Search results for: delivery outcomes

Authors: Michael Airton

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This case study examines the development of a new service delivery model for prisons that focuses on using NGO’s to provide more effective case management and post release support functions. The model includes the co-design of the service delivery model and innovative commercial agreements that encourage embedded service providers within the prison and continuity of services post release with outcomes based payment mechanisms. The collaboration of prison staff, probation and parole officers and NGO’s is critical to the success of the model and its ability to deliver value and positive outcomes in relation to desistance from offending.

Keywords: collaborative service delivery, desistance, non-government organisations, post release support services

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Authors: Inas S. Khayal, Weiping Zhou, Jonathan Skinner

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Healthcare delivery systems around the world are in crisis. The need to improve health outcomes while decreasing healthcare costs have led to an imminent call to action to transform the healthcare delivery system. While Bioinformatics and Biomedical Engineering have primarily focused on biological level data and biomedical technology, there is clear evidence of the importance of the delivery of care on patient outcomes. Classic singular decomposition approaches from reductionist science are not capable of explaining complex systems. Approaches and methods from systems science and systems engineering are utilized to structure healthcare delivery system data. Specifically, systems architecture is used to develop a multi-scale and multi-dimensional characterization of the healthcare delivery system, defined here as the Healthcare Delivery System Knowledge Base. This paper is the first to contribute a new method of structuring and visualizing a multi-dimensional and multi-scale healthcare delivery system using systems architecture in order to better understand healthcare delivery.

Keywords: health informatics, systems thinking, systems architecture, healthcare delivery system, data analytics

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Authors: Alfred L. Guiffrida

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A review of the literature on supply chain delivery models which use delivery windows to measure delivery performance is presented. The review herein serves to meet the following objectives: (i) provide a synthesis of previously published literature on supply chain delivery performance models, (ii) provide in one paper a consolidation of research that can serve as a single source to keep researchers up to date with the research developments in supply chain delivery models, and (iii) identify gaps in the modeling of supply chain delivery performance which could stimulate new research agendas.

Keywords: delivery performance, delivery window, supply chain delivery models, supply chain performance

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Authors: Jiyoung Kim, Chae Weon Chung

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Labor pain is one of the most common concerns of pregnant women, thus women are in need of possible options they could take to control the pain. So, this study aimed to explore maternal perception of epidural anesthesia and to compare the childbirth outcomes according to the use of epidural anesthesia. For this descriptive study, women who were over 36 weeks of pregnancy were recruited from an out-patient obstetric clinic in a public hospital in Seoul. Women were included in the study if agreed to participate, were pregnant singleton, without pregnancy complication, and expecting a natural birth. Data collection was done twice, the first one at the prenatal care visit and the second one at an in-patient ward on 2nd day postpartum. The instrument of the beliefs about epidural anesthesia, one item of asking intention to use epidural anesthesia, demographics, and obstetrical characteristics were incorporated into a questionnaire. One nurse researcher performed data collection with the structured questionnaire after the approval of the institutional review board. At the initial data collection 133 women were included, while 117 were retained at the second point after excluded 13 women due to the occurrence of complications. Analyses were done by chi-square, t-test, and ANOVA using the SPSS program. Women were aged 32.5 years old, 22.2% were over 35 years old. The average gestational age was 38.5 weeks, and 67.5% were nulliparous. Out of 38 multiparous women, 20 women (52.6%) had received epidural anesthesia in the previous delivery. At the initial interview, 62.6% (n=73) of women wanted to receive epidural anesthesia while 22.4% answered not decided and 15.4% did not want to take the procedure. However, there were changes in proportions between women’s intention to take it and actual procedures done, particularly, two-thirds of women (n=26) who had been undecided were found to receive epidural anesthesia during labor. There was a significant difference in the perception of epidural anesthesia measured before delivery between women who received and not received it (t=3.68, p < .001). Delivery outcomes were statistically different between the two groups in delivery mode (chi-square=8.64, p=.01), O₂ supply during labor (chi-square =5.01, p=.03), duration of 2nd stage of labor (t=3.70, p < .001), and arterial cord blood pH (t=2.64, p=.01). Interestingly, there was no difference in labor pain perceived between women with and without epidural anesthesia. Considering the preference and use of epidural anesthesia, health professionals need to assess coping ability of women undergoing delivery and to provide accurate information about pain control to support their decision making and eventually to enhance delivery outcomes for mothers and neonates.

