Search results for: bladder management
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 9674

Search results for: bladder management

6974 Hydrological-Economic Modeling of Two Hydrographic Basins of the Coast of Peru

Authors: Julio Jesus Salazar, Manuel Andres Jesus De Lama

Abstract:

There are very few models that serve to analyze the use of water in the socio-economic process. On the supply side, the joint use of groundwater has been considered in addition to the simple limits on the availability of surface water. In addition, we have worked on waterlogging and the effects on water quality (mainly salinity). In this paper, a 'complex' water economy is examined; one in which demands grow differentially not only within but also between sectors, and one in which there are limited opportunities to increase consumptive use. In particular, high-value growth, the growth of the production of irrigated crops of high value within the basins of the case study, together with the rapidly growing urban areas, provides a rich context to examine the general problem of water management at the basin level. At the same time, the long-term aridity of nature has made the eco-environment in the basins located on the coast of Peru very vulnerable, and the exploitation and immediate use of water resources have further deteriorated the situation. The presented methodology is the optimization with embedded simulation. The wide basin simulation of flow and water balances and crop growth are embedded with the optimization of water allocation, reservoir operation, and irrigation scheduling. The modeling framework is developed from a network of river basins that includes multiple nodes of origin (reservoirs, aquifers, water courses, etc.) and multiple demand sites along the river, including places of consumptive use for agricultural, municipal and industrial, and uses of running water on the coast of Peru. The economic benefits associated with water use are evaluated for different demand management instruments, including water rights, based on the production and benefit functions of water use in the urban agricultural and industrial sectors. This work represents a new effort to analyze the use of water at the regional level and to evaluate the modernization of the integrated management of water resources and socio-economic territorial development in Peru. It will also allow the establishment of policies to improve the process of implementation of the integrated management and development of water resources. The input-output analysis is essential to present a theory about the production process, which is based on a particular type of production function. Also, this work presents the Computable General Equilibrium (CGE) version of the economic model for water resource policy analysis, which was specifically designed for analyzing large-scale water management. As to the platform for CGE simulation, GEMPACK, a flexible system for solving CGE models, is used for formulating and solving CGE model through the percentage-change approach. GEMPACK automates the process of translating the model specification into a model solution program.

Keywords: water economy, simulation, modeling, integration

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6973 Botulinum Toxin type A for Lower Limb Lengthening and Deformity Correction: A Systematic Review and Meta-analysis

Authors: Jawaher F. Alsharef, Abdullah A. Ghaddaf, Mohammed S. Alomari, Abdullah A. Al Qurashi, Ahmed S. Abdulhamid, Mohammed S. Alshehri, Majed Alosaimi

Abstract:

Botulinum toxin type A (BTX-A) is the most popular therapeutic agent for muscle relaxation and pain control. Lately, BTX-A injection received great interest as a part of multimodal pain management for lower limb lengthening and deformity correction. This systematic review aimed to determine the role of BTX-A injection in pain management for during lower limb lengthening and/or deformity correction. We searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared the BTX-A injection to placebo for individuals undergoing lower limb lengthening and/or deformity correction. We sought to evaluate the following outcomes: pain on visual analogue scale (VAS), range of motion parameters, average opioid consumption, and adverse events. The standardized mean difference (SMD) was used to represent continuous outcomes while risk ratio (RR) was used to represent dichotomous outcomes. A total of 4 RCTs that enrolled 257 participants (337 limbs) deemed eligible. Adjuvant BTX-A injection showed a significant reduction in post-operative pain compared to placebo (SMD=–0.28, 95% CI –0.53 to –0.04). No difference was found between BTX-A injection and placebo in terms of range of motion parameters, average opioid consumption, or adverse events after surgical limb lengthening and/or deformity correction (RR= 0.77, 95% CI –0.58 to 1.03). Conclusions: Adjuvant BTX-A injection conferred a discernible reduction in post-operative pain during surgical limb lengthening and/or deformity without increasing the risk of adverse events.

Keywords: botulinum toxin type A, limb lengthening, distraction osteogenesis, deformity correction, pain management

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6972 Fabrication of a Potential Point-of-Care Device for Hemoglobin A1c: A Lateral Flow Immunosensor

Authors: Shu Hwang Ang, Choo Yee Yu, Geik Yong Ang, Yean Yean Chan, Yatimah Binti Alias, And Sook Mei Khor

Abstract:

With the high prevalence of Type 2 diabetes mellitus across the world, the morbidities and mortalities associated with Type 2 diabetes have significant impact on the production line for a nation. With routine scheduled clinical visits to manage Type 2 diabetes, diabetic patients with hectic lifestyles can have low clinical compliance. Hence, it often decreases the effectiveness of diabetic management personalized for each diabetic patient. Here, we report a useful developed point-of-care (POC) device that detect glycated hemoglobin (HbA1c, biomarker for long-term Type 2 diabetic management). In fact, the established POC devices certified to be used in clinical setting are not only expensive ($ 8 to $10 per test), they also require skillful practitioners to perform sampling and interpretation. As a paper-based biosensor, the developed HbA1c biosensor utilized lateral flow principle to offer an alternative for cost-effective (approximately $2 per test) and end-user friendly device for household testing. Requiring as little as 2 L of finger-picked blood, the test can be performed at the household with just simple dilution and washings. With visual interpretation of numbers of test lines shown on the developed biosensor, it can be interpreted as easy as a urine pregnancy test, aided with scale of intensity provided. In summary, the developed HbA1c immunosensor has been tested to have high selectivity towards HbA1c, and is stable with reasonably good performance in clinical testing. Therefore, our developed HbA1c immunosensor has high potential to be an effective diabetic management tool to increase patient compliance and thus contain the progression of the diabetes.

Keywords: blood, glycated hemoglobin (HbA1c), lateral flow, type 2 diabetes mellitus

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6971 The Study of Factors Affecting Social Responsibility among Undergraduate Students of the Faculty of Management Science, Suan Sunandha Rajabhat University

Authors: Somtop Keawchuer

Abstract:

The purpose of the research is to study the level of social responsibility among the undergraduate students of the faculty of Management Science, Suan Sunandha Rajabhat University. The research also studies the factors affecting social responsibility of the undergraduate students. The research methodology applied a self-administered questionnaire as a quantitative method. A convenience sampling was used to distribute the questionnaire. Finally, 350 questionnaires were received for data analysis. Data were analyzed by using descriptive statistics including percentage, mean, standard deviation, and inferential statistics including regression analysis for hypothesis testing. The results indicated that the level of social responsibility of the students was at a good level. In addition, internal and external factors were related to social responsibility of the undergraduate students with the statistical significance level of 0.05.

