Search results for: continuous improvement sustainability

Authors: Anupam Sibal

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Whatever is measured tends to improve. With a view to objectively measuring and improving clinical quality across the Apollo Group Hospitals, the initiative of ACE @ 25 (Apollo Clinical Excellence@25) was launched on Jan 09. ACE @ 25 is a clinically balanced scorecard incorporating 25 clinical quality parameters involving complication rates, mortality rates, one-year survival rates and average length of stay after major procedures like liver and renal transplant, CABG, TKR, THR, TURP, PTCA, endoscopy, large bowel resection and MRM covering all major specialties. Also included are hospital acquired infection rates, pain satisfaction and medication errors. Benchmarks have been chosen from the world’s best hospitals. There are weighted scores for outcomes color coded green, orange and red. The cumulative score is 100. Data is reported monthly by 43 Group Hospitals online on the Lighthouse platform. Action taken reports for parameters falling in red are submitted quarterly and reviewed by the board. An audit team audits the data at all locations every six months. Scores are linked to appraisal of the medical head and there is an “ACE @ 25” Champion Award for the highest scorer. Scores for different parameters were variable from green to red at the start of the initiative. Most hospitals showed an improvement in scores over the last four years for parameters where they had showed scores in red or orange at the start of the initiative. The overall scores for the group have shown an increase from 72 in 2010 to 81 in 2015.

Keywords: benchmarks, clinical quality, lighthouse, platform, scores

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Authors: Jianwen Li, Hongfang Ma, Haitao Zhang, Qiwen Sun, Weiyong Ying

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Catalytic cracking of butene to propylene was carried out in a continuous-flow fixed-bed reactor over HZSM-5 catalysts modified by nickel and phosphorus. The structure and acidity of catalysts were measured by N2 adsorption, NH3-TPD and XPS. The results revealed that surface area and strong acid sites both decreased with increasing phosphorus loadings. The increment of phosphorus loadings reduced the butene conversion but enhanced the propylene selectivity and catalyst stability.

Keywords: butene, catalytic cracking, HZSM-5, modification

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Authors: Elle Hilke Dominski

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This paper explores the impact of intersectional bullying of lesbian, gay, bisexual, transgender (LGBT) youth from a multi-layered experience perspective within bullying incidents at school. Present inclusionary measures at school may not be designed as a continuous process of finding better methods for responding to diversity, rather remain ‘fixed’ as singular solutions applied universally. This paper argues recognizing education through a lens of inclusion begins to realize most educational systems are poorly equipped to handle diversity.

Keywords: bullying, education, intersectional bullying, LGBT

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Authors: Tzen-Ying Ling

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Recently, the resilience of dwellings in urban areas has been deliberated, as to accommodate the growing demand for changing the demography and rapid urbanization. The need to incorporate sustainability and cleaner production thinking have intensified to mitigate climate risks and satisfy the demand for housing. The modular thinking satisfies both the pressing call for fast-tracked housing stocks; while meeting the goal of more sustainable production. In the other side, the importance of the dwelling as a podium for well-being and social connectedness are sought to explore the key human/environment design thinking for the modular system in dwelling. We argue the best practice incorporates the concept of systemic components thinking. The fieldwork reported in this paper illustrates the process of the case study in a modular dwelling unit prototype development; focusing on the systemic frame system design process and adjustment recommendation hereafter. Using a case study method, the study identified that: (1) inclusive human dimensional factoring through systemic design thinking results in affordable implementations possibilities. (2) The environmental dimension encourages the place-based solution suited for the locality and the increasing demand for dwelling in the urban system. (3) Prototype design consideration avails module system component as dwelling construction alternative. (4) Building code often acts as an inhibitor for such dwelling units by the restriction in lot sizes and units placement. The demand for fast-track dwelling construction and cleaner production decisively outweighs the code inhibition; we further underscored the sustainability implication of the alternative prototype as the core of this study. The research suggests that modular thinking results in a resilient solution suited for the locality and the increasing demand for dwelling in the urban system.

Keywords: system prototype, urban resilience, human/environment dimension, modular thinking, dwelling alternative

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Authors: Abosede Omowumi Babatunde

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While the Niger Delta region satisfies the global thirst for oil, the inhabitants have not been adequately compensated for the use of their ancestral land. Besides, the ruthless exploitation and destruction of the natural environment upon which the inhabitants of the Niger Delta depend for their livelihood and sustenance by the activities of oil multinationals, pose major threats to food security in the region and by implication, Nigeria in general, Africa, and the world, given the present global emphasis on food security. This paper examines the effect of oil exploitation on household food security, identify key gaps in measures put in place to address the changes to livelihoods and food security and explore what should be done to improve the local people access to sufficient, safe and culturally acceptable food in the Niger Delta. Data is derived through interviews with key informants and Focus Group Discussions (FGDs) conducted with respondents in the local communities in the Niger Delta states of Delta, Bayelsa and Rivers as well as relevant extant studies. The threat to food security is one important aspect of the human security challenges in the Niger Delta which has received limited scholarly attention. In addition, successive Nigerian governments have not meaningfully addressed the negative impacts of oil-induced environmental degradation on traditional livelihoods given the significant linkages between environmental sustainability, livelihood security, and food security. The destructive impact of oil pollution on the farmlands, crops, economic trees, creeks, lakes, and fishing equipment is so devastating that the people can no longer engage in productive farming and fishing. Also important is the limited access to modern agricultural methods for fishing and subsistence farming as fishing and farming are done using mostly crude implements and traditional methods. It is imperative and urgent to take stock of the negative implications of the activities of oil multinationals for environmental and livelihood sustainability, and household food security in the Niger Delta.