Keywords: epidural anesthesia, delivery outcomes, labor pain, perception

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Authors: Daniel Klimovský

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Slovakia belongs to the most fragmented countries if one looks at its local government structure. The Slovak central governments implemented both broad devolution and fiscal decentralization some decades ago. However, neither territorial consolidation nor size categorization of local competences and powers has been implemented yet. Taking this fact into account, it is clear that the local governments are challenged not only by their citizens as customers but also by effectiveness as well as efficiency of delivered services. The paper is focused on behavior of the local governments in Slovakia and their approaches towards other local partners, including other local governments. Analysis of set of interviews shows that inter-municipal cooperation is the most common local partnership in Slovakia, but due to diversity of the local governments, this kind of cooperation leads to both intended and unintended outcomes. While in many cases the local governments are more efficient as well as effective in delivery of local services thanks to inter-municipal cooperation, there are many cases where inter-municipal cooperation fails, and it brings rather questionable or even negative outcomes.

Keywords: local governments, local partnerships, inter-municipal cooperation, delivery of local services

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Authors: Ada Garus

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This paper presents the outcomes of the sustainability assessment of food delivery with a last-mile delivery service introduced in a real-world case study. The methodology used in the sustainability assessment integrates multi-criteria decision-making analysis, sustainability pillars, and scenario analysis to best reflect the conflicting needs of stakeholders involved in the last mile delivery system. The case study provides an application of the framework to the food delivery system of the Joint Research Centre of the European Commission where three alternative solutions were analyzed I) the existent state in which individuals frequent the local cantine or pick up their food, using their preferred mode of transport II) the hypothetical scenario in which individuals can only order their food using the delivery droid system III) a scenario in which the food delivery droid based system is introduced as a supplement to the current system. The environmental indices are calculated using a simulation study in which decision regarding the food delivery is predicted using a multinomial logit model. The vehicle dynamics model is used to predict the fuel consumption of the regular combustion engines vehicles used by the cantine goers and the electricity consumption of the droid. The sustainability assessment allows for the evaluation of the economic, environmental, and social aspects of food delivery, making it an apt input for policymakers. Moreover, the assessment is one of the first studies to investigate automated delivery droids, which could become a frequent addition to the urban landscape in the near future.

Keywords: innovations in transportation technologies, behavioural change and mobility, urban freight logistics, innovative transportation systems

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Authors: Angela Knox

Abstract:

Student diversity in postgraduate classes puts major challengesoneducatorsseekingtoencouragestudentengagementand desired learning outcomes. This paper outlines the impact of a set of teaching initiatives aimed at addressing challenges associated with teaching and learning in an environment characterized by diversity in the student cohort. The study examines postgraduate students completing the core capstone unit within a specialized business degree. Although relatively small, the student cohort is highly diverse in terms of cultural backgrounds represented, prior learning and/or qualifications,aswellasdurationandtypeofworkexperiencerelevant to the degree being completed. The wide range of cultures, existing knowledge, and experience create enormous challenges with respect to students’ learning needs and outcomes. Subsequently, a suite of teaching innovations has been adopted to enhance curriculum content/delivery and the design of assessments. This paperexplores the impact of formalized group charters on students’ learning outcomes. Data from surveys and focus groups are used to assess the effectiveness of these practices. The results highlight the effectiveness of formalizedgroup charters in addressing diverse student needs and enhancing student engagement and learning outcomes. Thesefindings suggest that such practices would benefit students’ learning in environments marked by diversity in the student cohort. Specific recommendationsareofferedforothereducatorsworkingwithdiverse classes.

Keywords: assessment design, curriculum content, curriculum delivery, group charter, student diversity

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Authors: Genevieve R. Kan, Jolyon Ford

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Background: Caesarean section has become the routine route of delivery for breech fetuses, but breech cesarean deliveries are hypothesized to have poorer immediate neonatal outcomes when compared to cephalic deliveries. In accordance with this, in many Australian hospitals, the pediatric team is routinely required to attend every elective breech cesarean section in case urgent resuscitation is required. Our study aimed to determine whether term elective breech deliveries indeed had worse immediate neonatal outcomes at delivery, which will justify the necessity of pediatric staff presence at every elective breech cesarean delivery and influence the workload for the pediatric team. Objective: Elective breech cesarean deliveries were compared to elective cephalic cesarean deliveries at 37 weeks gestation or above to evaluate the immediate neonatal outcomes (Apgar scores <7 at 5 minutes, and Special Care Nursery admissions on Day 1 of life) of each group. Design: A retrospective cohort study Method: This study examined 2035 elective breech and cephalic singleton cesarean deliveries at term over 5 years from July 2017 to July 2022 at Frankston Hospital, a metropolitan hospital in Melbourne, Australia. There were 260 breech deliveries and 1775 cephalic deliveries. De-identified patient data were collected retrospectively from the hospital’s electronically integrated pregnancy and birth records to assess demographics and neonatal outcomes. Results: Apgar scores <7 at 5 minutes of life were worse in the breech group compared to the cephalic group (3.4% vs 1.6%). Special Care Nursery admissions on Day 1 of life were also higher for the breech cohort compared to the cephalic cohort (9.6% vs 8.7%). Conclusions: Our results support the expected findings that breech deliveries are associated with worse immediate neonatal outcomes. It, therefore, suggests that routine attendance at elective breech cesarean deliveries by the pediatric team is indeed required to assist with potentially higher needs for neonatal resuscitation and special care nursery admission.

