Search results for: icu management and care

Authors: Fiona Gibson

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This study is on sustainable capacity building in tourism management of the touristic destination of forts and castles within the Accra Metropolis, of the Greater Accra Region of Ghana, notably, the Christianbough Castle, the James and Ussher Forts. These forts and castle mentioned above have a rich colonial historical past that emerged from the 17th century onwards on the Gulf Coast of Guinea of the West Africa Sub-Region. Unfortunately, apart from the Christianbough Castle, which used to be the seat of government until recently, the environment of James and Ussher Forts are in a deployable state of decay due to years of neglect. Jamestown and Usshertown fishing communities with historical colonial past of a rich touristic heritage sites are predominantly indigenous Gas who speak only the Ga language, one of the languages of the six local languages spoken in Ghana, as a medium for sustainable tourism management. The purpose of this study is to investigate the reasons for years of decay and neglect, using both qualitative and quantitative research approach for individual interviews, to develop a rich picture of life situational story of the people of James and Ussher Forts environs and finding solutions to their predicaments through internal generated funds for sustainability of tourism management within the communities. The study recommends nation-wide educational campaigns and programmes on culture of maintenance and management for sustainable tourism development and management at all historical heritage sites in the country, specifically with the aim of promoting tourism in Ghana, using the indigenous local languages. The study also recommends formal and informal education for the residents, especially the youth to help them learn skills, either through local training or the formal education and this call for collaboration between the government of Ghana and other local and international bodies.

Keywords: sustainable capacity building, tourism management, forts, castles

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Authors: Alokananda Ghosh, Shraban Sarkar

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The study aims to identify suitable sites for new hospitals with critical obstetric care facilities in Birbhum, one of the vulnerable and underserved districts of Eastern India, considering six main and 14 sub-criteria, using GIS-based Analytic Hierarchy Process (AHP) and Multi-Attribute Utility Theory (MAUT) approach. The criteria were identified through field surveys and previous literature. After collecting expert decisions, a pairwise comparison matrix was prepared using the Saaty scale to calculate the weights through AHP. On the contrary, objective weighting methods, i.e., Entropy and Criteria Importance through Interaction Correlation (CRITIC), were used to perform the MAUT. Finally, suitability maps were prepared by weighted sum analysis. Sensitivity analyses of AHP were performed to explore the effect of dominant criteria. Results from AHP reveal that ‘maternal death in transit’ followed by ‘accessibility and connectivity’, ‘maternal health care service (MHCS) coverage gap’ were three important criteria with comparatively higher weighted values. Whereas ‘accessibility and connectivity’ and ‘maternal death in transit’ were observed to have more imprint in entropy and CRITIC, respectively. While comparing the predictive suitable classes of these three models with the layer of existing hospitals, except Entropy-MAUT, the other two are pointing towards the left-over underserved areas of existing facilities. Only 43%-67% of existing hospitals were in the moderate to lower suitable class. Therefore, the results of the predictive models might bring valuable input in future planning.

Keywords: hospital site suitability, analytic hierarchy process, multi-attribute utility theory, entropy, criteria importance through interaction correlation, multi-criteria decision analysis

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Authors: Ilzira A. Minigalieva

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Assessment of cumulative health risks associated with the widely observed combined exposures to two or more metals and their compounds on the organism in industrial or general environment, as well as respective regulatory and technical risk management decision-making have presumably the theoretical and experimental toxicology of mixtures as their reliable scientific basis. Analysis of relevant literature and our own experience proves, however, that there is no full match between these different practices. Moreover, some of the contradictions between them are of a fundamental nature. This unsatisfactory state of things may be explained not only by unavoidable simplifications characteristic of the methodologies of risk assessment and permissible exposure standards setting but also by the extreme intrinsic complexity of the combined toxicity theory, the most essential issues of which are considered and briefly discussed in this paper.

Keywords: toxic metals, nanoparticles, typology of combined toxicity, mathematical modeling, health risk assessment and management

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Authors: Karimeh Alnuaimi, Manal Kassab, Reem Ali, Khitam Mohammad, Kholoud Shattnawi

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Aim: To compare pregnancy outcomes of Syrian refugee women and Jordanian women. Background and introduction: The current conflict in Syria continues to displace thousands to neighboring countries, including Jordan. Pregnant refugee women are therefore facing many difficulties are known to increase the prevalence of poor reproductive health outcomes and antenatal complications. However, there is very little awareness of whether Syrian refugee women have different risks of pregnancy outcomes than Jordanian women. Methods: Using a retrospective cohort design, we examined pregnancy outcomes for Syrian refugee (N = 616) and Jordanian women (N = 644) giving birth at two governmental Hospitals in the north of Jordan, between January 1, 2014, and December 31, 2014. A checklist of 13 variables was utilized. The primary outcome measures were delivery by Caesarean section, maternal complications, low birth weight (< 2500 g), Apgar score and preterm delivery (< 37 weeks' gestational age). Results: Statistical analysis revealed that refugee mothers had a significant increase in the rate of cesarean section and the higher rate of anemia, a lower neonates’ weight, and Apgar scores when compared to their Jordanian counterparts. Discussion and Conclusion: Results were congruent with findings from other studies in the region and worldwide. Minimizing inequalities in pregnancy outcomes between Syrian refugees and Jordan women is a healthcare priority. Implications for nursing and health policy: The findings could guide the planning and development of health policies in Jordan that would help to alleviate the situation regarding refugee populations. The action is required by the policy makers, specifically targeting public and primary health care services, to address the problem of adequately meeting the need for antenatal care of this vulnerable population.

