Search results for: trauma team activations

Authors: Morteza Naderi

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The Persian fallow deer was considered as a globally extinct species until 1956 when a small population was rediscovered from Dez Wildlife Refuge and Karkheh Wildlife Refuge in southwestern parts of Iran. After long species rehabilitation process, the species was transplanted to Dasht-e-Naz Wildlife Refuge in northern Iran, and from where, follow deer was introduced to the different selected habitats such as Ashk Island in Lake Uromiyeh National Park. During 12 years, (from 1978 to 1989) 58 individuals (25 males and 33 females) were transferred to Ask Island. The main threat to the established population was related to the freshwater shortage and existing just one single trough such as high mortality rate of adult males during rutting season, snake biting and dilutional hyponatremia. Desiccation of Lake Uromiyeh in recent years raised new challenges to the conservation process, as about 80 individuals, nearly one third of the population were died in 2011. Connection of Island to the mainland caused predators’ accessibility (such as wolf and Jackal) to the Ask Island and higher mortality because of follow deer attraction to the surrounding mainland farms. Conservation team faced such new challenges that may cause introduction plan to be probably failed. Investigations about habitat affinities and carrying capacity are the main basic researches in the management and conservation of the species. Logistic regression analysis showed that the presence of the different fresh water resources as well as Allium akaka and Pistacia atlantica are the main environmental variables affect Follow deer habitat selection. Habitat carrying capacity analysis both in summer and winter seasons indicated that Ashk Island can support 240±30 of Persian follow deer.

Keywords: carrying capacity, follow deer, lake Uromiyeh, microhabitat affinities, population oscillation, predation, sex ratio

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Authors: Namratha Pai, K. Vasantharaj, K. Haribabu

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Our Team is developing an innovative cost effective biological technique to desulfurize crude oil. ’Sulphur’ is found to be present in crude oil samples from .05% - 13.95% and its elimination by industrial methods is expensive currently. Materials required :- Alicyclobacillus acidoterrestrius, potato dextrose agar, oxygen, Pyragallol and inert gas(nitrogen). Method adapted and proposed:- 1) Growth of bacteria studied, energy needs. 2) Compatibility with crude-oil. 3) Reaction rate of bacteria studied and optimized. 4) Reaction development by computer simulation. 5) Simulated work tested by building the reactor. The method being developed requires the use of bacteria Alicyclobacillus acidoterrestrius - an acidothermophilic heterotrophic, soil dwelling aerobic, Sulfur bacteria. The bacteria are fed to crude oil in a unique manner. Its coated onto potato dextrose agar beads, cultured for 24 hours (growth time coincides with time when it begins reacting) and fed into the reactor. The beads are to be replenished with O2 by passing them through a jacket around the reactor which has O2 supply. The O2 can’t be supplied directly as crude oil is inflammable, hence the process. Beads are made to move around based on the concept of fluidized bed reactor. By controlling the velocity of inert gas pumped , the beads are made to settle down when exhausted of O2. It is recycled through the jacket where O2 is re-fed and beads which were inside the ring substitute the exhausted ones. Crude-oil is maintained between 1 atm-270 M Pa pressure and 45°C treated with tartaric acid (Ph reason for bacteria growth) for optimum output. Bacteria being of oxidising type react with Sulphur in crude-oil and liberate out SO4^2- and no gas. SO4^2- is absorbed into H2O. NaOH is fed once reaction is complete and beads separated. Crude-oil is thus separated of SO4^2-, thereby Sulphur, tartaric acid and other acids which are separated out. Bio-corrosion is taken care of by internal wall painting (phenolepoxy paints). Earlier methods used included use of Pseudomonas and Rhodococcus species. They were found to be inefficient, time and energy consuming and reduce the fuel value as they fed on skeleton.

Keywords: alicyclobacillus acidoterrestrius, potato dextrose agar, fluidized bed reactor principle, reaction time for bacteria, compatibility with crude oil

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Authors: Si Jack Chong, Chew Theng Yap, Wan Loong James Mok

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Introduction: Regional burn centres face the spectra of introduced multi-drug resistant organisms (MDRO) from transfer patients resident in MDRO endemic countries. MDRO can cause severe nosocomial infection, which in massive burn patients, will lead to greater morbidity and mortality and strain the institution financially. We aim to highlight 4 key measures that have effectively prevented transmission of imported MDRO. Methods: A case of Candida auris (C. auris) from a massive burn patient transferred from an MDRO endemic country is used to illustrate the measures. C. auris is a globally emerging multi-drug resistant fungal pathogen causing nosocomial transmission. Results: Infection control measures used to mitigate the risk of outbreak from transfer cases are: (1) Multidisciplinary team approach involving Infection Control and Infectious Disease specialists early to ensure appropriate antibiotics use and implementation of barrier measures, (2) aseptic procedures for dressing change with strict isolation and donning of personal protective equipment in the ward, (3) early screening of massive burn patient from MDRO endemic region, (4) hydrogen peroxide vaporization terminal cleaning for operating theatres and rooms. Conclusion: The prevalence of air travel and international transfer to regional burn centres will need effective infection control measures to reduce the risk of transmission from imported massive burn patients. In our centre, we have effectively implemented 4 measures which have reduced the risks of local contamination. We share a recent case report to illustrate successful management of a potential MDRO outbreak resulting from transfer of massive burn patient resident in an MDRO endemic area.

Keywords: burns, burn unit, cross infection, infection control

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Authors: N. Ismail, O. Thammajinda, U. Thongpanya

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Games-based learning (GBL) has become increasingly important in teaching and learning. This paper explains the first two phases (analysis and design) of a GBL development project, ending up with a prototype design based on students’ and teachers’ perceptions. The two phases are part of a full cycle GBL project aiming to help secondary school students in Thailand in their study of Comprehensive Sex Education (CSE). In the course of the study, we invited 1,152 students to complete questionnaires and interviewed 12 secondary school teachers in focus groups. This paper found that GBL can serve students in their learning about CSE, enabling them to gain understanding of their sexuality, develop skills, including critical thinking skills and interact with others (peers, teachers, etc.) in a safe environment. The objectives of this paper are to outline the development of GBL variables from the research question(s) into the developers’ flow chart, to be responsive to the GBL beneficiaries’ preferences and expectations, and to help in answering the research questions. This paper details the steps applied to generate GBL variables that can feed into a game flow chart to develop a GBL prototype. In our approach, we detailed two models: (1) Game Elements Model (GEM) and (2) Game Object Model (GOM). There are three outcomes of this research – first, to achieve the objectives and benefits of GBL in learning, game design has to start with the research question(s) and the challenges to be resolved as research outcomes. Second, aligning the educational aims with engaging GBL end users (students) within the data collection phase to inform the game prototype with the game variables is essential to address the answer/solution to the research question(s). Third, for efficient GBL to bridge the gap between pedagogy and technology and in order to answer the research questions via technology (i.e. GBL) and to minimise the isolation between the pedagogists “P” and technologist “T”, several meetings and discussions need to take place within the team.

