose soil particles. Hygroscopic property of jute effects overland storage of the flow. JGT acts as mulch and creates a congenial micro-climate that fosters quick growth of vegetation on bio-degradation. In fact JGT plays an important role in bio-remediation of slope-erosion problems. Considering the environmental aftermath, JGT is the preferred option in developed countries for surface soil conservation against erosion. In India JGT has not been tried in low temperature zones at high altitudes where temperature goes below the freezing point (even below - 25° Celsius). The behavior of JGT in such low-temperature zones is not precisely known. The 16th BRTF of Project Himank of Border Roads Organization (BRO) has recently taken the initiative to try two varieties of JGT , ie, 292 gsm and 500 gsm at two different places for hill slope management in Leh, a high altitude place of about 2,660 mtrs and 4900 mtrs above MSL respectively in Jammu & Kashmir where erosion is caused more as a result of rapid movement of sand particles due to high wind (wind erosion. Soil particles of the region formed naturally by weathering of fragile rocks are usually loosely bonded (non-cohesive), undergo dissociation with the rise in wind force and kinetic energy of rain drops and are blown away by wind. Open weave JGT interestingly was observed to contain the dissociated soil particles within its pores and lend stability the affected soil mass to a great extent thus preventing its movement by extraneous agents such as wind. The paper delineates about climatic factors, type of JGT used and the prevailing site conditions with an attempt to analyze the mechanism of functioning of JGT in low temperature zones.

Keywords: climate, erosion, jutegeotextile, stabilize

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6393 Workforce Optimization: Fair Workload Balance and Near-Optimal Task Execution Order

Authors: Alvaro Javier Ortega

Abstract:

A large number of companies face the challenge of matching highly-skilled professionals to high-end positions by human resource deployment professionals. However, when the professional list and tasks to be matched are larger than a few dozens, this process result is far from optimal and takes a long time to be made. Therefore, an automated assignment algorithm for this workforce management problem is needed. The majority of companies are divided into several sectors or departments, where trained employees with different experience levels deal with a large number of tasks daily. Also, the execution order of all tasks is of mater consequence, due to some of these tasks just can be run it if the result of another task is provided. Thus, a wrong execution order leads to large waiting times between consecutive tasks. The desired goal is, therefore, creating accurate matches and a near-optimal execution order that maximizes the number of tasks performed and minimizes the idle time of the expensive skilled employees. The problem described before can be model as a mixed-integer non-linear programming (MINLP) as it will be shown in detail through this paper. A large number of MINLP algorithms have been proposed in the literature. Here, genetic algorithm solutions are considered and a comparison between two different mutation approaches is presented. The simulated results considering different complexity levels of assignment decisions show the appropriateness of the proposed model.

Keywords: employees, genetic algorithm, industry management, workforce

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6392 Uncommon Presentation of Iscahemic Heart Disease with Sheehan’s Syndrome at Mid-Level Private Hospital of Bangladesh and Its Management- A Case Report

Authors: Nazmul Haque, Syeda Tasnuva Maria

Abstract:

Sheehan's Syndrome (SS), also known as postpartum hypopituitarism, is a rare but potentially serious condition resulting from ischemic necrosis of the pituitary gland, often occurring during or after childbirth. This syndrome is characterized by hypopituitarism, leading to deficiencies in various hormones produced by the pituitary gland. The primary cause is typically severe postpartum hemorrhage, leading to inadequate blood supply and subsequent necrosis of the pituitary tissue. This chronic hypopituitarism sometimes plays the role of premature atherosclerosis, which may lead to cardiovascular disease. This abstract provides a comprehensive overview of Sheehan's Syndrome with ischaemic heart disease, encompassing its pathophysiology, clinical manifestations, and current management strategies. The disorder presents a wide spectrum of symptoms, including chest pain, fatigue, amenorrhea, lactation failure, hypothyroidism, and adrenal insufficiency. Timely diagnosis is crucial, as delayed recognition can lead to complications and long-term health consequences. We herein report a patient complaining of chronic fatigue symptoms, aggressiveness, chest pain, and breathlessness with repeated LOC that were diagnosed with SS with IHD. The patient was treated with antiplatelet, antianginal, steroids, and hormone replacement with marked improvement in his overall condition.

Keywords: ischaemic heart disease, Sheehan's syndrome, post-partum haemorrhage, pituitary gland

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6391 Crowdsensing Project in the Brazilian Municipality of Florianópolis for the Number of Visitors Measurement

Authors: Carlos Roberto De Rolt, Julio da Silva Dias, Rafael Tezza, Luca Foschini, Matteo Mura

Abstract:

