Search results for: arterial compliance
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 914

Search results for: arterial compliance

764 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

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763 Evaluation of Traffic Noise Level: A Case Study in Residential Area of Ishbiliyah , Kuwait

Authors: Jamal Almatawah, Hamad Matar, Abdulsalam Altemeemi

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The World Health Organization (WHO) has recognized environmental noise as harmful pollution that causes adverse psychosocial and physiologic effects on human health. The motor vehicle is considered to be one of the main source of noise pollution. It is a universal phenomenon, and it has grown to the point that it has become a major concern for both the public and policymakers. The aim of this paper, therefore, is to investigate the Traffic noise levels and the contributing factors that affect its level, such as traffic volume, heavy-vehicle Speed and other metrological factors in Ishbiliyah as a sample of a residential area in Kuwait. Three types of roads were selected in Ishbiliyah expressway, major arterial and collector street. The other source of noise that interferes the traffic noise has also been considered in this study. Traffic noise level is measured and analyzed using the Bruel & Kjaer outdoor sound level meter 2250-L (2250 Light). The Count-Cam2 Video Camera has been used to collect the peak and off-peak traffic count. Ambient Weather WM-5 Handheld Weather Station is used for metrological factors such as temperature, humidity and wind speed. Also, the spot speed was obtained using the radar speed: Decatur Genesis model GHD-KPH. All the measurement has been detected at the same time (simultaneously). The results showed that the traffic noise level is over the allowable limit on all types of roads. The average equivalent noise level (LAeq) for the Expressway, Major arterial and Collector Street was 74.3 dB(A), 70.47 dB(A) and 60.84 dB(A), respectively. In addition, a Positive Correlation coefficient between the traffic noise versus traffic volume and between traffic noise versus 85th percentile speed was obtained. However, there was no significant relation and Metrological factors. Abnormal vehicle noise due to poor maintenance or user-enhanced exhaust noise was found to be one of the highest factors that affected the overall traffic noise reading.

Keywords: traffic noise, residential area, pollution, vehicle noise

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762 Efficiency of Nutritional Support Treatments in Children With Failure to Thrive

Authors: Mehves Isiklar Ekici, Ceyda Tuna Kirsaclioglu, Zarife Kuloglu, Aydan Kansu

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Malnutrition is an important cause of morbidity and mortality as it accounts for 45% of child deaths under the age of 5 worldwide. Therefore, early recognition and effective treatment of failure to thrive and malnutrition are important. In this study, it was aimed to retrospectively evaluate the nutritional support treatment approaches (nutrition education and diet enrichment / use of enteral nutrition products) applied in children followed up with growth failure without underlying organic causes, and to compare the efficacy of nutritional support treatments. In this study, children aged 1 month to 18 years diagnosed with growth failure who were followed up for at least 12 months between January 2011 and February 2020, were included. Anthropometric measurements at baseline and during follow-up, type of nutritional support therapy and treatment compliance were evaluated based on the retrospective records. 119 children (median age:3.2, 69 girls) were included in the study. Nutrition education and dietary enrichment were provided to 28% of the patients (Group 1). In addition to dietary education and recommendations, enteral nutrition supplements was given in 78% of them (Group 2). Compliance to the treatment rates of the patients in Group 1 and Group 2 were not significantly different at both 6th and 12th month controls. At the end of the follow up children who comply with the treatment in Group 1 had significant increase in weight for age z scores (-1.74 vs 0.05, respectively, p=0.019) and body mass index z scores (-1.47 vs -0.53, respectively, p=0.034) compared with baseline measurements. Similar to Group 1, in Group 2 children with treatment compliance, had a significant increase in weight for age z scores (-2.24 vs. -0.54, respectively, p=0.00) and body mass index z scores (-2.27 vs. -1.06, respectively, p=0.00) compared with baseline measurements. The rate of patients with severe malnutrition decreased from 15% to 12%, for moderate malnutrition decreased from 54% to 33%. Moreover, it was observed that this decrease in the rate of patients with both severe and moderate malnutrition was more prominent in patients under 3 years of age. Although there was a significant increase in anthropometric measurements with treatment in both groups, there was no significant difference in between two groups terms of change in anthropometric measurements (p>0.05), therefore effectiveness. Failure to thrive and malnutrition in infancy and childhood cause health problems that can affect adult life. To conclude, nutritional education - dietary enrichment. recommendations and use of enteral nutrition supplements were both proven beneficial in this study. Researchers are willing to underline that the most important part of the treatment is to include the family to the process to ensure the treatment compliance.

Keywords: enteral nutrition supplements, failure to thrive, malnutrition, nutritional education

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761 Retrospective Casenote Audit of Venous Thromboembolism Prophylaxis in Maxillofacial Patients

Authors: Joshua Abraham, Craig Wales

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Abstract—SIGN Guideline 122 recommends that all patients who are admitted to hospital are assessed for venous thromboembolism risk within 24 hours of admission. NHS Greater Glasgow and Clyde provide guidance on this in the form of a proforma. Patients are then subsequently prescribed either thrombo-embolic-deterrent stockings (TEDS)/low molecular weight heparin (LMWH) for the prevention of VTE based on their score. A retrospective casenote audit of a random sample of fifty oncology and trauma inpatients at the QEUH in December 2019 was performed. 90% of patients had a risk assessment conducted as evidenced by a completed proforma. In 78% of these patients, the proforma fully completed. Overall 94% of patients had some for of thromboprophylaxis prescribed in the form of TEDS or LMWH. A lack of 100% compliance against the given standards highlighted potential implications for patient safety, but also medico-legal ramifications for staff. Clinical judgement can only be relied upon if there is written documentation as evidence. Further staff education and the suggestion of a written prompt to the clerk-in documentation will hopefully improve compliance, whilst a repeat audit should demonstrate any improvement.

Keywords: Maxillofacial , Thromboembolism, Thromboprophylaxis , Prescription

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760 Communicating Safety: Warnings, Appeals for Compliance and Visual Resources of Meaning

Authors: Sean McGovern

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Discourses, in Foucault's sense of the term, exist as alternate knowledges about some aspect of reality. Discourses act as cognitive frameworks for how social matters are understood and legitimated. Alternate social discourses can stand competing and in conflict or be effectively interwoven. Discourses of public safety, for instance, can alternately be formulated in terms of physical risk; as a matter of social responsibility; or in terms of penalties and litigation. This research study investigates discourses of safety used in public transportation and consumer products in the Japanese cultural context. Employing a social semiotic analytic approach, it examines how posters, consumer manuals and other forms of visual (written and pictorial) warnings have been designed to influence behavioral compliance. The presentation identifies specific ways in which Japanese cultural sensibilities and social needs inform cultural design principles that operate in the visual domain. It makes the case that societies are not uniform in the way that objects and actions are represented and that visual forms of meaning are culturally shaped in ways consistent with social understandings and values.

