Search results for: icu management and care

Authors: Thaminda Liyanage, Anuga Liyanage, Chamila Kurukulasuriya, Sidath Bandara

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Background: The burden of chronic kidney disease (CKD) is growing rapidly around the world, particularly in Asia. Over the last two decades Sri Lanka has experienced an epidemic of CKD with ever growing number of patients pursuing medical care due to CKD and its complications, specially in the “Mahaweli” river basin in north central region of the island nation. This was apparently a new form of CKD which was not attributable to conventional risk factors such as diabetes mellitus, hypertension or infection and widely termed as “CKD-unknown” or “CKDu”. In the past decade a number of small scale studies were conducted to determine the aetiology, prevalence and complications of CKDu in North Central region. These hospital-based studies did not provide an accurate estimate of the problem as merely 10% or less of the people with CKD are aware of their diagnosis even in developed countries with better access to medical care. Interestingly, similar observations were made on the changing epidemiology of obesity in the region but no formal study was conducted to date to determine the magnitude of obesity burden. Moreover, if increasing obesity in the region is associated with CKD epidemic is yet to be explored. Methods: We will conduct an area wide cross sectional survey among all adult residents of the “Mahaweli” development project area 5, in the North Central Province of Sri Lanka. We will collect relevant medical history, anthropometric measurements, blood and urine for hematological and biochemical analysis. We expect a participation rate of 75%-85% of all eligible participants. Participation in the study is voluntary, there will be no incentives provided for participation. Every analysis will be conducted in a central laboratory and data will be stored securely. We will calculate the prevalence of obesity and chronic kidney disease, overall and by stage using total number of participants as the denominator and report per 1000 population. The association of obesity and CKD will be assessed with regression models and will be adjusted for potential confounding factors and stratified by potential effect modifiers where appropriate. Results: This study will provide accurate information on the prevalence of obesity and CKD in the region. Furthermore, this will explore the association between obesity and CKD, although causation may not be confirmed. Conclusion: Obesity and CKD are increasingly recognized as major public health problems in Sri Lanka. Clearly, documenting the magnitude of the problem is the essential first step. Our study will provide this vital information enabling the government to plan a coordinated response to tackle both obesity and CKD in the region.

Keywords: BMI, Chronic Kidney Disease, obesity, Sri Lanka

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Authors: A. Youseef

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One of the most aims of IEEE 802.16 (WiMAX) is to present high-speed wireless access to cover wide range coverage. The base station (BS) and the subscriber station (SS) are the main parts of WiMAX. WiMAX uses either Point-to-Multipoint (PMP) or mesh topologies. In the PMP mode, the SSs connect to the BS to gain access to the network. However, in the mesh mode, the SSs connect to each other to gain access to the BS. The main components of QoS management in the 802.16 standard are the admission control, buffer management, and packet scheduling. There are several researches proposed to create an efficient packet scheduling schemes. Therefore, we use QualNet 5.0.2 to study the performance of different scheduling schemes, such as WFQ, SCFQ, RR, and SP when the numbers of SSs increase. We find that when the number of SSs increases, the average jitter and average end-to-end delay is increased and the throughput is reduced.

Keywords: WiMAX, scheduling scheme, QoS, QualNet

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Authors: Maha Rashid Al-Azib, Almuzn Qasem Alqathradi, Amal Munir Alshahrani, Bilqis Mohammed Assiri, Ali Almuflih

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The Occupational Safety and Health Management System in one of the largest Saudi companies has been experiencing in the last 10 years extensive direct and indirect expenses due to lack of proactive leading indicators and safety leadership effective procedures. And since there are no studies that are associated with this department of safety in the company, this research has been conducted. In this study we used a mixed method approach containing a literature review and experts input, then a qualitative questionnaire provided by Institute for Work and Health related to determining the company’s occupational safety and health management system level out from three levels (Compliance - Improvement - Continuous Learning) and the output regarding the company’s level was in Continuous Learning. After that Deming cycle was employed to create a set of proactive leading indicators and analyzed using the SMART method to make sure of its effectiveness and suitability to the company. The objective of this research is to provide a set of proactive indicators to contribute in making an efficient occupational safety and health management system that has less accidents which results in less expenses. Therefore, we provided the company with a prototype of an APP, designed and empowered with our final results to contribute in supporting decisions making processes.

Keywords: proactive leading indicators, OSH MS, safety leadership, accidents reduction

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Authors: Man-Yu Wong, Siyu Zhou, Zhiqiang Cao