Keywords: internal and external factors, social responsibility, Suan Sunandha Rajabhat University, undergraduate students

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6970 The Adoption of Process Management for Accounting Information Systems in Thailand

Authors: Manirath Wongsim

Abstract:

Information Quality (IQ) has become a critical, strategic issue in Accounting Information Systems (AIS) adoption. In order to implement AIS adoption successfully, it is important to consider the quality of information use throughout the adoption process, which seriously impacts the effectiveness of AIS adoption practice and the optimization of AIS adoption decisions. There is a growing need for research to provide insights into issues and solutions related to IQ in AIS adoption. The need for an integrated approach to improve IQ in AIS adoption, as well as the unique characteristics of accounting data, demands an AIS adoption specific IQ framework. This research aims to explore ways of managing information quality and AIS adoption to investigate the relationship between the IQ issues and AIS adoption process. This study has led to the development of a framework for understanding IQ management in AIS adoption. This research was done on 44 respondents as ten organisations from manufacturing firms in Thailand. The findings of the research’s empirical evidence suggest that IQ dimensions in AIS adoption to provide assistance in all process of decision making. This research provides empirical evidence that information quality of AIS adoption affect decision making and suggests that these variables should be considered in adopting AIS in order to improve the effectiveness of AIS.

Keywords: information quality, information quality dimensions, accounting information systems, accounting information system adoption

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6969 Healthcare Learning From Near Misses in Aviation Safety

Authors: Nick Woodier, Paul Sampson, Iain Moppett

Abstract:

Background: For years, healthcare across the world has recognised that patients are coming to harm from the very processes meant to help them. In response, healthcare tells itself that it needs to ‘be more like aviation.’ Aviation safety is highly regarded by those in healthcare and is seen as an exemplar. Specifically, healthcare is keen to learn from how aviation uses near misses to make their industry safer. Healthcare is rife with near misses; however, there has been little progress addressing them, with most research having focused on reporting. Addressing the factors that contribute to near misses will potentially help reduce the number of significant, harm patientsafety incidents. While the healthcare literature states the need to learn from aviation’s use of near misses, there is nothing that describes how best to do this. The authors, as part of a larger study of near-miss management in healthcare, sought to learn from aviation to develop principles for how healthcare can identify, report, and learn from near misses to improve patient safety. Methods: A Grounded Theory (GT) methodology, augmented by a scoping review, was used. Data collection included interviews, field notes, and the literature. The review protocol is accessible online. The GT aimed to develop theories about how aviation, amongst other safety-critical industries, manages near misses. Results: Twelve aviation interviews contributed to the GT across passenger airlines, air traffic control, and bodies involved in policy, regulation, and investigation. The scoping review identified 83 articles across a range of safety-critical industries, but only seven focused on aviation. The GT identified that aviation interprets the term ‘near miss’ in different ways, commonly using it to specifically refer to near-miss air collisions, also known as Airproxes. Other types of near misses exist, such as health and safety, but the reporting of these and the safety climate associated with them is not as mature. Safety culture in aviation was regularly discussed, with evidence that culture varies depending on which part of the industry is being considered (e.g., civil vs. business aviation). Near misses are seen as just one part of an extensive safety management system, but processes to support their reporting and their analysis are not consistent. Their value alone is also questionable, with the challenge to long-held beliefs originating from the ‘common cause hypothesis.’ Conclusions: There is learning that healthcare can take from how parts of aviation manage and learn from near misses. For example, healthcare would benefit from a formal safety management system that currently does not exist. However, it may not be as simple as ‘healthcare should learn from aviation’ due to variation in safety maturity across the industry. Healthcare needs to clarify how to incorporate near misses into learning and whether allocating resources to them is of value; it was heard that catastrophes have led to greater improvements in safety in aviation.

Keywords: aviation safety, patient safety, near miss, safety management systems

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6968 Class Control Management Issues and Solutions in Interactive Learning Theories’ Efficiency and the Application Case Study: 3rd Year Primary School

Authors: Mohammed Belalia Douma

Abstract:

Interactive learning is considered as the most effective strategy of learning, it is an educational philosophy based on the learner's contribution and involvement mainly in classroom and how he interacts toward his small society “classroom”, and the level of his collaboration into challenge, discovering, games, participation, all these can be provided through the interactive learning, which aims to activate the learner's role in the operation of learning, which focuses on research and experimentation, and the learner's self-reliance in obtaining information, acquiring skills, and forming values and attitudes. Whereas not based on memorization only, but rather on developing thinking and the ability to solve problems, on teamwork and collaborative learning. With the exchange or roles - teacher to student- , when the student will be more active and performing operations more than the student under the interactive learning method; we might face a several issues dealing with class controlling management, noise, and stability of learning… etc. This research paper is observing the application of the interactive learning on reality “classroom” and answers several assumptions and analyzes the issues coming up of these strategies mainly: noise, class control…etc The research sample was about 150 student of the 3rd year primary school in “Chlef” district, Algeria, level: beginners in the range of age 08 to 10 years old . We provided a questionnaire of confidential fifteen questions and also analyzing the attitudes of learners during three months. it have witnessed as teachers a variety of strategies dealing with applying the interactive learning but with a different issues; time management, noise, uncontrolled classes, overcrowded classes. Finally, it summed up that although the active education is an inevitably effective method of teaching, however, there are drawbacks to this, in addition to the fact that not all theoretical strategies can be applied and we conclude with solutions of this case study.

Keywords: interactive learning, student, learners, strategies.

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6967 Solid Waste Management Challenges and Possible Solution in Kabul City

Authors: Ghulam Haider Haidaree, Nsenda Lukumwena

Abstract:

Most developing nations face energy production and supply problems. This is also the case of Afghanistan whose generating capacity does not meet its energy demand. This is due in part to high security and risk caused by war which deters foreign investments and insufficient internal revenue. To address the issue above, this paper would like to suggest an alternative and affordable way to deal with the energy problem. That is by converting Solid Waste to energy. As a result, this approach tackles the municipal solid waste issue (potential cause of several diseases), contributes to the improvement of the quality of life, local economy, and so on. While addressing the solid waste problem in general, this paper samples specifically one municipality which is District-12, one of the 22 districts of Kabul city. Using geographic information system (GIS) technology, District-12 is divided into nine different zones whose municipal solid waste is respectively collected, processed, and converted into electricity and distributed to the closest area. It is important to mention that GIS has been used to estimate the amount of electricity to be distributed and to optimally position the production plant.