Keywords: communication design, culture, discourse, public safety

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759 Framework for Implementation of National Electrical Safety Grounding Standards for Communication Infrastructure

Authors: Atif Mahmood, Mohammad Inayatullah Khan Babar

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Communication infrastructure has been installed, operated, and maintained all over the world according to defined electrical safety standards for separate or joint structures. These safety standards have been set for the safeguard of public, utility workers (employees and contractors), utility facilities, electrical communication equipment’s connected to the utility facilities and other facilities or premise adjacent to utility facilities. Different communication utilities in Pakistan use standards of different countries due to the absence of Common National Electrical Safety Standards of Pakistan. It is really important to devise a framework for implementation of a uniform standard for strict compliance. In this context, it is important to explore the compliance of safety standards for communication conductors and equipment for separate or joint structures for which NESC standards are taken as reference. Specific reference to grounding techniques including grounding AC/DC systems and its frames, leaving Fences, Messenger wires and special circuits used for the protection for lightning etc, ungrounded so recommendations are also given after in-depth analysis of current technical practices for the installation and maintenance of communication infrastructure.

Keywords: utility facilities, grounding electrodes, special circuits, grounding conductor

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758 Functionalized Ultra-Soft Rubber for Soft Robotics Application

Authors: Shib Shankar Banerjeea, Andreas Ferya, Gert Heinricha, Amit Das

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Recently, the growing need for the development of soft robots consisting of highly deformable and compliance materials emerge from the serious limitations of conventional service robots. However, one of the main challenges of soft robotics is to develop such compliance materials, which facilitates the design of soft robotic structures and, simultaneously, controls the soft-body systems, like soft artificial muscles. Generally, silicone or acrylic-based elastomer composites are used for soft robotics. However, mechanical performance and long-term reliabilities of the functional parts (sensors, actuators, main body) of the robot made from these composite materials are inferior. This work will present the development and characterization of robust super-soft programmable elastomeric materials from crosslinked natural rubber that can serve as touch and strain sensors for soft robotic arms with very high elastic properties and strain, while the modulus is altered in the kilopascal range. Our results suggest that such soft natural programmable elastomers can be promising materials and can replace conventional silicone-based elastomer for soft robotics applications.

Keywords: elastomers, soft materials, natural rubber, sensors

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757 Study of Hypertension at Sohag City: Upper Egypt Experience

Authors: Aly Kassem, Eman Sapet, Eman Abdelbaset, Hosam Mahmoud

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Objective: Hypertension is an important public health challenge being one of the most common worldwide disease-affecting human. Our aim is to study the clinical characteristics, therapeutic regimens, treatment compliance, and risk factors in a sector of of hypertensive patients at Sohag City. Subject and Methods: A cross sectional study; conducted in Sohag city; it involved 520 patients; males (45.7 %) and females (54.3 %). Their ages ranged between 35-85 years. BP measurements, BMI, blood glucose, Serum creatinine, urine analysis, serum Lipids, blood picture and ECG were done all the studied patients. Results: Hypertension presented more between non-smokers (72.55%), females (54.3%), educated patients (50.99%) and patients with low SES (54.9%). CAD presented in (51.63%) of patients, while laboratory investigations showed hyperglycaemia in (28.7%), anemia in (18.3%), high serum creatinine level in (8.49%) and proteinuria in (10.45%) of patient. Adequate BP control was achieved in (49.67%); older patients had lower adequacy of BP control in spite of the extensive use of multiple-drug therapy. Most hypertensive patients had more than one coexistent CV risk factor. Aging, being a female (54.3%), DM (32.3%), family history of hypertension (28.7%), family history of CAD (25.4%), and obesity (10%) were the common contributing risk factors. ACE-inhibitors were prescribed in (58.16%), Beta-blockers in (34.64%) of the patients. Monotherapy was prescribed for (41.17%) of the patients. (75.81%) of patients had regular use of their drug regimens. (49.67%) only of patients had their condition under control, the number of drugs was inversely related to BP control. Conclusion: Hypertensive patients in Sohag city had a profile of high CV risks, and poor blood pressure control particularly in the elderly. A multidisciplinary approach for routine clinical check-up, follow-up, physicians and patients training, prescribing simple once-daily regimens and encouraging life style modifications are recommended. Anti hypertensives, hypertension, elderly patients, risk factors, treatment compliance.

Keywords: anti hypertensives, hypertension, elderly patients, risk factors, treatment compliance

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756 Accessibility for the Disabled in Public Buildings: The Case of a Nigerian University

Authors: S. P. Akinbogun, P. Oloruntoyin

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One of the millennium development goals is the reduction of illiteracy. The state of user friendliness of the educational buildings is expected to play a significant role in the quest, particularly among the physically challenged. This study considers the state of access of educational buildings to disabled on wheel chair and crutches. It draws context from one of the federal universities in Nigeria. The study is basically qualitative; data were collected through structured interview and observation to assess compliance with the prescribed accessibility standard of academic buildings in the Federal University of Technology Akure. The study found that narrow entrances and routes of buildings, raised steps at entrances of the buildings, and ramps were absent. This implies exclusion as it renders most of the buildings inaccessible to wheelchair users. Perhaps, it accounts for low enrolment of wheelchair users in the institution despite many of them in the city. The implication is a challenge in the achievement of the millennium development goal concerning the reduction in the level of illiteracy in the country. The study suggests that government should strictly ensure that public buildings should satisfy or retrofitted to meet disabled access before development approval. This should be followed with the issuance of certificate of compliance upon completion.