Keywords: challenges, food security, Nigeria's Niger delta, oil

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Authors: Bheeshma B., Mathivanan N., Manoj Deepak M., Prabhu Thangaraju, K. Venkatachalam

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This study involves the effect of autologous blood injection for patients who had degeneration of the origin of extensor carpi radialis brevis which was confirmed radio logically and by ultrasound examination and failed cortisone injections to the lateral epicondylitis. In this prospective longitudinal series involves pre-injection assessment of grip strength, pain, and function, using the patient-rated tennis elbow evaluation. In this study, blood from the contralateral limb is taken and injected into the affected limb with the help of ultrasound guidance and then the patient wore a customized wrist support for five days, after which they were commenced with stretching, strengthening, and massage programme with an occupational therapist. In these patients assessment was done after six months and then finally at 12 months after injection, using the patient-rated tennis elbow evaluation. 50 patients completed the study, showing significant improvement in pain; the worst pain decreased by two to five points out of a 10-point visual analogue for pain. Self-perceived function improved by 11–25 points out of 100. Women showed significant increase in grip, but men did not. Our study thus concludes that autologous blood injection show significant improvement in pain and function in patients with chronic lateral epicondylitis, who did not have relief with cortisone injection.

Keywords: lateral epicondylitis, autologous blood injection, conservative treatment, plasma-rich proteins (PRPs)

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Authors: Yasser Y. Lenis, Daniela Garcia Gonzalez, Cristian Solarte Bacca, Diego F. Carrillo González, Amy Jo Montgomery, Dursun Barrios

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Introduction: Artificial insemination in bovines helps to promote genetic improvement and can positively impact the rural economy. The Colombian armed conflict has forced a large portion of the rural population to abandon their territory, affecting their education, family integration, and economics. Justification: The achievement of education in rural populations was one of the Millennium Development Goals (MDGs) made by the United Nations. During the last World Summit on Sustainable Development (WSSD), it was concluded that most of the world’s poor, illiterate and undernourished population lives in rural areas; therefore, access to education is considered one of the most significant challenges for governments in countries with developing economies. Objectives: To study the effects of training in artificial insemination and rural management on the perception of knowledge and the level of knowledge in rural residents affected by the armed conflict in Nariño, Colombia. Methods: The perception of knowledge and the theoretical-practical knowledge of 63 rural residents were evaluated on the topics of bovine agribusiness management, artificial insemination, and genetic improvement through the application of three surveys. 1) evaluated the perceived level of knowledge each rural resident had about each topic using the Likert scale, 2) evaluated the theoretical knowledge before training, and 3) evaluated the theoretical knowledge upon completion of training. Results/discussion: Of the surveyed rural residents, 54% stated that they knew how business management improved the performance of their bovine agribusiness, 54% answered the pre-training knowledge test correctly, while 83% correctly answered the post-training knowledge test. Only 6% of surveyed residents perceived that they had prior knowledge of artificial insemination and reproductive anatomy topics. Before training, 35% of surveyed residents answered correctly on these topics, while upon completion of training, 65% answered correctly. Regarding genetic improvement, 11% of participating rural residents stated that they knew this subject. The correct answers on this topic went from 57% to 89% before and post-training. Conclusion: Rural extension programs contribute to closing knowledge gaps in relation to the use of reproductive biotechnologies and bovine management in rural areas affected by armed conflict.

Keywords: agribusiness, insemination, knowledge, reproduction

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Authors: Diana González, Marta Gràcia, Ana Luisa Adam-Alcocer

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Incorporating digital tools into educational practices represents a valuable approach for enriching the quality of teachers' educational practices in oral competence and fostering improvements in student learning outcomes. This study aims to promote a collaborative and culturally sensitive approach to professional development between teachers and a speech therapist to enhance their self-awareness and reflection on high-quality educational practices that integrate school components to strengthen children’s oral communication and pragmatic skills. The study involved five bilingual teachers fluent in both English and Spanish, with three specializing in special education and two in general education. It focused on Spanish-English bilingual students, aged 3-6, who were experiencing speech delays or disorders in a New York City public school, with the collaboration of a speech therapist. Using EVALOE-DSS (Assessment Scale of Oral Language Teaching in the School Context - Decision Support System), teachers conducted self-assessments of their teaching practices, reflect and make-decisions throughout six classes from March to June, focusing on students' communicative competence across various activities. Concurrently, the speech therapist observed and evaluated six classes per teacher using EVALOE-DSS during the same period. Additionally, professional development meetings were held monthly between the speech therapist and teachers, centering on discussing classroom interactions, instructional strategies, and the progress of both teachers and students in their classes. Findings highlight the digital tool EVALOE-DSS's value in analyzing communication patterns and trends among bilingual children in inclusive settings. It helps in identifying improvement areas through teacher and speech therapist collaboration. After self-reflection meetings, teachers demonstrated increased awareness of student needs in oral language and pragmatic skills. They also exhibited enhanced utilization of strategies outlined in EVALOE-DSS, such as actively guiding and orienting students during oral language activities, promoting student-initiated communicative interactions, teaching students how to seek and provide information, and managing turn-taking to ensure inclusive participation. Teachers participating in the professional development program have shown positive progress in assessing their classes across all dimensions of the training tool, including instructional design, teacher conversation management, pupil conversation management, communicative functions, teacher strategies, and pupil communication functions. This includes aspects related to both teacher actions and child actions, particularly in child language development. This progress underscores the effectiveness of individual reflection (conducted weekly or biweekly using EVALOE-DSS) as well as collaborative reflection among teachers and the speech therapist during meetings. The EVALOE-SSD has proven effective in supporting teachers' self-reflection, decision-making, and classroom changes, leading to improved development of students' oral language and pragmatic skills. It has facilitated culturally sensitive evaluations of communication among bilingual children, cultivating collaboration between teachers and speech therapist to identify areas of growth. Participants in the professional development program demonstrated substantial progress across all dimensions assessed by EVALOE-DSS. This included improved management of pupil communication functions, implementation of effective teaching strategies, and better classroom dynamics. Regular reflection sessions using EVALOE-SSD supported continuous improvement in instructional practices, highlighting its role in fostering reflective teaching and enriching student learning experiences. Overall, EVALOE-DSS has proven invaluable for enhancing teaching effectiveness and promoting meaningful student interactions in diverse educational settings.