Keywords: breech, cesarean section, Apgar scores, special care nursery admission

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Authors: Ying Bo Xie, Hisa Yuki Kurokawa

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Due to the fast development, China's express delivery industry has involved in a dilemma that the service quality are keeping decreasing while the construction rate of delivery network cannot meet the customers’ demand. In order to get out of this dilemma and enjoy a succession development rate, it is necessary to understand the current situation of China's express delivery industry. Firstly, the evolution of China's express delivery industry was systematical presented. Secondly, according to the number of companies and the amount of parcels they has dealt each year, the merits and faults of tow kind of operating pattern was analyzed. Finally, based on the characteristics of these express companies, the problems of China's express delivery industry was divided into several types and the countermeasures were given out respectively.

Keywords: China, express delivery industry, status, problem

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Authors: Colette Malyack, Pius Egbelu

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Business-to-Customer (B2C) delivery options have improved to meet increased demand in recent years. The change in end users has forced logistics networks to focus on customer service and sentiment that would have previously been the priority of the company or organization of origin. This has led to increased pressure on logistics companies to extend traditional B2B networks into a B2C solution while accommodating additional costs, roadblocks, and customer sentiment; the result has been the creation of the omnichannel delivery network encompassing a number of traditional and modern methods of package delivery. In this paper the many solutions within the omnichannel delivery network are defined and discussed. It can be seen through this analysis that the omnichannel delivery network can be applied to reduce the complexity of package delivery and provide customers with more options. Applied correctly the result is a reduction in cost to the logistics company over time, even with an initial increase in cost to obtain the technology.

Keywords: network planning, last mile delivery, omnichannel delivery network, omnichannel logistics

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Authors: Jutharat Attawet, Alex Y. Wang, Cindy M. Farquhar, Elizabeth A. Sullivan

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Background: Adverse maternal and perinatal outcomes of multiple pregnancies resulting from multiple embryo transfers (ET) has become significant concerns. This is particularly relevant for gestational carriers since they usually do not have infertility issues. Single embryo transfer (SET) therefore has been encouraged to assist reproductive technology (ART) practice in order to reduce multiple pregnancies. Objectives: This systematic review aims to investigate the pregnancy and birth outcomes of SET and multiple ET in surrogacy arrangements. Search methods: This study is a systematic review. Electronic databases were searched from CINAHL, Medline, Embase, Scopus and ProQuest for studies from 1980 to 2017. Cross-references and national ART reports were also manual searchings. Articles without restriction of English language and study types were accessed. Carrier cycles involving in SET and multiple ET were identified in database searching. The main outcome measures including clinical pregnancy, live delivery and multiple deliveries per gestational carrier cycle were compared between SET and multiple ET. Mantel-Haenzel risk ratios (RRs) with 95% confidence intervals (CIs), using the numbers of outcome events in SET and multiple ET of each study were calculated suing RevMan5.3. Outcomes: The search returned 97 articles of which 5 met the inclusion criteria. Approximately 50% of carrier cycles were transferred a single embryo and 50% were transferred more than one embryo. The clinical pregnancy rate (CPR) was 39% for SET and 53% for multiple ET, which was not significantly different with RR = 0.83 (95% CI: 0.67-1.03). The live delivery rate was 33% for SET and 57% for multiple ET which was not significantly different with RR = 0.78 (95% CI: 0.61-1.00). The multiple delivery rate per carrier was greater risks in the multiple ET carrier cycles (RR =0.4, 95% CI: 0.01-0.26). There were 104 sets of twins (including one set of twins selectively reduced from triplets to twins) and 1 set of triples in the multiple ET carrier cycle. In the SET carrier cycles, there were 2 sets of twins. Significance of the study: SET should be advocated among surrogate carriers to prevent multiple pregnancies and subsequent adverse outcomes for both carrier and baby. Surrogacy practice should be reviewed and surrogate carriers should be fully informed of the risk of adverse maternal and birth outcome of multiple pregnancies due to multiple embryo transfers.

