Search results for: risk management failure

Authors: M. Mokhber, J. Hedayati

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From the managerial perspective, it is important to devise an operational plan based on top priorities due to limited resources, diversity of measures and high costs needed to improve safety in infrastructure. Dealing with the high-risk corridors across Iran, this study prioritized the corridors according to statistical data on accidents involving fatalities, injury or damage over three consecutive years. In collaboration with the Iranian Police Department, data were collected and modified. Then, the prioritization criteria were specified based on the expertise opinions and international standards. In this study, the prioritization criteria included accident severity and accident density. Finally, the criteria were standardized and weighted (equal weights) to score each high-risk corridor. The prioritization phase involved the scoring and weighting procedure. The high-risk corridors were divided into twelve groups out of 50. The results of data analysis for a three-year span suggested that the first three groups (150 corridors) along with a quarter of Iranian road network length account for nearly 60% of traffic accidents. In the next step, according to variables including weather conditions particular roads for the purpose of winter safety measures were extracted from the abovementioned categories. According to the results ranking, ‎‏9‏‎ roads with the overall ‎length of about ‎‎‏1000‏‎ Km of high-risk corridors are considered as preferences of ‎safety measures‎.

Keywords: high-risk corridors, HRCs, road safety rating, road scoring, winter safety measures

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Authors: Vajhollah Ghorbanizadeh, Seyed Mohsen Asadi, Mirali Seyednaghavi, Davoud Hoseynpour

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In the current era, all organizations need knowledge to be able to manage the diverse human resources. Creative, dynamic and knowledge-based Human resources are important competitive advantage and the scarcest resource in today's knowledge-based economy. In addition managers with skills of knowledge management must be aware of human resource management science. It is now generally accepted that successful implementation of knowledge management requires dynamic interaction between knowledge management and human resource management. This is emphasized at systematic approach to knowledge management as well. However human resource management can be complementary of knowledge management because human resources management with the aim of empowering human resources as the key resource organizations in the 21st century, the use of other resources, creating and growing and developing today. Thus, knowledge is the major capital of every organization which is introduced through the process of knowledge management. In this context, knowledge management is systematic approach to create, receive, organize, access, and use of knowledge and learning in the organization. This article aims to define and explain the concepts of knowledge management and human resource management and the importance of these processes and concepts. Literature related to knowledge management and human resource management as well as related topics were studied, then to design, illustrate and provide a theoretical model to explain the factors affecting the relationship between knowledge management and human resource management and knowledge management system approach, for schematic design and are drawn.

Keywords: systemic approach, human resources, knowledge, human resources management, knowledge management

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Authors: Muhammad Sheraz, Vasile Preda, Silvia Dedu

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Concepts of econophysics are usually used to solve problems related to uncertainty and nonlinear dynamics. In the theory of option pricing the risk neutral probabilities play very important role. The application of entropy in finance can be regarded as the extension of both information entropy and the probability entropy. It can be an important tool in various financial methods such as measure of risk, portfolio selection, option pricing and asset pricing. Gulko applied Entropy Pricing Theory (EPT) for pricing stock options and introduced an alternative framework of Black-Scholes model for pricing European stock option. In this article, we present solutions to maximum entropy problems based on Tsallis, Weighted-Tsallis, Kaniadakis, Weighted-Kaniadakies entropies, to obtain risk-neutral densities. We have also obtained the value of European call and put in this framework.

Keywords: option pricing, Black-Scholes model, Tsallis entropy, Kaniadakis entropy, weighted entropy, risk-neutral density

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Authors: Dana Cassandra Winkler, Delia Leiding, Rene Bergs, Franziska Kaiser, Ramona Kirchhart, Ute Habel

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Background: Violence is a multidimensional phenomenon, affecting people of every age, socio-economic status and gender. Nevertheless, most studies primarily focus on men perpetrating women. Aim of the present study is to identify the likelihood of mental and somatic disorders and risk-taking behavior in male violence affected. In addition, the relationship between age of violence experience and the risk for health-related problems was analyzed. Method: On the basis of current evidence, a questionnaire was developed focusing on demographic background, health status, risk-taking behavior, and active and passive violence exposure. In total, 5221 males (Mean: 56,1 years, SD: 17,6) were consulted. To account for the time of violence experience in an efficient way, age clusters ‘0-12 years’, ‘13-20 years’, ‘21-35 years’, ‘36-65 years’ and ‘over 65 years’ were defined. A binary logistic regression was calculated to reveal differences in violence-affected and non-violence affected males regarding health and risk-taking factors. Males who experienced violence on a daily/ almost daily basis vs. males who reported violence occurrence once/ several times a month/ year were compared with respect to health factors and risk-taking behavior. Data of males, who indicated active and passive violence exposure, were analyzed by a chi²-analysis, to investigate a possible relation between the age of victimization and violence perpetration. Findings: Results imply that general violence experience, independent of active and passive violence exposure increases the likelihood in favor of somatic-, psychosomatic- and mental disorders as well as risk-taking behavior in males. Experiencing violence on a daily or almost daily basis in childhood and adolescence may serve as a predictor for increased health problems and risk-taking behavior. Furthermore, the violence experience and perpetration occur significantly within the same age cluster. This underlines the importance of a near-term intervention to minimize the risk, that victims become perpetrators later. Conclusion: The present study reveals predictors concerning health risk factors as well as risk-taking behavior in males with violence exposure. The results of this study may underscore the benefit of intervention and regular health care approaches in violence-affected males and underline the importance of acknowledging the overlap of violence experience and perpetration for further research.