Keywords: pregnancy, Syrian refugee, Jordanian women, comparative study

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Authors: Jules Selles

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The Atlantic and Mediterranean bluefin tuna fishery have been considered as the archetype of an overfished and mismanaged fishery. This crisis has demonstrated the role of public awareness and the importance of the interactions between science and management about scientific uncertainties. This work aims at investigating the policy making process associated with a regional fisheries management organization. We propose a contextualized computer-based experimental approach, in order to explore the effects of key factors on the cooperation process in a complex straddling stock management setting. Namely, we analyze the effects of the introduction of a socio-economic tipping point and the uncertainty surrounding the estimation of the resource level. Our approach is based on a Gordon-Schaefer bio-economic model which explicitly represents the decision making process. Each participant plays the role of a stakeholder of ICCAT and represents a coalition of fishing nations involved in the fishery and decide unilaterally a harvest policy for the coming year. The context of the experiment induces the incentives for exploitation and collaboration to achieve common sustainable harvest plans at the Atlantic bluefin tuna stock scale. Our rigorous framework allows testing how stakeholders who plan the exploitation of a fish stock (a common pool resource) respond to two kinds of effects: i) the inclusion of a drastic shift in the management constraints (beyond a socio-economic tipping point) and ii) an increasing uncertainty in the scientific estimation of the resource level.

Keywords: economic experiment, fisheries management, game theory, policy making, Atlantic Bluefin tuna

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Authors: Fedil Jemal Ahmed

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This conference abstract paper presents a study that aimed to explore the impact of talent management and business skills on performance improvement in mini markets located in Johannesburg and Cape Town, South Africa. Mini markets are small retail stores that play a crucial role in providing essential goods and services to communities. However, due to their small size, they often face significant challenges in terms of resources and management. The study conducted interviews with mini market owners and managers in Johannesburg and Cape Town to understand their approach to talent management, business skills, and their impact on business performance. The results showed that effective talent management practices, including recruitment, training, and retention, along with strong business skills, had a significant positive impact on business performance in mini markets. Furthermore, the study found that the use of technology, such as point of sale systems and inventory management software, can also contribute to business performance improvement in mini markets. The results suggest that mini market owners and managers should prioritize talent management, business skills, and invest in technology to improve their business performance. Comparing the improvements made by mini markets in Johannesburg and Cape Town to those made by others, the study found that the adoption of effective talent management practices and strong business skills were key factors in driving performance improvement. Mini market owners and managers who invested in these areas were better equipped to manage their resources, enhance their customer service, and increase their profitability. When comparing the personal experiences of the fedil jemal who improved their business performance from a small market to a large one, they found that effective talent management practices and strong business skills were crucial in achieving success. Through the adoption of effective talent management practices, the fedil was able to attract and retain top talent, ensuring that the business was managed effectively. Furthermore, the fedil invested in improving their business skills, such as financial management, marketing, and customer service, which helped to increase their revenue and profitability. In terms of technology adoption, the author found that the use of point-of-sale systems and inventory management software were essential in managing their inventory and improving their customer service. By investing in technology, the fedil was able to streamline their operations and enhance their overall business performance. In conclusion, this study provides valuable insights into the importance of talent management, business skills, and technology adoption in improving business performance in mini markets. It highlights the need for mini market owners and managers to prioritize these areas and invest in them to enhance their business performance. The findings of this study have practical implications for mini market owners and managers who are looking to improve their business performance and compete in a highly competitive market. By adopting effective talent management practices, developing strong business skills, and investing in technology, mini market owners and managers can improve their operations and increase their profitability.

Keywords: talent management, business skills, technology adoption, mini markets

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Authors: Abdulaziz Alnajem, Amit Sharma

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Business Case: Project delivery and enhancing activities' completion in the shortest possible time is critical during execution to proceed with the subsequent phases of Procurement, C & C phases of Contracts to have the required Production facilities/Infrastructure in place to achieve the Company strategic objective of 4.0 MBOPD oil production. SOR (Statement of requirement): Design and Engineering phase of Projects execution takes a long time. It is observed that, in most of the cases, company has crossed the Project Design Submittals review time as per the Contract/Company Standards, resulting into delays in projects completion, and cost impact to the company. Study Scope: Scope of the study covers the process from date of first submission of D & E documents by the contractor to final approval by the controlling team to proceed with the procurement of materials. This scope covers projects handled by the company’s project management teams and includes only the internal review process by the company.

Keywords: business management system, project management, oil and gas, analysis, improvement, design, delays

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Authors: Van Son Huynh, Thanh Huan Nguyen, Tat Thien Do, Thi Mai Thu Nguyen, Thien Vu Giang

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Given the necessity for substantial and all-encompassing educational reform, particularly in elementary Education, it is imperative to prioritize learner-centered instruction at the elementary level. This study focuses on the difficulties encountered in overseeing learner-centered instructional activities for elementary school children in Ho Chi Minh City (HCMC), the largest city in Vietnam in terms of population. Although learner-centered solutions have been implemented, there are still certain weaknesses, including an emphasis on content and worries about lax monitoring. The purpose of this study, named "Management of Learner-Centered Teaching Activities for Primary School Students in HCMC," is to enhance and advance theories related to the management of learner-centered teaching activities. The study evaluates the present condition of learner-centered teaching activities and management practices in HCMC, aiming to suggest solutions for improving the efficiency of managing such activities in primary schools.

Keywords: primary school, school children in Ho Chi Minh City, learner-centered instructional activities, learner-centered teaching activities and management.