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In quality of life, health service utilization is an important determinant of medical resource expenditures on Colorectal cancer (CRC) care, a better understanding of the increased utilization of health services is essential for optimizing the allocation of healthcare resources to services and thus for enhancing the service quality, especially for high expenditure on CRC care like Hong Kong region. In assessing the association between the health-related quality of life (HRQOL) and health service utilization in patients with colorectal neoplasm, count data models can be used, which account for over dispersion or extra zero counts. In our data, the HRQOL evaluation is a self-reported measure obtained from a questionnaire completed by the patients, misreports and variations in the data are inevitable. Besides, there are more zero counts from the observed number of clinical consultations (observed frequency of zero counts = 206) than those from a Poisson distribution with mean equal to 1.33 (expected frequency of zero counts = 156). This suggests that excess of zero counts may exist. Therefore, we study tests for detecting zero-inflation in models with measurement error in covariates. Method: Under classical measurement error model, the approximate likelihood function for zero-inflation Poisson regression model can be obtained, then Approximate Maximum Likelihood Estimation(AMLE) can be derived accordingly, which is consistent and asymptotically normally distributed. By calculating score function and Fisher information based on AMLE, a score test is proposed to detect zero-inflation effect in ZIP model with measurement error. The proposed test follows asymptotically standard normal distribution under H0, and it is consistent with the test proposed for zero-inflation effect when there is no measurement error. Results: Simulation results show that empirical power of our proposed test is the highest among existing tests for zero-inflation in ZIP model with measurement error. In real data analysis, with or without considering measurement error in covariates, existing tests, and our proposed test all imply H0 should be rejected with P-value less than 0.001, i.e., zero-inflation effect is very significant, ZIP model is superior to Poisson model for analyzing this data. However, if measurement error in covariates is not considered, only one covariate is significant; if measurement error in covariates is considered, only another covariate is significant. Moreover, the direction of coefficient estimations for these two covariates is different in ZIP regression model with or without considering measurement error. Conclusion: In our study, compared to Poisson model, ZIP model should be chosen when assessing the association between condition-specific HRQOL and health service utilization in patients with colorectal neoplasm. and models taking measurement error into account will result in statistically more reliable and precise information.

Keywords: count data, measurement error, score test, zero inflation

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Authors: Farhan Nayyar, A. Batool

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The red palm weevil (RPW), being the most invasive insect pest of palm family, is considered as the most dangerous pest around the globe. As three out of four life stages of weevils are concealed inside the host plants, leaving only the adult stage for controlling it. The use of sex pheromone (Ferrugineol) for the management of red palm weevil is considered as the most rewarding technique of IPM. The current studies were conducted to find the relative potential of four different treatments including Sex pheromone, sex pheromone + date fruit + sugarcane pieces, sex pheromone + ethyl acetate and sex pheromone + jaggary water applied on the attraction behavior of weevils. The treatments were applied randomly at two different locations of Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan including Germ Plasm Unit (GPU) and fruit nursery farm having date palm plants of different ages of four varieties of date palm. The treatments were applied for three consecutive months, including February, March, and April 2022. The pheromone traps were installed at the height of two feet under shade on the western side of date palm plants. The results revealed that among the treatments, T4 consisting of Jaggary water and sex pheromone was found as the most effective treatment and attracted the maximum number of 127 weevils followed by T3 consisting of ethyl acetate and sex pheromone, attracting 53 weevils. In contrast to this, T2 consisting of sex pheromone and date fruit was found as the least effective treatment in attracting red palm weevil and attracted only 15 adult weevils. Among the two selected locations, the population of red palm weevil was found comparatively higher at GPU compared to the nursery farm, Dera Ismail Khan. In conclusion, T4 may be used for the effective and safer management of red palm weevil.

Keywords: red palm weevil, integrated management, sex pheromones, Jaggary water

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Authors: Tri Murti, Muhammad Hanafiah Juni, Hejar Abdul Rahman, Salmiah Binti Said

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The diarrhoeal disease continues to be a leading cause of childhood mortality in countries such as Indonesia, where it is estimated to be responsible for 300,000 deaths annually in children under the age of years. Morbidity survey the Ministry of Health of Indonesia from 2000 to 2010 showed incidence diarrhoea remains a leading cause of infant mortality. Causes of death from diarrhoea is related to poor governance both at home and in health facilities. Despite the improvement of health facilities and government effort to reduce the occurrence of diarrhoea among children and death from diarrhoea, the incidence of diarrhoea among children area still high.

Keywords: management diarrheal disease, practices mother, treatment, diarrhoea among children

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Authors: Veronica S. Moertini, Niko Ibrahim, Verliyantina

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As market intermediary firms, e-commerce transaction broker firms need to strongly collaborate with suppliers in order to develop brands seek by customers. Developing suitable electronic Supplier Relationship Management (e-SRM) system is the solution to the need. In this paper, we propose our concept of e-SRM for transaction brokers owned by small medium enterprises (SMEs), which includes the integrated e-SRM and e-CRM architecture, the e-SRM applications with their functions. We then discuss the customization and implementation of the proposed e-SRM model in a specific transaction broker selling hotel rooms, which owned by an SME, KlikHotel.com. The implementation of the e-SRM in KlikHotel.com has been successfully boosting the number of suppliers (hotel members) and hotel room sales.

Keywords: e-CRM, e-SRM, SME, transaction broker

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Authors: Jeaha Yang, Ahmed Khan, Donna L. Rodela, Mohammed A. Qaudeer

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Traditional supply chain silos still exist today due to the difficulty of establishing trust between various partners and technological barriers across industries. Companies lose opportunities and revenue and inadvertently make poor business decisions resulting in further challenges. Blockchain technology can bring a new level of transparency through sharing information with a distributed ledger in a decentralized manner that creates a basis of trust for business. Blockchain is a loosely coupled, hub-style communication network in which trading partners can work indirectly with each other for simpler integration, but they work together through the orchestration of their supply chain operations under a coherent process that is developed jointly. A Blockchain increases efficiencies, lowers costs, and improves interoperability to strengthen and automate the supply chain management process while all partners share the risk. Blockchain ledger is built to track inventory lifecycle for supply chain transparency and keeps a journal of inventory movement for real-time reconciliation. State design patterns are used to capture the life cycle (behavior) of inventory management as a state machine for a common, transparent and coherent process which creates an opportunity for trading partners to become more responsive in terms of changes or improvements in process, reconcile discrepancies, and comply with internal governance and external regulations. It enables end-to-end, inter-company visibility at the unit level for more accurate demand planning with better insight into order fulfillment and replenishment.

