Search results for: supply side barriers

Authors: Shirin Jalili, Ramin Ghasemi Shayan

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Coarctation of the aorta (CoA) may be a common (CHD), which is the seventh most common sort of CHD. Still, this is often likely a think little off since the determination may be deferred, indeed within the pediatric populace. The choice for surgical repair incorporates resection of the contracted section with end-to-end or end-to-side anastomosis, subclavian fold aortoplasty, resection, and join the intervention, or prosthetic fix aortoplasty. Drastically expanded end-to-end repair or switched subclavian fold aortoplasty can be utilized when the coarctation expands to the distal arch. Swell angioplasty can be a palliative choice sometime recently the conclusive redress. Its objective is to stabilize high-risk patients that cannot be submitted to quick surgical intercession, such as untimely newborns. For disconnected and discrete coarctations, it can, as a rule, be drawn nearer and repaired by means of cleared out thoracotomy, extraction of the infected aorta (coarctectomy), and remaking, ordinarily by amplified end-to-end anastomosis. In this article, we need to supply a diagram of current proposals and strategies utilized to picture coarctations of the aorta.

Keywords: coarctation of the aorta, congenital heart disease, strategies, surgical repair

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Authors: Zeeshan Hamid, Asher Ramish

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The purpose of this paper is to focus on security and safety issues facing by pharmaceutical industry globally when counterfeit drugs are in question. Hence, there is an intense need to secure and authenticate pharmaceutical products in the emerging counterfeit product market. This paper will elaborate the application of radio frequency identification (RFID) in pharmaceutical industry and to identify its key benefits for patient’s care. The benefits are: help to co-ordinate the stream of supplies, accuracy in chains of supplies, maintaining trustworthy information, to manage the operations in appropriate and timely manners and finally deliver the genuine drug to patient. It is discussed that how RFID supported supply chain information sharing (SCIS) helps to combat against counterfeit drugs. And a solution how to tag pharmaceutical products; since, some products prevent RFID implementation in this industry. In this paper, a proposed model for pharma industry distribution suggested to combat against the counterfeit drugs when they are in supply chain.

Keywords: supply chain, RFID, pharmaceutical industry, counterfeit drugs, patients care

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Authors: Qurat Ul Ain Bashir

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Since the inception of Pakistan Tourism industry was not on developed level but afterwards 9/11 the tourism has declined rapidly in the country. Despite Northern areas full potential, rich historical and cultural heritage, natural beauty, museums, art galleries, hiking tracks, tourism is not getting that response in Pakistan, which it deserves. In fact Pakistan has been blessed with all the features that could make her a tourist destination. On the other side the attitude of the local people, socio-political condition, lack of facilities of international standards, media’s way of reporting about country, governments’ negligence etc has more adversely affected the international tourism than domestic tourism. From 2013 onward some developments in the said industry has been shown but that is not much encouraging. In 2017 approximately two million tourist visited Pakistan in comparison to 1.75 million in 2016. In the light of above debate the paper attempts to diagnose the causes which are not allowing the reasonable growth of tourism in Pakistan and suggests steps which must be taken to develop the industry through a large scale campaign and long term planning. The methodology about this research is quantitative with reference to description, analysis and recommendations. The material would be collected from the government publications, articles, surveys, tourist accounts, books, internet, magazines.

Keywords: tourism, terrorism, barriers, infrastructure, culture, northern areas

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Authors: Ashan Wijekoon, Abi Beane, Subashini Jayawardana

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Background: Soldiers' physical rehabilitation and long term health status has been hindered due to limited investment in and access to rehabilitation services. Home-based rehabilitation programmes could offer a potentially feasible alternative to facilitate long-term recovery. Objectives: To explore Sri Lankan soldiers' perceptions of barriers and facilitators to a home-based physical rehabilitation programme.Methods and Materials: We conducted qualitative semi-structured interviews with community re-integrated army veterans who had undergone unilateral lower limb amputation following war related trauma. Veterans were identified from five districts of Sri Lanka, based on a priori knowledge of veteran community settlements (Disabled Category Registry) obtained from Directorate of Rehabilitation, MoD, Sri Lanka. Individuals were stratified for purposive selection. The interview guide was developed from existing methods and adapted for context. Verbatim transcripts of interviews were analyzed for emerging themes using an inductive approach. Following consent, participants met the researcher (AW- a trained physiotherapist fluent in Sinhalese). Results: Twenty-five Interviews were conducted, totaling 7.2 hours of new data (Mean±SD: 0.28±0.11). All participants were male, aged 30-55 years (Mean±SD: 46.1±7.4), and had experienced traumatic amputation as a result of conflict. Twenty-four sub themes were identified. Inadequate space for exercises, absence of equipment and assistance to conduct the exercises at home, alongside absence of community healthcare services were all barriers. Burden of comorbidities, including chronic pain and disability level, were also barriers. Social support systems, including soldier societies, family, and kinship with other amputees, were seen as facilitators to an at-home programme. Motivation for independence was a strong indicator of engagement. Conclusion: Environment, chronic pain, and absence of well-established community health services were key barriers. Family and soldier support was a facilitator. Engagement with community healthcare providers (physiotherapist and primary care physicians) will be essential to the success of an at-home rehabilitation program.