Keywords: bilingual students, collaboration, culturally sensitive, oral communication skills, self-reflection

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Authors: Supriya Ambawat, Subaran Singh, C. Tara Satyavathi, B. S. Rajpurohit, Ummed Singh, Balraj Singh

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Pearl millet [Pennisetum glaucum (L.) R. Br.] is an important staple food of the arid and semiarid tropical regions of Asia, Africa, and Latin America. It is rightly termed as nutricereal as it has high nutrition value and a good source of carbohydrate, protein, fat, ash, dietary fiber, potassium, magnesium, iron, zinc, etc. Pearl millet has low prolamine fraction and is gluten free which is useful for people having a gluten allergy. It has several health benefits like reduction in blood pressure, thyroid, diabe¬tes, cardiovascular and celiac diseases but its direct consumption as food has significantly declined due to several reasons. Keeping this in view, it is important to reorient the ef¬forts to generate demand through value-addition and quality improvement and create awareness on the nutritional merits of pearl millet. In India, through Indian Council of Agricultural Research-All India Coordinated Research Project on Pearl millet, multilocational coordinated trials for developed hybrids were conducted at various centers. The gene banks of pearl millet contain varieties with high levels of iron and zinc which were used to produce new pearl millet varieties with elevated iron levels bred with the high‐yielding varieties. Thus, using breeding approaches and biochemical analysis, a total of 167 hybrids and 61 varieties were identified and released for cultivation in different agro-ecological zones of the country which also includes some biofortified hybrids rich in Fe and Zn. Further, using several biotechnological interventions such as molecular markers, next-generation sequencing (NGS), association mapping, nested association mapping (NAM), MAGIC populations, genome editing, genotyping by sequencing (GBS), genome wide association studies (GWAS) advancement in millet improvement has become possible by identifying and tagging of genes underlying a trait in the genome. Using DArT markers very high density linkage maps were constructed for pearl millet. Improved HHB67 has been released using marker assisted selection (MAS) strategies, and genomic tools were used to identify Fe-Zn Quantitative Trait Loci (QTL). The draft genome sequence of millet has also opened various ways to explore pearl millet. Further, genomic positions of significantly associated simple sequence repeat (SSR) markers with iron and zinc content in the consensus map is being identified and research is in progress towards mapping QTLs for flour rancidity. The sequence information is being used to explore genes and enzymatic pathways responsible for rancidity of flour. Thus, development and application of several biotechnological approaches along with biofortification can accelerate the genetic gain targets for pearl millet improvement and help improve its quality.

Keywords: Biotechnological approaches, genomic tools, malnutrition, MAS, nutricereal, pearl millet, sequencing.

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Authors: Eugene Allevato

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Developing a responsible personal worldview is central to sustainable development, but achieving quality education to promote transformative learning for sustainability is thus far, poorly understood. Most programs involving education for sustainable development rely on changing behavior, rather than attitudes. The emphasis is on the scientific and utilitarian aspect of sustainability with negligible importance on the intrinsic value of nature. Campus sustainability projects include building sustainable gardens and implementing energy-efficient upgrades, instead of focusing on educating for sustainable development through exploration of students’ values and beliefs. Even though green technology adoption maybe the right thing to do, most schools are not targeting the root cause of the environmental crisis; they are just providing palliative measures. This study explores the under-examined factors that lead to pro-environmental behavior by investigating the environmental perceptions of both college business students and personnel of green organizations. A mixed research approach of qualitative, based on structured interviews, and quantitative instruments was developed including 30 college-level students’ interviews and 40 green organization staff members involved in sustainable activities. The interviews were tape-recorded and transcribed for analysis. Categorization of the responses to the open‐ended questions was conducted with the purpose of identifying the main types of factors influencing attitudes and correlating with behaviors. Overall the findings of this study indicated a lack of appreciation for nature, and inability to understand interconnectedness and apply critical thinking. The results of the survey conducted on undergraduate students indicated that the responses of business and liberal arts students by independent t-test were significantly different, with a p‐value of 0.03. While liberal arts students showed an understanding of human interdependence with nature and its delicate balance, business students seemed to believe that humans were meant to rule over the rest of nature. This result was quite intriguing from the perspective that business students will be defining markets, influencing society, controlling and managing businesses that supposedly, in the face of climate change, shall implement sustainable activities. These alarming results led to the focus on green businesses in order to better understand their motivation to engage in sustainable activities. Additionally, a probit model revealed that childhood exposure to nature has a significantly positive impact in pro-environmental attitudes to most of the New Ecological Paradigm scales. Based on these findings, this paper discusses educators including Socrates, John Dewey and Paulo Freire in the implementation of eco-pedagogy and transformative learning following a curriculum with emphasis on critical and systems thinking, which are deemed to be key ingredients in quality education for sustainable development.

Keywords: eco-pedagogy, environmental behavior, quality education for sustainable development, transformative learning

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Authors: Zhenjie Liu

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This paper investigates the existence and uniqueness of solutions for singular higher order boundary value problems on time scales by using mixed monotone method. The theorems obtained are very general. For the different time scale, the problem may be the corresponding continuous or discrete boundary value problem.