Keywords: energy problem, estimation of electricity, GIS zones, solid waste management system

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6966 The Côa Valley Ecosystem (Douro, Portugal) as a Cultural Landscape. Approach to the Management Challenges

Authors: Mariana Durana Pinto, Thierry Aubry, Eduarda Vieira

Abstract:

The Côa River is one of the tributaries of the Douro River, which in turn connects two Portuguese regions: Beira-Alta (Serra das Mesas, Sabugal) and Trás-os-Montes (Douro River, Vila Nova de Foz Côa). The river, which is approximately 140 kilometres in length, is surrounded by characteristic Northern-Estearn Portugal landscape. The dominant flora in the region includes olive and almond trees and vines, which provide habitat for a diverse range of native species. These include mammals such as the lynx and Iberian wolf, as well as birds of prey such as the Egyptian vulture and the griffon vulture. Additionally, herbivorous species such as red deer and roe deer also inhabit the region. However, the Vale Côa is inextricably linked with the rocky outcrops bearing the emblematic open-air Upper Palaeolithic rock art, indeed, it houses the world's largest collection of prehistoric open-air rock art, inscribed on the World Heritage list by UNESCO in 1998. From the initial discovery of the first engravings in 1991 to the present day, approximally 1,500 panels with rock art, mostly engravings and carving, but also some paintings, have been discovered, inventoried and recorded spanning from earlu Upper Paleolithic to the 20th century. The study and interpretation of the engravings and its geoarchaeological context, allow the construction of a chronological timeline of the human occupation and graphical production in this region. The area has been inhabited since the Early Palaeolithic, with human communities exploiting the diversity of the natural resources of the environment and adapting it to their needs. This led to the creation of an archaeological and historical cultural landscape.The region is currently inhabited by rural communities whose primary source of income is derived from agricultural activities, with a particular focus on olive oil and wine production, including the emblematic Vinho do Porto. Additionally, the region is distinguished by activities such as stone exploration and extraction (e.g. schist and granite quarries) and tourism. The latter has progressively assumed a role in the promotion and development of the region, primarily due to the engravings of the Côa Valley itself, as well as the Alto Douro Wine Region. Furthermore, this cultural landscape has been inscribed in the UNESCO World Heritage Site in 2001. The aforementioned factors give rise to a series of challenges and issues pertaining to the management and safeguarding of rock art on a daily basis. These include: I) the management of conflicts between cultural heritage and economic activity (between Rock art and vineyards, both classified as World Heritage Sites); II) the management of land-use planning in areas where the engravings are located (since the areas with engravings are larger than those identified as buffer zones by UNESCO); III) the absence of the legal figure of an 'archaeological park' and the need to solve this issue; IV) the management of tourist pressure and unauthorised visits; and V) the management of vandalism (as a consequence of misinformation and denial).

Keywords: Douro and Côa Valleys, archaeological cultural landscapes, rock art, Douro wine, conservation challenges

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6965 An Evolutionary Multi-Objective Optimization for Airport Gate Assignment Problem

Authors: Seyedmirsajad Mokhtarimousavi, Danial Talebi, Hamidreza Asgari

Abstract:

Gate Assignment Problem (GAP) is one of the most substantial issues in airport operation. In principle, GAP intends to maintain the maximum capacity of the airport through the best possible allocation of the resources (gates) in order to reach the optimum outcome. The problem involves a wide range of dependent and independent resources and their limitations, which add to the complexity of GAP from both theoretical and practical perspective. In this study, GAP was mathematically formulated as a three-objective problem. The preliminary goal of multi-objective formulation was to address a higher number of objectives that can be simultaneously optimized and therefore increase the practical efficiency of the final solution. The problem is solved by applying the second version of Non-dominated Sorting Genetic Algorithm (NSGA-II). Results showed that the proposed mathematical model could address most of major criteria in the decision-making process in airport management in terms of minimizing both airport/airline cost and passenger walking distance time. Moreover, the proposed approach could properly find acceptable possible answers.

Keywords: airport management, gate assignment problem, mathematical modeling, genetic algorithm, NSGA-II

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6964 Project Management and International Development: Competencies for International Assignment

Authors: M. P. Leroux, C. Coulombe

Abstract:

Projects are popular vehicles through which international aid is delivered in developing countries. To achieve their objectives, many northern organizations develop projects with local partner organizations in the developing countries through technical assistance projects. International aid and international development projects precisely have long been criticized for poor results although billions are spent every year. Little empirical research in the field of project management has the focus on knowledge transfer in international development context. This paper focuses particularly on personal dimensions of international assignees participating in project within local team members in the host country. We propose to explore the possible links with a human resource management perspective in order to shed light on the less research problematic of knowledge transfer in development cooperation projects. The process leading to capacity building being far complex, involving multiple dimensions and far from being linear, we propose here to assess if traditional research on expatriate in multinational corporations pertain to the field of project management in developing countries. The following question is addressed: in the context of international development project cooperation, what personal determinants should the selection process focus when looking to fill a technical assistance position in a developing country? To answer that question, we first reviewed the literature on expatriate in the context of inter organizational knowledge transfer. Second, we proposed a theoretical framework combining perspectives of development studies and management to explore if parallels can be draw between traditional international assignment and technical assistance project assignment in developing countries. We conducted an exploratory study using case studies from technical assistance initiatives led in Haiti, a country in Central America. Data were collected from multiple sources following qualitative study research methods. Direct observations in the field were allowed by local leaders of six organization; individual interviews with present and past international assignees, individual interview with local team members, and focus groups were organized in order to triangulate information collected. Contrary from empirical research on knowledge transfer in multinational corporations, results tend to show that technical expertise rank well behind many others characteristics. Results tend to show the importance of soft skills, as a prerequisite to succeed in projects where local team have to collaborate. More importantly, international assignees who were talking knowledge sharing instead of knowledge transfer seemed to feel more satisfied at the end of their mandate than the others. Reciprocally, local team members who perceived to have participated in a project with an expat looking to share instead of aiming to transfer knowledge seemed to describe the results of project in more positive terms than the others. Results obtained from this exploratory study open the way for a promising research agenda in the field of project management. It emphasises the urgent need to achieve a better understanding on the complex set of soft skills project managers or project chiefs would benefit to develop, in particular, the ability to absorb knowledge and the willingness to share one’s knowledge.

Keywords: international assignee, international project cooperation, knowledge transfer, soft skills

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6963 Predictability of Supply Chain in Indian Automobile Division

Authors: Dharamvir Mangal

Abstract:

Supply chain management has increasingly become an inevitable challenge to most companies to continuously survive and prosper in the global chain-based competitive environment. The current challenges of the Indian automotive world, their implications on supply chain are summarized and analyzed in this paper. In this competitive era of ‘LPG’ i.e. Liberalization, Privatization and Globalization, modern marketing systems, introduction of products with short life cycles, and the discriminating expectations of customers have enforced business enterprises to invest in and focus attention on their Supply Chains (SCs) in order to meet out the level of customer’s satisfaction and to survive in the competitive market. In fact, many of trends in the auto industry are reinforcing the need to redefine supply chain strategies layouts, and operations etc. Many manufacturing operations are designed to maximize throughput and lower costs with modest considerations for the crash on inventory levels and distribution capabilities. To improve profitability and efficiency, automotive players are seeking ways to achieve operational excellence, reduce operating cost and enhance customer service through efficient supply chain management.