Keywords: games-based learning, engagement, pedagogy, preferences, prototype

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Authors: Anand Malik

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The Himalayas with high tectonic activities poses a great threat to human life and property. Climate change is another reason which triggering extreme events multiple fold effect on high mountain glacial environment, rock falls, landslides, debris flows, flash flood and snow avalanches. One such extreme event of cloud burst along with breach of moraine dammed Chorabri Lake occurred from June 14 to June 17, 2013, triggered flooding of Saraswati and Mandakini rivers in the Kedarnath Valley of Rudraprayag district of Uttrakhand state of India. As a result, huge volume of water with its high velocity created a catastrophe of the century, which resulted into loss of large number of human/animals, pilgrimage, tourism, agriculture and property. Thus a comprehensive assessment of debris flow hazards requires GIS-based modeling using numerical methods. The aim of present study is to focus on analysis and mapping of debris flow movements using geospatial data with flow-r (developed by team at IGAR, University of Lausanne). The model is based on combined probabilistic and energetic algorithms for the assessment of spreading of flow with maximum run out distances. Aster Digital Elevation Model (DEM) with 30m x 30m cell size (resolution) is used as main geospatial data for preparing the run out assessment, while Landsat data is used to analyze land use land cover change in the study area. The results of the study area show that model can be applied with great accuracy as the model is very useful in determining debris flow areas. The results are compared with existing available landslides/debris flow maps. ArcGIS software is used in preparing run out susceptibility maps which can be used in debris flow mitigation and future land use planning.

Keywords: debris flow, geospatial data, GIS based modeling, flow-R

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Authors: M. Ekiert, T. Uhl, A. Mlyniec

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Tendons are the biological soft tissue structures composed of collagen, proteoglycan, glycoproteins, water and cells of extracellular matrix (ECM). Tendons, which primary function is to transfer force generated by the muscles to the bones causing joints movement, are exposed to many micro and macro damages. In fact, tendons and ligaments trauma are one of the most numerous injuries of human musculoskeletal system, causing for many people (particularly for athletes and physically active people), recurring disorders, chronic pain or even inability of movement. The number of tendons reconstruction and transplantation procedures is increasing every year. Therefore, studies on soft tissues storage conditions (influencing i.e. tissue aging) seem to be an extremely important issue. In this study, an atomic-scale investigation on the kinetics of decomposition of two selected tendon components – collagen type I (which forms a 60-85% of a tendon dry mass) and elastin protein (which combine with ECM creates elastic fibers of connective tissues) is presented. A molecular model of collagen and elastin was developed based on crystal structure of triple-helical collagen-like 1QSU peptide and P15502 human elastin protein, respectively. Each model employed 4 linear strands collagen/elastin strands per unit cell, distributed in 2x2 matrix arrangement, placed in simulation box filled with water molecules. A decomposition phenomena was simulated with molecular dynamics (MD) method using ReaxFF force field and periodic boundary conditions. A set of NVT-MD runs was performed for 1000K temperature range in order to obtained temperature-depended rate of production of decomposition by-products. Based on calculated reaction rates activation energies and pre-exponential factors, required to formulate Arrhenius equations describing kinetics of decomposition of tested soft tissue components, were calculated. Moreover, by adjusting a model developed for collagen, system scalability and correct implementation of the periodic boundary conditions were evaluated. An obtained results provide a deeper insight into decomposition of selected tendon components. A developed methodology may also be easily transferred to other connective tissue elements and therefore might be used for further studies on soft tissues aging.

Keywords: decomposition, molecular dynamics, soft tissue, tendons

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Authors: Alexandra Shipley

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Background: Undergraduate paediatric teaching must overcome two major challenges: 1) balancing patient safety with active student engagement and 2) exposing students to a comprehensive range of pathologies within a relatively short clinical placement. Whilst lectures and shadowing on paediatric wards constitute the mainstay of learning, Simulation and Virtual Reality (VR) are emerging as effective teaching tools, which - immune to the unpredictability and seasonal variation of hospital presentations - could expose students to the entire syllabus more reliably, efficiently, and independently. We aim to evaluate the potential utility of Simulation and VR in addressing gaps within the traditional paediatric curriculum from the perspective of medical students. Summary of Work: Exposure to and perceived utility of various learning opportunities within the Paediatric and Emergency Medicine courses were assessed through a questionnaire completed by 5th year medical students (n=23). Summary of Results: Students reported limited exposure to several common acute paediatric presentations, such as bronchiolitis (41%), croup (32%) or pneumonia (14%), and to clinical emergencies, including cardiac/respiratory arrests or trauma calls (27%). Across all conditions, average self-reported confidence in assessment and management to the level expected of an FY1 is greater amongst those who observed at least one case (e.g. 7.6/10 compared with 3.6/10 for croup). Students rated exposure through Simulation or VR to be of similar utility to witnessing a clinical scenario on the ward. In free text responses, students unanimously favoured being ‘challenged’ through ‘hands-on’ patient interaction over passive shadowing, where it is ‘easy to zone out.’ In recognition of the fact that such independence is only appropriate in certain clinical situations, many students reported wanting more Simulation and VR teaching. Importantly, students raised the necessity of ‘proper debriefs’ after these sessions to maximise educational value. Discussion and Conclusion: Our questionnaire elicited several student-perceived challenges in paediatric education, including incomplete exposure to common pathologies and limited opportunities for active involvement in patient care. Indeed, these experiences seem to be important predictors of confidence. Quantitative and qualitative feedback suggests that VR and Simulation satisfy students’ self-reported appetite for independent engagement with authentic clinical scenarios. Take-aways: Our findings endorse further development of VR and Simulation as high-yield adjuncts to paediatric education.

Keywords: paediatric emergency education, simulation, virtual reality, medical education

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Authors: Ahmed Stifi, Sascha Gentes

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The contract in its simplest definition is an agreement involving parties with a number of documents which may be as little as a marriage contract involving two parties or as big as a contract of construction and operation of a nuclear power plant involving companies and stakeholders with hundreds or even thousands of documents. All parties in the construction industry, not only the contract experts, agree that the success of a project is linked primarily to the form of contract regulating the relationship between stakeholders of the project. Therefore it is essential for the construction industry to study, analyze and improve its contracts forms continuously. However, it should be mentioned that different contract forms are developed to suit the construction evolution in term of its machinery, materials and construction process. There exist some similarities in some clauses and variations in many of these forms depending upon the type of project, the kind of clients and more importantly the laws and regulations governing the transaction in the country where the project is carried out. This paper will discuss the most important forms of construction contracts starting from national level, intended to the contract form in Germany and moving on to the international level introducing FIDIC contracts and its different forms, some newly developed contracts forms namely the integrated form of agreement, the new engineering contract and the project alliance agreement. The result of the study shows that many of the contract’s paragraphs are similar and the main difference comes in the approach of the relationship between the parties. Is it based on co-operation and mutual trust, or in some cases a load of responsibility for a particular party which increases the problems and disputes that affects the success of the project negatively. Thus we can say that the form of the contract, that plays an essential role in the approach of the project management, which is ultimately the key factor for the success of the project. So we advise to use a form of contract, which enhance the mutual trust between the project parties, contribute to support the cooperation between them, distribute responsibility and risks on an equitable basis and build on the principle “win-win". In additional to the conventional role of the contract it should integrate all parties into one team to achieve the target value of the project.

