Search results for: regional anaesthesia
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1668

Search results for: regional anaesthesia

1668 Evaluation of Regional Anaesthesia Practice in Plastic Surgery: A Retrospective Cross-Sectional Study

Authors: Samar Mousa, Ryan Kerstein, Mohanad Adam

Abstract:

Regional anaesthesia has been associated with favourable outcomes in patients undergoing a wide range of surgeries. Beneficial effects have been demonstrated in terms of postoperative respiratory and cardiovascular endpoints, 7-day survival, time to ambulation and hospital discharge, and postoperative analgesia. Our project aimed at assessing the regional anaesthesia practice in the plastic surgery department of Buckinghamshire trust and finding out ways to improve the service in collaboration with the anaesthesia team. It is a retrospective study associated with a questionnaire filled out by plastic surgeons and anaesthetists to get the full picture behind the numbers. The study period was between 1/3/2022 and 23/5/2022 (12 weeks). The operative notes of all patients who had an operation under plastic surgery, whether emergency or elective, were reviewed. The criteria of suitable candidates for the regional block were put by the consultant anaesthetists as follows: age above 16, single surgical site (arm, forearm, leg, foot), no drug allergy, no pre-existing neuropathy, no bleeding disorders, not on ant-coagulation, no infection to the site of the block. For 12 weeks, 1061 operations were performed by plastic surgeons. Local cases were excluded leaving 319 cases. Of the 319, 102 patients were suitable candidates for regional block after applying the previously mentioned criteria. However, only seven patients had their operations under the regional block, and the rest had general anaesthesia that could have been easily avoided. An online questionnaire was filled out by both plastic surgeons and anaesthetists of different training levels to find out the reasons behind the obvious preference for general over regional anaesthesia, even if this was against the patients’ interest. The questionnaire included the following points: training level, time taken to give GA or RA, factors that influence the decision, percentage of RA candidates that had GA, reasons behind this percentage, recommendations. Forty-four clinicians filled out the questionnaire, among which were 23 plastic surgeons and 21 anaesthetists. As regards the training level, there were 21 consultants, 4 associate specialists, 9 registrars, and 10 senior house officers. The actual percentage of patients who were good candidates for RA but had GA instead is 93%. The replies estimated this percentage as between 10-30%. 29% of the respondents thought that this percentage is because of surgeons’ preference to have GA rather than RA for their operations without medical support for the decision. 37% of the replies thought that anaesthetists prefer giving GA even if the patient is a suitable candidate for RA. 22.6% of the replies thought that patients refused to have RA, and 11.3% had other causes. The recommendations were in 5 main accesses, which are protocols and pathways for regional blocks, more training opportunities for anaesthetists on regional blocks, providing a separate block room in the hospital, better communication between surgeons and anaesthetists, patient education about the benefits of regional blocks.

Keywords: regional anaesthesia, regional block, plastic surgery, general anaesthesia

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1667 Regional Anesthesia in Carotid Surgery: A Single Center Experience

Authors: Daniel Thompson, Muhammad Peerbux, Sophie Cerutti, Hansraj Riteesh Bookun

Abstract:

Patients with carotid stenosis, which may be asymptomatic or symptomatic in the form of transient ischaemic attack (TIA), amaurosis fugax, or stroke, often require an endarterectomy to reduce stroke risk. Risks of this procedure include stroke, death, myocardial infarction, and cranial nerve damage. Carotid endarterectomy is most commonly performed under general anaesthetic, however, it can also be undertaken with a regional anaesthetic approach. Our tertiary centre generally performs carotid endarterectomy under regional anaesthetic. Our major tertiary hospital mostly utilises regional anaesthesia for carotid endarterectomy. We completed a cross-sectional analysis of all cases of carotid endarterectomy performed under regional anaesthesia across a 10-year period between January 2010 to March 2020 at our institution. 350 patients were included in this descriptive analysis, and demographic details for patients, indications for surgery, procedural details, length of surgery, and complications were collected. Data was cross tabulated and presented in frequency tables to describe these categorical variables. 263 of the 350 patients in the analysis were male, with a mean age of 71 ± 9. 172 patients had a history of ischaemic heart disease, 104 had diabetes mellitus, 318 had hypertension, and 17 patients had chronic kidney disease greater than Stage 3. 13.1% (46 patients) were current smokers, and the majority (63%) were ex-smokers. Most commonly, carotid endarterectomy was performed conventionally with patch arterioplasty 96% of the time (337 patients). The most common indication was TIA and stroke in 64% of patients, 18.9% were classified as asymptomatic, and 13.7% had amaurosis fugax. There were few general complications, with 9 wound complications/infections, 7 postoperative haematomas requiring return to theatre, 3 myocardial infarctions, 3 arrhythmias, 1 exacerbation of congestive heart failure, 1 chest infection, and 1 urinary tract infection. Specific complications to carotid endarterectomy included 3 strokes, 1 postoperative TIA, and 1 cerebral bleed. There were no deaths in our cohort. This analysis of a large cohort of patients from a major tertiary centre who underwent carotid endarterectomy under regional anaesthesia indicates the safety of such an approach for these patients. Regional anaesthesia holds the promise of less general respiratory and cardiac events compared to general anaesthesia, and in this vulnerable patient group, calls for comparative research between local and general anaesthesia in carotid surgery.

