Search results for: Risk management

Authors: Renata Konadu

Abstract:

Over the last two decades, the concept of environmental management and its related issues have received increased attention in global discourse and on management research agenda due to climate change and other environmental challenges. To abate and avert these challenges, diverse environmental policies, strategies and practices have been adopted by businesses and economies as a whole. Extant literature has placed much emphasis on whether improved environmental operational performance improves firm performance. However, there is a huge gap in the literature with regards to whether the adoption of environmental management practices and policies has a direct relationship with environmental operational performance (EOP). The current paper is intended to provide a comprehensive perspective of how different aspects of environmental management can relate to firms EOP. Using a panel regression analysis of 149 large listed firms in the UK, the study found evidence of both negative and positive statistically significant link between some Environmental Policies (EP), Environmental Processes (EPR), Environmental Management Systems (EMS) and EOP. The findings suggest that in terms of relating EP, EPR and EMS to Greenhouse Gases (GHGs) emissions for instance, the latter should be viewed separately in Scopes 1, 2 and 3 as developed by GHG protocol. The results have useful implication for policy makers and managers when designing strategies and policies to reduce negative environmental impacts.

Keywords: environmental management, environmental operational performance, GHGs, large listed firms

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Authors: Ammar Asma, Bouafia Nabiha, Ben Cheikh Asma, Ezzi Olfa, Mahjoub Mohamed, Sma Nesrine, Chouchène Imed, Boussarsar Hamadi, Njah Mansour

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Background: Ventilator-associated pneumonia (VAP) is currently recognized as one of the most relevant causes of morbidity and mortality among intensive care unit (ICU) patients worldwide. Identifying modifiable risk factors for VAP could be helpful for future controlled interventional studies aiming at improving prevention of VAP. The purposes of this study were to determine the incidence and risk factors for VAP in in a Tunisian medical ICU. Materials / Methods: A retrospective case-control study design based on the prospective database collected over a 14-month period from September 15th, 2015 through November 15th, 2016 in an 8-bed medical ICU. Patients under ventilation for over 48 h were included. The number of cases was estimated by Epi-info Software with the power of statistical test equal to 90 %. Each case patient was successfully matched to two controls according to the length of mechanical ventilation (MV) before VAP for cases and the total length of MV in controls. VAP in the ICU was defined according to American Thoracic Society; Infectious Diseases Society of America guidelines. Early onset or late-onset VAP were defined whether the infectious process occurred within or after 96 h of ICU admission. Patients’ risk factors, causes of admission, comorbidities and respiratory specimens collected were reviewed. Univariate and multivariate analyses were performed to determine variables associated with VAP with a p-value < 0.05. Results: During the period study, a total of 169 patients under mechanical ventilation were considered, 34 patients (20.11%) developed at least one episode of VAP in the ICU. The incidence rate for VAP was 14.88/1000 ventilation days. Among these cases, 9 (26.5 %) were early-onset VAP and 25 (73.5 %) were late-onset VAP. It was a certain diagnosis in 66.7% of cases. Tracheal aspiration was positive in 80% of cases. Multi-drug resistant Acinerobacter baumanii was the most common species detected in cases; 67.64% (n=23). The rate of mortality out of cases was 88.23% (n= 30). In univariate analysis, the patients with VAP were statistically more likely to suffer from cardiovascular diseases (p=0.035) and prolonged duration of sedation (p=0.009) and tracheostomy (p=0.001), they also had a higher number of re-intubation (p=0.017) and a longer total time of intubation (p=0.012). Multivariate analysis showed that cardiovascular diseases (OR= 4.44; 95% IC= [1.3 - 14]; p=0.016), tracheostomy (OR= 4.2; 95% IC= [1.16 -15.12]; p= 0.028) and prolonged duration of sedation (OR=1.21; 95% IC= [1.07, 1.36]; p=0.002) were independent risk factors for the development of VAP. Conclusion: VAP constitutes a therapeutic challenge in an ICU setting, therefore; strategies that effectively prevent VAP are needed. An infection control-training program intended to all professional heath care in this unit insisting on bundles and elaboration of procedures are planned to reduce effectively incidence rate of VAP.

Keywords: case control study, intensive care unit, risk factors, ventilator associated pneumonia

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Authors: M. G. Mattos, J. E. Pécora Jr, T. A. Briso

Abstract:

Today's challenging business environment, with unpredictable demand and volatility, requires a supply chain strategy that handles uncertainty and risks in the right way. Even though inventory models have been previously explored, this paper seeks to apply these concepts on a practical situation. This study involves the inventory replenishment problem, applying techniques that are mainly based on mathematical assumptions and modeling. The primary goal is to improve the retailer’s supply chain processes taking store differences when setting the various target stock levels. Through inventory review policy, picking piece implementation and minimum exposure definition, we were able not only to promote the inventory reduction as well as improve sales results. The inventory management theory from literature review was then tested on a single case study regarding a particular department in one of the largest Latam retail chains.

Keywords: inventory, distribution, retail, risk, safety stock, sales, uncertainty

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Authors: Luiz Drude de Lacerda, Kevin Luiz Cordeiro Ferrer do Carmo, Victor Lacerda Moura, Rayone Wesley Santos de Oliveira, Moisés Fernandes Bezerra

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Fish is a food source well recognized for its health benefits. However, the consumption of fish, especially carnivorous species, is the main path of human exposure to Hg, a widely distributed pollutant on the planet and that accumulates along food chains. Studies on the impacts on public health by fish intake show existing toxic risks even when at low concentrations. This study quantifies, for the first time, the concentrations of Hg in muscle tissue of the nine most commercialized fish species in the fish market of São Luís (MA) in north Brazil and estimates the consequent human exposure through consumption. Concentrations varied according to trophic level, with the highest found in the larger carnivorous species; the Yellow hake (Cynoscion acoupa) (296.4 ± 241.2 ng/g w.w) and the Atlantic croaker (Micropogonias undulatus) (262.8 ± 89.1 ng/g w.w.), whereas the lowest concentrations were recorded in iliophagous Mullets (Mugil curema) (20.5 ± 9.6 ng/g w.w.). Significant correlations were observed between Hg concentrations and individual length in only two species: the Flaming catfish (Bagre marinus) and the Atlantic bumper (Chloroscombrus crysurus). Given the relatively uniform size of individuals of the other species and/or the small number of samples, this relationship was not found for the other species. The estimated risk coefficients, despite the relatively low concentrations of Hg, suggest that yellow hake and Whitemouth croaker (Micropogonias furnieri), fish most consumed by the local population, present some risk to human health (> 1) HQ and THQ, depending on the frequency of their consumption.