Keywords: public building, accessibility, physically challenged, education

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755 O2 Saturation Comparison Between Breast Milk Feeding and Tube Feeding in Very Low Birth Weight Neonates

Authors: Ashraf Mohammadzadeh, Ahmad Shah Farhat, Azin Vaezi, Aradokht Vaezi

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Background & Aim: Preterm infants born at less than 34 weeks postconceptional age are not as neurologically mature as their term counterparts and thus have difficulty coordinating sucking, swallowing and breathing. As a result, they are traditionally gavage fed until they are able to oral feed successfully. The aim of study was to evaluate comparative effect of orogastric and breast feeding on oxygen saturation in very low birth weight infant (<1500gm). Patients and Methods: In this clinical trial all babies admitted in the Neonatal Research Center of Imamreza Hospital, Mashhad during a 4 months period were elected. Criteria for entrance to study included birth weight ≤ 1500 grams, exclusive breastfeeding, having no special problem after 48 hours, receivinge only routine care and intake of milk was 100cc/kg/day. Each neonate received two rounds of orogastric and breast feeding in the morning and in the afternoon, during which mean oxygen saturation was measured by pulse-oxymetry. During the study the heart rate and temperature of the neonates were monitored, and in case of hypothermia, bradycardia(less than 100 per minute) or apnea the feeding was discontinued and the study was repeated the following day. Data analysis was carried out using SPSS. Results: Fifty neonates were studied. The average birth weight was 1267.20±165.42 grams and average gestational age was 31.81±1.92 and female/male ratio was 1.2. There was no significant statistical difference in arterial oxygen saturation in orogastric and breast feeding in the morning and in the afternoon. (p=0.16 in the morning and p=0.6 in the afternoon). There was no complication of apnea, hypothermia or bradycardia. Conclusion: There was no significant statistical difference between the two methods in arterial oxygen saturation. It seems that oral feeding (which is a natural route) and skin contact between the mother and neonate causes a strong emotional bonding between the two and brings about better social adaptation for the neonate. Also shorter period of stay in hospital is more preferred, and breast feeding should be started at the earliest possible time after birth.

Keywords: Very low birth weight (V.L.B.W), O2 Saturation, Breast Feeding, Tube Feeding

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754 The Effect of Kangaroo Mother Care and Swaddling Method on Venipuncture Pain in Premature Infant: Randomized Clinical Trials

Authors: Faezeh Jahanpour, Shahin Dezhdar, Saeedeh Firouz Bakht, Afshin Ostovar

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Objective: The hospitalized premature babies often undergo various painful procedures such as venous sampling. The Kangaroo mother care (KMC) method is one of the pain reduction methods, but as mother’s presence is not always possible, this research was done to compare the effect of swaddling and KMC method on venous sampling pain on premature neonates. Methods: In this randomized clinical trial 90 premature infants selected and randomly alocated into three groups; Group A (swaddling), Group B (the kangaroo care), and group C (the control). From 10 minutes before blood sampling to 2 minutes after that in group A, the infant was wrapped in a thin sheet, and in group B, the infant was under Kangaroo care. In all three groups, the heart rate and arterial oxygen saturation in time intervals of 30 seconds before, during, 30-60-90, and 120 seconds after sampling were measured and recorded. The infant’s face was video recorded since sampling till 2 minutes and the videos were checked by a researcher who was unaware of the kind of intervention and the pain assessment tools for infants (PIPP) for time intervals of 30 seconds were completed. Data analyzed by t-test, Q square, Repeated Measure ANOVA, Kruskal-Wallis, Post-hoc and Bonferroni test. Results: Findings revealed that the pain was reduced to a great extent in swaddling and kangaroo method compared to that in control group. But there was not a significant difference between kangaroo and swaddling care method (P ≥ 0.05). In addition, the findings showed that the heart rate and arterial oxygen saturation was low and stable in swaddling and Kangaroo care method and returned to base status faster, whereas, the changes were severe in control group and did not return to base status even after 120 seconds. Discussion: The results of this study showed that there was not a meaningful difference between swaddling and kangaroo care method on physiological indexes and pain in infants. Therefore, swaddling method can be a good substitute for kangaroo care method in this regard.

Keywords: Kangaroo mother care, neonate, pain, premature, swaddling, venipuncture,

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753 Environmental Quality On-Line Monitoring Based on Enterprises Resource Planning on Implementation ISO 14001:2004

Authors: Ahmad Badawi Saluy

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This study aims to develop strategies for the prevention or elimination of environmental pollution as well as changes in external variables of the environment in order to implement the environmental management system ISO 14001:2004 by integrating analysis of environmental issues data, RKL-RPL transactional data and regulation as part of ERP on the management dashboard. This research uses a quantitative descriptive approach with analysis method comparing with air quality standard (PP 42/1999, LH 21/2008), water quality standard (permenkes RI 416/1990, KepmenLH 51/2004, kepmenLH 55/2013 ), and biodiversity indicators. Based on the research, the parameters of RPL monitoring have been identified, among others, the quality of emission air (SO₂, NO₂, dust, particulate) due to the influence of fuel quality, combustion performance in a combustor and the effect of development change around the generating area. While in water quality (TSS, TDS) there was an increase due to the flow of water in the cooling intake carrying sedimentation from the flow of Banjir Kanal Timur. Including compliance with the ISO 14001:2004 clause on application design significantly contributes to the improvement of the quality of power plant management.

Keywords: environmental management systems, power plant management, regulatory compliance , enterprises resource planning

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752 Prevalence and Clinical Significance of Antiphospholipid Antibodies in COVID-19 Patients Admitted to Intensive Care Units

Authors: Mostafa Najim, Alaa Rahhal, Fadi Khir, Safae Abu Yousef, Amer Aljundi, Feryal Ibrahim, Aliaa Amer, Ahmed Soliman Mohamed, Samira Saleh, Dekra Alfaridi, Ahmed Mahfouz, Sumaya Al-Yafei, Faraj Howady, Mohamad Yahya Khatib, Samar Alemadi

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Background: Coronavirus disease 2019 (COVID-19) increases the risk of coagulopathy among critically ill patients. Although the presence of antiphospholipid antibodies (aPLs) has been proposed as a possible mechanism of COVID-19 induced coagulopathy, their clinical significance among critically ill patients with COVID-19 remains uncertain. Methods: This prospective observational study included patients with COVID-19 admitted to intensive care units (ICU) to evaluate the prevalence and clinical significance of aPLs, including anticardiolipin IgG/IgM, anti-β2-glycoprotein IgG/IgM, and lupus anticoagulant. The study outcomes included the prevalence of aPLs, a primary composite outcome of all-cause mortality, and arterial or venous thrombosis among aPLs positive patients versus aPLs negative patients during their ICU stay. Multiple logistic regression was used to assess the influence of aPLs on the primary composite outcome of mortality and thrombosis. Results: A total of 60 critically ill patients were enrolled. Of whom, 57 (95%) were male, with a mean age of 52.8 ± 12.2 years, and the majority were from Asia (68%). Twenty-two patients (37%) were found to have positive aPLs; of whom 21 patients were positive for lupus anticoagulant, whereas one patient was positive for anti-β2-glycoprotein IgG/IgM. The composite outcome of mortality and thrombosis during ICU did not differ among patients with positive aPLs compared to those with negative aPLs (4 (18%) vs. 6 (16%), aOR= 0.98, 95% CI 0.1-6.7; p-value= 0.986). Likewise, the secondary outcomes, including all-cause mortality, venous thrombosis, arterial thrombosis, discharge from ICU, time to mortality, and time to discharge from ICU, did not differ between those with positive aPLs upon ICU admission in comparison to patients with negative aPLs. Conclusion: The presence of aPLs does not seem to affect the outcomes of critically ill patients with COVID-19 in terms of all-cause mortality and thrombosis. Therefore, clinicians may not screen critically ill patients with COVID-19 for aPLs unless deemed clinically appropriate.