Keywords: supply chain management, inventory trace-ability, perpetual inventory system, inventory lifecycle, blockchain, inventory consignment, supply chain transparency, digital thread, demand planning, hyper ledger fabric

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Authors: S. Periyadharshini, K. Ramkumar, S. Jayalalitha, M. GuruPrasath, R. Manikandan

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This paper presents a formulation and solution for industrial load management and product grade problem. The formulation is created using linear programming technique thereby optimizing the electricity cost by scheduling the loads satisfying the process, storage, time zone and production constraints which will create an impact of reducing maximum demand and thereby reducing the electricity cost. Product grade problem is formulated using integer linear programming technique of optimization using lingo software and the results show that overall increase in profit margin. In this paper, time of use tariff is utilized and this technique will provide significant reductions in peak electricity consumption.

Keywords: cement industries, integer programming, optimal formulation, objective function, constraints

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Authors: Sarah Taylor, Nor Zarina Zainal Abidin, Mohd Zabri Adil Talib

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Although cybercrime is on the rise, yet many Law Enforcement Agencies in Malaysia faces difficulty in establishing own digital forensics capability and capacity. The main reasons are undoubtedly because of the high cost and difficulty in convincing their management. A survey has been conducted among Malaysia’s Law Enforcement Agencies owning a digital forensics laboratory to understand their history of building digital forensics capacity and capability, the challenges and the impact of having own laboratory to their case investigation. The result of the study shall be used by other Law Enforcement Agencies in justifying to their management to establish own digital forensics capability and capacity.

Keywords: digital forensics, digital forensics capacity and capability, laboratory, law enforcement agency

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Authors: Odeh Regina Comfort, Angelina Okewu Ogwuche

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The study investigated transformational leadership style of principal and conflict management in secondary schools in North Central Nigeria. A descriptive survey design was adopted. The population of the study comprised 34,473 teachers in 1949 public secondary schools in the study area. Proportionate stratified random sampling and simple random sampling techniques were used to select 39 public secondary schools and 689 respondents, respectively, for the study. The researcher utilized a self-structured questionnaire titled 'Influence of Transformational Leadership Style Questionnaire (ITLSQ)'. Face and content validity were ensured. The reliability index of 0.86 was obtained through Cronbach alpha statistics. The instrument was a modified Likert rating scale of Very High Extent (4), High Extent (3), Low Extent (2) and Very Low Extent (1). Mean, and standard deviation were used to answer 2 research questions, while chi-square goodness of fit was used to test the 2 hypotheses at 0.05 level of significance. The results among others indicate: that intellectual stimulation and individualized components of transformational leadership style of principal in public secondary schools in the study area have significant influence on conflict management in secondary schools. Based on the results, it was recommended that principals of secondary schools should be encouraged to practice the intellectual stimulation component of transformational leadership style that would help to consider teachers' levels of knowledge to decide what suits them to reach high levels of attainment thereby minimizing conflict in school settings; also transformational leadership should be taught to all people at all levels of secondary school especially that which pertains to individualized consideration to have a positive impact on the overall performance of teachers and this would help to minimize conflict in schools.

Keywords: conflict management, individualized consideration, intellectual stimulation, transformational leadership style

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Authors: Hsiang-Chun Lai, Hsien-Yin Liao, Yi-Wen Lin

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Migraine is a primary headache disorder which presented as recurrent and moderate to severe headaches and affects nearly fifteen percent of people’s daily life. In East Asia, acupuncture is a common treatment for migraine prevention. Acupuncture can modulate migraine through both peripheral and central mechanism and decrease the allodynia process. Molecular pathway suggests that acupuncture relief migraine by regulating neurotransmitters/neuromodulators. This process was also proven by neural imaging. Acupuncture decrease the headache frequency and intensity compared to routine care. We also review the most common chosen acupoints to treat migraine and its treatment protocol. As a result, we suggested that acupuncture can serve as an option to migraine treatment and prevention. However, more studies are needed to establish the mechanism and therapeutic roles of acupuncture in treating migraine.