The seasonal population fluctuation presents a challenge to touristic cities since the number of inhabitants can double according to the season. The aim of this work is to develop a model that correlates the waste collected with the population of the city and also allow cooperation between the inhabitants and the local government. The model allows public managers to evaluate the impact of the seasonal population fluctuation on waste generation and also to improve planning resource utilization throughout the year. The study uses data from the company that collects the garbage in Florianópolis, a Brazilian city that presents the profile of a city that attracts tourists due to numerous beaches and warm weather. The fluctuations are caused by the number of people that come to the city throughout the year for holidays, summer time vacations or business events. Crowdsensing will be accomplished through smartphones with access to an app for data collection, with voluntary participation of the population. Crowdsensing participants can access information collected in waves for this portal. Crowdsensing represents an innovative and participatory approach which involves the population in gathering information to improve the quality of life. The management of crowdsensing solutions plays an essential role given the complexity to foster collaboration, establish available sensors and collect and process the collected data. Practical implications of this tool described in this paper refer, for example, to the management of seasonal tourism in a large municipality, whose public services are impacted by the floating of the population. Crowdsensing and big data support managers in predicting the arrival, permanence, and movement of people in a given urban area. Also, by linking crowdsourced data to databases from other public service providers - e.g., water, garbage collection, electricity, public transport, telecommunications - it is possible to estimate the floating of the population of an urban area affected by seasonal tourism. This approach supports the municipality in increasing the effectiveness of resource allocation while, at the same time, increasing the quality of the service as perceived by citizens and tourists.

Keywords: big data, dashboards, floating population, smart city, urban management solutions

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6390 Assessment of the Standard of Referrals for Extraction of Carious Primary Teeth under General Anaesthetic

Authors: Emma Carr, Jennifer Morrison, Peter Walker

Abstract:

Background: Due to COVID-19, there was a significant reduction in the number of children being treated under general anaesthetic (GA) within the health board, which led to a backlog of referrals. The referrals were being triaged and added to a waiting list in order of priority -determined by the information given. By implementing a checklist, it is anticipated that at least 70% of referrals will have the majority of the information required to effectively prioritise patients. The gold standard, as defined in ‘Guidelines For The Management Of Children Referred For Dental Extractions Under General Anaesthesia’, indicates that all referrals should mention: (i) Inability of the child to cooperate, (ii) Previously tried anxiety management techniques, (iii) Existence of psychological disorders, (iv) Presence of acute dental infection, (v) Requirement for extractions in multiple quadrants. Method: 130 referrals were examined over three months and compared to the recommended standard. A letter was emailed to referring dentists within Ayrshire & Arran outlining the recommended information to be included within the referral. The second round of data collection was then carried out, which involved an examination of 105 referrals. Results: The first round revealed that only 28% of referrals mentioned at least four defined standards outlined above. Following issuing a checklist to all dentists, this increased to 72%. Conclusion: As many of the children referred for extractions under GA have suffered pain and infection because of dental caries, it is important that delay of treatment is minimised, where possible. The implementation of a standardised checklist has enabled more effective prioritisation of patients.

Keywords: caries, dentistry, general anaesthetic, paediatrics

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6389 The Effectiveness of High-Frequency Repetitive Transcranial Magnetic Stimulation in Persistent Somatic Symptoms Disorder: A Case Report Study

Authors: Mohammed Khamis Albalushi

Abstract:

Background: Somatic symptoms disorders are usually comorbid with depressive disorders despite the fact that there is little evidence for effective treatment for it. Repetitive transcranial magnetic stimulation (rTMS) has been approved by the FDA for mildly resistant depression. From this point, we hypothesized that rTMS delivered over the prefrontal cortex (PFC) may be useful in somatic symptoms disorder. Therefore, in our case report, we want to shed light on the potential effectiveness of rTMS in somatic symptoms disorder. Case Report: A 65-year-old Omani female with multiple medical comorbidities on multiple medications. She presented complaining of multiple somatic complaints in the last 2 years after visiting multiple clinics and underwent several specialists’ examinations, investigations and procedures for somatic treatments; all of them were normal. Then patient was seen by a different psychiatric clinic; multiple anti-depressant and adjuvant anti-psychotic medications were tried, patient still did not improve. The patient was admitted to the hospital for observation and management. Initially, she was preoccupied with her somatic complaint and kept on Fluoxetine and Olanzapine along with that, topiramate was added, but still with minimal improvement. Then rTMS was added to her management plan following Intermittent theta burst (iTBS) rTMS protocol. After completing all sessions of rTMS, the patient was recovering from all her symptoms, and no complaints were reported from her. Conclusion: Our case highlights the importance of investigating more thoroughly in rTMS as a treatment option for Persistent Somatic symptoms Disorder.

Keywords: rTMS, somatic symptoms disorder, resistive cases, TMS

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6388 The Relationship between the Use of Social Networks with Executive Functions and Academic Performance in High School Students in Tehran

Authors: Esmail Sadipour

Abstract:

The use of social networks is increasing day by day in all societies. The purpose of this research was to know the relationship between the use of social networks (Instagram, WhatsApp, and Telegram) with executive functions and academic performance in first-year female high school students. This research was applied in terms of purpose, quantitative in terms of data type, and correlational in terms of technique. The population of this research consisted of all female high school students in the first year of district 2 of Tehran. Using Green's formula, the sample size of 150 people was determined and selected by cluster random method. In this way, from all 17 high schools in district 2 of Tehran, 5 high schools were selected by a simple random method and then one class was selected from each high school, and a total of 155 students were selected. To measure the use of social networks, a researcher-made questionnaire was used, the Barclay test (2012) was used for executive functions, and last semester's GPA was used for academic performance. Pearson's correlation coefficient and multivariate regression were used to analyze the data. The results showed that there is a negative relationship between the amount of use of social networks and self-control, self-motivation and time self-management. In other words, the more the use of social networks, the fewer executive functions of students, self-control, self-motivation, and self-management of their time. Also, with the increase in the use of social networks, the academic performance of students has decreased.