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Authors: Gavin Quibell, Martin Kleynhans, Margot Soler

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The Sendai Framework notes that disaster risk reduction is essential for sustainable development, and Disaster Risk Reduction is included in 3 of the Sustainable Development Goals (SDGs), and 4 of the SDG targets. However, apart from promoting better governance and resourcing of disaster management agencies, little guidance is given how low-income nations can balance investments across the SDGs to achieve sustainable development in an increasingly climate vulnerable world with increasing prevalence of flood and drought disasters. As one of the world’s poorest nations, Malawi must balance investments across all the SDGs. This paper explores how Malawi’s National Guidelines for Community-based Flood Risk Management integrate sustainable development and flood management objectives at different administrative levels. While Malawi periodically suffers from large, widespread flooding, the greatest impacts are felt through the smaller annual floods and flash floods. The Guidelines address this through principles that recognize that while the protection of human life is the most important priority for flood risk management, addressing the impacts of floods on the rural poor and the economy requires different approaches. The National Guidelines are therefore underpinned by the following; 1. In the short-term investments in flood risk management must focus on breaking the poverty – vulnerability cycle; 2. In the long-term investments in the other SDGs will have the greatest flood risk management benefits; 3. If measures are in place to prevent loss of life and protect strategic infrastructure, it is better to protect more people against small and medium size floods than fewer people against larger floods; 4. Flood prevention measures should focus on small (1:5 return period) floods; 5. Flood protection measures should focus on small and medium floods (1:20 return period) while minimizing the risk of failure in larger floods; 6. The impacts of larger floods ( > 1:50) must be addressed through improved preparedness; 7. The impacts of climate change on flood frequencies are best addressed by focusing on growth not overdesign; and 8. Manage floods and droughts conjunctively. The National Guidelines weave these principles into Malawi’s approach to flood risk management through recommendations for planning and implementing flood prevention, protection and preparedness measures at district, traditional authority and village levels.

Keywords: flood risk management in low-income countries, sustainable development, investments in prevention, protection and preparedness, community-based flood risk management, Malawi

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Authors: S. Masud, J. Merson, D. F. Robinson

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The management of environmental resources requires engagement of a range of stakeholders including public/private agencies and different community groups to implement sustainable conservation practices. The challenge which is often ignored is the analysis of agencies involved and their power relations. One of the barriers identified is the difference in risk perceptions among the agencies involved that leads to disjointed efforts of assessing and managing risks. Wood et al 2012, explains that it is important to have an integrated approach to risk management where decision makers address stakeholder perspectives. This is critical for an effective risk management policy. This abstract is part of a PhD research that looks into barriers to flood management under a changing climate and intends to identify bottlenecks that create maladaptation. Experiences are drawn from international practices in the UK and examined in the context of Australia through exploring the flood governance in a highly flood-prone region in Australia: the Hawkesbury Ne-pean catchment as a case study. In this research study several aspects of governance and management are explored: (i) the complexities created by the way different agencies are involved in assessing flood risks (ii) different perceptions on acceptable flood risk level; (iii) perceptions on community engagement in defining acceptable flood risk level; (iv) Views on a holistic flood risk management approach; and, (v) challenges of centralised information system. The study concludes that the complexity of managing a large catchment is exacerbated by the difference in the way professionals perceive the problem. This has led to: (a) different standards for acceptable risks; (b) inconsistent attempt to set-up a regional scale flood management plan beyond the jurisdictional boundaries: (c) absence of a regional scale agency with license to share and update information (d) Lack of forums for dialogue with insurance companies to ensure an integrated approach to flood management. The research takes the Hawkesbury-Nepean catchment as case example and draws from literary evidence from around the world. In addition, conclusions were extrapolated from eighteen semi-structured interviews from agencies involved in flood risk management in the Hawkesbury-Nepean catchment of NSW, Australia. The outcome of this research is to provide a better understanding of complexity in assessing risks against a rapidly changing climate and contribute towards developing effective risk communication strategies thus enabling better management of floods and achieving increased level of support from insurance companies, real-estate agencies, state and regional risk managers and the affected communities.

Keywords: adaptive governance, flood management, flood risk communication, stakeholder risk perceptions

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Authors: A. F. Jaber, E. Dean, M. Liu, J. He, D. Sabata, J. Radel

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Background: Stroke is a serious health care concern and a major cause of disability in the United States. This condition impacts the individual’s functional ability to perform daily activities. Predicting functional performance of people with stroke assists health care professionals in optimizing the delivery of health services to the affected individuals. The purpose of this study was to identify significant predictors of Motor FIM and of Cognitive FIM subscores among individuals with stroke after discharge from inpatient rehabilitation (typically 4-6 weeks after stroke onset). A second purpose is to explore the relation among personal characteristics, health status, and functional performance of daily activities within 2 weeks of stroke onset. Methods: This study used a retrospective chart review to conduct a secondary analysis of data obtained from the Healthcare Enterprise Repository for Ontological Narration (HERON) database. The HERON database integrates de-identified clinical data from seven different regional sources including hospital electronic medical record systems of the University of Kansas Health System. The initial HERON data extract encompassed 1192 records and the final sample consisted of 207 participants who were mostly white (74%) males (55%) with a diagnosis of ischemic stroke (77%). The outcome measures collected from HERON included performance scores on the National Institute of Health Stroke Scale (NIHSS), the Glasgow Coma Scale (GCS), and the Functional Independence Measure (FIM). The data analysis plan included descriptive statistics, Pearson correlation analysis, and Stepwise regression analysis. Results: significant predictors of discharge Motor FIM subscores included age, baseline Motor FIM subscores, discharge NIHSS scores, and comorbid electrolyte disorder (R2 = 0.57, p <0.026). Significant predictors of discharge Cognitive FIM subscores were age, baseline cognitive FIM subscores, client cooperative behavior, comorbid obesity, and the total number of comorbidities (R2 = 0.67, p <0.020). Functional performance on admission was significantly associated with age (p < 0.01), stroke severity (p < 0.01), and length of hospital stay (p < 0.05). Conclusions: our findings show that younger age, good motor and cognitive abilities on admission, mild stroke severity, fewer comorbidities, and positive client attitude all predict favorable functional outcomes after inpatient stroke rehabilitation. This study provides health care professionals with evidence to evaluate predictors of favorable functional outcomes early at stroke rehabilitation, to tailor individualized interventions based on their client’s anticipated prognosis, and to educate clients about the benefits of making lifestyle changes to improve their anticipated rate of functional recovery.

