Search results for: rating criteria

Authors: E. Asadollahi-Yazdi, J. Gardan, P. Lafon

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Nowadays, manufactures are encountered with production of different version of products due to quality, cost and time constraints. On the other hand, Additive Manufacturing (AM) as a production method based on CAD model disrupts the design and manufacturing cycle with new parameters. To consider these issues, the researchers utilized Design For Manufacturing (DFM) approach for AM but until now there is no integrated approach for design and manufacturing of product through the AM. So, this paper aims to provide a general methodology for managing the different production issues, as well as, support the interoperability with AM process and different Product Life Cycle Management tools. The problem is that the models of System Engineering which is used for managing complex systems cannot support the product evolution and its impact on the product life cycle. Therefore, it seems necessary to provide a general methodology for managing the product’s diversities which is created by using AM. This methodology must consider manufacture and assembly during product design as early as possible in the design stage. The latest approach of DFM, as a methodology to analyze the system comprehensively, integrates manufacturing constraints in the numerical model in upstream. So, DFM for AM is used to import the characteristics of AM into the design and manufacturing process of a hybrid product to manage the criteria coming from AM. Also, the research presents an integrated design method in order to take into account the knowledge of layers manufacturing technologies. For this purpose, the interface model based on the skin and skeleton concepts is provided, the usage and manufacturing skins are used to show the functional surface of the product. Also, the material flow and link between the skins are demonstrated by usage and manufacturing skeletons. Therefore, this integrated approach is a helpful methodology for designer and manufacturer in different decisions like material and process selection as well as, evaluation of product manufacturability.

Keywords: additive manufacturing, 3D printing, design for manufacturing, integrated design, interoperability

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Authors: Sameh El Mahdy

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Recording and documenting archaeological collections, especially photographic documentation, is considered one of the very important matters that museums care about and give great priority, as photographic documentation is of great importance. We monitor some of them for example, Photographs of collectibles are considered evidence and an archival record that proves the condition of the collectibles at various stages. A photo of the possessions is placed on the paper record of the possessions registration. These photos are used in inventorying archaeological collections. These pictures are viewed by researchers and scholars interested in studying these collections. These images are used in advertising campaigns for museum displays of archaeological collections. The Grand Egyptian Museum is considered one of the museums that is a unique model in terms of establishing a specific system that is used when photographing archaeological collections. The Grand Egyptian Museum sets standards for the photos that are taken inside the Grand Egyptian Museum. We mention some of them for example, Pictures must be of high quality. It is necessary to set a color scale for the drawing in order to clarify the dimensions of the collectibles in the picture and also in order to clarify the natural colors of the collectibles without any additions. Putting the numbers of the collectibles in the pictures, especially the number of the Grand Egyptian Museum. To take a good photo of the artifacts in the Grand Egyptian Museum, there are many steps: (1) Create a good location, (2) How to handle the Artifacts. (3) Choose the best position for the artifact, (4) Make the light to create a good photo without shadows to make the photo represent all the artifact details. (5) Be sure of the camera settings, and their quality. All of these steps and other ones are the best criteria for taking the best photo, which helps us in the database to represent the details of the artifact in our interface.

Keywords: grand egyptian museum, photographing, museum collections, registration and documentation

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Authors: Kamel Abd Elaziz Mohamed, Ahmed Yehia Mousa, Ahmed Samir ElSawy, Adel Mohamed Saleem

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Introduction: Critically ill patients frequently require tracheostomy to simplify long term air way management. While tracheostomy indications have remained unchanged, the timing of elective tracheostomy for the ventilated patient has been questioned. Aim of the work: This study was performed to compare the differences between early and late percutaneous dilatational tracheostomy (PDT) regarding, mechanical ventilation duration (MVD), length of ICU stay, length of hospital stay, incidence of ventilator associated pneumonia and hospital outcome. Patients and methods: Forty patients who met the inclusion criteria were randomly divided into early PDT who had the tracheostomy within the first 10 days of mechanical ventilation (MV) and the late PDT who had the tracheostomy after 10 days of MV. On admission, demographic data and Acute Physiology and Chronic ill Health II and GCS were collected. The duration of mechanical ventilation, ICU length of stay (LOS) and hospital LOS were all calculated. Results: Total of 40 patients were randomized to either early PDT (n= 20) or late PDT (n= 20). There were no significant differences between both groups regarding demographic data or the scores: APACHE II (22.75± 7 vs 24.35 ± 8) and GCS (6.10 ±2 vs 7.10 ± 2.71). An early PDT showed fewer complications vs late procedure, however it was insignificant. There were significant differences between the two groups regarding mean (MVD) which was shorter in early PDT than the late PDT group (32.2± 10.5) vs (20.6 ± 13 days; p= 0.004). Mean ICU stay was shorter in early PDT than late PDT (21 .0± 513.4) vs (40.15 ±12.7 days; p 6 0.001). Mean hospital stay was shorter in early PDT than late PDT (34.60± 18.37) vs (55.60± 25.73 days; p=0.005). Patients with early PDT suffered less sepsis and VAP than late PDT, there was no difference regarding the mortality rate between the two groups. Conclusion: Early PDT is recommended for patients who require prolonged tracheal intubation in the ICU as outcomes like the duration of mechanical ventilation length of ICU stay and hospital stay were significantly shorter in early tracheostomy.

Keywords: intensive care unit, early PDT, late PDT, intubation

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Authors: Abdul Waris Jalili, Yanqing Wang, Som Suor

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This research paper explores the relationship between entrepreneurship education and students' entrepreneurial intentions. It aims to determine if entrepreneurship education reliably predicts students' intention to become entrepreneurs and how and when this relationship occurs. This study aims to investigate the predictive relationship between entrepreneurship education and student entrepreneurial intentions. The goal is to understand the factors that influence this relationship and to identify any mediating or moderating factors. A thorough and systematic search and review of empirical articles published between 2013 and 2023 were conducted. Three databases, Google Scholar, Science Direct, and PubMed, were explored to gather relevant studies. Criteria such as reporting empirical results, publication in English, and addressing the research questions were used to select 35 papers for analysis. The collective findings of the reviewed studies suggest a generally positive relationship between entrepreneurship education and student entrepreneurial intentions. However, recent findings indicate that this relationship may be more complex than previously thought. Mediators and moderators have been identified, highlighting instances where entrepreneurship education indirectly influences student entrepreneurial intentions. The review also emphasizes the need for more robust research designs to establish causality in this field. This research adds to the existing literature by providing a comprehensive review of the relationship between entrepreneurship education and student entrepreneurial intentions. It highlights the complexity of this relationship and the importance of considering mediators and moderators. The study also calls for future research to explore different facets of entrepreneurship education independently and examine complex relationships more comprehensively.

