Search results for: regional anaesthesia
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1672

Search results for: regional anaesthesia

1642 A Rare Entity: Case Report on Anaesthetic Management in Robinow Syndrome

Authors: Vidhi Chandra, Arshpreet Singh Grewal

Abstract:

A five-year-old male child born from non-consanguineous marriage, who presented with complaints of growth retardation and no appreciable increase in the penile size since birth and he was posted for de-gloving of penis with dissection of corpora under anaesthesia. After thorough preoperative evaluation it was revealed that patient had peculiar facial dysmorphism that of Robinow Syndrome, high arched palate, Mallampati grade III, mesomelic limbs, scoliotic spine and short stature. All routine investigation were within normal limit, electrocardiography (ECG) and 2D-Echocardiography (ECHO) were normal. In antero-posterior roentgenogram chest showed butterfly and hemivertebrae at multiple levels. The patient was considered to be ASA II. On the day of surgery after ensuring fasting of 6 hours, patient was taken in operation theatre, all standard ASA monitoring was done with ECG, non-invasive blood pressure, peripheral oxygen saturation (SpO2) and body temperature. The patient was pre-oxygenated with 100% oxygen with anatomical face mask. General anaesthesia was induced with Sevoflurane 1-8%, and airway was secured with an appropriate size supraglottic airway and anaesthesia was maintained with nitrous oxide and oxygen in 1:1 ratio along with sevoflurane 2%. An ultrasound guided caudal block was given owing to the skeletal deformities making it difficult even under USG guidance. Post operatively patient was given supportive care with proper hydration, antibiotics, anti-inflammatory and analgesics. He was discharged the next day and followed up weekly for a month. DISCUSSION Robinow syndrome is genetically inherited as autosomal dominant, autosomal recessive or heterogenous disorder involving tyrosine kinase ROR2 gene located on chromosome 9. It has low incidence with no preponderance for any gender. Though intelligence is normal but developmental delay and mental retardation occurs in 20%cases

Keywords: Robinow Syndrome, dwarfism, paediatric, anaesthesia

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1641 Regional Competitiveness and Innovation in the Tourism Sector: A Systematic Review and Bibliometric Analysis

Authors: Sérgio J. Teixeira, João J. Ferreira

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Tourism frequently gets identified as one of the sectors with the greatest potential for expansion on a global scale and hence conveying the importance of attempting to better understand the regional factors of competitiveness prevailing in this sector. This study’s objective essentially strives to provide a mapping of the scientific publications and the intellectual knowledge therein contained while conveying past research trends and identifying potential future lines of research in the fields of regional competitiveness and tourism innovation. This correspondingly deploys a systematic review of the literature in keeping with the bibliometric approach based upon VOSviewer software, with a particular focus on drafting maps for visualising the underlying intellectual structure. This type of analysis encapsulates the number of articles published and their annual number of citations for the period between 1900 and 2016 as registered by the Web of Science database. The results demonstrate how the intellectual structure on regional competitiveness divides essentially into three major categories: regional competitiveness, tourism innovation, and tourism clusters. Thus, the main contribution of this study arises out of identifying the main research trends in this field and the respective shortcomings and specific needs for future scientific research in the field of regional competitiveness and innovation in tourism.

Keywords: regional competitiveness, tourism cluster, bibliometric studies, tourism innovation, systematic review

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1640 A Regional Innovation System Model Based on the Systems Thinking Approach

Authors: Samara E., Kilintzis P., Katsoras E., Martinidis G.

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Regions play an important role in the global economy by driving research and innovation policies through a major tool, the Regional Innovation System (RIS). RIS is a social system that encompasses the systematic interaction of the various organizations that comprise it in order to improve local knowledge and innovation. This article describes the methodological framework for developing and validating a RIS model utilizing system dynamics. This model focuses on the functional structure of the RIS, separating it in six diverse, interacting sub-systems.

Keywords: innovations, regional development, systems thinking, social system

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1639 Postoperative Emergence Delirium in Children: An Incomprehensible Scenario For Parents’

Authors: Jenny Ringblom, Marie Proczkowska, Laura Korhonen, Ingrid Wåhlin

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Background: Emergence delirium is a well-known behaviour of perceptual disturbances that may occur after general anaesthesia in children. Children with emergence delirium are often confused; they cry, are involuntarily physically active and are almost impossible to console. The prevalence varies considerably between about 13% and 53%. Research has mainly focused on how different medication accents affect the incidence of emergence delirium, but less is known about parents’ experiences of emergence delirium during the recovery process. Aim: The aim of this study was to describe parents’ experiences and reflections during their child's emergence delirium behaviour when recovering from anaesthesia. Method: The study has a qualitative design, and the data has been analyzed using thematic analysis. A total of 16 parents were interviewed at two county hospitals in Sweden. Results: When the parents reunited with their child at the recovering unit, they felt as if they were encountering an incomprehensible scenario. When watching their child demonstrating emergence delirium, they experienced fear and insecurity and had feelings of powerlessness and guilt. Information and previous experience turned out to offer relief and being seen by the healthcare staff when they, in their vulnerability, failed to reach or console their child gave hope and energy. Conclusion: Emergence delirium must be extensively considered in children undergoing general anaesthesia. Healthcare staff needs to be aware of the parental difficulties it may cause. There is also important to know what parents experience as relieving, such as receiving information and when staff members are being available, responsive and supportive during the wake-up period.