Keywords: social networks, executive function, academic performance, working memory

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6387 Information Management Approach in the Prediction of Acute Appendicitis

Authors: Ahmad Shahin, Walid Moudani, Ali Bekraki

Abstract:

This research aims at presenting a predictive data mining model to handle an accurate diagnosis of acute appendicitis with patients for the purpose of maximizing the health service quality, minimizing morbidity/mortality, and reducing cost. However, acute appendicitis is the most common disease which requires timely accurate diagnosis and needs surgical intervention. Although the treatment of acute appendicitis is simple and straightforward, its diagnosis is still difficult because no single sign, symptom, laboratory or image examination accurately confirms the diagnosis of acute appendicitis in all cases. This contributes in increasing morbidity and negative appendectomy. In this study, the authors propose to generate an accurate model in prediction of patients with acute appendicitis which is based, firstly, on the segmentation technique associated to ABC algorithm to segment the patients; secondly, on applying fuzzy logic to process the massive volume of heterogeneous and noisy data (age, sex, fever, white blood cell, neutrophilia, CRP, urine, ultrasound, CT, appendectomy, etc.) in order to express knowledge and analyze the relationships among data in a comprehensive manner; and thirdly, on applying dynamic programming technique to reduce the number of data attributes. The proposed model is evaluated based on a set of benchmark techniques and even on a set of benchmark classification problems of osteoporosis, diabetes and heart obtained from the UCI data and other data sources.

Keywords: healthcare management, acute appendicitis, data mining, classification, decision tree

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6386 The Impact of Supply Chain Strategy and Integration on Supply Chain Performance: Supply Chain Vulnerability as a Moderator

Authors: Yi-Chun Kuo, Jo-Chieh Lin

Abstract:

The objective of a supply chain strategy is to reduce waste and increase efficiency to attain cost benefits, and to guarantee supply chain flexibility when facing the ever-changing market environment in order to meet customer requirements. Strategy implementation aims to fulfill common goals and attain benefits by integrating upstream and downstream enterprises, sharing information, conducting common planning, and taking part in decision making, so as to enhance the overall performance of the supply chain. With the rise of outsourcing and globalization, the increasing dependence on suppliers and customers and the rapid development of information technology, the complexity and uncertainty of the supply chain have intensified, and supply chain vulnerability has surged, resulting in adverse effects on supply chain performance. Thus, this study aims to use supply chain vulnerability as a moderating variable and apply structural equation modeling (SEM) to determine the relationships among supply chain strategy, supply chain integration, and supply chain performance, as well as the moderating effect of supply chain vulnerability on supply chain performance. The data investigation of this study was questionnaires which were collected from the management level of enterprises in Taiwan and China, 149 questionnaires were received. The result of confirmatory factor analysis shows that the path coefficients of supply chain strategy on supply chain integration and supply chain performance are positive (0.497, t= 4.914; 0.748, t= 5.919), having a significantly positive effect. Supply chain integration is also significantly positively correlated to supply chain performance (0.192, t = 2.273). The moderating effects of supply chain vulnerability on supply chain strategy and supply chain integration to supply chain performance are significant (7.407; 4.687). In Taiwan, 97.73% of enterprises are small- and medium-sized enterprises (SMEs) focusing on receiving original equipment manufacturer (OEM) and original design manufacturer (ODM) orders. In order to meet the needs of customers and to respond to market changes, these enterprises especially focus on supply chain flexibility and their integration with the upstream and downstream enterprises. According to the observation of this research, the effect of supply chain vulnerability on supply chain performance is significant, and so enterprises need to attach great importance to the management of supply chain risk and conduct risk analysis on their suppliers in order to formulate response strategies when facing emergency situations. At the same time, risk management is incorporated into the supply chain so as to reduce the effect of supply chain vulnerability on the overall supply chain performance.

Keywords: supply chain integration, supply chain performance, supply chain vulnerability, structural equation modeling

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6385 Helicoverpa armigera Hubner (Lepidoptera: Noctuidae) Susceptibility to Bacillus thuringiensis Crystal Toxins

Authors: Muhammad Jawad Saleem, Faisal Hafeez, Muhammad Arshad, Afifa Naeem, Ayesha Iftekhar

Abstract:

Bacillus thuringiensis is a gram-positive spore-forming bacterium that belongs to the Bacillus cereus group of Bacilli and it produces ICP (insecticidal crystal protein) Cry toxins or Cysts toxins. Spores are produced as parasporal crystalline inclusions bodies (also known as endotoxins) at the onset of sporulation during the stationary growth phase. During vegetative growth that does not form crystals and is called vegetative insecticidal proteins (VIP) and secreted an insecticidal protein (SIP). Bacillus thuringiensis (Bt) is important for pest management either in the form of insecticides or through incorporated in the gene of the crop. Bioassays were conducted on the F2 generation of 1st instar larvae of H. armigera by the diet incorporation method to determine the susceptibility to Bt Cry toxins (Cry1Ac, Cry2Ab, Cry2A). The median lethal concentration (LC₅₀) of Cry1Ac, Cry2Ab, Cry2A ranged from 0.11 to 1.06 µg/ml and moult inhibitory concentration (MIC₅₀) of Cry1Ac, Cry2Ab, Cry2A ranged from 0.05 to 0.25 µg/ml. Cry1Ac was found most toxic to 1st instar larvae of H. armigera as compared to other Bt Cry toxins (Cry1Ac, Cry2Ab, Cry2A). The experimental results are important to policy-makers and technology providers to develop strategies for the exploitation of transgenic Bt cotton varieties as a component of integrated pest management.