Keywords: entrepreneurship, entrepreneurship education, entrepreneurial intention, entrepreneurial self-efficacy

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Authors: Siddhartha Bhattacharya

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Steam Turbine-Generators (STG) and Combustion Turbine-Generator (CTG) are used in almost all modern petrochemical, LNG plants and power plant facilities. The reinforced concrete table top foundations are required to support these high speed rotating heavy machineries and is one of the most critical and challenging structures on any industrial project. The paper illustrates through a practical example, the step by step procedure adopted in designing a table top foundation supported on piles for a steam turbine generator with operating speed of 60 Hz. Finite element model of a table top foundation is generated in ANSYS. Piles are modeled as springs-damper elements (COMBIN14). Basic loads are adopted in analysis and design of the foundation based on the vendor requirements, industry standards, and relevant ASCE & ACI codal provisions. Static serviceability checks are performed with the help of Misalignment Tolerance Matrix (MTM) method in which the percentage of misalignment at a given bearing due to displacement at another bearing is calculated and kept within the stipulated criteria by the vendor so that the machine rotor can sustain the stresses developed due to this misalignment. Dynamic serviceability checks are performed through modal and forced vibration analysis where the foundation is checked for resonance and allowable amplitudes, as stipulated by the machine manufacturer. Reinforced concrete design of the foundation is performed by calculating the axial force, bending moment and shear at each of the critical sections. These values are calculated through area integral of the element stresses at these critical locations. Design is done as per ACI 318-05.

Keywords: steam turbine generator foundation, finite element, static analysis, dynamic analysis

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Authors: Vafa Delphi, Maryam Delphi, Talieh Zarifian, Enayatolah Bakhshi

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Background and Aim: Bilingualism is a common phenomenon in many countries of the world and May be consistent consonant errors in the speech of bilingual children. The aim of this study was to evaluate Phonological skills include occurrence proportion, frequency and type of phonological processes in Persian-Arabic speaking children in Ahvaz city, the center of Khuzestan. Method: This study is descriptive-analytical and cross-sectional. Twenty-eight children aged 36-48 months were divided into two groups Persian monolingual and Persian-Arabic bilingual: (14 participants in each group). Sampling was recruited randomly based on inclusion criteria from kindergartens of the Ahvaz city in Iran. The tool of this study was the Persian Phonological Test (PPT), a subtest of Persian Diagnostic Evaluation Articulation and Phonological test. In this test, Phonological processes were investigated in two groups: structure and substitution processes. Data was investigated using SPSS software and the U Mann-Whitney test. Results: The results showed that the proportion occurrence of substitution process was significantly different between two groups of monolingual and bilingual (P=0/001), But the type of phonological processes didn’t show a significant difference in both monolingual and bilingual children of the Persian-Arabic.The frequency of phonological processes is greater in bilingual children than monolingual children. Conclusion: The study showed that bilingualism has no effect on type of phonological processes, but this can be effective on the frequency of processes. Since the type of phonological processes in bilingual children is similar to monolingual children So we can conclude the Persian_arabic bilingual children's phonological system is similar to monolingual children.

Keywords: Persian-Arabic bilingual child, phonological processes, the proportion occurrence of syllable structure, the proportion occurrence of substitution

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Authors: Md. Shakhawat Hossain, Jimma Hossain, Md. Naushad Ali

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Acute pancreatitis is a dangerous medical emergency in the practice of gastroenterology. Management of acute pancreatitis needs multidisciplinary approach with support starts from emergency to ICU. So, there is a chance of mismanagement in every steps, especially in low resource settings. Other factors such as patient’s financial condition, education, social custom, transport facility, referral system from periphery may also challenge the current guidelines for management. The present study is intended to determine the clinico-pathological profile, severity assessment and challenges of management of acute pancreatitis in a government laid tertiary care hospital to image the real scenario of management in a low resource place. A total 100 patients of acute pancreatitis were studied in this prospective study, held in the Department of Gastroenterology, Rangpur medical college hospital, Bangladesh from July 2017 to July 2018 within one year. Regarding severity, 85 % of the patients were mild, whereas 13 were moderately severe, and 2 had severe acute pancreatitis according to the revised Atlanta criteria. The most common etiologies of acute pancreatitis in our study were gall stone (15%) and biliary sludge (15%), whereas 54% were idiopathic. The most common challenges we faced were delay in hospital admission (59%) and delay in hospital diagnosis (20%). Others are non-adherence of patient party, and lack of investigation facility, physician’s poor knowledge about current guidelines. We were able to give early aggressive fluid to only 18% of patients as per current guideline. Conclusion: Management of acute pancreatitis as per guideline is challenging when optimum facility is lacking. So, modified guidelines for assessment and management of acute pancreatitis should be prepared for low resource setting.

Keywords: acute pancreatitis, challenges of management, severity, prognosis

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Authors: Adrien Pyskir, Manuel Collet, Zoran Dimitrijevic, Claude-Henri Lamarque

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During the last decades, great efforts have been made to reduce acoustic and vibrational disturbances in transportations, as it has become a key feature for comfort. Today, isolation and design have neutralized most of the troublesome vibrations, so that cars are quieter and more comfortable than ever. However, some problems remain unsolved, in particular concerning low-frequency isolation and the frequency-dependent stiffening of materials like rubber. To sum it up, a balance has to be found between a high static stiffness to sustain the vibration source’s mass, and low dynamic stiffness, as wideband as possible. Systems meeting these criteria are yet to be designed. We thus investigated solutions inspired by metamaterials to control efficiently low-frequency wave propagation. Structures exhibiting a negative Poisson ratio, also called auxetic structures, are known to influence the propagation of waves through beaming or damping. However, their stiffness can be quite peculiar as well, as they can present regions of zero stiffness on the stress-strain curve for compression. In addition, auxetic materials can be easily adapted in many ways, inducing great tuning potential. Using finite element software COMSOL Multiphysics, a resonant design has been tested through statics and dynamics simulations. These results are compared to experimental results. In particular, the bandgaps featured by these structures are analyzed as a function of design parameters. Great stiffness properties can be observed, including low-frequency dynamic stiffness loss and broadband transmission loss. Such features are very promising for practical isolation purpose, and we hope to adopt this kind of metamaterial into an effective industrial damper.