Keywords: contamination, fish, human exposure, risk assessment

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Authors: Vichai Tienthavorn

Abstract:

Background: Recently, the patients of non-communicable diseases (NCDs) are increasing in Thailand; especially hypertension and diabetes. Hypertension and Diabetes patients were found to be of 3.7 million in 2008. The varieties of human behaviors have been extensively changed in health. Hence, Thai Government has a policy to reduce NCDs. Generally, primary care plays an important role in treatment using medical process. However, NCDs patients have not been decreased. Objectives: This study not only reduce the patient and mortality rate but also increase the quality of life, could apply in different areas and propose to be the national policy, effectively for a long term operation. Methods: Here we report that primary health care (PHC), which is a primary process to screening, rapidly seek the person's risk. The screening tool of the study was Vichai's 7 color balls model, the medical education tool to transfer knowledge from student health team to community through health volunteers, creating community engagement in terms of social participation. It was found that people in community were realized in their health and they can evaluate the level of risk using this model. Results: Projects implementation (2015) in Nong Lom Health Center in Phayao (target group 15-65 years, 2529); screening hypertension coveraged 99.01%, risk group (light green) was decreased to normal group (white) from 1806 to 1893, significant severe patient (red) was decreased to moderate (orange) from 10 to 5. Health Program in behaving change with best practice of 3Es (Eating, Exercise, Emotion) and 3Rs (Reducing tobacco, alcohol, obesity) were applied in risk group; and encourage strictly medication, investigation in severe patient (red). Conclusion: This is the first demonstration of knowledge transfer to community engagement by student, which is the sustainable education in PHC.

Keywords: non-communicable disease, surveillance control and prevention systems, community engagement, primary health care

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Authors: Hossein Rassi, Marjan Moradi Fard, Masoud Houshmand

Abstract:

Background: Cervical cancer is multistep disease that is thought to result from an interaction between genetic background and environmental factors. Human papillomavirus (HPV) infection is the leading risk factor for cervical intraepithelial neoplasia(CIN)and cervical cancer. In other hand, some of p53 and miRNA polymorphism may plays an important role in carcinogenesis. This study attempts to clarify the relation of p53 genotypes and miR-146a rs2910164 polymorphism in cervical lesions. Method: Forty two archival samples with cervical lesion retired from Khatam hospital and 40 sample from healthy persons used as control group. A simple and rapid method was used to detect the simultaneous amplification of the HPV consensus L1 region and HPV-16,-18, -11, -31, 33 and -35 along with the b-globin gene as an internal control. We use Multiplex PCR for detection of P53 and miR-146a rs2910164 genotypes in our lab. Finally, data analysis was performed using the 7 version of the Epi Info(TM) 2012 software and test chi-square(x2) for trend. Results: Cervix lesions were collected from 42 patients with Squamous metaplasia, cervical intraepithelial neoplasia, and cervical carcinoma. Successful DNA extraction was assessed by PCR amplification of b-actin gene (99bp). According to the results, p53 GG genotype and miR-146a rs2910164 CC genotype was significantly associated with increased risk of cervical lesions in the study population. In this study, we detected 13 HPV 18 from 42 cervical cancer. Conclusion: The connection between several SNP polymorphism and human virus papilloma in rare researches were seen. The reason of these differences in researches' findings can result in different kinds of races and geographic situations and also differences in life grooves in every region. The present study provided preliminary evidence that a p53 GG genotype and miR-146a rs2910164 CC genotype may effect cervical cancer risk in the study population, interacting synergistically with HPV 18 genotype. Our results demonstrate that the testing of p53 codon 72 polymorphism genotypes and miR-146a rs2910164 polymorphism genotypes in combination with HPV18 can serve as major risk factors in the early identification of cervical cancers. Furthermore, the results indicate the possibility of primary prevention of cervical cancer by vaccination against HPV18 in Iran.

Keywords: cervical cancer, p53, miR-146a, rs2910164, polymorphism

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Authors: Uwera Monique, Bagweneza Vedaste, Rugema Joselyne, Lakshmi Rajeswaran

Abstract:

Background: Malnutrition contributes significantly to childhood morbidity and mortality. Nurses usually exhibit inadequate knowledge of childhood malnutrition management. Nurses require appropriate knowledge and skills to manage malnutrition using appropriate protocols. Objectives: The general objective of this study was to assess Nurses’ knowledge and practice in the management of childhood malnutrition in selected health centers in Rwanda. The specific objectives were to assess the level of nurses’ knowledge in the management of childhood malnutrition, to determine the level of practice in the management of childhood malnutrition in selected health centers in Rwanda, and to establish the relationship between the demographic profile and nurses’ knowledge in the management of childhood malnutrition in selected health centers in Rwanda. Methods: The study used a descriptive cross-sectional study design and quantitative approach among 196 nurses from 24 health centers in one district. A questionnaire was used to collect data on knowledge and practice towards childhood malnutrition management. The entire population was used, and SPSS version 25 helped to analyze data. Descriptive statistics helped to produce the frequencies and percentages, while chi-square helped to determine the relationship between demographic variables and knowledge and practice scores. Results: The study findings showed that of 196 participants, 48% had a high level of knowledge about malnutrition management with more than 75% score, and 17% and 35% had low and moderate levels of knowledge, respectively. 61% of them had a high level of practice in malnutrition management, as the acceptable score was 75%. 13% had a low level, while 26% had a moderate level of practice. Most socio-demographic characteristics have shown a statistical relationship with the level of knowledge. Conclusion: The study findings revealed that almost half of the nurses had good knowledge of childhood malnutrition management, and this was associated with many socio-demographic data, while more than half had good practice in that aspect. However, some nurses who still have gaps in knowledge and practice require necessary measures to boost these components.

