Search results for: patient management

Authors: Jeremy Bost, Matthew Brett, Jacob Flynn, Weihui Li

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One response during anaphylaxis is reduced blood pressure due to blood vessels relaxing and dilating. Epinephrine causes the blood vessels to constrict, which raises blood pressure to counteract the symptoms. When going through an allergic reaction, an Epinephrine injector is used to administer a shot of epinephrine intramuscularly. Epinephrine injectors have become an integral part of day-to-day life for people with allergies. Current Epinephrine injectors (EpiPen) are completely mechanical and have no sensors to monitor the vital signs of patients or give suggestions the optimal time for the shot. The EpiPens are also large and inconvenient to carry daily. The current price of an EpiPen is roughly 600$ for a pack of two. This makes carrying an EpiPen very expensive, especially when they need to be switched out when the epinephrine expires. This new design is in the form of a bracelet, which has the ability to inject epinephrine. The bracelet will be equipped with vital signs monitors that can aid the patient to sense the allergic reaction. The vital signs that would be of interest are blood pressure, heart rate and Electrodermal activity (EDA). The heart rate of the patient will be tracked by a photoplethysmograph (PPG) that is incorporated into the sensors. The heart rate is expected to increase during anaphylaxis. Blood pressure will be monitored through a radar sensor, which monitors the phase changes in electromagnetic waves as they reflect off of the blood vessel. EDA is under autonomic control. Allergen-induced anaphylaxis is caused by a release of chemical mediators from mast cells and basophils, thus changes the autonomic activity of the patient. So by measuring EDA, it will give the wearer an alert on how their autonomic nervous system is reacting. After the vital signs are collected, they will be sent to an application on a smartphone to be analyzed, which can then alert an emergency contact if the epinephrine injector on the bracelet is activated. Overall, this design creates a safer system by aiding the user in keeping track of their epinephrine injector, while making it easier to track their vital signs. Also, our design will be more affordable and more convenient to replace. Rather than replacing the entire product, only the needle and drug will be switched out and not the entire design.

Keywords: allergy, anaphylaxis, epinephrine, injector, vital signs monitor

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Authors: Paola Villoria Sáez, Mercedes Del Río Merino, Jaime Santa Cruz Astorqui, Antonio Rodríguez Sánchez

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The Spanish construction industry generates large volumes of waste. However, despite the legislative improvements introduced for construction and demolition waste (CDW), construction waste recycling rate remains well below other European countries and also below the target set for 2020. This situation can be due to many difficulties. i.e.: The difficulty of onsite segregation or the estimation in advance of the total amount generated. Despite these difficulties, the proper management of CDW must be one of the main aspects to be considered by the construction companies. In this sense, some large national companies are implementing Integrated Management Systems (IMS) including not only quality and safety aspects, but also environment issues. However, although this fact is a reality for large construction companies still the vast majority of companies need to adopt this trend. In short, it is common to find in small and medium enterprises a decentralized management system: A single system of quality management, another for system safety management and a third one for environmental management system (EMS). In addition, the EMSs currently used address CDW superficially and are mainly focus on other environmental concerns such as carbon emissions. Therefore, this research determines and implements a specific best practice management system for CDW based on eight procedures in a Spanish Construction company. The main advantages and drawbacks of its implementation are highlighted. Results of this study show that establishing and implementing a CDW management system in building works, improve CDW quantification as the company obtains their own CDW generation ratio. This helps construction stakeholders when developing CDW Management Plans and also helps to achieve a higher adjustment of CDW management costs. Finally, integrating this CDW system with the EMS of the company favors the cohesion of the construction process organization at all stages, establishing responsibilities in the field of waste and providing a greater control over the process.

Keywords: construction and demolition waste, waste management, best practices, waste minimization, building, quality management systems

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Authors: Osama Sassi, Manal Eltorki, Iftikhar Ahmad

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Poor integrity is one of the major causes of leaks and accidents in gas transmission pipelines. To ensure safe operation, it is must to have efficient and effective pipeline integrity management (PIM) system. The corrosion management is one of the important aspects of successful pipeline integrity management program together design, material selection, operations, risk evaluation and communication aspects to maintain pipelines in a fit-for-service condition. The objective of a corrosion management plan is to design corrosion mitigation, monitoring, and inspection strategy, and for maintenance in a timely manner. This paper presents the experience of corrosion management of a gas transmission pipeline from Wafa field to Mellitah gas plant in Libya. The pipeline is 525.5 km long and having 32 inches diameter. It is a buried pipeline. External corrosion on pipeline is controlled with a combination of coatings and cathodic protection while internal corrosion is controlled with a combination of chemical inhibitors, periodic cleaning and process control. The monitoring and inspection techniques provide a way to measure the effectiveness of corrosion control systems and provide an early warning when changing conditions may be causing a corrosion problem. This paper describes corrosion management system used in Mellitah Oil & Gas BV for its gas transmission pipeline based on standard practices of corrosion mitigation and inspection.

Keywords: corrosion mitigation on gas transmission pipelines, pipeline integrity management, corrosion management of gas pipelines, prevention and inspection of corrosion

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Authors: Yaxian Chen, Yeonhee Park

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Driven by evolving FDA recommendations, modern clinical trials demand innovative designs that strike a balance between statistical rigor and ethical considerations. Covariate-adjusted response-adaptive (CARA) designs bridge this gap by utilizing patient attributes and responses to skew treatment allocation in favor of the treatment that is best for an individual patient’s profile. However, existing CARA designs for survival outcomes often hinge on specific parametric models, constraining their applicability in clinical practice. In this article, we address this limitation by introducing a CARA design for survival outcomes (CARAS) based on the Cox model and a variance estimator. This method addresses issues of model misspecification and enhances the flexibility of the design. We also propose a group sequential overlapweighted log-rank test to preserve type I error rate in the context of group sequential trials using extensive simulation studies to demonstrate the clinical benefit, statistical efficiency, and robustness to model misspecification of the proposed method compared to traditional randomized controlled trial designs and response-adaptive randomization designs.