Keywords: physical rehabilitation, home-based, soldiers, disability, lower-limb amputation, qualitative

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Authors: Ying Shi, June Zhang, Lu Shao, Xiyan Xie, Aidi Lao, Zhangan Wang

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Background: Low levels of physical activity are associated with poorer health outcomes, and this situation is more critical in older adults living in long‐term care facilities. Objectives: To systematically identify, appraise, and synthesize current qualitative research evidence regarding the barriers and facilitators to physical activity as reported by older adults and care staff in long‐term care facilities. Design: This is a systematic review with qualitative evidence synthesis adhering to PRISMA guidelines. Methods: We conducted a systematic search on PubMed, Science Citation Index Expanded, Social Sciences Citation Index, EMBASE, CINAHL, and PsychInfo databases from inception until 30 June 2023. Thematic synthesis was undertaken to identify the barriers and facilitators relating to physical activity. Then, we mapped them onto the Capability, Opportunity, Motivation, and Behavior model and Theoretical Domains Framework. Methodological quality was assessed using the CASP Qualitative Studies Checklist, and confidence in review findings was assessed using the GRADE-CERQual approach. Results: We included 32 studies after screening 10496 citations and 177 full texts. Seven themes and 17 subthemes were identified relating to barriers and facilitators influencing physical activity in elderly residents. The main themes were mapped onto COM-B) model-Capability (physical activity knowledge gaps and individual health issues), Opportunity (social support and macro-level resources) and Motivation (health beliefs, fear of falling or injury, and personal and social incentives to physical activity). Most subthemes were graded as high (n = 9) or moderate (n = 3) confidence. Conclusions and Implications: Our comprehensive synthesis of 32 studies provides a wealth of knowledge of barriers and facilitators to physical activity from both residents and care staff’s perspectives. Intervention components were also suggested within the context of long‐term care facilities. End users such as older residents, care staff, and researchers can have confidence in our findings when formulating policies and guidance on promoting physical activity among elderly residents in long‐term care facilities.

Keywords: long‐term care, older adults, physical activity, qualitative, systematic review

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Authors: Eman M. Elmazek

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Green roofs and walls are a rising technology in the global sustainable architectural industry. The idea takes great steps towards the future of sustainable design due to its many benefits. However, there are many barriers and constraints. Economical, structural, and knowledge barriers prevent the spread of the usage of green roofs and living walls. Understanding the benefits and expanding them will spread the idea. Benefits provided by these green spots interrupt and maintain the current urban cover. Food production is one of the benefits of green roofs. It can save money and energy spent in food transportation. The goal of this paper is to put a better understanding of implementing green systems. The paper aims to identify gains versus challenges facing the technology. It surveys with case studies buildings with green roofs and walls used for food production.

Keywords: green roof, green walls, urban farming, roof herb garden

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Authors: Fumiko Kojima, Shuji Fujimoto

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Anisakiasis is a disease caused by infection with an anisakid larvae, mostly Anisakis simplex. The larvae commonly infect in marine fish and the disease is frequently reported in areas of the world where fish is consumed raw, lightly pickled or salted. In Japan, people have the habit of eating raw fish such as ‘sushi’ or ‘sashimi’, so they have more chance of infection with larvae of anisakid nematodes. There are three sibling species in A. simplex larvae, namely, A. simplex sensu stricto (Asss), A. pegreffii (Ap) and A. simplex C. It was revealed that Ap is dominant among the larvae from fish (Scomber japonics) in the Japan Sea side and Asss is dominant among those of the Pacific Ocean side conversely. Although anisakiasis has happened in Japan among both the Japan Sea side area and the Pacific Ocean side area. The aim of this study was to investigate genetic variations between the siblings (Asss and Ap) and within the same sibling species by random amplified polymorphic DNA (RAPD) technique. In order to investigate the genetic difference among the each A. simplex larvae, we used RAPD technique to differentiate individuals of A. simplex obtained from Scomber japonics fish those were caught in the Japan sea (Goto Islands in Nagasaki Prefecture) and the cost of Pacific Ocean (Kanagawa Prefecture). The RAPD patterns of the control DNA (Genus Raphidascaris) were markedly different from those of the A. simplex. There were differences in amplification patterns between Asss and Ap. The RAPD patterns for larvae obtained from fish of the same sea were somewhat different and variations were detected even among larvae from the same fish. These results suggest the considerable high genetic variability between Asss and Ap and the possible existence of genetic variation within the sibling species.

Keywords: Anisakiasis in Japan, Anisakis simplex, genomic identification, PCR-RAPD

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Authors: Seigo Matsuno, Yasuo Uchida, Shozo Tokinaga

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This paper proposes and empirically tests a model of the relationships between green supply chain management (GSCM) activities and corporate performance. From the literature review, we identified five constructs, namely, environmental commitment, supplier collaboration, supplier assessment, information sharing among suppliers, and business process improvement. These explanatory variables are used to form a structural model explaining the environmental and economic performance. The model was analyzed using the data from a survey of a sample of manufacturing firms in Japan. The results suggest that the degree of supplier collaboration has an influence on the environmental performance directly. While, the impact of supplier assessment on the environmental performance is mediated by the information sharing and/or business process improvement. And the environmental performance has a positive relationship on the economic performance. Academic and managerial implications of our findings are discussed.