Keywords: nurse, knowledge, practice, childhood malnutrition

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Authors: Chitrangi Gupta, Arvind Bhardwaj

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This study seeks to investigate and quantify the influence of various dimensions of supply chain management (namely, supplier relationships, compatibility, specifications and standards, delivery processes, and after-sales service) on distinct dimensions of healthcare service quality (specifically, responsiveness, trustworthiness, and security) within the operational framework of XYZ Superspeciality Hospital, situated in Delhi. The name of the Hospital is not being mentioned here because of the privacy policy of the hospital. The primary objective of this research is to elucidate the impact of supply chain management practices on the overall quality of healthcare services offered within hospital settings. Employing a quantitative research design, this study utilizes a hypothesis-testing approach to systematically discern the relationship between supply chain management dimensions and the quality of health services. The findings of this study underscore the significant influence exerted by supply chain management dimensions, specifically supplier relationships, specifications and standards, delivery processes, and after-sales service, on the enhancement of healthcare service quality. Moreover, the study's results reveal that demographic factors such as gender, qualifications, age, and experience do not yield discernible disparities in the relationship between supply chain management and healthcare service quality.

Keywords: supply chain management, healthcare, hospital operations, service delivery

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Authors: Martin Kartomo

Abstract:

Though Management Control Systems (MCS) research has evolved beyond intra-organizational boundaries, there is limited understanding of the impact of a functioning MCS being functional beyond intra-organizational boundaries. The purpose of this research is to investigate factors that have an impact on functioning management Control Systems (MCS)becoming (dys-)functional beyond its intra-organizational boundaries. To bridge the theoretical gap, a systematic literature review is conducted to identify inter-and extra-organizational factors that are purposely suggested or unintendingly mentioned by MCS researchers to evaluate functioning MCS becoming (dys-)functional. A conceptual map is rationalized and constructed from five contingent inter-and extra-organizational MCS frameworks illuminating under-investigated MSC research areas and allowing new research avenues based on academically known factors. A multiple case study followed by a co-researcher discussion group with the purpose of identifying academically unknown factors for evaluating MCS (dys-)functionality beyond its intra-organizational boundaries. The study's result will help bridge the gap between what academics know and not know of evaluating MCS being functional beyond intra-organizational boundaries with the opportunity to develop better, more complete theories. Furthermore, it will help organizations to evaluate the impact of their activities beyond intra-organizational boundaries.

Keywords: management control systems, management control systems evaluation, management controls, control system

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Authors: Dirk Bruland, Paulo Pinheiro, Ullrich Bauer

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Introduction: Over 3 million children, about one quarter of all students, experience at least one parent with mental disorder in Germany every year. Children of mentally-ill parents are at considerably higher risk of developing serious mental health problems. The different burden patterns and coping attempts often become manifest in children's school lives. In this context, schools can have an important protective function, but can also create risk potentials. In reference to Jorm, pupil-related teachers’ mental health literacy (Teacher-MHL) includes the ability to recognize change behaviour, the knowledge of risk factors, the implementation of first aid intervention, and seeking professional help (teacher as gatekeeper). Although teachers’ knowledge and increased awareness of this topic is essential, the literature provides little information on the extent of teachers' abilities. As part of a German-wide research consortium on health literacy, this project, launched in March for 3 years, will conduct evidence-based mental health literacy research. The primary objective is to measure Teacher-MHL in the context of pupil-related psychosocial factors at primary and secondary schools (grades 5 & 6), while also focussing on children’s social living conditions. Methods: (1) A systematic literature review in different databases to identify papers with regard to Teacher-MHL (completed). (2) Based on these results, an interview guide was developed. This research step includes a qualitative pre-study to inductively survey the general profiles of teachers (n=24). The evaluation will be presented on the conference. (3) These findings will be translated into a quantitative teacher survey (n=2500) in order to assess the extent of socio-analytical skills of teachers as well as in relation to institutional and individual characteristics. (4) Based on results 1 – 3, developing a training program for teachers. Results: The review highlights a lack of information for Teacher-MHL and their skills, especially related to high-risk-groups like children of mentally ill parents. The literature is limited to a few studies only. According to these, teacher are not good at identifying burdened children and if they identify those children they do not know how to handle the situations in school. They are not sufficiently trained to deal with these children, especially there are great uncertainties in dealing with the teaching situation. Institutional means and resources are missing as well. Such a mismatch can result in insufficient support and use of opportunities for children at risk. First impressions from the interviews confirm these results and allow a greater insight in the everyday school-life according to critical life events in families. Conclusions: For the first time schools will be addressed as a setting where children are especially "accessible" for measures of health promotion. Addressing Teacher-MHL gives reason to expect high effectiveness. Targeting professionals' abilities for dealing with this high-risk-group leads to a discharge for teacher themselves to handle those situations and increases school health promotion. In view of the fact that only 10-30% of such high-risk families accept offers of therapy and assistance, this will be the first primary preventive and health-promoting approach to protect the health of a yet unaffected, but particularly burdened, high-risk group.

Keywords: children of mentally ill parents, health promotion, mental health literacy, school

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Authors: Marjan Moradi fard, Hossein Rassi, Masoud Houshmand

Abstract:

Aim: Breast cancer is one of the most common cancers affecting the morbidity and mortality of Iranian women. This disease is a result of collective alterations of oncogenes and tumor suppressor genes. Studies have produced conflicting results concerning the role of p53 codon 72 polymorphism (G>C) and miR-146a rs2910164 polymorphism (G>C) on the risk of several cancers; therefore, a research was performed to estimate the association between the p53 codon 72 polymorphism and miR-146a rs2910164 polymorphism in breast cancer. Methods and Materials: A total of 45 archival breast cancer samples from Khatam hospital and 40 healthy samples were collected. Verification of each cancer reported in a relative was sought through the pathology reports of the hospital records. Then, DNA extracted from all samples by standard methods and p53 codon 72 polymorphism genotypes and miR-146a rs2910164 polymorphism genotypes were analyzed using multiplex PCR. The tubules, mitotic activity, necrosis, polymorphism and grade of breast cancer were staged by Nottingham histological grading and immunohistochemical staining of the sections from the paraffin wax embedded tissues for the expression of ER, PR and p53 was carried out using a standard method. Finally, data analysis was performed using the 7 version of the Epi Info(TM) 2012 software and test chi-square(x2) for trend. Results: Successful DNA extraction was assessed by PCR amplification of b-actin gene (99 bp). According to the results, p53 GG genotype and miR-146a rs2910164 CC genotype was significantly associated with increased risk of breast cancer in the study population. In this study, we established that tumors of p53 GG genotype and miR-146a rs2910164 CC genotype exhibited higher mitotic activity, higher polymorphism, lower necrosis, lower tubules, higher ER- and PR-negatives and lower TP53-positives than the other genotypes. Conclusion: The present study provided preliminary evidence that a p53 GG genotype may effect breast cancer risk in the study population, interacting synergistically with miR-146a rs2910164 CC genotype. Our results demonstrate that the testing of p53 codon 72 polymorphism genotypes and miR-146a rs2910164 polymorphism genotypes in combination with clinical parameters can serve as major risk factors in the early identification of breast cancers.