Keywords: anaesthesia, carotid endarterectomy, stroke, carotid stenosis

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1666 Signals Monitored during Anaesthesia

Authors: Launcelot.McGrath

Abstract:

A comprehensive understanding of physiological data is a vital aid to the anaesthesiologist in monitoring and maintaining the well-being of a patient undergoing surgery. Biosignal analysis is one of the most important topics that researchers have tried to develop over the last century to understand numerous human diseases. Understanding which biological signals are most important during anaesthesia is critically important. It is important that the anaesthesiologist understand both the signals themselves and the limitations introduced by the processes of acquisition. In this article, we provide an overview of different types of biological signals as well as the mechanisms applied to acquire them.

Keywords: general biosignals, anaesthesia, biological, electroencephalogram

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1665 Signals Monitored During Anaesthesia

Authors: Launcelot McGrath, Xiaoxiao Liu, Colin Flanagan

Abstract:

It is widely recognised that a comprehensive understanding of physiological data is a vital aid to the anaesthesiologist in monitoring and maintaining the well-being of a patient undergoing surgery. Bio signal analysis is one of the most important topics that researchers have tried to develop over the last century to understand numerous human diseases. There are tremendous biological signals during anaesthesia, and not all of them are important, which to choose to observe is a significant decision. It is important that the anaesthesiologist understand both the signals themselves, and the limitations introduced by the processes of acquisition. In this article, we provide an all-sided overview of different types of biological signals as well as the mechanisms applied to acquire them.

Keywords: general biosignals, anaesthesia, biological, electroencephalogram

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1664 The Analgesic Impact of Adding Intrathecal Ketamine to Spinal Anaesthesia for Hip or Knee Arthroplasty: A Clinical Audit

Authors: Carl Ashworth, Matthys Campher

Abstract:

Spinal anaesthesia has been identified as the “gold standard” for primary elective total hip and knee arthroplasty, which is most commonly performed using longer-acting local anaesthetics, such as hyperbaric bupivacaine, to prolong the duration of anaesthesia and analgesia suitable for these procedures. Ketamine is known to have local anaesthetic effects with potent analgesic properties and has been evaluated as a sole anaesthetic agent via intrathecal administration; however, the use of intrathecal ketamine as an adjunct to intrathecal hyperbaric bupivacaine, morphine, and fentanyl has not been extensively studied. The objective of this study was to identify the potential analgesic effects of the addition of intrathecal ketamine to spinal anaesthesia and to compare the efficacy and safety of adding intrathecal ketamine to spinal anaesthesia for hip- or knee arthroplasty with spinal anaesthesia for hip- or knee arthroplasty without intrathecal ketamine. The medical records of patients who underwent elective hip- or knee arthroplasty under spinal anaesthesia performed by an individual anaesthetist with either intrathecal hyperbaric bupivacaine, morphine and fentanyl or intrathecal hyperbaric bupivacaine, morphine, fentanyl and ketamine between June 4, 2020, and June 4, 2022, were retrospectively reviewed. These encounters were reviewed and analyzed from a perioperative pain perspective, with the primary outcome measure as the oral morphine equivalent (OME) usage in the 48 hours post-spinal anaesthesia, and secondary outcome measures including time to breakthrough analgesia, self-reported pain scores at rest and during movement at 24 and 48 hours after surgery, adverse effects of analgesia, complications, and length of stay. There were 26 patients identified who underwent TKR between June 4, 2020, and June 4, 2022, and 25 patients who underwent THR with the same conditions. It was identified that patients who underwent traditional spinal anaesthesia with the addition of ketamine for elective hip- or knee arthroplasty had a lower mean total OME in the 48 hours immediately post-spinal anaesthesia yet had a shorter time to breakthrough analgesia administration. The proposed mechanism of action for intrathecal ketamine as an additive to traditional spinal anaesthesia for elective hip- or knee arthroplasty is that it may prolong and attenuate the analgesic effect of traditional spinal anaesthesia. There were no significant differences identified in comparing the efficacy and safety of adding intrathecal ketamine to spinal anaesthesia for hip- or knee arthroplasty with spinal anaesthesia for hip- or knee arthroplasty without intrathecal ketamine.

Keywords: anaesthesia, spinal, intra-thecal, ketamine, spinal-morphine, bupivacaine

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1663 The Benefits of Regional Brand for Companies

Authors: H. Starzyczna, M. Stoklasa, K. Matusinska

Abstract:

This article deals with the benefits of regional brands for companies in the Czech Republic. Research was focused on finding out the expected and actual benefits of regional brands for companies. The data were obtained by questionnaire survey and analysed by IBM SPSS. Representative sample of 204 companies was created. The research analysis disclosed the expected benefits that the regional brand should bring to companies. But the actual benefits are much worse. The statistical testing of hypotheses revealed that the benefits depend on the region of origin, which surprised both us and the regional coordinators.