Keywords: corporate performance, empirical study, green supply chain management, path modeling

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Authors: Naci Büyükkaracığan, Murat Ahmet Ökmen

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In parallel with the population growth rate, the need of human being for energy sources in the world is gradually increasing incessant. The addition of this situation that demand for energy will be busier in the future, industrialization, the rise in living standards and technological developments, especially in developing countries. Alternative energy sources have aroused interest due to reasons such as serious environmental issues that were caused by fossil energy sources, potentially decreasing reserves, different social, political and economic problems caused by dependency on source providing countries and price instability. Especially in developed countries as European countries and also U.S.A particularly, alternative energy sources such as wind, geothermal, solar and biomass energy, hydrolic and hydrogen have been utilized in different forms, especially in electricity production. It includes a review of technical and environmental factors for energy sources that are potential replacements for fossil fuels and examines their fitness to supply the energy for a high standard of living on a worldwide basis. Despite all developments, fossil energy sources have been overwhelmingly used all around the world in primary energy sources consumption and they will outnumber other energy sources in the short term. Today, parallel to population growth and economy in Turkey, energy sources consumption is increasingly continuing. On one side, Turkey, currently 80% dependent on energy providing countries, has been heavily conducting fossil energy sources raw material quest within its own borders in order to lower the percentage, and the other side, there have been many researches for exploring potential of alternative energy sources and utilization. This case will lead to both a decrease in foreign energy dependency and a variety of energy sources. This study showed the current energy potential of Turkey and presents historical development of these energy sources and their share in electricity production. The research also seeked for answers to arguments that if the potential can be sufficient in the future. As a result of this study, it was concluded that observed geothermal energy, particularly active tectonic regions of Turkey, to have an alternative energy potential could be considered to be valuable on bass wind and solar energy.

Keywords: alternative energy sources, energy productions, hydroenergy, solar energy, wind energy

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Authors: Ehsan Yadegari

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While there are several metaheuristics and exact approaches to solving the Supply Chain Network Design (SCND) problem, there still remains an unfilled gap in using the Teaching-Learning-Based Optimization (TLBO) algorithm. The algorithm has demonstrated desirable results with problems with complicated combinational optimization. The present study introduces a Discrete Self-Study TLBO (DSS-TLBO) with priority-based solution representation that can solve a supply chain network configuration model to lower the total expenses of establishing facilities and the flow of materials. The network features four layers, namely suppliers, plants, distribution centers (DCs), and customer zones. It is designed to meet the customer’s demand through transporting the material between layers of network and providing facilities in the best economic Potential locations. To have a higher quality of the solution and increase the speed of TLBO, a distinct operator was introduced that ensures self-adaptation (self-study) in the algorithm based on the four types of local search. In addition, while TLBO is used in continuous solution representation and priority-based solution representation is discrete, a few modifications were added to the algorithm to remove the solutions that are infeasible. As shown by the results of experiments, the superiority of DSS-TLBO compared to pure TLBO, genetic algorithm (GA) and firefly Algorithm (FA) was established.

Keywords: supply chain network design, teaching–learning-based optimization, improved metaheuristics, discrete solution representation

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Authors: Raja Kannusamy

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The research focuses on reducing food waste in the restaurant industry. A study has been conducted on the chain of retail restaurant outlets. It has been observed that the food wastages are due to the inefficient inventory management systems practiced in the restaurant outlets. The major food items which are wasted more in quantity are being selected across the retail chain outlets. A moving average forecasting method has been applied for the selected food items so that their future demand could be predicted accurately and food wastage could be avoided. It has been found that the moving average prediction method helps in predicting forecasts accurately. The demand values obtained from the moving average method have been compared to the actual demand values and are found to be similar with minimum variations. The inventory optimization technique helps in reducing food wastage in restaurant supply chain outlets.

Keywords: food wastage, restaurant supply chain, inventory optimisation, demand forecasting

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Authors: Clemens Pizzinini, Philipp Rosner, David Ziegler, Markus Lienkamp

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Transportation is a constitutional part of most supply and value chains in modern economies. Smallholder farmers in rural Ethiopia face severe challenges along their supply and value chains. In particular, suitable, affordable, and available transport services are in high demand. To develop a context-specific technical solutions, a problem-to-solution methodology based on the interaction with technology is developed. With this approach, we fill the gap between proven transportation assessment frameworks and general user-centered techniques. Central to our approach is an electric test vehicle that is implemented in rural supply and value chains for research, development, and testing. Based on our objective and the derived methodological requirements, a set of existing methods is selected. Local partners are integrated into an organizational framework that executes major parts of this research endeavour in the Arsi Zone, Oromia Region, Ethiopia.

Keywords: agricultural value chain, participatory methods, agile methods, sub-Saharan Africa, Ethiopia, electric vehicle, transport service

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Authors: Assefa Mitike Janko, Gosa Alemu

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The review of supply and marketing of floriculture in Ethiopia was conducted to analyses the production potential and to know the marketing share of the country. The data was collected from secondary and primary. Ethiopia has been operating in the floriculture industry for over 20 years. As is the case in many developing countries, the major export items of Ethiopia are dominated by few agricultural products that earn very small amounts in the international market. Moreover, most of the exports are destined to only few countries. Given the highly capital intensive nature of production and processing, rose farming is not a smallholder activity. It is also important to note the extremely tightly controlled time dimension of the logistics process, given the product attributes desired and the fragility and perishability of the roses. Another characteristic of the Ethiopian floriculture sector is the lack of domestically produced inputs that flower producers can access. The export volume and value of cut-flowers accounts for a small proportion of the total exports of Ethiopia. In recent years the sector is showing improvements in terms of the quality and quantity of exports to the international market.