Keywords: auxetics, metamaterials, structural dynamics, vibration isolation

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Authors: Bo-wen Zhu, Bin Wu, Feng Chen

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It has become a common measure among governments to support green development of enterprises through Green Credit policies. In China, the Central Bank of China and other authorities even put forward corresponding assessment requirements for proportion of green credit in commercial banks. Policy changes might raise concerns about commercial banks turning a blind eye to greenwashing behavior by enterprises. The lack of effective regulation may lead to a diffusion of such behavior, and eventually result in the phenomenon of “bad money driving out good money”, which could dampen the incentive effect of Green Credit policies. This paper employs a complex network model based on an evolutionary game analysis framework involving enterprises, banks, and regulatory authorities to investigate inhibitory effect of the Green Credit regulation on enterprises’ greenwashing behavior, banks’ opportunistic and collusive behaviors. The findings are as follows: (1) Banking opportunism rises with Green Credit evaluation criteria and requirements for the proportion of credit balance. Restrictive regulation against violating banks is necessary as there is an increasing trend of banks adopting opportunistic strategy. (2) Raising penalties and probability of regulatory inspections can effectively suppress banks’ opportunistic behavior, however, it cannot entirely eradicate the opportunistic behavior on the bank side. (3) Although maintaining a certain inspection probability can inhibit enterprises from adopting greenwashing behavior, enterprises choose a catering production strategy instead. (4) One-time rewards from local government have limited effects on the equilibrium state and diffusion trend of bank regulatory decision-making.

Keywords: green credit, greenwashing behavior, regulation, diffusion effect

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Authors: Choppala Pratheek, Vineet Ahuja

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Background: Crohn's disease (CD) recurrence following surgery is a common challenge, and current detection methods rely on risk factors identified in Western populations. This study aimed to investigate the risk factors and rates of postoperative CD recurrence in a tuberculosis-endemic region like India. Retrospective data was collected from a structured database from a specialty IBD clinic by reviewing case files from January 2005 to December 2021. Inclusion criteria involved CD patients diagnosed based on the ECCO-ESGAR consensus guidelines, who had undergone at least one intestinal resection and had a minimum follow-up period of one year at the IBD clinic. Results: A total of 90 patients were followed up for a median period of 45 months (IQR, 20.75 - 72.00). Out of the 90 patients, 61 received ATT prior to surgery, with a mean delay in diagnosis of 2.5 years, although statistically non-significant (P=0.078). Clinical recurrence occurred in 50% of patients, with the cumulative rate increasing from 13.3% at one year to 40% at three years. Among 63 patients who underwent endoscopy, 65.7% showed evidence of endoscopic recurrence, with the cumulative rate increasing from 31.7% at one year to 55.5% at four years. Smoking was identified as a significant risk factor for early endoscopic recurrence (P=0.001) by Cox regression analysis, but no other risk factors were identified. Initiating post-operative medications prior to clinical recurrence delayed its onset (P=0.004). Subgroup analysis indicated that endoscopic monitoring aided in the early identification of recurrence (P=0.001). The findings contribute to enhancing post-operative CD management strategies in such regions where the disease burden is escalating.

Keywords: crohns, post operative, tuberculosis-endemic, risk factors

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Authors: Jonathan Glazzard

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National student satisfaction data in England demonstrate that undergraduate students are less satisfied overall with assessment and feedback than other aspects of their higher education courses. Given that research findings suggest that high-quality feedback is a critical factor associated with academic achievement, it is important that feedback enables students to demonstrate improved academic achievement in their subsequent assessments. Given the growing importance of staff-student partnerships in higher education, this research examined students’ perceptions of assessment and feedback in one UK university. Students’ perceptions were elicited through the use of a university-wide survey which was completed by undergraduate students. In addition, three focus groups were used to provide qualitative student perception data across the three university Facilities. The data indicate that whilst students valued detailed feedback on their work, less detailed feedback could be compensated for by the development of pre-assessment literacy skills which are front-loaded into courses. Assessment literacy skills valued by students included the use of clear assessment criteria and assignment briefings which enabled students to fully understand the assessment task. Additionally, students valued assessment literacy pre-assessment tasks which enabled them to understand the standards which they were expected to achieve. Students valued opportunities for self and peer assessment prior to the final assessment and formative assessment feedback which matched the summative assessment feedback. Students also valued dialogic face-to-face feedback after receiving written feedback Above all, students valued feedback which was particular to their work and which gave recognition for the effort they had put into completing specific assessments. The data indicate that there is a need for higher education lecturers to receive systematic training in assessment and feedback which provides a comprehensive grounding in pre-assessment literacy skills.

Keywords: formative assessment, summative assessment, feedback, marking

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Authors: Masoud Mohammadpour, Blair Carlson, Radovan Kovacevic

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The quality of laser welded-brazed (LWB) joints were strongly dependent on the main process parameters, therefore the effect of laser power (3.2–4 kW), welding speed (60–80 mm/s) and wire feed rate (70–90 mm/s) on mechanical strength and surface roughness were investigated in this study. The comprehensive optimization process by means of response surface methodology (RSM) and desirability function was used for multi-criteria optimization. The experiments were planned based on Box– Behnken design implementing linear and quadratic polynomial equations for predicting the desired output properties. Finally, validation experiments were conducted on an optimized process condition which exhibited good agreement between the predicted and experimental results. AlSi3Mn1 was selected as the filler material for joining aluminum alloy 6022 and hot-dip galvanized steel in coach peel configuration. The high scanning speed could control the thickness of IMC as thin as 5 µm. The thermal simulations of joining process were conducted by the Finite Element Method (FEM), and results were validated through experimental data. The Fe/Al interfacial thermal history evidenced that the duration of critical temperature range (700–900 °C) in this high scanning speed process was less than 1 s. This short interaction time leads to the formation of reaction-control IMC layer instead of diffusion-control mechanisms.