Keywords: health disease, male, mental health, prevalence, risk-taking behavior, violence

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Authors: Alisher Agzamov, Hanan Al Harbi

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BACKGROUND: The timely assessment and treatment of ICU Surgical and Medical Oncology patients is important for Oncology surgeons and Medical Oncologists and Intensivists (1). We hypothesized that the use of Robot Physician’s (RP - 7) ICU management and care in ICU can improve ICU physician rapid response to unstable ICU Oncology patients. METHODS: This is a prospective study of 1501 oncology patients using a before-after, cohort-control design to test the effectiveness of RP. We have used RP to make multidisciplinary ICU rounds in the ICU and for Emergency cases. Data concerning several aspects of the RP interaction, including the latency of the response, the problem being treated, the intervention that was ordered, and the type of information gathered using the RP, were documented. The effect of RP on ICU length of stay and cost was assessed. RESULTS: The use of RP was associated with a reduction in latency of attending physician face-to-face response for routine and urgent pages compared to conventional care (RP: 10.2 +/- 3.3 minutes vs conventional: 210 +/- 40 minutes). The response latencies to Oncology Emergency (8.0 +/- 2.8 vs 140 +/- 35 minutes) and for Respiratory Failure (12 +/- 04 vs 110 +/- 45 minutes) were reduced (P < .001), as was the LOS for oncology patients (5 days) and ARDS (10 day). There was an increase in ICU occupancy by 29 % compared with the prerobot era, and there was an ICU cost savings of KD2.2 million attributable to the use of RP. CONCLUSION: The use of RP enabled rapid face-to-face ICU Intensivist - physician response to unstable ICU Oncology patients and resulted in decreased ICU cost and LOS.

Keywords: robot physician, oncology patients, icu management and care, cost and icu occupancy

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Authors: Alon Cohen, Jeffrey Kantor, Shalom Levy

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The use of the audit risk model in auditing has faced limitations and difficulties, leading auditors to rely on a conceptual level of its application. The qualitative approach to assessing risks has resulted in different risk assessments, affecting the quality of audits and decision-making on the adoption of CAATTs. This study aims to investigate risk factors impacting the implementation of the audit risk model and propose a complementary risk-based instrument (KRIs) to form substance risk judgments and mitigate against heightened risk of material misstatement (RMM). The study addresses the question of how risk factors impact the implementation of the audit risk model, improve risk judgments, and aid in the adoption of CAATTs. The study uses a three-stage scale development procedure involving a pretest and subsequent study with two independent samples. The pretest involves an exploratory factor analysis, while the subsequent study employs confirmatory factor analysis for construct validation. Additionally, the authors test the ability of the KRIs to predict audit efforts needed to mitigate against heightened RMM. Data was collected through two independent samples involving 767 participants. The collected data was analyzed using exploratory factor analysis and confirmatory factor analysis to assess scale validity and construct validation. The suggested KRIs, comprising two risk components and seventeen risk items, are found to have high predictive power in determining audit efforts needed to reduce RMM. The study validates the suggested KRIs as an effective instrument for risk assessment and decision-making on the adoption of CAATTs. This study contributes to the existing literature by implementing a holistic approach to risk assessment and providing a quantitative expression of assessed risks. It bridges the gap between intuitive risk evaluation and the theoretical domain, clarifying the mechanism of risk assessments. It also helps improve the uniformity and quality of risk assessments, aiding audit standard-setters in issuing updated guidelines on CAATT adoption. A few limitations and recommendations for future research should be mentioned. First, the process of developing the scale was conducted in the Israeli auditing market, which follows the International Standards on Auditing (ISAs). Although ISAs are adopted in European countries, for greater generalization, future studies could focus on other countries that adopt additional or local auditing standards. Second, this study revealed risk factors that have a material impact on the assessed risk. However, there could be additional risk factors that influence the assessment of the RMM. Therefore, future research could investigate other risk segments, such as operational and financial risks, to bring a broader generalizability to our results. Third, although the sample size in this study fits acceptable scale development procedures and enables drawing conclusions from the body of research, future research may develop standardized measures based on larger samples to reduce the generation of equivocal results and suggest an extended risk model.

Keywords: audit risk model, audit efforts, CAATTs adoption, key risk indicators, sustainability

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Authors: Iftikhar Ahmad, Youssef Elkezza

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Sarir oilfield is in North Africa. It has facilities for oil and gas production. The assets of the Sarir oilfield can be divided into five following categories, namely: (i) well bore and wellheads; (ii) vessels such as separators, desalters, and gas processing facilities; (iii) pipelines including all flow lines, trunk lines, and shipping lines; (iv) storage tanks; (v) other assets such as turbines and compressors, etc. The nature of the petroleum industry recognizes the potential human, environmental and financial consequences that can result from failing to maintain the integrity of wellheads, vessels, tanks, pipelines, and other assets. The importance of effective asset integrity management increases as the industry infrastructure continues to age. The primary objective of assets integrity management (AIM) is to maintain assets in a fit-for-service condition while extending their remaining life in the most reliable, safe, and cost-effective manner. Corrosion management is one of the important aspects of successful asset integrity management. It covers corrosion mitigation, monitoring, inspection, and risk evaluation. External corrosion on pipelines, well bores, buried assets, and bottoms of tanks is controlled with a combination of coatings by cathodic protection, while the external corrosion on surface equipment, wellheads, and storage tanks is controlled by coatings. The periodic cleaning of the pipeline by pigging helps in the prevention of internal corrosion. Further, internal corrosion of pipelines is prevented by chemical treatment and controlled operations. This paper describes the integrity management system used in the Sarir oil field for its oil and gas production facilities based on standard practices of corrosion mitigation and inspection.

