Search results for: retention challenges in project management

Authors: Revathi S. Rajan, Pratibha Malik, Nupur Garg, Smitha Avula, Kamini A. Rao

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This study aimed to analyse the pregnancy outcomes in patients with TPO positivity after appropriate L-Thyroxin supplementation with close surveillance. All pregnant women attending the antenatal clinic at Milann-The Fertility Center, Bangalore, India- from Aug 2013 to Oct 2014 whose booking TSH was more than 2.5 mIU/L were included along with those pregnant women with prior hypothyroidism who were TPO positive. Those with TPO positive status were vigorously managed with appropriate thyroxin supplementation and the doses were readjusted every 3 to 4 weeks until delivery. Women with recurrent pregnancy loss were also tested for TPO positivity and if tested positive, were monitored serially with TSH and fT4 levels every 3 to 4 weeks and appropriately supplemented with thyroxin when the levels fluctuated. The testing was done after an informed consent in all these women. The statistical software namely SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Systat 12.0 and R environment ver.2.11.1 were used for the analysis of the data. 460 pregnant women were screened for thyroid dysfunction at booking of which 52% were hypothyroid. Majority of them (31.08%) were subclinically hypothyroid and the remaining were overt. 25% of the total no. of patients screened were TPO positive. The various pregnancy complications that were observed in the TPO positive women were gestational glucose intolerance [60%], threatened abortion [21%], midtrimester abortion [4.3%], premature rupture of membranes [4.3%], cervical funneling [4.3%] and fetal growth restriction [3.5%]. 95.6% of the patients who followed up till the end delivered beyond 30 weeks. 42.6% of these patients had previous history of recurrent abortions or adverse obstetric outcome and 21.7% of the delivered babies required NICU admission. Obstetric outcomes in our study in terms of midtrimester abortions, placental abruption, and preterm delivery improved for the better after close monitoring of the thyroid hormone [TSH and fT4] levels every 3 to 4 weeks with appropriate dose adjustment throughout pregnancy. Euthyroid women with TPO positive status enrolled in the study incidentally were those with recurrent abortions/infertility and required thyroxin supplements due to elevated Thyroid hormone (TSH, fT4) levels during the course of their pregnancy. Significant associations were found with age>30 years and Hyperhomocysteinemia [p=0.017], recurrent pregnancy loss or previous adverse obstetric outcomes [p=0.067] and APLA [p=0.029]. TPO antibody levels >600 I U/ml were significantly associated with development of gestational hypertension [p=0.041] and fetal growth restriction [p=0.082]. Euthyroid women with TPO positivity were also screened periodically to counter fluctuations of the thyroid hormone levels with appropriate thyroxin supplementation. Thus, early identification along with aggressive management of thyroid dysfunction and stratification of these patients based on their TPO status with appropriate thyroxin supplementation beginning in the first trimester will aid risk modulation and also help avert complications.

Keywords: TPO antibody, subclinical hypothyroidism, anti nuclear antibody, thyroxin

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Authors: Mojtaba Eshraghi Arani

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The freight forwarders, who are known as the Architect of Transportation, play a vital role in the supply chain management. The package of various services which they provide has made the legal nature of freight forwarders very controversial, so that they might be qualified once as principal or carrier and, on other occasions, as agent of the shipper as the case may be. They could even be involved in the transportation process as the agent of shipping line, which makes the situation much more complicated. The courts in all countries have long had trouble in distinguishing the “forwarder as agent” from “forwarder as principal” (as it is outstanding in the prominent case of “Vastfame Camera Ltd v Birkart Globistics Ltd And Others” 2005, Hong Kong). It is not fully known that in the case of a claim against the forwarder, what particular parameter would be used by the judge among multiple, and sometimes contradictory, tests for determining the scope of the forwarder liability. In particular, every country has its own legal parameters for qualifying the freight forwarders that is completely different from others, as it is the case in France in comparison with Germany and England. The unpredictability of the courts’ decisions in this regard has provided the freight forwarders with the opportunity to impose any limitation or exception of liability while pretending to play the role of a principal, consequently making the cargo interests incur ever-increasing damage. The transportation industry needs to remove such uncertainty by unifying national laws governing freight forwarders liability. A long time ago, in 1967, The International Institute for Unification of Private Law (UNIDROIT) prepared a draft convention called “Draft Convention on Contract of Agency for Forwarding Agents Relating to International Carriage of Goods” (hereinafter called “UNIDROIT draft convention”). The UNIDROIT draft convention provided a clear and certain framework for the liability of freight forwarder in each capacity as agent or carrier, but it failed to transform to a convention, and eventually, it was consigned to oblivion. Today, after nearly 6 decades from that era, the necessity of such convention can be felt apparently. However, one might reason that the same grounds, in particular, the resistance by forwarders’ association, FIATA, exist yet, and thus it is not logical to revive a forgotten draft convention after such long period of time. It is argued in this article that the main reason for resisting the UNIDROIT draft convention in the past was pending efforts for developing the “1980 United Nation Convention on International Multimodal Transport of Goods”. However, the latter convention failed to become in force on due time in a way that there was no new accession since 1996, as a result of which the UNIDROIT draft convention must be revived strongly and immediately submitted to the relevant diplomatic conference. A qualitative method with the concept of interpretation of data collection has been used in this manuscript. The source of the data is the analysis of international conventions and cases.

Keywords: freight forwarder, revival, agent, principal, uidroit, draft convention

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Authors: Maryam Mohammadi, Mohammadjavad Mahdavinejad, Mojtaba Ansari

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The main driving force for increasing movement towards the design of High-Performance Buildings (HPB) are building codes and rating systems that address the various components of the building and their impact on the environment and energy conservation through various methods like prescriptive methods or simulation-based approaches. The methods and tools developed to meet these needs, which are often based on building performance simulation tools (BPST), have limitations in terms of compatibility with the integrated design process (IDP) and HPB design, as well as use by architects in the early stages of design (when the most important decisions are made). To overcome these limitations in recent years, efforts have been made to develop Design Decision Support Systems, which are often based on artificial intelligence. Numerous needs and steps for designing and developing a Decision Support System (DSS), which complies with the early stages of energy-efficient architecture design -consisting of combinations of different methods in an integrated package- have been listed in the literature. While various review studies have been conducted in connection with each of these techniques (such as optimizations, sensitivity and uncertainty analysis, etc.) and their integration of them with specific targets; this article is a critical and holistic review of the researches which leads to the development of applicable systems or introduction of a comprehensive framework for developing models complies with the IDP. Information resources such as Science Direct and Google Scholar are searched using specific keywords and the results are divided into two main categories: Simulation-based DSSs and Meta-simulation-based DSSs. The strengths and limitations of different models are highlighted, two general conceptual models are introduced for each category and the degree of compliance of these models with the IDP Framework is discussed. The research shows movement towards Multi-Level of Development (MOD) models, well combined with early stages of integrated design (schematic design stage and design development stage), which are heuristic, hybrid and Meta-simulation-based, relies on Big-real Data (like Building Energy Management Systems Data or Web data). Obtaining, using and combining of these data with simulation data to create models with higher uncertainty, more dynamic and more sensitive to context and culture models, as well as models that can generate economy-energy-efficient design scenarios using local data (to be more harmonized with circular economy principles), are important research areas in this field. The results of this study are a roadmap for researchers and developers of these tools.

Keywords: integrated design process, design decision support system, meta-simulation based, early stage, big data, energy efficiency

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Authors: Ali Saeed Alghamdi, Basel Mazen Alsolami, Basel Saeed Alghamdi, Muhanad Saleh Alzahrani Alamri, Salman Anwar Thabet, Abdulhalim J. Kinsara

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Objectives: This study measures the knowledge of the cardiovascular disease among the general population in western regions of Saudi Arabia, and it aimed to increase the level of awareness about cardiovascular diseases among the general population by providing an awareness lecture that included information about the risk factors, major symptoms, and prevention of cardiovascular diseases. The lecture has been attached at the end of the questionnaire. Setting: This study was conducted through an online questionnaire that included our aim and main objectives that targeted the general population in the Western regions of Saudi Arabia (Makkah and Madinah regions). Participants: This study participants were 460 collected through an online questionnaire. Methods: All Saudi citizens and residents who live in the western region of Saudi Arabia aged 18 years and above will be invited to participate voluntarily. A pre-structured questionnaire was designed to collect data on age, gender, marital status, education level, occupation, lifestyle habits, and history of heart diseases, with cardiac symptoms and risk factors sections. Results: The majority of respondents were females (74.8%) and Saudis. The knowledge about cardiovascular disease risk factors was weak. Only (18.5%) scores an excellent response regarding risk factors awareness. Lack of exercise, stress, and obesity were the most known risk factors. Regarding cardiovascular disease symptoms, chest pain scores the highest symptom (87.6%) among other symptoms like dyspnea, syncope, and excessive sweating. Participants revealed a poor awareness regarding cardiovascular disease symptoms also (0.9%). However, preventable factors for cardiovascular diseases were more knowledgeable than others categories in this study (60% fall into excellent knowledge). Smoking cessation, normal cholesterol level, and normal blood pressure score the highest preventable methods (92.2%), (88.6%), and (78.7%) respectively. 83.7% of the participant have attended the awareness lecture, and 99 of the attendees reported that the lecture increased their knowledge about cardiovascular disease. Conclusion: This study discussed the level of community awareness of cardiovascular disease in terms of symptoms, risk factors, and protective factors. We found a huge lack of the participant's level of knowledge about the disease and how to prevent it. Moreover, we measure the prevalence of the comorbidities among our participants (diabetes, hypertension, hypercholesterolemia/ hypertriglyceridemia) and their extent of adherence to their medication. In conclusion, this study not only demonstrates awareness of cardiovascular disease risk factors, symptoms, management, and the association between each domain but also provides educational material. Further educational material and campaigns are required to increase awareness and knowledge about cardiovascular diseases.