Keywords: acupuncture, allodynia, headache, migraine

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Authors: Dr. Jenit Gandhi, Dr. Manojith SS, Dr. Nakul GV, Dr. Sharath Honnani, Dr. Shaurav Ghosh, Dr. Neel Shetty, Dr. Nagabhushan JS, Dr. Manish Joshi

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Introduction: Acute pancreatitis is an inflammatory condition of the pancreas which begins in pancreatic acinar cells and triggers local inflammation that may progress to systemic inflammatory response (SIRS) and causing distant organ involvement and its function and ending up with multiple organ dysfunction syndromes (MODS). Aim: A comparative study in acute pancreatitis to find out the effectiveness of early addition of Ulinastatin to current standard care in Indian subjects . Methodology: A current prospective observational study is done during study period of 1year (Dec 2018 –Dec 2019) duration to evaluate the effect of early addition of Ulinastatin to the current standard treatment and its efficacy to reduce the early complication, analgesic requirement and duration of hospital stay in patients with Acute Pancreatitis. Results: In the control group 25 were males and 05 were females. In the test group 18 were males and 12 females. Majority was in the age group between 30 - 70 yrs of age with >50% in the 30-50yrs age group in both test and control groups. The VAS was median grade 3 in control group as compared to median grade 2 in test group , the pain was more in the initial 2 days in test group compared to 4 days in test group , the analgesic requirement was used for more in control group (median 6) to test group( median 3 days ). On follow up after 5 days for a period of 2 weeks none of the patients in the test group developed any complication. Where as in the control group 8 patients developed pleural effusion, 04-Pseudopancreatic cyst, 02 – patient developed portal vein and splenic vein thrombosis, 02 patients – ventilator with ARDS which were treated symptomatically whereas in test group 02 patient developed pleural effusions and 01 pseudo pancreatic cyst with splenic artery aneurysm, 01 – patient with AKI and MODS symptomatically treated. The duration of hospital stay for a median period of 4 days (2 – 7 days) in test group and 7 days (4 -10 days) in control group. All patients were able to return to normal work on an average of 5days compared 8days in control group, the difference was significant. Conclusion:The study concluded that early addition of Ulinastatin to current standard treatment of acute Pancreatitis is effective in reducing pain, early complication and duration of hospital stay in Indian subject

Keywords: Ulinastatin, VAS – visual analogue score , AKI – acute kidney injury , ARDS – acute respiratory distress syndrome

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Authors: ȘercăIanu Mihai, Aldea Mihaela, Iacoboaea Cristina, Luca Oana, Nenciu Ioana

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The emergence and neutralization of illegal waste dumps represent a global concern for waste management ecosystems with a particularly pronounced impact on disadvantaged communities. All over the world, and in this particular case in Romania, a relevant number of people resided in houses lacking any legal forms such as land ownership documents or building permits. These areas are referred to as “informal settlements”. An increasing number of regions and cities in Romania are struggling to manage their waste dumps, especially in the context of increasing poverty and lack of regulation related to informal settlements. An example of such informal settlement can be found at the terminus of Bistra Street in Câlnic, which falls under the jurisdiction of the Municipality of Reșița in Caras Severin County. The article presents a case study that focuses on employing remote sensing techniques and spatial data to monitor and map illegal waste practices, with subsequent integration into a geographic information system tailored for the Reșița community. In addition, the paper outlines the steps involved in devising strategies aimed at enhancing waste management practices in disadvantaged areas, aligning with the shift toward a circular economy. Results presented in the paper contain a spatial mapping and visualization methodology calibrated with in situ data collection applicable for identifying illegal landfills. The emergence and neutralization of illegal dumps pose a challenge in the field of waste management. These approaches, which prove effective where conventional solutions have failed, need to be replicated and adopted more wisely.

Keywords: waste dumps, waste management, monitoring, GIS, informal settlements

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Authors: Judith Partouche-Sebban, Saeedeh Rezaee Vessal

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Because of the rising number of new cases of cancer, especially among women, it is more than essential to better understand how women experience cancer in order to bring them adapted to support and care and enhance their well-being and patient experience. Cancer stands for a traumatic experience in which the diagnosis, its medical treatments, and the related side effects lead to deep physical and psychological changes that may arouse considerable stress and anxiety. In order to reduce these negative emotions, women tend to use various defense mechanisms, among which denial has been defined as the most frequent mechanism used by breast cancer patients. This study aims to better understand the consequences of the experience of cancer and their link with the adoption of a denial strategy. The empirical research was done among female cancer survivors in France. Since the topic of this study is relatively unexplored, a qualitative methodology and open-ended interviews were employed. In total, 25 semi-directive interviews were conducted with a female with different cancers, different stages of treatment, and different ages. A systematic inductive method was performed to analyze data. The content analysis enabled to highlight three different denial-related behaviors among women with cancer, which serve a self-protective function. First, women who expressed high levels of anxiety confessed they tended to completely deny the existence of their cancer immediately after the diagnosis of their illness. These women mainly exhibit many fears and a deep distrust toward the medical context and professionals. This coping mechanism is defined by the patient as being unconscious. Second, other women deliberately decided to deny partial information about their cancer, whether this information is related to the stages of the illness, the emotional consequences, or the behavioral consequences of the illness. These women use this strategy as a way to avoid the reality of the illness and its impact on the different aspects of their life as if cancer does not exist. Third, some women tend to reinterpret and give meaning to their cancer as a way to reduce its impact on their life. To this end, they may use magical thinking or positive reframing, or reinterpretation. Because denial may lead to delays in medical treatments, this topic deserves a deep investigation, especially in the context of oncology. As denial is defined as a specific defense mechanism, this study contributes to the existing literature in service marketing which focuses on emotions and emotional regulation in healthcare services which is a crucial issue. Moreover, this study has several managerial implications for healthcare professionals who interact with patients in order to implement better care and support for the patients.