Keywords: functional performance, predictors, stroke, recovery

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Authors: Ayeshmanthe Rathnayake, Ashutosh Hardikar

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Introduction: Lung cancer is the most common cause of cancer death in Australia, with more than 13000 cases per year. Until now, there has been a major deficiency of national comprehensive thoracic surgery data. The thoracic workload for surgeons as well as caseload per unit, is highly variable, with some centres performing less than 15 cases per annum, thus raising concerns about optimal care at low-volume sites. This is an attempt to review the outcomes of lung cancer surgery in Tasmania. Method: The objective of this study is to determine the surgical outcomes of lung cancer surgery at Royal Hobart Hospital (RHH) with the primary outcome of surgical mortality. Four hundred fifty-one cases were analysed retrospectively from 2010 to May 2022. Results: A total of 451 patients underwent thoracic surgery with a primary diagnosis of lung cancer. The primary outcome of 30-day mortality was <0.5%. The mean age was 65.3 years, with male predominance and a 4.2% prevalence of Indigenous Australians. The mean LOS was 7.5 days. The surgical approach was either VATS (50.3%) or Thoracotomy (49.7%), with a trend towards the former in recent years with an increase in the proportion of VATS from 18.2% to 51% (p<0.05) in complex resections since 2019. A corresponding reduction in conversion rate to open was observed (18% vs. 5.5%), and there were no deaths within this subgroup. Lung resections were divided into lobectomy (55.4%), wedge resection (36.8%), segmentectomy (2.9%) and pneumonectomy (4.9%). The RHH demonstrates good surgical outcomes for lung cancer and provides a sustainable service for Tasmania. Conclusion: This retrospective study reports the surgical outcomes of lung cancer surgery at the Royal Hobart Hospital, thereby providing insight into the surgical management of lung cancer in the state thus far. The state has been slow to catch up on the minimally invasive program, but the overall results have been comparable to most peers.

Keywords: lung cancer, thoracic surgery, lung resection, surgical outcomes

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Authors: Shekoufeh Behdad, Amirhossein Yadegari, Leila Ghodrati, Saman Yadegari

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Context: Preoperative anxiety is a common psychological reaction experienced by all patients undergoing surgery. It can have negative effects on the patient's well-being and even impact surgical outcomes. Therefore, finding effective interventions to reduce preoperative anxiety is important in improving patient care. Research Aim: The aim of this study is to compare the effects of oral administration of zaleplon (5 mg) and alprazolam (0.5 mg) on preoperative anxiety levels in women undergoing gynecological abdominal surgery. Methodology: This study is a double-blind, randomized clinical trial conducted after receiving approval from the university's ethics committee and obtaining written informed consent from the patients. The night before the surgery, patients were randomly assigned to receive either 0.5 mg of alprazolam or 5 mg of zaleplon orally. Anxiety levels, measured using a 10-cm visual analog scale, and hemodynamic variables (blood pressure and heart rate) were assessed before drug administration and on the morning of the operation after the patient entered the pre-operation room. Findings: The study found that there were no significant differences in mean anxiety levels or hemodynamic variables before and after administration of either drug in both groups (P value > 0.05). This suggests that both 0.5 mg of alprazolam and 5 mg of zaleplon effectively reduce preoperative anxiety in women undergoing abdominal surgery without serious side effects. Theoretical Importance: This study contributes to the understanding of the effectiveness of alprazolam and zaleplon in reducing preoperative anxiety. It adds to the existing literature on pharmacological interventions for anxiety management, specifically in the context of gynecological abdominal surgery. Data Collection: Data for this study were collected through the assessment of anxiety levels using a visual analog scale and measuring hemodynamic variables, including systolic, diastolic, and mean arterial blood pressures, as well as heart rate. These measurements were taken before drug administration and on the morning of the surgery. Analysis Procedures: Statistical analysis was performed to compare the mean anxiety levels and hemodynamic variables before and after drug administration in the two groups. The significance of the differences was determined using appropriate statistical tests. Questions Addressed: This study aimed to answer the question of whether there are differences in the effects of alprazolam and zaleplon on preoperative anxiety levels in women undergoing gynecological abdominal surgery. Conclusion: The oral administration of both 0.5 mg of alprazolam and 5 mg of zaleplon the night before surgery effectively reduces preoperative anxiety in women undergoing abdominal surgery. These findings have important implications for the management of preoperative anxiety and can contribute to improving the overall surgical experience for patients.

Keywords: zaleplon, alprazolam, premedication, abdominal surgery

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Authors: W. Schellong

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Industry accounts for one-third of global final energy demand. Crossover technologies (e.g. motors, pumps, process heat, and air conditioning) play an important role in improving energy efficiency. These technologies are used in many applications independent of the production branch. Especially electrical power is used by drives, pumps, compressors, and lightning. The paper demonstrates the algorithm of the energy analysis by some selected case studies for typical industrial processes. The energy analysis represents an essential part of energy management systems (EMS). Generally, process control system (PCS) can support EMS. They provide information about the production process, and they organize the maintenance actions. Combining these tools into an integrated process allows the development of an energy critical equipment strategy. Thus, asset and energy management can use the same common data to improve the energy efficiency.