Keywords: awareness, cardiovascular diseases, education, prevention, risk factors

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Authors: Zhihua Cao, Hongfei Zhao, Zhongneng Wu

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The development of polar-based agroforestry was necessary due to the influence of the timber market environment in China, which can promote the coordinated development of forestry and agriculture, and gain remarkable ecological, economic and social benefits. The main agroforestry models of the main poplar planting area in Huaibei plain and along the Yangtze River plain were carried out. 11 typical management models of poplar were selected to sum up: pure poplar forest, poplar-rape-soybean, poplar-wheat-soybean, poplar-rape-cotton, poplar-wheat, poplar-chicken, poplar-duck, poplar-sheep, poplar-Agaricus blazei, poplar-oil peony, poplar-fish, represented by M0-M10, respectively. 12 indexes related with economic, ecological and social benefits (annual average cost, net income, ratio of output to investment, payback period of investment, land utilization ratio, utilization ratio of light energy, improvement and system stability of ecological and production environment, product richness, labor capacity, cultural quality of labor force, sustainability) were screened out to carry on the comprehensive evaluation and analysis to 11 kinds of typical agroforestry models based on analytic hierarchy process (AHP). The results showed that the economic benefit of each agroforestry model was in the order of: M8 > M6 > M9 > M7 > M5 > M10 > M4 > M1 > M2 > M3 > M0. The economic benefit of poplar-A. blazei model was the highest (332, 800 RMB / hm²), followed by poplar-duck and poplar-oil peony model (109, 820RMB /hm², 5, 7226 RMB /hm²). The order of comprehensive benefit was: M8 > M4 > M9 > M6 > M1 > M2 > M3 > M7 > M5 > M10 > M0. The economic benefit and comprehensive benefit of each agroforestry model were higher than that of pure poplar forest. The comprehensive benefit of poplar-A. blazei model was the highest, and that of poplar-wheat model ranked second, while its economic benefit was not high. Next were poplar-oil peony and poplar-duck models. It was suggested that the model of poplar-wheat should be adopted in the plain along the Yangtze River, and the whole cycle mode of poplar-grain, popalr-A. blazei, or poplar-oil peony should be adopted in Huaibei plain, northern Anhui. Furthermore, wheat, rape, and soybean are the main crops before the stand was closed; the agroforestry model of edible fungus or Chinese herbal medicine can be carried out when the stand was closed in order to maximize the comprehensive benefit. The purpose of this paper is to provide a reference for forest farmers in the selection of poplar agroforestry model in the future and to provide the basic data for the sustainable and efficient study of poplar agroforestry in Anhui province, eastern China.

Keywords: agroforestry, analytic hierarchy process (AHP), comprehensive benefit, model, poplar

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Authors: Lakmali Anthony, Madeline Gillies

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Background: Colorectal cancer (CRC) is usually managed with surgical resection. Many of the outcomes traditionally used to define successful operative management, such as resection margin, do not adequately reflect patients’ experience. Patient-reported outcomes (PRO), such as Health-Related Quality of life (HRQoL), provide a means by which the impact of surgery for cancer can be reported in a patient-centered way. HRQoL has previously been shown to be impacted by psychosocial, behavioral and disease-specific characteristics. This exploratory cross-sectional study aims to; (1) describe postoperative HRQoL in patients who underwent primary resection in a regional Australian hospital; (2) describe the prevalence of anxiety, depression and clinically significant fear of cancer recurrence (FCR) in this population; and (3) identify demographic, psychosocial, disease and treatment factors associated with poorer self-reported HRQoL. Methods: Consecutive patients who had resection of colorectal cancer in a single regional Australian hospital between 2015 and 2022 were eligible. Participants were asked to complete a survey instrument designed to assess HRQoL, as well as validated instruments that assess several other psychosocial PROs hypothesized to be associated with HRQoL; emotional distress, fear of cancer recurrence, social support, dispositional optimism, body image and spirituality. Demographic and disease-specific data were also collected via medical record review. Results: Forty-six patients completed the survey. Clinically significant levels of fear of recurrence as well as emotional distress, were present in this group. Many domains of HRQoL were significantly worse than an Australian reference population for CRC. Demographic and disease factors associated with poor HRQoL included smoking and ongoing adjuvant systemic therapy. The primary operation was not associated with HRQoL; however, the operative approach (laparoscopic vs. open) was associated with HRQoL for these patients. All psychosocial factors measured were associated with HRQoL, including cancer worry, emotional distress, body image and dispositional optimism. Conclusion: HRQoL is an important outcome in surgery for both research and clinical practice. This study provides an overview of the quality of life in a regional Australian population of postoperative colorectal cancer patients and the factors that affect it. Understanding HRQoL and awareness of patients particularly vulnerable to poor outcomes should be used to aid the informed consent and shared decision-making process between surgeon and patient.

Keywords: surgery, colorectal, cancer, PRO, HRQoL

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Authors: Haiying Zong, Yi Yuan, Pengcheng Li

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Cadmium (Cd), one of the toxic heavy metals, has high solubility and mobility in agricultural soils and is readily taken up by roots and transported to the vegetative and reproductive organs which can cause deleterious effects on crop yield and quality. Excess Cd in plants can interfere with many metabolic processes, such as photosynthesis, transpiration, respiration or nutrients homeostasis. Generally, the main methods to reduce Cd accumulation in plants are to decrease the concentration of Cd in the soil solution through reduction of Cd influx into the soil system, site selection, and management practices. However, these approaches can be very costly and consume a lot of energy Therefore, it is critical to develop effective approaches to reduce the Cd concentration in plants. It is proved that chitooligosaccharide (COS) can enhance the plant's tolerance to abiotic stress including drought stress, salinity stress, and toxic metal stress. However, so far little information is known about whether foliar application with COS modulates Cd-induced toxicity in plants. The metal detoxification processes of plants treated with COS also remain unclear. In this study, edible rape (Brassica rapa L.), one of the most widely consumed leafy vegetables, was selected as an experimental mode plant. The effect of foliar application with COS on reducing Cd accumulation in edible rape was investigated. Moreover, Cd subcellular distribution pattern in response to Cd stress in the rape plant sprayed with COS was further tested in order to explore the potential detoxification mechanisms in plants. The results demonstrated that spraying COS at different concentrations (25, 50,100 and 200 mg L-1) possess diverse functions including growth-promoting,chlorophyll contents-enhancing, malondialdehyde (MDA) level-decreasing in leaves, Cd2+ concentration-decreasingin shoots and roots of edible rape under Cd stress. In addition, it was found that COS can also dramatically improve superoxide dismutase (SOD) activity, catalase (CAT) activity and peroxidase (POX) activity of edible rape leaves. The relievingeffect of COS was related to theconcentration and COS with 50-100 mg L-1 displayed the best activity. Furtherly, theexperiments results exhibitedthat COS could decrease the proportion of Cd in the organelle fraction of leaves by 40.1% while enhance the proportion of Cd in the soluble fraction by 13.2% at the concentration of 50 mg L-1. The above results showed that COS may have thepotential to improve plant resistance to Cd via promoting antioxidant enzyme activities and altering Cd subcellular distribution. All the results described here open up a new way to study the protection role of COS in alleviating Cd tolerance and lay the foundation for future research about the detoxification mechanism at subcellular level.