Keywords: contract, FIDIC, integrated form of agreement, new engineering contract, project alliance agreemen

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Authors: Suzanne L. Stewart, Sarah J. Ponton, Mikaela D. Gabriel, Roy Strebel, Xinyi Lu

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Indigenous Peoples have faced unique barriers to accessing and receiving culturally safe and appropriate mental health care while also facing daunting rates of mental health diagnoses and comorbidities. Indigenous researchers and clinicians have well established the connection of the current mental health issues in Indigenous communities as a direct result of colonization by way of intergenerational trauma throughout Canada’s colonial history. Such mental health barriers and challenges have become exacerbated during the COVID-19 pandemic. Throughout the pandemic, access to mental health, cultural, ceremonial, and community services were severely impacted and restricted; however, it is these same cultural activities and community resources that are key to supporting Indigenous mental health from a traditional and community-based perspective. This research employed a unique combination of a thorough, analytical scoping review of the existent mental health literature of Indigenous mental health in the COVID-19 pandemic, alongside narrative interviews employing an oral storytelling tradition methodology with key community informants that provide comprehensive cultural services to the Indigenous community of Toronto, as well as across Canada. These key informant interviews provided a wealth of insights into virtual transitions of Indigenous care and mental health support; intersections of historical underfunding and current financial navigation in technology infrastructure; accessibility and connection with Indigenous youth in remote locations; as well as maintaining community involvement and traditional practices in a current pandemic. Both the scoping review and narrative interviews were meticulously analyzed for overarching narrative themes to best explore the extent of the literature on Indigenous mental health and services during COVID-19; identify gaps in this literature; identify barriers and supports for the Indigenous community, and explore the intersection of community and cultural impacts to mental health. Themes of the scoping review included: Historical Context; Challenges in Culturally-Based Services; and Strengths in Culturally-Based Services. Meta themes across narrative interviews included: Virtual Transitions; Financial Support for Indigenous Services; Health Service Delivery & Wellbeing; and Culture & Community Connection. The results of this scoping review and narrative interviews provide wide application and contribution to the mental health literature, as well as recommendations for policy, service provision, autonomy in Indigenous health and wellbeing, and crucial insights into the present and enduring mental health needs of Indigenous Peoples throughout the COVID-19 pandemic.

Keywords: indigenous community services, indigenous mental health, indigenous scoping review, indigenous peoples and Covid-19

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Authors: Diego Abbo

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On February 15, 2012 off the Indian coast of Kerala, in position 091702N-0760180E by the oil tanker Enrica Lexie, flying the Italian flag, bursts of 5.56 x45 caliber shots were fired from assault rifles AR/70 Italian-made Beretta towards the Indian fisher boat St. Anthony. The shots that hit the St. Anthony fishing boat were six, of which two killed the Indian fishermen Ajesh Pink and Valentine Jelestine. From the analysis concerning the kinematic engagement of the two ships and from the autopsy and ballistic results of the Indian judicial authorities it is possible to reconstruct the trajectories of the six aforementioned shots. This essay reconstructs the trajectories of the six shots that cannot be of direct shooting but have undergone a rebound on the water. The investigation carried out scientifically demonstrates the rebound of the blows on the water, the gyrostatic deviation due to the rebound and the tumbling effect always due to the rebound as regards intermediate ballistics. In consideration of the four shots that directly impacted the fishing vessel, the current examination proves, with scientific value, that the trajectories could not be downwards but upwards. Also, the trajectory of two shots that hit to death the two fishermen could not be downwards but only upwards. In fact, this paper demonstrates, with scientific value: The loss of speed of the projectiles due to the rebound on the water; The tumbling effect in the ballistic medium within the two victims; The permanent cavities subject to the injury ballistics and the related ballistic trauma that prevented homeostasis causing bleeding in one case; The thermo-hardening deformation of the bullet found in Valentine Jelestine's skull; The upward and non-downward trajectories. The paper constitutes a tool in forensic ballistics in that it manages to reconstruct, from the final spot of the projectiles fired, all phases of ballistics like the internal one of the weapons that fired, the intermediate one, the terminal one and the penetrative structural one. In general terms the ballistics reconstruction is based on measurable parameters whose entity is contained with certainty within a lower and upper limit. Therefore, quantities that refer to angles, speed, impact energy and firing position of the shooter can be identified within the aforementioned limits. Finally, the investigation into the internal bullet track, obtained from any autopsy examination, offers a significant “lesson learned” but overall a starting point to contain or mitigate bleeding as a rescue from future gunshot wounds.

Keywords: impact physics, intermediate ballistics, terminal ballistics, tumbling effect

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Authors: Noor Abdelhamid, Donovan Nelson, Cara Prosser

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The architectural design process could be mapped out as a dialogue between designer and user that is constructed across multiple phases with the overarching goal of aligning design outcomes with user needs. Traditionally, this dialogue is bounded within a preliminary phase of determining factors that will direct the design intent, and a completion phase, of handing off the project to the client. Pre- and post-occupancy evaluations (P/POE’s) could provide an alternative process by extending this dialogue on both ends of the design process. The purpose of this research is to study the influence of systematic pre-occupancy data collection in achieving design goals by conducting post-occupancy evaluations of two case studies. In the context of this study, systematic pre-occupancy data collection is defined as the preliminary documentation of the existing conditions that helps portray stakeholders’ needs. When implemented, pre-occupancy occurs during the early phases of the architectural design process, utilizing the information to shape the design intent. Investigative POE’s are performed on two case studies with distinct early design approaches to understand how the current space is impacting user needs, establish design outcomes, and inform future strategies. The first case study underwent systematic pre-occupancy data collection and synthesis, while the other represents the traditional, uncoordinated practice of informally collecting data during an early design phase. POE’s target the dynamics between the building and its occupants by studying how spaces are serving the needs of the users. Data collection for this study consists of user surveys, audiovisual materials, and observations during regular site visits. Mixed methods of qualitative and quantitative analyses are synthesized to identify patterns in the data. The paper concludes by positioning value on both sides of the architectural design process: the integration of systematic pre-occupancy methods in the early phases and the reinforcement of a continued dialogue between building and design team after building completion.