Keywords: Bt toxin, Cry1Ac, Cry2Ab, Cry2A, susceptibility, Helicoverpa armigera

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6384 A Framework for University Social Responsibility and Sustainability: The Case of South Valley University, Egypt

Authors: Alaa Tag-Eldin Mohamed

Abstract:

The environmental, cultural, social, and technological changes have led higher education institutes to question their traditional roles. Many declarations and frameworks highlight the importance of fulfilling social responsibility of higher education institutes. The study aims at developing a framework of university social responsibility and sustainability (USR&S) with focus on South Valley University (SVU) as a case study of Egyptian Universities. The study used meetings with 12 vice deans of community services and environmental affairs on social responsibility and environmental issues. The proposed framework integrates social responsibility with strategic management through the establishment and maintenance of the vision, mission, values, goals and management systems; elaboration of policies; provision of actions; evaluation of services and development of social collaboration with stakeholders to meet current and future needs of the community and environment. The framework links between different stakeholders internally and externally using communication and reporting tools. The results show that SVU integrates social responsibility and sustainability in its strategic plans. It has policies and actions however fragmented and lack of appropriate structure and budgeting. The proposed framework could be valuable for researchers and decision makers of the Egyptian Universities. The study proposed recommendations and highlighted building on the results and conducting future research.

Keywords: corporate social responsibility (CSR), south valley university, sustainable university, university social responsibility and sustainability (USR&S)

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6383 Endometrial Thickness Cut-Off for Evacuation of Retained Product of Conception

Authors: Nambiar Ritu, Ali Ban, Munawar Farida, Israell Imelda, T. Farouk Eman Rasheeda, Jangalgi Renuka, S. Boma Nellie

Abstract:

Aim: To define the ultrasonographic endometrial thickness (USG ET) cutoff for evacuation of retained pieces of conception (ERPC). Background: Studies of conservative management of 1st trimester miscarriage have questioned the need for post miscarriage curettage. Therapeutic decision making with transvaginal scan post miscarriage endometrial thickness in patients clinically thought to be incomplete miscarriage is often not clear. Method: Retrospective analysis of all 1ST trimester ERPC at Al Rahba Hospital from June 2012 to July 2013 was done. Total of 164 patients underwent ERPC. All cases were reviewed for pre-operative USG ET and post ERPC histopathological examination. TVS was done to evaluate the maximum ET of the uterine cavity along the long axis of the uterus and features of retained products was noted. All cases without preoperative USG ET measurement were excluded from the study, therefore only 62 out of 164 cases were included in the study. The patients were divided into three groups: o Group A: have retained products within endometrial cavity. o Group B: endometrial thickness equal or more than 20 mm. o Group C: endometrial thickness equal or less than 19.9 mm. o Post ERPC product was sent for HPE and the results were compared. Transvaginal sonographic findings can be used as a deciding factor in the management of patients with 1st trimester miscarriage who need ERPC. Our proposed cutoff in clinically stable patients requiring ERPC is more than 20 mm.

Keywords: ERPC, histopathological examination, long axis of the uterus, USG ET

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6382 Institutional Design for Managing Irrigation Problems: A Case Study of Farmers'- and Agency-Managed Irrigation Systems of Nepal

Authors: Tirtha Raj Dhakal, Brian Davidson, Bob Farquharson

Abstract:

Institutional design is an important aspect in efficient water resource management. In Nepal, the water supply in both farmers’- and agency-managed irrigation systems has become sub-standard because of the weak institutional framework. This study characterizes both forms of the schemes and links existing institution and governance of the schemes with its performance with reference to cost recovery, maintenance of the schemes and water distribution throughout the schemes. For this, two types of surveys were conducted. A management survey of ten farmers’-managed and five agency-managed schemes of Chitwan valley and its periphery was done. Also, a farm survey comprising 25 farmers from each of head, middle and tail regions of both schemes; Narayani Lift Irrigation Project (agency-managed) and Khageri Irrigation System (farmers’-managed) of Chitwan Valley as a case study was conducted. The results showed that cost recovery of agency-managed schemes in 2015 was less than two percent whereas service fee collection rate in farmers’-managed schemes was nearly 2/3rd that triggered poor maintenance of the schemes and unequal distribution of water throughout the schemes. Also, the institution on practice is unable to create any incentives for farmers for economical use of water as well as willingness to pay for its use. This, thus, compels the need of refined institutional framework which has been suggested in this paper aiming to improve the cost recovery and better water distribution throughout the irrigation schemes.