Keywords: antiphospholipid antibodies, critically ill patients, coagulopathy, coronavirus

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751 Association of Daily Physical Activity with Diabetes Control in Patients with Type II Diabetes

Authors: Chia-Hsun Chang

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Background: Combination of drug treatment, dietary management, and regular exercise can effectively control type II diabetes mellitus (T2DM). Performing daily physical activities other than structured exercise is much easier and whether daily physical activities including work, walking, housework, gardening, leisure exercise, or transportation have a similar effect on diabetes control is not well studied.Aims and Objectives: This study aims to determine whether daily physical activity undertaken by patients with T2DM is associated with their diabetes control. Design: A correlation study with prospective design. Methods: Purposive sampling of 206 patients with T2DM was recruited from a medical center in Central Taiwan. The International Physical Activity Questionnaire was used to assess daily levels of physical activities, and the Diabetes Compliance Questionnaire was used to assess medication and dietary compliance. Data of diabetes control (hemoglobin A1c, HbA1c)were followed up every three months for one year after recruitment. Results: In this study, the average age of the participants was 62.5 years (±10.4 years), and the average duration of diabetes since diagnosis was 13.2 years (±7.8), 112 of the participants were women (54.4%) and 94 of the participants were men (45.6%). The mean HbA1c level was 7.8% (±1.4), and 78.2% of the participants presented with unsatisfactory diabetes control. Because the participants were distributed across a wide age range, and their physical health, activity levels, and comorbidities might have varied with age, the participants were divided into two groups: 121 participants who were younger than 65 years (58.7%) and 85 participants who were older than 65 years (41.3%). Both younger (< 65 years) and older (> 65 years) patients with diabetes engaged in more moderate and low levels of physical activity (89.3% and 87%, respectively). Results showed that the levels of daily physical activity were not significantly associated with diabetes control after adjustment for medication and dietary compliance in both groups. Conclusion: Performing daily physical activity is not significantly correlated with diabetes control. Daily physical activity cannot completely replace exercise. Relevance to Clinical Practice: Health personnel must encourage patients to engage in exercise that is planned, structured, and repetitive for improving diabetes control.

Keywords: daily physical activity, diabetes control, international physical activity questionnaire (IPAQ), type II diabetes mellitus (T2DM)

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750 Hypotensive, Free Radical Scavenging and Anti-Lipid Peroxidation Activities of Crataegus azarolus L. Leaves Extracts Growing in Algeria

Authors: Amel Bouaziz, Seddik Khennouf, Mussa Abu Zarga, Shtayway Abdalla, Saliha Djidel, Assia Bentahar, Saliha Dahamna, Smain Amira

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The present study aimed to evaluate the hypotensive and the in vitro antioxidant activities of Crataegus azarolus L. (Rosaceae), a plant widely used as natural remedy for hypertension in folk medicine. The antioxidant potential of methanolic extract (ME)and its three fractions of Chloroform (CHE), ethyl acetate (EAE)and water (AqE) have been investigated using several assays, including the DPPH scavenging, ABTS scavenging, hydroxyl radical scavenging. Inhibition of lipid peroxidation was performed by the β-carotene bleaching assay, ferric thiocyanate method and thiobarburic acid method. Total phenolic and total flavonoid contents of the extracts were estimated using Folin-Chiocalteu reagent and AlCl3, respectively. EAE extract showed the highest polyphenolic and flavonoids contents (396,04±1.20 mg GAE/g of dry extract and 32,73 ± 0.03mg QE/g of dry extract) respectively. Similarly, this extract possessed the highest scavenging activity for DPPH radical (IC 50 = 0,006±0,0001mg /ml), ABTS radical (IC50=0.0035±0,0007 mg/ml) and hydroxyl radical(IC 50=0,283± 0.01 mg/ml). In addition, the EAE exhibited the highest antioxidant activity in the inhibition of linoleic acid/ß-carotene coupled oxidation (89,21%), lipid peroxidation in the ferric thiocyanate(FTC) method (90.13%), and thio-barbituric acid (TBA) method (74.23%). Intravenous administration of Me and EAE decreased mean arterial blood pressure, systolic and diastolic blood pressure in anesthetized rats dose-dependently, at the dose range of 0.4 to 12 mg/kg. The mean arterial blood pressure dropped by 27.58 and 39.37% for ME and EAE, respectively. In conclusion, The present study supported the significant potential to use C. azarolus by-products as a source of natural antioxidants and provides scientific justification for its traditional uses as cardio-protective and anti-hypertensive remedy.

Keywords: Crataegus azarolus, polyphenols, flavonoids, hypertension, antioxidant activity, free radicals, peroxidation

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749 Case Report on Anaesthesia for Ruptured Ectopic with Severe Pulmonary Hypertension in a Mute Patient