Keywords: cancer, coping mechanisms, denial, healthcare services

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Authors: Sahara Piang Brahim

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This paper looks at the current state of water governance in the Philippines. It is mainly descriptive and relies on an analysis of secondary data gathered during the author’s fieldwork as well as those found in available scholarly literature, legal and government policy documents, reports and publicly available information on the official websites of government agencies and departments. This paper finds that despite the Philippines having relatively abundant water resources due to its topographical characteristics, it is facing a number of water-related problems, including the availability of water supply in light of growing water demand, increasing population and urbanization as well as climate change. Another key finding is that the sheer number of agencies, which have overlapping legal mandates and functions in relation to water governance and management, make coordination, planning and data collection difficult especially since they are neither vertically nor horizontally integrated. These findings have obvious implications for water policy and governance in the country. This study also finds that 'predict and control' characterizes the government’s approach to water resources management and allocation. This paper argues that taking such an approach and the existing institutional context into account is quite relevant not only in terms of making sense of how decision-making and policymaking take place but also when contemplating the kinds of alternative governance arrangements that could address water-related issues and challenges and that might work 'best' in the Philippines.

Keywords: Philippines, water governance, water issues, water policy

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Authors: Brenda Thean I. Lim, Safurah Jaafar

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Augmented reality (AR) in the healthcare industry has been gaining popularity in recent years, principally in areas of medical education, patient care and digital health solutions. One of the drivers in deciding to invest in AR technology is the potential economic benefits it could bring for patients and healthcare providers, including the pharmaceutical and medical technology sectors. Works of literature have shown that the benefits and impact of AR technologies have left trails of achievements in improving medical education and patient health outcomes. However, little has been published on the economic impact of AR in healthcare, a very resource-intensive industry. This systematic review was performed on studies focused on the benefits and impact of AR in healthcare to appraise if they meet the founded quality criteria so as to identify relevant publications for an in-depth analysis of the economic impact assessment. The literature search was conducted using multiple databases such as PubMed, Cochrane, Science Direct and Nature. Inclusion criteria include research papers on AR implementation in healthcare, from education to diagnosis and treatment. Only papers written in English language were selected. Studies on AR prototypes were excluded. Although there were many articles that have addressed the benefits of AR in the healthcare industry in the area of medical education, treatment and diagnosis and dental medicine, there were very few publications that identified the specific economic impact of technology within the healthcare industry. There were 13 publications included in the analysis based on the inclusion criteria. Out of the 13 studies, none comprised a systematically comprehensive cost impact evaluation. An outline of the cost-effectiveness and cost-benefit framework was made based on an AR article from another industry as a reference. This systematic review found that while the advancements of AR technology is growing rapidly and industries are starting to adopt them into respective sectors, the technology and its advancements in healthcare were still in their early stages. There are still plenty of room for further advancements and integration of AR into different sectors within the healthcare industry. Future studies will require more comprehensive economic analyses and costing evaluations to enable economic decisions for or against implementing AR technology in healthcare. This systematic review concluded that the current literature lacked detailed examination and conduct of economic impact and benefit analyses. Recommendations for future research would be to include details of the initial investment and operational costs for the AR infrastructure in healthcare settings while comparing the intervention to its conventional counterparts or alternatives so as to provide a comprehensive comparison on impact, benefit and cost differences.

Keywords: augmented reality, benefit, economic impact, healthcare, patient care

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Authors: Dong-Ho Kim, Su-Sang Lim, Sang-Won Han, Chang-Taek Hyun

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In the construction site, the cost and schedules are the most important management elements. Despite efforts to integrated management the cost and schedule, WBS classification is struggling to differ from each other. The cost and schedule can be integrated and can be managed due to the characteristic of the detail system in the case of Korea around the axis of pressure and official fixture system. In this research, the Work Breakdown Structure (WBS) integrating the cost and schedules around in government office construction, WBS which can be used in common was presented in order to analyze the detail system of the public institution construction and improve. As to this method, the efficient administration of not only the link application of the cost and schedule but also construction project is expected.

Keywords: WBS, EVMS, integrated cost and schedule, Korea case

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Authors: Klazina T. Havinga, Hilde R. H. de Geus

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Introduction: Pre-operative coagulation management of Apixaban prescribed patients, a new oral anticoagulant (a factor Xa inhibitor), is difficult, especially when chronic kidney disease (CKD) causes drug overdose. Apixaban is not dialyzable due to its high level of protein binding. An antidote, Andexanet α, is available but expensive and has an unfavorable short half-life. We report the successful extracorporeal removal of Apixaban prior to emergency surgery with the CytoSorb® Hemoadsorption device. Methods: A 89-year-old woman with CKD, with an Apixaban prescription for atrial fibrillation, was presented at the ER with traumatic rib fractures, a flail chest, and an unstable spinal fracture (T12) for which emergency surgery was indicated. However, due to very high Apixaban levels, this surgery had to be postponed. Based on the Apixaban-specific anti-factor Xa activity (AFXaA) measurements at admission and 10 hours later, complete clearance was expected after 48 hours. In order to enhance the Apixaban removal and reduce the time to operation, and therefore reduce pulmonary complications, CRRT with CytoSorb® cartridge was initiated. Apixaban-specific anti-factor Xa activity (AFXaA) was measured frequently as a substitute for Apixaban drug concentrations, pre- and post adsorber, in order to calculate the adsorber-related clearance. Results: The admission AFXaA concentration, as a substitute for Apixaban drug levels, was 218 ng/ml, which decreased to 157 ng/ml after ten hours. Due to sustained anticoagulation effects, surgery was again postponed. However, the AFXaA levels decreased quickly to sub-therapeutic levels after CRRT (Multifiltrate Pro, Fresenius Medical Care, Blood flow 200 ml/min, Dialysate Flow 4000 ml/h, Prescribed renal dose 51 ml-kg-h) with Cytosorb® connected in series into the circuit was initiated (within 5 hours). The adsorber-related (indirect) Apixaban clearance was calculated every half hour (Cl=Qe * (AFXaA pre- AFXaA post/ AFXaA pre) with Qe=plasma flow rate calculated with Ht=0.38 and system blood flow rate 200 ml-min): 100 ml/min, 72 ml/min and 57 ml/min. Although, as expected, the adsorber-related clearance decreased quickly due to saturation of the beads, still the reduction rate achieved resulted in a very rapid decrease in AFXaA levels. Surgery was ordered and possible within 5 hours after Cytosorb initiation. Conclusion: The CytoSorb® Hemoadsorption device enabled rapid correction of Apixaban associated anticoagulation.