Keywords: assets integrity management, corrosion prevention in oilfield assets, corrosion management in oilfield, corrosion prevention, inspection activities

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Authors: Ellis Kofi Akwaa-Sekyi, Jordi Moreno Gené

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Managerial actions which negatively profile banks and impair corporate reputation are addressed through effective internal control systems. Disregard for acceptable standards and procedures for granting credit have affected bank loan portfolios and could be cited for the crises in some European countries. The study intends to determine the effectiveness of internal control systems, investigate whether perceived agency problems exist on the part of board members and to establish the relationship between internal controls and credit risk among listed banks in the European Union. Drawing theoretical support from the behavioural compliance and agency theories, about seventeen internal control variables (drawn from the revised COSO framework), bank-specific, country, stock market and macro-economic variables will be involved in the study. A purely quantitative approach will be employed to model internal control variables covering the control environment, risk management, control activities, information and communication and monitoring. Panel data from 2005-2014 on listed banks from 28 European Union countries will be used for the study. Hypotheses will be tested and the Generalized Least Squares (GLS) regression will be run to establish the relationship between dependent and independent variables. The Hausman test will be used to select whether random or fixed effect model will be used. It is expected that listed banks will have sound internal control systems but their effectiveness cannot be confirmed. A perceived agency problem on the part of the board of directors is expected to be confirmed. The study expects significant effect of internal controls on credit risk. The study will uncover another perspective of internal controls as not only an operational risk issue but credit risk too. Banks will be cautious that observing effective internal control systems is an ethical and socially responsible act since the collapse (crisis) of financial institutions as a result of excessive default is a major contagion. This study deviates from the usual primary data approach to measuring internal control variables and rather models internal control variables in a quantitative approach for the panel data. Thus a grey area in approaching the revised COSO framework for internal controls is opened for further research. Most bank failures and crises could be averted if effective internal control systems are religiously adhered to.

Keywords: agency theory, credit risk, internal controls, revised COSO framework

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Authors: Iacopo Carnacina, Mohammad Keshtpoor, Richard Yablonsky

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Non-structural protection measures against flooding are becoming increasingly popular flood risk mitigation strategies. In particular, coastal flood insurance impacts not only private citizens but also insurance and reinsurance companies, who may require it to retain solvency and better understand the risks they face from a catastrophic coastal flood event. In this context, a framework is presented here to assess the risk for coastal flooding across the UK. The area has a long history of catastrophic flood events, including the Great Flood of 1953 and the 2013 Cyclone Xaver storm, both of which led to significant loss of life and property. The current framework will leverage a technology based on a hydrodynamic model (Delft3D Flexible Mesh). This flexible mesh technology, coupled with a calibration technique, allows for better utilisation of computational resources, leading to higher resolution and more detailed results. The generation of a stochastic set of extra tropical cyclone (ETC) events supports the evaluation of the financial losses for the whole area, also accounting for correlations between different locations in different scenarios. Finally, the solution shows a detailed analysis for the Thames River, leveraging the information available on flood barriers and levees. Two realistic disaster scenarios for the Greater London area are simulated: In the first scenario, the storm surge intensity is not high enough to fail London’s flood defences, but in the second scenario, London’s flood defences fail, highlighting the potential losses from a catastrophic coastal flood event.

Keywords: storm surge, stochastic model, levee failure, Thames River

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Authors: Ali Musbah Mohamed Elwahishi

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Democracy is demand for the majority of people in the whole world, Specifically in the regions that are still outside the democratic life such as Libya and other Arab countries. Although democracy has spread across the world through three waves of democratization, Libya is still outside the democratic process, even recently its regime has changed. The challenges of democracy in Libya are not new, they represent accumulations over time that impeded to achieve this goal. This paper concludes that the absence of democracy in Libya because of set of factors that include: colonial legacy, oil wealth, the lack of institutions, the lack of political parties, tribal factor and recently the spread of the armed groups. These factors prevented Libya to be democratic state whether during King Idris’, Qaddafi’s or even after Qaddafi rule.

Keywords: the failure of democracy, political transition, the lack of institutions, Libya, Arab countries

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Authors: Juan Carlos Montalvo-Rodriguez, Juan Felipe Espinosa-Cristia, Pablo Islas Madariaga, Jorge Cifuentes Valenzuela

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This article presents different relationships between top management and innovative companies, based on the developments of creativity and innovation management. First of all, it contextualizes the innovative company in relation to management, creativity, and innovation. Secondly, it delves into the vision of top management of innovative companies, from the perspectives of the management of creativity and innovation. Thirdly, their commonalities are highlighted, bearing in mind the importance that both approaches attribute to aspects such as leadership, networks, strategy, culture, technology, environment, and complexity in the top management of innovative companies. Based on the above, an integration of both fields of study is proposed, as an alternative to deepen the relationship between senior management and the innovative company.

Keywords: top management, creativity, innovation, innovative firm, leadership, strategy

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Authors: Lokesh Varshney, R. K. Saket

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This paper presents reliability indices evaluation of the rotor core magnetization of the induction motor operated as a self-excited induction generator by using probability distribution approach and Monte Carlo simulation. Parallel capacitors with calculated minimum capacitive value across the terminals of the induction motor operating as a SEIG with unregulated shaft speed have been connected during the experimental study. A three phase, 4 poles, 50Hz, 5.5 hp, 12.3A, 230V induction motor coupled with DC Shunt Motor was tested in the electrical machine laboratory with variable reactive loads. Based on this experimental study, it is possible to choose a reliable induction machine operating as a SEIG for unregulated renewable energy application in remote area or where grid is not available. Failure density function, cumulative failure distribution function, survivor function, hazard model, probability of success and probability of failure for reliability evaluation of the three phase induction motor operating as a SEIG have been presented graphically in this paper.