Keywords: crossover technologies, data management, energy analysis, energy efficiency, process control

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Authors: Zubair Ahmad

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The aim of this study is to analyze the risks factors and issues with waste management in developing nations as barriers. Depending on their content and categorization, wastes are managed differently. Waste management strategies differ for liquid, solid, and organic wastes. The final stage of trash disposal entails procedures like burning, interment, recycling, and treatment. Due to the rising creation of solid waste, the growing urban population has a magnified impact on the environment and public health. All regions, but especially informal urban neighborhoods, tribal villages, and official rural settlements have a protracted backlog in waste services. Another significant impediment seen in the developing world is a lack of education and awareness of effective waste-management practices. Unauthorized dumpsites pose a serious risk to the environment since they could contain dangerous elements like radioactive, infectious, and toxic waste. Wealthier individuals are more inclined to think that their actions will have an impact on environmental problems and to act to address them. Waste managers need to take action to make sure the public is given information that is consistent with what they currently know. The results of the data analysis conducted with the aid of the various methodologies discussed in the preceding chapter are presented in this chapter by the researcher. Descriptive analysis has been used in research to determine whether or not there are relationships between variables and to determine the importance of the variables. According to a survey, there are no efforts being made to lessen the odor that garbage dump sites emit (in terms of treating or recycling the material placed at dumpsite) This might be the case since respondents only commented on the waste management conditions in their immediate surroundings and may not have fully understood the steps taken to resolve this issue.

Keywords: risk factor of waste material, lack of awareness, developing countries struggles, waste management

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Authors: Arsalan Memon

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There are many challenges that a caregiver faces in average everyday life. One such challenge is coping with the stress and negative emotions of caregiving. The Stoics (i.e. Lucius Annaeus Seneca [4 B.C.E. - 65 C.E.], Epictetus [50-135 C.E.], and Marcus Aurelius [121-180 C.E.]) have provided coping techniques that are useful for dealing with stress and negative emotions. This paper lists and explains some of the fundamental coping techniques provided by the Stoics. For instance, some Stoic coping techniques thus follow (the list is far from exhaustive): a) mindfulness: to the best of your ability, constantly being aware of your thoughts, habits, desires, norms, memories, likes/dislikes, beliefs, values, and of everything outside of you in the world (b) constantly adjusting one’s expectations in accordance with reality, c) memento mori: constantly reminding oneself that death is inevitable and that death is not to be seen as evil, and d) praemeditatio malorum: constantly detaching oneself from everything that is so dear to one so that the least amount of suffering follows from the loss, damage, or ceasing to be of such entities. All coping techniques will be extracted from the following original texts by the Stoics: Seneca’s Letters to Lucilius, Epictetus’ Discourses and the Encheiridion, and Marcus Aurelius’ Meditations. One major finding is that the usefulness of each Stoic coping technique can be empirically tested by anyone in the sense of applying it one’s own life especially when one is facing real-life challenges. Another major finding is that all of the Stoic coping techniques are predicated upon, and follow from, one fundamental principle: constantly differentiate what is and what is not in one’s control. After differentiating it, one should constantly habituate oneself in not controlling things that are beyond one’s control. For example, the following things are beyond one’s control (all things being equal): death, certain illnesses, being born in a particular socio-economic family, etc. The conclusion is that if one habituates oneself by practicing to the best of one’s ability both the fundamental Stoic principle and the Stoic coping techniques, then such a habitual practice can eventually decrease the stress and negative emotions that one experiences by being a caregiver.

Keywords: care-giving, coping techniques, negative emotions, stoicism, stress

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Authors: Jemini Vyas, Oluwatobi Adeyoe, Jenny Branagan, Chandran Tanabalan, John Beatty, Aakash Pai

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Introduction: The development of robotic surgery has accelerated centralisation to tertiary centres, where robotic radical prostatectomy (RP) is offered. The purpose of concentrating treatment in high volume specialist centres is to improve the quality of care and patient outcomes. The aim of this study was to assess the impact on clinical outcomes of centralisation for locally diagnosed patients undergoing RP. Methods: Clinical outcomes for 169 consecutive laparoscopic & open RP pre-centralisation were retrospectively compared with 50 consecutive robotic RP conducted over a similar period post-centralisation. Preoperative risk stratification and time to surgery were collected. Perioperative outcomes, including length of stay (LOS) and complications, were collated. Post-operative outcomes, including erectile dysfunction (ED), biochemical recurrence (BCR), and urinary continence, were assessed. Results: Preoperative risk stratification showed no difference between the two groups. The median time from diagnosis to treatment was similar between the two groups (pre-centralisation, 121 days, post-centralisation, 117 days). The mean length of stay (pre-centralisation, 2.1 days, post-centralisation, 1.6 days) showed no significant difference (p=0.073). Proportion of overall complications (pre-centralisation, 11.4%, post-centralisation, 8.7%) and complications, above Clavien-Dindo 2, were similar between the two groups (pre-centralisation1.2%, post-centralisation 2.2%). Post operative functional parameters, including continence and ED, were comparable. Five-year BCR free rate was 78% for the pre-centralisation group and 79% for the post centralisation group. Conclusion: For our cohort of patients, clinical outcomes have remained static during centralisation. It is imperative that centralisation is accompanied by increased capacity, streamlining of pathways, and training to ensure that improved quality of care is achieved. Our institution has newly acquired a robot, and prospectively studying this data may support the reversal of centralisation for RP surgery.

Keywords: prostate, cancer, prostatectomy, clinical

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Authors: Dina Muharib

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Specific metabolic challenges are present following spinal cord injury. The acute stage is characterized by a reduction in metabolic activity, as well as a negative nitrogen balance that cannot be corrected, even with aggressive nutritional support. Metabolic demands need to be accurately monitored to avoid overfeeding. Enteral feeding is the optimal route following SCI. When oral feeding is not possible, nasogastric, followed by nasojejunal, then by percutaneous endoscopic gastrostomy, if necessary, is suggested.