Keywords: automotive industry, supply chain, challenges, market potential

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6962 Analyzing the Mission Drift of Social Business: Case Study of Restaurant Providing Professional Training to At-Risk Youth

Authors: G. Yanay-Ventura, H. Desivilya Syna, K. Michael

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Social businesses are based on the idea that an enterprise can be established for the sake of profit and, at the same time, with the aim of fulfilling social goals. Yet, the question of how these goals can be integrated in practice to derive parallel benefit in both realms still needs to be examined. Particularly notable in this context is the ‘governance challenge’ of social businesses, meaning the danger of the mission drifts from the social goal in the pursuit of good business. This study is based on an evaluation study of a social business that operates as a restaurant providing professional training to at-risk youth. The evaluation was based on the collection of a variety of data through interviews with stakeholders in the enterprise (directors and managers, business partners, social partners, and position holders in the restaurant and the social enterprise), a focus group consisting of the youth receiving the professional training, observations of the restaurant’s operation, and analysis of the social enterprise’s primary documents. The evaluation highlighted significant strengths of the social enterprise, including reaching relatively fast business sustainability, effective management of the restaurant, stable employment of the restaurant staff, and effective management of the social project. The social enterprise and business management have both enjoyed positive evaluations from a variety of stakeholders. Clearly, the restaurant was deemed by all a promising young business. However, the social project suffered from a 90% dropout rate among the youth entering its ranks, extreme monthly fluctuation in the number of youths participating, and a distinct minority of the youth who have succeeded in completing their training period. Possible explanations of the high dropout rate included the small number of cooks, which impeded the effectiveness of the training process and the provision of advanced cooking skills; lack of clarity regarding the essence and the elements of training; and lack of a meaningful peer group for the youth engaged in the program. Paradoxically, despite the stakeholders’ great appreciation for the social enterprise, the challenge of governability was also formidable, revealing a tangible risk of mission drift in the reduction of the social enterprise’s target population and a breach of the commitment made to the youth with regard to practical training. The risk of mission drifts emerged as a hidden and evasive issue for the stakeholders, who revealed a deep appreciation for the management and the outcomes of the social enterprise. The challenge of integration, therefore, requires an in-depth examination of how to maintain a successful business without hindering the achievement of the social goal. The study concludes that clear conceptualization of the training process and its aims, increased cooks’ participation in the social project, and novel conceptions with regard to the evaluation of success could serve to benefit the youth and impede mission drift.

Keywords: evaluation study, management, mission drift, social business

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6961 Volume Estimation of Trees: An Exploratory Study on Pterocarpus erinaceus Logging Operations within Forest Transition and Savannah Ecological Zones of Ghana

Authors: Albert Kwabena Osei Konadu

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Pterocarpus erinaceus, also known as Rosewood, is tropical wood, endemic in forest savannah transition zones within the middle and northern portion of Ghana. Its economic viability has made it increasingly popular and in high demand, leading to widespread conservation concerns. Ghana’s forest resource management regime for these ecozones is mainly on conservation and very little on resource utilization. Consequently, commercial logging management standards are at teething stage and not fully developed, leading to a deficiency in the monitoring of logging operations and quantification of harvested trees volumes. Tree information form (TIF); a volume estimation and tracking regime, has proven to be an effective, sustainable management tool for regulating timber resource extraction in the high forest zones of the country. This work aims to generate TIF that can track and capture requisite parameters to accurately estimate the volume of harvested rosewood within forest savannah transition zones. Tree information forms were created on three scenarios of individual billets, stacked billets and conveying vessel basis. These TIFs were field-tested to deduce the most viable option for the tracking and estimation of harvested volumes of rosewood using the smallian and cubic volume estimation formula. Overall, four districts were covered with individual billets, stacked billets and conveying vessel scenarios registering mean volumes of 25.83m3,45.08m3 and 32.6m3, respectively. These adduced volumes were validated by benchmarking to assigned volumes of the Forestry Commission of Ghana and known standard volumes of conveying vessels. The results did indicate an underestimation of extracted volumes under the quotas regime, a situation that could lead to unintended overexploitation of the species. The research revealed conveying vessels route is the most viable volume estimation and tracking regime for the sustainable management of the Pterocarpous erinaceus species as it provided a more practical volume estimate and data extraction protocol.

Keywords: convention on international trade in endangered species, cubic volume formula, forest transition savannah zones, pterocarpus erinaceus, smallian’s volume formula, tree information form

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6960 Soil Quality Response to Long-Term Intensive Resources Management and Soil Texture

Authors: Dalia Feiziene, Virginijus Feiza, Agne Putramentaite, Jonas Volungevicius, Kristina Amaleviciute, Sarunas Antanaitis

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The investigations on soil conservation are one of the most important topics in modern agronomy. Soil management practices have great influence on soil physico-chemical quality and GHG emission. Research objective: To reveal the sensitivity and vitality of soils with different texture to long-term antropogenisation on Cambisol in Central Lithuania and to compare them with not antropogenised soil resources. Methods: Two long-term field experiments (loam on loam; sandy loam on loam) with different management intensity were estimated. Disturbed and undisturbed soil samples were collected from 5-10, 15-20 and 30-35 cm depths. Soil available P and K contents were determined by ammonium lactate extraction, total N by the dry combustion method, SOC content by Tyurin titrimetric (classical) method, texture by pipette method. In undisturbed core samples soil pore volume distribution, plant available water (PAW) content were determined. A closed chamber method was applied to quantify soil respiration (SR). Results: Long-term resources management changed soil quality. In soil with loam texture, within 0-10, 10-20 and 30-35 cm soil layers, significantly higher PAW, SOC and mesoporosity (MsP) were under no-tillage (NT) than under conventional tillage (CT). However, total porosity (TP) under NT was significantly higher only in 0-10 cm layer. MsP acted as dominant factor for N, P and K accumulation in adequate layers. P content in all soil layers was higher under NT than in CT. N and K contents were significantly higher than under CT only in 0-10 cm layer. In soil with sandy loam texture, significant increase in SOC, PAW, MsP, N, P and K under NT was only in 0-10 cm layer. TP under NT was significantly lower in all layers. PAW acted as strong dominant factor for N, P, K accumulation. The higher PAW the higher NPK contents were determined. NT did not secure chemical quality within deeper layers than CT. Long-term application of mineral fertilisers significantly increased SOC and soil NPK contents primarily in top-soil. Enlarged fertilization determined the significantly higher leaching of nutrients to deeper soil layers (CT) and increased hazards of top-soil pollution. Straw returning significantly increased SOC and NPK accumulation in top-soil. The SR on sandy loam was significantly higher than on loam. At dry weather conditions, on loam SR was higher in NT than in CT, on sandy loam SR was higher in CT than in NT. NPK fertilizers promoted significantly higher SR in both dry and wet year, but suppressed SR on sandy loam during usual year. Not antropogenised soil had similar SOC and NPK distribution within 0-35 cm layer and depended on genesis of soil profile horizons.