Keywords: laser welding-brazing, finite element, response surface methodology (RSM), multi-response optimization, cross-beam laser

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Authors: Kenneth A. Rostowsky, Alexander S. Maher, Nahian F. Chowdhury, Andrei Irimia

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The clinical significance of cerebral microbleeds (CMBs) due to mild traumatic brain injury (mTBI) remains unclear. Here we use magnetic resonance imaging (MRI), diffusion tensor imaging (DTI) and connectomic analysis to investigate the statistical association between mTBI-related CMBs, post-TBI changes to the human connectome and neurological/cognitive deficits. This study was undertaken in agreement with US federal law (45 CFR 46) and was approved by the Institutional Review Board (IRB) of the University of Southern California (USC). Two groups, one consisting of 26 (13 females) mTBI victims and another comprising 26 (13 females) healthy control (HC) volunteers were recruited through IRB-approved procedures. The acute Glasgow Coma Scale (GCS) score was available for each mTBI victim (mean µ = 13.2; standard deviation σ = 0.4). Each HC volunteer was assigned a GCS of 15 to indicate the absence of head trauma at the time of enrollment in our study. Volunteers in the HC and mTBI groups were matched according to their sex and age (HC: µ = 67.2 years, σ = 5.62 years; mTBI: µ = 66.8 years, σ = 5.93 years). MRI [including T1- and T2-weighted volumes, gradient recalled echo (GRE)/susceptibility weighted imaging (SWI)] and gradient echo (GE) DWI volumes were acquired using the same MRI scanner type (Trio TIM, Siemens Corp.). Skull-stripping and eddy current correction were implemented. DWI volumes were processed in TrackVis (http://trackvis.org) and 3D Slicer (http://www.slicer.org). Tensors were fit to DWI data to perform DTI, and tractography streamlines were then reconstructed using deterministic tractography. A voxel classifier was used to identify image features as CMB candidates using Microbleed Anatomic Rating Scale (MARS) guidelines. For each peri-lesional DTI streamline bundle, the null hypothesis was formulated as the statement that there was no neurological or cognitive deficit associated with between-scan differences in the mean FA of DTI streamlines within each bundle. The statistical significance of each hypothesis test was calculated at the α = 0.05 level, subject to the family-wise error rate (FWER) correction for multiple comparisons. Results: In HC volunteers, the along-track analysis failed to identify statistically significant differences in the mean FA of DTI streamline bundles. In the mTBI group, significant differences in the mean FA of peri-lesional streamline bundles were found in 21 out of 26 volunteers. In those volunteers where significant differences had been found, these differences were associated with an average of ~47% of all identified CMBs (σ = 21%). In 12 out of the 21 volunteers exhibiting significant FA changes, cognitive functions (memory acquisition and retrieval, top-down control of attention, planning, judgment, cognitive aspects of decision-making) were found to have deteriorated over the six months following injury (r = -0.32, p < 0.001). Our preliminary results suggest that acute post-TBI CMBs may be associated with cognitive decline in some mTBI patients. Future research should attempt to identify mTBI patients at high risk for cognitive sequelae.

Keywords: traumatic brain injury, magnetic resonance imaging, diffusion tensor imaging, connectomics

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Authors: Bernard Igoche Igoche, Olumuyiwa Matthew, Peter Bednar, Alexander Gegov

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This study presents an ontology-driven approach for knowledge discovery and validation from admission databases in Nigerian polytechnic institutions. The research aims to address the challenges of extracting meaningful insights from vast amounts of admission data and utilizing them for decision-making and process improvement. The proposed methodology combines the knowledge discovery in databases (KDD) process with a structural causal model (SCM) ontological framework. The admission database of Benue State Polytechnic Ugbokolo (Benpoly) is used as a case study. The KDD process is employed to mine and distill knowledge from the database, while the SCM ontology is designed to identify and validate the important features of the admission process. The SCM validation is performed using the conditional independence test (CIT) criteria, and an algorithm is developed to implement the validation process. The identified features are then used for machine learning (ML) modeling and prediction of admission status. The results demonstrate the adequacy of the SCM ontological framework in representing the admission process and the high predictive accuracies achieved by the ML models, with k-nearest neighbors (KNN) and support vector machine (SVM) achieving 92% accuracy. The study concludes that the proposed ontology-driven approach contributes to the advancement of educational data mining and provides a foundation for future research in this domain.

Keywords: admission databases, educational data mining, machine learning, ontology-driven knowledge discovery, polytechnic education, structural causal model

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Authors: Mohammad Reza Fazeli

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Nowadays, the fourth industry, known as the digital transformation of industries, is seen as one of the top subjects in the history of structural revolution, which has led to the high-tech and tactical dominance of the organization. In the face of these profits, the undefined and non-transparent nature of the after-effects of investing in digital transformation has hindered many organizations from attempting this area of this industry. One of the important frameworks in the field of understanding digital transformation in all organizations is the maturity model of digital transformation. This model includes two main parts of digital transformation maturity dimensions and digital transformation maturity stages. Mediating factors of digital maturity and organizational performance at the individual (e.g., motivations, attitudes) and at the organizational level (e.g., organizational culture) should be considered. For successful technology adoption processes, organizational development and human resources must go hand in hand and be supported by a sound communication strategy. Maturity models are developed to help organizations by providing broad guidance and a roadmap for improvement. However, as a result of a systematic review of the literature and its analysis, it was observed that none of the 18 maturity models in the field of digital transformation fully meet all the criteria of appropriateness, completeness, clarity, and objectivity. A maturity assessment framework potentially helps systematize assessment processes that create opportunities for change in processes and organizations enabled by digital initiatives and long-term improvements at the project portfolio level. Cultural characteristics reflecting digital culture are not systematically integrated, and specific digital maturity models for the service sector are less clearly presented. It is also clearly evident that research on the maturity of digital transformation as a holistic concept is scarce and needs more attention in future research.

Keywords: digital transformation, organizational performance, maturity models, maturity assessment

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Authors: Ishwor Paudel, Pratima Gautam, Sandeep Bhattarai

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Bile spillage occurs frequently during laparoscopic cholecystectomy yet its impact on postoperative outcomes remains unknown. It might not be as innocuous as some surgeons tend to believe and in fact, might be associated with post-operative surgical site infections (SSI). It often leads to patient dissatisfaction, emergency department visits, with subsequent readmission and additional procedures. While some authors found no increase in SSI following bile spillage (BS) compared to non-bile spillage cases, others found bile spillage to be associated with SSI. Therefore we sought to examine whether bile spillage is indeed associated with an increased risk of postoperative wound infections after laparoscopic cholecystectomy. I hypothesize that patients who experience BS during operation, have an increased risk of SSI compared to those who do not. This is a prospective observational study conducted in the Department of Surgery, Patan Hospital over a period of one year. Patients undergoing Laparoscopic cholecystectomy were included and bile spillage, if happened was noted. All cases were followed up for 30 days and SSI was diagnosed as per CDC-defined criteria. Fisher’s test was applied to compare SSI in bile spillage versus non-bile spillage cases. A total of 112 patients were included in the final analysis. Bile spillage occurred in 20 cases and was absent in the rest i.e.92 cases. Among bile spillage cases, SSI was found in 4 cases (20%), whereas in nonbile spillage cases, SSI was found in 8 cases (8.7%). However, it was statistically not significant (p-value>0.05). Eleven (92%) cases were superficial SSI and one was an organ-space infection. No mortality or 30-day readmission. Spillage of Gallbladder content does not lead to an increase in SSIs. However as the rate of SSI is still higher, Surgeons should be careful to avoid iatrogenic gallbladder perforation and in case of bile spillage thorough peritoneal irrigation with normal saline should be done.

