Search results for: organizational mortality

Authors: Jing Niu, Jun X. Wang

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Arterial stiffness predicts mortality and morbidity, independently of other cardiovascular risk factors. And it is a major risk factor for age-related morbidity and mortality. The non-invasive industry gold standard measurement system of arterial stiffness utilizes pulse wave velocity method. However, the desktop device is expensive and requires trained professional to operate. The main objective of this research is the proof of concept of the proposed non-invasive method which uses measurement of magnetic flux disturbance and electrocardiogram (ECG) signal for measuring arterial stiffness. The method could enable accurate and easy self-assessment of arterial stiffness at home, and to help doctors in research, diagnostic and prescription in hospitals and clinics. A platform for assessing arterial stiffness through acquisition and analysis of radial artery pulse waveform and ECG signal has been developed based on the proposed method. Radial artery pulse waveform is acquired using the magnetic based sensing technology, while ECG signal is acquired using two dry contact single arm ECG electrodes. The measurement only requires the participant to wear a wrist strap and an arm band. Participants were recruited for data collection using both the developed platform and the industry gold standard system. The results from both systems underwent correlation assessment analysis. A strong positive correlation between the results of the two systems is observed. This study presents the possibility of developing an accurate, easy to use and affordable measurement device for arterial stiffness assessment.

Keywords: arterial stiffness, electrocardiogram, pulse wave velocity, Magnetic Flux Disturbance

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Authors: Vinay Kumar, M. Kishor, Sathyanarayana Rao Ts

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Background: Growth of elderly people in the general population in recent years is termed as ‘greying of the world’ where there is a shift from high mortality & fertility to low mortality and fertility, resulting in an increased proportion of older people as seen in India. Improved health care promises longevity but socio-economic factors like poverty, joint families and poor services pose a psychological threat. Epidemiological data regarding the prevalence of mental disorders in geriatric population with physical illness is required for proper health planning. Methods: Sixty consecutive elderly patients aged 60 years or above of both sexes, reporting with physical illness to general outpatient registration counter of JSS Medical College and Hospital, Mysore, India, were considered for the Study. With informed consent, they were screened with General Health Questionnaire (GHQ-12) and were further evaluated for diagnosing mental disorders according to WHO International Classification of Diseases (ICD-10) criteria. Results: Mental disorders were detected in 48.3%, predominantly depressive disorders, nicotine dependence, generalized anxiety disorder, alcohol dependence and least was dementia. Most common physical illness was cardiovascular disease followed by metabolic, respiratory and other diseases. Depressive disorders, substance dependence and dementia were more associated with cardiovascular disease compared to metabolic disease and respiratory diseases were more associated with nicotine dependence. Conclusions: Depression and Substance use disorders among elderly population is of concern, which needs to be further studied with larger population. Psychiatric morbidity will adversely have an impact on physical illness which needs proper assessment and management. This will enhance our understanding and prioritize our planning for future.

Keywords: Geriatric, mental disorders, physical illness, psychiatry

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Authors: Siti Zabedah Saidin, Aidi Ahmi, Azharudin Ali, Wan Norhayati Wan Ahmad

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In today's increasingly complex and interconnected world, the concept of sustainability has transcended mere corporate social responsibility, evolving into a fundamental driver of organizational behaviour and disclosure. This content analysis study delves into the Malaysian federal-level statutory bodies’ annual report for the year 2021, aiming to elucidate the extent of sustainability disclosures within the non-financial sections of these reports. The escalating global emphasis on sustainability has prompted organizations to embrace transparency as a means to demonstrate their commitment to environmental, social, and governance (ESG) considerations. Voluntary sustainability disclosure has emerged as a crucial channel through which organizations communicate their efforts, initiatives, and impacts in these areas, thereby fostering trust and accountability with stakeholders. The study aims to identify and examine the types of sustainability information disclosed voluntarily by the federal-level statutory bodies, concentrating on the non-financial sections of the annual reports. To achieve this, the study adopts a simplified disclosure index, a pragmatic tool that quantifies the extent of sustainability reporting in a standardized manner. Using convenience sampling, the study selects a sample of annual reports from the federal-level statutory bodies in Malaysia, as provided on their respective websites. The content analysis is centred on the non-financial sections of these reports, allowing for an in-depth exploration of sustainability disclosures. The findings of the study present the extent to which Malaysian federal-level statutory bodies embrace sustainability reporting. Through thorough content analysis, the study uncovered diverse dimensions of sustainability information, encompassing environmental impact assessments, social engagement endeavours, and governance frameworks. This reveals a deliberate effort by these bodies to encapsulate their holistic organizational contributions and challenges, transcending traditional financial metrics. This research contributes to the existing literature by providing insights into the evolving landscape of sustainability disclosure practices among Malaysian federal-level statutory bodies. The findings underline the proactive nature of these bodies in voluntarily sharing sustainability-related information, reflecting their recognition of the interconnectedness between organizational success and societal well-being. Furthermore, the study underscores the potential influence of regulatory guidelines and societal expectations in shaping the extent and nature of voluntary sustainability disclosures. Organizations are not merely responding to regulatory mandates but are actively aligning with global sustainability goals and stakeholder expectations. As organizations continue to navigate the intricate web of stakeholder expectations and sustainability imperatives, this study enriches the discourse surrounding transparency and sustainability reporting. The analysis emphasizes the important role of non-financial disclosures in portraying a holistic organizational narrative. In an era where stakeholders demand accountability, and the interconnectedness of global challenges necessitates collaborative action, the voluntary disclosure of sustainability information stands as a testament to the commitment of Malaysian federal-level statutory bodies in shaping a more sustainable future.

Keywords: voluntary disclosure, sustainability information, annual report, federal-level statutory body

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Authors: Asanka U. K. Godamunne

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Road traffic accidents (RTA) are a leading cause of death globally as well as in Sri Lanka and results in a large proportion of disability especially among young people. Ninety-percent of world’s road traffic deaths occur in low- and middle-income countries. The gross disparities in injury outcomes relate to immediate post-crash and hospital management. Emergency management, methods of patient transportation following road traffic accidents and safety measures are important factors to reduce mortality and morbidity. Studies in this area are limited in Sri Lanka. The main objective of this research was to assess the emergency management and proper method of transportation of road traffic accident victims. This offers the best way to explore the ways to reduce the mortality and morbidity and raise the public awareness. This study was conducted as a descriptive cross-sectional study. All the consecutive road traffic accident victims admitted to surgical wards at District General Hospital, Matale, Sri Lanka, over a period of three months were included in the study. Data from 387 victims were analyzed. The majority were in the 20-30 year age group. Seventy six percent of the patients were males. Motorcycles and trishaws were most affected. First-aid was given to only 2% of patients and it was given by non-medical persons. A significant proportion of patients (75%) were transported to the hospital by trishaws and only 1% transported by ambulance. About 86% of the patients were seated while transport and 14% were flat. Limbs and head were the most affected areas of the body. As per this study, immediate post-crash management and patient transportation were not satisfactory. There is a need to strengthen certain road safety laws and make sure people follow them.