Keywords: fertilizers, long-term experiments, soil texture, soil tillage, straw

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6959 Balanced Scorecard (BSC) Project : A Methodological Proposal for Decision Support in a Corporate Scenario

Authors: David de Oliveira Costa, Miguel Ângelo Lellis Moreira, Carlos Francisco Simões Gomes, Daniel Augusto de Moura Pereira, Marcos dos Santos

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Strategic management is a fundamental process for global companies that intend to remain competitive in an increasingly dynamic and complex market. To do so, it is necessary to maintain alignment with their principles and values. The Balanced Scorecard (BSC) proposes to ensure that the overall business performance is based on different perspectives (financial, customer, internal processes, and learning and growth). However, relying solely on the BSC may not be enough to ensure the success of strategic management. It is essential that companies also evaluate and prioritize strategic projects that need to be implemented to ensure they are aligned with the business vision and contribute to achieving established goals and objectives. In this context, the proposition involves the incorporation of the SAPEVO-M multicriteria method to indicate the degree of relevance between different perspectives. Thus, the strategic objectives linked to these perspectives have greater weight in the classification of structural projects. Additionally, it is proposed to apply the concept of the Impact & Probability Matrix (I&PM) to structure and ensure that strategic projects are evaluated according to their relevance and impact on the business. By structuring the business's strategic management in this way, alignment and prioritization of projects and actions related to strategic planning are ensured. This ensures that resources are directed towards the most relevant and impactful initiatives. Therefore, the objective of this article is to present the proposal for integrating the BSC methodology, the SAPEVO-M multicriteria method, and the prioritization matrix to establish a concrete weighting of strategic planning and obtain coherence in defining strategic projects aligned with the business vision. This ensures a robust decision-making support process.

Keywords: MCDA process, prioritization problematic, corporate strategy, multicriteria method

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6958 An Analysis of Employee Attitudes to Organisational Change Management Practices When Adopting New Technologies Within the Architectural, Engineering, and Construction Industry: A Case Study

Authors: Hannah O'Sullivan, Esther Quinn

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Purpose: The Architectural, Engineering, and Construction (AEC) industry has historically struggled to adapt to change. Although the ability to innovate and successfully implement organizational change has been demonstrated to be critical in achieving a sustainable competitive advantage in the industry, many AEC organizations continue to struggle when affecting organizational change. One prominent area of organizational change that presents many challenges in the industry is the adoption of new forms of technology, for example, Building Information Modelling (BIM). Certain Organisational Change Management (OCM) practices have been proven to be effective in supporting organizations to adopt change, but little research has been carried out on diverging employee attitudes to change relative to their roles within the organization. The purpose of this research study is to examine how OCM practices influence employee attitudes to change when adopting new forms of technology and to analyze the diverging employee perspectives within an organization on the importance of different OCM strategies. Methodology: Adopting an interview-based approach, a case study was carried out on a large-sized, prominent Irish construction organization who are currently adopting a new technology platform for its projects. Qualitative methods were used to gain insight into differing perspectives on the utilization of various OCM practices and their efficacy when adopting a new form of technology on projects. Change agents implementing the organizational change gave insight into their intentions with the technology rollout strategy, while other employees were interviewed to understand how this rollout strategy was received and the challenges that were encountered. Findings: The results of this research study are currently being finalized. However, it is expected that employees in different roles will value different OCM practices above others. Findings and conclusions will be determined within the coming weeks. Value: This study will contribute to the body of knowledge relating to the introduction of new technologies, including BIM, to AEC organizations. It will also contribute to the field of organizational change management, providing insight into methods of introducing change that will be most effective for different employees based on their roles and levels of experience within the industry. The focus of this study steers away from traditional studies of the barriers to adopting BIM in its first instance at an organizational level and centers on the direct effect on employees when a company changes the technology platform being used.

Keywords: architectural, engineering, and construction (AEC) industry, Building Information Modelling, case study, challenges, employee perspectives, organisational change management.

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6957 Agricultural Knowledge Management System Design, Use, and Consequence for Knowledge Sharing and Integration

Authors: Dejen Alemu, Murray E. Jennex, Temtim Assefa

Abstract:

This paper is investigated to understand the design, the use, and the consequence of Knowledge Management System (KMS) for knowledge systems sharing and integration. A KMS for knowledge systems sharing and integration is designed to meet the challenges raised by knowledge management researchers and practitioners: the technical, the human, and social factors. Agricultural KMS involves various members coming from different Communities of Practice (CoPs) who possess their own knowledge of multiple practices which need to be combined in the system development. However, the current development of the technology ignored the indigenous knowledge of the local communities, which is the key success factor for agriculture. This research employed the multi-methodological approach to KMS research in action research perspective which consists of four strategies: theory building, experimentation, observation, and system development. Using the KMS development practice of Ethiopian agricultural transformation agency as a case study, this research employed an interpretive analysis using primary qualitative data acquired through in-depth semi-structured interviews and participant observations. The Orlikowski's structuration model of technology has been used to understand the design, the use, and the consequence of the KMS. As a result, the research identified three basic components for the architecture of the shared KMS, namely, the people, the resources, and the implementation subsystems. The KMS were developed using web 2.0 tools to promote knowledge sharing and integration among diverse groups of users in a distributed environment. The use of a shared KMS allows users to access diverse knowledge from a number of users in different groups of participants, enhances the exchange of different forms of knowledge and experience, and creates high interaction and collaboration among participants. The consequences of a shared KMS on the social system includes, the elimination of hierarchical structure, enhance participation, collaboration, and negotiation among users from different CoPs having common interest, knowledge and skill development, integration of diverse knowledge resources, and the requirement of policy and guideline. The research contributes methodologically for the application of system development action research for understanding a conceptual framework for KMS development and use. The research have also theoretical contribution in extending structuration model of technology for the incorporation of variety of knowledge and practical implications to provide management understanding in developing strategies for the potential of web 2.0 tools for sharing and integration of indigenous knowledge.