Keywords: cox model, log-rank test, optimal allocation ratio, overlap weight, survival outcome

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Authors: Lolwa Alansari, Hanen Mrabet, Kholoud Khaled, Abdelhamid Azhaghdani, Sufia Athar, Aska Kaima, Zaineb Mhamdia, Zubaria Altaf, Almunzer Zakaria, Tamara Alshadafat

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Introduction: The Obstetrics and Gynecology Emergency Department at Alwakra Hospital has faced significant challenges, which have been further worsened by the impact of the COVID-19 pandemic. These challenges involve issues such as overcrowding, extended wait times, and a notable surge in demand for emergency care services. Moreover, prolonged waiting times have emerged as a primary factor contributing to situations where patients leave without receiving attention, known as left without being seen (LWBS), and unexpectedly abscond. Addressing the issue of insufficient patient mobility in the obstetrics and gynecology emergency department has brought about substantial improvements in patient care, healthcare administration, and overall departmental efficiency. These changes have not only alleviated overcrowding but have also elevated the quality of emergency care, resulting in higher patient satisfaction, better outcomes, and operational rewards. Methodology: The COVID-19 pandemic has served as a catalyst for substantial transformations in the obstetrics and gynecology emergency, aligning seamlessly with the strategic direction of Hamad Medical Corporation (HMC). The fundamental aim of this initiative is to revolutionize the operational efficiency of the OB-GYN ED. To accomplish this mission, a range of transformations has been initiated, focusing on essential areas such as digitizing systems, optimizing resource allocation, enhancing budget efficiency, and reducing overall costs. The project utilized the Plan-Do-Study-Act (PDSA) model, involving a diverse team collecting baseline data and introducing throughput improvements. Post-implementation data and feedback were analysed, leading to the integration of effective interventions into standard procedures. These interventions included optimized space utilization, real-time communication, bedside registration, technology integration, pre-triage screening, enhanced communication and patient education, consultant presence, and a culture of continuous improvement. These strategies significantly reduced waiting times, enhancing both patient care and operational efficiency. Results: Results demonstrated a substantial reduction in overall average waiting time, dropping from 35 to approximately 14 minutes by August 2023. The wait times for priority 1 cases have been reduced from 22 to 0 minutes, and for priority 2 cases, the wait times have been reduced from 32 to approximately 13.6 minutes. The proportion of patients spending less than 8 hours in the OB ED observation beds rose from 74% in January 2022 to over 98% in 2023. Notably, there was a remarkable decrease in LWBS and absconded patient rates from 2020 to 2023. Conclusion: The project initiated a profound change in the department's operational environment. Efficiency became deeply embedded in the unit's culture, promoting teamwork among staff that went beyond the project's original focus and had a positive influence on operations in other departments. This effectiveness not only made processes more efficient but also resulted in significant cost reductions for the hospital. These cost savings were achieved by reducing wait times, which in turn led to fewer prolonged patient stays and reduced the need for additional treatments. These continuous improvement initiatives have now become an integral part of the Obstetrics and Gynecology Division's standard operating procedures, ensuring that the positive changes brought about by the project persist and evolve over time.

Keywords: overcrowding, waiting time, person centered care, quality initiatives

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Authors: Lusine S. Stepanyan, Elina V. Asriyan.

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It is known, that the efficiency of management depend on individual characteristics of manager. In case, was shown the role of personal position in the efficiency of management. Current research is aimed at reveal psychological and psychophysiological basis efficiency of management and finding ways of increasing the productivity of management that is most essential and topical problems of modern society. To understand the investigated phenomenon it was applied a complex approach. The Eysenk questionnaire was used for determining the level of aggression, frustration, anxiety and rigidity. The test of egocentric associations was used for determining the level of egocentrism. The test of COS (communicativeness and organizational skills) was used for diagnosing the level of communicativeness. The integral index of job satisfaction was used for diagnosis the efficiency of management activity. Then, the relationship between the above mentioned mental state, communicativeness, self-esteem, job satisfaction, locus of control, and egocentrism was investigated. The obtained results have shown the positive correlation between the egocentrism and frustration, anxiety and also the negative correlation with job satisfaction and communicativeness. Intergroup analyses has revealed the significant differences by communicativeness and the internality’ level. The revealed results can be used for diagnosis of efficiency of management.

Keywords: egocentrism, locus control, mental state, job satisfaction, professional activity

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Authors: Isomar Lima da Silva, Alcilene Batalha Pontes, Aristeu Jonatas Leite de Oliveira, Roberto Maia Augusto

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Context: Mechanical ventilators are medical devices that help provide oxygen and ventilation to patients with respiratory difficulties. This equipment consists of a manual breathing unit that can be operated by a doctor or nurse and a mechanical ventilator that controls the airflow and pressure in the patient's respiratory system. This type of ventilator is commonly used in emergencies and intensive care units where it is necessary to provide breathing support to critically ill or injured patients. Objective: In this context, this work aims to develop a reliable and low-cost mechanical ventilator to meet the demand of hospitals in treating people affected by Covid-19 and other severe respiratory diseases, offering a chance of treatment as an alternative to mechanical ventilators currently available in the market. Method: The project presents the development of a low-cost auxiliary ventilator with a controlled ventilatory system assisted by integrated hardware and firmware for respiratory cycle control in non-invasive mechanical ventilation treatments using a manual artificial respiration unit. The hardware includes pressure sensors capable of identifying positive expiratory pressure, peak inspiratory flow, and injected air volume. The embedded system controls the data sent by the sensors. It ensures efficient patient breathing through the operation of the sensors, microcontroller, and actuator, providing patient data information to the healthcare professional (system operator) through the graphical interface and enabling clinical parameter adjustments as needed. Results: The test data of the developed mechanical ventilator presented satisfactory results in terms of performance and reliability, showing that the equipment developed can be a viable alternative to commercial mechanical ventilators currently available, offering a low-cost solution to meet the increasing demand for respiratory support equipment.