Keywords: emergency management, patient transportation, road traffic accident victims, Sri Lanka

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Authors: Omnia Saidani Neffati, Rim Samia Kaabi, Naoufel Kraiem

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In this paper, we propose an approach aiming at (i) representing services at two levels: the intentional level and the organizational level, and (ii) establishing mechanisms allowing to make a transition from the first level to the second one in order to execute intentional services. An example is used to validate our approach.

Keywords: intentional service, business process, BPMN, MDE, intentional service execution

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Authors: Harmeet Pal Singh Dhooria, Deepinder Chinna, UPS Sidhu, Alok Jain

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Serious infections caused by gram-negative bacteria are a significant cause of mortality and morbidity in the hospital setting. In acute care facilities like in intensive care units (ICUs), the intensity of antimicrobial use together with a population highly susceptible to infection, creates an environment, which facilitates both emergence and transmission of Extended Spectrum -lactamase (ESBL) producing Enterobacteriaceae species. The study was conducted in the Medical Intensive Care Unit (MICU) and the Pulmonary Critical Care Unit (PCCU) of the Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India. Out of a total of 1108 samples of urine, blood and respiratory tract secretions received for culture and sensitivity analysis from Medical Intensive Care Unit and Pulmonary Critical Care Unit, a total of 170 isolates of Enterobacteriaceae species were obtained which were then included in our study. Out of these 170 isolates, confirmed ESBL production was seen in 116 (68.24%) cases. E.coli was the most common species isolated (56.47%) followed by Klebsiella (32.94%), Enterobacter (5.88%), Citrobacter (3.53%), Enterobacter (0.59%) and Morganella (0.59%) among the total isolates. The rate of ESBL production was more in Klebsiella (78.57%) as compared to E.coli (60.42%). ESBL producers were found to be significantly more common in patients with prior history of hospitalization, antibiotic use, and prolonged ICU stay. Also significantly increased the prevalence of ESBL related infections was observed in patients with a history of catheterization or central line insertion but not in patients with the history of intubation. Patients who had an underlying malignancy had significantly higher prevalence of ESBL related infections as compared to other co-morbid illnesses. A slightly significant difference in the rate of mortality/LAMA was observed in the ESBL producer versus the non-ESBL producer group. The rate of mortality/LAMA was significantly higher in the ESBL related UTI but not in the ESBL related respiratory tract and bloodstream infections. ESBL producing isolates had significantly higher rates of resistance to Cefepime and Piperacillin/Tazobactum, and to non β-lactum antibiotics like Amikacin and Ciprofloxacin. The level of resistance to Imipenem was lower as compared to other antibiotics. However, it was noted that ESBL producing isolates had higher levels of resistance to Imipenem as compared to non-ESBL producing isolates. Conclusion- The prevalence of ESBL producing organisms was found to be very high (68.24%) among Enterobacteriaceae isolates in our ICU setting as among other ICU care settings around the world.

Keywords: enterobacteriaceae, extended spectrum B-lactamase (ESBL), ICU, antibiotic resistance

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Authors: M. J. Reis Lima, J. Oliveira, M. Brito, C. Lemos, A. Mascarenhas, E. Teixeira Lemos

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Hypertension is a common condition causing cardio and cerebrovascular complications. Portugal has one of the highest mortality rates from stroke and a high prevalence of hypertension. Systolic blood pressure (SBP) is an important risk factor for cardiovascular events (myocardial infarction and stroke) and premature mortality, particularly in the elderly population. The present study aims to estimate the prevalence of hypertension in a Portuguese population living in a coastal city and to identify some of its determinants (namely gender, age, the body mass index and physical activity frequency). A total of 91 adults who attended three pharmacies of a coastal city in the center of Portugal, between May and August of 2013 were evaluated. Attendants who reported to have diabetes or taking antihypertensive drugs in the 2 previous weeks were excluded from the study. Sociodemographic factors, BMI, habits of exercise and BP were assessed. Hypertension was defined as blood pressure ≥140/90 mmHg. The majority of the studied population was constituted by women (75.8%), with a mean age of 54.2±1.6 years old, married or living in civil union and that had completed secondary school or had higher education (40%). They presented a mean BMI of 26.2±4.76 Kg/m2. and were sedentary. The mean BP was 127.0±17.77mmHg- 74.69 ± 9.53. In this population, we found 4.3% of people with hypertension and 16.1% with normal high blood pressure. Men exhibit a tendency to present higher systolic blood pressure values than women. Of all the factors considered, SBP values also tended to be higher with age and higher BMI values. Despite the fact that the mean values of SBP did not present values higher than 140 mmHg we must be concerned because the studied population is undiagnosed for hypertension. Our study even with some limitations might be a prelude to the upcoming research about the underlying factors responsible for the occurrence of SBP.

Keywords: hypertension, age, exercise, obesity and gender

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Authors: M. Soltani, K. Pakzad, A. Haghigh-Khiyabani, M. Alavi, R. Naderi, M. Castex

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Effect of probiotic Bactocell (Pediococcus acidilactici) as a supplementary diet was studied on post-larvae 12-15 of white leg shrimp (Litopenaeus vannamei) (150000 PL/0.5 h pond, average body weight=0.02 g) growth performance under farm condition for 102 days at water quality parameters consisting of temperature at 30.5-36οC, dissolved oxygen 4.1-6.6 mg/l, salinity 40-54 g/l, turbidity 35-110 cm, ammonia 0.1-0.8 mg/l and nitrite 0.1-0.9 mg/l. Also, the resistance level of the treated shrimps was assessed against a virulent strain of Vibrio paraheamolyticus as intramuscular injection route at 1.4 x 106 cells/shrimp. Significantly higher growth rate (11.3±1.54 g) and lower feed conversion ratio (1.1) were obtained in shrimps fed diets supplemented with Bactocell at 350 g/ tone feed compared to other treatments of 250 g Bactocell/ton feed (10.8±2 g, 1.3), 500 g Bactocell/ton feed (10.3±1.7 g, 1.3) and untreated control (10.1±2 g, 1.4). Also, thermal growth coefficient (0.057%) and protein efficiency ratio (2.13) were significantly improved in shrimps fed diets supplemented with Bactocell at 350 g/ton feed compare to other groups. Shrimps fed diet supplemented with Bactocell at 350 g/tone feed showed significantly higher protein content (72.56%) in their carcass composition than treatments of 250 g/ton feed (65.9%), 500 g/ton feed (67.5%) and control group (65.9%), while the carcass contents of moisture, lipid and ash in all shrimp groups were not significantly affected by different concentrations of Bactocell. No mortality occurred in the experimentally infected shrimps fed with Bactocell at 500 g/tone feed after 7 hours post-challenge with V. parahemolyticus. The mortality levels of 100%, 40%, 50% and 70% were obtained in shrimps fed with 0.0, 500 g/tone feed, 350 g/ton feed and 250 g/ton feed, respectively 14 hours post-infection. Also, the cumulative mortalities were achieved in 100%, 92% and 81% in shrimps few with Bactocell at 500 g/ton feed, 250 g/ton feed and 350 g/ton feed, respectively.