Keywords: Brand, regional brands, product protective branding programs, brand benefits

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1662 Verification of the Necessity of Maintenance Anesthesia with Isoflurane after Induction with Tiletamine-Zolazepam in Dogs Using the Dixon's up-and-down Method

Authors: Sonia Lachowska, Agnieszka Antonczyk, Joanna Tunikowska, Pawel Kucharski, Bartlomiej Liszka

Abstract:

Isoflurane is one of the most commonly used anaesthetic gases in veterinary medicine. Due to its numerous side effects, intravenous anaesthesia is more often used. The combination of tiletamine with zolazepam has proved to be a safe and pharmacologically beneficial combination. Analgesic effect, fast induction time, effective myorelaxation, and smooth recovery are the main advantages of this combination of drugs. In the following study, the authors verified the necessity of isoflurane to maintain anaesthesia in dogs after the use of tiletamine-zolazepam for induction. 12 dogs were selected to the group with the inclusion criteria: ASA (American Society of Anaesthesiology) I or II. Each dog received premedication intramuscularly with medetomidine-butorfanol (10 μg/kg, 0,1 mg/kg respectively). 15 minutes from premedication, preoxygenation lasting 5 minutes was started. Anaesthesia was induced with tiletamine-zolazepam at the dose of 5 mg/kg. Then the dogs were intubated and anaesthesia was maintained with isoflurane. Initially, MAC (Minimum Alveolar Concentration) was set to 0.7 vol.%. After 15 minutes equilibration, MAC was determined using Dixon’s up-and-down method. Painful stimulation including compressions of paw pad, phalange, groin area, and clamping Backhaus on skin. Hemodynamic and ventilation parameters were measured and noted in 2 minutes intervals. In this method, the positive or negative response to the noxious stimulus is estimated and then used to determine the concentration of isoflurane for next patient. The response is only assessed once in each patient. The results show that isoflurane is not necessary to maintain anaesthesia after tiletamine-zolazepam induction. This is clinically important because the side effects resulting from using isoflurane are eliminated.

Keywords: anaesthesia, dog, Isoflurane, The Dixon's up-and-down method, Tiletamine, Zolazepam

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1661 Rectus Sheath Block to Extend the Effectiveness of Post Operative Epidural Analgesia

Authors: Sugam Kale, Arif Uzair Bin Mohammed Roslan, Cindy Lee, Syed Beevee Mohammed Ismail

Abstract:

Preemptive analgesia is an established concept in the modern practice of anaesthesia. To be most effective, it is best instituted earlier than the surgical stimulus and should last beyond the offset of surgically induced pain till healing is complete. Whereas the start of afferent pain blockade with regional anaesthesia is common, its effect often falls short to cover the entire period of pain impulses making their way to CNS in the post-operative period. We tried to use a combination of two regional anaesthetic techniques used sequentially to overcome this handicap. Madam S., a 56 year old lady, was scheduled for elective surgery for pancreatic cancer. She underwent laparotomy and distal pancreatectomy, splenectomy, bilateral salpingo oophorectomy, and sigmoid colectomy. Surgery was expected to be extensive, and it was presumed that the standard pain relief with PCA with opiates and oral analgesics would not be adequate. After counselling the patient pre-operative about the technique of regional anaesthesia techniques, including epidural catheterization and rectus sheath catheter placement, their benefits, and potential complications, informed consent was obtained. Epidural catheter was placed awake, and general anaesthesia was then induced. Epidural infusion of local anaesthetics was started prior to surgical incision and was continued till 60 hours into the postoperative period. Before skin closure, the surgeons inserted commercially available rectus sheath catheters bilaterally along the midline incision used for laparotomy. After 46 hours post-op, local anaesthetic infusion via these was started as bridging while the epidural infusion rate was tapered off. The epidural catheter was removed at 75 hours. Elastomeric pumps were used to provide local anaesthetic infusion with the ability to vary infusion rates. Acute pain service followed up the patient’s vital signs and effectiveness of pain relief twice daily or more frequently as required. Rectus sheath catheters were removed 137 hours post-op. The patient had good post-op analgesia with the minimal additional analgesic requirement. For the most part, the visual analog score (VAS) for pain remained at 1-3 on a scale of 1 to 10. Haemodynamics remained stable, and surgical recovery was as expected. Minimal opiate requirement after an extensive laparotomy also translates to the early return of intestinal motility. Our experience was encouraging, and we are hoping to extend this combination of two regional anaesthetic techniques to patients undergoing similar surgeries. Epidural analgesia is denser and offers excellent pain relief for both visceral and somatic pain in the first few days after surgery. As the pain intensity grows weaker, rectus sheath block and oral analgesics provide almost the same degree of pain relief after the epidural catheter is removed. We discovered that the background infusion of local anaesthetic down the rectus sheath catherter largely reduced the requirement for other classes of analgesics. We aim to study this further with a larger patient cohort and hope that it may become an established clinical practice that benefits patients everywhere.