Keywords: assisted reproduction, birth outcomes, carrier, gestational surrogacy, multiple embryo transfer, multiple pregnancy, pregnancy outcomes, single embryo transfer, surrogate mother, systematic review

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Authors: A. Maruf Aytekin

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We present our approach on using continuous delivery pattern for release management. One of the key practices of agile and lean teams is the continuous delivery of new features to stakeholders. The main benefits of this approach lie in the ability to release new applications rapidly which has real strategic impact on the competitive advantage of an organization. Organizations that successfully implement Continuous Delivery have the ability to evolve rapidly to support innovation, provide stable and reliable software in more efficient ways, decrease the amount of resources need for maintenance, and lower the software delivery time and costs. One of the objectives of this paper is to elaborate a case study where IT division of Central Securities Depository Institution (MKK) of Turkey apply Continuous Delivery pattern to improve release management process.

Keywords: automation, continuous delivery, deployment, release management

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Authors: A.Knox

Abstract:

Student diversity in postgraduate classes puts major challenges on educators seeking to encourage student engagement and desired to learn outcomes. This paper outlines the impact of a set of teaching initiatives aimed at addressing challenges associated with teaching and learning in an environment characterized by diversity in the student cohort. The study examines postgraduate students completing the core capstone unit within a specialized business degree. Although relatively small, the student cohort is highly diverse in terms of cultural backgrounds represented, prior learning and/or qualifications, as well as duration and type of work experience relevant to the degree, is completed. The wide range of cultures, existing knowledge and experience create enormous challenges with respect to students’ learning needs and outcomes. Subsequently, a suite of teaching innovations has been adopted to enhance curriculum content/delivery and the design of assessments. This paper explores the impact of these specific teaching and learning practices, examining the ways they have supported students’ diverse needs and enhanced students’ learning outcomes. Data from surveys and focus groups are used to assess the effectiveness of these practices. The results highlight the effectiveness of peer-assisted learning, cultural competence-building, and advanced assessment options in addressing diverse student needs and enhancing student engagement and learning outcomes. These findings suggest that such practices would benefit students’ learning in environments marked by diversity in the student cohort. Specific recommendations are offered for other educators working with diverse classes.

Keywords: assessment design, curriculum content, curriculum delivery, student diversity

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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: Yibeltal T. Bayou, Yohana S. Mashalla, Gloria Thupayagale-Tshweneagae

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Background: According to the World Health Organization, caesarean section delivery rates of more than 10-15% caesarean section deliveries in any specific geographic region in the world are not justifiable. The aim of the study was to describe the level and analyse determinants of caesarean section delivery in Addis Ababa. Methods: Data was collected in Addis Ababa using a structured questionnaire administered to 901 women aged 15-49 years through a stratified two-stage cluster sampling technique. Binary logistic regression model was employed to identify predictors of caesarean section delivery. Results: Among the 835 women who delivered their last birth at healthcare facilities, 19.2% of them gave birth by caesarean section. About 9.0% of the caesarean section births were due to mother’s request or service provider’s influence without any medical indication. The caesarean section delivery rate was much higher than the recommended rate particularly among the non-slum residents (27.2%); clients of private healthcare facilities (41.1%); currently married women (20.6%); women with secondary (22.2%) and tertiary (33.6%) level of education; and women belonging to the highest wealth quintile household (28.2%). The majority (65.8%) of the caesarean section clients were not informed about the consequences of caesarean section delivery by service providers. The logistic regression model shows that older age (30-49), secondary and above education, non-slum residence, high-risk pregnancy and receiving adequate antenatal care were significantly positively associated with caesarean section delivery. Conclusion: Despite the unreserved effort towards achieving MDG 5 through safe skilled delivery assistance among others, the high caesarean section rate beyond the recommend limit, and the finding that caesarean sections done without medical indications were also alarming. The government and city administration should take appropriate measures before the problems become setbacks in healthcare provision. Further investigations should focus on the effect of caesarean section delivery on maternal and child health outcomes in the study area.