Keywords: chitooligosaccharide, cadmium, edible rape (Brassica rapa L.), subcellular distribution

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Authors: Heena Dabas, Anju Paul, Suman Chaurasia, Ramesh Agarwal, M. Jeeva Sankar, Anurag Bajpai, Manju Saksena

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Background: Traumatic lumbar puncture (LP) is a common occurrence and causes substantial diagnostic ambiguity. There is paucity of data regarding its epidemiology. Objective: To assess the incidence and risk factors of traumatic LP in newborns. Design/Methods: In a prospective cohort study, all inborn neonates admitted in NICU and planned to undergo LP for a clinical indication of sepsis were included. Neonates with diagnosed intraventricular hemorrhage (IVH) of grade III and IV were excluded. The LP was done by operator - often a fellow or resident assisted by bedside nurse. The unit has policy of not routinely using any sedation/analgesia during the procedure. LP is done by 26 G and 0.5-inch-long hypodermic needle inserted in third or fourth lumbar space while the infant is in lateral position. The infants were monitored clinically and by continuous measurement of vital parameters using multipara monitor during the procedure. The occurrence of traumatic tap along with CSF parameters and other operator and assistant characteristics were recorded at the time of procedure. Traumatic tap was defined as presence of visible blood or more than 500 red blood cells on microscopic examination. Microscopic trauma was defined when CSF is not having visible blood but numerous RBCs. The institutional ethics committee approved the study protocol. A written informed consent from the parents and the health care providers involved was obtained. Neonates were followed up till discharge/death and final diagnosis was assigned along with treating team. Results: A total of 362 (21%) neonates out of 1726 born at the hospital were admitted during the study period (July 2016 to January, 2017). Among these neonates, 97 (26.7%) were suspected of sepsis. A total of 54 neonates were enrolled who met the eligibility criteria and parents consented to participate in the study. The mean (SD) birthweight was 1536 (732) grams and gestational age 32.0 (4.0) weeks. All LPs were indicated for late onset sepsis at the median (IQR) age of 12 (5-39) days. The traumatic LP occurred in 19 neonates (35.1%; 95% C.I 22.6% to 49.3%). Frank blood was observed in 7 (36.8%) and in the remaining, 12(63.1%) CSF was detected to have microscopic trauma. The preliminary risk factor analysis including birth weight, gestational age and operator/assistant and other characteristics did not demonstrate clinically relevant predictors. Conclusion: A significant number of neonates requiring lumbar puncture in our study had high incidence of traumatic tap. We were not able to identify modifiable risk factors. There is a need to understand the reasons and further reduce this issue for improving management in NICUs.

Keywords: incidence, newborn, traumatic, lumbar puncture

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Authors: L. C. Nwosu, C. O. Adedire, M. O. Ashamo, E. O. Ogunwolu

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The maize weevil, Sitophilus zeamais Motschulsky is a notorious pest of stored maize (Zea mays L.). The development of resistant maize varieties to manage weevils is a major breeding objective. The study investigated the parameters and mechanisms that confer resistance on a maize variety to S. zeamais infestation using twenty elite maize varieties. Detailed morphological, physical and chemical studies were conducted on whole-maize grain and the grain pericarp. Resistance was assessed at 33, 56, and 90 days post infestation using weevil mortality rate, weevil survival rate, percent grain damage, percent grain weight loss, weight of grain powder, oviposition rate and index of susceptibility as indices rated on a scale developed by the present study and on Dobie’s modified scale. Linear regression models that can predict maize grain damage in relation to the duration of storage were developed and applied. The resistant varieties identified particularly 2000 SYNEE-WSTR and TZBRELD3C5 with very high degree of resistance should be used singly or best in an integrated pest management system for the control of S. zeamais infestation in stored maize. Though increases in the physical properties of grain hardness, weight, length, and width increased varietal resistance, it was found that the bases of resistance were increased chemical attributes of phenolic acid, trypsin inhibitor and crude fibre while the bases of susceptibility were increased protein, starch, magnesium, calcium, sodium, phosphorus, manganese, iron, cobalt and zinc, the role of potassium requiring further investigation. Characters that conferred resistance on the test varieties were found distributed in the pericarp and the endosperm of the grains. Increases in grain phenolic acid, crude fibre, and trypsin inhibitor adversely and significantly affected the bionomics of the weevil on further assessment. The flat side of a maize grain at the point of penetration was significantly preferred by the weevil. Why the south area of the flattened side of a maize grain was significantly preferred by the weevil is clearly unknown, even though grain-face-type seemed to be a contributor in the study. The preference shown to the south area of the grain flat side has implications for seed viability. The study identified antibiosis, preference, antixenosis, and host evasion as the mechanisms of maize post harvest resistance to Sitophilus zeamais infestation.

Keywords: maize weevil, resistant, parameters, mechanisms, preference

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Authors: Alisa Salimova, Jiane Zuo, Christopher Homer

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The objective of this study is to analyse the North Canal riparian zone land use with the help of remote sensing analysis in ArcGis using 30 cloudless Landsat8 open-source satellite images from May to August of 2013 and 2017. Land cover, urban construction, heat island effect, vegetation cover, and water system change were chosen as the main parameters and further analysed to evaluate its impact on the North Canal water quality. The methodology involved the following steps: firstly, 30 cloudless satellite images were collected from the Landsat TM image open-source database. The visual interpretation method was used to determine different land types in a catchment area. After primary and secondary classification, 28 land cover types in total were classified. Visual interpretation method was used with the help ArcGIS for the grassland monitoring, US Landsat TM remote sensing image processing with a resolution of 30 meters was used to analyse the vegetation cover. The water system was analysed using the visual interpretation method on the GIS software platform to decode the target area, water use and coverage. Monthly measurements of water temperature, pH, BOD, COD, ammonia nitrogen, total nitrogen and total phosphorus in 2013 and 2017 were taken from three locations of the North Canal in Tongzhou district. These parameters were used for water quality index calculation and compared to land-use changes. The results of this research were promising. The vegetation coverage of North Canal riparian zone in 2017 was higher than the vegetation coverage in 2013. The surface brightness temperature value was positively correlated with the vegetation coverage density and the distance from the surface of the water bodies. This indicates that the vegetation coverage and water system have a great effect on temperature regulation and urban heat island effect. Surface temperature in 2017 was higher than in 2013, indicating a global warming effect. The water volume in the river area has been partially reduced, indicating the potential water scarcity risk in North Canal watershed. Between 2013 and 2017, urban residential, industrial and mining storage land areas significantly increased compared to other land use types; however, water quality has significantly improved in 2017 compared to 2013. This observation indicates that the Tongzhou Water Restoration Plan showed positive results and water management of Tongzhou district had been improved.

Keywords: North Canal, land use, riparian vegetation, river ecology, remote sensing

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Authors: Jirapan Khruesarn, Wimwipa Boonklin

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Background: Currently, Thailand has an aging population. In 2017, the elderly population was over 11.14 million. There will be an increase in the number of elderly people, 8.39 million, some people grumble to themselves and have conflicts with their offspring or those close to them. It is a source of stress. Mental health promotion should be given to the elderly in order to cope with these changes. Due to the family characteristics of Thai society, these family members will act as caregivers for the elderly. Therefore, a group-counseling program based on Personnel-Centered Theory for Elderly Caregivers in Mental Health Promotion for Older People in Na Kaeo Municipality, Kau Ka District, Lampang Province, has been developed to compare the elderly care behavior before and after the participation. Methods: This research was study for 20 elderly' caregiver: Those aimed to compare the before and after use of group program for caregiver to promoting for the elderly by the following methods: Step 1 Establish a framework for evaluating elderly care behaviors and develop a group counseling program for promote mental health for elderly on: 1) Body 2) Willpower 3) Social and community management and 4) Organizing learning process. Step 2 Assessing an Elderly Care Behaviors by using "The behavior assessment on caring for the elderly" and assessing the mental health power level of the elderly and follow the counseling program 9 times and compare of the elderly care behaviors before and after joined a group program, and compare of mental health level of caregiver attends a group program. Results: This study is developing a group counseling program to promoting for the resilience quotient in elderly people that the results of the study could be summarized as follows: 1) Before the elderly's caregivers join a group counseling program: Mental health promotion behaviors of the elderly were at the high level of (3.32), and after: were at the high level of (3.44). 2) Before the elderly's caregiver attends a group counseling program: the mental health level of the elderly the mean score was (47.85 percent), and the standard deviation was (0.21 percent) and after. The elderly had a higher score of (51.45 percent) In summary, after the elderly caregivers joined the group, the elderly are higher in all aspects promote mental health for elderly and the statistically significance at the 0.05, It shows that programs are fit for personal and community condition in promoting the mental health of the elderly because this theory has the idea that: Humans have the ability to use their intelligence to solve problems or make decisions effectively, And member of group counseling program have ventured and express grievances that the counselor is a facilitator who focuses on personal development by building relationships among people. In other words, the factors contributing to higher levels of elderly care behaviors is group counseling, that isn't a hypothetical process but focus on building relationships that are based on mutual trust and Unconditional acceptance.