Keywords: SCI, energy, protein, nutrition assessment, eneral feeding, nitrogen balance

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Authors: Trang Pham

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Approximately 70% of the Vietnamese population lives in rural areas where the main livelihood is farming. For many years, the Vietnamese Government has been working towards improving farmers’ quality of life. In 2008, the Government issued the decree 115/2008/ND-CP to subsidize farmers’ water fees. The subsidy covers operation and management costs of major water infrastructure. Water users have only to pay for the operation and management of minor or tertiary canal systems. But the “subsidized water fee” has become contentious; there are two opposing schools of thought. One view is that the subsidy lessens the burden on farmers in terms of reducing their production costs, at the same time generating a sufficient budget for Irrigation Management Companies (IMCs) and Water User Association (WUAs). The alternate point of view is that the subsidy negatively effects irrigation performance, especially in tertiary canals. The aim of this study was to gain clear awareness of the perceptions of farmers, WUA members, and IMC staffs in regard to irrigation performance and management since the introduction of subsidies and local water fees. In order to find out how the government intervention has affected local farming communities, a series of questionnaires and interviews were administered in 2013. Four case studies were chosen which represent four different agricultural areas and four different irrigation systems in Vietnam. Interviews were conducted with IMC staffs and WUA members and questionnaires were used to gather information from farmers. The study compares the difference in operation and management costs across the four case studies both before and after the implementation of the decree. The results disclose factors behind the subsidized water fee that either allow or hinder improved irrigation performance and better irrigation management.

Keywords: water fee, irrigation performance, local farming, tertiary canal systems

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Authors: Muhammad Nouman, Fahad Tiwana, Muhammad Irfan, Mohsin Tiwana

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Traffic congestion has been increasing significantly in major metropolitan areas as a result of increased motorization, urbanization, population growth and changes in the urban density. Traffic congestion compromises efficiency of transport infrastructure and causes multiple traffic concerns; including but not limited to increase of travel time, safety hazards, air pollution, and fuel consumption. Traffic management has become a serious challenge for federal and provincial governments, as well as exasperated commuters. Effective, flexible, efficient and user-friendly traffic information/database management systems characterize traffic conditions by making use of traffic counts for storage, processing, and visualization. While, the emerging data collection technologies continue to proliferate, its accuracy can be guaranteed through the comparison of observed data with the manual handheld counters. This paper presents the design of tablet based manual traffic counting application and framework for development of traffic database management system for Pakistan. The database management system comprises of three components including traffic counting android application; establishing online database and its visualization using Google maps. Oracle relational database was chosen to develop the data structure whereas structured query language (SQL) was adopted to program the system architecture. The GIS application links the data from the database and projects it onto a dynamic map for traffic conditions visualization. The traffic counting device and example of a database application in the real-world problem provided a creative outlet to visualize the uses and advantages of a database management system in real time. Also, traffic data counts by means of handheld tablet/ mobile application can be used for transportation planning and forecasting.

Keywords: manual count, emerging data sources, traffic information quality, traffic surveillance, traffic counting device, android; data visualization, traffic management

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Authors: Pei-Fan Mu

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Background: Lung cancer is the most common cancer with the highest mortality rate. Patients with lung cancer under chemotherapy treatment experience life-threatening uncertainty. This study was based on the broaden-and-build theory using intentionality reflection of the body and internalization of positive prioritization strategies to enhance positive emotions of patients with lung cancer. Purpose: The purpose of this study was to use a quasi-experimental research design to examine the effectiveness of the enhancing positive emotion program. Method: Data were collected from a medical center in Taiwan. Fifty-four participants with lung cancer were recruited. Thirty participants were in the experiential group receiving the two weeks program. The content of the program includes awareness and understanding of the symptom experience, co-existing with illness and establishing self-identity, cognitive-emotion adjustment and establishing a new body schema, and symptom management to reach spiritual well-being. Twenty-four participants were in the control group receiving regular nursing care. Baseline, one month later and two months later, programmed measurements of symptoms of distress, positive emotion, and psychological well-being. Results: These two weeks of enhancing the positive emotion program resulted in a significantly improved positive emotion score for the experimental group compared to the control group. The findings of this study indicated that the positive emotion had significant differences between the two groups. There were no differences in symptom distress between the two groups. Discussion: The findings indicated that the enhancing positive emotion program could help patients enhance their life-threatening facing conditions.

Keywords: positive emotion, lung cancer, experimental design, symptom distress

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Authors: Marine Kobalava

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Introduction. The paper substantiates the crucial role of anti-crisis PR in managing the image and reputation of companies. The critical situation caused by the Covid-19 virus in various countries of the world and the actions taken have had a significant negative impact on the image of companies and public groups. The mentioned circumstance has caused some problems for companies’ products in terms of customer demand. Accordingly, the main goal of PR has become to achieve the optimal relationship between companies and society with effective management. It should also be taken into account that the range of action of PR in crisis situations is much wider than that of advertising. In the paper, Public Relations is evaluated as a determining factor of the companies' prestige, its reliability, which has a decisive effect on the goodwill, trust, and general reputation of the public towards the company. The purpose of the study is to reveal the challenges of anti-crisis PR in Georgian companies and to develop recommendations on effective management mechanisms. Methodologies. Analysis, induction, synthesis, and other methods are used in the paper; Matrix and SWOT analysis are constructed. Ways of establishing and implementing an anti-crisis PR system in companies are proposed. The main aspects of anti-crisis management are identified by using the matrix of the choice of diversification strategy of the companies' activities, the possibilities of making adequate decisions using PR are studied according to the characteristics of the companies' activities and priority directions. Conclusion. The paper draws conclusions on modern problems of anti-crisis PR, offers recommendations on ways to solve it through PR strategies.