Keywords: mechanical fans, breathing, medical equipment, COVID-19, intensive care units

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Authors: Shamim Akhtar

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The purpose of the present research was to analyse the performance level of district administrators and school heads teachers at secondary school level. The sample of the study was head teachers and teachers of secondary schools. In survey three scales were used, two scales were for the head teachers, one five point scale was for analysing the working efficiency of educational administrators and other seven points scale was for head teachers for analysing their own performance and one another seven point rating scale similar to head teacher was for the teachers for analysing the working performance of their head teachers. The results of the head teachers’ responses revealed that the performance of their District Educational Administrators was average and for the performance efficiency of the head teachers, researcher constructed the rating scales on seven parameters of management likely academic management, personnel management, financial management, infra-structure management, linkage and interface, student’s services, and managerial excellence. Results of percentages, means, and graphical presentation on different parameters of management showed that there was an obvious difference in head teachers and teachers’ responses and head teachers probably were overestimating their efficiency; but teachers evaluated that they were performing averagely on majority statements. Results of t-test showed that there was no significance difference in the responses of rural and urban teachers but significant difference in male and female teachers’ responses showed that female head teachers were performing their responsibilities better than male head teachers in public sector schools. When efficiency of the head teachers on different parameters of management were analysed it was concluded that their efficiency on academic and personnel management was average and on financial management and on managerial excellence was highly above of average level but on others parameters like infra-structure management, linkage and interface and on students services was above of average level on most statements but highly above of average on some statements. Hence there is need to improve the working efficiency in academic management and personnel management.

Keywords: educational administration, educational management, parameters of management, education

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Authors: Malki Fatima Zahra Nadia, Kellal Cheiimaa, Brahimi Houria

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Total Quality Management (TQM) is one of the most important modern management systems in marketing, that help organizations to survive and remain competitive in the dynamic market with frequent changes. It assists them in gaining a competitive advantage, growth, and excellence compared to their competitors. To understand the impact of TQM on competitive advantage in economic companies, a study was conducted in Ooredoo Telecommunications Company. A questionnaire was designed and distributed to OOredoo' 75 employees in each of the departments of leadership, quality assurance, quality control, research and development, production, customer service, Similarly, resulting in the retrieval of 72 questionnaires. To analyze the descriptive results of the study, the SPSS software version 25 was used. Additionally, Structural Equation Modeling (SEM) with the help of Smart Pls4 software was utilized to test the study's hypotheses. The study concluded that there is an impact between total quality management and competitive advantage in Ooredoo company to different degrees. On this basis, the study recommended the need to implement the total quality management system at the level of all organizations and in various fields.

Keywords: total quality management, ISO system, competitive advantage, competitive strategies

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Authors: Sana Ilyas

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Parry-Romberg syndrome is a rare condition clinically defined by slowly progressive atrophy of the skin and soft tissues. This usually effects one side of the face, although a few cases have been documented of bilateral presentation. It is more prevalent in females and usually affects the left side of the face. The syndrome can also be accompanied by neurological abnormalities. It usually occurs in the first two decades of life with a variable rate of progression. The aetiology is unknown, and the disease eventually stabilises. The treatment options usually involve surgical management. The least invasive of these options is the management of facial asymmetry, associated with Parry Romberg syndrome, through the use of tissue fillers. This paper will review the existing literature on the management of Parry Romberg syndrome with tissue filler. Aim: The aim of the study is to explore the current published literature for the management of Parry Romberg syndrome with fillers. It is to assess the development that has been made in this method of management, its benefits and limitations, and its effectiveness for the management of Parry Romberg syndrome. Methodology: There was a thorough assessment of the current literature published on this topic. PubMed database was used for search of the published literature on this method of the management. Papers were analysed and compared with one another to assess the success and limitation of the management of Parry Romberg with dermal fillers Results and Conclusion: Case reports of the use of tissue fillers discuss the varying degrees of success with the treatment. However, this procedure has it’s limitation, which are discussed in the paper in detail. However, it is still the least invasive of all the surgical options for the management of Parry Romberg Syndrome, and therefore, it is important to explore this option with patients, as they may be more comfortable with pursuingtreatment that is less invasive and can still improve their facial asymmetry

Keywords: dermal fillers, facial asymmetry, parry romberg syndrome, tissue fillers

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Authors: Jazmi Adlan Bohari, I. Dewa Ketut Kerta Widana

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Education on disaster management has been made as a mainstream focus of many countries. In Indonesia, this has been emphasized with the direct order of the President of Indonesia to implement disaster education at all levels in both formal and informal education. Indonesia Defense University (IDU) executes this order through Three Pillars of Higher Education, which consists of research, education, and community service. One of them is a five-day disaster management training for 105 participants divided into three batches that consist of faculty members and graduate students. This training uses the 2018 Basic Disaster Management Training Modul issued by the Indonesia National Disaster Management Agency (BNPB). This research aims to analyze the impact of this short training on the trainee’s knowledge and understanding of basic disaster management. This study is a qualitative research with case study approach. The research shows that after five days of training, there as a significant increase in knowledge and understanding of basic disaster management experienced by the trainees with a 61,73% overall increase. The post-training data shows that 61% of the trainees have a very good understanding, 24% with good understanding, 13% with adequate understanding, and 2% with poor understanding. The result suggests that a short-time education with a structured curriculum can successfully increase the knowledge and understanding of disaster management on a basic level and can hypothetically contribute to the effort to reduce disaster risks.