Keywords: communities of practice, indigenous knowledge, participation, structuration model of technology, Web 2.0 tools

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6956 Carbon Footprint of Road Project for Sustainable Development: Lessons Learnt from Traffic Management of a Developing Urban Centre

Authors: Sajjad Shukur Ullah, Syed Shujaa Safdar Gardezi

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Road infrastructure plays a vital role in the economic activities of any economy. Besides derived benefits from these facilities, the utilization of extensive energy resources, fuels, and materials results in a negative impact on the environment in terms of carbon footprint; carbon footprint is the overall amount of greenhouse gas (GHG) generated from any action. However, this aspect of environmental impact from road structure is not seriously considered during such developments, thus undermining a critical factor of sustainable development, which usually remains unaddressed, especially in developing countries. The current work investigates the carbon footprint impact of a small road project (0.8 km, dual carriageway) initiated for traffic management in an urban centre. Life cycle assessment (LCA) with boundary conditions of cradle to the site has been adopted. The only construction phase of the life cycle has been assessed at this stage. An impact of 10 ktons-CO2 (6260 ton-CO2/km) has been assessed. The rigid pavement dominated the contributions as compared to a flexible component. Among the structural elements, the underpass works shared the major portion. Among the materials, the concrete and steel utilized for various structural elements resulted in more than 90% of the impact. The earth-moving equipment was dominant in operational carbon. The results have highlighted that road infrastructure projects pose serious threats to the environment during their construction and which need to be considered during the approval stages. This work provides a guideline for supporting sustainable development that could only be ensured when such endeavours are properly assessed by industry professionals and decide various alternative environmental conscious solutions for the future.

Keywords: construction waste management, kiloton, life cycle assessment, rigid pavement

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6955 Land Use Changes and Impact around Maladumba Lake and Forest Reserve, Nigeria

Authors: M. B. Abdullahi, S. M. Gumel

Abstract:

This study was carried out to analyze and describe biodiversity changes in representative communities around Maladumba Lake and Forest Reserve (MLFR), Bauchi, Nigeria. Primary and secondary data were collected through formal and informal interviews of key informants and survey of local communities and government records. There has been a change in biodiversity; some of the cropping systems have become nonexistent whereas others have developed. The main aspect of the changes has been the decline of species diversity due to degradation and over utilization. The changes have also been positive through the introduction and intensification of cropping system. Options have been open for people to manipulate the cropping systems in order to efficiently use the limited resources. Farmers have opted not only to intensify agricultural practices but also to deliberately restore some of the lost species. Reduction in the number of animals per household, adoption of new techniques of land management, changes in the type of crops cultivated and intensive use of the available resources are some of the indicators describing farmers’ efforts to cope with the changes. Sustainability of the farming system and biodiversity has been enhanced through peoples’ efforts that include planting trees and use of fertilizers.

Keywords: cropping systems, historical trends, household, land management, sustainability

Procedia PDF Downloads 394
6954 Integrating Virtual Reality and Building Information Model-Based Quantity Takeoffs for Supporting Construction Management

Authors: Chin-Yu Lin, Kun-Chi Wang, Shih-Hsu Wang, Wei-Chih Wang

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A construction superintendent needs to know not only the amount of quantities of cost items or materials completed to develop a daily report or calculate the daily progress (earned value) in each day, but also the amount of quantities of materials (e.g., reinforced steel and concrete) to be ordered (or moved into the jobsite) for performing the in-progress or ready-to-start construction activities (e.g., erection of reinforced steel and concrete pouring). These daily construction management tasks require great effort in extracting accurate quantities in a short time (usually must be completed right before getting off work every day). As a result, most superintendents can only provide these quantity data based on either what they see on the site (high inaccuracy) or the extraction of quantities from two-dimension (2D) construction drawings (high time consumption). Hence, the current practice of providing the amount of quantity data completed in each day needs improvement in terms of more accuracy and efficiency. Recently, a three-dimension (3D)-based building information model (BIM) technique has been widely applied to support construction quantity takeoffs (QTO) process. The capability of virtual reality (VR) allows to view a building from the first person's viewpoint. Thus, this study proposes an innovative system by integrating VR (using 'Unity') and BIM (using 'Revit') to extract quantities to support the above daily construction management tasks. The use of VR allows a system user to be present in a virtual building to more objectively assess the construction progress in the office. This VR- and BIM-based system is also facilitated by an integrated database (consisting of the information and data associated with the BIM model, QTO, and costs). In each day, a superintendent can work through a BIM-based virtual building to quickly identify (via a developed VR shooting function) the building components (or objects) that are in-progress or finished in the jobsite. And he then specifies a percentage (e.g., 20%, 50% or 100%) of completion of each identified building object based on his observation on the jobsite. Next, the system will generate the completed quantities that day by multiplying the specified percentage by the full quantities of the cost items (or materials) associated with the identified object. A building construction project located in northern Taiwan is used as a case study to test the benefits (i.e., accuracy and efficiency) of the proposed system in quantity extraction for supporting the development of daily reports and the orders of construction materials.

Keywords: building information model, construction management, quantity takeoffs, virtual reality

Procedia PDF Downloads 132
6953 Data Integrity between Ministry of Education and Private Schools in the United Arab Emirates

Authors: Rima Shishakly, Mervyn Misajon

Abstract:

Education is similar to other businesses and industries. Achieving data integrity is essential in order to attain a significant supporting for all the stakeholders in the educational sector. Efficient data collect, flow, processing, storing and retrieving are vital in order to deliver successful solutions to the different stakeholders. Ministry of Education (MOE) in United Arab Emirates (UAE) has adopted ‘Education 2020’ a series of five-year plans designed to introduce advanced education management information systems. As part of this program, in 2010 MOE implemented Student Information Systems (SIS) to manage and monitor the students’ data and information flow between MOE and international private schools in UAE. This paper is going to discuss data integrity concerns between MOE, and private schools. The paper will clarify the data integrity issues and will indicate the challenges that face private schools in UAE.

Keywords: education management information systems (EMIS), student information system (SIS), United Arab Emirates (UAE), ministry of education (MOE), (KHDA) the knowledge and human development authority, Abu Dhabi educational counsel (ADEC)

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6952 Self-Inflicted Major Trauma: Inpatient Mental Health Management and Patient Outcomes