Authors: Pamela Chia, Tay Yoong Chuan

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Introduction: Severe pulmonary hypertension (PH) patients requiring non-cardiac surgery risk have increased mortality rates ranging. These patients are plagued with cardiorespiratory failure, dysrhythmias and anticoagulation potentially with concurrent sepsis and renal insufficiency, perioperative morbidity. We present a deaf-mute patient with severe idiopathic PH emergently prepared for ruptured ectopic laparotomy. Case Report: A 20 year-old female, 62kg (BMI 25 kg/m2) with severe idiopathic PH (2DE Ejection Fraction was 41%, Pulmonary Artery Systolic Pressure (PASP) 105 mmHg, Right ventricle strain and hypertrophy) and selective mutism was rushed in for emergency laparotomy after presenting to the emergency department for abdominal pain. The patient had an NYHA Class II with room air SpO2 93-95%. While awaiting lung transplant, the patient takes warfarin, Sildanefil, Macitentan and even Selexipag for rising PASP. At presentation, vital signs: BP 95/63, HR 119 SpO2 88% (room air). Despite decreasing haemoglobin 14 to 10g/dL, INR 2.59 was reversed with prothrombin concentrate, and Vitamin K. ECG revealed Right Bundle Branch Block with right ventricular strain and x-ray showed cardiomegaly, dilated Right Ventricle, Pulmonary Arteries, basal atelectasis. Arterial blood gas showed compensated metabolic acidosis pH 7.4 pCO2 32 pO2 53 HCO3 20 BE -4 SaO2 88%. The cardiothoracic surgeon concluded no role for Extracorporeal Membrane Oxygenation (ECMO). We inserted invasive arterial and central venous lines with blood transfusion via an 18G cannula before the patient underwent a midline laparotomy, haemostasis of ruptured ovarian cyst with 2.4L of clots under general anesthesia and FloTrac cardiac output monitoring. Rapid sequence induction was done with Midazolam/Propofol, remifentanil infusion, and rocuronium. The patient was maintained on Desflurane. Blood products and colloids were transfused for further 1.5L blood loss. Postoperatively, the patient was transferred to the intensive care unit and was extubated uneventfully 7hours later. The patient went home a week later. Discussion: Emergency hemostasis laparotomy in anticoagulated WHO Class I PH patient awaiting lung transplant with no ECMO backup poses tremendous stress on the deaf-mute patient and the anesthesiologist. Balancing hemodynamics avoiding hypotension while awaiting hemostasis in the presence of pulmonary arterial dilators and anticoagulation requires close titration of volatiles, which decreases RV contractility. We review the contraindicated anesthetic agents (ketamine, N2O), choice of vasopressors in hypotension to maintain Aortic-right ventricular pressure gradients and nitric oxide use perioperatively. Conclusion: Interdisciplinary communication with a deaf-mute moribund patient and anesthesia considerations pose many rare challenges worth sharing.

Keywords: pulmonary hypertension, case report, warfarin reversal, emergency surgery

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748 Surgical Team Perceptions of the Surgical Safety Checklist in a Tertiary Hospital in Jordan: A Descriptive Qualitative Study

Authors: Rania Albsoul, Muhammad Ahmed Alshyyab, Baraa Ayed Al Odat, Nermeen Borhan Al Dwekat, Batool Emad Al-masri, Fatima Abdulsattar Alkubaisi, Salsabil Awni Flefil, Majd Hussein Al-Khawaldeh, Ragad Ayman Sa’ed, Maha Waleed Abu Ajamieh, Gerard Fitzgerald

Abstract:

Purpose: The purpose of this paper is to explore the perceptions of operating room staff towards the use of the World Health Organization Surgical Safety Checklist in a tertiary hospital in Jordan. Design/methodology/approach: This was a qualitative descriptive study. Semi-structured interviews were conducted with a purposeful sample of 21 healthcare staff employed in the operating room (nurses, residents, surgeons, and anaesthesiologists). The interviews were conducted in the period from October to December 2021. Thematic analysis was used to analyse the data. Findings: Three main themes emerged from data analysis, namely compliance with the surgical safety checklist, the impact of the surgical safety checklist, and barriers and facilitators to the use of the surgical safety checklist. The use of the checklist was seen as enabling staff to communicate effectively and thus accomplish patient safety and positive outcomes. The perceived barriers to compliance included excessive workload, congestion, and lack of training and awareness. Enhanced training and education were thought to improve the utilization of the surgical safety checklist and help enhance awareness about its importance. Originality/value: While steps to utilize the surgical safety checklist by the operation room personnel may seem simple, the quality of its administration is not necessarily robust. There are several challenges to consistent, complete, and effective administration of the surgical safety checklist by the surgical team members. Healthcare managers must employ interventions to eliminate barriers to and offer facilitators of adherence to the application of the surgical safety checklist, therefore promoting quality healthcare and patient safety.

Keywords: patient safety, surgical safety checklist, compliance, utility, operating room, quality healthcare, communication, teamwork

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747 Environmental, Social and Corporate Governance Reporting With Regard to Best Practices of Companies Listed on the Warsaw Stock Exchange - Selected Problems

Authors: Katarzyna Olejko

Abstract:

The need to redefine the goals and adapt the operational activities carried out in accordance with the concept of sustainable management to these goals results in the increasing importance of information on the company's activities perceived from the perspective of the effectiveness and efficiency of environmental goals implementation. The narrow scope of reporting data on a company's impact on the environment is not adequate to meet the information needs of modern investors. Reporting obligations are therefore imposed on companies in order to increase the effectiveness of corporate governance and to improve the process of assessing the achievement of environmental goals. The non-financial reporting obligations introduced in Polish legislation increased the scope of reported information. However, the lack of detailed guidelines on the method of reporting resulted in a large diversification of the scope of non-financial information, making it impossible to compare the data presented by companies. The source of information regarding the level of the implementation of standards in Environmental, social and corporate governance (ESG) is the report on compliance with best practices published by the Warsaw Stock Exchange. The document Best Practices of Warsaw Stock Exchange (WSE) Listed Companies (2021), amended by the WSE in 2021, includes the rules applicable to this area (ESG). The aim of this article is to present the level of compliance with good practices in the area of ESG by selected companies listed on the Warsaw Stock Exchange The research carried out as part of this study, which was based on information from reports on the compliance with good practices of companies listed on the Warsaw Stock Exchange that was made available in the good practice scanner, have revealed that good practices in the ESG area are implemented by companies to a limited extent. The level of their application in comparison with other rules is definitely lower. The lack of experience and clear guidelines on ESG reporting may cause some confusion, which is why conscious investors and reporting companies themselves are pinning their hopes on the Corporate Sustainability Reporting Directive (CSRD) adopted by European Parliament.

Keywords: reporting, ESG, corporate governance, best practices

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746 Increasing Abundance of Jellyfish in the Shorelines of Bangladesh: Analyzing the Policy Framework for Facing the Challenges

Authors: Md Mizanur Rahman, M. Aslam Alam, Muhammad Abu Yusuf

Abstract:

The abundance of Jellyfish across the coasts of the Bay of Bengal is increasing sharply due to marine pollution, increased sea acidification and climate change. Jellyfish draws our attention to address the local and global stressors. This also indicates that something wrong is happening in this bay behind the scenes. This study aimed to investigate how the policy framework governing the sea can be reformed. To do so, this study evaluated the existing policy, regulatory and institutional framework. Empirical data were collected from the middle coastal zone of Bangladesh. The secondary literature on policy, legal documents, and institutional arrangements were reviewed. The causes of poor coordination among different public sectors and non-compliance of laws were identified. The key findings show that despite the existing of Department of Environment, poor coordination with other departments, and lack of logistics and technical staffs have resulted in severe marine pollution and degradation of coastal and marine living resources. The existing policies had no monitoring and evaluation mechanisms. Non-compliance of the existing laws has been fueling the problems. This study provides an integrated policy and a guideline for updating the legal and institutional mechanism to manage coastal and marine living resources sustainably in Bangladesh to achieve Sustainable Development Goal 14.