Keywords: rectus sheath, epidural infusion, post operative analgesia, elastomeric

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1660 Intrathecal Fentanyl with 0.5% Bupivacaine Heavy in Chronic Opium Abusers

Authors: Suneet Kathuria, Shikha Gupta, Kapil Dev, Sunil Katyal

Abstract:

Chronic use of opioids in opium abusers can cause poor pain control and increased analgaesic requirement. We compared the duration of spinal anaesthesia in chronic opium abusers and non-abusers. This prospective randomised study included 60 American Society of Anesthesiologists (ASA) Grade I or II adults undergoing surgery under spinal anaesthesia with 10 mg bupivacaine, and 25 μg fentanyl in non-opium abusers (Group A); and chronic opium abusers (Group B), and 40 μg fentanyl in chronic opium abusers (Group C). Patients were assessed for onset and duration of sensory and motor blockade and duration of effective analgesia. Mean time to onset of adequate analgesia in opium abusers was significantly longer in chronic opium abusers than in opium-naive patients. The duration of sensory block and motor block was significantly less in chronic opium abusers than in non-opium abusers. Duration of effective analgesia in groups A, B and C was 255.55 ± 26.84, 217.85 ± 15.15, and 268.20 ± 18.25 minutes, respectively; this difference was statistically significant. In chronic opium abusers, the duration of spinal anaesthesia is significantly shorter than that in opium nonabusers. The duration of spinal anaesthesia with bupivacaine and fentanyl in chronic opium abusers can be improved by increasing the intrathecal fentanyl dose from 25 μg to 40 μg.

Keywords: bupivacaine, chronic opium abusers, fentanyl, intrathecal

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1659 Illuminating Regional Identity: An Interdisciplinary Exploration in Saskatchewan

Authors: Anne Gibbons

Abstract:

Both inside and outside of academia, people have sought to understand the “sense of place” of various regions, many times over and for many different reasons. The concept of regional identity is highly complex and surrounded by considerable contention. There are multiple bodies of research on regional identity theory in many different disciplines and even across sub-disciplinary classifications. Each discipline takes a slightly different angle or perspective on regional identity, resulting in a fragmented body of work on this topic overall. There is a need to consolidate this body of increasingly fragmented theory through interdisciplinary integration. For the purpose of this study, the province of Saskatchewan will serve as an exemplar for exploring regional identity in a concrete context. Saskatchewan can be thought of as a ‘functional region,’ with clear boundaries and clear residency, from which regional identity can be studied. This thesis shares the outcomes of a qualitative study grounded in a series of group interviews with askatchewan residents, from which it is concluded that the use of interdisciplinary theory is an appropriate approach to the study of regional identity. Regional identity cannot be compartmentalized; it is a web of characteristics, attributes, and feelings that are inextricably linked. The thesis thus concludes by offering lessons learned about how we might better understand regional identity, as illuminated through both interdisciplinary theory and the lived experiences and imaginations of people living in the region of Saskatchewan.

Keywords: interdisciplinary, regional identity, Saskatchewan, tourism studies

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1658 How to Evaluate the Contribution of Social Finance to Regional Economy

Authors: Jungeun Cho

Abstract:

Social finance has received increasing attention as a means to promote the growth of regional economies. Despite the plenty of research discussed their critical role and functions in regional economic development such as the financing and promotion of co-operatives or social enterprises and the offering credit to the financially excluded in the region, however, rarely are efforts made to measure the contribution of social finance in the regional economy. It is essential to establish an evaluation model in order to encourage social finance institutions to perform their supposed role and functions on regional economic development. The objective of this paper is to formulate an evaluation model of the contribution of social finance to the regional economy through an analytic hierarchy process (AHP) approach. This study is expected to provide useful guidelines for social finance institutions’ strategies and the policies of local or central government regarding social finance.

Keywords: social finance, regional economy, social economy, policies of local or central government

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1657 Educational Mobility as a Factor of Tourism Development in the Regional University

Authors: К. Lisinchuk

Abstract:

An effective approach to the management of international educational mobility in regional universities with the purpose of increasing tourist activity in the region is considered.

Keywords: export and import of tourist and educational services, international academic mobility, regional tourist activities

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1656 Measuring Innovative and Entrepreneurial Networks Performance

Authors: Luís Farinha, João J. Ferreira

Abstract:

Nowadays innovation represents a challenge crucial to remaining globally competitive. This study seeks to develop a conceptual model aimed at measuring the dynamic interactions of the triple/quadruple helix, balancing innovation and entrepreneurship initiatives as pillars of regional competitiveness – the Regional Helix Scoreboard (RHS). To this aim, different strands of literature are identified according to their focus on specific regional competitiveness governance mechanisms. We put forward an overview of the state-of-the-art of research and is duly assessed in order to develop and propose a framework of analysis that enables an integrated approach in the context of collaborative dynamics. We conclude by presenting the RHS for the study of regional competitiveness dynamics, which integrates and associates different backgrounds and identifies a number of key performance indicators for research challenges.

Keywords: entrepreneurship, KPIs, innovation, performance measurement, regional competitiveness, regional helix scoreboard

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1655 Signals Monitored During Anaesthesia

Authors: Launcelot McGrath

Abstract:

A comprehensive understanding of physiological data is a vital aid to the anaesthesiologist in monitoring and maintaining the well-being of a patient undergoing surgery. Bio signal analysis is one of the most important topics that researchers have tried to develop over the last century to understand numerous human diseases. Understanding which biological signals are most important during anaesthesia is critically important. It is important that the anaesthesiologist understand both the signals themselves and the limitations introduced by the processes of acquisition. In this article, we provide an overview of different types of biological signals as well as the mechanisms applied to acquire them.