Keywords: cost recovery, governance, institution, schemes' performance

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6381 Exploring the Issue of Occult Hypoperfusion in the Pre-Hospital Setting

Authors: A. Fordham, A. Hudson

Abstract:

Background: Studies have suggested 16-25% of normotensive trauma patients with no clinical signs of shock have abnormal lactate and BD readings evidencing shock; a phenomenon known as occult hypoperfusion (OH). In light of the scarce quantity of evidence currently documenting OH, this study aimed to identify the prevalence of OH in the pre-hospital setting and explore ways to improve its identification and management. Methods: A quantitative retrospective data analysis was carried out on 75 sets of patient records for trauma patients treated by Kent Surrey Sussex Air Ambulance Trust between November 2013 and October 2014. The KSS HEMS notes and subsequent ED notes were collected. Trends between patients’ SBP on the scene, whether or not they received PRBCs on the scene as well as lactate and BD readings in the ED were assessed. Patients’ KSS HEMS notes written by the HEMS crew were also reviewed and recorded. Results: -Suspected OH was identified in 7% of the patients who did not receive PRBCs in the pre-hospital phase. -SBP heavily influences the physicians’ decision of whether or not to transfuse PRBCs in the pre-hospital phase. Preliminary conclusions: OH is an under-studied and underestimated phenomenon. We suggest a prospective trial is carried out to evaluate whether detecting trauma patients’ tissue perfusion status in the pre-hospital phase using portable devices capable of measuring serum BD and/or lactate could aid more accurate detection and management of all haemorrhaging trauma patients, including patients with OH.

Keywords: occult hypoperfusion, PRBC transfusion, point of care testing, pre-hospital emergency medicine, trauma

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6380 Sustainable Geographic Information System-Based Map for Suitable Landfill Sites in Aley and Chouf, Lebanon

Authors: Allaw Kamel, Bazzi Hasan

Abstract:

Municipal solid waste (MSW) generation is among the most significant sources which threaten the global environmental health. Solid Waste Management has been an important environmental problem in developing countries because of the difficulties in finding sustainable solutions for solid wastes. Therefore, more efforts are needed to be implemented to overcome this problem. Lebanon has suffered a severe solid waste management problem in 2015, and a new landfill site was proposed to solve the existing problem. The study aims to identify and locate the most suitable area to construct a landfill taking into consideration the sustainable development to overcome the present situation and protect the future demands. Throughout the article, a landfill site selection methodology was discussed using Geographic Information System (GIS) and Multi Criteria Decision Analysis (MCDA). Several environmental, economic and social factors were taken as criterion for selection of a landfill. Soil, geology, and LUC (Land Use and Land Cover) indices with the Sustainable Development Index were main inputs to create the final map of Environmentally Sensitive Area (ESA) for landfill site. Different factors were determined to define each index. Input data of each factor was managed, visualized and analyzed using GIS. GIS was used as an important tool to identify suitable areas for landfill. Spatial Analysis (SA), Analysis and Management GIS tools were implemented to produce input maps capable of identifying suitable areas related to each index. Weight has been assigned to each factor in the same index, and the main weights were assigned to each index used. The combination of the different indices map generates the final output map of ESA. The output map was reclassified into three suitability classes of low, moderate, and high suitability. Results showed different locations suitable for the construction of a landfill. Results also reflected the importance of GIS and MCDA in helping decision makers finding a solution of solid wastes by a sanitary landfill.

Keywords: sustainable development, landfill, municipal solid waste (MSW), geographic information system (GIS), multi criteria decision analysis (MCDA), environmentally sensitive area (ESA)

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6379 Effects of Dietary Synbiotics on Growth Performance, Antioxidant Capacity, Digestibility and Intestinal Health of Nile Tilapia (Oreochromis Niloticus)

Authors: Addise Kerebih Chekol

Abstract:

Current aquaculture practice is sustainable, environment friendly and produces safe products to end users. However, the disease becomes a limitation to the above-mentioned aquaculture practices. Excessive use of antibiotics and chemotherapeutics is practiced in aquaculture health management. The implication of excessive use of antibiotics leads to increasing antibiotic resistance cases among pathogenic bacteria from aquaculture sites and seeping into the food chain. Last but not least, cost is another key determinant for the applicability of the product. In fact, animal feed is one of the main expenditures in aquaculture, which typically accounts for more than 60% of the total expenditure in a fish farm. The intricate production method and the extensive research needed to validate treatment efficacy require sufficient funding. Therefore, the production of cost-effective yet high-quality feed has been a primary agenda for the industry. Therefore, plant herbal could be promising supplements added to fortify the existing animal feed attributed to their multiple potentials in promoting growth, strengthening immunity, and increasing the resistance of animals towards diseases and stresses. Thus, alternative methods in aquaculture species health management should be applied instantly. So, the aim of this study is to determine the effects of dietary synbiotics on growth performance, immunity, and intestinal health of aquatic animals.