Keywords: residual magnetism, magnetization curve, induction motor, self excited induction generator, probability distribution, Monte Carlo simulation

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Authors: Saeed Pourhassan, Nastaran Maghbouli

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Statement of the problem: The relationship between obesity and cardiovascular diseases has been studied widely(1). The distribution of fat tissue gained attention in relation to cardiovascular risk factors during lang-time research (2). American College of Cardiology/American Heart Association (ACC/AHA) is widely and the most reliable tool to be used as a cardiovascular risk (CVR) assessment tool(3). This study aimed to determine which anthropometric index is better in discrimination of high CVR patients from low risks using ACC/AHA score in addition to finding the best index as a CVR predictor among both genders in different races and countries. Methodology & theoretical orientation: The literature in PubMed, Scopus, Embase, Web of Science, and Google Scholar were searched by two independent investigators using the keywords "anthropometric indices," "cardiovascular risk," and "obesity." The search strategy was limited to studies published prior to Jan 2022 as full-texts in the English language. Studies using ACC/AHA risk assessment tool as CVR and those consisted at least 2 anthropometric indices (ancient ones and novel ones) are included. Study characteristics and data were extracted. The relative risks were pooled with the use of the random-effect model. Analysis was repeated in subgroups. Findings: Pooled relative risk for 7 studies with 16,348 participants were 1.56 (1.35-1.72) for BMI, 1.67(1.36-1.83) for WC [waist circumference], 1.72 (1.54-1.89) for WHR [waist-to-hip ratio], 1.60 (1.44-1.78) for WHtR [waist-to-height ratio], 1.61 (1.37-1.82) for ABSI [A body shape index] and 1.63 (1.32-1.89) for CI [Conicity index]. Considering gender, WC among females and WHR among men gained the highest RR. The heterogeneity of studies was moderate (α²: 56%), which was not decreased by subgroup analysis. Some indices such as VAI and LAP were evaluated just in one study. Conclusion & significance: This meta-analysis showed WHR could predict CVR better in comparison to BMI or WHtR. Some new indices like CI and ABSI are less accurate than WHR and WC. Among women, WC seems to be a better choice to predict cardiovascular disease risk.

Keywords: obesity, cardiovascular disease, risk assessment, anthropometric indices

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Authors: I. Szer, J. Szer, M. Pieńko, A. Robak, P. Jamińska-Gadomska

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Work at height, such as construction works on scaffoldings, is associated with a considerable risk. Scaffolding workers are usually exposed to changing weather conditions what can additionally increase the risk of dangerous situations. Therefore, it is very important to foresee the risk of adverse conditions to which the worker may be exposed. The data from meteorological stations may be used to asses this risk. However, the dependency between weather conditions on a scaffolding and in the vicinity of meteorological station, should be determined. The paper presents an analysis of two selected environmental parameters which have influence on the behavior of workers – air temperature and wind speed. Measurements of these parameters were made between April and November of 2016 on ten scaffoldings located in different parts of Poland. They were compared with the results taken from the meteorological stations located closest to the studied scaffolding. The results gathered from the construction sites and meteorological stations were not the same, but statistical analyses have shown that they were correlated.

Keywords: scaffolding, health and safety at work, temperature, wind velocity

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Authors: Bryan Jenkins

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

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

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Authors: Seyyed Mohammad Hasheminia, Heoung Jae Chun, Jong Chan Park, Hong Suk Chang

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Composite joints have been getting attention recently due to their high specific mechanical strength to weight ratio that is crucial for structures such as aircrafts and automobiles. In this study on hybrid joints, quasi-static experiments and finite element analysis were performed to investigate the failure mechanism of hybrid composite joint with respect to the joint properties such as the adhesive material, clamping force, and joint geometry. The outcomes demonstrated that the stiffness of the adhesive is the most imperative design parameter. In this investigation, two adhesives with various stiffness values were utilized. Regarding the joints utilizing the adhesive with the lower stiffness modulus, it was observed that the load was exchanged promptly through the adhesive since it was shared more proficiently between the bolt and adhesive. This phenomenon permitted the hybrid joints with low-modulus adhesive to support more prominent loads before failure when contrasted with the joints that utilize the stiffer adhesive. In the next step, the stress share between the bond and bolt as a function of various design parameters was studied using a finite element model in which it was understood that the geometrical parameters such as joint overlap and width have a significant influence on the load sharing between the bolt and the adhesive.

Keywords: composite joints, composite materials, hybrid joints, single-lap joint

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Authors: Benjamin J. Kuo, Silvia D. Vaca, Joao Ricardo Nickenig Vissoci, Catherine A. Staton, Linda Xu, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, Joel Kiryabwire, Lydia Nanjula, Christine Muhumuza, Henry E. Rice, Gerald A. Grant, Michael M. Haglund

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Background: Traumatic Brain Injury (TBI) is disproportionally concentrated in low- and middle-income countries (LMICs), with the odds of dying from TBI in Uganda more than 4 times higher than in high income countries (HICs). The disparities in the injury incidence and outcome between LMICs and resource-rich settings have led to increased health outcomes research for TBIs and their associated risk factors in LMICs. While there have been increasing TBI studies in LMICs over the last decade, there is still a need for more robust prospective registries. In Uganda, a trauma registry implemented in 2004 at the Mulago National Referral Hospital (MNRH) showed that RTI is the major contributor (60%) of overall mortality in the casualty department. While the prior registry provides information on injury incidence and burden, it’s limited in scope and doesn’t follow patients longitudinally throughout their hospital stay nor does it focus specifically on TBIs. And although these retrospective analyses are helpful for benchmarking TBI outcomes, they make it hard to identify specific quality improvement initiatives. The relationship among epidemiology, patient risk factors, clinical care, and TBI outcomes are still relatively unknown at MNRH. Objective: The objectives of this study are to describe the processes of care and determine risk factors predictive of poor outcomes for TBI patients presenting to a single tertiary hospital in Uganda. Methods: Prospective data were collected for 563 TBI patients presenting to a tertiary hospital in Kampala from 1 June – 30 November 2016. Research Electronic Data Capture (REDCap) was used to systematically collect variables spanning 8 categories. Univariate and multivariate analysis were conducted to determine significant predictors of mortality. Results: 563 TBI patients were enrolled from 1 June – 30 November 2016. 102 patients (18%) received surgery, 29 patients (5.1%) intended for surgery failed to receive it, and 251 patients (45%) received non-operative management. Overall mortality was 9.6%, which ranged from 4.7% for mild and moderate TBI to 55% for severe TBI patients with GCS 3-5. Within each TBI severity category, mortality differed by management pathway. Variables predictive of mortality were TBI severity, more than one intracranial bleed, failure to receive surgery, high dependency unit admission, ventilator support outside of surgery, and hospital arrival delayed by more than 4 hours. Conclusions: The overall mortality rate of 9.6% in Uganda for TBI is high, and likely underestimates the true TBI mortality. Furthermore, the wide-ranging mortality (3-82%), high ICU fatality, and negative impact of care delays suggest shortcomings with the current triaging practices. Lack of surgical intervention when needed was highly predictive of mortality in TBI patients. Further research into the determinants of surgical interventions, quality of step-up care, and prolonged care delays are needed to better understand the complex interplay of variables that affect patient outcome. These insights guide the development of future interventions and resource allocation to improve patient outcomes.