Keywords: biological signals, signal acquisition, anaesthesiology, patient monitoring

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1654 Evaluation of the Use of Proseal LMA in Patients Undergoing Elective Lower Segment Caesarean Section under General Anaesthesia: A Prospective Randomised Controlled Study

Authors: Shalini Saini, Sharmila Ahuja

Abstract:

Anaesthesia for caesarean section poses challenges unique to the obstetric patient due to changes in the airway and respiratory system. The choice of anaesthesia for caesarean section depends on various factors however general anaesthesia (GA) is necessary for certain situations. Supraglottic airway devices are an emerging method to secure airway, especially in difficult situations. Of these devices, proseal –LMA (PLMA) is designed to provide better protection of the airway. The use of PLMA has been reported successfully as a rescue device in difficult intubation situations and in patients undergoing elective caesarean section without any complications. The study was prospective and randomised and was designed to compare PLMA in patients undergoing elective lower segment caesarean section (LSCS) with the endotracheal tube (ETT). Patients undergoing LSCS under GA belonging to ASA grade 1 and 2 were included. Patients with the history of fewer than 6 hrs of fasting, known/predicted difficult airway, obesity, gastroesophageal reflux disease, hypertensive disorder were excluded. A standard anaesthesia protocol was followed. All patients received aspiration prophylaxis. The airway was secured with either PLMA or ETT. Parameters noted were- ease of insertion, adequacy of ventilation, hemodynamic changes at insertion and removal of device, incidence of regurgitation and aspiration. Data was analysed by unpaired t- test, Chi-square /Fisher’s test. The findings of our study indicated that PLMA was easy to insert (20.67±6.835 sec) with comparable insertion time to TT (18.33 ± 4.971, p 0.136) and adequate ventilation was achieved with very minimal hemodynamic changes seen with PLMA as compared to ETT at insertion and removal of devices (p 0.01). There was no incidence of regurgitation with the use of PLMA. The incidence of a postoperative sore throat was minimal (6.7%) with PLMA (p<0.05). PLMA appears to be a safe alternative to ETT for selected obstetric patients undergoing elective LSCS. Further study with a larger group of patients is required to establish the safety of PLMA in obstetric patients.

Keywords: caesarean section, general anaesthesia, proseal LMA, endotracheal tube

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1653 Classification of Regional Innovation Types and Region-Based Innovation Policies

Authors: Seongho Han, Dongkwan Kim

Abstract:

The focus of regional innovation policies is shifting from a central government to local governments. The central government demands that regions enforce autonomous and responsible regional innovation policies and that regional governments seek for innovation policies fit for regional characteristics. However, the central government and local governments have not arrived yet at a conclusion on what innovation policies are appropriate for regional circumstances. In particular, even if each local government is trying to find regional innovation strategies that are based on the needs of a region, its innovation strategies turn out to be similar with those of other regions. This leads to a consequence that is inefficient not only at a national level, but also at a regional level. Existing researches on regional innovation types point out that there are remarkable differences in the types or characteristics of innovation among the regions of a nation. In addition they imply that there would be no expected innovation output in cases in which policies are enforced with ignoring such differences. This means that it is undesirable to enforce regional innovation policies under a single standard. This research, given this problem, aims to find out the characteristics and differences in innovation types among the regions in Korea and suggests appropriate policy implications by classifying such characteristics and differences. This research, given these objectives, classified regions in consideration of the various indicators that comprise the innovation suggested by existing related researches and illustrated policies based on such characteristics and differences. This research used recent data, mainly from 2012, and as a methodology, clustering analysis based on multiple factor analysis was applied. Supplementary researches on dynamically analyzing stability in regional innovation types, establishing systematic indicators based on the regional innovation theory, and developing additional indicators are necessary in the future.

Keywords: regional innovation policy, regional innovation type, region-based innovation, multiple factor analysis, clustering analysis

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1652 Analysis of the Decoupling Relationship between Urban Green Development and the Level of Regional Integration Based on the Tapio Model

Authors: Ruoyu Mao

Abstract:

Exploring the relationship between urban green development and regional integration level is of great significance for realising regional high quality and sustainable development. Based on the Tapio decoupling model and the theoretical framework of urban green development and regional integration, this paper builds an analysis system, makes a quantitative analysis of urban green development and regional integration level in a certain period, and discusses the relationship between the two. It also takes China's Yangtze River Delta urban agglomeration as an example to study the degree of decoupling, the type of decoupling, and the trend of the evolution of the spatio-temporal pattern of decoupling between the level of urban green development and the level of regional integration in the period of 2014-2021, with the aim of providing a useful reference for the future development of the region.