Keywords: organ space infection, Laparoscopic cholecystectomy, biliary spillage, surgical site infection

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Authors: S. Tebibel, C. Mechati, S. Messaoudi

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Algeria is currently experiencing the same rate of cancer progression as that registered these last years in the western countries. Colorectal cancer, constituting increasingly a major public health problem, is the most common form of cancer after breast and Neck-womb cancer at the woman and prostate cancer at the man. Our work is based on a retrospective study to determine the cases of colorectal cancer through eastern Algeria. Our goal is to carry out an epidemiological, histological and immune- histochemical study to investigate different techniques for the diagnosis of colorectal cancer and their interests and specific in detecting the disease. The study includes 110 patients (aged between 20 to 87 years) with colorectal cancer where the inclusions and exclusions criteria were established. In our study, colorectal cancer, expresses a male predominance, with a sex ratio of 1, 99 and the most affected age group is between 50 and 59 years. We noted that the colon cancer rate is higher than rectal cancer rate, whose frequencies are respectively 60,91 % and 39,09 %. In the series of colon cancer, the ADK lieberkunien is histological the most represented type, or 85,07 % of all cases. In contrast, the proportion of ADK mucinous (colloid mucous) is only 1,49% only. Well-differentiated ADKS, are very significant in our series, they represent 83,58 % of cases. Adenocarcinoma moderately and poorly differentiated, whose proportions are respectively 2,99 % and 0.05 %. For histological varieties of rectal ADK, we see in our workforce that ADK lieberkunien represent the most common histological form, or 76,74%, while the mucosal colloid is 13,95 %. Research of the mutation on the gene encoding K-ras, a major step in the targeted therapy of colorectal cancers, is underway in our study. Colorectal cancer is the subject of much promising research concern: the evaluation of new therapies (antiangiogenic monoclonal antibodies), the search for predictors of sensitivity to chemotherapy and new prognostic markers using techniques of molecular biology and proteomics.

Keywords: adenocarcinoma, age, colorectal cancer, epidemiology, histological section, sex

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Authors: Patricia Wahl, Dirk Bruland, Albert Lenz

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Children of mentally ill parents are a large high risk group for mental disorders which is hardly reached by preventive programs. The children inherit a heightened risk to develop a mental disorder themselves during their lifetime, but they and their parents are often rejecting to seek help. To elicit the factors determining this prevention dilemma, an explorative qualitative interview study is conducted in 25 families with mentally ill parents and yet unaffected children. Inclusion criteria are the children’s age (7 to 14 years old) and that these children live together with the affected parent. With regard to the concept of Mental Health Literacy the following research questions are leading the Qualitative Content Analysis: What are the needs of families with mentally ill parents? How can their help-seeking behaviour be described? What are their subjective illness theories? And which influences do gender, ethnicity and socio-economic status have on needs, help-seeking and illness theories? Mental Health Literacy relates to the knowledge and attitudes towards mental disorders influencing the recognition, management or prevention of these disorders. The concept seems to be an interesting starting point for our analysis with the aim to understand antecedences and processes in the families more deeply. Results of an extensive literature review serve as deductive framework for our analysis, first findings from the interviews will be available up to the time of the conference and can be presented. They hopefully will give inside in the families’ living environment and help to adapt/develop interventions and in the long term reduce health inequalities. The project at hand is part of the Health Literacy in Childhood and Adolescence (HLCA) Research Consortium financed by the German Federal Ministry of Education and Research (BMBF).

Keywords: children of mentally ill parents, help-seeking behaviour, mental health literacy, prevention dilemma

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Authors: Keiko Naito, Y. Nakashima, S. Yamauchi, Y. Kunitani, Y. Ishigami, K. Numata, M. Mizobe, Y. Homma, J. Takahashi, T. Inoue, T. Shiga, H. Funakoshi

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Background: A presence of severe acidemia, defined as pH < 7.2, is common during endotracheal intubation for critically ill patients in the emergency department (ED). Severe acidemia is widely recognized as a predisposing factor for intubation failure. However, it is unclear that acidemic condition itself actually makes endotracheal intubation more difficult. We aimed to evaluate if a presence of severe acidemia before intubation is associated with the lower first attempt intubation success rate in the ED. Methods: This is a retrospective observational cohort study in the ED of an urban hospital in Japan. The collected data included patient demographics, such as age, sex, and body mass index, presence of one or more factors of modified LEMON criteria for predicting difficult intubation, reasons for intubation, blood gas levels, airway equipment, intubation by emergency physician or not, and the use of the rapid sequence intubation technique. Those with any of the following were excluded from the analysis: (1) no blood gas drawn before intubation, (2) cardiopulmonary arrest, and (3) under 18 years of age. The primary outcome was the first attempt intubation success rates between a severe acidemic patients (SA) group and a non-severe acidemic patients (NA) group. Logistic regression analysis was used to test the first attempt success rates for intubations between those two groups. Results: Over 5 years, a total of 486 intubations were performed; 105 in the SA group and 381 in the NA group. The univariate analysis showed that the first attempt intubation success rate was lower in the SA group than in the NA group (71.4% vs 83.5%, p < 0.01). The multivariate logistic regression analysis identified that severe acidemia was significantly associated with the first attempt intubation failure (OR 1.9, 95% CI 1.03-3.68, p = 0.04). Conclusions: A presence of severe acidemia before endotracheal intubation lowers the first attempt intubation success rate in the ED.