Keywords: legal, institutional, framework, jellyfish

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745 Stories of Women With Cervical Cancer in Taiwan: A Narrative Analysis Research

Authors: Pei-Yu Lee

Abstract:

This study investigates the life experience and self-interpretation of female cervical cancer patients under Taiwanese cultural context. Through a Narrative Analysis Research approach, the study took six cervical cancer female patients with an average age of 58 years (ranging from 55-66 years) for an average of twice, 60 minutes each time, in-depth recorded interviews under their consent. After converting the interview recordings into transcripts, the study applied the Riessman approach to analyze the contents. The results revealed two major theme, including 1. The symbolic meaning of the cervix, and 2. Women's perseverance and compliance. Because of the illness metaphor of cervical cancer and the designation of women being family caregivers under the Chinese patriarchal culture, females with cervical cancer are not only patients but also responsible for being family and partner roles, in which contradictions of intimate relationships exist. Show the strength of perseverance and compliance in the course of life. On the other hand, they have to identify and recognize their roles in life and strive to determine the situation of coexisting with the disease to picture their life. The results showed that female cervical cancer patients not only need to combat the disease but also stand against the stigma and the traditional responsibility given to women. The researchers recommend that nurses should include cultural implications in their care of female cervical cancer patients.

Keywords: female, cervical cancer, narrative analysis research, taiwan

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744 Health Belief Model to Predict Sharps Injuries among Health Care Workers at First Level Care Facilities in Rural Pakistan

Authors: Mohammad Tahir Yousafzai, Amna Rehana Siddiqui, Naveed Zafar Janjua

Abstract:

We assessed the frequency and predictors of sharp injuries (SIs) among health care workers (HCWs) at first level care facilities (FLCF) in rural Pakistan. HCWs working at public clinic (PC), privately owned licensed practitioners’ clinic (LPC) and non-licensed practitioners’ clinic (NLC) were interviewed on universal precautions (UPs) and constructs of health belief model (HBM) to assess their association with SIs through negative-binomial regression. From 365 clinics, 485 HCWs were interviewed. Overall annual rate of Sis was 192/100 HCWs/year; 78/100 HCWs among licensed prescribers, 191/100 HCWs among non-licensed prescribers, 248/100 HCWs among qualified assistants, and 321/100 HCWs among non-qualified assistants. Increasing knowledge score about bloodborne pathogens (BBPs) transmission (rate-ratio (RR): 0.93; 95%CI: 0.89–0.96), fewer years of work experience, being a non-licensed prescriber (RR: 2.02; 95%CI: 1.36–2.98) licensed (RR: 2.86; 9%CI: 1.81–4.51) or non-licensed assistant (RR: 2.78; 95%CI: 1.72–4.47) compared to a licensed prescriber, perceived barriers (RR: 1.06;95%CI: 1.03–1.08), and compliance with UPs scores (RR: 0.93; 95%CI: 0.87–0.97) were significant predictors of SIs. Improved knowledge about BBPs, compliance with UPs and reduced barriers to follow UPs could reduce SIs to HCWs.

Keywords: health belief model, sharp injuries, needle stick injuries, healthcare workers

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743 Storage Tank Overfill Protection in Compliance with Functional Safety Standard: IEC 61511

Authors: Hassan Alsada

Abstract:

Tank overfill accidents are major concerns for industries handling large volumes of hydrocarbons. Buncefield, Jaipur, Puerto Rico, and West Virginia are just a few accidents with catastrophic consequences. Thus, it is very important for any industry to take the right safety measures for overfill prevention. Moreover, one of the main causative factors in the overfill accidents was inadequate risk analysis and, subsequently, inadequate design. This study aims to provide a full assessment in accordance with the Functional safety standard: “IEC 615 11 – Safety instrumented systems for the process industry” to the tank overfill scenario according to the standard’s Safety Life Cycle (SLC), which includes: the analysis phase, the implementation phase, and the operation phase. The paper discusses in depth the tank overfills Independent Protection Layers (IPLs) with systematic analysis to avoid the safety risks of under-design and the financial risk of facility overdesign. The result shows a clear and systematic assessment in compliance with the standards that can help to assist existing tank overfilling setup or a guide to support designing new storage facilities overfill protection.

Keywords: IEC 61511, PHA, LOPA, process safety, safety, health, environment, safety instrumented systems, safety instrumented function, functional safety, safety life cycle

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742 Intrinsic Contradictions in Entrepreneurship Development and Self-Development

Authors: Revaz Gvelesiani

Abstract:

The problem of compliance between the state economic policy and entrepreneurial policy of businesses is primarily manifested in the contradictions related to the congruence between entrepreneurship development and self-development strategies. Among various types (financial, monetary, social, etc.) of the state economic policy aiming at the development of entrepreneurship, economic order policy is of special importance. Its goal is to set the framework for both public and private economic activities and achieve coherence between the societal value system and the formation of the economic order framework. Economic order policy, in its turn, involves intrinsic contradiction between the social and the competitive order. Competitive order is oriented on the principle of success, while social order _ on the criteria of need satisfaction, which contradicts, at least partly, to the principles of success. Thus within the economic order policy, on the one hand, the state makes efforts to form social order and expand its frontiers, while, on the other hand, market is determined to establish functioning competitive order and ensure its realization. Locating the adequate spaces for and setting the rational border between the state (social order) and the private (competitive order) activities, represents the phenomenon of the decisive importance from the entrepreneurship development strategy standpoint. In the countries where the above mentioned spaces and borders are “set” correctly, entrepreneurship agents (small, medium-sized and large businesses) achieve great success by means of seizing the respective segments and maintaining the leading positions in the internal, the European and the world markets for a long time. As for the entrepreneurship self-development strategy, above all, it involves: •market identification; •interactions with consumers; •continuous innovations; •competition strategy; •relationships with partners; •new management philosophy, etc. The analysis of compliance between the entrepreneurship strategy and entrepreneurship culture should be the reference point for any kind of internationalization in order to avoid shocks of cultural nature and the economic backwardness. Stabilization can be achieved only when the employee actions reflect the existing culture and the new contents of culture (targeted culture) is turned into the implicit consciousness of the personnel. The future leaders should learn how to manage different cultures. Entrepreneurship can be managed successfully if its strategy and culture are coherent. However, not rarely enterprises (organizations) show various forms of violation of both personal and team actions. If personal and team non-observances appear as the form of influence upon the culture, it will lead to global destruction of the system and structure. This is the entrepreneurship culture pathology that complicates to achieve compliance between the entrepreneurship strategy and entrepreneurship culture. Thus, the intrinsic contradictions of entrepreneurship development and self-development strategies complicate the task of reaching compliance between the state economic policy and the company entrepreneurship policy: on the one hand, there is a contradiction between the social and the competitive order within economic order policy and on the other hand, the contradiction exists between entrepreneurship strategy and entrepreneurship culture within entrepreneurship policy.