Keywords: care continuum, global neurosurgery, Kampala Uganda, LMIC, Mulago, prospective registry, traumatic brain injury

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Authors: Jo Angouri, Charlotte Kennedy, Shawnea Ting, David Rawlinson, Matthew Booker, Nigel Rees

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Ambulance services need to balance the large volume of emergency (999 in the UK) calls they receive (e.g., West Midlands Ambulance Service reports per day about 4,000 999 calls; about 679,000 calls per year are received in Wales), with dispatching limited resource for on-site intervention to the most critical cases. The process by which Emergency Medical Dispatch (EMD) decisions are made is related to risk assessment and involves the caller and call-taker as well as clinical teams negotiating risk levels on a case-by-case basis. Medical Priority Dispatch System (MPDS – also referred to as Advanced Medical Priority Dispatch System AMPDS) are used in the UK by NHS Trusts (e.,g WAST) to process and prioritise 999 calls. MPDS / AMPDS provide structured protocols for call prioritisation and call management. Protocols/policy frameworks have not been examined before in the way we propose in our project. In more detail, the risk factors that play a role in the EMD negotiation between the caller and call-taker have been analysed in both medical and social science research. Research has focused on the structural, morphological and phonological aspects that could improve, and train, human-to-human interaction or automate risk detection, as well as the medical factors that need to be captured from the caller to inform the dispatch decision. There are two significant gaps in our knowledge that we address in our work: 1. the role of backstage clinical teams in translating the caller/call-taker interaction in their internal risk negotiation and, 2. the role of policy frameworks, protocols and regulations in the framing of institutional priorities and resource allocation. We take a multi method approach and combine the analysis of 999 calls with the analysis of policy documents. We draw on interaction analysis, corpus methodologies and thematic analysis. In this paper, we report on our preliminary findings and focus in particular on the risk factors we have identified and the relationship with the regulations that create the frame within which teams operate. We close the paper with implications of our study for providing evidence-based policy intervention and recommendations for further research.

Keywords: emergency (999) call, interaction analysis, discourse analysis, ambulance dispatch, medical discourse

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Authors: Mujahid Ali, Wasif Mohammed Ali, Meraj Ahmad

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Background: Perforation peritonitis is the most common surgical emergency encountered by surgeons all over the world as well as in India. The etiology of perforation peritonitis in India continues to be different from its western counterparts. The aim of this study is to evaluate the spectrum of cases of perforation peritonitis at our hospital. Methods: A prospective study conducted includes three hundred thirtysix patients of perforation peritonitis at J. N. Medical College from October 2015 to July 2017. The patients were admitted, resuscitated and underwent emergency laparotomy. Data were collected in terms of demographic profile, clinical presentations, site of perforations, causes and surgical outcomes. Results: In this study, the most common cause of perforation peritonitis was peptic ulcer disease (43%), followed by enteric perforation (12.8%), tubercular perforation (12.5%), traumatic perforation (11.9%), appendicular perforation (9.8%), amoebic caecal perforation (3%), malignant perforation (1.5%), etc. The sites of perforations were stomach in majority (38.3%), ileum (31%), appendix (8%), duodenum (5.%), caecum (4.4%) ,colon (3%), jejunum (8.5%) and gall bladder (2%). The overall mortality was 21% in our study. Age >50 years (p= <0.0001, OR= 3.9260, CI= 2.2 to 6.9), organ failure (p= <0.0001, OR= 29.2, CI= 14.8 to 57.6), shock (p=<0.0001, OR=20.20, CI= 10.56 to 38.6), diffuse peritonitis (p<0.0015, OR= 6.8810, CI= 2.09 to 22.57) and faecal exudates (p<0.0001) were found to be significant factors affecting mortality. The most common complication associated was superficial wound infection (40%), followed by burst abdomen seen in 21% cases, intra-abdominal sepsis in 18% cases, electrolyte imbalances in 15% cases, anastomotic leak in 6% cases. Conclusion: In this study, stomach is the most common site of perforation with peptic ulcer disease being the most common etiology. Older age, presence of shock, organ failure and faecal peritonitis were the risk factors affecting the mortality of the patients. Early recognition, adequate resuscitation and referral of patients can influence outcome and reduces mortality as well as morbidity.

Keywords: etiology, mortality, perforation, spectrum

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Authors: Jawaher F. Alsharef, Abdullah A. Ghaddaf, Mohammed S. Alomari, Abdullah A. Al Qurashi, Ahmed S. Abdulhamid, Mohammed S. Alshehri, Majed Alosaimi

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Botulinum toxin type A (BTX-A) is the most popular therapeutic agent for muscle relaxation and pain control. Lately, BTX-A injection received great interest as a part of multimodal pain management for lower limb lengthening and deformity correction. This systematic review aimed to determine the role of BTX-A injection in pain management for during lower limb lengthening and/or deformity correction. We searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared the BTX-A injection to placebo for individuals undergoing lower limb lengthening and/or deformity correction. We sought to evaluate the following outcomes: pain on visual analogue scale (VAS), range of motion parameters, average opioid consumption, and adverse events. The standardized mean difference (SMD) was used to represent continuous outcomes while risk ratio (RR) was used to represent dichotomous outcomes. A total of 4 RCTs that enrolled 257 participants (337 limbs) deemed eligible. Adjuvant BTX-A injection showed a significant reduction in post-operative pain compared to placebo (SMD=–0.28, 95% CI –0.53 to –0.04). No difference was found between BTX-A injection and placebo in terms of range of motion parameters, average opioid consumption, or adverse events after surgical limb lengthening and/or deformity correction (RR= 0.77, 95% CI –0.58 to 1.03). Conclusions: Adjuvant BTX-A injection conferred a discernible reduction in post-operative pain during surgical limb lengthening and/or deformity without increasing the risk of adverse events.