Keywords: litopenaeus vannamei, vibrio paraheamolyticus, pediococcus acidilactici, growth performance, bactocell

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Authors: Rosa Nadine Danenberg

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In recent years, bottom-up urban development has started growing as an alternative to conventional top-down planning. In large proportions, citizens and communities initiate small-scale interventions; suddenly seeming to form a trend. As a result, more and more cities are witnessing not only the growth of but also an interest in these initiatives, as they bear the potential to reshape urban spaces. Such alternative city-making efforts cause new dynamics in urban governance, with inevitable consequences for the controlled city planning and its administration. The emergence of enabling relationships between top-down and bottom-up actors signals an increasingly common urban practice. Various case studies show that an enabling relationship is possible, yet, how it can be optimally realized stays rather underexamined. Therefore, the seemingly growing worldwide phenomenon of ‘municipal bottom-up urban development’ necessitates an adequate governance structure. As such, the aim of this research is to contribute knowledge to how municipalities can enable citizen-led urban initiatives from a governance innovation perspective. Empirical case-study research in Stockholm and Istanbul, derived from interviews with founders of four citizen-led urban initiatives and one municipal representative in each city, provided valuable insights to possibilities and constraints for enabling practices. On the one hand, diverging outcomes emphasize the extreme oppositional features of both cases (Stockholm and Istanbul). Firstly, both cities’ characteristics are drastically different. Secondly, the ideologies and motifs for the initiatives to emerge vary widely. Thirdly, the major constraints for citizen-led urban initiatives to relate to the municipality are considerably different. Two types of municipality’s organizational structures produce different underlying mechanisms which demonstrate the constraints. The first municipal organizational structure is steered by bureaucracy (Stockholm). It produces an administrative division that brings up constraints such as the lack of responsibility, transparency and continuity by municipal representatives. The second structure is dominated by municipal politics and governmental hierarchy (Istanbul). It produces informality, lack of transparency and a fragmented civil society. In order to cope with the constraints produced by both types of organizational structures, the initiatives have adjusted their organization to the municipality’s underlying structures. On the other hand, this paper has in fact also come to a rather unifying conclusion. Interestingly, the suggested possibilities for an enabling relationship underline converging new urban governance arrangements. This could imply that for the two varying types of municipality’s organizational structures there is an accurate governance structure. Namely, the combination of a neighborhood council with a municipal guide, with allowance for the initiatives to adopt a politicizing attitude is found as coinciding. Especially its combination appears key to redeem varying constraints. A municipal guide steers the initiatives through bureaucratic struggles, is supported by coproduction methods, while it balances out municipal politics. Next, a neighborhood council, that is politically neutral and run by local citizens, can function as an umbrella for citizen-led urban initiatives. What is crucial is that it should cater for a more entangled relationship between municipalities and initiatives with enhanced involvement of the initiatives in decision-making processes and limited involvement of prevailing constraints pointed out in this research.

Keywords: bottom-up urban development, governance innovation, Istanbul, Stockholm

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Authors: Pornthip Seangsanga

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Sepsis or septic shock needs urgent care because it is a cause of the high mortality rate if patients do not receive timely treatment. Songkhla Hospital does not have a clear system or clinical practice guidelines for treatment of patients with severe sepsis or septic shock, which contributes to the said problem.To compare clinical outcomes based on the protocol after using the clinical guidelines between the Emergency Room, Intensive Care Unit, and the Ward. This quasi-experimental study was conducted on the population and 50 subjects who were diagnosed with severe sepsis or septic shock from December 2013 to May 2014. The data were collected using a nursing care and referring record form for patients with severe sepsis or septic shock at Songkhla Hospital. The record form had been tested for its validity by three experts, and the IOC was 1.The mortality rate in patients with severe sepsis or septic shock who were moved from the ER to the ICU was significantly lower than that of those patients moved from the Ward to the ICU within 48 hours. This was because patients with severe sepsis or septic shock who were moved from the ER to the ICU received more fluid within the first six hours according to the protocol which helped patients to have adequate tissue perfusion within the first six hours, and that helped improve blood flow to the kidneys, and the patients’ urine was found to be with a higher quantity of 0.5 cc/kg/hr, than those patients who were moved from the Ward to the ICU. This study shows that patients with severe sepsis or septic shock need to be treated immediately. Using the clinical practice guidelines along with timely diagnosis and treatment based on the sepsis bundle in giving sufficient and suitable amount of fluid to help improve blood circulation and blood pressure can clearly prevent or reduce severity of complications.

Keywords: clinical practice guidelines, caring, septic shock, sepsis bundle protocol

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Authors: Fasil Wagnew, Kerri Viney, Kefyalew Addis Alene, Matthew Kelly, Darren Gray

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Background: Undernutrition is a risk factor for tuberculosis (TB), including poor treatment outcomes. However, evidence regarding the effect of undernutrition on TB treatment outcomes is not well understood. We aimed to evaluate the effect of undernutrition on sputum culture conversion and treatment outcomes among people with multi-drug resistance (MDR)-TB. Methods: We searched for publications in the Medline, Embase, Scopus, and Web of Science databases without restrictions on geography or year of publication. We conducted a random-effect meta-analysis to estimate the effects of undernutrition on sputum culture conversion and treatment outcomes. Two reviewers independently assessed the study eligibility, extracted the necessary information, and assessed the risk of bias. Depending on the nature of the data, odds ratio (OR) and hazard ratio (HR) with 95% confidence intervals (CIs) were used to summarize the effect estimates. Potential publication bias was checked using funnel plots and Egger’s tests. Results: Of 2358 records screened, 59 studies comprising a total of 31,254 people with MDR-TB were included. Undernutrition was significantly associated with a lower sputum culture conversion rate (HR 0·7, 95% CI 0·6–0·9, I2=67·1%) and a higher rate of mortality (OR 2·9, 95%CI 2·1–3·8, I2=23·7%) and unfavourable treatment outcomes (OR 1·8, 95%CI 1·5–2·0, I2=72·7%). There was no statistically significant publication bias in the included studies. Three studies were low, forty-two studies were moderate, and fourteen studies were high quality. Interpretations: Undernutrition was significantly associated with unfavourable treatment outcomes, including mortality and lower sputum culture conversion among people with MDR-TB. These findings have implications for supporting targeted nutritional interventions alongside standardised second-line TB drugs.