Keywords: synbiotics, probiotics, prebiotics, Nile Tilapia

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6378 Nurse Participation for the Economical Effectiveness in Medical Organizations

Authors: Alua Masalimova, Dameli Sulubecova, Talgat Isaev, Raushan Magzumova

Abstract:

The usual relation to nurses of heads of medical organizations in Kazakhstan is to use them only for per performing medical manipulations, but new economic conditions require the introduction of nursing innovations. There is an increasing need for managers of hospital departments and regions of ambulatory clinics to ensure comfortable conditions for doctors, nurses, aides, as well as monitoring marketing technology (the needs and satisfaction of staff work, the patient satisfaction of the department). It is going to the past the nursing activities as physician assistant performing his prescriptions passively. We are suggesting a model for the developing the head nurse as the manager on the example of Blood Service. We have studied in the scientific-production center of blood transfusion head nurses by the standard method of interviewing for involvement in coordinating the flow of information, promoting the competitiveness of the department. Results: the average age of the respondents 43,1 ± 9,8, female - 100%; manager in the Organization – 9,3 ± 10,3 years. Received positive responses to the knowledge of the nearest offices in providing similar medical service - 14,2%. The cost of similar medical services in other competitive organizations did not know 100%, did a study of employee satisfaction Division labour-85,7% answered negatively, the satisfaction donors work staff studied in 50.0% of cases involved in attracting paid Services Division showed a 28.5% of the respondent. Participation in management decisions medical organization: strategic planning - 14,2%, forming analysis report for the year – 14,2%, recruitment-30.0%, equipment-14.2%. Participation in the social and technical designing workplaces Division staff showed 85,0% of senior nurses. Participate in the cohesion of the staff of the Division method of the team used the 10.0% of respondents. Further, we have studied the behavioral competencies for senior sisters: customer focus – 20,0% of respondents have attended, the ability to work in a team – 40,0%. Personal qualities senior nurses were apparent: sociability – 80,0%, the ability to manage information – 40,0%, to make their own decisions - 14,2%, 28,5% creativity, the desire to improve their professionalism – 50,0%. Thus, the modern market conditions dictate this organization, which works for the rights of economic management; include the competence of the post of the senior nurse knowledge and skills of Marketing Management Department. Skills to analyses the information collected and use of management offers superior medical leadership organization. The medical organization in the recruitment of the senior nurse offices take into account personal qualities: flexibility, fluency of thinking, communication skills and ability to work in a team. As well as leadership qualities, ambition, high emotional and social intelligence, that will bring out the medical unit on competitiveness within the country and abroad.

Keywords: blood service, head nurse, manager, skills

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6377 Assessing the Impact of Human Behaviour on Water Resource Systems Performance: A Conceptual Framework

Authors: N. J. Shanono, J. G. Ndiritu

Abstract:

The poor performance of water resource systems (WRS) has been reportedly linked to not only climate variability and the water demand dynamics but also human behaviour-driven unlawful activities. Some of these unlawful activities that have been adversely affecting water sector include unauthorized water abstractions, water wastage behaviour, refusal of water re‐use measures, excessive operational losses, discharging untreated or improperly treated wastewater, over‐application of chemicals by agricultural users and fraudulent WRS operation. Despite advances in WRS planning, operation, and analysis incorporating such undesirable human activities to quantitatively assess their impact on WRS performance remain elusive. This study was then inspired by the need to develop a methodological framework for WRS performance assessment that integrates the impact of human behaviour with WRS performance assessment analysis. We, therefore, proposed a conceptual framework for assessing the impact of human behaviour on WRS performance using the concept of socio-hydrology. The framework identifies and couples four major sources of WRS-related values (water values, water systems, water managers, and water users) using three missing links between human and water in the management of WRS (interactions, outcomes, and feedbacks). The framework is to serve as a database for choosing relevant social and hydrological variables and to understand the intrinsic relations between the selected variables to study a specific human-water problem in the context of WRS management.

Keywords: conceptual framework, human behaviour; socio-hydrology; water resource systems

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6376 Ontology Expansion via Synthetic Dataset Generation and Transformer-Based Concept Extraction

Authors: Andrey Khalov

Abstract:

The rapid proliferation of unstructured data in IT infrastructure management demands innovative approaches for extracting actionable knowledge. This paper presents a framework for ontology-based knowledge extraction that combines relational graph neural networks (R-GNN) with large language models (LLMs). The proposed method leverages the DOLCE framework as the foundational ontology, extending it with concepts from ITSMO for domain-specific applications in IT service management and outsourcing. A key component of this research is the use of transformer-based models, such as DeBERTa-v3-large, for automatic entity and relationship extraction from unstructured texts. Furthermore, the paper explores how transfer learning techniques can be applied to fine-tune large language models (LLaMA) for using to generate synthetic datasets to improve precision in BERT-based entity recognition and ontology alignment. The resulting IT Ontology (ITO) serves as a comprehensive knowledge base that integrates domain-specific insights from ITIL processes, enabling more efficient decision-making. Experimental results demonstrate significant improvements in knowledge extraction and relationship mapping, offering a cutting-edge solution for enhancing cognitive computing in IT service environments.