Keywords: roses, production, value chain, floriculture, supply

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Authors: Danijela Tuljak-Suban, Valter Suban

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Food as perishable goods represents a specific and sensitive part in the supply chain theory, since changing of its physical or chemical characteristics considerably influences the approach to stock management. The most delicate phase of this process is transportation, where it becomes difficult to ensure stability conditions that limit the deterioration, since the value of the deterioration rate could be easily influenced by the transportation mode. Fuzzy definition of variables allows taking into account these variations. Furthermore an appropriate choice of the defuzzification method permits to adapt results, as much as possible, to real conditions. In the article will be applied the those methods to the relationship between the deterioration rate of perishable goods and transportation by ship, with the aim: (a) to minimize the total costs function, defined as the sum of the ordering cost, holding cost, disposing cost and transportation costs, and (b) to improve supply chain sustainability by reducing the environmental impact and waste disposal costs.

Keywords: perishable goods, fuzzy reasoning, transport by ship, supply chain sustainability

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Authors: Teresa Wills, Geraldine Mccarthy, Nicola Cornally

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Background: Obesity is an emerging healthcare epidemic affecting virtually all age and socio-economic groups and is one of the most serious and prevalent diseases of the 21st century. It is a public health challenge because of its prevalence, associated costs and health effects. The increasing prevalence of obesity has created a social perception that overweight body sizes are healthy and normal. This normalization of obesity within our society and the acceptance of higher body weights have led to individuals being unaware of the reality of their weight status and gravity of this situation thus impeding recognition of obesity. Given the escalating global health problem of obesity and its co-morbidities, the need to re-appraise its management is more compelling than ever. It is widely accepted that the causes of obesity are complex and multi-factorial. Engagement of individuals in weight management programmes is difficult if they do not perceive they have a problem with their weight. Recognition of the problem is a key component of obesity management and identifying the main predictors of behaviour is key to designing health behaviour interventions. Aim: The aim of the research was to determine factors relating to motivation to change behaviours in individuals who perceive themselves to be overweight. Method: The research design was quantitative, correlational and cross-sectional. The design was guided by the Health Belief Model. Data were collected online using a multi-section and multi-item questionnaire, developed from a review of the theoretical and empirical research. A sample of 202 men and women who perceived themselves to be overweight participated in the research. Descriptive and inferential statistical analyses were employed to describe relationships between variables. Findings: Following multivariate regression analysis, perceived barriers to weight loss and perceived benefits of weight loss were significant predictors of motivation to change behaviour. The perceived barriers to weight loss which were significant were psychological barriers to weight loss (p = < 0.019) and environmental barriers to physical activity (p= < 0.032).The greatest predictor of motivation to change behaviour was the perceived benefits of weight loss (p < 0.001). Perceived susceptibility to obesity and perceived severity of obesity did not emerge as significant predictors in this model. Total variance explained by the model was 33.5%. Conclusion: Perceived barriers to weight loss and perceived benefits of weight loss are important determinants of motivation to change behaviour. These findings have important implications for health professionals to help inform their practice and for the development of intervention programmes to prevent and control obesity.

Keywords: motivation to change behaviours, obesity, predictors of behavior, interventions, overweight

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Authors: Nunziata Ivana Guarneri, Arcangelo Bruna, Giuseppe Spampinato, Antonio Buemi

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In the last decade, automotive companies have invested a lot in terms of innovation about many aspects regarding the automatic driver assistance systems. One innovation regards the usage of a smart camera placed on the car’s side mirror for monitoring the back and lateral road situation. A common road scenario is the overtaking of the preceding car and, in this case, a brief distraction or a loss of concentration can lead the driver to undertake this action, even if there is an already overtaking vehicle, leading to serious accidents. A valid support for a secure drive can be a smart camera system, which is able to automatically analyze the road scenario and consequentially to warn the driver when another vehicle is overtaking. This paper describes a method for monitoring the side view of a vehicle by using camera optical flow motion vectors. The proposed solution detects the presence of incoming vehicles, assesses their distance from the host car, and warns the driver through different levels of alert according to the estimated distance. Due to the low complexity and computational cost, the proposed system ensures real time performances.

Keywords: camera calibration, ego-motion, Kalman filters, object tracking, real time systems

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Authors: Anabel Moriña

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In recent years, advances have been made in disability policy at Spanish universities, especially in terms of creating more inclusive learning environments. Nevertheless, while efforts to foster inclusion at the tertiary level -and the growing number of students with disabilities at university- are clear signs of progress, serious barriers to full participation in learning still exist. The research shows that university responses to diversity tend to be reactive, not proactive; as a result, higher education (HE) environments can be especially disabling. It has been demonstrated that the performance of students with disabilities is closely linked to the good will of university faculty and staff. Lectures are key players when it comes to helping or hindering students throughout the teaching/learning process. This paper presents an analysis of how lecturers respond to students with disabilities, the initial question being: do lecturers aid or hinder students? The general aim is to analyse-by listen to the students themselves-lecturers barriers and support identified as affecting academic performance and overall perception of the higher education (HE) experience. Biographical-narrative methodology was employed. This research analysed the results differentiating by fields of knowledge. The research was conducted in two phases: discussion groups along with individual oral/written interviews were set up with 44 students with disabilities and mini life histories were completed for 16 students who participated in the first stage. The study group consisted of students with disabilities enrolled during three academic years. The results of this paper noted that participating students identified many more barriers than bridges when speaking about the role lecturers play in their learning experience. Findings are grouped into several categories: Faculty attitudes when “dealing with” students with disabilities, teaching methodologies, curricular adaptations, and faculty training in working with students. Faculty does not always display appropriate attitudes towards students with disabilities. Study participants speak of them turning their backs on their problems-or behaving in an awkward manner. In many cases, it seems lecturers feel that curricular adaptations of any kind are a form of favouritism. Positive attitudes, however, often depend almost entirely on the good will of faculty and-although well received by students-are hard to come by. As the participants themselves suggest, this study confirms that good teaching practices not only benefit students with disabilities but the student body as a whole. In this sense, inclusive curricula provide new opportunities for all students. A general coincidence has been the lack of training on behalf of lecturers to adequately attend disabled students, and the need to cover this shortage. This can become a primary barrier and is more often due to deficient faculty training than to inappropriate attitudes on the part of lecturers. In conclusion, based on this research we can conclude that more barriers than bridges exist. That said, students do report receiving a good deal of support from their lecturers-although almost exclusively in a spirit of good will; when lecturers do help, however, it tends to have a very positive impact on students' academic performance.