Keywords: Apixaban, CytoSorb, emergency surgery, Hemoadsorption

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Authors: Srivatsav Sanjay Sridhar, Asvitha Raja, Prathit Kalra, Soni Gupta

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Database management is a system that keeps track of details about a person in an organisation. Not a lot of orphanages these days are shifting to a computer and program-based system, but unfortunately, most have only pen and paper-based records, which not only consumes space but it is also not eco-friendly. It comes as a hassle when one has to view a record of a person as they have to search through multiple records, and it will consume time. This program will organise all the data and can pull out any information about anyone whose data is entered. This is also a safe way of storage as physical data gets degraded over time or, worse, destroyed due to natural disasters. In this developing world, it is only smart enough to shift all data to an electronic-based storage system. The program comes with all features, including creating, inserting, searching, and deleting the data, as well as printing them.

Keywords: database, orphans, programming, C⁺⁺

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Authors: Bhavneet Bharti, Prahbhjot Malhi, Vandana Thakur

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Introduction: Children of the urban migrant laborers have great difficulty in accessing government programs which are otherwise routinely available in rural settings. These include programs for child care, nutrition, health and education. There are major communicative fault-lines preventing advocacy for these marginalized children. The overarching aim of this study was to investigate the role of an innovative strategy of children’s drawings in supporting communication between children, social workers, pediatricians and other child advocates to fulfil their fundamental child rights. Materials and Methods: The data was collected over a period of one-year April 2015 to April 2016 during the routine visits by the members of the Social Pediatrics team including a social worker, pediatricians and an artist to the makeshift colony of migrant laborers. Once a week a drawing session was organized where the children including adolescents were asked to any drawing and provide a narrative thereafter. 5-30 children attended these weekly sessions for one year. All these drawings were then classified into various themes and exhibited on 16th April 2016 in the Govt. College of Art Museum. The forum was used for advocacy of Child Rights of these underprivileged children to Secretary social welfare. Results: Mean (SD) age of children in present observational study was 8.5 (2.5) years, with 60% of the boys. Majority of children demonstrated themes which were local and contextualized to their daily needs, threats and festivals which clearly underscored their fundamental right to basic services and equality of opportunities to achieve their full development Drawings of tap with flowing water, queues of people collecting water from hand pumps reflect the local problem of water availability for these children. Young children talking about fear of rape and murder following their drawings indicate the looming threat of potential abuse and neglect. Besides reality driven drawing, children also echoed supernatural beliefs, dangers and festivities in their drawings. Anyone who watched these children at work with art materials was able to see the intense level of absorption, clearly indicating the enjoyment they received, making it a meaningful activity. Indeed, this self-advocacy through art exhibition led to the successful establishment of mobile Anganwadi (A social safety net programme of the government) in their area of stay. Conclusions: This observational study is an example of how children were able to do self-advocacy to protect their rights. Of particular importance, these drawings address how psychologists and other child advocates can ensure in a child-centered manner that the voice of children is heard and represented in all assessments of their well-being and future care options.

Keywords: child advocacy, children drawings, child rights, marginalized children

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Authors: Benhenni Abdellaziz

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Irrigation is a limiting factor for agricultural production and socio-economic development of many countries in arid and semiarid in the world. However, the sustainability of irrigation systems requires a rational management of the water resource that is becoming increasingly rare in these regions. The objective of this work is to apply a geographic information system (GIS) coupled to a model for calculating crop water requirements (CROPWATER) for the management of irrigation water in irrigated area and offer managers with an effective tool to better manage water resources in these areas. The application area of GIS is the irrigated perimeter of Western Middle Cheliff which is located in a semi-arid region (Middle Cheliff). The scope in question is a considerable agrarian dynamics and an increased need for irrigation of most crops.