Keywords: disaster education, basic disaster management training, three Pillars of Higher Education, disaster risk reduction

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Authors: Komal Fizza

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All around the world in every field professionals are taking great support from their computers. Computer assisted strategies not only increase the efficiency of the professionals but also in case of healthcare they help in life-saving interventions. The background of this current research is aimed towards two things; first to find out if computer assisted strategies are useful for Pharmacist for not and secondly how much these assist a Pharmacist to do quality interventions. Shifa International Hospital is a 500 bedded hospital, and it is running Antimicrobial Stewardship, during their stewardship rounds pharmacists observed that a lot of wrong doses of antibiotics were coming at times those were being overlooked by the other pharmacist even. So, with the help of MIS team the patients were categorized into adult and peads depending upon their age. Minimum and maximum dose of every single antibiotic present in the pharmacy that could be dispensed to the patient was developed. These were linked to the order entry window. So whenever pharmacist would type any order and the dose would be below or above the therapeutic limit this would give an alert to the pharmacist. Whenever this message pop-up this was recorded at the back end along with the antibiotic name, pharmacist ID, date, and time. From 14th of January 2015 and till 14th of March 2015 the software stopped different users 350 times. Out of this 300 were found to be major errors which if reached to the patient could have harmed them to the greater extent. While 50 were due to typing errors and minor deviations. The pilot study showed that computer assisted strategies can be of great help to the pharmacist. They can improve the efficacy and quality of interventions.

Keywords: antibiotics, computer assisted strategies, pharmacist, stewardship

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Authors: Yulinda Rizky Pratiwi, Fuji Anugrah Emily

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Management of Occupational Safety and Health (OSH) are appropriately applied properly by all workers and pekarya in the company. K3 management application also has become very important to prevent accidents. Violation of the rules regarding the K3 has often occurred from time to time. By 2015 the number of occurrences of a violation of the K3 or so-called unsafe action tends to increase. Until finally in January 2016, the number increased drastically unsafe action. Trigger increase in the number of unsafe action is a decrease in the quality of management practices K3. While the application of K3 management performed by each individual thought to be influenced by the attitude and observation guide the actions of each of the individual. In addition to the decline in the quality of K3 management application may result in increased likelihood of accidents and losses for the company as well as the local co-workers. The big difference in the number of unsafe action is very significant in the month of January 2016, making the company Pertamina as the national oil company must do a lot of effort to keep track of how the implementation of K3 management on every worker and pekarya, one at PT Pertamina EP Cepu Field Asset IV. To consider the effort to control the implementation of K3 management can be seen from the attitude and observation guide the actions of the workers and pekarya. By using Multiple Linear Regression can be seen the influence of attitude and action observation guide workers and pekarya the K3 management application that has been done. The results showed that scores K3 management application of each worker and pekarya will increase by 0.764 if the score pekarya worker attitudes and increase one unit, whereas if the score Reassurance action guidelines and pekarya workers increased by one unit then the score management application K3 will increase by 0.754.

Keywords: occupational safety and health, management of occupational safety and health, unsafe action, multiple linear regression

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Authors: Lea B. Milan

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This descriptive study evaluated the existing Food Safety Management in Central Elementary School Canteens of Region 3. It made used of survey questionnaires, interview guide questions and validated knowledge test on food for data gathering. Results of the study revealed that school principals and canteen managers shared responsibilities in food safety management of school canteen. It also showed that the schools applied different methods of communication, monitoring and evaluation of food safety management. The study further revealed that implementation of monitoring and evaluation of food safety compliance are not being practiced in all elementary schools in the region. The study also showed that school canteens in the Region 3 do not have the thermometers and timers to use to conduct proper monitoring of foods during storage, preparation and serving. It was also found out from the study that canteen personnel lacks the basic knowledge and trainings on food safety. Potential source of physical, chemical and biological hazards that could contaminate foods were also found present in the canteen facilities of the elementary schools in the region. Moreover, evaluation showed that the existing implementation of food safety management in the Central Elementary School Canteens of Region 3 were below the expected level and the need to strengthen the appreciation and advocacy on food safety management in school canteens of Region 3 is still wanting.

Keywords: food safety management, food safety school catering, food safety, school food safety management

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Authors: Yael Rieder, Yael Gilboa, S. O. Adva, Efrat Halevi, Ronnie Tepper