Keywords: barriers, disability, higher education, lecturers

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Authors: Geng Cui, Naoto Imura, Katsuhiro Nishinari, Takahiro Ezaki

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The bullwhip effect, which refers to the amplification of demand variance as one moves up the supply chain, has been observed in various industries and extensively studied through analytic approaches. Existing methods to mitigate the bullwhip effect, such as decentralized demand information, vendor-managed inventory, and the Collaborative Planning, Forecasting, and Replenishment System, rely on the willingness and ability of supply chain participants to share their information. However, in practice, information sharing is often difficult to realize due to privacy concerns. The purpose of this study is to explore new ways to mitigate the bullwhip effect without the need for information sharing. This paper proposes a 'bullwhip absorption strategy' (BAS) to alleviate the bullwhip effect by absorbing it downstream in the supply chain. To achieve this, a two-stage supply chain system was employed, consisting of a single retailer and a single manufacturer. In each time period, the retailer receives an order generated according to an autoregressive process. Upon receiving the order, the retailer depletes the ordered amount, forecasts future demand based on past records, and places an order with the manufacturer using the order-up-to replenishment policy. The manufacturer follows a similar process. In essence, the mechanism of the model is similar to that of the beer game. The BAS is implemented at the retailer's level to counteract the bullwhip effect. This strategy requires the retailer to reduce the uncertainty in its orders, thereby absorbing the bullwhip effect downstream in the supply chain. The advantage of the BAS is that upstream participants can benefit from a reduced bullwhip effect. Although the retailer may incur additional costs, if the gain in the upstream segment can compensate for the retailer's loss, the entire supply chain will be better off. Two indicators, order variance and inventory variance, were used to quantify the bullwhip effect in relation to the strength of absorption. It was found that implementing the BAS at the retailer's level results in a reduction in both the retailer's and the manufacturer's order variances. However, when examining the impact on inventory variances, a trade-off relationship was observed. The manufacturer's inventory variance monotonically decreases with an increase in absorption strength, while the retailer's inventory variance does not always decrease as the absorption strength grows. This is especially true when the autoregression coefficient has a high value, causing the retailer's inventory variance to become a monotonically increasing function of the absorption strength. Finally, numerical simulations were conducted for verification, and the results were consistent with our theoretical analysis.

Keywords: bullwhip effect, supply chain management, inventory management, demand forecasting, order-to-up policy

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Authors: Sharon Jackson White

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Purpose: Nurse practitioners (NPs) practicing within hospital medicine play a significant role in caring for patients who might benefit from palliative care (PC) services. Using the Theory of Planned Behavior, the purpose of this study was to examine the relationships among facilitators to referral, barriers to referral, self-efficacy with end-of-life discussions, history of referral, and referring to PC among NPs in hospital medicine. Hypotheses: 1) Perceived facilitators to referral will be associated with a higher history of referral and a higher number of referrals to PC. 2) Perceived barriers to referral will be associated with a lower history of referral and a lower number of referrals to PC. 3) Increased self-efficacy with end-of-life discussions will be associated with a higher history of referral and a higher number of referrals to PC. 4) Perceived facilitators to referral, perceived barriers to referral, and self–efficacy with end-of-life discussions will contribute to a significant variance in the history of referral to PC. 5) Perceived facilitators to referral, perceived barriers to referral, and self–efficacy with end-of-life discussions will contribute to a significant variance in the number of referrals to PC. Significance: Previous studies of referring patients to PC within the hospital setting care have focused on physician practices. Identifying factors that influence NPs referring hospitalized patients to PC is essential to ensure that patients have access to these important services. This study incorporates the SNRS mission of advancing nursing research through the dissemination of research findings and the promotion of nursing science. Methods: A cross-sectional, predictive correlational study was conducted. History of referral to PC, facilitators to referring to PC, barriers to referring to PC, self-efficacy in end-of-life discussions, and referral to PC were measured using the PC referral case study survey, facilitators and barriers to PC referral survey, and self-assessment with end-of-life discussions survey. Data were analyzed descriptively and with Pearson’s Correlation, Spearman’s Rho, point-biserial correlation, multiple regression, logistic regression, Chi-Square test, and the Mann-Whitney U test. Results: Only one facilitator (PC team being helpful with establishing goals of care) was significantly associated with referral to PC. Three variables were statistically significant in relation to the history of referring to PC: “Inclined to refer: PC can help decrease the length of stay in hospital”, “Most inclined to refer: Patients with serious illnesses and/or poor prognoses”, and “Giving bad news to a patient or family member”. No predictor variables contributed a significant variance in the number of referrals to PC for all three case studies. There were no statistically significant results showing a relationship between the history of referral and referral to PC. All five hypotheses were partially supported. Discussion: Findings from this study emphasize the need for further research on NPs who work in hospital settings and what factors influence their behaviors of referring to PC. Since there is an increase in NPs practicing within hospital settings, future studies should use a larger sample size and incorporate hospital medicine NPs and other types of NPs that work in hospitals.