Keywords: Addis Ababa, caesarean section, mode of delivery, slum residence

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Authors: Dada Kolawole Segun

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Transdermal drug delivery has gained popularity as a non-invasive method for controlled drug release compared to traditional delivery routes. Dissolvable transdermal patches have emerged as a promising platform for delivering a variety of drugs due to their ease of use. The objective of this research was to create and characterize dissolvable transdermal patches using various compositions and ratios of hyaluronic acid and zinc oxide nanoparticles. A micromolding technique was utilized to fabricate the patches, which were subsequently characterized using scanning electron microscopy, atomic force microscopy, and tensile strength testing. In vitro drug release studies were conducted to evaluate the drug release kinetics of the patches. The study found that the mechanical strength and dissolution properties of the patches were influenced by the hyaluronic acid and zinc oxide nanoparticle ratios used in the fabrication process. Moreover, the patches demonstrated controlled delivery of model drugs through the skin, highlighting their potential for transdermal drug delivery applications. The results suggest that dissolvable transdermal patches can be tailored to meet specific requirements for drug delivery applications using different compositions and ratios of hyaluronic acid and zinc oxide nanoparticles. This development has the potential to improve treatment outcomes and patient compliance in various therapeutic areas.

Keywords: transdermal drug delivery, characterization, skin permeation, biodegradable materials

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Authors: Jean Berger, Mohamed Barkaoui

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Discrete search path planning in time-constrained uncertain environment relying upon imperfect sensors is known to be hard, and current problem-solving techniques proposed so far to compute near real-time efficient path plans are mainly bounded to provide a few move solutions. A new information-theoretic –based open-loop decision model explicitly incorporating false alarm sensor readings, to solve a single agent military logistics search-and-delivery path planning problem with anticipated feedback is presented. The decision model consists in minimizing expected entropy considering anticipated possible observation outcomes over a given time horizon. The model captures uncertainty associated with observation events for all possible scenarios. Entropy represents a measure of uncertainty about the searched target location. Feedback information resulting from possible sensor observations outcomes along the projected path plan is exploited to update anticipated unit target occupancy beliefs. For the first time, a compact belief update formulation is generalized to explicitly include false positive observation events that may occur during plan execution. A novel genetic algorithm is then proposed to efficiently solve search path planning, providing near-optimal solutions for practical realistic problem instances. Given the run-time performance of the algorithm, natural extension to a closed-loop environment to progressively integrate real visit outcomes on a rolling time horizon can be easily envisioned. Computational results show the value of the approach in comparison to alternate heuristics.

Keywords: search path planning, false alarm, search-and-delivery, entropy, genetic algorithm

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Authors: Nur Aishah Binti Awi, Zulfiqar Khan

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Lean-kaizen has always been applied in manufacturing sector since many years ago. What about education sector? This paper discuss on how lean-kaizen can also be applied in education sector, specifically in academic area of Malaysian’s higher education sector. The purpose of this paper is to describe the application of lean kaizen in course plan and delivery. Lean-kaizen techniques have been used to identify waste in the course plan and delivery. A field study has been conducted to obtain the data. This study used both quantitative and qualitative data. The researcher had interviewed the chosen lecturers regarding to the problems of course plan and delivery that they encountered. Secondary data of students’ feedback at the end of semester also has been used to improve course plan and delivery. The result empirically shows that lean-kaizen helps to improve the course plan and delivery by reducing the wastes. Thus, this study demonstrates that lean-kaizen can also help education sector to improve their services as achieved by manufacturing sector.

Keywords: course delivery, education, Kaizen, lean

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Authors: William Elnemer, Nauman Hussain, Samir Al-Ali, Henry Shu, Diane Ghanem, Babar Shafiq

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Introduction: The incidence of infection in open tibial shaft injuries varies depending on the severity of the injury, with rates ranging from 1.8% for Gustilo-Anderson type I to 42.9% for type IIIB fractures. The timely administration of antibiotics upon presentation to the emergency department (ED) is an essential component of fracture management, and evidence indicates that prompt delivery of antibiotics is associated with improved outcomes. The objective of this study is to identify factors that contribute to the expedient administration of antibiotics. Methods: This is a retrospective study of open tibial shaft fractures at an academic Level I trauma center. Current Procedural Terminology (CPT) codes identified all patients treated for open tibial shaft fractures between 2015 and 2021. Open fractures were identified by reviewing ED and provider notes, and with ballistic fractures were considered open. Chart reviews were performed to extract demographics, fracture characteristics, postoperative outcomes, time to operative room, time to antibiotic order, and delivery. Univariate statistical analysis compared patients who received early antibiotics (EA), which were delivered within one hour of ED presentation, and those who received late antibiotics (LA), which were delivered outside of one hour of ED presentation. A multivariate analysis was performed to investigate patient, fracture, and transport/ED characteristics contributing to faster delivery of antibiotics. The multivariate analysis included the dependent variables: ballistic fracture, activation of Delta Trauma, Gustilo-Andersen (Type III vs. Type I and II), AO-OTA Classification (Type C vs. Type A and B), arrival between 7 am and 11 pm, and arrival via Emergency Medical Services (EMS) or walk-in. Results: Seventy ED patients with open tibial shaft fractures were identified. Of these, 39 patients (55.7%) received EA, while 31 patients (44.3%) received LA. Univariate analysis shows that the arrival via EMS as opposed to walk-in (97.4% vs. 74.2%, respectively, p = 0.01) and activation of Delta Trauma (89.7% vs. 51.6%, respectively, p < 0.001) was significantly higher in the EA group vs. the LA group. Additionally, EA cases had significantly shorter intervals between the antibiotic order and delivery when compared to LA cases (0.02 hours vs. 0.35 hours, p = 0.007). No other significant differences were found in terms of postoperative outcomes or fracture characteristics. Multivariate analysis shows that a Delta Trauma Response, arrival via EMS, and presentation between 7 am and 11 pm were independent predictors of a shorter time to antibiotic administration (Odds Ratio = 11.9, 30.7, and 5.4, p = 0.001, 0.016, and 0.013, respectively). Discussion: Earlier antibiotic delivery is associated with arrival to the ED between 7 am and 11 pm, arrival via EMS, and a coordinated Delta Trauma activation. Our findings indicate that in cases where administering antibiotics is critical to achieving positive outcomes, it is advisable to employ a coordinated Delta Trauma response. Hospital personnel should be attentive to the rapid administration of antibiotics to patients with open fractures who arrive via walk-in or during late-night hours.