Keywords: acidemia, airway management, endotracheal intubation, first-attempt intubation success rate

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Authors: Maliheh Rezaei

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Peace education has been introduced into many higher educational contexts by designing different programs, expecting to result in constructive changes, specifically in post-conflict countries. Teachers are the potential agents of positive change who play a major role in fostering the culture of peace in their classes. The purpose of this literature review was thus to evaluate the implementation of peace pedagogies by teachers in the context of higher education. More specifically, it addressed a) the role and characteristics of teachers and b) the pedagogies that they used to construct the culture of peace. The systematic literature review was used and several inclusion criteria were applied. Only papers published in English, which contained the keywords of university, higher education, peace, peace education, and similar derivatives such as ‘peacebuilding’ in their title and/or abstract, were included in this review. Moreover, only papers that dealt with the actual implementation of peace education theories were investigated. Findings highlighted that most teachers relied on pedagogies adopted from social justice, global citizenship, and positive psychology practices aiming to foster positive human traits such as resilience, empathy and reflection that were also believed to play an important role in peacebuilding efforts. Nevertheless, the incorporation of peace remained peripheral. The main challenge to incorporate the tenets of peace education was the shortage of teachers who were skilled and qualified enough to incorporate and promote the culture of peace in their classes. This literature review presents the body of research that has linked peace education to Higher Education. Therefore, it informs teachers about the potential roles they have in creating a peaceful and sustainable future. It also presents them with more effective pedagogies and practices to successfully integrate peace-related activities in Higher Education.

Keywords: culture of peace, higher education, teacher, pedogogy

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Authors: Ibrahim Mamat, Wan Mohd Zaifurin Wan Nawang

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Malaysia's poverty eradication program is a long-term plan that was initially implemented by the government after the riots of the races on May 13, 1969. The incident broke out due to the huge economic gap between the majority of Malaysians,Malays and non-Malays minorities. As a result of the event, the government drafted the New Economic Policy(NEP) in 1970 to reduce the differences in economic status among races in Malaysia. At the end of this policy period (NEP) in 1990, the incidence of poverty in Malaysia was around 6.5 per cent. The incidence of poverty in Malaysia continued to decline to 0.6 per cent (2014) through some other policy after the NEP. The decline in poverty has been the result of the government's efforts to implement the New Economic Policy (1970-1990), National Development Policy (1991-2000), NationalVision Policy (2001-2010), and National Transformation Policy (2011-2020).This article also explains the meaning, concepts and measurements of poverty in order to identify the Poverty Level and measure the Poverty Index using various dimensions. This explanation is very important for a country like Malaysia who has some people living below the poverty line. In such a context, an effective poverty eradication policy can benefit the poor.Consequently, this article examines the continuing involvement of the government and non-governmental organizations through the empowerment program of the hardcore poor to change their lifestyle and culture as well as the vicious circle of poverty is indispensable to ensure that poverty eradication programs are in line with current economic and social changes. In addition, the involvement of non-governmental organizations and the State Islamic Religious Council to provide assistance to the poor is appropriate as the institution has its own distinctive interpretation of poverty to determine the type of assistance, criteria and so on to enable the rights of the poor to be ensured and protected.

Keywords: economic policy, poor, poverty eradication, poverty program

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Authors: Fabiana Souza Orlandi, Juliana Gomes Duarte, Gabriela Dutra Gesualdo

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Chronic renal disease (CKD), accompanied by hemodialysis, causes chronic renal failure in a number of situations that compromises not only physical, personal and environmental aspects, but also psychological, social and family aspects. Objective: To verify the level of cognitive impairment of chronic renal patients on hemodialysis. Methodology: This is a descriptive, cross-sectional study. The present study was performed in a Dialysis Center of a city in the interior of the State of São Paulo. The inclusion criteria were: being 18 years or older; have a medical diagnosis of CKD; being in hemodialysis treatment in this unit; and agree to participate in the research, with the signature of the Informed Consent (TCLE). A total of 115 participants were evaluated through the Participant Characterization Instrument and the Addenbrooke Cognitive Exam - Revised Version (ACE-R), being scored from 0 to 100, stipulating the cut-off note for the complete battery <78 and subdivided into five domains: attention and guidance; memory; fluency; language; (66.9%) and caucasian (54.7%), 53.7 (±14.8) years old. Most of the participants were retired (74.7%), with incomplete elementary schooling (36.5%) and the average time of treatment was 46 months. Most of the participants (61.3%) presented impairment in the area of attention and orientation, 80.4% in the spatial visual domain. Regarding the total ACE-R score, 75.7% of the participants presented scores below the established cut grade. Conclusion: There was a high percentage (75.7%) below the cut-off score established for ACE-R, suggesting that there may be some cognitive impairment among these participants, since the instrument only performs a screening on cognitive health. The results of the study are extremely important so that possible interventions can be traced in order to minimize impairment, thus improving the quality of life of chronic renal patients.

Keywords: cognition, chronic renal insufficiency, adult health, dialysis

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Authors: Ghadeer M Alkusayer, Adelicia Yu, Pamela Orr

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Study objective: To report a case of postpartum pulmonary cryptococcal infection (CCI) in an otherwise healthy 35-year-old woman. Additionally, the cases of pulmonary cryptococcal infections either in the antepartum or the postpartum period with pregnancy outcomes, were systematically reviwed. Methods: A systematic search of Cochrane Library, MEDLINE, and EMBASE was conducted for peer-reviewed studies without date restrictions, published in English and relating to CCI during pregnancy or postpartum period. Conference press, editorials, opinion pieces and letters were excluded. Two authors independently screened citations and full-text articles, extracted data and assessed study quality. Given the heterogeneity of study designs, a narrative synthesis was conducted. Results: The search identified 128 references, of which 22 case reports and series met the inclusion criteria. This is a total of 29 women (including the current case) . The mean age of the women was 28.3 ± 12.3 years. Nine (31.03%) presented and were diagnosed in the postpartum period. Two (6.90%) of the patients were reported as immunocompromised with HIV. Four maternal deaths (13.79%) were found in this case series with one (4.3%) patient with severe neurological deficits. Four (17.4%) infant deaths were reported. Women primary presentation varied with chest pain 13 (44.82%), headache 10 (35.70%), dyspnea 19 (65.51%), or fever 12 (41.38%). Three studies reported placental pathology positive for C. neoformans. Conclusion: This case of pulmonary cryptococcal infection in the postpartum period is an important addition to the literature of this rare infection in pregnancy. The patient is not immunocompromised. The patient was successfully treated with 4 months of Fluconazole 400 mg and continued to breastfeed the healthy baby.