Keywords: architecture, design process, pre-occupancy data, post-occupancy evaluation

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Authors: Amaraporn Puraya, Roongtiva Boonpracom, Somsak Thojampa, Sirikanok Klankhajhon, Kittisak Kumpeera

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The objective of this qualitative research was to study the elderly health care process by community participation. Data were collected by quality research methods, including secondary data study, observation, in-depth interviews, and focus group discussions and analyzed by content analysis, reflection and review of information. The research results pointed out that the important elderly health care process by community participation consisted of 2 parts, namely the community participation development process in elderly health care and the outcomes from the participation development process. The community participation development process consisted of 4 steps as follows: 1) Building the leadership team, an important social capital of the community, which started from searching for both formal and informal leaders by giving the opportunity for public participation and creating clear agreements defining roles, duties and responsibilities; 2) investigating the problems and the needs of the community, 3) designing the elderly health care activities under the concept of self-care potential development of the elderly through participation in community forums and meetings to exchange knowledge with common goals, plans and operation and 4) the development process of sustainable health care agreement at the local level, starting from opening communication channels to create awareness and participation in various activities at both individual and group levels as well as pushing activities/projects into the community development plan consistent with the local administration policy. The outcomes from the participation development process were as follows. 1) There was the integration of the elderly for doing the elderly health care activities/projects in the community managed by the elderly themselves. 2) The service system was changed from the passive to the proactive one, focusing on health promotion rather than treating diseases or illnesses. 3) The registered nurses / the public health officers can provide care for the elderly with chronic illnesses through the implementation of activities/projects of elderly health care so that the elderly can access the services more. 4) The local government organization became the main mechanism in driving the elderly health care process by community participation.

Keywords: elderly health care process, community participation, elderly, Thailand

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Authors: M. B. Ricardo De Oliveira, A. Borghi-Silva, E. Paravizo, F. Lizarelli, L. Di Thomazzo, D. Braatz

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Prototypes are a critical feature in the product development process, as they help the project team visualize early concept flaws, communicate ideas and introduce an initial product testing. Involving stakeholders, such as consumers and users, in prototype tests allows the gathering of valuable feedback, contributing for a better product and making the design process more participatory. Even though recent studies have shown that user evaluation of prototypes is valuable, few articles provide a method or protocol on how designers should conduct it. This multidisciplinary study (involving the areas of physiotherapy, engineering and computer science) aims to develop an evaluation protocol, using an ergometric step prototype as the product prototype to be assessed. The protocol consisted of performing two tests (the 2 Minute Step Test and the Portability Test) to allow users (patients) and consumers (physiotherapists) to have an experience with the prototype. Furthermore, the protocol contained four Likert-Scale questionnaires (one for users and three for consumers), that inquired participants about how they perceived the design characteristics of the product (performance, safety, materials, maintenance, portability, usability and ergonomics), in their use of the prototype. Additionally, the protocol indicated the need to conduct interviews with the product designers, in order to link their feedback to the ones from the consumers and users. Both tests and interviews were recorded for further analysis. The participation criteria for the study was gender and age for patients, gender and experience with 2 Minute Step Test for physiotherapists and involvement level in the product development project for designers. The questionnaire's reliability was validated using Cronbach's Alpha and the quantitative data of the questionnaires were analyzed using non-parametric hypothesis tests with a significance level of 0.05 (p <0.05) and descriptive statistics. As a result, this study provides a concise evaluation protocol which can assist designers in their development process, collecting quantitative feedback from consumer and users, and qualitative feedback from designers.

Keywords: Product Design, Product Evaluation, Prototypes, Step

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Authors: Vidya Badrinarayanan, Appa Iyer Sivakumar

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The coronavirus pandemic has sent an important message that future project teams need to be trained to work under virtual conditions, which has already become the new norm in organizations across the world. As organizations increasingly rely on virtual teams to achieve project objectives, it is essential to comprehend how leadership functions in virtual project teams. The purpose of this research is to analyze the leadership behaviors exhibited by project managers for building trust and managing conflicts effectively in virtual project teams. This convergent parallel mixed method research was conducted by surveying 185 virtual leaders and conducting a semi-structured interview with 13 senior virtual leaders involved in managing projects across the industry sectors. The research findings indicate that establishing trust and managing conflicts were ranked as significant challenges in leading virtual project teams in the post-pandemic era. In contrast to earlier findings, our research findings suggest that productivity was not ranked as a significant challenge in leading virtual project teams. This indeed is a positive finding for organizations to consider adopting virtual project teams in the long run. Additionally, the research findings recommend that virtual leaders need to strive to build a high-trust environment and develop effective conflict resolution skills to improve the effectiveness of virtual project teams. As the project management profession struggles with low project success rates, mixed-method research aims to contribute to the knowledge in the growing research area of virtual project leadership. This research contributes to the knowledge by offering first-person accounts from senior virtual leaders on the innovative strategies they had implemented for building trust and resolving conflicts effectively in the virtual project when there were limited opportunities for face-to-face interaction on account of the pandemic. In addition, the leadership framework created as a part of this research for trust development and conflict management in virtual project teams will guide project managers to improve virtual project team effectiveness.

Keywords: conflict management, trust building, virtual leadership, virtual teams

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Authors: Mohammad H. Yarmohammadian, Masoud Ferdosi, Abbas Haghshenas, Fatemeh Rezaei

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Surgical procedures aim at preserving human life and improving quality of their life. However, there are many potential risk sources that can cause serious harm to patients. For centuries, managers believed that technical competence of a surgeon is the only key to a successful surgery. But over the past decade, risks are considered in terms of process-based safety procedures, teamwork and inter departmental communication. Aims: This study aims to determine how the process- biased surgical risk management should be done in terms of project management tool named ABS (Activity Breakdown Structure). Settings and Design: This study was conducted in two stages. First, literature review and meeting with professors was done to determine principles and framework of surgical risk management. Next, responsible teams for surgical patient journey were involved in following meeting to develop the process- biased surgical risk management. Methods and Material: This study is a qualitative research in which focus groups with the inductive approach is used. Sampling was performed to achieve representativeness through intensity sampling biased on experience and seniority. Analysis Method used: context analysis of interviews and consensus themes extracted from FDG meetings discussion was the analysis tool. Results: we developed the patient journey process in 5 main phases, 24 activities and 108 tasks. Then, responsible teams, transposition and allocated places for performing determined. Some activities and tasks themes were repeated in each phases like patient identification and records review because of their importance. Conclusions: Risk management of surgical departments is significant as this facility is the hospital’s largest cost and revenue center. Good communication between surgical team and other clinical teams outside surgery department through process- biased perspective could improve safety of patient under this procedure.