Keywords: undernutrition, MDR-TB, sputum culture conversion, treatment outcomes, meta-analysis

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Authors: Andrew Couch, Nicholas Loyd, Nathan Tenhundfeld

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The rapid emergence of technology observably induces disruptive effects that carry implications for internal organizational dynamics as well as external market opportunities, strategic pressures, and threats. An examination of the historical tendencies of technology innovation shows that the body of managerial knowledge for addressing such disruption is underdeveloped. Fundamentally speaking, the impacts of innovation are unique and situationally oriented. Hence, the appropriate managerial response becomes a complex function that depends on the nature of the emerging technology, the posturing of internal organizational dynamics, the rate of technological growth, and much more. This research considers a particular case of mismanagement, the BP Texas City Refinery explosion of 2005, that carries notable discrepancies on the basis of human factors principles. Moreover, this research considers the modern technological climate (shaped by Industry 4.0 technologies) and seeks to arrive at an appropriate conceptual lens by which human factors principles and Industry 4.0 may be favorably integrated. In this manner, the careful examination of these phenomena helps to better support the sustainment of human factors principles despite the disruptive impacts that are imparted by technological innovation. In essence, human factors considerations are assessed through the application of principles that stem from usability engineering, the Swiss Cheese Model of accident causation, human-automation interaction, signal detection theory, alarm design, and other factors. Notably, this stream of research supports a broader framework in seeking to guide organizations amid the uncertainties of Industry 4.0 to capture higher levels of adoption, implementation, and transparency.

Keywords: Industry 4.0, human factors engineering, management, case study

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Authors: Sandhya Rao

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Kevin Lynch’s Theory on Imeageability, let on explore a city in terms of five elements, Nodes, Paths, Edges, landmarks and Districts. What happens when we try to record the same data in an Indian context? What happens when we apply the same theory of Imageability to a complex shifting urban pattern of the Indian cities and how can we as Urban Designers demonstrate our role in the image building ordeal of these cities? The organizational patterns formed through mental images, of an Indian city is often diverse and intangible. It is also multi layered and temporary in terms of the spirit of the place. The pattern of images formed is loaded with associative meaning and intrinsically linked with the history and socio-cultural dominance of the place. The embedded memory of a place in one’s mind often plays an even more important role while formulating these images. Thus while deriving an image of a city one is often confused or finds the result chaotic. The images formed due to its complexity are further difficult to represent using a single medium. Under such a scenario it’s difficult to derive an output of an image constructed as well as make design interventions to enhance the legibility of a place. However, there can be a combination of tools and methods that allows one to record the key elements of a place through time, space and one’s user interface with the place. There has to be a clear understanding of the participant groups of a place and their time and period of engagement with the place as well. How we can translate the result obtained into a design intervention at the end, is the main of the research. Could a multi-faceted cognitive mapping be an answer to this or could it be a very transient mapping method which can change over time, place and person. How does the context influence the process of image building in one’s mind? These are the key questions that this research will aim to answer.

Keywords: imageability, organizational patterns, legibility, cognitive mapping

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Authors: Tien Hui Chiang

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Along with the predominant influence of neo-liberalism, public managerialism is viewed as a panacea for curing the institutionalized weakness caused by the monopoly of the public sector. In the name of efficiency, its outcome-led approach acquires a legitimate status and, in turn, it transforms into the discourse of performativity, reformulating the souls of individual members into the form of docile bodies who are willing to demonstrate their own ability in organizational contributions. The evaluation system and the organizational reconstruction are viewed as the crucial means for achieving this mission. Inevitably, university teachers are confined within a rigid and bureaucratic setting, in which they do not have too much latitude but are subject to the commands of senior administrators. However, the notion of duality highlights the interaction between structural constraints and agency. If the actor discovers the rules or properties of social structure, he/she is able to transform structural constraints into resources for developing creative actions, conceptualized as an agency. This study was designed for examining how duality operates within this hierarchical arrangement formed by public managerialism. Fourteen informants were interviewed from February to August 2014. The findings show that the evaluation system created the culture of neo-academicalism, addressing excellence in research and, in turn, motivating academic-oriented teachers. This correspondence provided a gateway for them to win honor, dignity, and prestige in groups. However, unlike the concept of duality, this agency was operating within the institutionalized context, regulated by structural constraint. Furthermore, complying with the rule/property of social structure was able to secure their advantages.

Keywords: public managerialism, social discourse, neo-academicalism, duality, structural constraint, agency

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Authors: Thinakar Mani Balusamy, Ratnakar S. Kini, Bharat Narasimhan, Venkateswaran A. R, Pugazhendi Thangavelu, Mohammed Ali, Prem Kumar K., Kani Sheikh M., Sibi Thooran Karmegam, Radhakrishnan N., Mohammed Noufal

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Introduction: Pancreatic injury remains a complicated condition requiring an individualized case by case approach to management. In this study, we aim to analyze the varied presentations and treatment outcomes of traumatic pancreatic injury in a tertiary care center. Methods: All consecutive patients hospitalized at our center with traumatic pancreatic injury between 2013 and 2017 were included. The American Association for Surgery of Trauma (AAST) classification was used to stratify patients into five grades of severity. Outcome parameters were then analyzed based on the treatment modality employed. Results: Of the 35 patients analyzed, 26 had an underlying blunt trauma with the remaining nine presenting due to penetrating injury. Overall in-hospital mortality was 28%. 19 of these patients underwent exploratory laparotomy with the remaining 16 managed nonoperatively. Nine patients had a severe injury ( > grade 3) – of which four underwent endotherapy, three had stents placed and one underwent an endoscopic pseudocyst drainage. Among those managed nonoperatively, three underwent a radiological drainage procedure. Conclusion: Mortality rates were clearly higher in patients managed operatively. This is likely a result of significantly higher degrees of major associated non-pancreatic injuries and not just a reflection of surgical morbidity. Despite this, surgical management remains the mainstay of therapy, especially in higher grades of pancreatic injury. However we would like to emphasize that endoscopic intervention definitely remains the preferred treatment modality when the clinical setting permits. This is especially applicable in cases of main pancreatic duct injury with ascites as well as pseudocysts.