Keywords: mixed monotone operator, boundary value problem, time scale, green's function, positive solution, singularity

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Authors: A. Haddick, A. Soltan

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Background: During the period of recovery from an operative obstetric procedure, a woman is not only at risk of the life-threatening complications accompanying labour but also those associated with surgery and anaesthesia. It is speculated that women in the recovery area may receive a lower standard of care over a night shift. Thus obstetric recovery room care should be evaluated regularly to ensure all women receive an equally high standard of care 24/7. Aim: The aim of this audit was to undertake an audit in the Liverpool Women’s Hospital on the care in recovery, and to ascertain the extent to which the standards were met. This audit included the full audit cycle. Method: Standards were taken from the AAGBI, RCOA, NICE and CNST guidelines. There were 12 standards including appropriate documentation of vital signs and appropriate length of stay after surgery. Notes from 100 patients were analysed from March 2011-March 2012. There were 52 day notes and 48 night notes; these were accessed to gain the relevant data. In the re audit 35 notes were accessed from March 14-September 14. Results: The Liverpool Women’s Hospital met in total 10 of these standards. 10 were met during the day shift (83%) and 0 met during the night shift. In the re audit, there was a significant improvement in the standards met at night. 9 of the standards were met during the day and 7 of the standards were met at night. Clearly there are still improvements to be made. Conclusions: In the original audit, an audit action plan was formulated. This was following discussion of the results of this audit in an MDT meeting and presentation with a consultant Obstetrician, the head of Midwifery, the head of Obstetrics theatres and a recovery nurse. This audit will be further discussed in the Liverpool Woman's Hospital in July 2015 for further implementation for improvement.

Keywords: care, recovery, room, women

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Authors: Abdelsalam Elawwad, Mostafa Ragab, Hisham Abdel-Halim

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Leakage in sewerage system can cause groundwater and soil contamination in urban areas, especially in area with a high groundwater table. This is a serious problem in small villages in developing countries that rely on ground water as a source for irrigation and drinking purposes. In the developed countries, the recent trend in areas with low population densities is vacuum sewerage system, which is environmentally safer than conventional gravity system, protecting public health, preventing exfiltration to the ground water, very easily applied in a relatively short time and can cope with a faster expansion of the urbanized areas. The aim of this work is to assess the feasibility of using vacuum sewerage in developing country, such as Egypt. Knowledge of local conditions can determine the most suitable sewer system for a specific region. Technical, environmental and financial comparisons between conventional sewerage system and vacuum sewerage system were held using statistical analysis. Different conditions, such as population densities, geometry of area, and ground water depths were evaluated. Sample comprising of 30 Egyptian villages was selected, where a complete design for conventional sewerage system and vacuum sewerage system was done. Based on this study, it is recommended from the environmental point of view to construct the vacuum sewerage system in such villages with low population densities; however, it is not economic for all cases. From financial point of view, vacuum sewerage system was a good competitor to conventional systems in flat areas and areas with high groundwater table. The local market supplying of the construction equipment especially collection chambers will greatly affect the investment cost. Capacity building and social mobilization will also play a great role in sustainability of this system. At the end, it is noteworthy that environmental sustainability and public health are more important than the financial aspects.

Keywords: ground water, conventional system, vacuum system, statistics, cost, density, terrain

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Authors: Chuan Yang, Jing Bie, Yueh-Lung Lin, Zhong Wang

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Transportation planning is an academic integration discipline combining research and practice with the aim of mobility and accessibility improvements at both strategic-level policy-making and operational dimensions of practical planning. Transportation planning could build the linkage between traffic and social development goals, for instance, economic benefits and environmental sustainability. The transportation planning analysis and evaluation tend to apply empirical quantitative approaches with the guidance of the fundamental principles, such as efficiency, equity, safety, and sustainability. Space syntax theory has been applied in the spatial distribution of pedestrian movement or vehicle flow analysis, however rare has been written about its application in transportation planning. The correlated relationship between the variables of space syntax analysis and authentic observations have declared that the urban configurations have a significant effect on urban dynamics, for instance, land value, building density, traffic, crime. This research aims to explore the potentials of applying Space Syntax methodology to evaluate urban transportation planning through studying the effects of urban configuration on cities transportation performance. By literature review, this paper aims to discuss the effects that urban configuration with different degrees of integration and accessibility have on three elementary components of transportation planning - transportation efficiency, transportation safety, and economic agglomeration development - via intensifying and stabilising the nature movements generated by the street network. And then the potential and limits of Space Syntax theory to study the performance of urban transportation and transportation planning would be discussed in the paper. In practical terms, this research will help future research explore the effects of urban design on transportation performance, and identify which patterns of urban street networks would allow for most efficient and safe transportation performance with higher economic benefits.

Keywords: transportation planning, space syntax, economic agglomeration, transportation efficiency, transportation safety

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Authors: Inese Trusina, Elita Jermolajeva

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Global challenges require a transition from the existing linear economic model to a model that will consider nature as a life support system for the developmenton the way to social well-being in the frame of the ecological economics paradigm. The article presentsbasic definitions for the development of formalized description of sustainabledevelopment monitoring. It provides examples of calculating the parameters of monitoring for the Baltic Sea region countries and their primary interpretation.

Keywords: sustainability, development, power, ecological economics, regional economic, monitoring

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Authors: Ahmed Ramadhan Al-Obaidi, Jassim Alhamid

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In this investigation, the flow pattern, characteristics of thermal-hydraulic, and improvement of heat transfer performance are evaluated using a numerical technique in three dimensions corrugated pipe heat exchanger. The modification was made under different corrugated pipe geometrical parameters, including corrugated ring angle (CRA), distance between corrugated ring (DBCR), and corrugated diameter (CD), the range of Re number from 2000 to 12000. The numerical results are validated with available experimental data. The numerical outcomes reveal that there is an important change in flow field behaviour and a significant increase in friction factor and improvement in heat transfer performance owing to the use of the corrugated shape in the heat exchanger pipe as compared to the conventional smooth pipe. Using corrugated pipe with different configurations makes the flow more turbulence, flow separation, boundary layer distribution, flow mixing, and that leads to augmenting the performance of heat transfer. Moreover, the value of pressure drop, and the Nusselt number increases as the corrugated pipe geometrical parameters increase. Furthermore, the corrugation configuration shapes have an important influence on the thermal evaluation performance factor, and the maximum value was more than 1.3. Numerical simulation can be performed to predict the various geometrical configurations effects on fluid flow, thermal performance, and heat transfer enhancement.