Keywords: risk management, activity breakdown structure (ABS), surgical department, medical sciences

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Authors: Chia-Ying Lin

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This paper explains how to enhance doctor-patient communication and nurse-patient communication through multiple intelligence signing methods and user-centered. It is hoped that through the implementation of the "electronic consent", the problems faced by the paper consent can be solved: storage methods, resource utilization, convenience, correctness of information, integrated management, statistical analysis and other related issues. Make better use and allocation of resources to provide better medical quality. First, invite the ｍedical records department to assist in the inventory of paper consent in the hospital: organising, classifying, merging, coding, and setting. Second, plan the electronic consent configuration file: set the form number, consent form group, fields and templates, and the corresponding doctor's order code. Next, Summarize four types of rapid methods of electronic consent: according to the doctor's order, according to the medical behavior, according to the schedule, and manually generate the consent form. Finally, system promotion and adjustment: form an "electronic consent promotion team" to improve, follow five major processes: planning, development, testing, release, and feedback, and invite clinical units to raise the difficulties faced in the promotion, and make improvements to the problems. The electronic signature rate of the whole hospital will increase from 4% in January 2022 to 79% in November 2022. Use the saved resources more effectively, including: reduce paper usage (reduce carbon footprint), reduce the cost of ink cartridges, re-plan and use the space for paper medical records, and save human resources to provide better services. Through the introduction of information technology and technology, the main spirit of "lean management" is implemented. Transforming and reengineering the process to eliminate unnecessary waste is also the highest purpose of this project.

Keywords: smart signature, electronic consent, electronic medical records, user-centered, doctor-patient communication, nurse-patient communication

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Authors: Anahita Dalmia

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There has been a recent rise in ‘audience-centric’ and immersive storytelling. This indicates audiences are gaining interest in experiencing real adventure with everything that encompasses the struggle, the new friendships, skill development, and growth. This paper examines two themed alternate reality games created by a group of students at the University of Southern California as an experiment in how to design an adventure and to evaluate its impact on participants. The experiences combined immersive improvisational theatre and live-action roleplaying to create socially aware experiences within the timespan of four hours, using Harry Potter and mythology as themes. In each experiment, over 500 players simultaneously embarked on quests -a series of challenges including puzzle-solving, scavenger-hunting, and character interactions- to join a narrative faction. While playing, the participants were asked to choose faction alignments based on the characters they interacted with, as well as their own backgrounds and moral values. During the narrative finale, the impact of their individual choices on the larger story and game were revealed. After the conclusion of each experience, participants filled out questionnaires and were interviewed. Through this, it was discovered that participants developed transferable problem-solving, team-work, and persuasion skills. They also learned about the theme of the experience and reflected on their own moral values and judgment-making abilities after they realized the consequences of their actions in the game-world, inspiring some participants to make changes outside of it. This reveals that alternative reality games can lead to socialization, educational development, and real-world change in a variety of contexts when implemented correctly. This experiment has begun to discover the value of alternate reality games in a real-world context and to develop a reproducible format to continue to create such an impact.

Keywords: adventure, alternate reality games, education, immersive entertainment, interactive entertainment

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Authors: Alex Eldo Simon, Abhishek Yadav

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This study aimed to evaluate the utility of postmortem computed tomography (CT) and heart weight measurements in the assessment of cardiomegaly in cases of sudden death due to cardiac origin by comparing the results of these two diagnostic methods. The study retrospectively analyzed postmortem computed tomography (PMCT) data from 54 cases of sudden natural death and compared the findings with those of the autopsy. The study involved measuring the cardiothoracic ratio (CTR) from coronal computed tomography (CT) images and determining the actual cardiac weight by weighing the heart during the autopsy. The inclusion criteria for the study were cases of sudden death suspected to be caused by cardiac pathology, while exclusion criteria included death due to unnatural causes such as trauma or poisoning, diagnosed natural causes of death related to organs other than the heart, and cases of decomposition. Sensitivity, specificity, and diagnostic accuracy were calculated, and to evaluate the accuracy of using the cardiothoracic ratio (CTR) to detect an enlarged heart, the study generated receiver operating characteristic (ROC) curves. The cardiothoracic ratio (CTR) is a radiological tool used to assess cardiomegaly by measuring the maximum cardiac diameter in relation to the maximum transverse diameter of the chest wall. The clinically used criteria for CTR have been modified from 0.50 to 0.57 for use in postmortem settings, where abnormalities can be detected by comparing CTR values to this threshold. A CTR value of 0.57 or higher is suggestive of hypertrophy but not conclusive. Similarly, heart weight is measured during the traditional autopsy, and a cardiac weight greater than 450 grams is defined as hypertrophy. Of the 54 cases evaluated, 22 (40.7%) had a cardiothoracic ratio (CTR) ranging from > 0.50 to equal 0.57, and 12 cases (22.2%) had a CTR greater than 0.57, which was defined as hypertrophy. The mean CTR was calculated as 0.52 ± 0.06. Among the 54 cases evaluated, the weight of the heart was measured, and the mean was calculated as 369.4 ± 99.9 grams. Out of the 54 cases evaluated, 12 were found to have hypertrophy as defined by PMCT, while only 9 cases were identified with hypertrophy in traditional autopsy. The sensitivity and specificity of the test were calculated as 55.56% and 84.44%, respectively. The sensitivity of the hypertrophy test was found to be 55.56% (95% CI: 26.66, 81.12¹), the specificity was 84.44% (95% CI: 71.22, 92.25¹), and the diagnostic accuracy was 79.63% (95% CI: 67.1, 88.23¹). The limitation of the study was a low sample size of only 54 cases, which may limit the generalizability of the findings. The comparison of the cardiothoracic ratio with heart weight in this study suggests that PMCT may serve as a screening tool for medico-legal autopsies when performed by forensic pathologists. However, it should be noted that the low sensitivity of the test (55.5%) may limit its diagnostic accuracy, and therefore, further studies with larger sample sizes and more diverse populations are needed to validate these findings.

Keywords: PMCT, virtopsy, CTR, cardiothoracic ratio

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Authors: Orly Yona Drori, Shirley Ben Shlomo

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Objectives: The participants will be able to recognize the predictors of binge eating addiction among women who suffer from psychological abuse in their relationships and will recognize the role of woman's defense mechanisms in moderating the association between psychological abuse and binge eating addiction. Methods: A convenience sample of 380 Israeli women in relationships were located via the Internet, and after consenting to participate in the study, they completed a series of structured questionnaires (The Yale Food Addiction Scale; The Defense Style Questionnaire; psychological maltreatment of women by their male partners; level of differentiation of self; sociodemographic questionnaire). Results: The higher the level of differentiation and mature defense mechanisms, the less addictive a woman is. However, the level of addiction among women who experience psychological abuse within their intimate relations is higher than women who do not experience psychological abuse in their relationship. Among women who experienced psychological abuse in their relations, the defense mechanisms moderate the association between psychological abuse within intimate relations and the extent of the addiction to binge eating. Conclusions: The study contributes to the therapy of women with binge eating addictions, as it raises awareness of therapeutic-related content that could strengthen women and help them to cope with situations in their lives without the need to binge. One of the significant variables for therapeutic work is the level of differentiation of the self. In addition, identifying the types of defense mechanisms might help to match treatment to the woman's emotional needs. The current study found also that it is important to identify the environmental systems by which the addict is surrounded, such as whether woman is in an abusive relationship. Finally the study leads to the recognition that binge eating, which is usually treated with an emphasis on nutritional behavior change, is an addiction, and as such, it requires a combination of mental, nutritional and behavioral therapy. In view of this approach, it is recommended that treating a woman who is addicted to binge eating should involve a multi-disciplinary team comprised of physicians, clinical dietitians, and clinical psychotherapists.