Keywords: endotherapy, non-operative management, surgery, traumatic pancreatic injury

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Authors: Naser Shagerdi Esmaeli, Mohsen Hamidpour

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Background and Objective: Hematopoietic stem cell transplantation (HSCT) has been widely used for treating oncological and hematological diseases. Although HSCT has helped to improve patient survival, the risk of developing an infection during hospitalization is an important cause of morbidity and mortality. This study aimed to analyze the infection profile during hospitalization and the associated risk factors among patients undergoing autologous HSCT at the University Hospital, Shahid Ghazi Tabatabaei Hospital, Tabriz, Iran. Subjects and Methods: This was a cross-sectional study on patients undergoing autologous HSCT at a public university hospital. Methods: Patients with febrile neutropenia between 2015 and 2018 were retrospectively evaluated regarding their infection profile and associated risk factors. This survey included: bacterial culture and blood culture on specific media. Results: Infection occurred in 57.2% of 56 patients with febrile neutropenia. The main source of infection was the central venous catheter (25.9%). Infection was chiefly due to Gram-positive bacteria, although Gram-negative-related infections were more severe and caused a higher death rate. Sex, age, skin color, nutritional status, and underlying disease were not associated with the development of infection. Patients with severe mucositis (Grades III and IV) had a higher infection rate (P < 0.001). Patients who developed pulmonary complications during hospitalization had higher infection rates (P = 0.002). Infection was the main cause of death (57.1%) in the study sample. Conclusion: Strategies aimed at reducing infection-related mortality rates among patients undergoing autologous HSCT are necessary.

Keywords: hematopoietic stem cell, autologous bone marrow transplantation, infection profile, tabriz, Iran

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Authors: Ramanen Sugunesegran, Michael L. Williams

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Over the past two decades surgical approaches for mitral valve (MV) disease have evolved with the advent of minimally invasive techniques. Robotic mitral valve repair (RMVr) safety and efficacy has been well documented, however, mid- to long-term data are limited. The aim of this review was to provide a comprehensive analysis of the available mid- to long-term term data for RMVr. Electronic searches of five databases were performed to identify all relevant studies reporting minimum 5-year data on RMVr. Pre-defined primary outcomes of interest were overall survival, freedom from MV reoperation and freedom from moderate or worse mitral regurgitation (MR) at 5-years or more post-RMVr. A meta-analysis of proportions or means was performed, utilizing a random effects model, to present the data. Kaplan-Meier curves were aggregated using reconstructed individual patient data. Nine studies totaling 3,300 patients undergoing RMVr were identified. Rates of overall survival at 1-, 5- and 10-years were 99.2%, 97.4% and 92.3%, respectively. Freedom from MV reoperation at 8-years post RMVr was 95.0%. Freedom from moderate or worse MR at 7-years was 86.0%. Rates of early post-operative complications were low with only 0.2% all-cause mortality and 1.0% cerebrovascular accident. Reoperation for bleeding was low at 2.2% and successful RMVr was 99.8%. Mean intensive care unit and hospital stay were 22.4 hours and 5.2 days, respectively. RMVr is a safe procedure with low rates of early mortality and other complications. It can be performed with low complication rates in high volume, experienced centers. Evaluation of available mid-term data post-RMVr suggests favorable rates of overall survival, freedom from MV reoperation and freedom from moderate or worse MR recurrence.

Keywords: mitral valve disease, mitral valve repair, robotic cardiac surgery, robotic mitral valve repair

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Authors: Jorge Martinez, Brandon Roberts, Holly Payton Toca

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Background: Therapeutic hypothermia (TH) is the international standard of care for all comatose patients after cardiac arrest, but criticism focuses on poor outcomes. We sought to develop criteria to identify American urban patients more likely to benefit from TH. Methods: Retrospective chart review of 107 consecutive adults undergoing TH in downtown New Orleans from 2010-2014 yielded records for 99 patients with all 44 survivors or families contacted up to four years. Results: 69 males and 38 females with a mean age of 60.2 showed 63 dead (58%) and 44 survivors (42%). Presenting cardiac rhythm was divided into shockable (Pulseless Ventricular Tachycardia, Ventricular Fibrillation) and non-shockable (Pulseless Electrical Activity, Asystole). Presenting in shockable rhythms with ROSC <20 minutes were 21 patients with 15 (71%) survivors (p=.001). Time >20 minutes until ROSC in shockable rhythms had 5 patients with 3 survivors (78%, p=0.001). Presenting in non-shockable rhythms with ROSC <20 minutes were 54 patients with 18 survivors (33%, p=.001). ROSC >20 minutes in non-shockable rhythms had 19 patients with 2 survivors (8%, p=.001). Survivors of shockable rhythms showed 19 (100%) living post TH. 15 survivors (79%, n=19, p=.001) had CPC score 1 or 2 with 4 survivors (21%, n=19) having a CPC score of 3. A total of 25 survived non-shockable rhythm. Acute survival of patients with non-shockable rhythm showed 18 expired <72 hours (72%, n=25) with long-term survival of 4 patients (5%, n=74) and CPC scores of 1 or 2 (p=.001). Interestingly, patients with time to ROSC <20 minutes exhibiting more than one loss of sustained ROSC showed 100% mortality (p=.001). Patients presenting with shockable >20 minutes ROSC had overall survival of 70% (p=.001), but those undergoing >3 cardiac rhythm changes had 100% mortality (p=.001). Conclusion: Patients presenting with shockable rhythms undergoing TH had overall acute survival of 70% followed by long-term survival of 100% after 4 years. In contrast, patients presenting with non-shockable rhythm had long-term survival of 5%. TH is not recommended for patients presenting with non-shockable rhythm and requiring greater than 20 minutes for restoration of ROSC.

Keywords: cardiac rhythm changes, Pulseless Electrical Activity (PEA), Therapeutic Hypothermia (TH)

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Authors: Parimalakrishnan Sundararjan, Madheswaran Murugan, Dhanya Dharman, Yatindra Kumar, Sudhir Singh Gangwar, Guru Prasad Mohanta

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Antibiotic resistance AR is a global issue, India started to redress the issues of antibiotic resistance late and it plans to have: active surveillance of microbial resistance and promote appropriate use of antibiotics. The present study attempted to achieve appropriate use of antibiotics through pharmacists’ intervention at practice point. In a quasi-experimental prospective cohort study, the cases with bacteremia from four hospitals were identified during 2015 and 2016 for intervention. The pharmacists centered intervention: active screening of each prescription and comparing with the selection of antibiotics with susceptibility of the bacteria. Wherever irrationality noticed, it was brought to the notice of the treating physician for making changes. There were two groups: intervention group and control group without intervention. The active screening and intervention in 915 patients has reduced therapeutic regimen time in patients with bacteremia. The intervention group showed the decreased duration of hospital stay 3.4 days from 5.1 days. Further, multivariate modeling of patients who were in control group showed that patients in the intervention group had a significant decrease in both duration of hospital stay and infection-related mortality. Unlike developed countries, pharmacists are not active partners in patient care in India. This unique attempt of pharmacist’ invention was planned in consultation with hospital authorities which proved beneficial in terms of reducing the duration of treatment, hospital stay, and infection-related mortality. This establishes the need for a collaborative decision making among the health workforce in patient care at least for promoting rational use of antibiotics, an attempt to combat resistance.