Authors: M. Walmsley, S. Elmatarri, S. Mannion

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Introduction: Self-inflicted injury is a recognised cause of major trauma in adults and is an independent indicator of a reduced functional outcome compared to non-intentional major trauma. There is little literature available on the inpatient mental health (MH) management of this vulnerable group. A retrospective review was conducted of inpatient MH management of major trauma patients admitted to a UK regional Major Trauma Centre (MTC). Their outcomes were compared to all major trauma patients. This group of patients required multiple MH interventions whilst on the Major Trauma Ward (MTW) and a had worse functional outcome compared to non-intentional trauma. Method: The national TARN (Trauma Audit and Research Network) database was used to identify patients admitted to a regional MTC over a 2-year period from June 2018 to July 2020. Patients with an ISS (Injury Severity Score) of greater than 15 with a mechanism of either self-harm or high-risk behavior were included for further analysis. Inpatient medical notes were reviewed for MH interventions on the MTW. Further outcomes, including mortality, length of stay (LOS) and Glasgow Outcome Score (GOS) were compared with all major trauma patients for the same time period. Results: A total of 60 patients were identified in the time period and of those, 27 spent time on the MTW. A total of 23 (85%) had a prior MH diagnosis, with 11 (41%) under the care of secondary MH services. Adequate inpatient records for review were available for 24 patients. During their inpatient stay, 8 (33%) were reviewed on the ward by the inpatient MH team. There were 10 interventions required for 6 (25%) patients on the MTW including, sections under the Mental Health Act, transfer to specialist MH facility, pharmacological sedation and security being called to the MTW. When compared to all major trauma patients, those admitted due to self-harm or high-risk behavior had a statistically significantly higher ISS (31.43 vs 24.22, p=0.0001) and LOS (23.51d vs 16.06d, p=0.002). Functional outcomes using the GOS were reduced in this group of patients, GOS 5 (low disability) (51.66% vs. 61.01%) and they additionally had a higher level of mortality, GOS 1 (15.00% vs 11.67%). Discussion: Intentional self-harm is a recognised cause of major trauma in adults and this patient group sustains more severe injuries, requiring a longer hospital stay with worse outcomes compared to all major trauma patients. Inpatient MH interventions are required for a significant proportion of these patients and therefore, there needs to be a close relationship with MH services. There is limited available evidence for how this patient group is best managed as an inpatient to aid their recovery and further work is needed on how outcomes in this vulnerable group can be improved.

Keywords: adult major trauma, attempted suicide, self-inflicted major trauma, inpatient management

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6951 Resilience Perspective on Response Strategies for Super-Standard Rain and Flood Disasters: A Case Study of the “Zhengzhou 7.20 Heavy Rain” Event

Authors: Luojie Tang

Abstract:

The article takes the "7.20 Heavy Rainstorm in Zhengzhou" as a starting point, collects relevant disaster data, reproduces the entire process of the disaster, and identifies the main problems exposed by the city in responding to super-standard rain and flood disasters. Based on the review of resilience theory, the article proposes a shift in thinking about the response to super-standard rain and flood disasters from the perspective of resilience, clarifies the differences in the emphasis on resilience at different stages of disasters, and preliminarily constructs a response system for super-standard rain and flood disasters based on the guidance of resilience theory. Finally, combined with the highlighted problems in the 7.20 Heavy Rainstorm in Zhengzhou, the article proposes targeted response strategies from three perspectives: institutional management, technological support, and infrastructure, under the perspective of resilience.

Keywords: resilient city, exceedance-based stormwater management, disaster risk reduction, megalopolis

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6950 Addressing Water Scarcity in Gomti Nagar, Lucknow, India: Assessing the Effectiveness of Rooftop Rainwater Harvesting Systems

Authors: Rajkumar Ghosh

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Water scarcity is a significant challenge in urban areas, even in smart cities (Lucknow, Bangalore, Jaipur, etc.) where efficient resource management is prioritized. The depletion of groundwater resources in Gomti Nagar, Lucknow, Uttar Pradesh, India is particularly severe, posing a significant challenge for sustainable development in the region. This study focuses on addressing the water shortage by investigating the effectiveness of rooftop rainwater harvesting systems (RTRWHs) as a sustainable approach to bridge the gap between groundwater recharge and extraction. The aim of this study is to assess the effectiveness of RTRWHs in reducing aquifer depletion and addressing the water scarcity issue in the Gomti Nagar region. The research methodology involves the utilization of RTRWHs as the primary method for collecting rainwater. RTRWHs will be implemented in residential and commercial buildings to maximize the collection of rainwater. Data for this study were collected through various sources such as government reports, surveys, and existing groundwater abstraction patterns. Statistical analysis and modelling techniques were employed to assess the current water situation, groundwater depletion rate, and the potential impact of implementing RTRWHs. The study reveals that the installation of RTRWHs in the Gomti Nagar region has a positive impact on addressing the water scarcity issue. Currently, RTRWHs cover only a small percentage of the total rainfall collected in the region. However, when RTRWHs are installed in all buildings, their influence on increasing water availability and reducing aquifer depletion will be significantly greater. The study also highlights the significant water imbalance in the region, emphasizing the urgent need for sustainable water management practices. This research contributes to the theoretical understanding of sustainable water management systems in smart cities. By highlighting the effectiveness of RTRWHs in reducing aquifer depletion, it emphasizes the importance of implementing such systems in urban areas. Data for this study were collected through various sources such as government reports, surveys, and existing groundwater abstraction patterns. The collected data were then analysed using statistical analysis and modelling techniques to assess the current water situation, groundwater depletion rate, and the potential impact of implementing RTRWHs. The findings of this study demonstrate that the implementation of RTRWHs can effectively mitigate the water scarcity crisis in Gomti Nagar. By reducing aquifer depletion and bridging the gap between groundwater recharge and extraction, RTRWHs offer a sustainable solution to the region's water scarcity challenges. Widespread adoption of RTRWHs in all buildings and integration into urban planning and development processes are crucial for efficient water management in smart cities like Gomti Nagar. These findings can serve as a basis for policymakers, urban planners, and developers to prioritize and incentivize the installation of RTRWHs as a potential solution to the water shortage crisis.

Keywords: water scarcity, urban areas, smart cities, resource management, groundwater depletion, rooftop rainwater harvesting systems, sustainable development, sustainable water management, mitigating water scarcity

Procedia PDF Downloads 76
6949 Reducing Change-Related Costs in Assembly of Lithium-Ion Batteries for Electric Cars by Mechanical Decoupling

Authors: Achim Kampker, Heiner Hans Heimes, Mathias Ordung, Nemanja Sarovic

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A key component of the drive train of electric vehicles is the lithium-ion battery system. Among various other components, such as the battery management system or the thermal management system, the battery system mostly consists of several cells which are integrated mechanically as well as electrically. Due to different vehicle concepts with regards to space, energy and power specifications, there is a variety of different battery systems. The corresponding assembly lines are specially designed for each battery concept. Minor changes to certain characteristics of the battery have a disproportionally high effect on the set-up effort in the form of high change-related costs. This paper will focus on battery systems which are made out of battery cells with a prismatic format. The product architecture and the assembly process will be analyzed in detail based on battery concepts of existing electric cars and key variety-causing drivers will be identified. On this basis, several measures will be presented and discussed on how to change the product architecture and the assembly process in order to reduce change-related costs.

Keywords: assembly, automotive industry, battery system, battery concept

Procedia PDF Downloads 306
6948 The Hyundai Model: A Self-Sufficient State like Entity Masquerading as a Company

Authors: Nikita Koradia

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Hyundai Motor Company, which started off as a small fish in a big sea, paved its way out successfully and established itself as an independent group from the conglomerate. Hyundai, with its officious power across the globe and particularly in South Korea in the automobile industry, has one the most complex yet fascinating governance structure. Being the second largest contributor to the Gross Domestic Product of South Korea after Samsung and having a market share of 51.3% domestically in automobile industry, Hyundai has faced its part of criticism owing to its anti-labor union approach and owing to its internalization of supply chain management. The censure has been coming from across jurisdictions like China, India, Canada, the EU, etc. The paper focuses on the growth of Hyundai and its inward and outward investment structure. The paper questions the ability of Hyundai to become a mini-state in itself by focusing on its governance structure. The paper further elaborates on its compliance and disclosure regime in the field of Corporate social responsibility and explores how far the business structure adopted by Hyundai works in its favor to become one of the leading automobile contenders in the market.