Keywords: pulmonary cryptococcus, pregnancy, cryptococci , postpartum

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Authors: Abdelkader Mendas

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The integration of MultiCriteria Decision Making (MCDM) approaches in a Geographical Information System (GIS) provides a powerful spatial decision support system which offers the opportunity to efficiently produce the land suitability maps for agriculture. Indeed, GIS is a powerful tool for analyzing spatial data and establishing a process for decision support. Because of their spatial aggregation functions, MCDM methods can facilitate decision making in situations where several solutions are available, various criteria have to be taken into account and decision-makers are in conflict. The parameters and the classification system used in this work are inspired from the FAO (Food and Agriculture Organization) approach dedicated to a sustainable agriculture. A spatial decision support system has been developed for establishing the land suitability map for agriculture. It incorporates the multicriteria analysis method ELECTRE Tri (ELimitation Et Choix Traduisant la REalité) in a GIS within the GIS program package environment. The main purpose of this research is to propose a conceptual and methodological framework for the combination of GIS and multicriteria methods in a single coherent system that takes into account the whole process from the acquisition of spatially referenced data to decision-making. In this context, a spatial decision support system for developing land suitability maps for agriculture has been developed. The algorithm of ELECTRE Tri is incorporated into a GIS environment and added to the other analysis functions of GIS. This approach has been tested on an area in Algeria. A land suitability map for durum wheat has been produced. Through the obtained results, it appears that ELECTRE Tri method, integrated into a GIS, is better suited to the problem of land suitability for agriculture. The coherence of the obtained maps confirms the system effectiveness.

Keywords: multicriteria decision analysis, decision support system, geographical information system, land suitability for agriculture

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Authors: Hannah Edwards, Femke T. A. Buisman-Pijlman, Adrian Esterman, Craig Phillips, Sandra Orgeig, Andrea Gordon

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Mother-infant bonding is a term which refers to the early emotional connectedness between a mother and her infant. Strong mother-infant bonding promotes higher quality mother and infant interactions including prolonged breastfeeding, secure attachment and increased sensitive parenting and maternal responsiveness. Strengthening of all such interactions leads to improved social behavior, and emotional and cognitive development throughout childhood, adolescence and adulthood. The positive outcomes observed following strong mother-infant bonding emphasize the need to screen new mothers for disrupted mother-infant bonding, and in turn the need for a robust, valid tool to assess mother-infant bonding. A recent scoping review conducted by the research team identified four tools to assess mother-infant bonding, all of which employed self-rating scales. Thus, whilst these tools demonstrated both adequate validity and reliability, they rely on self-reported information from the mother. As such this may reflect a mother’s perception of bonding with their infant, rather than their actual behavior. Therefore, a new tool to assess mother-infant bonding has been developed. The Recorded Interaction Task (RIT) addresses shortcomings of previous tools by employing observational methods to assess bonding. The RIT focusses on the common interaction between mother and infant of changing a nappy, at the target age of 2-6 months, which is visually recorded and then later assessed. Thirteen maternal and seven infant behaviors are scored on the RIT Observation Scoring Sheet, and a final combined score of mother-infant bonding is determined. The aim of the current study was to assess the content validity and inter-rater reliability of the RIT. A panel of six experts with specialized expertise in bonding and infant behavior were consulted. Experts were provided with the RIT Observation Scoring Sheet, a visual recording of a nappy change interaction, and a feedback form. Experts scored the mother and infant interaction on the RIT Observation Scoring Sheet and completed the feedback form which collected their opinions on the validity of each item on the RIT Observation Scoring Sheet and the RIT as a whole. Twelve of the 20 items on the RIT Observation Scoring Sheet were scored ‘Valid’ by all (n=6) or most (n=5) experts. Two items received a ‘Not valid’ score from one expert. The remainder of the items received a mixture of ‘Valid’ and ‘Potentially Valid’ scores. Few changes were made to the RIT Observation Scoring Sheet following expert feedback, including rewording of items for clarity and the exclusion of an item focusing on behavior deemed not relevant for the target infant age. The overall ICC for single rater absolute agreement was 0.48 (95% CI 0.28 – 0.71). Experts (n=6) ratings were less consistent for infant behavior (ICC 0.27 (-0.01 – 0.82)) compared to mother behavior (ICC 0.55 (0.28 – 0.80)). Whilst previous tools employ self-report methods to assess mother-infant bonding, the RIT utilizes observational methods. The current study highlights adequate content validity and moderate inter-rater reliability of the RIT, supporting its use in future research. A convergent validity study comparing the RIT against an existing tool is currently being undertaken to confirm these results.

Keywords: content validity, inter-rater reliability, mother-infant bonding, observational tool, recorded interaction task

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Authors: Elhussaien Elshiekh

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A study was performed to management and compare radiation doses and image quality during Lumbar spine PA and Lumbar spine LAT, x- ray radiography using Computed Radiography (CR) and Digital Radiography (DR). Standard exposure factors such as kV, mAs and FFD used for imaging the Lumbar spine anthropomorphic phantom obtained from average exposure factors that were used with CR in five radiology centres. Lumbar spine phantom was imaged using CR and DR systems. Entrance surface air kerma (ESAK) was calculated X-ray tube output and patient exposure factor. Images were evaluated using visual grading system based on the European Guidelines on Quality Criteria for diagnostic radiographic images. The ESAK corresponding to each image was measured at the surface of the phantom. Six experienced specialists evaluated hard copies of all the images, the image score (IS) was calculated for each image by finding the average score of the Six evaluators. The IS value also was used to determine whether an image was diagnostically acceptable. The optimum recommended exposure factors founded here for Lumbar spine PA and Lumbar spine LAT, with respectively (80 kVp,25 mAs at 100 cm FFD) and (75 kVp,15 mAs at 100 cm FFD) for CR system, and (80 kVp,15 mAs at100 cm FFD) and (75 kVp,10 mAs at 100 cm FFD) for DR system. For Lumbar spine PA, the lowest ESAK value required to obtain a diagnostically acceptable image were 0.80 mGy for DR and 1.20 mGy for CR systems. Similarly for Lumbar spine LAT projection, the lowest ESAK values to obtain a diagnostically acceptable image were 0.62 mGy for DR and 0.76 mGy for CR systems. At standard kVp and mAs values, the image quality did not vary significantly between the CR and the DR system, but at higher kVp and mAs values, the DR images were found to be of better quality than CR images. In addition, the lower limit of entrance skin dose consistent with diagnostically acceptable DR images was 40% lower than that for CR images.