Keywords: ontology expansion, synthetic dataset, transformer fine-tuning, concept extraction, DOLCE, BERT, taxonomy, LLM, NER

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6375 Managing Crowds at Sports Mega Events: Examining the Impact of ‘Fan Parks’ at International Football Tournaments between 2002 and 2016

Authors: Joel Rookwood

Abstract:

Sports mega events have become increasingly significant in sporting, political and economic terms, with analysis often focusing on issues including resource expenditure, development, legacy and sustainability. Transnational tournaments can inspire interest from a variety of demographics, and the operational management of such events can involve contributions from a range of personnel. In addition to television audiences events also attract attending spectators, and in football contexts the temporary migration of fans from potentially rival nations and teams can present event organising committees and security personnel with various challenges in relation to crowd management. The behaviour, interaction and control of supporters has previously led to incidents of disorder and hooliganism, with damage to property as well as injuries and deaths proving significant consequences. The Heysel tragedy at the 1985 European Cup final in Brussels is a notable example, where 39 fans died following crowd disorder and mismanagement. Football disasters and disorder, particularly in the context of international competition, have inspired responses from police, law makers, event organisers, clubs and associations, including stadium improvements, legislative developments and crowd management practice to improve the effectiveness of spectator safety. The growth and internationalisation of fandom and developments in event management and tourism have seen various responses to the evolving challenges associated with hosting large numbers of visiting spectators at mega events. In football contexts ‘fan parks’ are a notable example. Since the first widespread introduction in European football competitions at the 2006 World Cup finals in Germany, these facilities have become a staple element of such mega events. This qualitative, longitudinal, multi-continent research draws on extensive semi-structured interview and observation data. As a frame of reference, this work considers football events staged before and after the development of fan parks. Research was undertaken at four World Cup finals (Japan 2002, Germany 2006, South Africa 2010 and Brazil 2014), four European Championships (Portugal 2004, Switzerland/Austria 2008, Poland/Ukraine 2012 and France 2016), four other confederation tournaments (Ghana 2008, Qatar 2011, USA 2011 and Chile 2015), and four European club finals (Istanbul 2005, Athens 2007, Rome 2009 and Basle 2016). This work found that these parks are typically temporarily erected, specifically located zones where supporters congregate together irrespective of allegiances to watch matches on large screens, and partake in other forms of organised on-site entertainment. Such facilities can also allow organisers to control the behaviour, confine the movement and monitor the alcohol consumption of supporters. This represents a notable shift in policy from previous football tournaments, when the widely assumed causal link between alcohol and hooliganism which frequently shaped legislative and police responses to disorder, also dissuaded some authorities from permitting fans to consume alcohol in and around stadia. It also reflects changing attitudes towards modern football fans. The work also found that in certain contexts supporters have increasingly engaged with such provision which impacts fan behaviour, but that this is relative to factors including location, facilities, management and security.

Keywords: event, facility, fan, management, park

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6374 Internationalization and Management of Linguistic Diversity In Multilingual Higher Education Institutions: Lecturers’ Experience From Three Universities in Europe

Authors: Argyro Maria Skourmalla

Abstract:

Internationalization and management of linguistic diversity in Higher Education (HE) have gained much attention in research in the last few years. Internationalization policies in HE aims at promoting the dual role of Higher Education Institutions (HEIs), civilization and competitiveness. In the context of the European Union, the European Education Area initiative aims at “inclusive national education and training systems” through networking and exchange between HEIs. However, the use of English as a ‘lingua academica’ in the place of the official, national, and regional/minority languages raises questions regarding linguistic diversity, linguistic rights and concerns that have to do with the scientific weakening of these languages. In fact, the European Civil Society Platform for Multilingualism, in the Declaration for Multilingualism in Higher Education, draws attention to the use of English at the expense of other regional/national languages and the impact of English-only language policy on an epistemological level. The above issues were brought up during semi-structured interviews with lecturing staff coming from three multilingual Universities in Europe. Lecturers shared their experiences and the practices they use to manage linguistic diversity in these three Universities. Findings show that even though different languages are used in teaching across disciplines, English -or ‘Globish’ as mentioned during an interview- is widely used in research. Despite English being accepted as the “lingua academica,” issues regarding loss of identity come up

Keywords: higher education, internationalization, linguistic diversity, teaching, research, English

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6373 A Critical Examination of the Iranian National Legal Regulation of the Ecosystem of Lake Urmia

Authors: Siavash Ostovar

Abstract:

The Iranian national Law on the Ramsar Convention (officially known as the Convention of International Wetlands and Aquatic Birds' Habitat Wetlands) was approved by the Senate and became a law in 1974 after the ratification of the National Council. There are other national laws with the aim of preservation of environment in the country. However, Lake Urmia which is declared a wetland of international importance by the Ramsar Convention in 1971 and designated a UNESCO Biosphere Reserve in 1976 is now at the brink of total disappearance due mainly to the climate change, water mismanagement, dam construction, and agricultural deficiencies. Lake Urmia is located in the north western corner of Iran. It is the third largest salt water lake in the world and the largest lake in the Middle East. Locally, it is designated as a National Park. It is, indeed, a unique lake both nationally and internationally. This study investigated how effective the national legal regulation of the ecosystem of Lake Urmia is in Iran. To do so, the Iranian national laws as Enforcement of Ramsar Convention in the country including three nationally established laws of (i) Five sets of laws for the programme of economic, social and cultural development of Islamic Republic of Iran, (ii) The Iranian Penal Code, (iii) law of conservation, restoration and management of the country were investigated. Using black letter law methods, it was revealed that (i) regarding the national five sets of laws; the benchmark to force the implementation of the legislations and policies is not set clearly. In other words, there is no clear guarantee to enforce these legislations and policies at the time of deviation and violation; (ii) regarding the Penal Code, there is lack of determining the environmental crimes, determining appropriate penalties for the environmental crimes, implementing those penalties appropriately, monitoring and training programmes precisely; (iii) regarding the law of conservation, restoration and management, implementation of this regulation is adjourned to preparation, announcement and approval of several categories of enactments and guidelines. In fact, this study used a national environmental catastrophe caused by drying up of Lake Urmia as an excuse to direct the attention to the weaknesses of the existing national rules and regulations. Finally, as we all depend on the natural world for our survival, this study recommended further research on every environmental issue including the Lake Urmia.