Keywords: antibiotics, emergency department, fracture management, open tibial shaft fractures, orthopaedic surgery, time to or, trauma fractures

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Authors: Nuruddeen Usman, Mohammad Sani

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The performance of project delivery methods has been an issue of concern to various stakeholders in the construction industry. The contracting system of project delivery is the traditional system used in the delivery of most public projects in Nigeria. The direct labor system is used most times as an alternative to the traditional system. There were so many complain about the performance of contracting system and the suitability of direct labor as an alternative to the delivery of public projects. Therefore, this paper is aimed at investigating the effect of project size on the project delivery methods in the completed public buildings. Questionnaires were self-administered to managerial staff in the study area and analyzed using descriptive statistics. The findings reveals that contracting system was choosing for large size building construction project delivery with higher frequency (F) of 40 (76.9%) against direct labor with 12 (23.1%). While the small size project, the result revealed a frequency (F) of 26 (50%) for contracting system and direct labor system respectively. Base on the research findings, the contracting system, was recommended for all sizes of building construction project delivery while direct labor system can only use as an alternative for small size building construction projects delivery.

Keywords: construction size, contracting system, direct labour, effect

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Authors: Shan Li, Qiuwen Ma

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Integrated project delivery (IPD) is a project delivery method distinguished by a shared risk/rewards mechanism and multiparty agreement. IPD has drawn increasing attention from construction industry due to its reliability to deliver high-performing buildings. However, unavailable IPD specific insurance concerns the industry participants who are interested in IPD implementation. Even though the risk management capability can be enhanced using shared risk mechanism, some risks may occur when the partners do not commit themselves into the integrated practices in a desired manner. This is because the intense collaboration and close integration can not only create added value but bring new opportunistic behaviors and disputes. The study is aimed to investigate the risks of implementing IPD using Bayesian theory. IPD risk taxonomy is presented to identify all potential risks of implementing IPD and a risk network map is developed to capture the interdependencies between IPD risks. The conditional relations between risk occurrences and the impacts of IPD risks on project performances are evaluated and simulated based on Bayesian theory. The probability of project outcomes is predicted by simulation. In addition, it is found that some risks caused by integration are most possible occurred risks. This study can help the IPD project participants identify critical risks of adopting IPD to improve project performances. In addition, it is helpful to develop IPD specific insurance when the pertinent risks can be identified.

Keywords: Bayesian theory, integrated project delivery, project risks, project performances

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Authors: Antonia Harold-Barry, Eugene Dempsey