Keywords: economic order policy, entrepreneurship, development contradictions, self-development contradictions

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741 Compliance Of Dialysis patients With Nutrition Guidelines: Insights From A Questionnaire

Authors: Zeiler M., Stadler D., Schmaderer C.

Abstract:

Over the years of dialysis treatment, most patients experience significant weight loss. The primary emphasis in earlier research was the underlying mechanism of protein energy wasting and the subsequent malnutrition inflammation syndrome. In the interest to provide an effective and rapid solution for the patients, the aim of this study is identifying individual influences of their assumed reduced dietary intake, such as nausea, appetite loss and taste changes, and to determine whether the patients adhere to their nutrition guidelines. A prospective, controlled study with 38 end-stage renal disease patients was performed using a questionnaire to reflect their diet within the last 12 months. Thereby, the daily intake for the most important macro-and micronutrients was calculated to be compared with the individual KDQOI-guideline value, as well as controls matched in age and gender. The majority of the study population did not report symptoms commonly associated with dialysis, such as nausea or inappetence, and denied any change in dietary behavior since receiving renal replacement therapy. The patients’ daily intake of energy (3080kcal ± 1266) and protein (89,9g [53,4-142,0]) did not differ significantly from the controls (energy intake: 3233kcal ± 1046, p=0,597; protein intake: 103,7g [90,1-125,5], p=0,120). The average difference to the individual calculated KDQOI-guideline was +176,0kcal ± 1156 (p=0,357) for energy intake and -1,75g ± 45,9 (p=0,491) for protein intake. However, there was an observed imbalance in the distribution of macronutrients, with a preference for fats over proteins. The patients’ daily intake of sodium (5,4g [ 2,95-10,1]) was higher than in the controls (4,1g [2,04-5,99], p= 0,058) whereas both values for potassium (3,7g ± 1,84) and phosphorous (1,79g ± 0,91) went significantly below the controls’ values (potassium intake: 4,89g ± 1,74, p=0,014; phosphorous intake: 2,04g ± 0,64, p=0,038). Thus, the values exceeded the calculated KDQOI-recommendation by + 3,3g [0,63-7,90] (p<0,001) for sodium, +1,49g ± 1,84 (p<0,001) for potassium and +0,89g ± 0,91 (p<0,001) for phosphorous. Contrary to the assumption, the patients did not under-eat. Nevertheless, their diets did not align with the recommended values. These findings highlight the need for intervention and education among patients and that regular dietary monitoring could prevent unhealthy nutrition habits. The elaboration of individual references instead of standardized guidelines could increase the compliance to the advised diet so that interdisciplinary comorbidities do not develop or worsen.

Keywords: compliance, dialysis, end-stage renal disease, KDQOI, malnutrition, nutrition guidelines, questionnaire, salt intake

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740 Analysis of a Self-Acting Air Journal Bearing: Effect of Dynamic Deformation of Bump Foil

Authors: H. Bensouilah, H. Boucherit, M. Lahmar

Abstract:

A theoretical investigation on the effects of both steady-state and dynamic deformations of the foils on the dynamic performance characteristics of a self-acting air foil journal bearing operating under small harmonic vibrations is proposed. To take into account the dynamic deformations of foils, the perturbation method is used for determining the gas-film stiffness and damping coefficients for given values of excitation frequency, compressibility number, and compliance factor of the bump foil. The nonlinear stationary Reynolds’ equation is solved by means of the Galerkins’ finite element formulation while the finite differences method are used to solve the first order complex dynamic equations resulting from the perturbation of the nonlinear transient compressible Reynolds’ equation. The stiffness of a bump is uniformly distributed throughout the bearing surface (generation I bearing). It was found that the dynamic properties of the compliant finite length journal bearing are significantly affected by the compliance of foils especially when the dynamic deformation of foils is considered in addition to the static one by applying the principle of superposition.

Keywords: elasto-aerodynamic lubrication, air foil bearing, steady-state deformation, dynamic deformation, stiffness and damping coefficients, perturbation method, fluid-structure interaction, Galerk infinite element method, finite difference method

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739 The Impact of Informal Care on Health Behavior among Older People with Chronic Diseases: A Study in China Using Propensity Score Matching

Authors: Hong Wu, Naiji Lu

Abstract:

Improvement of health behavior among people with chronic diseases is vital for increasing longevity and enhancing quality of life. This paper researched the causal effects of informal care on the compliance with doctor’s health advices – smoking control, dietetic regulation, weight control and keep exercising – among older people with chronic diseases in China, which is facing the challenge of aging. We addressed the selection bias by using propensity score matching in the estimation process. We used the 2011-2012 national baseline data of the China Health and Retirement Longitudinal Study. Our results showed informal care can help improve health behavior of older people. First, informal care improved the compliance of smoking controls: whether smoke, frequency of smoking, and the time lag between wake up and the first cigarette was all lower for these older people with informal care; Second, for dietetic regulation, older people with informal care had more meals every day than older people without informal care; Third, three variables: BMI, whether gain weight and whether lose weight were used to measure the outcome of weight control. There were no significant difference between group with informal care and that without for BMI and the possibility of losing weight. Older people with informal care had lower possibility of gain weight than that without; Last, for the advice of keeping exercising, informal care increased the probability of walking exercise, however, the difference between groups for moderate and vigorous exercise were not significant. Our results indicate policy makers who aim to decrease accidents should take informal care to elders into account and provide an appropriate policy to meet the demand of informal care. Our birth policy and postponed retirement policy may decrease the informal caregiving hours, so adjustments of these policies are important and urgent to meet the current situation of aged tendency of population. In addition, government could give more support to develop organizations to provide formal care, such as nursing home. We infer that formal care is also useful for health behavior improvements.