Keywords: image quality, dosimetry, radiation protection, optimization, digital radiography, computed radiography

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Authors: Viral Nagori, Preeti Shroff, Prathana Dodia

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The paper presents the study on women entrepreneurship over the last decade in Indian and Global Context. This research study has its basis primarily in the literature review. The research methodology classifies the literature review paper based on different parameters of women entrepreneurship. The literature review relies on research papers in journals, articles in periodicals, and books published on women entrepreneurship. To accomplish this, the criteria included finding the most relevant, recent, and cited studies on women entrepreneurship over the last decade. It aims to evaluate the issues and challenges faced by women entrepreneurs. The finding suggested that there are several common obstacles, which hinders the pathway to success towards being a successful woman entrepreneur. The paper also describes such common obstacles like the level of education, family responsibilities, lack of business information, religious and cultural constraints, limited mobility, exposure, lack of working capital, and more. The in-depth analysis of literature review indicates that despite the numerous barriers, the arrival of social media has played a crucial role in enabling women to start and scale up their enterprises. Further, technology innovation has given them access to have relevant market information, increase reach and network with the customers. It enabled them to achieve work life balance and pursuing entrepreneur in them. The paper also describes the Government and Nongovernmental initiatives for promotion of women entrepreneurship. At the end, the study provides insights into the changing dynamics of women entrepreneurship in the current scenario and future prospects.

Keywords: changing dynamics, government initiatives, literature review, social media, technology innovation, women entrepreneurship

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Authors: Agoston Restas

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Introduction: In case of managing disasters decision makers can face many times such a special situation where any pre-sign of the drastically change is missing therefore the improvised decision making can be required. The complexity, ambiguity, uncertainty or the volatility of the situation can require many times the improvisation as decision making. It can be taken at any level of the management (strategic, operational and tactical) but at tactical level the main reason of the improvisation is surely time pressure. It is certainly the biggest problem during the management. Methods: The author used different tools and methods to achieve his goals; one of them was the study of the relevant literature, the other one was his own experience as a firefighting manager. Other results come from two surveys that are referred to; one of them was an essay analysis, the second one was a word association test, specially created for the research. Results and discussion: This article proves that, in certain situations, the multi-criteria, evaluating decision-making processes simply cannot be used or only in a limited manner. However, it can be seen that managers, directors or commanders are many times in situations that simply cannot be ignored when making decisions which should be made in a short time. The functional background of decisions made in a short time, their mechanism, which is different from the conventional, was studied lately and this special decision procedure was given the name recognition-primed decision. In the article, author illustrates the limits of the possibilities of analytical decision-making, presents the general operating mechanism of recognition-primed decision-making, elaborates on its special model relevant to managers at tactical level, as well as explore and systemize the factors that facilitate (catalyze) the processes with an example with fire managers.

Keywords: decision making, disaster managers, recognition primed decision, model for making decisions in emergencies

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Authors: Takalani Tshitangano

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Background: In Limpopo province the rate of new tuberculosis (TB) cases increase daily. The Infection Control (IC) plan is one of the essential actions for TB IC. This study aimed to establish the availability of these plans at health care facilities. Objectives: The objectives were to explore and describe the awareness and knowledge of health care workers (HCWs) of the availability and content of TB IC plan; and to identity the role of infection control committees from the perspective of HCWs. Method: A qualitative approach using a cross-sectional descriptive design was adopted. The target population was all HCWs from the seven hospitals of Vhembe district. A purposive sampling approach was used to select 57 participants. The approval to conduct this study was obtained from the relevant authorities and participants. Data were collected through seven focus group discussions comprising five to 10 members. An unstructured discussion guide was used to collect data, and an open-coding method was used to analyse the data. Lincoln and Guba’s criteria ensured trustworthiness of the study findings. Results: Findings revealed that HCWs were not aware of the availability and the information contained in the TB IC plans. No person was designated as TB IC officer at hospital level. There was lack of a TB IC Committee and teams as well as ineffective utilisation of those that did exist. Conclusions: It was concluded that if the TB IC plans are not available at health care facilities, then the TB IC practices implemented by HCWs vary, resulting in TB nosocomial infection transmission. It was recommended that the World Health Organisation’s TB IC plans be adopted and implemented in Vhembe district.

Keywords: health care workers' awareness, health care workers' knowledge, availability of TB infection control plans, rural hospitals

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Authors: Thanduxolo Elford Fana

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Rationale and Purpose: Performance management and development system are central to effective and efficient service delivery, especially in highly labour intensive sectors such as South African public health. Performance management and development systems seek to ensure that good employee performance is rewarded accordingly, while those who underperform are developed so that they can reach their full potential. An effective and efficiently implemented performance management system motivates and improves employee engagement. The purpose of this study is to examine the implementation of the performance management and development system and the challenges that are encountered during its implementation in the Eastern Cape Provincial Department of Health. Methods: A qualitative research approach and a case study design was adopted in this study. The primary data were collected through observations, focus group discussions with employees, a group interview with shop stewards, and in-depth interviews with supervisors and managers, from April 2019 to September 2019. There were 45 study participants. In-depth interviews were held with 10 managers at facility level, which included chief executive officer, chief medical officer, assistant director’s in human resources management, patient admin, operations, finance, and two area manager and two operation managers nursing. A group interview was conducted with five shop stewards and an in-depth interview with one shop steward from the group. Five focus group discussions were conducted with clinical and non-clinical staff. The focus group discussions were supplemented with an in-depth interview with one person from each group in order to counter the group effect. Observations included moderation committee, contracting, and assessment meetings. Findings: The study shows that the performance management and development system was not properly implemented. There was non-compliance to performance management and development system policy guidelines in terms of time lines for contracting, evaluation, payment of incentives to good performers, and management of poor performance. The study revealed that the system is ineffective in raising the performance of employees and unable to assist employees to grow. The performance bonuses were no longer paid to qualifying employees. The study also revealed that lack of capacity and commitment, poor communication, constant policy changes, financial constraints, weak and highly bureaucratic management structures, union interference were challenges that were encountered during the implementation of the performance management and development system. Lastly, employees and supervisors were rating themselves three irrespective of how well or bad they performed. Conclusion: Performance management is regarded as vital to improved performance of the health workforce and healthcare service delivery among populations. Effective implementation of performance management and development system depends on well-capacitated and unbiased management at facility levels. Therefore, there is an urgent need to improve communication, link performance management to rewards, and capacitate staff on performance management and development system, as it is key to improved public health sector outcomes or performance.

Keywords: challenges, implementation, performance management and development system, public hospital

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