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Background: The objective is to examine the survival and outcome of infants born under 26 weeks gestation in an Irish tertiary maternity hospital from 2007-2016 and to describe the survival and neurodevelopmental outcomes of these extremely preterm infants. Method: The population is 132 infants born at 23, 24, and 25 weeks in Cork University Maternity Hospital from 2007 to 2016. Ethical approval was granted by the Cork Clinical Research Ethics Committee. Patient details were obtained from the Vermont Oxford and Badger Networks. Survival rates and Bayley scores were calculated to assess neurodevelopmental outcomes. Statistical analysis with SPSS included frequencies, distributions, and comparisons between data from 2007-2011 and 2012-2016. Results: Overall survival rate was 63%. Of the surviving babies, 61% had Bayley scores calculated. Survival stood at 39% for delivery at 23 weeks, 50% at 24 weeks, and 83% at 25 weeks. The 2012 to 2016 cohort has shown further increases in survival, with 50% of babies at 23 weeks, 58% at 24 weeks, and 89% at 25 weeks. Corresponding figures for 2007-2011 are 20%, 39%, and 75%. Gestational age and incidence of periventricular leukomalacia were statistically significant, with a p-value of 0.022. Gestational age and delivery room deaths had a p-value of 0.025, as did gestational age and birth weight. A comparison of the two cohorts (2007-2011 and 2012-2016) with the administration of antenatal steroids showed a statistically significant p-value of 0.044. Conclusion: There is less morbidity and mortality in infants born at 25 than at 23 or 24 weeks. Survival of extremely premature infants has increased significantly over the past ten years. Survival rates with normal neurodevelopmental outcomes are comparable with international standards and reflect positive changes in attitude and practices in neonatal intensive care. This study will inform parents about the potential outcomes of extreme prematurity and policy regarding the management of extreme prematurity.

Keywords: extreme of viability, neurodevelopmental outcome, periventricular leukomalacia, prematurity

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Authors: A. Hilsana, Vinay U. Rao, M. Sudhakar

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Even though a number of non-steroidal anti-inflammatory drugs (NSAIDS) are available with different chemistries, they share a common solubility characteristic that is they are relatively more soluble in alkaline environment and practically insoluble in acidic environment. This work deals with developing a wax matrix drug delivery platform for controlled delivery of three model NSAIDS, Diclofenac sodium (DNa), Mefenamic acid (MA) and Naproxen (NPX) using the melt granulation technique. The aim of developing the platform was to have a general understanding on how an erodible matrix system modulates drug delivery rate and extent and how it can be optimized to give a delivery system which shall release the drug as per a common target product profile (TPP). Commonly used waxes like Cetostearyl alcohol and stearic acid were used singly an in combination to achieve a TPP of not 15 to 35% in 1 hour and not less than 80% Q in 24 hours. Full factorial design of experiments was followed for optimization of the formulation.

Keywords: NSAIDs, controlled delivery, target product profile, melt granulation

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Authors: Shideh Mohseni Movahed, Mansoureh Safari

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Intelligent drug delivery systems (IDDS) are innovative technological innovations and clinical way to advance current treatments. These systems differ in technique of therapeutic administration, intricacy, materials and patient compliance to address numerous clinical conditions that require different pharmacological therapies. IDDS capable of releasing an active molecule at the proper site and at a amount that adjusts in response to the progression of the disease or to certain functions/biorhythms of the organism is particularly appealing. In this paper, we describe the most recent advances in the development of intelligent drug delivery systems.

Keywords: drug delivery systems, IDDS, medicine, health

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Authors: nafees mahbub, blake tindol, utkarsh shrivastava, kuanchin chen

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Online shopping has become an integral part of businesses today. Big players such as Amazon are setting the bar for delivery services, and many businesses are working towards meeting them. However, what happens if a seller underestimates or overestimates the delivery time? Does it translate to consumer comments, ratings, or lost sales? Although several prior studies have investigated the impact of poor logistics on customer satisfaction, that impact of under estimation of delivery times has been rarely considered. The study uses real-time customer online purchase data to study the impact of missed delivery times on satisfaction.

Keywords: LOST SALES, DELIVERY TIME, CUSTOMER SATISFACTION, CUSTOMER REVIEWS

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Authors: Matthew O. Ikuabe, Ayodeji E. Oke, Clinton O. Aigbavboa, Douglas O. Aghimien

Abstract:

The use of technological innovations have been touted to be beneficial in the delivery of construction projects. Particularly, Radio Frequency Identification (RFID) technology is widely regarded to be of immense advantage for the management of construction projects. This study focused on evaluating the barriers to the use of Radio Frequency Identification (RFID) technology for the delivery of construction projects. Using Gauteng Provincein South Africa as the study area, questionnaire was used in eliciting responses from construction professionals, which made up the population of the study. Retrieved data was analysed using Mean Item Score and One-Sample t-test. Findings from the study showed that the most significant barriers to the deployment of RFID for construction project delivery are high cost and lack of awareness. Conclusively, the study made recommendations that would aid in the abatement of the barriers to the use of RFID technology for construction project delivery.