Keywords: regional integration, urban green development, Tapio decoupling model, Yangtze River Delta urban agglomeration

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1651 Exploring Dynamics of Regional Creative Economy

Authors: Ari Lindeman, Melina Maunula, Jani Kiviranta, Ronja Pölkki

Abstract:

The aim of this paper is to build a vision of the utilization of creative industry competences in industrial and services firms connected to Kymenlaakso region, Finland, smart specialization focus areas. Research indicates that creativity and the use of creative industry’s inputs can enhance innovation and competitiveness. Currently creative methods and services are underutilized in regional businesses and the added value they provide is not well grasped. Methodologically, the research adopts a qualitative exploratory approach. Data is collected in multiple ways including a survey, focus groups, and interviews. Theoretically, the paper contributes to the discussion about the use creative industry competences in regional development, and argues for building regional creative economy ecosystems in close co-operation with regional strategies and traditional industries rather than as treating regional creative industry ecosystem initiatives separate from them. The practical contribution of the paper is the creative vision for the use of regional authorities in updating smart specialization strategy as well as boosting industrial and creative & cultural sectors’ competitiveness. The paper also illustrates a research-based model of vision building.

Keywords: business, cooperation, creative economy, regional development, vision

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1650 Great Powers’ Proxy Wars in Middle East and Difficulty in Transition from Cold War to Cold Peace

Authors: Arash Sharghi, Irina Dotu

Abstract:

The developments in the Middle East region have activated the involvement of a numerous diverse state and non-state actors in the regional affairs. The goals, positions, ideologies, different, and even contrast policy behaviors had procured the spreading and continuity of crisis. Non-state actors varying from Islamic organizations to takfiri-terrorist movements on one hand and regional and trans- regional actors, from another side, seek to reach their interests in the power struggle. Here, a research worthy question comes on the agenda: taking into consideration actors’ contradictory interests and constraints what are the regional peace and stability perspectives? Therein, different actors’ aims definition, their actions and behaviors, which affect instability, can be regarded as independent variables; whereas, on the contrary, Middle East peace and stability perspective analysis is a dependent variable. Though, this regional peace and war theory based research admits the significant influence of trans-regional actors, it asserts the roots of violence to derive from region itself. Consequently, hot war and conflict prevention and hot peace assurance in the Middle East region cannot be attained only by demands and approaches of trans-regional actors. Moreover, capacity of trans-regional actors is sufficient only for a cold war or cold peace to be reached in the region. Furthermore, within the framework of current conflict (struggle) between regional actors it seems to be difficult and even impossible to turn the cold war into a cold peace in the region.

Keywords: cold peace, cold war, hot war, Middle East, non-state actors, regional and Great powers, war theory

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1649 AgriFood Model in Ankara Regional Innovation Strategy

Authors: Coskun Serefoglu

Abstract:

The study aims to analyse how a traditional sector such as agri-food could be mobilized through regional innovation strategies. A principal component analysis as well as qualitative information, such as in-depth interviews, focus group and surveys, were employed to find the priority sectors. An agri-food model was developed which includes both a linear model and interactive model. The model consists of two main components, one of which is technological integration and the other one is agricultural extension which is based on Land-grant university approach of U.S. which is not a common practice in Turkey.

Keywords: regional innovation strategy, interactive model, agri-food sector, local development, planning, regional development

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1648 Perceived Quality of Regional Products in MS Region

Authors: M. Stoklasa, H. Starzyczna, K. Matusinska

Abstract:

This article deals with the perceived quality of regional products in the Moravian-Silesian region in the Czech Republic. Research was focused on finding out what do consumers perceive as a quality product and what characteristics make a quality product. The data were obtained by questionnaire survey and analysed by IBM SPSS. From the thousands of respondents the representative sample of 719 for MS region was created based on demographic factors of gender, age, education and income. The research analysis disclosed that consumers in MS region are still price oriented and that the preference of quality over price does not depend on regional brand knowledge.

Keywords: regional brands, quality products, characteristics of quality, quality over price

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1647 PSS®E Based Modelling, Simulation and Synchronous Interconnection of Eastern Grid and North-Eastern Regional Grid of India

Authors: Toushik Maiti, Saibal Chatterjee, Kamaljyoti Gogoi, Arijit Basuray

Abstract:

Eastern Regional(ER) Grid and North Eastern Regional (NER) Grid are two major grids of Eastern Part of India. Both of the grid consists of voltage level 765kV, 400 kV, 220 kV and numerous buses at lower voltage range. Eastern Regional Grid and North Eastern Regional Grid are not only connected among themselves but are also connected to various other grids of India. ER and NER Grid having various HVDC lines or back to back systems which form the total network. The studied system comprises of 340 buses of different voltage levels and transmission lines running over a length of 32089 km. The validation of load flow has been done using IEEE STANDARD 30 bus system. The power flow simulation analysis has been performed after synchronizing both the Eastern Grid and North-Eastern Regional Grid of India using Power System Simulators for Engineering (PSS®E) Important inferences has been drawn from the study.