Keywords: group counseling base on person-centered theory, elderly person, resilience quotient: RQ, caregiver

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Authors: Anna Fowler

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When considering assets that may need protection, the mind begins to contemplate homes, cars, and investment funds. In most cases, the protection of those assets can be covered through security systems and insurance. Data is not the first thought that comes to mind that would need protection, even though data is at the core of most supply chain operations. It includes trade secrets, management of personal identifiable information (PII), and consumer data that can be used to enhance the overall experience. Data is considered a critical element of success for supply chains and should be one of the most critical areas to protect. In the supply chain industry, there are two major misconceptions about protecting data: (i) We do not manage or store confidential/personally identifiable information (PII). (ii) Reliance on Third-Party vendor security. These misconceptions can significantly derail organizational efforts to adequately protect data across environments. These statistics can be exciting yet overwhelming at the same time. The first misconception, “We do not manage or store confidential/personally identifiable information (PII)” is dangerous as it implies the organization does not have proper data literacy. Enterprise employees will zero in on the aspect of PII while neglecting trade secret theft and the complete breakdown of information sharing. To circumvent the first bullet point, the second bullet point forges an ideology that “Reliance on Third-Party vendor security” will absolve the company from security risk. Instead, third-party risk has grown over the last two years and is one of the major causes of data security breaches. It is important to understand that a holistic approach should be considered when protecting data which should not involve purchasing a Data Loss Prevention (DLP) tool. A tool is not a solution. To protect supply chain data, start by providing data literacy training to all employees and negotiating the security component of contracts with vendors to highlight data literacy training for individuals/teams that may access company data. It is also important to understand the origin of the data and its movement to include risk identification. Ensure processes effectively incorporate data security principles. Evaluate and select DLP solutions to address specific concerns/use cases in conjunction with data visibility. These approaches are part of a broader solutions framework called Data Security Assurance (DSA). The DSA Framework looks at all of the processes across the supply chain, including their corresponding architecture and workflows, employee data literacy, governance and controls, integration between third and fourth-party vendors, DLP as a solution concept, and policies related to data residency. Within cloud environments, this framework is crucial for the supply chain industry to avoid regulatory implications and third/fourth party risk.

Keywords: security by design, data security architecture, cybersecurity framework, data security assurance

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Authors: Selin Top, Raul Marcos, M. Sinan Bilgili

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Although there have been several studies related to collection, temporary storage, handling and disposal of solid wastes generated by hospitals, there are only a few studies related to liquid wastes generated by hospitals or hospital wastewaters. There is an important amount of water consumptions in hospitals. While minimum domestic water consumption per person is 100 L/day, water consumption per bed in hospitals is generally ranged between 400-1200 L. This high amount of consumption causes high amount of wastewater. The quantity of wastewater produced in a hospital depends on different factors: bed numbers, hospital age, accessibility to water, general services present inside the structure (kitchen, laundry, laboratory, diagnosis, radiology, and air conditioning), number and type of wards and units, institution management policies and awareness in managing the structure in safeguarding the environment, climate and cultural and geographic factors. In our country, characterization of hospital wastewaters conducted by classical parameters in a very few studies. However, as mentioned above, this type of wastewaters may contain different compounds than domestic wastewaters. Hospital Wastewater (HWW) is wastewater generated from all activities of the hospital, medical and non medical. Nowadays, hospitals are considered as one of the biggest sources of wastewater along with urban sources, agricultural effluents and industrial sources. As a health-care waste, hospital wastewater has the same quality as municipal wastewater, but may also potentially contain various hazardous components due to using disinfectants, pharmaceuticals, radionuclides and solvents making not suitable the connection of hospital wastewater to the municipal sewage network. These characteristics may represent a serious health hazard and children, adults and animals all have the potential to come into contact with this water. Therefore, the treatment of hospital wastewater is an important current interest point to focus on. This paper aims to approach on the investigation of hospital wastewater treatment by membrane systems. This study aim is to determined hospital wastewater’s characterization and also evaluates the efficiency of hospital wastewater treatment by high pressure filtration systems such as ultrafiltration (UF). Hospital wastewater samples were taken directly from sewage system from Şişli Etfal Training and Research Hospital, located in the district of Şişli, in the European part of Istanbul. The hospital is a 784 bed tertiary care center with a daily outpatient department of 3850 patients. Ultrafiltration membrane is used as an experimental treatment and the influence of the pressure exerted on the membranes was examined, ranging from 1 to 3 bar. The permeate flux across the membrane was observed to define the flooding membrane points. The global COD and BOD5 removal efficiencies were 54% and 75% respectively for ultrafiltration, all the SST removal efficiencies were above 90% and a successful removal of the pathological bacteria measured was achieved.

Keywords: hospital wastewater, membrane, ultrafiltration, treatment

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Authors: Meryam Labyad, Karima Fakiri, Widad Lahmini, Ghizlane Draiss, Mohamed Bouskraoui, Nadia Ouzennou

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Background: Asthma is the most common chronic disease in children, affecting nearly 235 million people worldwide (OMS). In Morocco, asthma is much more common in children than in adults; the prevalence rate in children between 13 and 14 years of age is 20%.1 This pathology is marked by high morbidity, a significant impact on the quality of life and development of children 2 This requires a rigorous management strategy in order to achieve clinical control and reduce any risk to the patient 3 A search for aggravating factors is mandatory if a child has difficulty maintaining good asthma control. The objective of the present study is to describe asthma control during this confinement period in children aged 4 to 11 years followed by a pneumo-paediatric consultation. For children whose asthma is not controlled, a search for associations with promoting factors and adherence to treatment is also among the objectives of the study. Knowing the level of asthma control and influencing factors is a therapeutic priority in order to reduce hospitalizations and emergency care use. Objective: To assess asthma control and determine the factors influencing asthma levels in children with asthma during confinement following the COVID 19 pandemic. Method: Prospective cross-sectional study by questionnaire and structured interview among 66 asthmatic children followed in pediatric pneumology consultation at the CHU MED VI of Marrakech from 13/06/2020 to 13/07/2020, asthma control was assessed by the Childhood Asthma Control Test (C-ACT). Results: 66 children and their parents were included (mean age is 7.5 years), asthma was associated with allergic rhinitis (13.5% of cases), conjunctivitis (9% of cases), eczema (12% of cases), occurrence of infection (10.5% of cases). The period of confinement was marked by a decrease in the number of asthma attacks translated by a decrease in the number of emergency room visits (7.5%) of these asthmatic children, control was well controlled in 71% of the children, this control was significantly associated with good adherence to treatment (p<0.001), no infection (p<0.001) and no conjunctivitis (p=002) or rhinitis (p<0.001). This improvement in asthma control during confinement can be explained by the measures taken in the Kingdom to prevent the spread of COVID 19 (school closures, reduction in industrial activity, fewer means of transport, etc.), leading to a decrease in children's exposure to triggers, which justifies the decrease in the number of children having had an infection, allergic rhinitis or conjunctivitis during this period. In addition, the close monitoring of parents resulted in better therapeutic adherence (42.4% were fully observant). Confinement was positively perceived by 68% of the parents; this perception is significantly associated with the level of asthma control (p<0.001). Conclusion: Maintaining good control can be achieved through improved therapeutic adherence and avoidance of triggers, both of which were achieved during the containment period following the VIDOC pandemic 19.

Keywords: Asthma, control , COVID-19 , children

Procedia PDF Downloads 184

Authors: Francis Deinmodei W. Poazi, Jasmine O. Tamunosiki-Amadi, Maurice Fems

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In recent times the resource-based view (RBV) of strategic management has recorded a sizeable attention yet there has not been a considerable scholarly and managerial discourse, debate and attention. As a result, this paper gives special bit of critical reasoning as well as top-notch analyses and relationship between RBV and organizational innovation. The study examines those salient aspects of RBV that basically have the will power in ensuring the organization's capacity to go for innovative capability. In achieving such fit and standpoint, the paper joins other relevant academic discourse and empirical evidence. To this end, a reasonable amount of contributions in setting the ground running for future empirical researches would have been provided. More so, the study is guided and built on the following strength and significance: Firstly, RBV sees resources as heterogeneity which forms a strong point of strength and allows organisations to gain competitive advantage. In order words, competitive advantage can be achieved or delivered to the organization when resources are distinctively utilized in a valuable manner more than the envisaged competitors of the organization. Secondly, RBV is significantly influential in determining the real resources that are available in the organization with a view to locate capabilities within in order to attract more profitability into the organization when applied. Thus, there will be more sustainable growth and success in the ever competitive and emerging market. Thus, to have succinct description of the basic methodologies, the study adopts both qualitative as well as quantitative approach with a view to have a broad samples of opinion in establishing and identifying key and strategic organizational resources to enable managers of resources to gain a competitive advantage as well as generating a sustainable increase and growth in profit. Furthermore, a comparative approach and analysis was used to examine the performance of RBV within the organization. Thus, the following are some of the findings of the study: it is clear that there is a nexus between RBV and growth of competitively viable organizations. More so, in most parts, organizations have heterogeneous resources domiciled in their organizations but not all organizations as it was specifically and intelligently adopting the tenets of RBV to strengthen heterogeneity of resources which allows organisations to gain competitive advantage. Other findings of this study reveal that of managerial perception of RBV with respect to application and transformation of resources to achieve a profitable end. It is against this backdrop, the importance of RBV cannot be overemphasized; the study is strongly convinced and think that RBV view is one focal and distinct approach that is focused on internal to outside strategy which engenders sourcing or generating resources internally as well as having the quest to apply such internally sourced resources diligently to increase or gain competitive advantage.