Keywords: breast cancer, miR-146a rs2910164 polymorphism, p53 codon 72 polymorphism, tumors, pathology reports

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Authors: Md. Aminul Islam, Adel Merabet, Rachid Beguenane, Hussein Ibrahim

Abstract:

This paper presents a simulation and mathematical model of stand-alone solar-wind-diesel based hybrid energy system (HES). A power management system is designed for multiple energy resources in a stand-alone hybrid energy system. Both Solar photovoltaic and wind energy conversion system consists of maximum power point tracking (MPPT), voltage regulation, and basic power electronic interfaces. An additional diesel generator is included to support and improve the reliability of stand-alone system when renewable energy sources are not available. A power management strategy is introduced to distribute the generated power among resistive load banks. The frequency regulation is developed with conventional phase locked loop (PLL) system. The power management algorithm was applied in Matlab®/Simulink® to simulate the results.

Keywords: solar photovoltaic, wind energy, diesel engine, hybrid energy system, power management, frequency and voltage regulation

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Authors: Fares Mahdi

Abstract:

Background: Infection control is an important concern for all health care professionals, especially nurses. Nurses have a higher risk for both self-acquiring and transmitting infections to other patients. Aim of this study: to assess nurses' knowledge regarding infection control for wound care. Methodology: a descriptive research design was used in the study. The total number studied sample was 200 nurses, were conducting in Amran Public Hospitals in Amran City- Yemen. The study covered sample nurses in the hospital according to the study population; a standard closed-ended questionnaire was used to collect the data. Results: The results showed less than half (37.5 %) of nurses were from 22 May Hospital, also followed by (62.5%) of them were from Maternal and Child Hospital. Also according to the department name. Most (22.5%) of nurses worked in an intensive care unit, followed by (20%) of them were working in the pediatric world, also about (19%) of them were working in the surgical department. While in finally, only about (8.5%) of them worked from another department. According to course training, The results showed about (21%) of nurses had course training in wound care management. At the same time, others (79%) of them have not had course training in wound care management. According to the total nurse's knowledge of infection control for wound care, that find more than two-thirds (68%) of nurses had fair knowledge according to total all of nurse's knowledge of infection control wound care. Conclusion:The results showed that more than two-thirds (68%) of nurses had fair knowledge according to total all of the nurse's knowledge of infection control for wound care. Recommendations: There should be providing training program about infection control masseurs and it's important for new employees of nurses. Providing continuing refreshment training courses about infection control programs and about evidence-based practice in infection control for all health care teams.

Keywords: assessment, knowledge, infection control, wound care, nurses, amran hospitals

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Authors: Hossein Rassi, Marjan Moradi fard, Masoud Houshmand

Abstract:

Background: Cervical cancer is multistep disease that is thought to result from an interaction between genetic background and environmental factors. Human Papillomavirus (HPV) infection is the leading risk factor for Cervical Intraepithelial Neoplasia (CIN) and cervical cancer. In other hand, some of p53 and miRNA polymorphism may plays an important role in carcinogenesis. This study attempts to clarify the relation of p53 genotypes and miR-146a rs2910164 polymorphism in cervical lesions. Method: Forty two archival samples with cervical lesion retired from Khatam hospital and 40 sample from healthy persons used as control group. A simple and rapid method was used to detect the simultaneous amplification of the HPV consensus L1 region and HPV-16,-18, -11, -31, 33, and -35 along with the b-globin gene as an internal control. We use Multiplex PCR for detection of P53 and miR-146a rs2910164 genotypes in our lab. Finally, data analysis was performed using the 7 version of the Epi Info(TM) 2012 software and test chi-square(x2) for trend. Results: Cervix lesions were collected from 42 patients with Squamous metaplasia, cervical intraepithelial neoplasia, and cervical carcinoma. Successful DNA extraction was assessed by PCR amplification of b-actin gene (99 bp). According to the results, p53 GG genotype and miR-146a rs2910164 CC genotype was significantly associated with increased risk of cervical lesions in the study population. In this study, we detected 13 HPV 18 from 42 cervical cancer. Conclusion: The connection between several SNP polymorphism and human virus papilloma in rare researches were seen. The reason of these differences in researches' findings can result in different kinds of races and geographic situations and also differences in life grooves in every region. The present study provided preliminary evidence that a p53 GG genotype and miR-146a rs2910164 CC genotype may effect cervical cancer risk in the study population, interacting synergistically with HPV 18 genotype. Our results demonstrate that the testing of p53 codon 72 polymorphism genotypes and miR-146a rs2910164 polymorphism genotypes in combination with HPV18 can serve as major risk factors in the early identification of cervical cancers. Furthermore, the results indicate the possibility of primary prevention of cervical cancer by vaccination against HPV18 in Iran.

Keywords: cervical cancer, miR-146a rs2910164 polymorphism, p53 polymorphism, intraepithelial, neoplasia, HPV

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Authors: Zhan Panpan, Lu Lan, Sun Yong, He Xiongwen, Yan Dong, Gu Ming

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The function of the two spacecraft docking network, the communication and control of a docking target with various spacecrafts is realized in the space lab data management system. In order to solve the problem of the complex data communication mode between the space lab and various spaceships, and the problem of software reuse caused by non-standard protocol, a data management software system supporting rendezvous and docking with various spaceships has been designed. The software system is based on CCSDS Spcecraft Onboard Interface Service(SOIS). It consists of Software Driver Layer, Middleware Layer and Appliaction Layer. The Software Driver Layer hides the various device interfaces using the uniform device driver framework. The Middleware Layer is divided into three lays, including transfer layer, application support layer and system business layer. The communication of space lab plaform bus and the docking bus is realized in transfer layer. Application support layer provides the inter tasks communitaion and the function of unified time management for the software system. The data management software functions are realized in system business layer, which contains telemetry management service, telecontrol management service, flight status management service, rendezvous and docking management service and so on. The Appliaction Layer accomplishes the space lab data management system defined tasks using the standard interface supplied by the Middleware Layer. On the basis of layered architecture, rendezvous and docking tasks and the rendezvous and docking management service are independent in the software system. The rendezvous and docking tasks will be activated and executed according to the different spaceships. In this way, the communication management functions in the independent flight mode, the combination mode of the manned spaceship and the combination mode of the cargo spaceship are achieved separately. The software architecture designed standard appliction interface for the services in each layer. Different requirements of the space lab can be supported by the use of standard services per layer, and the scalability and flexibility of the data management software can be effectively improved. It can also dynamically expand the number and adapt to the protocol of visiting spaceships. The software system has been applied in the data management subsystem of the space lab, and has been verified in the flight of the space lab. The research results of this paper can provide the basis for the design of the data manage system in the future space station.