Keywords: HVDC, load flow, PSS®E, unsymmetrical and symmetrical faults

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1646 Development of Regional Cooperation to Sustainable Implementation of Customary Refugee Solutions in International Arena

Authors: Md. Reduanul Haque

Abstract:

In recent time, more and more refugees are emerging in the international arena than the times ever that has come into the notice of world scholars. The prevailing customary solutions such as voluntary repatriation, local integration, and resettlement of refugee problem have been reflected unsustainable one for the lack of regional cooperation. In the international arena, the protraction of refugee problems is seen, and refugees are suffering due to the outrageous process of customary refugee solutions. If the regional cooperation can be developed, then the suffering of the refugees can be mitigated by the contribution of neighboring country and international and regional organizations. Data collected from the various secondary sources have been used throughout the research. It has been discussing in the refugee academia for a long time to develop regional cooperation mechanisms to ensure the sustainability of this solution and to make the environment of the country of origin for suitable voluntary repatriation as well as a durable solution. It is mainly qualitative research based on primary and secondary data will be studied on library-based project. Data collected by such methodology on this study indicates to make a bridge between the gaps of the cooperation mechanism and to make a more regional approach to share the burden and to strengthen the customary refugee solution. Hence, the importance of questing for a regional mechanism is to ensure the responsible countries to be more responsible towards refugees, their human rights, and durable solution under the mandate of the UNHCR. To implement effectively all the customary durable solutions, country to country or regional organization to organization based regional cooperation can be developed where the countries and regional organizations will work together to draw a sustainable solution to this problem in international context.

Keywords: refugee, regional cooperation, sustainable implementation, customary solutions, international arena

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1645 Indicators of Regional Development, Case Study: Bucharest-Ilfov Region

Authors: Dan Cristian Popescu

Abstract:

The new territorial identities and global dynamics have determined a change of policies of economics, social and cultural development from a vertical to a horizontal approach, which is based on cooperation networks between institutional actors, economic operators or civil society representatives. The European integration has not only generated a different patterns of competitiveness, economic growth, concentration of attractive potential, but also disparities among regions of this country, or even in the countryside within a region. To a better understanding of the dynamics of regional development and the impact of this concept on Romania, I chose as a case study the region Bucharest-Ilfov which is analyzed on the basis of predetermined indicators and of the impact of European programs.

Keywords: regional competition, regional development, rural, urban

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1644 The Regional Novel in India: Its Emergence and Trajectory

Authors: Aruna Bommareddi

Abstract:

The journey of the novel is well examined in Indian academia as an offshoot of the novel in English. There have been many attempts to understand aspects of the early novel in India which shared a commonality with the English novel. The regional novel has had an entirely different trajectory which is mapped in the paper. The main focus of the paper would be to look at the historical emergence of the genre of the regional novel in Indian Literatures with specific reference to Kannada, Hindi, and Bengali. The selection of these languages is guided not only by familiarity with these languages as also based on the significance that these languages enjoy in the sub-continent and for the emergence of the regional novel as a specific category in these languages. The regional novels under study are Phaneeswaranath Renu’s Maila Anchal, Tarashankar Bandopadhyaya’s Ganadevata, and Kuvempu’s House of Kanuru for exploration of the themes of its emergence and some aspects of the regional novel common to and different from each other. The paper would explore the various movements that have shaped the genre regional novel in these Literatures. Though Phaneeswarnath Renu’s Maila Anchal is published in 1956, the novel is set in pre-Independent India and therefore shares a commonality of themes with the other two novels, House of Kanuru and Ganadevata. All three novels explore themes of superstition, ignorance, poverty, and the interventions of educated youth to salvage the crises in these backward regional worlds. In fact, it was Renu who assertively declared that he was going to write a regional novel and hence the tile of the first regional novel in Hindi is Maila Anchal meaning the soiled border. In Hindi, anchal also means the region therefore, the title is suggestive of a dirty region as well. The novel exposes the squalor, ignorance, and the conflict ridden life of the village or region as opposed to the rosy image of the village in literature. With this, all such novels which depicted conflicts of the region got recognized as regional novels even though they may have been written prior to Renu’s declaration. All three novels under study succeed in bringing out the complexity of rural life at a given point of time in its history.

Keywords: bengali, hindi, kannada, regional novel, telugu

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1643 Value of Unilateral Spinal Anaesthesia For Hip Fracture Surgery In The Elderly (75 Cases)

Authors: Fedili Benamar, Beloulou Mohamed Lamine, Ouahes Hassane, Ghattas Samir

Abstract:

Background and aims: While in Western countries, unilateral spinal anesthesia has been widely practiced for a long time, it remains little known in the local anesthesia community, and has not been the object of many studies. However, it is a simple, practical and effective technique. Our objective was to evaluate this practice in emergency anesthesia management in frail patients and to compare it with conventional spinal anesthesia. Methods: This is a prospective, observational, comparative study between hypobaric unilateral and conventional spinal anaesthesia for hip fracture surgery carried out in the operating room of the university military hospital of Staoueli. The work was spread over of 12-month period from 2019 to 2020. The parameters analyzed were hemodynamic variations, vasopressor use, block efficiency, postoperative adverse events, and postoperative morphine consumption. Results: -75 cases (mean age 72±14 years) -Group1= 41 patients (54.6%) divided into (ASA1=14.6% ASA2=60.98% ASA3=24.39%) single shoot spinal anaesthesia -Group2= 34 patients (45.3%) divided into (ASA1=2.9%, ASA2=26.4% ASA3=61.7%, ASA4=8.8%) unilateral hypobaric spinal anesthesia. -Hemodynamic variations were more severe in group 1 (51% hypotension) compared to 30% in group 2 RR=1.69 and odds ratio=2.4 -these variations were more marked in the ASA3 subgroup (group 1=70% hypotension versus group 2=30%) with an RR=2.33 and an odds ratio=5.44 -39% of group 1 required vasoactive drugs (15mg +/- 11) versus 32% of group 2 (8mg+/- 6.49) - no difference in the use of morphine in post-op. Conclusions: Within the limits of the population studied, this work demonstrates the clinical value of unilateral spinal anesthesia in ortho-trauma surgery in the frail patient.