Keywords: antibiotics resistance, intervention, bacteremia, multivariate modeling

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Authors: Babar Rasheed

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The organizations are in continuous effort to increase their yield and to retain their associates, employees. Technology is considered an integral part of attaining apposite work practices, work environment, and employee engagement. Unconsciously, these advanced practices like work from home, personalized intra-network are disturbing employee work-life balance which ultimately increases psychological pressure on employees. The smart work practice is to develop business models and organizational practices with enhanced employee engagement, minimum trouncing of organization resources with persistent revenue and positive addition in global societies. Need of smart work practices comes from increasing employee turnover rate, global economic recession, unnecessary job pressure, increasing contingent workforce and advancement in technologies. Current practices are not enough elastic to tackle global changing work environment and organizational competitions. Current practices are causing many reciprocal problems among employee and organization mechanically. There is conscious understanding among business sectors smart work practices that will deal with new century challenges with addressing the concerns of relevant issues. It is aimed in this paper to endorse customized and smart work practice tools along knowledge framework to manage the growing concerns of employee engagement, use of technology, orgaization concerns and challenges for the business. This includes a Smart Management Information System to address necessary concerns of employees and combine with a framework to extract the best possible ways to allocate companies resources and re-align only required efforts to adopt the best possible strategy for controlling potential risks.

Keywords: employees engagement, management information system, psychological pressure, current and future HR practices

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Authors: Ainura Tursunalieva, Irene Hudson

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Continuous improvement of both the quality and safety of health care is an important goal in Australia and internationally. The intensive care unit (ICU) receives patients with a wide variety of and severity of illnesses. Accurately identifying patients at risk of developing complications or dying is crucial to increasing healthcare efficiency. Thus, it is essential for clinicians and researchers to have a robust framework capable of evaluating the risk profile of a patient. ICU scoring systems provide such a framework. The Acute Physiology and Chronic Health Evaluation III and the Simplified Acute Physiology Score II are ICU scoring systems frequently used for assessing the severity of acute illness. These scoring systems collect multiple risk factors for each patient including physiological measurements then render the assessment outcomes of individual risk factors into a single numerical value. A higher score is related to a more severe patient condition. Furthermore, the Mortality Probability Model II uses logistic regression based on independent risk factors to predict a patient’s probability of mortality. An important overlooked limitation of SAPS II and MPM II is that they do not, to date, include interaction terms between a patient’s vital signs. This is a prominent oversight as it is likely there is an interplay among vital signs. The co-existence of certain conditions may pose a greater health risk than when these conditions exist independently. One barrier to including such interaction terms in predictive models is the dimensionality issue as it becomes difficult to use variable selection. We propose an innovative scoring system which takes into account a dependence structure among patient’s vital signs, such as systolic and diastolic blood pressures, heart rate, pulse interval, and peripheral oxygen saturation. Copulas will capture the dependence among normally distributed and skewed variables as some of the vital sign distributions are skewed. The estimated dependence parameter will then be incorporated into the traditional scoring systems to adjust the points allocated for the individual vital sign measurements. The same dependence parameter will also be used to create an alternative copula-based model for predicting a patient’s probability of mortality. The new copula-based approach will accommodate not only a patient’s trajectories of vital signs but also the joint dependence probabilities among the vital signs. We hypothesise that this approach will produce more stable assessments and lead to more time efficient and accurate predictions. We will use two data sets: (1) 250 ICU patients admitted once to the Chui Regional Hospital (Kyrgyzstan) and (2) 37 ICU patients’ agitation-sedation profiles collected by the Hunter Medical Research Institute (Australia). Both the traditional scoring approach and our copula-based approach will be evaluated using the Brier score to indicate overall model performance, the concordance (or c) statistic to indicate the discriminative ability (or area under the receiver operating characteristic (ROC) curve), and goodness-of-fit statistics for calibration. We will also report discrimination and calibration values and establish visualization of the copulas and high dimensional regions of risk interrelating two or three vital signs in so-called higher dimensional ROCs.

Keywords: copula, intensive unit scoring system, ROC curves, vital sign dependence

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Authors: Kunal Mankodi, Sudhir Pandey

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This study aims to assess the factors that play a role in setting up and running a social enterprise driven towards sustainability at the intersection of energy, environment, and poverty alleviation. According to the theory of sustainability-oriented innovation (SOI), conventional organisations adapt their processes to focus on sustainability-oriented innovations. On the other hand, social enterprises that are purpose-driven are also influenced by the context of innovation, which need due attention. This paper presents an account of innovation at Oorja - an Indian social enterprise operating with a farming-as-a-service business model. It aims to illustrate the contexts in which the innovative solutions were developed to work at an intersection between agriculture and clean energy, thereby allowing small farmers access to efficient solutions in the agriculture cycle. Primary data was collected through in-depth interviews, and secondary data was collected from company sources. The study finds that in the case of a social enterprise, the definition of innovation assumes a wider scope by going beyond the introduction of a new product/service. The context of innovation for social enterprise is affected by organisational factors such as organisation’s philosophical mindset, behaviour towards innovation, organisation’s capabilities, regulatory environment, and customer receptiveness. Additionally, the study also finds that the context of innovation for a social enterprise is affected by its organizational structure. A majority of these organizational factors are, in turn, affected by individual (Founder’s) factors such as the founder’s formative years, education, direct exposure to relevant issues, complementary skills of co-founders, and a common calling.

Keywords: context of innovation, social enterprise, sustainability oriented innovations, emerging markets, agriculture

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Authors: Po-Ching Chou, Wen-Chen Liang, I. Chen Chen, Jong-Hau Hsu, Yuh-Jyh Jong

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Background：Cardiopulmonary complications seem to cause high morbidity and mortality in patients with neuromuscular diseases (NMD) but so far there is no domestic data reported in Taiwan. We, therefore attempted to analyze the factors to cause the death in NMD patients from our cohort. Methods：From 1998 to 2013, we retrospectively collected the information of the NMD patients treated and followed up in Kaohsiung Medical University Hospital. Forty-two patients with NMD who expired during these fifteen years were enrolled. The medical records of these patients were reviewed and the causes of death and the associated affecting factors were analyzed. Results：Eighteen patients with NMD (mean age=13.3, SD=12.4) with complete medical record and detailed information were finally included in this study, including spinal muscular atrophy (SMA) (n=9, 7/9: type 1), Duchenne muscular dystrophy (n=6), congenital muscular dystrophy (n=1), carnitine acyl-carnitine translocase (CACT) deficiency (n=1) and spinal muscular atrophy with respiratory distress (SMARD)(n=1). The place of death was in ICU (n=11, 61%), emergency room (n=3, 16.6%) or home (n=4, 22.2%). For SMA type 1 patients, most of them (71.4%, 5/7) died in emergency room or home and the other two expired during an ICU admission. The causes of death included acute respiratory failure due to pneumonia (n=13, 72.2 %), ventilator failure or dislocation (n=2, 11.1%), suffocation/choking (n=2, 11.1%), and heart failure with hypertrophic cardiomyopathy (n=1, 5.55%). Among the 15 patients died of respiratory failure or choking, 73.3% of the patients (n=11) received no ventilator care at home. 80% of the patients (n=12) received no cough assist at home. The patient died of cardiomyopathy received no medications for heart failure until the last admission. Conclusion: Respiratory failure and choking are the leading causes of death in NMD patients. Appropriate respiratory support and airway clearance play the critical role to reduce the mortality.