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Background: Operation of ultrasound equipment is a core skill for many clinical specialties. As part of the training program at -Simultech- a simulation center for Ob\Gyn at the Meir Medical Center, Israel, teaching how to operate ultrasound equipment requires dealing with misunderstandings of spatial and 3D orientation, failure of the operator to hold a transducer correctly, and limited ability to evaluate the data on the screen. We have developed a platform intended to endow physicians and sonographers with clinical and operational skills of obstetric ultrasound. Simultech's simulations are focused on medical knowledge, risk management, technology operations and physician-patient communication. The simulations encompass extreme work conditions. Setup: Between eight and ten of the eight hundred and fifty physicians and sonographers of the Clalit health services from seven hospitals and eight community centers across Israel, participate in individual Ob/Gyn training sessions each week. These include Ob/Gyn specialists, experts, interns, and sonographers. Innovative teaching and training methodologies: The six-hour training program includes: (1) An educational computer program that challenges trainees to deal with medical questions based upon ultrasound pictures and films. (2) Sophisticated hands-on simulators that challenge the trainees to practice correct grip of the transducer, elucidate pathology, and practice daily tasks such as biometric measurements and analysis of sonographic data. (3) Participation in a video-taped simulation which focuses on physician-patient communications. In the simulation, the physician is required to diagnose the clinical condition of a hired actress based on the data she provides and by evaluating the assigned ultrasound films accordingly. Giving ‘bad news’ to the patient may put the physician in a stressful situation that must be properly managed. (4) Feedback at the end of each phase is provided by a designated trainer, not a physician, who is specially qualified by Ob\Gyn senior specialists. (5) A group exercise in which the trainer presents a medico-legal case in order to encourage the participants to use their own experience and knowledge to conduct a productive ‘brainstorming’ session. Medical cases are presented and analyzed by the participants together with the trainer's feedback. Findings: (1) The training methods and content that Simultech provides allows trainees to review their medical and communications skills. (2) Simultech training sessions expose physicians to both basic and new, up-to-date cases, refreshing and expanding the trainee's knowledge. (3) Practicing on advanced simulators enables trainees to understand the sonographic space and to implement the basic principles of ultrasound. (4) Communications simulations were found to be beneficial for trainees who were unaware of their interpersonal skills. The trainer feedback, supported by the recorded simulation, allows the trainee to draw conclusions about his performance. Conclusion: Simultech was found to contribute to physicians at all levels of clinical expertise who deal with ultrasound. A break in daily routine together with attendance at a neutral educational center can vastly improve performance and outlook.

Keywords: medical training, simulations, ultrasound, Simultech

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Authors: Maria Dora Horvath, Norbert Buzas, Zsanett Tesch

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Diabetes management poses many unique challenges for children and their parents. The use of a diabetes management device should not be one of these challenges as the purpose of these devices is to make the management more convenient. The objective of our study was to examine how demographical, psychological and diabetes-related factors determine the choices parents make regarding their child’s diabetes management technologies and how they perceive advanced devices. We conducted the study using an online questionnaire with 318 parents (mostly mothers). The questions of the survey were about demographical, diabetes-related and psychological factors (diabetes management problems, diabetes management competence). In addition, we asked the parents opinions about advanced diabetes management devices. We expanded our data with semi-structured in-depth interviews. 61 % of the participants Self-Monitored Blood Glucose (SMBG), and 39 % used a Continuous Glucose Monitoring System (CGM). Considering insulin administration, 58 % used Multiple Daily Insulin Injections (MDII) and 42 % used Continuous Subcutaneous Insulin Infusion (CSII). Parents who used diverse combinations of diabetes management devices showed significant differences in age (parents’ and child’s), the monthly cost of diabetes, the duration of diabetes, the highest level of education and average monthly household income. CGM users perceived diabetes management problems significantly more severe than SMBG users and CSII users felt significantly more competent in diabetes management than MDII users. Avoiding CGM use due to lack of financial resources was determined by diagnosis duration. While avoiding its use by the cause of the child rejecting, it was determined by the child’s age and diabetes competence. Using MDII instead of CSII because of the child’s rejection was determined by the monthly cost of diabetes and child’s age. We conducted a complex empirical study in which we examined perceptions and experiences of advanced and less advanced diabetes management technologies comprehensively. Our study highlights the factors that fundamentally influence parents’ motivations and choices about diabetes management technologies. These results could contribute to developing diabetes management technologies more suitable for children living with type 1 diabetes and their parents.

Keywords: advanced diabetes management technologies, children living with type 1 diabetes, diabetes management, motivation, parents

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Authors: Madhumita Sahu, S. S. Tiwary

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The Radiotherapy of Carcinoma Lung has always been difficult and a matter of great concern. The significant movement due to fractional motion caused due to non-rhythmic respiratory motion poses a great challenge for the treatment of Lung cancer using Ionizing Radiation. The present study compares the accuracy in the measurement of Target Volume using Slow-CT and 4DCT Imaging in SBRT for Lung Tumor. The experimental samples were extracted from patients with Lung Cancer who underwent SBRT. Slow-CT and 4DCT images were acquired under free breathing for each patient. PTV were delineated on Slow CT images. Similarly, ITV was also delineated on each of the 4DCT volumes. Volumetric and Statistical analysis were performed for each patient by measuring corresponding PTV and ITV volumes. The study showed (1) The Maximum Deviation observed between Slow-CT-based PTV and 4DCT imaging-based ITV is 248.58 cc. (2) The Minimum Deviation observed between Slow-CT-based PTV and 4DCT imaging-based ITV is 5.22 cc. (3) The Mean Deviation observed between Slow-CT-based PTV and 4DCT imaging-based ITV is 63.21 cc. The present study concludes that irradiated volume ITV with 4DCT is less as compared to the PTV with Slow-CT. A better and more precise treatment could be given more accurately with 4DCT Imaging by sparing 63.21 CC of mean body volume.