Keywords: compliance regime, disclosure regime, Hyundai motor company, supply-chain management

Procedia PDF Downloads 118
6947 Factors Affecting Implementation of Construction Health and Safety Regulations, Their Effects and Mitigation Measures in Building Construction Project Sites of Hawassa City

Authors: Tadewos Awugchew Wudineh

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Health and safety issues have always been a major problem and concern in the building construction industry. The health and safety regulations are stated to eliminate the potential hazards and to reduce the consequential risks. However, the importance of the regulations seems to be overlooked in building construction sites of Hawassa City. Accordingly, many companies don’t follow the regulations as construction workers are more likely to be injured and killed by construction accident than any other type of employment. This paper aimed to identify factors that affect the implementation of construction health and safety regulations, their effects and mitigation measures in building construction project sites of Hawassa City. To reach this objective, a review of literature as well as the Ethiopian construction health and safety regulations have been undertaken. Mainly a five-point Likert scale questionnaire was distributed, and statistical analysis was used to summarize, interpret the data, and to find the significances of the responses. In addition, interviews were carried out. Accordingly, the findings indicate that the top factors which affect the implementation of CHS regulations are, availability and development of a clear health and safety policy, health and safety inspections by top management, conducting health and safety training and orientation, provision of healthy and safe working environment and employment of trained safety officers. The study revealed that implementation or non-implementation of CHS regulations have effects on the worker’s productivity, job satisfaction, rate of accidents, and cost greatly. Thus, the suggestion to minimize the impact on worker’s job performance are, developing of a clear health and safety policy, management commitment towards implementation of health and safety regulations, health and safety education and training and conducting regular health and safety inspections. It was concluded from the study that good implementation of health and safety regulations are the results from administrative and management commitment which calls for more attention to be paid to improve the implementation of CHS regulations in building construction sites of Hawassa City.

Keywords: construction health and safety regulations, effects, factors, mitigation

Procedia PDF Downloads 260
6946 Effects of Tenefovir Disiproxil Fumarate on the Renal Sufficiency of HIV Positive Patients

Authors: Londeka Ntuli, Frasia Oosthuizen

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Background: Tenefovir disiproxil fumarate (TDF) is a nephrotoxic drug and has been proven to contribute to renal insufficiency necessitating intensive monitoring and management of adverse effects arising from prolonged exposure to the drug. TDF is one of the preferred first-line drugs used in combination therapy in most regions. There are estimated 300 000 patients being initiated on the Efavirenz/TDF/Emtricitabine first-line regimen annually in South Africa. It is against this background that this study aims to investigate the effects of TDF on renal sufficiency of HIV positive patients. Methodology: A retrospective quantitative study was conducted, analysing clinical charts of HIV positive patient’s older than 18 years of age and on a TDF-containing regimen for more than 1 year. Data were obtained from the analysis of patient files and was transcribed into Microsoft® Excel® spreadsheet. Extracted data were coded, categorised and analysed using STATA®. Results: A total of 275 patient files were included in this study. Renal function started decreasing after 3 months of treatment (with 93.5% patients having a normal EGFR), and kept on decreasing as time progressed with only 39.6% normal renal function at year 4. Additional risk factors for renal insufficiency included age below 25, female gender, and additional medication. Conclusion: It is clear from this study that the use of TDF necessitates intensive monitoring and management of adverse effects arising from prolonged exposure to the drug. The findings from this study generated pertinent information on the safety profile of the drug TDF in a resource-limited setting of a public health institution. The appropriate management is of tremendous importance in the South African context where the majority of HIV positive individuals are on the TDF containing regimen; thus it is beneficial to ascertain the possible level of toxicities these patients may be experiencing.

Keywords: renal insufficiency, tenefovir, HIV, risk factors

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6945 Developing and integrated Clinical Risk Management Model

Authors: Mohammad H. Yarmohammadian, Fatemeh Rezaei

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Introduction: Improving patient safety in health systems is one of the main priorities in healthcare systems, so clinical risk management in organizations has become increasingly significant. Although several tools have been developed for clinical risk management, each has its own limitations. Aims: This study aims to develop a comprehensive tool that can complete the limitations of each risk assessment and management tools with the advantage of other tools. Methods: Procedure was determined in two main stages included development of an initial model during meetings with the professors and literature review, then implementation and verification of final model. Subjects and Methods: This study is a quantitative − qualitative research. In terms of qualitative dimension, method of focus groups with inductive approach is used. To evaluate the results of the qualitative study, quantitative assessment of the two parts of the fourth phase and seven phases of the research was conducted. Purposive and stratification sampling of various responsible teams for the selected process was conducted in the operating room. Final model verified in eight phases through application of activity breakdown structure, failure mode and effects analysis (FMEA), healthcare risk priority number (RPN), root cause analysis (RCA), FT, and Eindhoven Classification model (ECM) tools. This model has been conducted typically on patients admitted in a day-clinic ward of a public hospital for surgery in October 2012 to June. Statistical Analysis Used: Qualitative data analysis was done through content analysis and quantitative analysis done through checklist and edited RPN tables. Results: After verification the final model in eight-step, patient's admission process for surgery was developed by focus discussion group (FDG) members in five main phases. Then with adopted methodology of FMEA, 85 failure modes along with its causes, effects, and preventive capabilities was set in the tables. Developed tables to calculate RPN index contain three criteria for severity, two criteria for probability, and two criteria for preventability. Tree failure modes were above determined significant risk limitation (RPN > 250). After a 3-month period, patient's misidentification incidents were the most frequent reported events. Each RPN criterion of misidentification events compared and found that various RPN number for tree misidentification reported events could be determine against predicted score in previous phase. Identified root causes through fault tree categorized with ECM. Wrong side surgery event was selected by focus discussion group to purpose improvement action. The most important causes were lack of planning for number and priority of surgical procedures. After prioritization of the suggested interventions, computerized registration system in health information system (HIS) was adopted to prepare the action plan in the final phase. Conclusion: Complexity of health care industry requires risk managers to have a multifaceted vision. Therefore, applying only one of retrospective or prospective tools for risk management does not work and each organization must provide conditions for potential application of these methods in its organization. The results of this study showed that the integrated clinical risk management model can be used in hospitals as an efficient tool in order to improve clinical governance.

Keywords: failure modes and effective analysis, risk management, root cause analysis, model

Procedia PDF Downloads 249