Keywords: botulinum toxin type A, limb lengthening, distraction osteogenesis, deformity correction, pain management

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Authors: Jerry Szatko, Edan L. Jorgensen, Stacia Jorgensen

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A crucial component to the success of any financial advising relationship is for the financial professional to understand the perceptions, preferences and thought-processes carried by the financial clients they serve. Armed with this information, financial professionals are more quickly able to understand how they can tailor their approach to best match the individual preferences and needs of each personal investor. Our research explores the use of a quantitative assessment tool in the financial services industry to assist in the identification of the personal investor’s consumer behaviors, especially in terms of financial risk tolerance, as it relates to their financial decision making. Through this process, the Unitifi Consumer Insight Tool (UCIT) was created and refined to capture and categorize personal investor financial behavioral categories and the financial personality tendencies of individuals prior to the initiation of a financial advisement relationship. This paper discusses the use of this tool to place individuals in one of four behavior-based financial risk tolerance categories. Our discoveries and research were aided through administration of a web-based survey to a group of over 1,000 individuals. Our findings indicate that it is possible to use a quantitative assessment tool to assist in predicting the behavioral tendencies of personal consumers when faced with consumer financial risk and decisions.

Keywords: behavior-based advising, financial relationship building, risk capacity based on behavior, risk tolerance, systematic way to assist in financial relationship building

Procedia PDF Downloads 158

Authors: Mehves Isiklar Ekici, Ceyda Tuna Kirsaclioglu, Zarife Kuloglu, Aydan Kansu

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Malnutrition is an important cause of morbidity and mortality as it accounts for 45% of child deaths under the age of 5 worldwide. Therefore, early recognition and effective treatment of failure to thrive and malnutrition are important. In this study, it was aimed to retrospectively evaluate the nutritional support treatment approaches (nutrition education and diet enrichment / use of enteral nutrition products) applied in children followed up with growth failure without underlying organic causes, and to compare the efficacy of nutritional support treatments. In this study, children aged 1 month to 18 years diagnosed with growth failure who were followed up for at least 12 months between January 2011 and February 2020, were included. Anthropometric measurements at baseline and during follow-up, type of nutritional support therapy and treatment compliance were evaluated based on the retrospective records. 119 children (median age:3.2, 69 girls) were included in the study. Nutrition education and dietary enrichment were provided to 28% of the patients (Group 1). In addition to dietary education and recommendations, enteral nutrition supplements was given in 78% of them (Group 2). Compliance to the treatment rates of the patients in Group 1 and Group 2 were not significantly different at both 6th and 12th month controls. At the end of the follow up children who comply with the treatment in Group 1 had significant increase in weight for age z scores (-1.74 vs 0.05, respectively, p=0.019) and body mass index z scores (-1.47 vs -0.53, respectively, p=0.034) compared with baseline measurements. Similar to Group 1, in Group 2 children with treatment compliance, had a significant increase in weight for age z scores (-2.24 vs. -0.54, respectively, p=0.00) and body mass index z scores (-2.27 vs. -1.06, respectively, p=0.00) compared with baseline measurements. The rate of patients with severe malnutrition decreased from 15% to 12%, for moderate malnutrition decreased from 54% to 33%. Moreover, it was observed that this decrease in the rate of patients with both severe and moderate malnutrition was more prominent in patients under 3 years of age. Although there was a significant increase in anthropometric measurements with treatment in both groups, there was no significant difference in between two groups terms of change in anthropometric measurements (p>0.05), therefore effectiveness. Failure to thrive and malnutrition in infancy and childhood cause health problems that can affect adult life. To conclude, nutritional education - dietary enrichment. recommendations and use of enteral nutrition supplements were both proven beneficial in this study. Researchers are willing to underline that the most important part of the treatment is to include the family to the process to ensure the treatment compliance.

Keywords: enteral nutrition supplements, failure to thrive, malnutrition, nutritional education

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Authors: Carlos Cuenca, Diego Sarzosa

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Ductile fracture occurs by the mechanism of void nucleation, void growth and coalescence. Potential sites for initiation are second phase particles or non-metallic inclusions. Modelling of ductile damage at the microscopic level is very difficult and complex task for engineers. Therefore, conservative predictions of ductile failure using simple models are necessary during the design and optimization of critical structures like pressure vessels and pipelines. Nowadays, it is well known that the initiation phase is strongly influenced by the stress triaxiality and plastic deformation at the microscopic level. Thus, a simple model used to study the ductile failure under multiaxial stress condition is the Stress Modified Critical Strain (SMCS) approach. Ductile rupture has been study for a structural steel under different stress triaxiality conditions using the SMCS method. Experimental tests are carried out to characterize the relation between stress triaxiality and equivalent plastic strain by notched round bars. After calibration of the plasticity and damage properties, predictions are made for low constraint bending specimens with and without side grooves. Stress/strain fields evolution are compared between the different geometries. Advantages and disadvantages of the SMCS methodology are discussed.