Keywords: binge eating, defence mechanism, food addiction, psychological abuse

Procedia PDF Downloads 151

Authors: Pranay Mathur, Carlo Michelassi, Simi Karatha, Gilda Pedoto

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Industrial plant uptime is top most importance for reliable, profitable & sustainable operation. Trip and failed start has major impact on plant reliability and all plant operators focussed on efforts required to minimise the trips & failed starts. The performance of these CTQs are measured with 2 metrics, MTBT(Mean time between trips) and SR (Starting reliability). These metrics helps to identify top failure modes and identify units need more effort to improve plant reliability. Baker Hughes Trip reduction program structured to reduce these unwanted trip 1. Real time machine operational parameters remotely available and capturing the signature of malfunction including related boundary condition. 2. Real time alerting system based on analytics available remotely. 3. Remote access to trip logs and alarms from control system to identify the cause of events. 4. Continuous support to field engineers by remotely connecting with subject matter expert. 5. Live tracking of key CTQs 6. Benchmark against fleet 7. Break down to the cause of failure to component level 8. Investigate top contributor, identify design and operational root cause 9. Implement corrective and preventive action 10. Assessing effectiveness of implemented solution using reliability growth models. 11. Develop analytics for predictive maintenance With this approach , Baker Hughes team is able to support customer in achieving their Reliability Key performance Indicators for monitored units, huge cost savings for plant operators. This Presentation explains these approach while providing successful case studies, in particular where 12nos. of LNG and Pipeline operators with about 140 gas compressing line-ups has adopted these techniques and significantly reduce the number of trips and improved MTBT

Keywords: reliability, availability, sustainability, digital infrastructure, weibull, effectiveness, automation, trips, fail start

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Authors: Theophilus O. Odunlami, Hasan Haroglu, Nader Saleh-Matter

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The challenges facing the construction industry are often worsened by the compounded nature of projects coupled with the complexity of key stakeholders involved at different stages of the project. Projects are planned to achieve outlined benefits in line with the business case; however, a lack of effective management of key stakeholders can result in unrealistic delivery aspirations, unnecessary re-works, and overruns. The aim of this study is to examine the early stages of a project lifecycle and investigate the stakeholder management and involvement processes and their impact on the successful delivery of the project. The research engaged with conventional construction organisations and project personnel and stakeholders on diverse projects, using a research strategy to analyse existing project case studies, narrative enquiries, interviews, and surveys using a combined qualitative, quantitative, and mixed method of analysis. Research findings have shown that the involvement of stakeholders at different levels during the early stages has pronounced effects on project delivery; it helps to forge synergy and promotes a clear understanding of individual responsibilities, strengths, and weaknesses. This has often fostered a positive sense of productive collaboration right through the early stages of the project. These research findings intend to contribute to the development of a process framework for stakeholder and project team involvement in the early stages of a project. This framework will align with the selection criteria for stakeholders, contractors, and resources, ultimately contributing to the successful completion of projects. The primary question addressed in this study is stakeholder involvement and management of the early stages of a building project life cycle impacts project delivery. Findings showed that early-stage stakeholder involvement and collaboration between project teams and contractors significantly contribute to project success. However, a strong and healthy communication strategy would be required to maintain the flow of value-added ideas among stakeholders at the early stages to benefit the project at the execution stage.

Keywords: early stages, project lifecycle, stakeholders, decision-making strategy, project framework

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Authors: Lindy Van Vliet, Saloni Phadke, Anthea Nelson, Ann Gallant

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Comprehensive and compassionate palliative care and support requires an integrated system of care that draws on formal health and social service providers working together with community and informal networks to ensure that patients and families have access to the care they need. The objective of this study is to further explore and understand the community supports, services, and informal networks that health care professionals and social service providers rely on to allow their patients to die in their homes and communities. Drawing on an interpretivist, exploratory, qualitative design, our multidisciplinary research team (medicine, nursing and social work) conducted interviews with 15 health care and social service providers in the Ottawa region. Interview data was audio-recorded, transcribed and analyzed using a reflexive thematic analysis approach. The data deepens our understandings of the facilitators and barriers that arise as health care and social service providers attempt to build networks of care for patients with life limiting illnesses and families. Three main findings emerged: First, the variability that arises due to systemic barriers in accessing and providing care; second, the exceptionally challenging workload that providers are facing as they work to address complex social care needs (housing, disability, food security), along with escalating palliative care needs; and, finally, the lack of structural support that providers and informal care networks receive. Conclusion: These findings will facilitate and build stronger person-centred/relationship-centred principles and practices between providers, patients, community, and informal care networks by highlighting the systemic barriers to accessing and providing person-centred care. Further, they will have important implications for future partnerships in integrated care delivery programs and initiatives, community policies, education programs, and provincial and national palliative care strategies.

Keywords: public health palliative care, palliative care nursing, care networks, informal care, integrated health care

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Authors: Gedefaye Nibret Mihretie

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Background: Transactional sex is casual sex between two people to receive material incentives in exchange for sexual favors. Transactional sex is associated with negative consequences, which increase the risk of sexually transmitted diseases, including HIV/AIDS, unintended pregnancy, unsafe abortion, and physiological trauma. Many primary studies in Sub-Saharan Africa have been conducted to assess the prevalence and associated factors of transactional sex among women. These studies had great discrepancies and inconsistent results. Hence, this systematic review and meta-analysis aimed to synthesize the pooled prevalence of the practice of transactional sex among women and its associated factors in Sub-Saharan Africa. Method: Cross-sectional studies were systematically searched from March 6, 2022, to April 24, 2022, using PubMed, Google Scholar, HINARI, Cochrane Library, and grey literature. The pooled prevalence of transactional sex and associated factors was estimated using DerSemonial-Laird Random Effect Model. Stata (version 16.0) was used to analyze the data. The I-squared statistic was used to assess the studies' heterogeneity. A funnel plot and Egger's test were used to check for publication bias. A subgroup analysis was performed to minimize the underline heterogeneity depending on the study years, source of data, sample sizes and geographical location. Results: Four thousand one hundred thirty articles were extracted from various databases. The final thirty-two studies were included in this systematic review, including 108,075 participants. The pooled prevalence of transactional sex among women in Sub-Saharan Africa was 12.55%, with a confidence interval of 9.59% to 15.52%. Educational status (OR = .48, 95%CI, 0.27, 0.69) was the protective factors of transactional sex whereas, alcohol use (OR = 1.85, 95% CI: 1.19, 2.52), early sex debut (OR = 2.57, 95%CI, 1.17, 3.98), substance abuse (OR = 4.21, 95% CI: 2.05, 6.37), having history of sexual experience abuse (OR = 4.08, 95% CI: 1.38, 6.78), physical violence abuse (OR = 6.59, 95% CI: 1.17, 12.02), and sexual violence abuse (OR = 3.56, 95% CI: 1.15, 8.27) were the risk factors of transactional sex. Conclusion: The prevalence of transactional sex among women in Sub-Saharan Africa was high. Educational status, alcohol use, substance abuse, early sex debut, having a history of sexual experiences, physical violence, and sexual violence were predictors of transaction sex. Governmental and other stakeholders are designed to reduce alcohol utilization, provide health information about the negative consequences of early sex debut, substance abuse, and reduce sexual violence, ensuring gender equality through mass media, which should be included in state policy.