Keywords: neuromuscular disease, cause of death, tertiary care hospital, medical sciences

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Authors: Priyanka Botny Srinath, Alessandro Suglia, Mel McKendrick

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Background: Organizational cultural studies integrate sociology and anthropology, portraying man as a creator of symbols, languages, beliefs, and ideologies -essentially, a creator and manager of meaning. In our research, we leverage analytical measures to discern whether an organization embodies a singular culture or a myriad of subcultures. Fast-forward to 2023, our research thesis focuses on digitally measuring culture, coining it as the "Work Culture Quotient." This entails conceptually mapping common experiential patterns to provide executives insights into the digital organization journey, aiding in understanding their current position and identifying future steps. Objectives: Finding the new age skills that help in defining the culture; understand the implications of post-COVID effects; derive a digital framework for measuring skillsets. Method: We conducted two comprehensive Delphi studies to distill essential insights. Delphi 1: Through a thematic analysis of interviews with 20 high-level leaders representing companies across diverse regions -India, Japan, the US, Canada, Morocco, and Uganda- we identified 20 key skills critical for cultivating a robust organizational culture. The skills are -influence, self-confidence, optimism, empathy, leadership, collaboration and cooperation, developing others, commitment, innovativeness, leveraging diversity, change management, team capabilities, self-control, digital communication, emotional awareness, team bonding, communication, problem solving, adaptability, and trustworthiness. Delphi 2: Subject matter experts were asked to complete a questionnaire derived from the thematic analysis in stage 1 to formalise themes and draw consensus amongst experts on the most important workplace skills. Results: The thematic analysis resulted in 20 workplace employee skills being identified. These skills were all included in the Delphi round 2 questionnaire. From the outputs, we analysed the data using R Studio for arriving at agreement and consensus, we also used sum of squares method to compare various agreements to extract various themes with a threshold of 80% agreements. This yielded three themes at over 80% agreement (leadership, collaboration and cooperation, communication) and three further themes at over 60% agreement (commitment, empathy, trustworthiness). From this, we selected five questionnaires to be included in the primary data collection phase, and these will be paired with the digital footprints to provide a workplace culture quotient. Implications: The findings from these studies bear profound implications for decision-makers, revolutionizing their comprehension of organizational culture. Tackling the challenge of mapping the digital organization journey involves innovative methodologies that probe not only external landscapes but also internal cultural dynamics. This holistic approach furnishes decision-makers with a nuanced understanding of their organizational culture and visualizes pivotal skills for employee growth. This clarity enables informed choices resonating with the organization's unique cultural fabric. Anticipated outcomes transcend mere individual cultural measurements, aligning with organizational goals to unveil a comprehensive view of culture, exposing artifacts and depth. Armed with this profound understanding, decision-makers gain tangible evidence for informed decision-making, strategically leveraging cultural strengths to cultivate an environment conducive to growth, innovation, and enduring success, ultimately leading to measurable outcomes.

Keywords: leadership, cooperation, collaboration, teamwork, work culture

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Authors: Miraç Savaş Turhan, Ali Danişman

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Recently scholars of new institutional theory have used institutional logics perspective to explain the contradictory practices in modern western societies. Accordingly, distinct institutional logics are embedded in central institutions such as the market, state, democracy, family, and religion. They guide individual and organizational actors and constraint their behaviors in a particular organizational field. Through this perspective, actors are assumed to have a situated, embedded, boundedly intentional, and adaptive role against the structure in social, cultural and political context. On the other hand, over a decade, there is an emerging attempt focusing on the role of actors on creating, maintaining, and changing the institutions. Such attempts brought out the concept of institutional entrepreneurs to explain the role of individual actors in relation to institutions. Institutional entrepreneurs are individuals, groups of individuals, organizations or groups of organizations that are able to initiate some actions to build, maintain or change institutions. While recent studies on institutional logics perspective have attempted to explain roles of entrepreneurial actors who have resources and skills, little is known about the effects of multiple institutional logics on the ability of institutional entrepreneurs. In this study, we aim to find out that how multiple institutional logics affect the ability of institutional entrepreneurs during the process of institutional change. We examine this issue in the Turkish Education Field. While institutional logics were identified based on the previous studies in the education field, the actions taken by Turkish National Education Ministry from 2003 to 2013 was examined through content analysis The early results indicate that there are remarkable shift and contradictions in the ability of institutional entrepreneur in taking actions to change the field in relationship to balance of power shift among the carriers of institutional logics.

Keywords: institutional theory, institutional logics, institutional entrepreneurs, Turkish national education

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Authors: Amy Y. Wang, Eko L. Yi

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Can vicarious experiences of workplace ostracism affect employees’ willingness to voice? Given the increasingly interdependent nature of the modern workplace in which employees rely on social interactions to fulfill organizational goals, workplace ostracism –the extent to which an individual perceives that he or she is ignored or excluded by others in the workplace– has garnered significant interest from scholars and practitioners alike. Extending beyond conventional studies that largely focus on the perspectives and outcomes of ostracized targets, we address the indirect effects of workplace ostracism on third-party employees embedded in the same social context. Using a social information processing approach, we propose that the ostracism of coworkers acts as political information that influences third-party employees in their decisions to engage in risky and discretionary behaviors such as employee voice. To make sense of and to navigate through experiences of workplace ostracism, we posit that both political understanding and political skill allow third party employees to minimize the risks and uncertainty of voicing. This conceptual model was tested by a study involving 154 supervisor-subordinate dyads of a publicly listed bio-technology firm located in Mainland China. Each supervisor and their direct subordinates composed of a work team; each team had a minimum of two subordinates and a maximum of four subordinates. Human resources used the master list to distribute the ID coded questionnaires to the matching names. All studied constructs were measured using existing scales proved effective in previous literature. Hypotheses were tested using Confirmatory Factor Analysis and Hierarchal Multiple Regression. All three hypotheses were supported which showed that employees were less likely to engage in voice behaviors when their coworkers reported having experienced ostracism in the workplace. Results also showed a significant three-way interaction between political understanding and political skill on the relationship between coworkers’ ostracism and employee voice, indicating that political savviness is a valuable resource in mitigating ostracism’s negative and indirect effects. Our results illustrated that an employee’s coworkers being ostracized indeed adversely impacted his or her own voice behavior. However, not all individuals reacted passively to the social context; rather, we found that politically savvy individuals – possessing both political understanding and political skill – and their voice behaviors were less impacted by ostracism in their work environment. At the same time, we found that having only political understanding or only political skill was significantly less effective in mitigating ostracism’s negative effects, suggesting a necessary duality of political knowledge and political skill in combatting ostracism. Organizational implications, recommendations, and future research ideas are also discussed.