Keywords: spinal anaesthesia, vasopressor, morphine, hypobaric unilateral spinal anesthesia, ropivacaine, hip surgery, eldery, hemodynamic

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1642 Keys of Success in Regional Entrepreneurial Media Collaboration Linked With a New Concept of Citizenship

Authors: Rianne Voet

Abstract:

This paper uses a literature review to search for keys of success for entrepreneurial regional media collaborations in the Netherlands and elsewhere. It specifies keys on general aspects: a digital-first strategy, innovation, a particular journalistic mission and a new role for the public. It outlines keys in practicalities: competencies, revenue model, legal structure, communication structure and organization structure. The paper elaborates on a new public function and a new concept of citizenship which, according to several authors in the literature, are required in order to be successful. Finally, it offers a model of keys for success in regional entrepreneurial media collaboration.

Keywords: media collaboration, factors of success, keys of success, regional media cooperation

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1641 An enhanced Framework for Regional Tourism Sustainable Adaptation to Climate Change

Authors: Joseph M. Njoroge

Abstract:

The need for urgent adaptation have triggered tourism stakeholders and research community to develop generic adaptation framework(s) for national, regional and or local tourism desti-nations. Such frameworks have been proposed to guide the tourism industry in the adaptation process with an aim of reducing tourism industry’s vulnerability and to enhance their ability to cope to climate associated externalities. However research show that current approaches are far from sustainability since the adaptation options sought are usually closely associated with development needs-‘business as usual’-where the implication of adaptation to social justice and environmental integrity are often neglected. Based on this view there is a need to look at adaptation beyond addressing vulnerability and resilience to include the need for adaptation to enhance social justice and environmental integrity. This paper reviews the existing adaptation frameworks/models and evaluates their suitability in enhancing sustainable adaptation for regional tourist destinations. It is noted that existing frameworks contradicts the basic ‘principles of sustainable adaptation’. Further attempts are made to propose a Sustainable Regional Tourism Adaptation Framework (SRTAF) to assist regional tourism stakeholders in the achieving sustainable adaptation.

Keywords: sustainable adaptation, sustainability principles, sustainability portfolio, Regional Tourism

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1640 Regional Advantages Analysis: An Interactive Approach of Comparative and Competitive Advantages

Authors: Abdolrasoul Ghasemi, Ali Arabmazar Yazdi, Yasaman Boroumand, Aliasghar Banouei

Abstract:

In regional studies, choosing an appropriate approach to analyze regional success or failure has always been a challenge. Hence, this study introduces an innovative approach to establish a link between regional success and failure in the past as well as the potential success of a region in the future. The former can be sought in the historical evaluation of comparative advantages, while the latter is portrayed as competitive advantage analysis with a forward-looking approach. Based on the interaction of comparative and competitive advantages, activities are classified into four groups, including activities with no advantage, hidden advantage, fragile advantage and synergistic advantage. In analyzing the comparative advantage of activities, the location quotient method is applied, and in analyzing their competitive advantage, Porter`s diamond model using the survey method is applied. According to the results, the share of no advantage, fragile advantage, hidden advantage and synergic advantage activities are respectively 10%, 42%, 16%, and 32%. Also, to achieve economic development in regional activities, our model provides various levels of priority. First, the activities with synergistic advantage should be prioritized, then the ones with hidden advantage, and finally the activities with fragile advantage.

Keywords: regional advantage, comparative advantage, competitive advantage, Porter's diamond model

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1639 Entrepreneurial Ecosystems and Innovation Systems: An Appraisal of Literature

Authors: Jose Carlos Rodriguez, Mario Gomez

Abstract:

In the last years, the concept of entrepreneurial ecosystems has gained popularity. It reveals the importance of a supportive community and adequate economic environment for entrepreneurial activity, and thus the possibility of developing a different perspective on the innovation system. On the other hand, the (regional/technology) innovation system approach lacks in its analyses the presence of an entrepreneur as a key actor that develops innovations. In this regard, this paper examines the foundations of both theoretical approaches (the entrepreneurial ecosystems and the regional/technology systems of innovation) and their contributions to understand entrepreneurial activity at different levels of analyses, namely national, regional or local. The paper makes a literature review on both perspectives of innovation stressing the role played by entrepreneurs in these theoretical approaches. It concludes remarking that the regional/technology innovation systems approach and the entrepreneurial ecosystem approach have established themselves in their own right, but the regional/technology innovation system approach is a predecessor of the entrepreneurial ecosystem approach.

Keywords: entrepreneurial ecosystems, innovation systems, entrepreneurial activity, comparative analysis

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