Keywords: women’s health, child health, reproductive health, midwifery

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Authors: Mohammad Mahdi Hajiali

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Many of construction projects estimated in Iran have been influenced by the limitations of financial resources. As for Iran, a country that is developing, and to follow this development-oriented approach which many numbers of projects each year run in, if we can reduce the cost of projects by applying a method we will help greatly to minimize the cost of major construction projects and therefore projects will finish faster and more efficiently. One of the components of transportation infrastructure are roads that are considered to have a considerable share of the country budget. In addition, major budget of the related ministry is spending to repair, improve and maintain roads. Value Engineering is a simple and powerful methodology over the past six decades that has been successful in reducing the cost of many projects. Specific solution for using value engineering in the stage of project implementation is called value engineering change proposal (VECP). It was tried in this research to apply VECP in one of the road-building projects in Iran in order to enhance the value of this kind of projects and reduce their cost. In this case study after applying VECP, an idea was raised. It was about use of concrete pavement instead of hot mixed asphalt (HMA) and also using fiber in order to improve concrete pavement performance. VE group team made a decision that for choosing the best alternatives, get expert’s opinions in pavement systems and use Fuzzy TOPSIS (Technique for Order of Preference by Similarity to Ideal Solution) for ranking opinions of the experts. Finally, Jointed Plain Concrete Pavement (JPCP) was selected. Group also experimented concrete samples with available fibers in Iran and the results of experiments showed a significant increment in concrete specifications such as flexural strength. In the end, it was shown that by using of fiber-reinforced concrete pavement instead of asphalt pavement, we can achieve a significant saving in cost, time and also increment in quality, durability, and longevity.

Keywords: road-building projects, value engineering change proposal (VECP), Jointed Plain Concrete Pavement (JPCP), Fuzzy TOPSIS, fiber-reinforced concrete

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Authors: Rana Waqar Aslam, Urooj Saeed, Hammad Mehmood, Hameed Ullah, Imtiaz Younas

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This research has been conducted to assess the water quality in and around Lahore Metropolitan area on the basis of three different land uses, i.e. residential, commercial, and industrial land uses. For this, 29 sample sites have been selected on the basis of simple random sampling technique. Samples were collected at the source (WASA tube wells). The criteria for selecting sample sites are to have a maximum concentration of population in the selected land uses. The results showed that in the residential land use the proportion of nitrate and turbidity is at their highest level in the areas of Allama Iqbal Town and Samanabad Town. Commercial land use of Gulberg and Data Gunj Bakhsh Town have highest level of proportion of chlorides, calcium, TDS, pH, Mg, total hardness, arsenic and alkalinity. Whereas in industrial type of land use in Ravi and Wahga Town have the proportion of arsenic, Mg, nitrate, pH, and turbidity are at their highest level. The high rate of concentration of these parameters in these areas is basically due to the old and fractured pipelines that allow bacterial as well as physiochemical contaminants to contaminate the portable water at the sources. Furthermore, it is seen in most areas that waste water from domestic, industrial, as well as municipal sources may get easy discharge into open spaces and water bodies, like, cannels, rivers, lakes that seeps and become a part of ground water. In addition, huge dumps located in Lahore are becoming the cause of ground water contamination as when the rain falls, the water gets seep into the ground and impures the ground water quality. On the basis of the derived results with the help of Geo-spatial technology ACRGIS 9.3 Interpolation (IDW), it is recommended that water filtration plants must be installed with specific parameter control. A separate team for proper inspection has to be made for water quality check at the source. Old water pipelines must be replaced with the new pipelines, and safe water depth must be ensured at the source end.

Keywords: GIS, remote sensing, pH, nitrate, disaster, IDW

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Authors: P. P. L. Kwan, D. K. S. Chan

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Organizations are constantly changing in today’s business environment. Research findings have revealed that overcoming resistance and getting employees ready for change is a crucial driver for organizational change success. Thus, change adaptability has become a more prominent selection criterion used in many organizations. Although change readiness could be situation-specific, employees’ personality, emotion, and cognition should also be crucial factors in shaping their readiness. However, relatively little research has focused on the roles of individual characteristics in organizational changes. The present study examines the relations between individual characteristics and change readiness with the aim to validate a model, which proposes three types of individual attributes as antecedents to change readiness. The three attributes considered are trait cynicism, positive affectivity, and personal valence covering personality, emotional, and cognitive aspects respectively. The model also hypothesizes that relations between the three antecedents and change readiness will be moderated by a positive mental resource known as psychological capital (PsyCap), which consists of hope, optimism, efficacy and resilience; and a learning culture within the organization. We are currently collecting data from a targeted sample size of 300 Hong Kong employees. Specifically, participants complete a questionnaire which was designed to measure their perceived change efficacy in response to three scenarios commonly happened in the workplace (i.e., business acquisition, team restructuring, and information system change) as a measure of change readiness, as well as the aforementioned individual characteristics. Preliminary analysis provides some support to the hypotheses. That is, employees who are less cynical in personality and more positive in their cognition and affectivity particularly welcome the potential changes in their organizations. Further data collection and analyses are continuously carried out for a more definitive conclusion. Our findings will shed light on employee selection; and on how strengthening positive psychological resources and promoting the culture of learning organization among employees may enhance the chance to succeed for organizations undergoing change.