Keywords: chronic diseases, compliance, CHARLS, health advice, informal care, older people, propensity score matching

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738 A Mixed-method Study of Psychological Empowerment in Child Protection Practitioners

Authors: Amy Bromley

Abstract:

Child protection practitioners are a vital part of systems designed to protect children from abuse and neglect. Reforms in Anglo-American systems have shown a trend towards compliance-culture that reduces practitioner autonomy and empowerment, increasing staff turnover and negatively impacting outcomes for children. This explanatory mixed-methods study examined psychological empowerment in a national sample of child protection practitioners in Australia (n=109) using the Psychological Empowerment Instrument followed by semi-structured interviews (n=19). The results show that practitioners experience the sub-dimensions of psychological empowerment differently, perceiving themselves to have high levels of competence and satisfaction in their work but limited opportunities for self-determination and low levels of impact on decision-making in their organizations. The qualitative data revealed that practitioners do not trust systemic reforms and have experienced them as ineffective, politically driven, and bureaucratic. The increased compliance demanded from these reforms has left practitioners feeling that their expertise is not valued, leading many to leave their organizations. The practitioners who remain employed in child protection identified their use of advocacy, curiosity, and child-centered values as ways of protecting their psychological empowerment. The findings highlight the ways psychological empowerment can be promoted within child protection systems, improving staff retention and building expertise.

Keywords: child protection, implementation, psychological empowerment, systems theory

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737 The Routine Use of a Negative Pressure Incision Management System in Vascular Surgery: A Case Series

Authors: Hansraj Bookun, Angela Tan, Rachel Xuan, Linheng Zhao, Kejia Wang, Animesh Singla, David Kim, Christopher Loupos

Abstract:

Introduction: Incisional wound complications in vascular surgery patients represent a significant clinical and econometric burden of morbidity and mortality. The objective of this study was to trial the feasibility of applying the Prevena negative pressure incision management system as a routine dressing in patients who had undergone arterial surgery. Conventionally, Prevena has been applied to groin incisions, but this study features applications on multiple wound sites such as the thigh or major amputation stumps. Method: This was a cross-sectional observational, single-centre case series of 12 patients who had undergone major vascular surgery. Their wounds were managed with the Prevena system being applied either intra-operatively or on the first post-operative day. Demographic and operative details were collated as well as the length of stay and complication rates. Results: There were 9 males (75%) with mean age of 66 years and the comorbid burden was as follows: ischaemic heart disease (92%), diabetes (42%), hypertension (100%), stage 4 or greater kidney impairment (17%) and current or ex-smoking (83%). The main indications were acute ischaemia (33%), claudication (25%), and gangrene (17%). There were single instances of an occluded popliteal artery aneurysm, diabetic foot infection, and rest pain. The majority of patients (50%) had hybrid operations with iliofemoral endarterectomies, patch arterioplasties, and further peripheral endovascular treatment. There were 4 complex arterial bypass operations and 2 major amputations. The mean length of stay was 17 ± 10 days, with a range of 4 to 35 days. A single complication, in the form of a lymphocoele, was encountered in the context of an iliofemoral endarterectomy and patch arterioplasty. This was managed conservatively. There were no deaths. Discussion: The Prevena wound management system shows that in conjunction with safe vascular surgery, absolute wound complication rates remain low and that it remains a valuable adjunct in the treatment of vasculopaths.

Keywords: wound care, negative pressure, vascular surgery, closed incision

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736 Total Arterial Coronary Revascularization with Aorto-Bifemoral Bipopliteal Bypass: A Case Report

Authors: Nuruddin Mohammod Zahangir, Syed Tanvir Ahmady, Firoz Ahmed, Mainul Kabir, Tamjid Mohammad Najmus Sakib Khan, Nazmul Hossain, Niaz Ahmed, Madhava Janardhan Naik

Abstract:

The management of combined Coronary Artery Disease and Peripheral Vascular Disease is a challenge and brings with it numerous clinical dilemmas.The 56 year old gentleman presented to our department with significant triple vessel disease with occluded lower end of aorta just before bifurcation and bilateral superficial femoral arteries. Operation was done on 11.03.14. The The Left Internal Mammary Artery (LIMA) and the Right Internal Mammary Artery (RIMA) were harvested in skeletonized manner. The free RIMA was then anastomosed with LIMA to make LIMA-RIMA Y. Cardio Pulmonary Bypass was then established and coronary artery bypass grafts performed. LIMA was anastomosed to the Left Anterior Descending artery. RIMA was anastomosed to Posterior Descending Artery, 1st and 2nd Obtuse Marginal arteries in a sequential manner. Abdomen was opened by midline incision. The infrarenal aorta exposed and was found to be severely diseased. A Vascular Clamp was applied infrarenally, aortotomy done and limited endarterectomy performed. An end-to-side anastomosis was done with upper end of PTFE synthetic Y-graft (14/7 mm) to the infarenal Aorta and the Clamp released. Good flow noted in both limbs of the graft. Patient was then slowly weaned off from Cardio Pulmonary Bypass without difficulty. The distal two limbs of the Y graft were passed to the groin through retroperitoneal tunnels and anastomosed end-to-side with the common femoral arteries. Saphenous vein was interposed between common femoral and popliteal arteries bilaterally through subfascial tunnels in both thigh. On 12th postoperative day he was discharged from hospital in good general condition. Follow up after 3 months of operation the patient is doing good and free of chest pain and claudication pain.

Keywords: total arterial, coronary revascularization, aorto-bifemoral bypass, bifemoro-bipopliteal bypass

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735 Transfer of Business Anti-Corruption Norms in Developing Countries: A Case Study of Vietnam

Authors: Candice Lemaitre

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During the 1990s, an alliance of international intergovernmental and non-governmental organizations proposed a set of regulatory norms designed to reduce corruption. Many governments in developing countries, such as Vietnam, enacted these global anti-corruption norms into their domestic law. This article draws on empirical research to understand why these anti-corruption norms have failed to reduce corruption in Vietnam and many other developing countries. Rather than investigating state compliance with global anti-corruption provisions, a topic that has already attracted considerable attention, this article aims to explore the comparatively under-researched area of business compliance. Based on data collected from semi-structured interviews with business managers in Vietnam and archival research, this article examines how businesses in Vietnam interpret and comply with global anti-corruption norms. It investigates why different types of companies in Vietnam engage with and respond to these norms in different ways. This article suggests that global anti-corruption norms have not been effective in reducing corruption in Vietnam because there is fragmentation in the way companies in Vietnam interpret and respond to these norms. This fragmentation results from differences in the epistemic (or interpretive) communities that companies draw upon to interpret global anti-corruption norms. This article uses discourse analysis to understand how the communities interpret global anti-corruption norms. This investigation aims to generate some predictive insights into how companies are likely to respond to anti-corruption regimes based on global anti-corruption norms.

Keywords: anti-corruption, business law, legal transfer, Vietnam

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