Keywords: resource-based view, innovation, organisation, recognition significant relationship and theoretical perspective

Procedia PDF Downloads 306

Authors: Sherly Shelton, Zhaohui Lin

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In recent decades, the inter-annual variability of summer precipitation over the India and Sri Lanka has intensified significantly with an increased frequency of both abnormally dry and wet summers. Therefore prediction of the inter-annual variability of summer precipitation is crucial and urgent for water management and local agriculture scheduling. However, none of the hypotheses put forward so far could understand the relationship to monsoon variability and related factors that affect to the South West Monsoon (SWM) variability in Sri Lanka. This study focused to identify the spatial and temporal variability of SWM rainfall events from June to September (JJAS) over Sri Lanka and associated trend. The monthly rainfall records covering 1980-2013 over the Sri Lanka are used for 19 stations to investigate long-term trends in SWM rainfall over Sri Lanka. The linear trends of atmospheric variables are calculated to understand the drivers behind the changers described based on the observed precipitation, sea surface temperature and atmospheric reanalysis products data for 34 years (1980–2013). Empirical orthogonal function (EOF) analysis was applied to understand the spatial and temporal behaviour of seasonal SWM rainfall variability and also investigate whether the trend pattern is the dominant mode that explains SWM rainfall variability. The spatial and stations based precipitation over the country showed statistically insignificant decreasing trends except few stations. The first two EOFs of seasonal (JJAS) mean of rainfall explained 52% and 23 % of the total variance and first PC showed positive loadings of the SWM rainfall for the whole landmass while strongest positive lording can be seen in western/ southwestern part of the Sri Lanka. There is a negative correlation (r ≤ -0.3) between SMRI and SST in the Arabian Sea and Central Indian Ocean which indicate that lower temperature in the Arabian Sea and Central Indian Ocean are associated with greater rainfall over the country. This study also shows that consistently warming throughout the Indian Ocean. The result shows that the perceptible water over the county is decreasing with the time which the influence to the reduction of precipitation over the area by weakening drawn draft. In addition, evaporation is getting weaker over the Arabian Sea, Bay of Bengal and Sri Lankan landmass which leads to reduction of moisture availability required for the SWM rainfall over Sri Lanka. At the same time, weakening of the SST gradients between Arabian Sea and Bay of Bengal can deteriorate the monsoon circulation, untimely which diminish SWM over Sri Lanka. The decreasing trends of moisture, moisture transport, zonal wind, moisture divergence with weakening evaporation over Arabian Sea, during the past decade having an aggravating influence on decreasing trends of monsoon rainfall over the Sri Lanka.

Keywords: Arabian Sea, moisture flux convergence, South West Monsoon, Sri Lanka, sea surface temperature

Procedia PDF Downloads 130

Authors: Liaqat Ali, Ehsan, Muhammad Shahzad, Nasir Orakzai

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Introduction: Internal optical urethrotomy is the main stay treatment modality in management of urethral stricture. Being minimal invasive with less morbidity, it is commonly performed and favored procedure by urologists across the globe. Although short-term success rate of optical urethrotomy is promising but long-term efficacy of IOU is questionable with high recurrence rate in different studies. Numerous techniques had been adopted to reduce the recurrence after IOU like prolong catheterization and self-clean intermittent catheterization with varying success. Mitomycin C has anti-fibroblast and anti-collagen properties and has been used in trabeculectomy, myringotomy and after keloid scar excision in contemporary surgical practice. Present study according to the best of our knowledge is a pioneer pilot study in Pakistan to determine the efficacy of Mitomycin C in preventing recurrence of urethral stricture after internal optical urethrotomy. Objective: To determine the efficacy of Mitomycin C in reducing the recurrence of anterior urethral stricture after internal optical urethrotomy. Methods: It is a randomized control trial conducted in department of urology, Institute of Kidney Diseases Hayatabad Medical Complex Peshawar from March 2011 till December 2013. After approval of hospital ethical committee, we included maximum of 2 cm anterior urethral stricture irrespective of etiology. Total of 140 patients were equally divided into two groups by lottery method. Group A (Case) comprising of 70 patients in whom Mitomycin C 0.1% was injected sub mucosal in stricture area at 1,11,6 and 12 O clock position using straight working channel paediatric cystoscope after conventional optical urethrotomy. Group B (Control) 70 patients in whom only optical urethrotomy was performed. SCIC was not offered in both the groups. All the patients were regularly followed on a monthly basis for 3 months then three monthly for remaining 9 months. Recurrence was diagnosed by using diagnostic tools of retrograde urethrogram and flexible urethroscopy in selected cased. Data was collected on structured Proforma and was analyzed on SPSS. Result: The mean age in Group A was 33 ±1.5 years and Group B was 35 years. External trauma was leading cause of urethral stricture in both groups 46 (65%) Group A and 50 (71.4%) Group B. In Group A. Iatrogenic urethral trauma was 2nd etiological factor in both groups. 18(25%) Group A while 15( 21.4%) in Group B. At the end of 1 year, At the end of one year, recurrence of urethral stricture was recorded in 11 (15.71%) patient in Mitomycin C Group A and it was recorded in 27 (38.5 %) patients in group B. Significant difference p=0.001 was found in favour of group A Mitomycin group. Conclusion: Recurrence of urethral stricture is high after optical urethrotomy. Mitomycin C is found highly effective in preventing recurrence of urethral stricture after IOU.

Keywords: urethral stricture, mitomycine, internal optical urethrotomy, medical and health sciences

Procedia PDF Downloads 380

Authors: Sidharth Talan, Sanjay Kumar Sharma, Eoin Joseph Wallace, Nikita Agrawal

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Underground mining is at the core of rapidly evolving metals and minerals sector due to the increasing mineral consumption globally. Even though the surface mines are still more abundant on earth, the scales of industry are slowly tipping towards underground mining due to rising depth and complexities of orebodies. Thus, the efficient and productive functioning of underground operations depends significantly on the synchronized performance of key elements such as operating site, mining equipment, manpower and mine services. Production drilling is the process of conducting long hole drilling for the purpose of charging and blasting these holes for the production of ore in underground metal mines. Thus, production drilling is the crucial segment in the underground metal mining value chain. This paper presents the process mapping tool to evaluate the production drilling process in the underground metal mining operation by dividing the given process into three segments namely Input, Process and Output. The three segments are further segregated into factors and sub-factors. As per the study, the major input factors crucial for the efficient functioning of production drilling process are power, drilling water, geotechnical support of the drilling site, skilled drilling operators, services installation crew, oils and drill accessories for drilling machine, survey markings at drill site, proper housekeeping, regular maintenance of drill machine, suitable transportation for reaching the drilling site and finally proper ventilation. The major outputs for the production drilling process are ore, waste as a result of dilution, timely reporting and investigation of unsafe practices, optimized process time and finally well fragmented blasted material within specifications set by the mining company. The paper also exhibits the drilling loss matrix, which is utilized to appraise the loss in planned production meters per day in a mine on account of availability loss in the machine due to breakdowns, underutilization of the machine and productivity loss in the machine measured in drilling meters per unit of percussion hour with respect to its planned productivity for the day. The given three losses would be essential to detect the bottlenecks in the process map of production drilling operation so as to instigate the action plan to suppress or prevent the causes leading to the operational performance deficiency. The given tool is beneficial to mine management to focus on the critical factors negatively impacting the production drilling operation and design necessary operational and maintenance strategies to mitigate them. 

Keywords: process map, drilling loss matrix, SIPOC, productivity, percussion rate

Procedia PDF Downloads 214

Authors: Katarina Pogacnik, Ursa Zakrajsek, Nejc Sirk, Ziga Lampret

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Due to an increase in living standards along with global population growth and a trend of urbanization, municipalities and regions are faced with an ever rising energy demand. A challenge has arisen for cities around the world to modify the energy supply chain in order to reduce its consumption and CO₂ emissions. The aim of our work is the development of a computational-analytical platform for dynamic support in decision-making and the determination of economic and technical indicators of energy efficiency in a smart city, named Energy Atlas. Similar products in this field focuse on a narrower approach, whereas in order to achieve its aim, this platform encompasses a wider spectrum of beneficial and important information for energy planning on a local or regional scale. GIS based interactive maps provide an extensive database on the potential, use and supply of energy and renewable energy sources along with climate, transport and spatial data of the selected municipality. Beneficiaries of Energy atlas are local communities, companies, investors, contractors as well as residents. The Energy Atlas platform consists of three modules named E-Planning, E-Indicators and E-Cooperation. The E-Planning module is a comprehensive data service, which represents a support towards optimal decision-making and offers a sum of solutions and feasibility of measures and their effects in the area of efficient use of energy and renewable energy sources. The E-Indicators module identifies, collects and develops optimal data and key performance indicators and develops an analytical application service for dynamic support in managing a smart city in regards to energy use and sustainable environment. In order to support cooperation and direct involvement of citizens of the smart city, the E-cooperation is developed with the purpose of integrating the interdisciplinary and sociological aspects of energy end-users. Interaction of all the above-described modules contributes to regional development because it enables for a precise assessment of the current situation, strategic planning, detection of potential future difficulties and also the possibility of public involvement in decision-making. From the implementation of the technology in Slovenian municipalities of Ljubljana, Piran, and Novo mesto, there is evidence to suggest that the set goals are to be achieved to a great extent. Such thorough urban energy planning tool is viewed as an important piece of the puzzle towards achieving a low-carbon society, circular economy and therefore, sustainable society.