Keywords: learning organization, psychological capital, readiness for change, employee selection

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Authors: Dyah Larasati, Karishma Alize Huda, Sri Kusumastuti Rahayu, Martin Daniel Siyaranamual

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Indonesia continues to reform its social protection system to provide the needed protection for its citizen. Indonesia Social Protection consisted of social assistance programs (non-contributory/tax-financed) specifically targeted for the poor and at-risk and social security/insurance program (contributory system). The social assistance programs have mostly been implemented since 1998. The national health insurance has been implemented since 2014 and the employment social insurance since 2015. One major reform implemented has been improving the targeting performance of its major social assistance portfolios including (1) Food Assistance for the poor families (Rastra and BPNT/noncash foods assistance); (2) Education Assistance for poor children; (3) Conditional Cash Transfer for poor families (PKH); and (4) Subsidized beneficiaries of National Health Insurance (JKN-PBI) for the poor and at-risk individuals. For the Social Insurance (through BPJS Employment program), several initiatives have been implemented to expand the program contributing members, although it mostly benefits the formal sector workers. However, major gaps still exist especially for the emerging middle-income groups who typically work at the informal sectors. They have yet to get the protection needed to sustain their social and economic growth. Since 2017, TNP2K (the National Team for Poverty Reduction) under the Vice President office has led the social protection discourse as the government understands the need to address vulnerabilities across the lifecycle and prioritize support to the most at-risk population particularly the elderly, young children and people with disabilities. Discussion and advocacy to recommend for more investment is continuing in order for the government to establish a comprehensive social protection system in the near future (2020-2024) that protects children through an inclusive child benefit program; build a system to benefit more working-age adults (including individuals with disabilities) and a three-tier elderly protection as they reach 65 years.

Keywords: poverty reduction, social assistance, social insurance, social protection

Procedia PDF Downloads 159

Authors: Joanna Peksa, Faith Dillon-Lee

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Current developments in the Western economies have turned some universities into corporate institutions driven by practices of production and commodity. Academia is increasingly becoming integrated into national economies as a result of students paying fees and is consequently using business practices in student retention and engagement. With these changes, pedagogy status as a priority within the institution has been changing in light of these new demands. New strategies have blurred the boundaries that separate a student from a client. This led to a change of the dynamic, disrupting the traditional idea of the knowledge market, and emphasizing the corporate aspect of universities. In some cases, where students are seen primarily as a customer, the purpose of academia is no longer to educate but sell a commodity and retain fee-paying students. This paper considers opposing viewpoints on the commodification of higher education, reflecting on the reality of maintaining a pedagogic grounding in an increasingly commercialized sector. By analysing a case study of the Student Success Festival, an event that involved academic and marketing teams, the differences are considered between the respective visions of the pedagogic arm of the university and the corporate. This study argues that the initial concept of the event, based on the principles of gamification, independent learning, and cognitive criticality, was more clearly linked to a grounded pedagogic approach. However, when liaising with the marketing team in a crucial step in the creative process, it became apparent that these principles were not considered a priority in terms of their remit. While the study acknowledges in the power of pedagogy, the findings show that a pact of concord is necessary between different stakeholders in order for students to benefit fully from their learning experience. Nevertheless, while issues of power prevail and whenever power is unevenly distributed, reaching a consensus becomes increasingly challenging and further research should closely monitor the developments in pedagogy in the UK higher education.

Keywords: economic pressure, commodification, pedagogy, gamification, public service, marketization

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Authors: Maryam Firouzmandi, Moosa Miri

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Common reasons for early tooth loss are trauma, extraction due to caries or periodontal disease and congenital missing. The remaining space after tooth loss may cause functional and esthetic problems. Therefore restorative dentists should attempt to manage these spaces using conservative methods. The goal is to restore the lost esthetic and function, prevent phonetic, self-esteem and personality problems and tongue habits. Preserving alveolar bone is also of great importance during the growth stage. Purpose: When deciding about the management of the missing tooth, space implants are contradicted until the completion of dentoalveolar development. Even in adulthood, due to systemic or periodontal problems or biological and economic issues, the implant might not be indicated. In this article, the alternative conservative restorative methods of space maintenance are going to be discussed. Essix retainers are made chair-side as easy as forming a custom bleaching tray with some modifications. They are esthetically acceptable and not expensive. These temporaries provide support for the lips but could not be used during function. Mini-screw-supported temporaries are another option for maintaining the space, especially after orthodontic treatment when there is a time lag between the termination of orthodontic treatment and definitive restoration. Two techniques will be presented for this kind of restoration: Denture tooth pontic or a composite crown. The benefits are alveolar bone preservation, Physiologic pressure on the alveolar ridge to increase its density and even can be retained until the completion of the definitive treatment. Bonded fixed partial denture includes Maryland bridge, fiber-reinforced composite bridge, resin-bonded bridge, and ceramic bonded bridge. These types of bridges are recommended to be used after a pubertal growth spurt and a recent meta-analysis considered their clinical success similar to conventional FDPs and implant-supported crowns. However, they have several advantages that are going to be discussed by presenting some clinical examples. Practical instruction on how to construct an FRC bridge and a novel chair-side Maryland bridge will be given by means of clinical cases. Clinical relevance: minimally invasive options should always be considered and destruction of healthy enamel and dentin during the preparation phase should be avoided as much as possible.

Keywords: tooth missing, fiber-reinforced composite, Maryland, Essix retainers, screw-retained restoration

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Authors: A. R. Nor Azlina, H. Salwana, I. Zuraeda, A. R. Rashidah, O. Normah

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Transitioning towards globalization in the business environment has necessitated more essential growing changes such as competition, business strategy, innovation in technology and effectiveness of societal trends on adopting corporate governance are seen to be drivers of the future. This transformations on business environment has a significant impact to organizations’ performances. Many organizations are demanding for more proactive entrepreneurs with dynamic team, who can run and steer their business to success. Changing on strategy, roles, tasks, entrepreneurial skills and implementing corporate governance in relationship development is important to enhance the organization’s performance towards being more cost-efficient and subsequently increase its efficiency. Small Medium Enterprises (SMEs) in most developing countries are contributors to the economic growth of a nation. However, the potential of Microfinance Institutions (MFIs) is always overlooked in contributing towards SMEs development. The adoption of corporate governance and accountability in MFIs as driving forces for these SMEs is not incorporated in measurements of organization performance. This paper attempts to address some of the governance issues associated with dimensions of accountability in improving performances of microfinance institutions. Qualitative approach was adopted in this study to analyze the data collected. The qualitative approach emerges as contributing factor in understanding and critiquing accountability processes, as well as addressing the concerns of practitioners and policymakers. A close researcher engagement with the field which concerns process, embracing of situational complexity, as well as critical and reflective understandings of organizational phenomena remain as hallmarks of the tradition. It is concluded that in describing and scrutinizing an understanding of managerial behavior, organizational factors and macro-economic relationship in SMEs firm need to be improved. This is also the case in MFIs. A framework is developed to explore the linkage of corporate governance and accountability issues related to entrepreneurship as factors affecting MFIs performances in facing ongoing transformation of organization performance within Malaysian SMEs industries.

Keywords: accountability, corporate governance, microfinance, organization performance

Procedia PDF Downloads 358