Keywords: barriers, construction, project delivery, RFID

Procedia PDF Downloads 154

Authors: Ria Ghosh, Soumendra Singh, Dipanjan Mukherjee, Susmita Mondal, Monojit Das, Uttam Pal, Aniruddha Adhikari, Aman Bhushan, Surajit Bose, Siddharth Sankar Bhattacharyya, Debasish Pal, Tanusri Saha-Dasgupta, Maitree Bhattacharyya, Debasis Bhattacharyya, Asim Kumar Mallick, Ranjan Das, Samir Kumar Pal

Abstract:

Drug delivery to a target without adverse effects is one of the major criteria for clinical use. Herein, we have made an attempt to explore the delivery efficacy of SDS surfactant in a monomer and micellar stage during the delivery of the model drug, Toluidine Blue (TB) from the micellar cavity to DNA. Molecular recognition of pre-micellar SDS encapsulated TB with DNA occurs at a rate constant of k1 ~652 s 1. However, no significant release of encapsulated TB at micellar concentration was observed within the experimental time frame. This originated from the higher binding affinity of TB towards the nano-cavity of SDS at micellar concentration which does not allow the delivery of TB from the nano-cavity of SDS micelles to DNA. Thus, molecular recognition controls the extent of DNA recognition by TB which in turn modulates the rate of delivery of TB from SDS in a concentration-dependent manner.

Keywords: DNA, drug delivery, micelle, pre-micelle, SDS, toluidine blue

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Authors: Alessandro Marano

Abstract:

Aim: The author describes a strategy for choosing between two different rhinoplasty approaches for outcomes treatment. Methods: Series of the case study. There are advantages and disadvantages on both approaches for rhinoplasty. On the side of the open approach, we are be able to better manage the techniques for shaping and restoring nasal structures in rhinoplasty outcomes; on the other side, the closed approach requires more practice and experience to achieve good results. Results: Author’s choice is the closed approach on rhinoplasty outcomes. Anyway, the open approach is most commonly preferred due to superior management and better vision on nasal structures. Conclusions: Both approaches are valid for the treatment of rhinoplasty outcomes, author's preferred approach is closed, with minimally invasive modification focused on restoring outcomes in nasal function and aesthetics.

Keywords: rhinoplasty, aesthetic, face, outcomes

Procedia PDF Downloads 75

Authors: Onyeka Nkwonta, Theo Haupt, Karana Padayachee

Abstract:

This study aims primarily to identify potential causes of the bottlenecks in the public sector that affect delivery and formulate evidence-based interventions to improve delivery and management of infrastructure projects. An initial literature review was carried out on infrastructural development and delivery in South Africa, with the aim to formulate evidence-based interventions to improve delivery within the sector. The infrastructure delivery management model was developed to map out best practice delivery processes. These will become the backbone on which improvement initiatives that will be developed within participating stakeholders. The model will, in turn, support a range of methodologies, including the risk system and a knowledge management framework. It will also look at key challenges facing departments with the ability to ensure knowledge and skills transfer at various sectors. The research is limited because the findings were based on existing literature. This study adopted an indirect approach for infrastructure management by focussing on the challenges faced and approaches adopted to overcome these challenges. This may narrow the consideration of some of the viewpoints, thereby limiting the richness of experience available to this research.

Keywords: infrastructure, management, challenges, South Africa

Procedia PDF Downloads 99

Authors: Kaarunya Sampathkumar, Say Chye Joachim Loo

Abstract:

Oral delivery is regarded as the facile method for the administration of active pharmaceutical ingredients (API) and drug carriers. In an initiative towards sustainable nanotechnology, an oral nano-delivery system has been developed that is made entirely of food-based materials and can also act as a site-specific delivery device depending on the stimulus encountered in different parts of the gastrointestinal tract (GIT). The delivery system has been fabricated from food grade polysaccharide materials like chitosan and starch through electrospraying technique without the use of any organic solvents. A nutraceutical extracted from an Indian medicinal plant, has been loaded into the nano carrier to test its efficacy in encapsulation and stimuli based release of the active ingredient. The release kinetics of the nutraceutical from the carrier was evaluated in simulated gastric, intestinal and colonic fluid and was found to be triggered both by the enzymes and the pH in each part of the intestinal tract depending on the polysaccharide being used. The toxicity of the nanoparticles on the intestinal epithelial cells was tested and found to be relatively safe for up to 24 hours at a concentration of 0.2 mg/mL with cellular uptake also being observed. The developed nano carrier thus serves as a promising delivery vehicle for targeted delivery to different parts of the GIT with the inherent conditions of the GIT itself acting as the stimulus. In addition, being fabricated from food grade materials, the carrier could be potentially used for the targeted delivery of nutrients through functional foods.

Keywords: bioavailability, chitosan, delivery systems, encapsulation

Procedia PDF Downloads 179