Keywords: anti-crisis PR, effective management, company, PR strategy

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Authors: Rajlakshmi Guha, Sajjad Ansari, Shazia Nasreen, Hirak Banerjee, Jiaul Paik

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Dyslexia is a neurocognitive disorder, affecting around fifteen percent of the Indian population. The symptoms include difficulty in reading alphabet, words, and sentences. This can be difficult at the phonemic or recognition level and may further affect lexical structures. Therapeutic intervention of dyslexic children post assessment is generally done by special educators and psychologists through one on one interaction. Considering the large number of children affected and the scarcity of experts, access to care is limited in India. Moreover, unavailability of resources and timely communication with caregivers add on to the problem of proper intervention. With the development of Educational Technology and its use in India, access to information and care has been improved in such a large and diverse country. In this context, this paper proposes an ICT enabled home-based intervention program for dyslexic children which would support the child, and provide an interactive interface between expert, parents, and students. The paper discusses the details of the database design and system layout of the program. Along with, it also highlights the development of different technical aids required to build out personalized android applications for the Indian dyslexic population. These technical aids include speech database creation for children, automatic speech recognition system, serious game development, and color coded fonts. The paper also emphasizes the games developed to assist the dyslexic child on cognitive training primarily for attention, working memory, and spatial reasoning. In addition, it talks about the specific elements of the interactive intervention tool that makes it effective for home based intervention of dyslexia.

Keywords: Android applications, cognitive training, dyslexia, intervention

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Authors: Brenda Margaret Behan

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Kenya is a water-stressed country with highly varied socio-ecological environments in its devolved county system, and is currently implementing a polycentric water governance system; this paper examines the importance of social capital in community-based natural resource management and its role in supporting good water governance systems in the Kenya context. Through a robust literature review of theory and case studies, specific aspects of social capital are examined to determine their importance in the implementation of local community-based water management arrangements which support and complement the more formal institutions outlined in the 2002 and 2016 Water Acts of Kenya. Water is an increasingly important and scarce resource not only for Kenya, but for many communities across the globe, and lessons learned in the Kenya context can be useful for other countries and communities faced with similar challenges. Changing climates, increasing populations, and increased per capita consumption of water is contributing to a situation in which the management of water resources will be vital to community resilience. Community-based natural resource management is widely recognized as a building block and component of wider water resource management systems, and when properly conducted can provide a way to enable sustainable use of resources and empower communities. Greater attention to the social and cultural norms and traditional institutions associated with a community’s social capital can lead to better results for Kenya’s polycentric governance of water. The key findings and recommendations from this research show that in Kenya, traditional institutions need to be understood and integrated into governance systems; social values and cultural norms have a significant impact on the implementation of community-based water management efforts; and social capital is a dynamic concept which influences and is influenced by policies and practices. The community-based water management approach will continue to be a key cornerstone for Kenya’s polycentric water governance structure, especially in the more remote arid and semi-arid lands; thus, the successful integration of social capital aspects into planning and implementation will contribute to a strengthened, sustainable, and more equitable national water governance system. Specific observations and recommendations from this study will help practitioners and policymakers to better craft community-based interventions.

Keywords: community-based natural resource management, social capital, traditional institutions, water governance

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Authors: Nam Kyu Kim, Hee Jun Cha, Jae Jin Seo, Dong Jun Won

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Output power of a photovoltaic (PV) generator depends on incident solar irradiance. If the clouds pass or the climate condition is bad, the PV output fluctuates frequently. When PV generator is connected to the grid, these fluctuations adversely affect power quality. Thus, ramp rate control with battery energy storage system (BESS) is needed to reduce PV output fluctuations. At the same time, for effective BESS operation and sizing the optimal BESS capacity, managing state of charge (SOC) is the most important part. In addition, managing SOC helps to avoid violating the SOC operating range of BESS when performing renewable integration (RI) continuously. As PV and BESS increase, the SOC management of BESS will become more important in the future. This paper presents the SOC management algorithm which helps to operate effectively BESS, and has focused on method to manage SOC while reducing PV output fluctuations. A simulation model is developed in PSCAD/EMTDC software. The simulation results show that the SOC is maintained within the operating range by adjusting the output distribution according to the SOC of the BESS.

Keywords: battery energy storage system, ramp rate control, renewable integration, SOC management

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Authors: T. Elrazaz

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This paper examines accrual and real earnings management by publicly listed targets around mergers and acquisitions. Prior literature shows that earnings management around mergers and acquisitions can have a significant economic impact because of the associated wealth transfers among stakeholders. More importantly, acting on behalf of their shareholders or pursuing their self-interests, managers of both targets and acquirers may be equally motivated to manipulate earnings prior to an acquisition to generate higher gains for their shareholders or themselves. Building on the grounds of information asymmetry, agency conflicts, stewardship theory, and the revelation principle, this study addresses the question of whether takeover targets employ accrual and real earnings management in the periods prior to the announcement of Mergers and Acquisitions (M&A). Additionally, this study examines whether acquirers are able to detect targets’ earnings management, and in response, adjust the acquisition premium paid in order not to face the risk of overpayment. This study uses an aggregate accruals approach in estimating accrual earnings management as proxied by estimated abnormal accruals. Additionally, real earnings management is proxied for by employing widely used models in accounting and finance literature. The results of this study indicate that takeover targets manipulate their earnings using accruals in the second year with an earnings release prior to the announcement of the M&A. Moreover, in partitioning the sample of targets according to the method of payment used in the deal, the results are restricted only to targets of stock-financed deals. These results are consistent with the argument that targets of cash-only or mixed-payment deals do not have the same strong motivations to manage their earnings as their stock-financed deals counterparts do additionally supporting the findings of prior studies that the method of payment in takeovers is value relevant. The findings of this study also indicate that takeover targets manipulate earnings upwards through cutting discretionary expenses the year prior to the acquisition while they do not do so by manipulating sales or production costs. Moreover, in partitioning the sample of targets according to the method of payment used in the deal, the results are restricted only to targets of stock-financed deals, providing further robustness to the results derived under the accrual-based models. Finally, this study finds evidence suggesting that acquirers are fully aware of the accrual-based techniques employed by takeover targets and can unveil such manipulation practices. These results are robust to alternative accrual and real earnings management proxies, as well as controlling for the method of payment in the deal.