Keywords: corrugated ring angle, corrugated diameter, Nusselt number, heat transfer

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Authors: Robert E. Kenney, Richard B. Aguilar, Efrain Antunez, Gregory Schor-Haskin, Rafael Rey, Catie Falcon, Luis Arce

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This study sought to explore the effect of Sarapin injections on chronic knee pain (CKP). Many adults suffer from CKP which is most often attributed to osteoarthritis. Current treatment regimens for CKP involve the use NSAIDS medications, injections with steroids/analgesic, platelet rich plasma injections, or orthopedic surgical interventions. Sarapin is a commercially available homeopathic aqueous extract from the pitcher plant. Studies on the use of Sarapin as a treatment for cervical, thoracic, and lumbosacral facet joint nerve blocks have been performed with mixed results. There is little available evidence on the use of Sarapin in CKP. This study examines the effect of a series of 3 weekly injections of aqueous Sarapin in 95 elderly patients with CKP in a primary care setting. Cano Health, a primary care group, identified 95 successive patients with CKP from its multimodal physiotherapy program for chronic pain. Patients underwent evaluation by a clinician, underwent diagnostic Xrays of the knees, and the treatment plan with three weekly Sarapin injections was discussed. A pain and functional limitation survey (a modified Lower Extremity Functional Scale (mLEFS)) was administered prior to initiating treatment (Entry Survey (ES)). Each patient received an intraarticular injection of 2 cc of aqueous Sarapin with 1cc 1% lidocaine during weeks 1, 2 and 3. The mLEFS was administered again at week 4, one week after the third Sarapin injection (Exit Survey (ExS)). Demographics: Mean Age 62 +/- 9.8; 73% female; 89% Hispanic/Latino; mean time between ES and ExS was 27.5 +/-8.2 days. Survey: The mLEFS was based on a published Lower Extremity Functional Scale and each patient rated their pain or functional limitation from 0 (no difficulty) to 5 (severe difficulty) for 10 questions. Answers were summed and compared. Maximum score for severe difficulty would be 50 points. Results: Mean pain/functional scores: ES was 30.3 +/-12.1 and ExS was 19.5 +/- 12.5. This represents a relative improvement of 35.7% (P<0.00001). A total of 81% (77/95) of the patients showed improvement in symptoms at week four as assessed by the mLEFS. There were 11 patients who reported an increase in their survey scores while 7 patients reported no change. When evaluating the cohort that reported improvement, the ES was 30.9 +/-11.4 and ExS was 16.3 +/-9.8 yielding a 47.2% relative improvement (P<0.00001). Injections were well tolerated, and no adverse events were reported. Conclusions: In this cohort of 95 elderly patients with CKP, treatment with 3 weekly injections of Sarapin significantly improved pain and function as assessed by a mLEFS survey. The majority (81%) of patients responded positively to therapy, 12% had worsening symptoms and 7% reported no change. The use of intraarticular injections of Sarapin for CKP was shown to be an effective modality of treatment. Sarapin’s low cost, tolerability, and ease of use make it an attractive alternative to NSAIDS, steroids, PRP or surgical intervention for this common debilitating condition.

Keywords: Sarapin, intraarticular, chronic knee pain, osteoarthritis

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Authors: Liudmila Garzanova, Lidia Ananyeva, Olga Koneva, Olga Ovsyannikova, Oxana Desinova, Mayya Starovoytova, Rushana Shayahmetova, Anna Khelkovskaya-Sergeeva

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Objectives. The age of the disease onset could have an impact on the effect of therapy in systemic sclerosis(SSc). Late-age onset in SSc could have a more severe course of the disease and worse clinical effects on therapy. The aim of our study was to evaluate changes in skin fibrosis on rituximab(RTX) therapy in patients with SSc and different ages of the disease onset. Methods. 151 patients with SSc were included in this study. Patients were divided into groups depending on the age of the disease onset: group 1 - younger than 30 years (40 patients(26%), group 2 - 31-59 years (90 patients(60%) and group 3 – more than 60 years (21 patients(14%). The mean follow-up period was 13±2.3month. The mean age was 48±13years, female-83% of patients, and the diffuse cutaneous subset of the disease had 52% of patients. The mean disease duration was 6.4±5years. The cumulative mean dose of RTX was 1.5±0.6grams. Patients received RTX as a therapy for interstitial lung disease. All patients received prednisone at a dose of 11.6±4.8mg/day, immunosuppressants received 48% of them. The results at baseline and at the end of the follow-up are presented in the form of mean values. Results. There was a significant decrease of modified Rodnan skin score(mRss) in all groups: in group 1 - from 10.2±8 to 7.7±6.5(p=0.01); in group 2 - from 9±7.2 to 6.2±4.7(p=0.0001); in group 3 - from 20.5±14.1 to 10.8±9.4(p=0.001). There was a significant decrease of the activity index (EScSG-AI): in group 1 from 2.5±1.8 to 1.3±1.1; in group 2 – from 3.2±1.6 to 1.5±1.2; in group 3 – from 4.2±2.1 to 1.3±1. Conclusion. There was a significant improvement in skin fibrosis in a year after initiation of RTX therapy regardless of the age of the disease onset. The improvement was more pronounced in the group with late-age onset of the disease, but these data require further investigations.

Keywords: skin fibrosis, systemic sclerosis, rituximab, disease onset

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Authors: Pascal U. Onu, Doris A. Ogbang, Emmanuel Okechukwu.

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Background: Plastics in their various forms have become ubiquitous in a very short space of time. This ubiquitous nature has plagued and daunted nations globally, overwhelming their ability to manage the environmental impact, especially its linkages to climate change. This has mobilized nations globally and triggered debates on the best approaches to ensure sustainability in terms of its production and utilization, as total elimination seems unrealistic. Objective: This study undertook to understand the pattern of plastic waste management, and its pollution awareness levels by the residents of the study area. Methods: Data were obtained through questionnaires designed specifically for plastic waste and qualitatively via journals and articles. Simple descriptive survey techniques with a survey population size of 300 respondents using kobo collect were employed. Results: Analysis based on disaggregated data indicated a proportionate distribution among male and female respondents (53% male and 47% female, respectively). Overall awareness levels on plastic waste's contribution to climate change, compared to its environmental impact, are reflective of a dire need for increased efforts in strengthening awareness creation, especially across gender populations and religious backgrounds. Drainage blockage topped the ranks among common problems caused by plastic waste within the area. Various plastic waste disposal methods were ranked, while pro-environmental measures for reducing the waste menace showed more willingness from males at 52%. Conclusion: These outcomes are instructive and suggest the need for renewed and increased awareness/education on the nexus of plastic pollution to climate change and also appropriate synergies/collaboration between government, private sector, and local communities, especially in the area of recycling to improve sustainability in plastic waste management.