Keywords: palliative care, nurse practitioners, hospital medicine, referral

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Authors: Nwauzoma Ohale Rowland, Bright Ugochukwu Umunna

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The world has been referred to as a global village for decades, adapting various technological and digital innovations to progress along the lines of development. Different continents have fully automated processes and procedures in the various sectors of their economies. This paper attempts to ascertain why the West African sub-continent while displaying a slow progression, has also joined the race toward having a fully automated process, albeit only in certain areas of its economy. Different reasons for this have been posited and will be discussed in this work. These reasons include high illiteracy rates and poor acceptance of new technologies. Studies were carried out that involved interactions with different business sectors and also a secondary-level investigation of experiments to ascertain the impact of automation in supply chain management on the West African market. Our reports show remarkable growth in businesses and sectors that have automated their processes. While this is the case, other results have also confirmed as due to the high illiteracy rates; the labour force has also been affected.

Keywords: Africa, automation, business, innovation, supply chain management, technology

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Authors: Reza Behtash, Enayat Enayati

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The pool condenser is in principal a horizontal reactor, containing a bundle of U-tubes for heat exchange, coupling to low pressure steam drum. Condensation of gas takes place in a condensed pool around the tubes of the condenser. The heat of condensation is removed by the generation of low pressure steam on the inner tube side of the bundle. A circulation pump transfers ample boiler feed water to these tubes. The pressure of the steam generated influenced the heat flux. Changing the steam pressure means changing the steam condensate temperature and therefore the temperature difference between the tube side and the shell side. 2NH3 + CO2 ↔ NH2COONH4 + Heat. This reaction is exothermic and according to Le Chatelier's Principle if the heat is not removed enough, it will come back to left side and generate of the gas and so the Urea synthesis pressure will rise. The most principal reasons for high Urea synthesis pressure are non proportional of Ammonia/Dioxide Carbon ratio and too high a pressure in low pressure steam drum. Proportional of Ammonia/Dioxide Carbon ratio is 3.0 and normal pressure for low pressure steam drum is 4.5 bar. As regards these conditions were proportional but we could not control the synthesis pressure the plant endangered, therefore we had to control the steam drum pressure at about 3.5 bar. While we opened the pool condenser, we found the partition plate used to divide inlet and outlet boiler feed water to tubes, was broken partially and so amount of boiler feed water bypass the tubes and the heat was not removed totally and it resulted in the generation of gases and high pressure in synthesis.

Keywords: boiler, pressure, pool condenser, partition plate

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Authors: K. Reitner, F. Staberhofer, W. Ortner, M. Gerschberger

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The purpose of this paper is to identify the main challenges faced by companies in the timber construction sector and to provide improvement opportunities that can be implemented on a short-, medium- and long-term basis. To identify the challenges and propose actions for each company a literature review and a multiple case research were conducted using the Quick Scan Audit Methodology. Finally, the findings and outcomes are compared with each other to support companies in the timer construction sector when implementing and restructuring their day-to-day activities.

Keywords: supply chain management, supply chain challenges and opportunities, timber construction sector

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Authors: Nirmal Kundu, Chandan Bhar, Visveswaran Pandurangan

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Technology is the most valued possession for a country or an organization. The economic development depends not on stock of technology but on the capabilities how the technology is being exploited. The technology transfer is the best way how the developing countries have an access to state-of- the-art technology. Traditional technology transfer is a unidirectional phenomenon where technology is transferred from developed to developing countries. But now there is a change of wind. There is a general agreement that global shift of economic power is under way from west to east. As China and India are making the transition from users to producers, and producers to innovators, this has increasing important implications on economy, technology and policy of global trade. As a result, Reverse technology transfer has become a phenomenon and field of study in technology management. The term “Reverse Technology Transfer” is not well defined. Initially the concept of Reverse technology transfer was associated with the phenomenon of “Brain drain” from developing to developed countries. In the second phase, Reverse Technology Transfer was associated with the transfer of knowledge and technology from subsidiaries to multinationals. Finally, time has come now to extend the concept of reverse technology transfer to two different organizations or countries related or unrelated by traditional technology transfer but the transfer or has essentially received the technology through traditional mode of technology transfer. The objective of this paper is to study; 1) the present status of Reverse technology transfer, 2) the factors which are the enablers and barriers of Reverse technology transfer and 3) how the reverse technology transfer strategy can be integrated in the technology policy of a country which will give the countries an economic boost. The research methodology used in this study is a combination of literature review, case studies and key informant interviews. The literature review includes both published as well as unpublished sources of literature. In case study, attempt has been made to study the records of reverse technology transfer that have been occurred in developing countries. In case of key informant interviews, informal telephonic discussions have been carried out with the key executives of the organizations (industry, university and research institutions) who are actively engaged in the process of technology transfer- traditional as well as reverse. Reverse technology transfer is possible only by creating technological capabilities. Following four important enablers coupled with government active and aggressive action can help to build technology base to reach to the goal of Reverse technology transfer 1) Imitation to innovation, 2) Reverse engineering, 3) Collaborative R & D approach, and 4) Preventing reverse brain drain. The barriers that come in the way are the mindset of over dependence, over subordination and parent–child attitude (not adult attitude). Exploitation of these enablers and overcoming the barriers of reverse technology transfer, the developing countries like India and China can prove that going “reverse” is the best way to move forward and again establish themselves as leader of the future world.