Keywords: geographical information, irrigation, economical, use rational

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Authors: Nidhi Gadura

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Given the increase in the number of students and administrators asking for online courses the author developed two partially online courses. One was a biology majors at genetics course while the other was a non-majors at biology course. The student body at Queensborough Community College is generally underprepared and has work and family obligations. As an educator, one has to be mindful about changing the pedagogical approach, therefore, special care was taken when designing the course material. Despite the initial concerns, both of these partially online courses were received really well by students. Lessons learnt were that student engagement is the key to success in an online course. Good practices to run a successful online course for underprepared students are discussed in this paper. Also discussed are the lessons learnt for making the eLearning environment better for all the students in the class, overachievers and underachievers alike.

Keywords: partially online course, pedagogy, student engagement, community college

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Authors: Tim Nedyalkov

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A business decision to move to the cloud brings fundamental changes in how an organization develops and delivers its Information Technology solutions. The accelerated pace of digital transformation across businesses and government agencies increases the reliance on cloud-based services. They are collecting, managing, and retaining large amounts of data in cloud environments makes information security and data privacy protection essential. It becomes even more important to understand what key factors drive successful cloud adoption following the commencement of the Privacy Amendment Notifiable Data Breaches (NDB) Act 2017 in Australia as the regulatory changes impact many organizations and industries. This quantitative correlational research investigated the governance, risk management, and compliance factors contributing to cloud security success. The factors influence the adoption of cloud computing within an organizational context after the commencement of the NDB scheme. The results and findings demonstrated that corporate information security policies, data storage location, management understanding of data governance responsibilities, and regular compliance assessments are the factors influencing cloud computing adoption. The research has implications for organizations, future researchers, practitioners, policymakers, and cloud computing providers to meet the rapidly changing regulatory and compliance requirements.

Keywords: cloud compliance, cloud security, data governance, privacy protection

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Authors: Mazyar Taghavi

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This research examines middle-level managers’ involvement in strategy process in 15 manufacturing and service companies in Iran. We considered two dominant theoretical arguments for expecting a positive association. According to the first direction involvement improves organizational performance by improving the quality of strategic decisions. According to the second track, middle managers contribute to increased levels of performance through strategic consensus among them. Results indicate that involvement in the strategy is related to organizational performance. Involvement is associated with consensus (i.e. strategic understanding and commitment) among middle-level managers. However, findings indicate that consensus is not related to the organizational performance.

Keywords: middle-level management, strategy process, organizational performance, strategy consensus

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Authors: Kwasi Dartey-Baah, Mias De Klerk

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Project complexity has been cited as one of the essential areas of project management. It can be observed from environmental, social, technological, and organisational viewpoints, and its handling is critical to project success. Conceptualised in varied industries, this paper seeks to ascertain the meaning and understanding of project complexity within the Ghanaian construction industry based on the three dimensions of complexities (faith, fact, and interaction) using experts' opinions. Taking the form of a focus group discussion, the paper sought to gain an in-depth understanding of project complexity issues in Ghana’s construction industry. The method use obtained data from experts (a purposely selected group) comprising project leaders and project management academics. The findings indicated that the experts broadly agreed with the complexity items but offered varied reasons for their agreement. In the composite assessment of the complexity dimensions of (faith, fact, and interaction), it emerged that there was some agreement with the complexity dimensions of fact and interaction within Ghana’s construction industry. On the other hand, with the dimension for complexity by faith, it was noted that the experts in Ghana’s construction construed complexity by faith, not as the absence of evidence but the evidence that hinges on at least a member of the project team. It is expected that other researches on project complexity will focus on other industries to enhance the knowledge of the same within the field of project management.

Keywords: project complexity, complexity by faith, complexity by fact, complexity by interaction, construction industry, Ghana

Procedia PDF Downloads 152

Authors: Suby Khanam, Faisal Talib, Jamshed Siddiqui

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Total Quality Management (TQM) is a managerial approach that improves the competitiveness of the industry, meanwhile Information technology (IT) was introduced with TQM for handling the technical issues which is supported by quality experts for fulfilling the customers’ requirement. Present paper aims to utilise AHP (Analytic Hierarchy Process) methodology to priorities and rank the hierarchy levels of TQM enablers and IT resource together for its successful implementation in the Information and Communication Technology (ICT) industry. A total of 17 TQM enablers (nine) and IT resources (eight) were identified and partitioned into 3 categories and were prioritised by AHP approach. The finding indicates that the 17 sub-criteria can be grouped into three main categories namely organizing, tools and techniques, and culture and people. Further, out of 17 sub-criteria, three sub-criteria: Top management commitment and support, total employee involvement, and continuous improvement got highest priority whereas three sub-criteria such as structural equation modelling, culture change, and customer satisfaction got lowest priority. The result suggests a hierarchy model for ICT industry to prioritise the enablers and resources as well as to improve the TQM and IT performance in the ICT industry. This paper has some managerial implication which suggests the managers of ICT industry to implement TQM and IT together in their organizations to get maximum benefits and how to utilize available resources. At the end, conclusions, limitation, future scope of the study are presented.