Keywords: space lab, rendezvous and docking, data management, software system

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Authors: Alison L. Miles

Abstract:

Almost all major financial institutions in the world suffered losses due to the financial crisis of 2007, but the extent varied widely. The causes of the crash of 2007 are well documented and predominately focus on the role and complexity of the financial markets. The dominant theme of the literature suggests the causes of the crash were a combination of globalization, financial sector innovation, moribund regulation and short termism. While these arguments are undoubtedly true, they do not tell the whole story. A key weakness in the current analysis is the lack of consideration of those leading the banks pre and during times of crisis. This purpose of this study is to examine the possible link between the leadership styles and characteristics of the CEO, CFO and chairman and the financial institutions that failed or needed recapitalization. As such, it contributes to the literature and debate on international financial crises and systemic risk and also to the debate on risk management and regulatory reform in the banking sector. In order to first test the proposition (p1) that there are prevalent leadership characteristics or traits in financial institutions, an initial study was conducted using a sample of the top 65 largest global banks and financial institutions according to the Banker Top 1000 banks 2014. Secondary data from publically available and official documents, annual reports, treasury and parliamentary reports together with a selection of press articles and analyst meeting transcripts was collected longitudinally from the period 1998 to 2013. A computer aided key word search was used in order to identify the leadership styles and characteristics of the chairman, CEO and CFO. The results were then compared with the leadership models to form a picture of leadership in the sector during the research period. As this resulted in separate results that needed combining, SPSS data editor was used to aggregate the results across the studies using the variables ‘leadership style’ and ‘company financial performance’ together with the size of the company. In order to test the proposition (p2) that there was a prevalent leadership style in the banks that failed and the proposition (P3) that this was different to those that did not, further quantitative analysis was carried out on the leadership styles of the chair, CEO and CFO of banks that needed recapitalization, were taken over, or required government bail-out assistance during 2007-8. These included: Lehman Bros, Merrill Lynch, Royal Bank of Scotland, HBOS, Barclays, Northern Rock, Fortis and Allied Irish. The findings show that although regulatory reform has been a key mechanism of control of behavior in the banking sector, consideration of the leadership characteristics of those running the board are a key factor. They add weight to the argument that if each crisis is met with the same pattern of popular fury with the financier, increased regulation, followed by back to business as usual, the cycle of failure will always be repeated and show that through a different lens, new paradigms can be formed and future clashes avoided.

Keywords: banking, financial crisis, leadership, risk

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Authors: Adriana C. Panayi, Riaz A. Agha, Brady A. Sieber, Dennis P. Orgill

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Background: Increased rates of both breast cancer and obesity have resulted in more women seeking breast reconstruction. These women may be at increased risk for perioperative complications. A systematic review was conducted to assess the outcomes in obese women who have undergone breast reconstruction following mastectomy. Methods: Cochrane, PUBMED and EMBASE electronic databases were screened and data was extracted from included studies. The clinical outcomes assessed were surgical complications, medical complications, length of postoperative hospital stay, reoperation rate and patient satisfaction. Results: 33 studies met the inclusion criteria for the review and 29 provided enough data to be included in the meta-analysis (71368 patients, 20061 of which were obese). Obese women were 2.3 times more likely to experience surgical complications (95 percent CI 2.19 to 2.39; P < 0.00001), 2.8 times more likely to have medical complications (95 percent CI 2.41 to 3.26; P < 0.00001) and had a 1.9 times higher risk of reoperation (95 percent CI 1.75 to 2.07; P < 0.00001). The most common complication, wound dehiscence, was 2.5 times more likely in obese women (95 percent CI 1.80 to 3.52; P < 0.00001). Sensitivity analysis confirmed that obese women were more likely to experience surgical complications (RR 2.36, 95% CI 2.22–2.52; P < 0.00001). Conclusions: This study provides evidence that obesity increases the risk of complications in both implant and autologous reconstruction. Additional prospective and observational studies are needed to determine if weight reduction prior to reconstruction reduces the perioperative risks associated with obesity.

Keywords: autologous reconstruction, breast cancer, breast reconstruction, literature review, obesity, oncology, prosthetic reconstruction

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Authors: Suzanne Phibbs, Christine Kenney, Robyn Richardson

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The Sendai Framework for Disaster Risk Reduction called for the inclusion of indigenous people in the design and implementation of all hazard policies, plans, and standards. Ensuring that indigenous knowledge practices were included alongside scientific knowledge about disaster risk was also a key priority. Indigenous communities have specific knowledge about climate and natural hazard risk that has been developed over an extended period of time. However, research within indigenous communities can be fraught with issues such as power imbalances between the researcher and researched, the privileging of researcher agendas over community aspirations, as well as appropriation and/or inappropriate use of indigenous knowledge. This paper documents the process of working alongside a Māori community to develop a successful community-led research project. Research Design: This case study documents the development of a qualitative community-led participatory project. The community research project utilizes a kaupapa Māori research methodology which draws upon Māori research principles and concepts in order to generate knowledge about Māori resilience. The research addresses a significant gap in the disaster research literature relating to indigenous knowledge about collective hazard mitigation practices as well as resilience in rurally isolated indigenous communities. The research was designed in partnership with the Ngāti Raukawa Northern Marae Collective as well as Ngā Wairiki Ngāti Apa (a group of Māori sub-tribes who are located in the same region) and will be conducted by Māori researchers utilizing Māori values and cultural practices. The research project aims and objectives, for example, are based on themes that were identified as important to the Māori community research partners. The research methodology and methods were also negotiated with and approved by the community. Kaumātua (Māori elders) provided cultural and ethical guidance over the proposed research process and will continue to provide oversight over the conduct of the research. Purposive participant recruitment will be facilitated with support from local Māori community research partners, utilizing collective marae networks and snowballing methods. It is envisaged that Māori participants’ knowledge, experiences and views will be explored using face-to-face communication research methods such as workshops, focus groups and/or semi-structured interviews. Interviews or focus groups may be held in English and/or Te Reo (Māori language) to enhance knowledge capture. Analysis, knowledge dissemination, and co-authorship of publications will be negotiated with the Māori community research partners. Māori knowledge shared during the research will constitute participants’ intellectual property. New knowledge, theory, frameworks, and practices developed by the research will be co-owned by Māori, the researchers, and the host academic institution. Conclusion: An emphasis on indigenous knowledge systems within the Sendai Framework for Disaster Risk Reduction risks the appropriation and misuse of indigenous experiences of disaster risk identification, mitigation, and response. The research protocol underpinning this project provides an exemplar of collaborative partnership in the development and implementation of an indigenous project that has relevance to policymakers, academic researchers, other regions with indigenous communities and/or local disaster risk reduction knowledge practices.