Keywords: employee voice, organizational politics, social information processing, workplace ostracism

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Authors: Saeeda Batool, Ather Maqsood Ahmed

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This study investigates the impact of public healthcare facilities and socio-economic circumstances on the status of child health in Pakistan. The complete analysis is carried out in correspondence with fourth and sixth millennium development goals. Further, the health variables chosen are also inherited from targeted indicators of the mentioned goals (MDGs). Trends in the Human Opportunity Index (HOI) for both health inequalities and coverage are analyzed using the Pakistan Social and Living Standards Measurement (PLSM) data set for 2001-02 to 2012-13 at the national and provincial level. To reveal the relative importance of each circumstance in achieving the targeted values for child health, Shorrocks decomposition is applied on HOI. The annual point average growth rate of HOI is used to simulate the time period for the achievement of target set by MDGs and universal access also. The results indicate an improvement in HOI for a reduction in child mortality rates from 52.1% in 2001-02 to 67.3% in 2012-13, which confirms the availability of healthcare opportunities to a larger segment of society. Similarly, immunization against measles and other diseases such as Diphtheria, Polio, Bacillus Calmette-Guerin (BCG), and Hepatitis has also registered an improvement from 51.6% to 69.9% during the period of study at the national level. On a positive note, no gender disparity has been found for child health indicators and that health outcome is mostly affected by the parental and geographical features and availability of health infrastructure. However, the study finds that this achievement has been uneven across provinces. Pakistan is not only lagging behind in achieving its health goals, disappointingly with the current rate of health care provision, but it will take many additional years to achieve its targets.

Keywords: socio-economic circumstances, unmet MDGs, public healthcare services, child and infant mortality

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Authors: Shariffah Dawood

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During the past decade, workplace bullying has attracted increasing attention from researchers internationally as it is reported to be a major social problem and has severe consequences towards the job satisfaction and health of victims and towards the organization. It is characterized by “systematic aggression or violence targeted towards one or more individuals by one individual or by a group, consists of repeated and enduring acts, and the target is or ends up in an inferior position from which it is difficult to defend oneself.” Despite the seriousness of workplace bullying, not all sectors have received the same degree of scholarly attention. Most studies have been undertaken in the public and private sectors, such as, in hospitals, universities, retail industry, local council, and restaurant kitchens. The nonprofit sector has received limited attention despite its significant economic and social role in the society. In order to understand the nature of workplace bullying in non-profit sector, this research explored 29 British nonprofit organizations through surveys and interviews. Despite the nonprofit sector’s emphasis on an egalitarianism ethos, their reputation to be the defenders of the most vulnerable/disadvantaged and the perception that they are protected from such negative behaviors in the workplace, the findings uncovered pertinent factors that make this sector highly vulnerable towards workplace bullying. Overall, the study identifies some organizational factors which need to be addressed in order to curb bullying in this sector: management commitment towards a zero-tolerance bullying policy; management training in areas such as conflict resolution, organizational changes, and maintenance of the commitment of a conscientious workforce. The researcher further recommends that the nonprofit organizations work towards improving relationships with voluntary board members and funding bodies. The researcher will also outline the second phase of the study, which aims to investigate bullying in the nonprofit sector across cultures (the USA, Malaysia and Japan), and implications for the research will be identified.

Keywords: nonprofit sector, workplace bullying, harassment, management, HRM

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Authors: David Maman, David E. Rothem, Merav Ben Natan, Yaron Berkovich

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Introduction: Hip fractures are a major health concern due to their impact on disability, independence, and mortality. Timely rehabilitation is crucial for improving patient outcomes and reducing healthcare costs, yet delays in rehabilitation, often due to challenges in discharge processes, can lead to adverse events and increased healthcare burdens. Aim: The study aimed to investigate two primary aspects related to hip fracture older adults patients: firstly, identifying subgroups more prone to delayed discharge for further rehabilitation; and secondly, exploring the consequences of this delay on short-term outcomes and the incidence of adverse events. Methods: Conducting a retrospective analysis, we examined the medical records of 474 patients aged 65 and older, hospitalized for hip fractures between 2018 and 2022 in a major hospital in the north-central region of Israel. All patients were eligible for further rehabilitation, including options for in-patient or home-based care. Results: Of the studied patients, 61.4% experienced delayed discharge, with an average waiting period of 3.5 days. Factors such as older age, prolonged hospital stay, and the need for in-patient rehabilitation were associated with a higher likelihood of delayed discharge. Those promptly discharged demonstrated lower rates of infections, falls, and mortality. Furthermore, delayed discharge to further rehabilitation correlated with elevated hospitalization costs. Notably, no significant differences were observed in re-hospitalization or repeat surgery rates. Conclusion: This study underscores the pressing need for efficient strategies to ensure timely rehabilitation, particularly for older adults. Implementing such strategies can optimize outcomes, mitigate adverse events, and contribute to a reduction in healthcare costs.

Keywords: hip fracture rehabilitation, delayed discharge, older adults, healthcare coordination, adverse events

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Authors: Yibeltal T. Bayou, Yohana S. Mashalla, Gloria Thupayagale-Tshweneagae

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Background: Maternal mortality has been shown to be lower in urban areas than in rural areas. However, disparities for the fast-growing population of urban poor who struggle as much their rural counterparts to access quality healthcare are masked by the urban averages. The aim of this paper is to report on the findings of antenatal adequacy among slum residents in Addis Ababa, Ethiopia. Methods and Materials: A quantitative and cross-sectional community-based study design was employed. A stratified two-stage cluster sampling technique was used to determine the sample and data was collected using structured questionnaire administered to 837 women aged 15-49 years. Binary logistic regression models were employed to identify predictors of adequacy of antenatal care. Results: The majority of slum residents did not have adequate antenatal care services i.e., only 50.7%, 19.3% and 10.2% of the slum resident women initiated early antenatal care, received adequate antenatal care service contents and had overall adequate antenatal care services. Pregnancy intention, educational status and place of ANC visits were important determinant factors for adequacy of ANC in the study area. Women with secondary and above educational status were 2.9 times more likely to have overall adequate care compared to those with no formal education. Similarly, women whose last pregnancy was intended and clients of private healthcare facilities were 1.8 and 2.8 times more likely to have overall adequate antenatal care compared to those whose last pregnancy was unintended and clients of public healthcare facilities respectively. Conclusion: In order to improve ANC adequacy in the study area, the policymaking, planning, and implementation processes should focus on the poor adequacy of ANC among the disadvantaged groups in particular and the slum residents in general.

Keywords: Addis Ababa, adequacy of antenatal care, slum residents, maternal mortality

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