Keywords: circular economy, energy atlas, energy management, energy planning, low-carbon society

Procedia PDF Downloads 304

Authors: Sahar Heidary

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Radiography and radiotherapy have emerged as crucial pillars of modern medical practice, revolutionizing diagnostics and treatment for a myriad of health conditions. This abstract highlights the pivotal role of radiography and radiotherapy in favor of healthcare and society. Radiography, a non-invasive imaging technique, has significantly advanced medical diagnostics by enabling the visualization of internal structures and abnormalities within the human body. With the advent of digital radiography, clinicians can obtain high-resolution images promptly, leading to faster diagnoses and informed treatment decisions. Radiography plays a pivotal role in detecting fractures, tumors, infections, and various other conditions, allowing for timely interventions and improved patient outcomes. Moreover, its widespread accessibility and cost-effectiveness make it an indispensable tool in healthcare settings worldwide. On the other hand, radiotherapy, a branch of medical science that utilizes high-energy radiation, has become an integral component of cancer treatment and management. By precisely targeting and damaging cancerous cells, radiotherapy offers a potent strategy to control tumor growth and, in many cases, leads to cancer eradication. Additionally, radiotherapy is often used in combination with surgery and chemotherapy, providing a multifaceted approach to combat cancer comprehensively. The continuous advancements in radiotherapy techniques, such as intensity-modulated radiotherapy and stereotactic radiosurgery, have further improved treatment precision while minimizing damage to surrounding healthy tissues. Furthermore, radiography and radiotherapy have demonstrated their worth beyond oncology. Radiography is instrumental in guiding various medical procedures, including catheter placement, joint injections, and dental evaluations, reducing complications and enhancing procedural accuracy. On the other hand, radiotherapy finds applications in non-cancerous conditions like benign tumors, vascular malformations, and certain neurological disorders, offering therapeutic options for patients who may not benefit from traditional surgical interventions. In conclusion, radiography and radiotherapy stand as indispensable tools in modern medicine, driving transformative improvements in patient care and treatment outcomes. Their ability to diagnose, treat, and manage a wide array of medical conditions underscores their favor in medical practice. As technology continues to advance, radiography and radiotherapy will undoubtedly play an ever more significant role in shaping the future of healthcare, ultimately saving lives and enhancing the quality of life for countless individuals worldwide.

Keywords: radiology, radiotherapy, medical imaging, cancer treatment

Procedia PDF Downloads 68

Authors: B. T. Naveen Kumar, Anuj Tyagi, Niraj Kumar Singh, Visanu Boonyawiwat, A. H. Shanthanagouda, Orawan Boodde, K. M. Shankar, Prakash Patil, Shubhkaramjeet Kaur

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Early mortality syndrome (EMS)/Acute Hepatopancreatic Necrosis Disease (AHPND) has emerged as a major obstacle for the shrimp farming around the world. It is caused by a strain of Vibrio parahaemolyticus. The possible preventive and control measure is, early and rapid detection of the pathogen in the broodstock, post-larvae and monitoring the shrimp during the culture period. Polymerase chain reaction (PCR) based early detection methods are good, but they are costly, time taking and requires a sophisticated laboratory. The present study was conducted to develop a simple, sensitive and rapid diagnostic farmer level kit for the reliable detection of AHPND in shrimp. A panel of monoclonal antibodies (MAbs) were raised against the recombinant Pir B protein (rPirB). First, an immunodot was developed by using MAbs G3B8 and Mab G3H2 which showed specific reactivity to purified r-PirB protein with no cross-reactivity to other shrimp bacterial pathogens (AHPND free Vibrio parahaemolyticus (Indian strains), V. anguillarum, WSSV, Aeromonas hydrophila, and Aphanomyces invadans). Immunodot developed using Mab G3B8 is more sensitive than that with the Mab G3H2. However, immunodot takes almost 2.5 hours to complete with several hands-on steps. Therefore, the flow-through assay (FTA) was developed by using a plastic cassette containing the nitrocellulose membrane with absorbing pads below. The sample was dotted in the test zone on the nitrocellulose membrane followed by continuos addition of five solutions in the order of i) blocking buffer (BSA) ii) primary antibody (MAb) iii) washing Solution iv) secondary antibody and v) chromogen substrate (TMB) clear purple dots against a white background were considered as positive reactions. The FTA developed using MAbG3B8 is more sensitive than that with MAb G3H2. In FTA the two MAbs showed specific reactivity to purified r-PirB protein and not to other shrimp bacterial pathogens. The FTA is simple to farmer/field level, sensitive and rapid requiring only 8-10 min for completion. Tests can be developed to kits, which will be ideal for use in biosecurity, for the first line of screening (at the port or pond site) and during monitoring and surveillance programmes overall for the good management practices to reduce the risk of the disease.

Keywords: acute hepatopancreatic necrosis disease, AHPND, flow-through assay, FTA, farmer level, immunodot, pond site, shrimp

Procedia PDF Downloads 172

Authors: D. Tedesco, G. Feletti, P. Trucco

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The present study aims to develop a Decision Support System (DSS) to support the operational decision of the Emergency Medical Service (EMS) regarding the assignment of medical emergency requests to Emergency Departments (ED). In the literature, this problem is also known as “hospital selection” and concerns the definition of policies for the selection of the ED to which patients who require further treatment are transported by ambulance. The employed research methodology consists of the first phase of revision of the technical-scientific literature concerning DSSs to support the EMS management and, in particular, the hospital selection decision. From the literature analysis, it emerged that current studies are mainly focused on the EMS phases related to the ambulance service and consider a process that ends when the ambulance is available after completing a request. Therefore, all the ED-related issues are excluded and considered as part of a separate process. Indeed, the most studied hospital selection policy turned out to be proximity, thus allowing to minimize the transport time and release the ambulance in the shortest possible time. The purpose of the present study consists in developing an optimization model for assigning medical emergency requests to the EDs, considering information relating to the subsequent phases of the process, such as the case-mix, the expected service throughput times, and the operational capacity of different EDs in hospitals. To this end, a Discrete Event Simulation (DES) model was created to evaluate different hospital selection policies. Therefore, the next steps of the research consisted of the development of a general simulation architecture, its implementation in the AnyLogic software and its validation on a realistic dataset. The hospital selection policy that produced the best results was the minimization of the Time To Provider (TTP), considered as the time from the beginning of the ambulance journey to the ED at the beginning of the clinical evaluation by the doctor. Finally, two approaches were further compared: a static approach, which is based on a retrospective estimate of the TTP, and a dynamic approach, which is based on a predictive estimate of the TTP determined with a constantly updated Winters model. Findings reveal that considering the minimization of TTP as a hospital selection policy raises several benefits. It allows to significantly reduce service throughput times in the ED with a minimum increase in travel time. Furthermore, an immediate view of the saturation state of the ED is produced and the case-mix present in the ED structures (i.e., the different triage codes) is considered, as different severity codes correspond to different service throughput times. Besides, the use of a predictive approach is certainly more reliable in terms of TTP estimation than a retrospective approach but entails a more difficult application. These considerations can support decision-makers in introducing different hospital selection policies to enhance EMSs performance.

Keywords: discrete event simulation, emergency medical services, forecast model, hospital selection

Procedia PDF Downloads 88

Authors: Ting-I Lin

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Purpose: This article explores the care experience of a 34-year-old female breast cancer patient who was admitted to the intensive care unit after undergoing a modified radical mastectomy. The patient discovered a lump in her right breast during a self-examination and, after mammography and ultrasound-guided biopsy, was diagnosed with a malignant tumor in the right breast. The tumor measured 1.5 x 1.4 x 2 cm, and the patient underwent a modified radical mastectomy. Postoperatively, she exhibited feelings of inferiority due to changes in her appearance. Method: During the care period, we engaged in conversations, observations, and active listening, using Gordon's Eleven Functional Health Patterns for a comprehensive assessment. In collaboration with the critical care team, a psychologist, and an oncology case manager, we conducted an interdisciplinary discussion and reached a consensus on key nursing issues. These included pain related to postoperative tumor excision and disturbed body image due to changes in appearance after surgery. Result: During the care period, a private space was provided to encourage the patient to express her feelings about her altered body image. Communication was conducted through active listening and a non-judgmental approach. The patient's anxiety level, as measured by the depression and anxiety scale, decreased from moderate to mild, and she was able to sleep for 6-8 hours at night. The oncology case manager was invited to provide education on breast reconstruction using breast models and videos to both the patient and her husband. This helped rebuild the patient's confidence. With the patient's consent, a support group was arranged where a peer with a similar experience shared her journey, offering emotional support and encouragement. This helped alleviate the psychological stress and shock caused by the cancer diagnosis. Additionally, pain management was achieved through adjusting the dosage of analgesics, administering Ultracet 37.5 mg/325 mg 1# Q6H PO, along with distraction techniques and acupressure therapy. These interventions helped the patient relax and alleviate discomfort, maintaining her pain score at a manageable level of 3, indicating mild pain. Conclusion: Disturbance in body image can cause significant psychological stress for patients. Through support group discussions, encouraging patients to express their feelings, and providing appropriate education on breast reconstruction and dressing techniques, the patient's self-concept was positively reinforced, and her emotions were stabilized. This led to renewed self-worth and confidence.