Keywords: damage, SMSC, SEB, steel, failure

Procedia PDF Downloads 292

Authors: M. A. Stoian, D. M. Cocarta, A. Badea

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The main sources of soil pollution due to petroleum contaminants are industrial processes involve crude oil. Soil polluted with crude oil is toxic for plants, animals, and humans. Human exposure to the contaminated soil occurs through different exposure pathways: Soil ingestion, diet, inhalation, and dermal contact. The present study research is focused on soil contamination with heavy metals as a consequence of soil pollution with petroleum products. Human exposure pathways considered are: Accidentally ingestion of contaminated soil and dermal contact. The purpose of the paper is to identify the human health risk (carcinogenic risk) from soil contaminated with heavy metals. The human exposure and risk were evaluated for five contaminants of concern of the eleven which were identified in soil. Two soil samples were collected from a bioremediation platform from Muntenia Region of Romania. The soil deposited on the bioremediation platform was contaminated through extraction and oil processing. For the research work, two average soil samples from two different plots were analyzed: The first one was slightly contaminated with petroleum products (Total Petroleum Hydrocarbons (TPH) in soil was 1420 mg/kg_d.w.), while the second one was highly contaminated (TPH in soil was 24306 mg/kg_d.w.). In order to evaluate risks posed by heavy metals due soil pollution with petroleum products, five metals known as carcinogenic were investigated: Arsenic (As), Cadmium (Cd), Chromium^VI (Cr^VI), Nickel (Ni), and Lead (Pb). Results of the chemical analysis performed on samples collected from the contaminated soil evidence soil contamination with heavy metals as following: As in Site 1 = 6.96 mg/kg_d.w; As in Site 2 = 11.62 mg/kg_d.w, Cd in Site 1 = 0.9 mg/kg_d.w; Cd in Site 2 = 1 mg/kg_d.w; Cr^VI was 0.1 mg/kg_d.w for both sites; Ni in Site 1 = 37.00 mg/kg_d.w; Ni in Site 2 = 42.46 mg/kg_d.w; Pb in Site 1 = 34.67 mg/kg_d.w; Pb in Site 2 = 120.44 mg/kg_d.w. The concentrations for these metals exceed the normal values established in the Romanian regulation, but are smaller than the alert level for a less sensitive use of soil (industrial). Although, the concentrations do not exceed the thresholds, the next step was to assess the human health risk posed by soil contamination with these heavy metals. Results for risk were compared with the acceptable one (10^-6, according to World Human Organization). As, expected, the highest risk was identified for the soil with a higher degree of contamination: Individual Risk (IR) was 1.11×10^-5 compared with 8.61×10^-6. 

Keywords: carcinogenic risk, heavy metals, human health risk assessment, soil pollution

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Authors: Sharon Garyn-Tal, Shoshana Shahrabani

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Military service in general, and in combat units in particular, can be physically and psychologically stressful. Therefore, type of service may have significant implications for soldiers during and after their military service including emotions, judgments and risk perceptions. Previous studies have focused on risk propensity and risky behavior among soldiers, however there is still lack of knowledge on the impact of type of army service on risk perceptions. The current study examines the effect of type of army service (combat versus non-combat service) and negative incidental emotions on risk perceptions. In 2014 a survey was conducted among 153 combat and non-combat Israeli soldiers. The survey was distributed in train stations and central bus stations in various places in Israel among soldiers waiting for the train/bus. Participants answered questions related to the levels of incidental negative emotions they felt, to their risk perceptions (chances to be hurt by terror attack, by violent crime and by car accident), and personal details including type of army service. The data in this research is unique because military service in Israel is compulsory, so that the Israeli population serving in the army is wide and diversified. The results indicate that currently serving combat participants were more pessimistic in their risk perceptions (for all type of risks) compared to the currently serving non-combat participants. Since combat participants probably experienced severe and distressing situations during their service, they became more pessimistic regarding their probabilities of being hurt in different situations in life. This result supports the availability heuristic theory and the findings of previous studies indicating that those who directly experience distressing events tend to overestimate danger. The findings also indicate that soldiers who feel higher levels of incidental fear and anger have pessimistic risk perceptions. In addition, respondents who experienced combat army service also have pessimistic risk perceptions if they feel higher levels of fear. In addition, the findings suggest that higher levels of the incidental emotions of fear and anger are related to more pessimistic risk perceptions. These results can be explained by the compulsory army service in Israel that constitutes a focused threat to soldiers' safety during their period of service. Thus, in this stressful environment, negative incidental emotions even during routine times correlate with higher risk perceptions. In conclusion, the current study results suggest that combat army service shapes risk perceptions and the way young people control their negative incidental emotions in everyday life. Recognizing the factors affecting risk perceptions among soldiers is important for better understanding the impact of army service on young people.

Keywords: army service, combat soldiers, incidental emotions, risk perceptions

Procedia PDF Downloads 227

Authors: S. Benmebarek, S. Benmoussa, N. Benmebarek

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Natural soils are often deposited in layers. The estimation of the bearing capacity of the soil using conventional bearing capacity theory based on the properties of the upper layer introduces significant inaccuracies if the thickness of the top layer is comparable to the width of the foundation placed on the soil surface. In this paper, numerical computations using the FLAC code are reported to evaluate the two clay layers effect on the bearing capacity beneath rigid circular rough footing subject to axial static load. The computation results of the parametric study are used to illustrate the sensibility of the bearing capacity, the shape factor and the failure mechanisms to the layered strength and layered thickness.