Keywords: barriers of reverse technology transfer, enablers of reverse technology transfer, knowledge transfer, reverse technology transfer, technology transfer

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Authors: Nabil A. Ahmed

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DC-DC converters are necessary to interface low-voltage fuel cell power generation systems to a higher voltage DC bus system. A system and method for generating a regulated output power from fuel cell power generation systems is proposed in this paper, this includes a soft-switching isolated DC-DC converter to reduce the idling and circulating currents. The system incorporates a high-frequency center tap transformer link DC-DC converter using secondary-side soft switching control. Snubber capacitors including the parasitic capacitance of the switching devices and the transformer leakage inductance are utilized to achieve zero-voltage switching (ZVS) in the primary side of the high-frequency transformer. Therefore, no extra resonant components are required for ZVS. The inherent soft-switching capability allows high power density, efficient power conversion, and compact packaging. A prototype rated at 6.5 kW is proposed and simulated. Simulation results confirmed a wide range of soft-switching operation and consequently high conversion efficiency will be achieved.

Keywords: secondary-side, phase-shift, high-frequency transformer, zero voltage, zero current, soft switching operation, switching losses

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Authors: Kim H. K. Choy, Oliva H. K. Chu, W. Y. Keung, B. Lim, Winnie P. Y. Tang

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Background: Health care providers have been identified as an at-risk group for obesity. Mobile health technology can be used to motivate lifestyle behavioral changes. The aim of this study was to investigate hospital-based health care providers’ perceptions of mHealth Workplace Nutrition Wellness Program. Methods: This qualitative study was conducted at a regional hospital in Hong Kong. Ten health care providers were purposively selected for the study. Qualitative data was collected by individual face-to-face semi-structured interviews which were audio-taped, transcribed verbatim and analyzed by thematic analysis. Results: Four themes were identified: (1) mobile health technology motivates lifestyle changes, (2) self-perceived body weight initiates health behavioral changes, (3) organizational support promotes healthy behavior, (4) lack of self-confidence hinders lifestyle modification. The health care providers’ perceptions of mobile health technology, barriers, and facilitators to participation in the mHealth Workplace Nutrition Wellness Program were discussed in the study. Conclusions: Barriers, facilitators, self-perceived body weight and experiences of mobile health technology were associated with intention of participation in mHealth Workplace Nutrition Wellness Program. The knowledge generated from the study could be used to guide the design and implementation of effective interventions, strategies and policies of workplace wellness programs to promote participation for hospital’s employees.

Keywords: workplace wellness program, mobile health, barriers, facilitators, qualitative

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Authors: L. Parisi

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In this research work, neural networks were applied to classify two types of hip joint implants based on the relative hip joint implant side speed and three components of each ground reaction force. The condition of walking gait at normal velocity was used and carried out with each of the two hip joint implants assessed. Ground reaction forces’ kinetic temporal changes were considered in the first approach followed but discarded in the second one. Ground reaction force components were obtained from eighteen patients under such gait condition, half of which had a hip implant type I-II, whilst the other half had the hip implant, defined as type III by Orthoload®. After pre-processing raw gait kinetic data and selecting the time frames needed for the analysis, the ground reaction force components were used to train a MLP neural network, which learnt to distinguish the two hip joint implants in the abovementioned condition. Further to training, unknown hip implant side and ground reaction force components were presented to the neural networks, which assigned those features into the right class with a reasonably high accuracy for the hip implant type I-II and the type III. The results suggest that neural networks could be successfully applied in the performance assessment of hip joint implants.

Keywords: kinemic gait data, neural networks, hip joint implant, hip arthroplasty, rehabilitation engineering

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Authors: Lesley Clack, Rachel Ellison, Elizabeth Chambers

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A belief exists that there are huge gender and racial disparities among hospital CEO’s in the United States, and historically, male, Caucasian healthcare executives have made significantly larger salaries than females and other races. With a recent focus on reducing barriers and disparities in healthcare, it remains to be seen whether there have been changes in these disparities over time. The purpose of this study was to explore disparities among salaries of hospital executives in the United States. Analysis of salary data was conducted utilizing online hospital salary databases. Statistical analysis was conducted to examine the significance of the differences. Results indicated that there had been improvements in disparities among some ethnicities. Gender disparities remain the largest gap. The implications of this study are significant for the field of healthcare management as disparities can affect both social dynamics and organizational culture. Understanding where disparities lie is the first step towards bridging the gap and reducing barriers for cultural diversity within healthcare management.