Keywords: accrual earnings management, acquisition premium, real earnings management, takeover targets

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Authors: Adegoriola Mayowa I., Lai Joseph H. K., Yung Esther H. K., Chan Edwin H. K.

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Heritage buildings (HBs) as structures with historical and architectural relevance that form an integral part of contemporary society. These buildings deserve to be protected for as long as possible to retain their significance. Therefore, the need to prioritize HB maintenance management is pertinent. However, the decision-making process of HBMM can be relatively daunting. The decision-making challenge may be attributed to the multiple 'stakeholders' expectation and requirement which needs to be met. To this end, professionals in the built environment have identified the need to apply the strategic concept of facilities management (FM) in decision making. Furthermore, the different maintenance dimensions have been applied to maintenance management of residential, commercial, and health facilities. Unfortunately, these different maintenance approaches, such as FM, sustainable FM, urban FM, green FM, and strategic FM, are yet to be fully explored in the decision-making process of HBMM. To bridge this gap, this study focuses on developing a framework for strategic decision-making HBMM, which helps achieve HBMM sustainability. At the study's inception, relevant works of literature in the domains of HBMM and FM were conducted. This review helped in the identification of contemporary maintenance practices and their applicability to HBMM. Afterward, a conceptual framework to aid decision-making in HBMM was developed. This framework integrated the concept of FM scope (people, place, process, and technology) while ensuring that decisions plans were made at strategic, tactical, and operational levels. Also, the different characteristics of HBs and stakeholders' requirements were considered in the framework. The conceptual framework presents a holistic guide for professionals in HBMM to ensure that decision processes and outcomes are practical and efficient. It also contributes to the existing body of knowledge on the integration of FM in HBMM. Furthermore, it will serve as a basis for future studies by applying the conceptualized framework in actual cases.

Keywords: decision-making, facility management, strategy, sustainability, heritage building, maintenance

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Authors: Marinko Maslaric, Maja Jokic

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When searching for fast and long term responses, sustainable logistics and supply chain applications have developed irrefutable theories and hypotheses towards market requirements. Nevertheless, there are certain misunderstandings on how the implementation of sustainability principles (social, economical, and environmental) and concepts should work in practice, more specifically, within a humanitarian supply chain management context. This paper will focus on the review and analysis of risk management concepts in humanitarian supply chain in order to identify their compliance with sustainable principles. In this direction, the study will look for strategies that suggest: minimization of environmental impacts throughout the reduction of resources consumption, depreciation of logistics costs, including supply chain ones, minimization of transportation and service costs, elaboration of quality performance of supply chain and logistics, and reduction of supply chain delivery time. On the side of meeting all defense, trades and humanitarian logistics needs, the research will be aligned to UN Sustainable Development Goals, standards, and performances. It will start with relevant strategies for identification of risk indicators and it will end with suggestion of valuable strategic approaches for their minimization or total prevention. Finally, a content analysis will propose a suitable methodological structure for the creation of most sustainable strategy in risk management of humanitarian supply chain. Content analysis will accompany thorough, consistent and methodical approach of literature review for potential disaster risk management plan. Thereupon, the propositions of this research will look for contemporary literature gaps, with respect to operate the literature analysis and to suggest the appropriate sustained risk low master plan. The indicated is here to secure the high quality of logistics practices in hazardous events.

Keywords: humanitarian logistics, sustainability, supply chain risk, risk management plan

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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: Mohammad S. Razai, Jan Williams, Rachel Nestel, Dermot Dalton

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Purpose: This descriptive qualitative study aimed to obtain parents recommendations for improving the notification process and communication of positive newborn screening result for cystic fibrosis (CF). Methods: Thematic analysis of semi-structured open-ended interviews with 11 parents of 7 children with confirmed diagnosis of CF between 2 months — 2 years of age. Results: Parents preferred face to face disclosure of positive NBS results by a pediatrician with CF professional qualification. They trusted a pediatrician more than any other professional in providing accurate, credible and comprehensive information about the diagnosis and its implications. Parents recommended that health professionals be knowledgeable and provide clear, succinct and understandable information. Providers should also explore parents concerns and acknowledge feelings and emotions. Most parents reported that they preferred to be notified immediately as soon as the results were available. Several parents preferred to be told once the diagnosis was certain. Most parents regarded open access to CF team as the most significant part of care coordination. In addition to health professionals, most parents used internet as an important source of information, interaction and exchange of experiences. Most parents also used social networking sites such as Facebook groups and smart phone apps. Conclusion: This study provides significant new evidence from parental perspective in emphasizing the pivotal role of good communication skills deployed by a knowledgeable CF specialist in person. Parents use of social media and internet has replaced some traditional methods of information exchange and may reduce the need for professional input for newly diagnosed CF patients.

Keywords: care coordination, cystic fibrosis, newborn screening, notification process, parental preferences, professional-paren communication

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