Keywords: CT imaging, 4DCT imaging, lung cancer, statistical analysis

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Authors: Chatelier Charlene, Oyegoke Adekunle, Ajayi Saheed, Jeffries Andrew

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This study seeks to understand Schedule Risk Assessments as a priori for better performance whilst exploring the strategies employed to deliver complex projects like the New Polar research ship. This high-profile vessel was offered to Natural Environment Research Council and British Antarctic Survey (BAS) by Cammell Laird Shipbuilders. The Research Ship was designed to support science in extreme environments, with the expectancy to provide a wide range of specialist scientific facilities, instruments, and laboratories to conduct research over multiple disciplines. Aim: The focus is to understand the allocation and management of schedule risk on such a Major Project. Hypothesising that "effective management of schedule risk management" could be the most critical factor in determining whether the intended benefits mentioned are delivered within time and cost constraints. Objective 1: Firstly, the study seeks to understand the allocation and management of schedule risk in Major Projects. Objective 2: Secondly, it explores "effective management of schedule risk management" as the most critical factor determining the delivery of intended benefits. Methodology: This study takes a retrospective review of schedule risk management and how it influences project performance using a case study approach for the RRS (Royal Research Ship) Sir David Attenborough. Research Contribution: The outcomes of this study will contribute to a better understanding of project performance whilst building on its under-researched relationship to schedule risk management for complex projects. The outcomes of this paper will guide further research on project performance and enable the understanding of how risk-based estimates over time impact the overall risk management of the project.

Keywords: complexity, major projects, performance management, schedule risk management, uncertainty

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Authors: Rachael Andrews, Viktoria McMillan, Shuaib Nasser, Christopher M. Roberts

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Background and objective: The National Review of Asthma Deaths (NRAD) found that asthma management and care was inadequate in 26% of cases reviewed. Major shortfalls identified were adherence to national guidelines and standards and, particularly, the organisation of care, including supervision and monitoring in primary care, with 70% of cases reviewed having at least one avoidable factor in this area. 5.4 million people in the UK are diagnosed with and actively treated for asthma, and approximately 60,000 are admitted to hospital with acute exacerbations each year. The majority of people with asthma receive management and treatment solely in primary care. This has therefore created concern that many people within the UK are receiving sub-optimal asthma care resulting in unnecessary morbidity and risk of adverse outcome. NRAD concluded that a national asthma audit programme should be established to measure and improve processes, organisation, and outcomes of asthma care. Objective: To develop a primary care dataset enabling extraction of information from GP practices in Wales and providing robust data by which results and lessons could be drawn and drive service development and improvement. Methods: A multidisciplinary group of experts, including general practitioners, primary care organisation representatives, and asthma patients was formed and used as a source of governance and guidance. A review of asthma literature, guidance, and standards took place and was used to identify areas of asthma care which, if improved, would lead to better patient outcomes. Modified Delphi methodology was used to gain consensus from the expert group on which of the areas identified were to be prioritised, and an asthma patient and carer focus group held to seek views and feedback on areas of asthma care that were important to them. Areas of asthma care identified by both groups were mapped to asthma guidelines and standards to inform and develop primary and secondary care datasets covering both adult and pediatric care. Dataset development consisted of expert review and a targeted consultation process in order to seek broad stakeholder views and feedback. Results: Areas of asthma care identified as requiring prioritisation by the National Asthma Audit were: (i) Prescribing, (ii) Asthma diagnosis (iii) Asthma Reviews (iv) Personalised Asthma Action Plans (PAAPs) (v) Primary care follow-up after discharge from hospital (vi) Methodologies and primary care queries were developed to cover each of the areas of poor and variable asthma care identified and the queries designed to extract information directly from electronic patients’ records. Conclusion: This paper describes the methodological approach followed to develop primary care datasets for a National Asthma Audit. It sets out the principles behind the establishment of a National Asthma Audit programme in response to a national asthma mortality review and describes the development activities undertaken. Key process elements included: (i) mapping identified areas of poor and variable asthma care to national guidelines and standards, (ii) early engagement of experts, including clinicians and patients in the process, and (iii) targeted consultation of the queries to provide further insight into measures that were collectable, reproducible and relevant.

Keywords: asthma, primary care, general practice, dataset development

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Authors: Öykü Barutçu, Mehmet Özgür Kuzdan

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Aim: Laparoscopy is very risky in patients undergoing, multiple open abdominal surgeries. The aim of this study, to define a safe method for the first trocar placement in children with a history of multiple open abdominal surgeries. Methods: Children who underwent laparoscopic surgery between March 2019 and April 2020 with a history of three or more open abdominal surgeries were included in the retrospective study. Patient information was obtained from the hospital automation system. Ultrasonography was used to determine the location of adhesions preoperatively. The first trocar was placed according to ultrasonography findings, using the Hasson technique to create an air pocket with finger dissection. The patient's preoperative, perioperative, and postoperative findings are reported. Results: A total of 10 patients were included in the study. The median number of operations before laparoscopy was three. The most common site for the first trocar entry was Palmer's point (40%). No mortality or morbidity was observed amongst any patients. The average number of adhesions detected by USG and observed on laparoscopy were significantly positively correlated. Conclusion: In children with a history of multiple abdominal surgeries, abdominal wall ultrasonography for visualization of adhesions and finger dissection for the formation of an air pocket appears to be a safe method for the first trocar insertion.

Keywords: abdominal wall, child, laparoscopy, ultrasonography

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Authors: Carl Eiselen, Stephen O’Hagan

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Background: Q fever, caused by the obligate intracellular bacterium Coxiella burnetii, is an infectious disease with variable systemic manifestations. Its potential to cause ocular complications has not been reported before in Australia. This case study explores the unusual presentation of asymptomatic acute multifocal retinitis (AMR) in a patient with acute Q fever endocarditis and hepatitis in rural Queensland, Australia. Case Presentation: A 48-year-old male gardener presented with flu-like symptoms, weight loss, and encephalopathy. Despite systemic malaise, he had no ocular symptoms. Laboratory investigations confirmed acute Q fever, and imaging studies identified hepatic involvement and endocarditis. The retinal screening revealed asymptomatic AMR, corroborated by fundus examination and SD-OCT. Following treatment with Doxycycline and hydroxychloroquine, both systemic and ocular manifestations improved. Discussion: This is the first documented case of asymptomatic AMR associated with Q fever. The patient’s lack of autoantibodies challenges the established understanding of Q fever endocarditis and suggests potential alternative mechanisms. Conclusion: This case report expands our understanding of the multi-systemic impact of Q fever, highlighting the need for comprehensive clinical evaluation and including retinal screening in the setting of acute infection. The disease's underlying mechanism for ocular involvement is not yet established.