Keywords: community resilience, indigenous disaster risk reduction, Maori, research methods

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Authors: Areej Makeineldein Mustafa

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The study evaluates the management processes and healthcare provider compliance with the National Institute for Health and Care Excellence recommendations for constipation management. We aimed to evaluate the adherence to National Institute for Health and Care Excellence guidelines in the management of constipation during the period from February to June 2023. We collected data from a random sample ( 51 patients) over 4 months with inclusion criteria for patients above 60 who were just admitted to the care of the elderly department during this period. Patient age, sex, medical records for constipation, acute or chronic constipation, or opioid-induced constipation, and treatment options were used to identify constipation and the type of treatment given. Our findings indicate that there is a gap between practice and National Institute for Health and Care Excellence guideline steps; only 3 patient was given medications according to National Institute for Health and Care Excellence guidelines in order of combination or steps of escalation. Addressing these gaps could potentially lead to enhanced patient outcomes and an overall improvement in the quality of care provided to individuals suffering from constipation.

Keywords: constipation, elderly, management, patient

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Authors: Hasibe Caballero-Gomez, Richard Pepino

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Childhood lead poisoning is an issue that continues to plague major U.S. cities. Lead poisoning has been linked to decreases in academic achievement and IQ at levels as low as 5 ug/dL. Despite efforts from the Philadelphia Health Department to curtail systemic childhood lead poisoning, children continue to be identified with elevated blood lead levels (EBLLs) above the CDC reference level for diagnosis. This problem disproportionately affects low-income Black communities. At the moment, remediation is costly, and with the current policies in place, comprehensive remediation seems unrealistic. This research investigates community engagement policy and the ways pre-exisiting resources in target communities can be adjusted to decrease childhood lead poisoning. The study was done with two methods: content analysis and case studies. The content analysis includes 12 interviews from stakeholders and five published policy recommendations. The case studies focus on Baltimore, Chicago, Rochester, and St. Louis, four cities with significant childhood lead poisoning. Target communities were identified by mapping five factors that indicate a higher risk for lead poisoning. Seven priority zipcodes were identified for the model developed in this study. For these urban centers, 28 policy solutions and suggestions were identified, with three being identified at least four times in the content analysis and case studies. These three solutions create an interdependent model that offers increased community awareness and engagement with the issue that could potentially improve health and social outcomes for at-risk children.

Keywords: at-risk populations, community engagement, environmental justice, policy translation

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Authors: Leila H. Khiabani, Mohammadreza Vafaee, Farshad Hashemzadeh

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Industrial waste management regulates different stages of production, storage, transfer, recycling and waste disposal. There are several common practices for industrial waste management. However, due to various local health, economic, social, environmental and aesthetic considerations, the most optimal principles and measures often vary at each specific industrial zone. In addition, waste management strategies are heavily impacted by local administrative, legal, and financial regulations. In this study, a hybrid qualitative and quantitative research methodology has been designed for waste management planning in an industrial city. Firstly, following a qualitative research methodology, the most relevant waste management strategies for the specific industrial city were identified through interviews with environmental planning and waste management experts. Forty experts participated in this study. Alborz industrial city in Iran, which hosts more than one thousand industrial units in nine hundred acres, was chosen as the sample industrial city in this study. The findings from the expert interviews at the first phase were then used to design a quantitative questionnaire for the second phase of the study. The aim of the questionnaire was to quantify the relative impact of different waste management strategies in the sample industrial city. Eight waste management strategies and three implementation policies were included in the questionnaire. The experts were asked to rank the relative effectiveness of each strategy for environmental planning of the sample industrial city. They were also asked to rank the relative effectiveness of each planning policy on each of the waste management strategies. In the end, the weighted average of all the responses was calculated to identify the most effective waste management strategy and planning policies for the sample industrial city. The results suggested that among the eight suggested waste management strategies, industrial composting is the most effective (31%) strategy based on the collective evaluation of the local expert. Additionally, the results suggested that the most effective policy (58%) in the city’s environmental planning is to reduce waste generation by prolonging the effective life of industrial products using higher quality and recyclable materials. These findings can provide useful expert guidelines for prioritization between different waste management strategies in the city’s overall environmental planning roadmap. The findings may also be applicable to similar industrial cities. In addition, a similar methodology can be utilized in the environmental planning of other industrial cities.

Keywords: environmental planning, industrial city, quantitative research, waste management

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Authors: Nattapong Techarattanased, Paweena Sribunrueng

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The objective of this study is to investigate strategies in customer relationship management and customers’ behavior in making decision on buying car insurance of Southeast Insurance Co. Ltd. in Bangkok. Subjects in this study included 400 customers with the age over 20 years old to complete questionnaires. The data were analyzed by arithmetic mean and multiple regressions. The results revealed that the customers’ opinions on the strategies in customer relationship management, i.e. customer relationship, customer feedback, customer follow-up, useful service suggestions, customer communication, and service channels were in moderate level but on the customer retention was in high level. Moreover, the strategy in customer relationship management, i.e. customer relationship, and customer feedback had an influence on customers’ buying decision on buying car insurance. The two factors above can be used for the prediction at the rate of 34%. In addition, the strategy in customer relationship management, i.e. customer retention, customer feedback, and useful service suggestions had an influence on the customers’ buying decision on period of being customers. The three factors could be used for the prediction at the rate of 45%.