Keywords: breast cancer, modified radical mastectomy, acupressure therapy, Gordon's 11 functional health patterns

Procedia PDF Downloads 27

Authors: Bu Kyung Park

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Background: The survival rate of pediatric cancer patients has been increased. Thus, the needs of long-term management and follow-up education after discharge continue to grow. Purpose: The purpose of this study was to explore the experiences of pediatric cancer patients and their families from first diagnosis to returning their social life. The ultimate goal of this study was to assess which information and intervention did pediatric cancer patients and their families required and needed, so that this could provide fundamental information for developing educational content of web-based intervention program for pediatric cancer patients. Research Approach: This study was based on a descriptive qualitative research design using semi-structured focus group interview. Participants: Twelve pediatric cancer patients and 12 family members participated in a total six focus group interview sessions. Methods: All interviews were audiotaped after obtaining participants’ approval. The recordings were transcribed. Qualitative Content analysis using the inductive coding approach was performed on the transcriptions by three coders. Findings: Eighteen categories emerged from the six main themes: 1) Information needs, 2) Support system, 3) Barriers to treatment, 4) Facilitators to treatment, 5) Return to social life, 6) Healthcare system issues. Each theme had both pediatric cancer patients’ codes and their family members’ codes. Patients and family members had high information needs through the whole process of treatment, not only the first diagnosis but also after completion of treatment. Hospitals provided basic information on chemo therapy, medication, and various examinations. However, they were more likely to rely on information from other patients and families by word of mouth. Participants’ information needs were different according to their treatment stage (e.g., first admitted patients versus cancer survivors returning to their social life). Even newly diagnosed patients worried about social adjustment after completion of all treatment, such as return to school and diet and physical activity at home. Most family members had unpleasant experiences while they were admitted in hospitals and concerned about healthcare system issues, such as medical error and patient safety. Conclusions: In conclusion, pediatric cancer patients and their family members wanted information source which can provide tailored information based on their needs. Different information needs with patients and their family members based on their diagnosis, progress, stage of treatment were identified. Findings from this study will be used to develop a patient-centered online health intervention program for pediatric cancer patients. Pediatric cancer patients and their family members had variety fields of education needs and soak the information from various sources. Web-based health intervention program for them is required to satisfy their inquiries to provide reliable information.

Keywords: focus group interview, family caregivers, pediatric cancer patients, qualitative content analysis

Procedia PDF Downloads 180

Authors: Kevin Potoczny, Katsuichiro Goda

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The St. Lawrence lowlands extend from Ottawa to Quebec City and are known for large deposits of sensitive Leda clay. Leda clay deposits are responsible for many large landslides, such as the 1993 Lemieux and 2010 St. Jude (4 fatalities) landslides. Due to the large extent and sensitivity of Leda clay, regional hazard analysis for landslides is an important tool in risk management. A 2018 regional study by Farzam et al. on the susceptibility of Leda clay slopes to landslide hazard uses 1 arc second topographical data. A qualitative method known as Hazus is used to estimate susceptibility by checking for various criteria in a location and determine a susceptibility rating on a scale of 0 (no susceptibility) to 10 (very high susceptibility). These criteria are slope angle, geological group, soil wetness, and distance from waterbodies. Given the flat nature of St. Lawrence lowlands, the current assessment fails to capture local slopes, such as the St. Jude site. Additionally, the data did not allow one to analyze failure planes accurately. This study majorly improves the analysis performed by Farzam et al. in two aspects. First, regional assessment with high resolution data allows for identification of local locations that may have been previously identified as low susceptibility. This then provides the opportunity to conduct a more refined analysis on the failure plane of the slope. Slopes derived from 1 arc second data are relatively gentle (0-10 degrees) across the region; however, the 1- and 2-meter resolution 2022 HRDEM provided by NRCAN shows that short, steep slopes are present. At a regional level, 1 arc second data can underestimate the susceptibility of short, steep slopes, which can be dangerous as Leda clay landslides behave retrogressively and travel upwards into flatter terrain. At the location of the St. Jude landslide, slope differences are significant. 1 arc second data shows a maximum slope of 12.80 degrees and a mean slope of 4.72 degrees, while the HRDEM data shows a maximum slope of 56.67 degrees and a mean slope of 10.72 degrees. This equates to a difference of three susceptibility levels when the soil is dry and one susceptibility level when wet. The use of GIS software is used to create a regional susceptibility map across the St. Lawrence lowlands at 1- and 2-meter resolutions. Failure planes are necessary to differentiate between small and large landslides, which have so far been ignored in regional analysis. Leda clay failures can only retrogress as far as their failure planes, so the regional analysis must be able to transition smoothly into a more robust local analysis. It is expected that slopes within the region, once previously assessed at low susceptibility scores, contain local areas of high susceptibility. The goal is to create opportunities for local failure plane analysis to be undertaken, which has not been possible before. Due to the low resolution of previous regional analyses, any slope near a waterbody could be considered hazardous. However, high-resolution regional analysis would allow for more precise determination of hazard sites.

Keywords: hazus, high-resolution DEM, leda clay, regional analysis, susceptibility

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Authors: Usha S. Adiga, Sachidanada Adiga

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Introduction: Diabetes Mellitus (DM) is one of the most common non-communicable diseases which imposes a large economic burden on the global health-care system. Cost of illness studies in India have assessed the health care cost of DM, but have certain limitations due to lack of standardization of the methods used, improper documentation of data, lack of follow up, etc. The objective of the study was to estimate the cost of illness of uncomplicated versus complicated type 2 diabetes mellitus in Coastal Karnataka, India. The study also aimed to find out the trend of cost of illness of the disease over a decade. Methodology: A prevalence based bottom-up approach study was carried out in two tertiary care hospitals located in Coastal Karnataka after ethical approval. Direct Medical costs like annual laboratory costs, pharmacy cost, consultation charges, hospital bed charges, surgical /intervention costs of 238 diabetics and 340 diabetic patients respectively from two hospitals were obtained from the medical record sections. Patients were divided into six groups, uncomplicated diabetes, diabetic retinopathy(DR), nephropathy(DN), neuropathy(DNeu), diabetic foot(DF), and ischemic heart disease (IHD). Different costs incurred in 2008 and 2017 in these groups were compared, to study the trend of cost of illness. Kruskal Wallis test followed by Dunn’s test were used to compare median costs between the groups and Spearman's correlation test was used for correlation studies. Results: Uncomplicated patients had significantly lower costs (p <0.0001) compared to other groups. Patients with IHD had highest Medical expenses (p < 0.0001), followed by DN and DF (p < 0.0001 ). Annual medical costs incurred were 1.8, 2.76, 2.77, 1.76, and 4.34 times higher in retinopathy, nephropathy, diabetic foot, neuropathy and IHD patients as compared to the cost incurred in managing uncomplicated diabetics. Other costs also showed a similar pattern of rising. A positive correlation was observed between the costs incurred and duration of diabetes, a negative correlation between the glycemic status and cost incurred. The cost incurred in the management of DM in 2017 was found to be elevated 1.4 - 2.7 times when compared to that in 2008. Conclusion: It is evident from the study that the economic burden due to diabetes mellitus is substantial. It poses a significant financial burden on the healthcare system, individual and society as a whole. There is a need for the strategies to achieve optimal glycemic control and operationalize regular and early screening methods for complications so as to reduce the burden of the disease.

Keywords: COI, diabetes mellitus, a bottom up approach, economics

Procedia PDF Downloads 115

Authors: Ananya Pal, Neelakshi Sarkar, Debraj Saha, Dipanwita Das, Subhashish Kamal Guha, Bibhuti Saha, Runu Chakravarty