Keywords: conservation, environmental law, Lake Urmia, national laws, Ramsar Convention, water management, wetlands

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6372 A Mother’s Silent Adversary: A Case of Pregnant Woman with Cervical Cancer

Authors: Paola Millare, Nelinda Catherine Pangilinan

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Background and Aim: Cervical cancer is the most commonly diagnosed gynecological malignancy during pregnancy. Owing to the rarity of the disease, and the complexity of all factors that have to be taken into consideration, standardization of treatment is very difficult. Cervical cancer is the second most common malignancy among women. The treatment of cancer during pregnancy is most challenging in the case of cervical cancer, since the pregnant uterus itself is affected. This report aims to present a case of cervical cancer in a pregnant woman and how to manage this case and several issues accompanied with it. Methods: This is a case of a 28 year-old, Gravida 4 Para 2 (1111), who presented with watery to mucoid, whitish, non-foul smelling and increasing in amount. Internal examination revealed normal external genitalia, parous outlet, cervix was transformed into a fungating mass measuring 5x4 cm, with left parametrial involvement, body of uterus was enlarged to 24 weeks size, no adnexal mass or tenderness. She had cervical punch biopsy, which revealed, adenocarcinoma, well-differentiated cervical tissue. Standard management for cases with stage 2B cervical carcinoma was to start radiation or radical hysterectomy. In the case of patients diagnosed with cervical cancer and currently pregnant, these kind of management will result to fetal loss. The patient still declined the said management and opted to delay the treatment and wait for her baby to reach at least term and proceed to cesarean section as route of delivery. Results: The patient underwent an elective cesarean section at 37th weeks age of gestation, with an outcome of a term, live baby boy APGAR score 7,9 birthweight 2600 grams. One month postpartum, the patient followed up and completed radiotherapy, chemotherapy and brachytherapy. She was advised to go back after 6 months for monitoring. On her last check up, an internal examination was done which revealed normal external genitalia, vagina admits 2 fingers with ease, there is a palpable fungating mass at the cervix measuring 2x2 cm. A repeat gynecologic oncologic ultrasound was done revealing cervical mass, endophytic, grade 1 color score with stromal invasion 35% post radiation reactive lymph nodes with intact paracolpium, pericervical, and parametrial involvement. The patient was then advised to undergo pelvic boost and for close monitoring of the cervical mass. Conclusion: Cervical cancer in pregnancy is rare but is a dilemma for women and their physicians. Treatment should be multidisciplinary and individualized following careful counseling. In this case, the treatment was clearly on the side of preventing the progression of cervical cancer while she is pregnant, however due to ethical reasons, the management deviates on the right of the patient to decide for her own health and her unborn child. The collaborative collection of data relating to treatment and outcome is strongly encouraged.

Keywords: cancer, cervical, ethical, pregnancy

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6371 Cytokine Changes of Auricular Point Acupressure to Manage Aromatase Inhibitor-Induced Arthralgia in Postmenopausal Breast Cancer Survivors

Authors: Chao Hsing Yeh, Wei Chun Lin

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Background: Current management of aromatase inhibitor-induced arthralgia (AIA) in postmenopausal breast cancer survivors (PBCS) has limited effect. Method: In this prospective randomized clinical trial (RCT), a 4-week APA treatment was used to manage AIA. Twenty PBCS participated. After baseline data was collected, participants were waited for a month before they receive APA at a convenient time once a week for 4 weeks. Blood samples from participants in both groups were collected at baseline and after 4 weeks of treatment. The primary outcomes included: pain intensity, pain interference, stiffness, and physical function. Results: After the 4-week APA treatment, the pro-inflammatory cytokines and chemokines display a trend of mean percentage reduction (i.e., -22% in IL-1α, -4% in IL-1β, -1% in IL-2, -3% in IL-6, -19% in IL-12, -9% in Eotaxin, and -2% in MCP-1). The anti-inflammatory cytokine IL-10 and IL-13 (i.e., 5% in IL-10 and 29% in IL-13) increased from pre- to post-APA treatment. Significant positive correlation of percentage mean change was observed between symptom severity and eotaxin (ρ = 0.56; p < 0.01) & MCP-1 (ρ = 0.65; p < 0.01). Interference and chemokines (eotaxin & MIP-1) also shows positive correlation (ρ = 0.48; p < 0.01 & ρ = 0.39; p < 0.05). Another positive correlation was found between worst pain and chemokines (eotaxin, ρ = 0.48; p < 0.01 & MIP-1, ρ = 0.39; p < 0.05). Additionally, interference also shows positive correlation among IL-1α (ρ = 0.36; p < 0.05) and IL-β (ρ = 0.33; p < 0.05). Conclusion: These findings suggest that APA intervention may inhibit inflammation of AIA patients and chemokine could be one of the key factors of AIA symptom improvement.

Keywords: acupressure, cytokine, pain management, breast cancer survivors

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