Keywords: strategies, customer relationship management, behavior in buying decision, car insurance

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Authors: Titilope F. Onaolapo, Christiana A. Breed, Maya Pasgaard, Kristine E. Jensen, Peta Brom

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In the face of fast-growing urbanization in most of the world's developing countries, there is a need to understand and address the risk and consequences involved in the indiscriminate use of urban green space. Tshwane city in South Africa has the potential to become one of the world's top biodiversity cities as South Africa is ranked one of the mega countries in biodiversity conservation, and Tshwane metropolitan municipality is the city with the wealthiest biodiversity with grassland biomes. In this study, we focus on the potentials and challenges of urban green transitioning from the Global South perspective with Tshwane city as the case study. We also address the issue of management conflicts that have resulted in informal and illegal activities in and around green spaces, with consequences such as land degradation, loss of livelihoods and biodiversity, and socio-ecological imbalances. A desk study review of eight policy frameworks related to green urban planning and development was done based on four GI principles: multifunctionality, connectivity, interdisciplinary and social inclusion. We interviewed 15 key informants in related departments in the city and administered 200 survey questionnaires among residents. We also had several workshops the other researchers and experts on biodiversity and ecosystem. We found out there is no specific document dedicated to green space management, and where green infrastructure was mentioned, it was focused on as an approach to climate mitigation and adaptation. Also, residents perceive green and open spaces as extra land that could be developed at will. We demonstrated the use of collaborative learning approaches in ecological and development research and the tying research to the existing frameworks, programs, and strategies. Based on this understanding. We outlined the need to incorporate principles of green infrastructure in policy frameworks on spatial planning and environmental development. Furthermore, we develop a model for co-management of green infrastructures by stakeholders, such as residents, developers, policymakers, and decision-makers, to maximize benefits. Our collaborative, interdisciplinary projects pursue SDG multifunctionality of goals 11 and 15 by simultaneously addressing issues around Sustainable Cities and Communities, Climate Action, Life on Land, and Strong Institutions, and halt and reverse land degradation and biodiversity.

Keywords: governance, green infrastructure, South Africa, sustainable development, urban planning, Tshwane

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Authors: Adepeju Simon-Oke, Olatunji Odeyemi, Mobolanle Oniya

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Urinary tract infection has become the most common bacterial infections in humans, both at the community and hospital settings; it has been reported in all age groups and in both sexes. This study was carried out in order to determine and evaluate the prevalence, current drug susceptibility pattern of the isolated organisms and identify the associated risk factors of UTIs among the pregnant women in Akure, Ondo State, Nigeria. A cross-sectional study was conducted on the urine of pregnant women, and socio-demographic information of the women was collected. A total of 300 clean midstream urine samples were collected, and a general urine microscopic examination and culture were carried out, the Microbact identification system was used to identify gram-negative bacteria. Out of the 300 urine samples cultured, 183(61.0%) yielded significant growth of urinary pathogens while 117(39.0%) yielded either insignificant growth or no growth of any urinary pathogen. Prevalence of UTI was significantly associated with the type of toilet used, symptoms of UTI, and previous history of urinary tract infection (p<0.05). Escherichia coli 58(31.7%) was the dominant pathogen isolated, and the least isolated uropathogens were Citrobacter freudii and Providencia retgerri 2(1.1%) respectively. Gram-negative bacteria showed 77.6%, 67.9%, and 61.2% susceptibility to ciprofloxacin, augmentin, and chloramphenicol, respectively. Resistance against septrin, chloramphenicol, sparfloxacin, amoxicillin, augmentin, gentamycin, pefloxacin, trivid, and streptomycin was observed in the range of 23.1 to 70.1%. Gram-positive uropathogens isolated showed high resistance to amoxicillin (68.4%) and high susceptibility to the remaining nine antibiotics in the range 65.8% to 89.5%. This study justifies that pregnant women are at high risk of UTI. Therefore screening of pregnant women during antenatal clinics should be considered very important to avoid complications. Health education with regular antenatal and personal hygiene is recommended as precautionary measures to UTI.

Keywords: pregnant women, prevalence, risk factor, UTIs

Procedia PDF Downloads 147

Authors: Gus Calderon, Richard McCreight, Tammy Schwartz

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Forensic analysis of community wildfire destruction in California has shown that reducing or removing flammable vegetation in proximity to buildings and structures is one of the most important wildfire defenses available to homeowners. State laws specify the requirements for homeowners to create and maintain defensible space around all structures. Unfortunately, this decades-long effort had limited success due to noncompliance and minimal enforcement. As a result, vulnerable communities continue to experience escalating human and economic costs along the wildland-urban interface (WUI). Quantifying vegetative fuels at both the community and parcel scale requires detailed imaging from an aircraft with remote sensing technology to reduce uncertainty. FireWatch has been delivering high spatial resolution (5” ground sample distance) wildfire hazard maps annually to the community of Rancho Santa Fe, CA, since 2019. FireWatch uses a multispectral imaging system mounted onboard an aircraft to create georeferenced orthomosaics and spectral vegetation index maps. Using proprietary algorithms, the vegetation type, condition, and proximity to structures are determined for 1,851 properties in the community. Secondary data processing combines object-based classification of vegetative fuels, assisted by machine learning, to prioritize mitigation strategies within the community. The remote sensing data for the 10 sq. mi. community is divided into parcels and sent to all homeowners in the form of defensible space maps and reports. Follow-up aerial surveys are performed annually using repeat station imaging of fixed GPS locations to address changes in defensible space, vegetation fuel cover, and condition over time. These maps and reports have increased wildfire awareness and mitigation efforts from 40% to over 85% among homeowners in Rancho Santa Fe. To assist homeowners fighting increasing insurance premiums and non-renewals, FireWatch has partnered with Black Swan Analytics, LLC, to leverage the multispectral imagery and increase homeowners’ understanding of wildfire risk drivers. For this study, a subsample of 100 parcels was selected to gain a comprehensive understanding of wildfire risk and the elements which can be mitigated. Geospatial data from FireWatch’s defensible space maps was combined with Black Swan’s patented approach using 39 other risk characteristics into a 4score Report. The 4score Report helps property owners understand risk sources and potential mitigation opportunities by assessing four categories of risk: Fuel sources, ignition sources, susceptibility to loss, and hazards to fire protection efforts (FISH). This study has shown that susceptibility to loss is the category residents and property owners must focus their efforts. The 4score Report also provides a tool to measure the impact of homeowner actions on risk levels over time. Resiliency is the only solution to breaking the cycle of community wildfire destruction and it starts with high-quality data and education.

Keywords: defensible space, geospatial data, multispectral imaging, Rancho Santa Fe, susceptibility to loss, wildfire risk.