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Presently, tenofovir disoproxil fumurate (TDF) is the most effective anti-viral agent for the treatment of hepatitis B virus (HBV) in individuals co-infected with HIV and HBV as TDF has activity to suppress both wild-type and lamivudine (3TC)-resistant HBV. However, suboptimal response to TDF was reported in HIV-HBV co-infected individuals with prior 3TC therapy from different countries recently. The incidence of 3TC-resistant HBV strains is quite high in HIV-HBV co-infected patients experiencing long-term anti-retroviral therapy (ART) in eastern India. In spite of this risk, most of the patients with long-term 3TC treatment are continued with the same anti-viral agent in this country. Only a few have received TDF in addition to 3TC in the ART regimen since TDF has been available in India for the treatment of HIV-infected patients in 2012. In this preliminary study, we investigated the virologic and biochemical parameters among HIV-HBV co-infected patients who are non-responders to 3TC treatment during the continuation of 3TC or TDF add-on to 3TC in their ART regimen. Fifteen HIV-HBV co-infected patients who experienced long-term 3TC (mean duration months 36.87 ± 24.08 months) were identified with high HBV viremia ( > 20,000 IU/ml) or harbouring 3TC-resistant HBV. These patients receiving ART from School of Tropical Medicine Kolkata, the main ART centre in eastern India were followed-up semi-annually for next three visits. Different virologic parameters including quantification of plasma HBV load by real-time PCR, detection of hepatitis B e antigen (HBeAg) by commercial ELISA and anti-viral resistant mutations by sequencing were studied. During three follow-up among study subjects, 86%, 47%, and 43% had 3TC-mono-therapy (mean treatment-duration 41.54±18.84, 49.67±11.67, 54.17±12.37 months respectively) whereas 14%, 53%, and 57% experienced TDF in addition to 3TC (mean treatment duration 4.5±2.12, 16.56±11.06, and 23±4.07 months respectively). Mean CD4 cell-count in patients receiving 3TC was tended to be lower during third follow-up as compared to the first and the second [520.67±380.30 (1st), 454.8±196.90 (2nd), and 397.5±189.24 (3rd) cells/mm3) and similar trend was seen in patients experiencing TDF in addition to 3TC [334.5±330.218 (1st), 476.5±194.25 (2nd), and 461.17±269.89 (3rd) cells/mm3]. Serum HBV load was increased during successive follow-up of patients with 3TC-mono-therapy. Initiation of TDF lowered serum HBV-load among 3TC-non-responders at the time of second visit ( < 2,000 IU/ml), interestingly during third follow-up, mean HBV viremia increased >1 log IU/ml (mean 3.56±2.84 log IU/ml). Persistence of 3TC-resistant double and triple mutations was also observed in both the treatment regimens. Mean serum alanine aminotransferase remained elevated in these patients during this follow-up study. Persistence of high HBV viraemia and 3TC-resistant mutation in HBV during the continuation of 3TC might lead to major public health threat in India. The inclusion of TDF in the ART regimen of 3TC non-responder HIV-HBV co-infected patients showed adverse treatment response in terms of virologic and biochemical parameters. Therefore, serious attention is necessary for proper management of long-term 3TC experienced HIV-HBV co-infected patients with high HBV viraemia or 3TC-resistant HBV mutants in India.

Keywords: HBV, HIV, TDF, 3TC-resistant

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Authors: Ernest Nweke, Enkhtuya Bavuudorj

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The harsh realities of the scandalous failure of several notable corporations in the past two decades have inextricably resulted in a surge in corporate governance studies. Nevertheless, little or no attention has been paid to corporate governance studies in Mongolian firms and much less to the comprehension of the correlation among ownership structure, corporate governance mechanisms and trend of innovative activities. Innovation is the bed rock of enterprise success. However, the funding and support for innovative activities in many firms are to a great extent determined by the incentives provided by the firm’s internal and external governance mechanisms. Mongolia is an East Asian country currently undergoing a fast-paced transition from socialist to democratic system and it is a widely held view that private ownership as against public ownership fosters innovation. Hence, following the privatization policy of Mongolian Government which has led to the transfer of the ownership of hitherto state controlled and state directed firms to private individuals and organizations, expectations are high that sufficient motivation would be provided for firm managers to engage in innovative activities. This research focuses on the relationship between ownership structure, corporate governance on one hand and the level of innovation on the hand. The paper is empirical in nature and derives data from both reliable secondary and primary sources. Secondary data for the study was in respect of ownership structure of Mongolian listed firms and innovation trend in Mongolia generally. These were analyzed using tables, charts, bars and percentages. Personal interviews and surveys were held to collect primary data. Primary data was in respect of corporate governance practices in Mongolian firms and were collected using structured questionnaire. Out of a population of three hundred and twenty (320) companies listed on the Mongolian Stock Exchange (MSE), a sample size of thirty (30) randomly selected companies was utilized for the study. Five (5) management level employees were surveyed in each selected firm giving a total of one hundred and fifty (150) respondents. Data collected were analyzed and research hypotheses tested using Chi-Square test statistic. Research results showed that corporate governance mechanisms were better and have significantly improved overtime in privately held as opposed to publicly owned firms. Consequently, the levels of innovation in privately held firms were considerably higher. It was concluded that a significant and positive relationship exists between private ownership and good corporate governance on one hand and the level of funding provided for innovative activities in Mongolian firms on the other hand.

Keywords: corporate governance, innovation, ownership structure, stock exchange

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Authors: Revaz Gvelesiani

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The problem of compliance between the state economic policy and entrepreneurial policy of businesses is primarily manifested in the contradictions related to the congruence between entrepreneurship development and self-development strategies. Among various types (financial, monetary, social, etc.) of the state economic policy aiming at the development of entrepreneurship, economic order policy is of special importance. Its goal is to set the framework for both public and private economic activities and achieve coherence between the societal value system and the formation of the economic order framework. Economic order policy, in its turn, involves intrinsic contradiction between the social and the competitive order. Competitive order is oriented on the principle of success, while social order _ on the criteria of need satisfaction, which contradicts, at least partly, to the principles of success. Thus within the economic order policy, on the one hand, the state makes efforts to form social order and expand its frontiers, while, on the other hand, market is determined to establish functioning competitive order and ensure its realization. Locating the adequate spaces for and setting the rational border between the state (social order) and the private (competitive order) activities, represents the phenomenon of the decisive importance from the entrepreneurship development strategy standpoint. In the countries where the above mentioned spaces and borders are “set” correctly, entrepreneurship agents (small, medium-sized and large businesses) achieve great success by means of seizing the respective segments and maintaining the leading positions in the internal, the European and the world markets for a long time. As for the entrepreneurship self-development strategy, above all, it involves: •market identification; •interactions with consumers; •continuous innovations; •competition strategy; •relationships with partners; •new management philosophy, etc. The analysis of compliance between the entrepreneurship strategy and entrepreneurship culture should be the reference point for any kind of internationalization in order to avoid shocks of cultural nature and the economic backwardness. Stabilization can be achieved only when the employee actions reflect the existing culture and the new contents of culture (targeted culture) is turned into the implicit consciousness of the personnel. The future leaders should learn how to manage different cultures. Entrepreneurship can be managed successfully if its strategy and culture are coherent. However, not rarely enterprises (organizations) show various forms of violation of both personal and team actions. If personal and team non-observances appear as the form of influence upon the culture, it will lead to global destruction of the system and structure. This is the entrepreneurship culture pathology that complicates to achieve compliance between the entrepreneurship strategy and entrepreneurship culture. Thus, the intrinsic contradictions of entrepreneurship development and self-development strategies complicate the task of reaching compliance between the state economic policy and the company entrepreneurship policy: on the one hand, there is a contradiction between the social and the competitive order within economic order policy and on the other hand, the contradiction exists between entrepreneurship strategy and entrepreneurship culture within entrepreneurship policy.

Keywords: economic order policy, entrepreneurship, development contradictions, self-development contradictions

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Authors: Michelo Obrey

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Traditionally, mutual funds have long been esteemed as stand-alone entities in the U.S. However, the prevalence of the fund families’ affiliation to financial conglomerates is eroding this striking feature. Mutual fund families' affiliation with financial conglomerates can potentially be an important source of superior performance or cost to the affiliated mutual fund investors. On the one hand, financial conglomerates affiliation offers the mutual funds access to abundant resources, better research quality, private material information, and business connections within the financial group. On the other hand, conflict of interest is bound to arise between the financial conglomerate relationship and fund management. Using a sample of U.S. domestic equity mutual funds from 1994 to 2017, this paper examines whether fund family affiliation to an investment bank help the affiliated mutual funds deliver superior performance through private material information advantage possessed by the investment banks or it costs affiliated mutual fund shareholders due to the conflict of interest. Robust to alternative risk adjustments and cross-section regression methodologies, this paper finds that the investment bank-affiliated mutual funds significantly outperform those of the mutual funds that are not affiliated with an investment bank. Interestingly the paper finds that the outperformance is confined to holding return, a return measure that captures the investment talent that is uninfluenced by transaction costs, fees, and other expenses. Further analysis shows that the investment bank-affiliated mutual funds specialize in hard-to-value stocks, which are not more likely to be held by unaffiliated funds. Consistent with the information advantage hypothesis, the paper finds that affiliated funds holding covered stocks outperform affiliated funds without covered stocks lending no support to the hypothesis that affiliated mutual funds attract superior stock-picking talent. Overall, the paper findings are consistent with the idea that investment banks maximize fee income by monopolistically exploiting their private information, thus strategically transferring performance to their affiliated mutual funds. This paper contributes to the extant literature on the agency problem in mutual fund families. It adds to this stream of research by showing that the agency problem is not only prevalent in fund families but also in financial organizations such as investment banks that have affiliated mutual fund families. The results show evidence of exploitation of synergies such as private material information sharing that benefit mutual fund investors due to affiliation with a financial conglomerate. However, this research has a normative dimension, allowing such incestuous behavior of insider trading and exploitation of superior information not only negatively affect the unaffiliated fund investors but also led to an unfair and unleveled playing field in the financial market.

Keywords: mutual fund performance, conflicts of interest, informational advantage, investment bank

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