Keywords: numerical modeling, circular footings, layered clays, bearing capacity, failure

Procedia PDF Downloads 486

Authors: Ram V. Mohan, John Rivas-Murillo, Ahmed Mohamed, Wayne D. Hodo

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Cementitious materials, an excellent example of highly complex, heterogeneous material systems, are cement-based systems that include cement paste, mortar, and concrete that are heavily used in civil infrastructure; though commonly used are one of the most complex in terms of the material morphology and structure than most materials, for example, crystalline metals. Processes and features occurring at the nanometer sized morphological structures affect the performance, deformation/failure behavior at larger length scales. In addition, cementitious materials undergo chemical and morphological changes gaining strength during the transient hydration process. Hydration in cement is a very complex process creating complex microstructures and the associated molecular structures that vary with hydration. A fundamental understanding can be gained through multi-scale level modeling for the behavior and properties of cementitious materials starting from the material chemistry level atomistic scale to further explore their role and the manifested effects at larger length and engineering scales. This predictive modeling enables the understanding, and studying the influence of material chemistry level changes and nanomaterial additives on the expected resultant material characteristics and deformation behavior. Atomistic-molecular dynamic level modeling is required to couple material science to engineering mechanics. Starting at the molecular level a comprehensive description of the material’s chemistry is required to understand the fundamental properties that govern behavior occurring across each relevant length scale. Material chemistry level models and molecular dynamics modeling and simulations are employed in our work to describe the molecular-level chemistry features of calcium-silicate-hydrate (CSH), one of the key hydrated constituents of cement paste, their associated deformation and failure. The molecular level atomic structure for CSH can be represented by Jennite mineral structure. Jennite has been widely accepted by researchers and is typically used to represent the molecular structure of the CSH gel formed during the hydration of cement clinkers. This paper will focus on our recent work on the shear and compressive deformation and failure behavior of CSH represented by Jennite mineral structure that has been widely accepted by researchers and is typically used to represent the molecular structure of CSH formed during the hydration of cement clinkers. The deformation and failure behavior under shear and compression loading deformation in traditional hydrated CSH; effect of material chemistry changes on the predicted stress-strain behavior, transition from linear to non-linear behavior and identify the on-set of failure based on material chemistry structures of CSH Jennite and changes in its chemistry structure will be discussed.

Keywords: cementitious materials, deformation, failure, material chemistry modeling

Procedia PDF Downloads 279

Authors: Ida Ngurah

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Indonesia is one of the most prone disaster countries, which has earthquake, tsunami or high wave, flood and landslide as well as volcano eruption and drought. Disaster risk reduction has been developing extensively and comprehensively, particularly after tsunami hit in 2004. Yet, saving people live including children and youth from disaster risk is still far from succeed. Poor management of environment, poor development of policy and high level of corruption has become challenges for Indonesia to save its people from disaster impact. Indonesia is struggling to ensure its future best investment, children and youth to have better protection when disaster strike in school hours and have basic knowledge on disaster risk reduction. The program of safe school is being initiated and developed by Plan Indonesia since 2010, yet this effort still needs to be elaborated. This paper is reviewing sporadic safe school programs that have been implemented or currently being implemented Plan Indonesia in few areas of Indonesia, including both rural and urban setting. Methods used are in-depth interview with dedicated person for the program from Plan Indonesia and its implementing patners and analysis of project documents. The review includes program’s goal and objectives, implementation activity, result and achievement as well as its monitoring and evaluation scheme. Moreover, paper will be showing challenges, lesson learned and best practices of the program. Eventually, paper will come up with recommendation for strategy for better implementation of safe school program in Indonesia.

Keywords: disaster impact, safe school, programs, children, youth

Procedia PDF Downloads 362

Authors: Faci Youcef

Abstract:

In the present work, an experimental study is carried out using the digital image correlation (DIC) technique to analyze the damage and behavior of woven composite carbon/epoxy under tensile loading. The tension mechanisms associated with failure modes of bolted joints in advanced composites are studied, as well as displacement distribution and strain distribution. The evolution value of bolt angle inclination during tensile tests was studied. In order to compare the distribution of displacements and strains along the surface, figures of image mapping are made. Several factors that are responsible for the failure of fiber-reinforced polymer composite materials are observed. It was found that strain concentrations observed in the specimens can be used to identify full-field damage onset and to monitor damage progression during loading. Moreover, there is an interaction between laminate pattern, laminate thickness, fastener size and type, surface strain concentrations, and out-of-plane displacement. Conclusions include a failure analysis associated with bolt angle inclinations and supported by microscopic visualizations of the composite specimen. The DIC results can be used to develop and accurately validate numerical models.

Keywords: Carbone, woven, damage, digital image, bolted joint, the inclination of angle

Procedia PDF Downloads 67

Authors: Krzysztof J. Czarnocki, F. Silveira, E. Czarnocka, K. Szaniawska

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Research background: Problems related to the occupational health and decreasing level of safety occur commonly in the construction industry. Important factor in the occupational safety in construction industry is scaffold use. All scaffolds used in construction, renovation, and demolition shall be erected, dismantled and maintained in accordance with safety procedure. Increasing demand for new construction projects unfortunately still is linked to high level of occupational accidents. Therefore, it is crucial to implement concrete actions while dealing with scaffolds and risk assessment in construction industry, the way on doing assessment and liability of assessment is critical for both construction workers and regulatory framework. Unfortunately, professionals, who tend to rely heavily on their own experience and knowledge when taking decisions regarding risk assessment, may show lack of reliability in checking the results of decisions taken. Purpose of the article: The aim was to indicate crucial parameters that could be modeling with Risk Assessment Model (RAM) use for improving both building enterprise productivity and/or developing potential and safety climate. The developed RAM could be a benefit for predicting high-risk construction activities and thus preventing accidents occurred based on a set of historical accident data. Methodology/Methods: A RAM has been developed for assessing risk levels as various construction process stages with various work trades impacting different spheres of enterprise activity. This project includes research carried out by teams of researchers on over 60 construction sites in Poland and Portugal, under which over 450 individual research cycles were carried out. The conducted research trials included variable conditions of employee exposure to harmful physical and chemical factors, variable levels of stress of employees and differences in behaviors and habits of staff. Genetic modeling tool has been used for developing the RAM. Findings and value added: Common types of trades, accidents, and accident causes have been explored, in addition to suitable risk assessment methods and criteria. We have found that the initial worker stress level is more direct predictor for developing the unsafe chain leading to the accident rather than the workload, or concentration of harmful factors at the workplace or even training frequency and management involvement.

Keywords: safety climate, occupational health, civil engineering, productivity

Procedia PDF Downloads 305