Keywords: plastic waste, KAP, climate change, Nigeria

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Authors: Stacia E. H. Sitohang, S.Mn., Socrates Rudy Sirait

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The first movie theater in Indonesia was established in December 1900. The movie industry started with international movie penetration. After a while, local movie producers started to rise and created local Indonesian movies. The industry is growing through ups and downs in Indonesia. In 2008, Visinema was founded in Jakarta, Indonesia, by AnggaDwimasSasongko, one of the most respected movie director in Indonesia. After getting achievements and recognition, Visinema chose to grow the company horizontally as opposed to only grow vertically and gain another similar achievement. Visinemachose to build the ecosystem that enables them to obtain many more opportunities and generatebusiness sustainability. The company proceed as an agile company. They created several business subsidiaries to support the company’s Intellectual Property (IP) development. This research was done through interview with the key persons in the company and questionnaire to get market insights regarding Visinema. The is able to transform their IP that initially started from movies to different kinds of business model. Interestingly, Angga chose to use the start up approach to create Visinema. In 2019, the company successfully gained Series A funding from Intudo Ventures and got other various investment schemes to support the business. In early 2020, Covid-19 pandemic negatively impacted many industries in Indonesia, especially the entertainment and leisure businesses. Fortunately, Visinema did not face any significant problem regarding survival during the pandemic, there were nolay-offs nor work hour reductions. Instead, they were thinking of much bigger opportunities and problems. While other companies suffer during the pandemic, Visinema created the first focused Transactional Video On Demand (TVOD) in Indonesia named Bioskop Online. The platform was created to keep the company innovating and adapting with the new online market as the result of the Covid-19 pandemic. Other than a digital platform, Visinemainvested heavily in animation to target kids and family business. They believed that penetrating the technology and animation market is going to be the biggest opportunity in Visinema’s road map. Besides huge opportunities, Visinema is also facing problems. The first is company brand positioning. Angga, as the founder, felt the need to detach his name from the brand image of Visinema to create system sustainability and scalability. Second, the company has to create a strategy to refocus in a particular business area to maintain and improve the competitive advantages. The third problem, IP piracy is a huge structural problem in Indonesia, the company considers IP thieves as their biggest competitors as opposed to other production company. As the recommendation, we suggest a set of branding and management strategy to detach the founder’s name from Visinema’s brand and improve the competitive advantages. We also suggest Visinema invest in system building to prevent IP piracy in the entertainment industry, which later can be another business subsidiary of Visinema.

Keywords: business ecosystem, agile, sustainability, scalability, start Up, intellectual property, digital platform

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Authors: Bolanle Deborah Motilewa, E. K. Rowland Worlu, Gbenga Mayowa Agboola, Ayodele Maxwell Olokundun

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In the pursuit of profit maximization as a major objective of business organizations, several firms forfeit their social and economic responsibility whilst focusing on activities that are deemed to solely profit the firm, without taking into cognizance the effect of their operations on the society in which they operate. Business analysts have, however, realized the determinant role of social responsibility in corporate performance, such that firms that are able to imbibe corporate social responsibility in their core business operations may be able to take advantage of the social reputation gained across their several stakeholders. Small and medium enterprises operating in highly competitive markets are also advised to leverage on this reputation gained from being socially responsible, if they seek ways to remain relevant in the same markets dominated by multinational corporations. Adapting a case study approach, this study highlights the advantages (such as employee and customer loyalty) gained by House of Tara, a small business operating in the beauty and make-up industry in Nigeria, resulting from the firm’s commitment to advancing the society in which it operates through several social responsibility activities. It is observed that although competing with major makeup brands such as MAC, Maybelline, Dior, Mary Kay and others, House of Tara has been able to not only thrive, but gain a sizeable market in the Nigerian makeup industry, because several consumers purchase their products not solely because of the quality or price of their product, but because they perceive themselves as buying into the firm’s CSR vision. This study, therefore, recommends that small and medium enterprises that may lack adequate resources (manpower, technology, capital) needed to successfully compete with multinationals, can harness the potentials in the reputation and loyalty gained from adequate investment in corporate social responsibility.

Keywords: corporate social responsibility, small and medium enterprises, House of Tara, sustainability

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Authors: Brandtner Patrick, Staberhofer Franz

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Logistics and Supply Chain Management are of crucial importance for organisational success. In the era of Digitalization, several implications and improvement potentials for these domains arise, which at the same time could lead to decreased competitiveness and could endanger long-term company success if ignored or neglected. However, empirical research on the issue of Digitalization and benefits purported to it by practitioners is scarce and mainly focused on single technologies or separate, isolated Supply Chain blocks as e.g. distribution logistics or procurement only. The current paper applies a holistic focus group approach to elaborate practitioner use cases at the nexus of the concepts of Supply Chain Management (SCM) and Digitalization. In the course of three focus group workshops with over 45 participants from more than 20 organisations, a comprehensive set of benefit entitlements and areas for improvement in terms of applying digitalization to SCM is developed. The main results of the paper indicate the relevance of Digitalization being realized in practice. In the form of seventeen concrete research action fields, the benefit entitlements are aggregated and transformed into potential starting points for future research projects in this area. The main contribution of this paper is an empirically grounded basis for future research projects and an overview of actual research action fields from practitioners’ point of view.