Keywords: Coxiella Burnetti, Q fever, ocular manifestation, acute multifocal retintis, endocarditis

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Authors: Rajesh Kumar

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The largest issue in the current situation is managing solid waste since it pollutes the ecosystem. When considering how to manage waste, even the disposal of mixed waste is a challenge. The Saksham Yuva Project, which is managed by the Haryana government, highlights the consequences and drivers of managing the solid waste of urban areas in the municipal committee pundri in the present study. The overall goal of the Saksham Yuva project is to mobilise the public and educate them about the dangers associated with garbage management. There has been a 20% reduction in waste, according to the study's impacts, and the cost of waste management has also gone down. Further, the study also reported the alternative use of wastes in revenue generation by generating Khaad for agricultural purposes.

Keywords: solid waste management, people awareness, dry and wet waste disposal, material recover facility

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Authors: Gregory Michael McMahon

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Risk management for the purposes of minimizing the damages from the operations of dams has met with opposition emerging from organisations and authorities, and their practitioners. It appears that the cause may be a misunderstanding of risk management arising from exchanges that mix deterministic thinking with risk-centric thinking and that do not separate uncertainty from reliability and accuracy from probability. This paper sets out those misunderstandings that arose from dam operations at Wivenhoe in 2011, using a comparison of outcomes that have been based on the methodology and its rules and those that have been operated by applying misunderstandings of the rules. The paper addresses the performance of one risk-centric Flood Manual for Wivenhoe Dam in achieving a risk management outcome. A mixture of engineering, administrative, and legal factors appear to have combined to reduce the outcomes from the risk approach. These are described. The findings are that a risk-centric Manual may need to assist administrations in the conduct of scenario training regimes, in responding to healthy audit reporting, and in the development of decision-support systems. The principal assistance needed from the Manual, however, is to assist engineering and the law to a good understanding of how risks are managed – do not assume that risk management is understood. The wider findings are that the critical profession for decision-making downstream of the meteorologist is not dam engineering or hydrology, or hydraulics; it is risk management. Risk management will provide the minimum flood damage outcome where actual rainfalls match or exceed forecasts of rainfalls, that therefore risk management will provide the best approach for the likely history of flooding in the life of a dam, and provisions made for worst cases may be state of the art in risk management. The principal conclusion is the need for training in both risk management as a discipline and also in the application of risk management rules to particular dam operational scenarios.

Keywords: risk management, flood control, dam operations, deterministic thinking

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Authors: Peter U. Eze, P. Udaya, Robin J. Evans

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Data hiding can be achieved by Steganography or invisible digital watermarking. For digital watermarking, both accurate retrieval of the embedded watermark and the integrity of the cover image are important. Medical image security in Teleradiology is one of the applications where the embedded patient record needs to be extracted with accuracy as well as the medical image integrity verified. In this research paper, the Constant Correlation Spread Spectrum digital watermarking for medical image tamper detection and accurate embedded watermark retrieval is introduced. In the proposed method, a watermark bit from a patient record is spread in a medical image sub-block such that the correlation of all watermarked sub-blocks with a spreading code, W, would have a constant value, p. The constant correlation p, spreading code, W and the size of the sub-blocks constitute the secret key. Tamper detection is achieved by flagging any sub-block whose correlation value deviates by more than a small value, ℇ, from p. The major features of our new scheme include: (1) Improving watermark detection accuracy for high-pixel depth medical images by reducing the Bit Error Rate (BER) to Zero and (2) block-level tamper detection in a single computational process with simultaneous watermark detection, thereby increasing utility with the same computational cost.

Keywords: Constant Correlation, Medical Image, Spread Spectrum, Tamper Detection, Watermarking

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Authors: Frederick Johnson

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Product management has a long and well-established history within the consumer goods industry, despite being one of the most obscure aspects of brand management. Many global manufacturing organizations are now opting for external cloud-based Manufacturing Execution Systems (MES) to replace costly and outdated monolithic MES solutions. Other global manufacturing leaders are restructuring their organizations to support human-centered values, agile methodologies, and fluid operating principles. Still, industry-leading organizations struggle to apply the appropriate framework for managing evolving external MES solutions as internal "digital products." Product management complements these current trends in technology and philosophical thinking in the market. This paper discusses the central problems associated with adopting product management processes by analyzing its traditional theories and characteristics. Considering these ideas, the article then constructs a translated internal digital product management framework by combining new and existing approaches and principles. The report concludes by demonstrating the framework's capabilities and potential effectiveness in achieving digital maturity and business agility within a manufacturing environment.

Keywords: internal product management, digital transformation, manufacturing information technology, manufacturing execution systems

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Authors: Joseph Uche Azubike, Evelyn Ngozi Agbasi, M. I. Ogbonna

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The audit committee of the board of directors could no longer handle the enterprise's risks. Therefore, a risk management committee was created to control them. Thus, this study examined how enterprise risk management committee characteristics affected Nigerian exchange-listed banks' financial performance from 2013 to 2022. The study's hypotheses and three objectives were to determine how enterprise risk management committee size, composition, and gender diversity affect Nigerian banks' performance. An ex-post facto study design collected secondary data from bank annual reports. We used descriptive statistics, correlation analysis, and Ordinary least square regression to analyze panel data. Enterprise risk management committee size and composition had both negative and no significant effect on bank financial performance in Nigeria, whereas enterprise risk committee gender diversity has a 10% favorable effect. The report advises that adding more women with relevant knowledge to the risk committee to boost performance and allowing women to be at the lead of such risk management could improve bank performance in Nigeria since they are noted to be thorough in their tasks.