Keywords: health care, disparities, management, executives

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Authors: Weldeabrha Kiros Kidanemaryam

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The investigation is to examine intra-organizational supply chain relationships of firms, which will help to look at and give an emphasis on internal processes and operations strength and achievements to make an influence even for external relationship management and outstanding performances of organizations. The purpose of the study is to scrutinize the internal supply chain relationships within manufacturing companies located in Tigray. The qualitative and quantitative data analysis methods were employed during the study by applying the primary data sources (questionnaires & interviews) and secondary data sources (organizational reports and documents) with the purposive sampling method. Thus, a descriptive research design was also applied in the research project in line with the cross-sectional research design which portrays simply the magnitude of the issues and problems by collecting the required and necessary data once from the sample respondents. This is because the study variables don’t have any cause-and-effect relationship in the research project that requires other types of research design than a descriptive research design; it already needs to be assessed and analyzed with a detailed description of the results after quantifying the outcomes and degree of the issues and problems based on the data gathered from respondents. The collected data was also analyzed by using the statistical package for social sciences (SPSS Version 20). The intra-organizational relationships of the companies are moderately accomplished, which requires an improvement for enhancing the performances of each unit or department within the firms so as to upgrade and ensure the progress of the companies’ effectiveness and efficiency. Moreover, the manufacturing companies have low industrial discipline and working culture, weak supervision of manpower, delayed delivery in the process within the companies, unsatisfactory quality of products, underutilization of capacity, and low productivity and profitability, which in turn results in minimizing the performance of intra-organizational supply chain relationships and to reduce the companies’ organizational efficiency, effectiveness and sustainability. Hence, the companies should have to give emphasize building and managing the intra-organizational supply chain relationships effectively because nothing can be done without creating successful and progressive relationships with internal units or functional areas and individuals for the production and provision of the required and qualified products that permits to meet the intended customers’ desires. The study contributes to improving the practical applications and gives an emphasis on the policy measurements and implications of the manufacturing companies with regard to intra-organizational supply chain relationships.

Keywords: supply chain, supply chain relationships, intra-organizational relationships, manufacturing companies

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Authors: Janet Ige, Paul Pilkington, Selena Gray, Jane Powell

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Older adults from socially disadvantaged groups and Black and Minority Ethnic (BME) groups experience a higher burden of physical inactivity. Physical inactivity among BME groups is associated with the disproportionately higher level of health inequalities. People from minority ethnic groups encounter more barriers to physical activity. However, this is not often reported. There is very limited review-level evidence on the barriers and facilitators of physical activity among older adults from BME groups in the UK. This study aims to answer the following research question: what are the barriers and facilitators of physical activity participation among adults and older adults from BME background in the UK? To address this, we conducted a review of qualitative studies investigating the barriers and opportunities for physical activity among of BME adults and older adults in the UK. Method: This study is nested in an interpretive paradigm of meta-ethnography. A structured search for published literature was conducted on 6 electronic databases (MEDLINE, PsychINFO, Cumulative Index to Nursing & Allied Health Literature, Applied Social Sciences Index and Abstracts, Cochrane Database of Systematic Reviews, Allied and Complementary Medicine) from January 2007 to July 2017. Hand searching of the reference list of publications was performed in addition to a search conducted on Google Scholar to identify grey literature. Studies were eligible provided they employed any qualitative method and included participants identified as being BME, aged 50 and above, living in any community within the UK. In total, 1036 studies were identified from the structured search for literature, 718 studies were screened by titles after duplicates were removed. On applying the inclusion and exclusion criteria, a final selection of 10 studies was considered eligible for synthesis. Quality assessment was performed using the Critical Appraisal Skills Programme tool. Logic maps were used to show the relationship between factors that impact on physical activity participation among adults and older adults Result: Six key themes emerged from the data: awareness of the links between physical activity and health, interaction, and engagement with health professionals, cultural expectations and social responsibilities, appropriate environment, religious fatalism and practical challenges. Findings also showed that the barriers and facilitators of physical activity exist at the individual, community, and socio-economic, cultural and environmental level. There was a substantial gap in research among Black African groups. Findings from the review also informed the design of an ongoing survey investigating the experience and attitude of adults from Somali backgrounds towards physical activity in the UK. Conclusion: Identifying the barriers and facilitators of physical activity among BME groups is a crucial step in addressing the widening inequality gap. Findings from this study highlight the importance of engaging local BME residents in the design of exercise facilities within the community. This will ensure that cultural and social concerns are recognized and properly addressed.

Keywords: BME, UK, meta-ethnographic, adults

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Authors: A. Anitha, M. Aishwariya

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The realization of truly ubiquitous wireless sensor networks (WSN) demands Ultra-low power wireless communication capability. Because the radio transceiver in a wireless sensor node consumes more power when compared to the computation part it is necessary to reduce the power consumption. Hence, a low power transceiver is designed and implemented in a 120 nm CMOS technology for wireless sensor nodes. The power consumption of the transceiver is reduced still by maintaining the sensitivity. The transceiver designed combines the blocks including differential oscillator, mixer, envelope detector, power amplifiers, and LNA. RF signal modulation and demodulation is carried by On-Off keying method at 2.4 GHz which is said as ISM band. The transmitter demonstrates an output power of 2.075 mW while consuming a supply voltage of range 1.2 V-5.0 V. Here the comparison of LNA and power amplifier is done to obtain an amplifier which produces a high gain of 1.608 dB at receiver which is suitable to produce a desired sensitivity. The multistage RF amplifier is used to improve the gain at the receiver side. The power dissipation of the circuit is in the range of 0.183-0.323 mW. The receiver achieves a sensitivity of about -95 dBm with data rate of 1 Mbps.

Keywords: CMOS, envelope detector, ISM band, LNA, low power electronics, PA, wireless transceiver

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