Keywords: digital supply chain, digital transformation, supply chain management, value networks

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Authors: Abhisek Sarkar, Abhimanyu Gaur

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In this report we have discussed the theoretical aspects of the flow transformation, occurring through a series of bifurcations. The parameters and their continuous diversion, the intermittent bursts in the transition zone, variation of velocity and pressure with time, effect of roughness in turbulent zone, and changes in friction factor and head loss coefficient as a function of Reynolds number for a transverse flow across a cylinder have been discussed. An analysis of the variation in the wake length with Reynolds number was done in FORTRAN.

Keywords: bifurcation, attractor, intermittence, energy cascade, energy spectra, vortex stretching

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Authors: Sitaram Dahal

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Sustainable Development, a universal need for the present generation and the future generation, is an accepted way to assure intra and inter-generational equity. International movements like Rio Earth Summit 1992, Stockholm Conference 1972, Kyoto Protocol, Sustainable Development Goals (SDGs) proclaim the need of sustainable globe. The socio- economic disparity prevailing in the society shows that the indigenous peoples are living life far below poverty line. These indigenous people, aboriginal social groups sharing common cultural values and with a unique identity, are away from development being merely focused on the growth. Though studies suggest that most of the indigenous practices are often environment-friendly, alert about the plunging trend of the practices. This study explores the trend of intergenerational transmission of indigenous profession of pottery making of Kumal community (Meghauli Village Development Committee of Chitwan district) and factors affecting the trend. The SD indicators - contribution of IP to well-being of pottery makers had been query in the study. The study reveals that the pottery making profession can stand sustainable in terms of environment and socio-economic capital compared to modern technologies. However, the number of practitioners has been decreasing and youths hardly show interest to continue their indigenous profession. The new generations are not in a stage of accepting pottery in complete profession, that challenges the social and cultural sustainability of the profession. Indigenous profession demand people investments over modern technology and innovations. The relative investment of human labour is dramatically high with the indigenous profession. In addition, the fashion and innovations of market rule challenge the sustainability of the pottery making profession. The practice is limited to small cluster as a show piece at present. The study illustrates the market driven unsustainability of indigenous profession of Kumal community.

Keywords: professional unsustainability, pottery making, Kumal Community, Indigenous Professoin

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Authors: Vu Hoang Thu Huong

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Background and Purpose: The effects of Extracorporeal Shockwave Therapy (ESWT) in the participants with knee osteoarthritis (KOA) were unclear on physical performance although its effects on pain had been investiagted. This study aims to explore the effects of ESWT on pain relief and physical performance on KOA. Methods: The studies with the randomized controlled design to investigate the effects of ESWT on KOA were systematically searched using inclusion and exclusion criteria through seven electronic databases including Pubmed etc. between 1990 and Dec 2022. To summarize those data, visual analog scale (VAS) or pain scores were determined for measure of pain intensity. Range of knee motion, or the scores of physical activities including Lequesne index (LI), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were determined for measure of physical performances. The first evaluate after treatment period was define as the effect of post-treatment period or immediately effect; and the last evaluate was defined as the effect of following period or the end effect in our study. Data analysis was performed using RevMan 5.4.1 software. A significant level was set at p<0.05. Results: Eight studies (number of participant= 499) reporting the ESWT effects on mild-to-moderate severity (Grades I to III Kellgren–Lawrence) of KOA were qualified for meta-analysis. Compared with sham or placebo group, the ESWT group had a significant decrease of VAS rest score (0.90[0.12~1.67] as mean difference [95% confidence interval]) and pain score WOMAC (2.49[1.22~3.76]), and a significant improvement of physical performance with a decrease of the scores of WOMAC activities (8.18[3.97~12.39]), LI (3.47[1.68~5.26]), and KOOS (5.87[1.73~ 10.00]) in the post-treatment period. There were also a significant decrease of WOMAC pain score (2.83[2.12~3.53]) and a significant decrease of the scores of WOMAC activities (9.47[7.65~11.28]) and LI (4.12[2.34 to 5.89]) in the following period. Besides, compared with other treatment groups, ESWT also displayed the improvement in pain and physical performance, but it is not significant. Conclusions: The ESWT was effective and valuable method in pain relief as well as in improving physical activities in the participants with mild-to-moderate KOA. Clinical Relevance: There are the effects of ESWT on pain relief and the improvement of physical performance in the with KOA.

Keywords: knee osteoarthritis, extracorporeal shockwave therapy, pain relief, physical performance, shockwave

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Authors: Mst. Nilufa Sultana, Shatirah Akib, Muhammad Aqeel Ashraf, Mohamed Roseli Zainal Abidin

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Most people today are aware that global Climate change, is not just a scientific theory but also a fact with worldwide consequences. Global climate change is due to rapid urbanization, industrialization, high population growth and current vulnerability of the climatic condition. Water is becoming scarce as a result of global climate change. To mitigate the problem arising due to global climate change and its drought effect, harvesting rainwater from green roofs, an environmentally-friendly and versatile technology, is becoming one of the best assessment criteria and gaining attention in Malaysia. This paper addresses the sustainability of green roofs and examines the quality of water harvested from green roofs in comparison to rainwater. The factors that affect the quality of such water, taking into account, for example, roofing materials, climatic conditions, the frequency of rainfall frequency and the first flush. A green roof was installed on the Humid Tropic Centre (HTC) is a place of the study on monitoring program for urban Stormwater Management Manual for Malaysia (MSMA), Eco-Hydrological Project in Kualalumpur, and the rainwater was harvested and evaluated on the basis of four parameters i.e., conductivity, dissolved oxygen (DO), pH and temperature. These parameters were found to fall between Class I and Class III of the Interim National Water Quality Standards (INWQS) and the Water Quality Index (WQI). Some preliminary treatment such as disinfection and filtration could likely to improve the value of these parameters to class I. This review paper clearly indicates that there is a need for more research to address other microbiological and chemical quality parameters to ensure that the harvested water is suitable for use potable water for domestic purposes. The change in all physical, chemical and microbiological parameters with respect to storage time will be a major focus of future studies in this field.