Keywords: bank, committee, enterprise, management, performance, risk

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Authors: Lisandro Blas, Héctor Tamanini

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From earliest 90 to now, no many companies or organization can “really” implement a knowledge management (KM) system that works (no only viewed from a measurement model, but in this continuity). Which are the reasons of that? Some of the reason maybe could be embedded in how KM is demanded (usefulness, priority, experts, a definition of KM) vs the importance and resources that the organizations afford (budget, responsible of a specific area of KM, intangibility). Many organizations “claim” the importance of Knowledge Management but thhese demands are not reflecting these claims in their future actions. With another’s tools or managements ideas the organizations put the economics and human resources to work. Why it´s not occur in KM? This paper tray to explain some of this reasons and tray to deal with this situations through a survey done in 2011 for a IAPG (Argentinean Institute from Oil & Gas) Congress.

Keywords: knowledge management into organizations, new perspectives, failure in implementation, claim

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Authors: Naznin Sultana Daisy, Mohammad Hesam Hafezi, Lei Liu

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Nowadays, oily solid waste management has become an important issue for many countries due to frequent oil spill accidents and the increase of industrial oily wastewater. The historical oil spill data show that marine oil spills that affect the shoreline can, in extreme cases, produce up to 30 or 40 times more waste than the volume of oil initially released. Hence, responsive authorities aim to develop the most effective oily waste management solution in a timely manner to manage and minimize the waste generated. In this study initially, we tried to develop the roadmap of oily waste management for three-tiered spill scenarios for Atlantic Canada. For that purpose, three oily waste disposal scenarios are evaluated via six criteria which are determined according to the opinions of the experts from the field. Consequently, through sustainable response strategies, the most appropriate and feasible scenario is determined. The results of this study will assist to develop an integrated oily waste management system for identifying the optimal waste-generation-allocation-disposal schemes and generating the optimal management alternatives based on the holistic consideration of environmental, technological, economic, social, and regulatory factors.

Keywords: oily waste management, marine oil spill, multi-criteria decision making, oil spill response

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Authors: Jerzy Slowik, Elzbieta Grochowska-Niedworok

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The analysis of the market needs and trends in both treatment and prophylaxis shows the growing need to implement comprehensive solutions that would enable safe contact of the beneficiaries with the therapeutic and diagnostic support group. Based on the evaluation of the medical and sports industry services market, projects co-financed by the EFRR in the form of comprehensive care systems using IT tools for patients under treatment in the field of obesity and metabolism using the system were implemented under the Regional Operational Program of the Silesian Voivodeship for 2014-2020. SFAO 1.0 (Support for the Fight Against Obesity) number of the WND-RPSL project. 01.02.00-24-06EA / 16) as well as for competitors in qualified sports SK system (qualified sports) project number WND-RPSL. 01.02.00-24-0630 / 17-002. The service provided in accordance with SFAO 1.0 has shown a wide range of therapy possibilities - from monitoring the body's reactions during sports activities of healthy people to remote care for sick patients. As a result of the introduction of an innovative service, it was possible to increase the effectiveness of the therapy, which was manifested in the reduction of the starting doses of drugs by 10%, improvement of the efficiency of the respiratory and blood circulation system, and a 10% increase in bone density. Innovation in the provision of medical services in the field of qualified sports SK was a response to the needs of the athletes and their parents, coaches, physiotherapists, dieticians, and doctors who take care of people actively practicing qualified sports. The creation of the platform made it possible to constantly monitor the trainers necessary for both the proper training process and the control over the health of patients. Monitoring the patient's health by a specialized team in the field of various specialties allows for the proper targeting of the treatment and training process due to the increase in the availability of medical counseling. Specialists taking care of the patient can provide additional advice and modify the medical treatment of the patient on an ongoing basis, which is why we are dealing with a holistic approach.

Keywords: innovation of medical services, sport, obesity, innovation

Procedia PDF Downloads 125

Authors: Bahman Ghaderi, Hedayat Hosseini, Parviz Kafche

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The role of knowledge management processes in achieving the strategic goals of organizations is crucial. To this end, understanding the relationship between knowledge management processes and different aspects of strategic thinking (followed by long-term organizational planning) should be considered. This research examines the relationship between each of the five knowledge management processes (creation, storage, transfer, audit, and deployment) with each dimension of strategic thinking (vision, creativity, thinking, communication and analysis) in one of the major sectors of the food industry in Iran. In this research, knowledge management and its dimensions (knowledge acquisition, knowledge storage, knowledge transfer, knowledge auditing, and finally knowledge utilization) as independent variables and strategic thinking and its dimensions (creativity, systematic thinking, vision, strategic analysis, and strategic communication) are considered as the dependent variable. The statistical population of this study consisted of 245 managers and employees of Minoo Food Industrial Group in Tehran. In this study, a simple random sampling method was used, and data were collected by a questionnaire designed by the research team. Data were analyzed using SPSS 21 software. LISERL software is also used for calculating and drawing models and graphs. Among the factors investigated in the present study, knowledge storage with 0.78 had the most effect, and knowledge transfer with 0.62 had the least effect on knowledge management and thus on strategic thinking.

Keywords: knowledge management, strategic thinking, knowledge management processes, food industry

Procedia PDF Downloads 168