Keywords: analytic hierarchy process, information technology, information and communication technology, prioritization, total quality management

Procedia PDF Downloads 344

Authors: J. H. Boonzaaier, A. C. Brent

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South Africa, a water scarce country, experiences the phenomenon that its life supporting natural water resources is seriously threatened by the users that are totally dependent on it. South Africa is globally applauded to have of the best and most progressive water laws and policies. There are however growing concerns regarding natural water resource quality deterioration and a critical void in the management of natural resources and compliance to policies due to increasing institutional uncertainties and failures. These are in accordance with concerns of many South African researchers and practitioners that call for a change in paradigm from talk to practice and a more constructive, practical approach to governance challenges in the management of water resources. A qualitative theory-building case study through longitudinal action research was conducted from 2014 to 2017. The research assessed whether a strategic positioned institutional agent can be parlayed to facilitate and execute WRM on catchment level by engaging multiple stakeholders in a polycentric setting. Through a critical realist approach a distinction was made between ex ante self-deterministic human behaviour in the realist realm, and ex post governance-management in the constructivist realm. A congruence analysis, including Toulmin’s method of argumentation analysis, was utilised. The study evaluated the unique case of a self-steering local water management institution, the Impala Water Users Association (WUA) in the Pongola River catchment in the northern part of the KwaZulu-Natal Province of South Africa. Exploiting prevailing water resource threats, it expanded its ancillary functions from 20,000 to 300,000 ha. Embarking on WRM activities, it addressed natural water system quality assessments, social awareness, knowledge support, and threats, such as: soil erosion, waste and effluent into water systems, coal mining, and water security dimensions; through structured engagement with 21 different catchment stakeholders. By implementing a proposed polycentric governance-management model on a catchment scale, the WUA achieved to fill the void. It developed a foundation and capacity to protect the resilience of the natural environment that is critical for freshwater resources to ensure long-term water security of the Pongola River basin. Further work is recommended on appropriate statutory delegations, mechanisms of sustainable funding, sufficient penetration of knowledge to local levels to catalyse behaviour change, incentivised support from professionals, back-to-back expansion of WUAs to alleviate scale and cost burdens, and the creation of catchment data monitoring and compilation centres.

Keywords: institutional agent, water governance, polycentric water resource management, water resource management

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Authors: Bryan Jenkins

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Introduction: The expansion of irrigation in the Canterbury region has led to the sustainability limits being reached for water availability and the cumulative effects of land use intensification. The institutional framework under New Zealand’s Resource Management Act was found to be an inadequate basis for managing water at sustainability limits. An alternative paradigm for water management was developed based on collaborative governance and nested adaptive systems. This led to the formulation and implementation of the Canterbury Water Management Strategy. Methods: The nested adaptive system approach was adopted. Sustainability issues were identified at multiple spatial and time scales and defined potential failure pathways for the water resource system. These included biophysical and socio-economic issues such as water availability, cumulative effects on water quality due to land use intensification, projected changes in climate, public health, institutional arrangements, economic outcomes and externalities, and, social effects of changing technology. This led to the derivation of sustainability strategies to address these failure pathways. The collaborative governance approach involved stakeholder participation and community engagement to decide on a regional strategy; regional and zone committees of community and rūnanga (Māori groups) members to develop implementation programmes for the strategy; and, farmer collectives for operational management. Findings: The strategy identified improvements in the efficiency of use of water already allocated was more effective in improving water availability than a reliance on increased storage alone. New forms of storage with less adverse impacts were introduced, such as managed aquifer recharge and off-river storage. Reductions of nutrients from land use intensification by improving management practices has been a priority. Solutions packages for addressing the degradation of vulnerable lakes and rivers have been prepared. Biodiversity enhancement projects have been initiated. Greater involvement of Māori has led to the incorporation of kaitiakitanga (resource stewardship) into implementation programmes. Emerging issues are the need for improved integration of surface water and groundwater interactions, increased use of modelling of water and financial outcomes to guide decision making, and, equity in allocation among existing users as well as between existing and future users. Conclusions: However, sustainability analysis indicates that the proposed levels of management interventions are not sufficient to achieve community targets for water management. There is a need for more proactive recovery and rehabilitation measures. Managing to environmental limits is not sufficient, rather managing adaptive cycles is needed. Better measurement and management of water use efficiency is required. Proposed implementation packages are not sufficient to deliver desired water quality outcomes. Greater attention to targets important to environmental and recreational interests is needed to maintain trust in the collaborative process. Implementation programmes don’t adequately address climate change adaptations and greenhouse gas mitigation. Affordability is a constraint on adaptive capacity of farmers and communities. More funding mechanisms are required to implement proactive measures. The legislative and institutional framework needs to be changed to incorporate water framework legislation, regional sustainability strategies and water infrastructure coordination.

Keywords: collaborative governance, irrigation management, nested adaptive systems, sustainable water management

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Authors: Nancy Wilson

Abstract:

In utero, fetal drug exposure is prevalent amongst birthing facilities. Assessment tools for neonatal abstinence syndrome (NAS) are often cumbersome and ill-fitting, harboring immense subjectivity. This paradox often leads the clinical assessor to be hypervigilant when assessing the newborn for subtle symptoms of NAS, often mistaken for normal newborn behaviors. As a quality improvement initiative, this project led to a more adaptable NAS tool termed eat, sleep, console (ESC). This function-based NAS assessment scores the infant based on the ability to accomplish three basic newborn necessities- to sleep, to eat, and to be consoled. Literature supports that ESC methodology improves patient and family outcomes while providing more cost-effective care.

Keywords: neonatal abstinence syndrome, neonatal opioid withdrawal, maternal substance abuse, pregnancy, and addiction, Finnegan neonatal abstinence syndrome tool, eat, sleep, console

Procedia PDF Downloads 146