Keywords: Green roofs, INWQS, MSMA-SME, rainwater harvesting, water treatment, water quality parameter, WQI

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Authors: Surjeet Bakshi, Surabhi Sharma

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Objective: To assess the impact of educational sessions by reputed regional faculties on knowledge of primary care physicians on evidence based diabetes management methods and practice. Study Design: Retrospective pre-post intervention study. Methodology: Nine cities in Kerala from August to October, 2012 were selected for the study. 125 MBBS doctors participated in the study. 11 regional faculties provided six educational sessions throughout the period. Validated questionnaires were used to evaluate the knowledge of the participants on evidence based diabetes management methods before and after the intervention. Results: The mean score on pre-test was 8 and the mean score on post-test was 9. A paired t-test was conducted on participant’s pre- and post test score and the results were statistically significant (p<0.001). Conclusion: Even though the general attitude to and level of knowledge of diabetes management is good among the primary care physicians in India, there do exist some knowledge gaps which might influence their future practices when it comes to counselling and information on diabetes management methods. In the present study, the performance and awareness level of the participants have expressively improved among primary care physicians. There is a significant improvement in the test score and the training conducted. It seems that if such study programmes are included in the students study programme, it will give higher score in the knowledge and attitude towards diabetes management.

Keywords: diabetes, management, primary care physicians, evidence base, improvement score, knowledge

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Authors: Gabriela Kloudova, Miloslav Stehlik, Peter Sos

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The quality of sleep can affect combat performance where the vigilance, accuracy and reaction time are a decisive factor. In the present study, airborne and special units are measured on duty using actigraphy fingerprint scoring algorithm and QEEG (quantitative EEG). Actigraphic variables of interest will be: mean nightly sleep duration, mean napping duration, mean 24-h sleep duration, mean sleep latency, mean sleep maintenance efficiency, mean sleep fragmentation index, mean sleep onset time, mean sleep offset time and mean midpoint time. In an attempt to determine the individual somnotype of each subject, the data like sleep pattern, chronotype (morning and evening lateness), biological need for sleep (daytime and anytime sleepability) and trototype (daytime and anytime wakeability) will be extracted. Subsequently, a series of recommendations will be included in the training plan based on daily routine, timing of the day and night activities, duration of sleep and the number of sleeping blocks in a defined time. The aim of these modifications in the training plan is to reduce day-time sleepiness, improve vigilance, attention, accuracy, speed of the conducted tasks and to optimize energy supplies. Regular improvement of the training supposed to have long-term neurobiological consequences including neuronal activity changes measured by QEEG. Subsequently, that should enhance cognitive functioning in subjects assessed by the digital cognitive test batteries and improve their overall performance.

Keywords: sleep quality, combat performance, actigraph, somnotype

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Authors: Sedigheh Salemi, Mahnaz Sanjari, Maryam Aalaa, Mohammad Mirzabeigi

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Clinical governance is the framework within which the health service provider is required to ongoing accountability and improvement of the quality of their services. This cross-sectional study was conducted in 661 nurses who work in government hospitals from 35 hospitals of 9 provinces in Iran. The study was approved by the Nursing Council and was carried out with the authorization of the Research Ethics Committee. The questionnaire included 24 questions in which 4 questions focused on clinical governance defining from the nurses' perspective. The reliability was evaluated by Cronbach's alpha (α=0/83). Statistical analyzes were performed, using SPSS version 16. Approximately 40% of nurses correctly answered that clinical governance is not "system of punishment and rewards for the staff". The most nurses believed that "clinical efficacy" is one of the main components of clinical governance. A few of nurses correctly responded that "Evidence Based Practice" and "management" is not part of clinical governance. The small number of nurses correctly answered that the "maintenance of patient records" and "to recognize the adverse effects" is not the role of nurse in clinical governance. Most "do not know" answer was to the "maintenance of patient records". The most nurses unanimously believed that the implementation of clinical governance led to "promoting the quality of care". About a third of nurses correctly stated that the implementation of clinical governance will not lead to "an increase in salaries and benefits of the medical team". As a member of the health team, nurses are responsible in terms of participation in quality improvement and it is necessary to create an environment in which clinical care will flourish and serve to preserve the high standards.

Keywords: clinical governance, nurses, salary, health team

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Authors: Kurias George, Ildefonso Cuesta Romeo, Clara Salueña Pérez, Jordi Sole Olle

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With the growing prevalence of wind energy there is a need, for modeling techniques to evaluate the impact of wind farms on meteorology and oceanography. This study presents an approach that utilizes the WRF (Weather Research and Forecasting )with that include a Wind Farm Parametrization model to simulate the dynamics around Parc Tramuntana project, a offshore wind farm to be located near the Gulf of Roses off the coast of Barcelona, Catalonia. The model incorporates parameterizations for wind turbines enabling a representation of the wind field and how it interacts with the infrastructure of the wind farm. Current results demonstrate that the model effectively captures variations in temeperature, pressure and in both wind speed and direction over time along with their resulting effects on power output from the wind farm. These findings are crucial for optimizing turbine placement and operation thus improving efficiency and sustainability of the wind farm. In addition to focusing on atmospheric interactions, this study delves into the wake effects within the turbines in the farm. A range of meteorological parameters were also considered to offer a comprehensive understanding of the farm's microclimate. The model was tested under different horizontal resolutions and farm layouts to scrutinize the wind farm's effects more closely. These experimental configurations allow for a nuanced understanding of how turbine wakes interact with each other and with the broader atmospheric and oceanic conditions. This modified approach serves as a potent tool for stakeholders in renewable energy, environmental protection, and marine spatial planning. environmental protection and marine spatial planning. It provides a range of information regarding the environmental and socio economic impacts of offshore wind energy projects.

Keywords: weather research and forecasting, wind turbine wake effects, environmental impact, wind farm parametrization, sustainability analysis

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