Procedia PDF Downloads 108

Authors: V. A. Ritchie

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The loss of life and livelihood experienced after the magnitude 9.3 Sumatra earthquake and tsunami on 26 December 2004 and magnitude 9 earthquake and tsunami in northeastern Japan on 11 March 2011, has raised global awareness and brought tsunami phenomenology, nomenclature, and representation into sharp focus. At the same time, travel and tourism continue to increase, contributing around 1 in 11 jobs worldwide. This increase in tourism is especially true for coastal zones, placing pressure on decision-makers to downplay tsunami risks and at the same time provide adequate tsunami warning so that holidaymakers will feel confident enough to visit places of high tsunami risk. This study investigates how well tsunami preparedness messages are getting through for tourist-based businesses in Hawke’s Bay New Zealand, a region of frequent seismic activity and a high probability of experiencing a nearshore tsunami. The aim of this study is to investigate whether tourists based businesses are well informed about tsunamis, how well they understand that information and to what extent their clients are included in awareness raising and evacuation processes. In high-risk tsunami zones, such as Hawke’s Bay, tourism based businesses face competitive tension between short term business profitability and longer term reputational issues related to preventable loss of life from natural hazards, such as tsunamis. This study will address ways to accommodate culturally and linguistically relevant tourist awareness measures without discouraging tourists or being too costly to implement.

Keywords: tsunami risk and response, travel and tourism, business preparedness, cross cultural knowledge transfer

Procedia PDF Downloads 152

Authors: Aizati N. A. Daud, Jorieke E. H. Bergman, Wilhelmina S. Kerstjens-Frederikse, Pieter Van Der Vlies, Eelko Hak, Rolf M. F. Berger, Henk Groen, Bob Wilffert

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Prenatal use of SRIs was previously associated with Congenital Heart Anomalies (CHA). The aim of the study is to explore whether pharmacogenetics plays a role in this teratogenicity using a gene-environment interaction study. A total of 33 case-mother dyads and 2 mother-only (children deceased) registered in EUROCAT Northern Netherlands were included in a case-only study. Five case-mother dyads and two mothers-only were exposed to SRIs (paroxetine=3, fluoxetine=2, venlafaxine=1, paroxetine and venlafaxine=1) in the first trimester of pregnancy. The remaining 28 case-mother dyads were not exposed to SRIs. Ten genes that encode the enzymes or proteins important in determining fetal exposure to SRIs or its mechanism of action were selected: CYPs (CYP1A2, CYP2C9, CYP2C19, CYP2D6), ABCB1 (placental P-glycoprotein), SLC6A4 (serotonin transporter) and serotonin receptor genes (HTR1A, HTR1B, HTR2A, and HTR3B). All included subjects were genotyped for 58 genetic variations in these ten genes. Logistic regression analyses were performed to determine the interaction odds ratio (OR) between genetic variations and SRIs exposure on the risk of CHA. Due to low phenotype frequencies of CYP450 poor metabolizers among exposed cases, the OR cannot be calculated. For ABCB1, there was no indication of changes in the risk of CHA with any of the ABCB1 SNPs in the children and their mothers. Several genetic variations of the serotonin transporter and receptors (SLC6A4 5-HTTLPR and 5-HTTVNTR, HTR1A rs1364043, HTR1B rs6296 & rs6298, HTR3B rs1176744) were associated with an increased risk of CHA, but with too limited sample size to reach statistical significance. For SLC6A4 genetic variations, the mean genetic scores of the exposed case-mothers tended to be higher than the unexposed mothers (2.5 ± 0.8 and 1.88 ± 0.7, respectively; p=0.061). For SNPs of the serotonin receptors, the mean genetic score for exposed cases (children) tended to be higher than the unexposed cases (3.4 ± 2.2, and 1.9 ± 1.6, respectively; p=0.065). This study might be among the first to explore the potential gene-environment interaction between pharmacogenetic determinants and SRIs use on the risk of CHA. With small sample sizes, it was not possible to find a significant interaction. However, there were indications for a role of serotonin receptor polymorphisms in fetuses exposed to SRIs on fetal risk of CHA which warrants further investigation.

Keywords: gene-environment interaction, heart defects, pharmacogenetics, serotonin reuptake inhibitors, teratogenicity

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Authors: Shubhangi Salokhe

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Agriculture encompasses crop and livestock production, forestry, and fisheries for food and non-food products. Farmers combine land, water, commercial inputs, labor, and their management skills into practices and systems that produce food and fibre. Harvesting of agricultural produce is either followed by the processing of fresh produce or storage for later consumption. All these activities result in a vast generation of waste in terms of crop residue or food waste. So, a large amount of agricultural waste is produced every year. Waste arising from food and agricultural sectors has the potential for vast applications. So, agricultural waste management is an essential component of sustainable agriculture. The major portion of the waste comes from the residues of crops on farms, food processing, livestock, aquaculture, and agro-industry waste. Therefore, management of these agricultural wastes is an important task, and it requires robust strategic planning. It can contribute to three pillars of sustainable agriculture development. It protects the environment (environmental pillar), enhances the livelihoods of farmers (economic pillar), and can contribute to increasing the sustainability of the agricultural sector (social pillar). This paper addresses the essential technological aspects, possible solutions, and sound policy concerns to accomplish long-term way out of agriculture waste management and to minimize the negative impact of waste on the environment. The author has developed a sustainable agriculture waste management model for improving the sustainability of agriculture.

Keywords: agriculture, development, management, waste

Procedia PDF Downloads 51

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

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

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

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Authors: Anyia Nduka, Aslan Bin Amad Senin, Ayu Azrin Bte Abdul Aziz

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A management practice characterised by a value chain as its relatively flexible culture is replacing the old bureaucratic model of organisational practice that was built on dominance. Using a management practice fruition paradigm, the study delves into the implications of organisational culture and leadership. Developing a theory of leadership called the “cultural model” of organisational leadership by explaining how the shift from bureaucracy to management practises altered the roles and interactions of leaders. This model is well-grounded in leadership theory, considering the concept's adaptability to different leadership ideologies. In organisations where operational procedures and borders are not clearly defined, hierarchies are flattened, and work collaborations are sometimes based on contracts rather than employment. This cultural model of organizational leadership is intended to be a useful tool for predicting how effectively a leader will perform.

Keywords: leadership, organizational culture, management practices, efficiency

Procedia PDF Downloads 84