Keywords: emergence delirium, experiences, pediatrics, parents, postoperative care

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1638 Turkey’s Ideological and Identity Politics towards Iran in the Arab Uprising: The Case of Syrian Civil War

Authors: Cangul Altundas Akcay

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With the beginning of the mass movement called as the Arab Uprising, Middle Eastern politics has demonstrated an influential shift which has been threatening the existence of the ruling regimes. In this environment, in particular, regional powers have desired to control regional politics, and to expand their regional influence. Bearing that in mind, Turkey and Iran, two significant regional powers, have engaged in competition so as to affect the shifted regional geopolitics. In this context, this paper aims to investigate how regional powers, especially non-Arab ones, have viewed each other in the Arab Uprising, whereby focusing on Turkish perspectives towards Iran. In other words, it will shed light on how Turkey has conducted foreign policy towards Iran during the Arab Uprising. To analyse this, Turkey’s ideological and identity politics towards Iran will be examined as one of its foreign policy approaches. The question is thus that how ideological and identity politics have determined Turkish foreign policy towards Iran in the Arab Uprising. To answer that, the Syrian civil war will be analysed as the case study in this qualitative study, hypothesising that Turkey, which has both Turkish identity and Sunni sect, has competed with Iran, which has both Farsi identity and Shia sect, over the Syrian civil war.

Keywords: Arab uprising, ideological and identity politics, Iran, Turkey, Syrian civil war

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1637 The First Tendency in Foreign Policy: Theories, Motives, and Effects

Authors: Djehich Mohamed Yousri

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In this paper, we explore the extent to which states seek to promote regional foreign policy. More specifically, the analytical feasibility is to find out exactly what countries seek to export, and how they have used their relations and foreign policies to enhance cooperation with other countries. The first part discusses the development of regional interests and theoretical approaches that attempted to explain the push for regionalism in the field of foreign policy. The second part of the paper presents the motives and mechanisms through which states spread the idea of regionalism in making foreign policy. Finally, we assess the implications of regionalism for the nature and practice of foreign policy, particularly with regard to the gains or constraints to which various actors are exposed in their regional endeavors. We conclude with some considerations that indicate that strengthening regionalism has become an additional and real program in the field of foreign policy analysis.

Keywords: foreign policy, collective foreign policy, regionalization and foreign policy, regional foreign policy, foreign affairs

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1636 Associated Risks of Spontaneous Lung Collapse after Shoulder Surgery: A Literature Review

Authors: Fiona Bei Na Tan, Glen Wen Kiat Ho, Ee Leen Liow, Li Yin Tan, Sean Wei Loong Ho

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Background: Shoulder arthroscopy is an increasingly common procedure. Pneumothorax post-shoulder arthroscopy is a rare complication. Objectives: Our aim is to highlight a case report of pneumothorax post shoulder arthroscopy and to conduct a literature review to evaluate the possible risk factors associated with developing a pneumothorax during or after shoulder arthroscopy. Case Report: We report the case of a 75-year-old male non-smoker who underwent left shoulder arthroscopy without regional anaesthesia and in the left lateral position. The general anaesthesia and surgery were uncomplicated. The patient was desaturated postoperatively and was found to have a pneumothorax on examination and chest X-ray. A chest tube drain was inserted promptly into the right chest. He had an uncomplicated postoperative course. Methods: PubMed Medline and Cochrane database search was carried out using the terms shoulder arthroplasty, pneumothorax, pneumomediastinum, and subcutaneous emphysema. We selected full-text articles written in English. Results: Thirty-two articles were identified and thoroughly reviewed. Based on our inclusion and exclusion criteria, 14 articles, which included 20 cases of pneumothorax during or after shoulder arthroscopy, were included. Eighty percent (16/20) of pneumothoraxes occurred postoperatively. In the articles that specify the side of pneumothorax, 91% (10/11) occur on the ipsilateral side of the arthroscopy. Eighty-eight percent (7/8) of pneumothoraxes occurred when subacromial decompression was performed. Fifty-six percent (9/16) occurred in patients placed in the lateral decubitus position. Only 30% (6/20) occurred in current or ex-smokers, and only 25% (5/20) had a pre-existing lung condition. Overall, of the articles that posit a mechanism, 75% (9/12) deem the pathogenesis to be multifactorial. Conclusion: The exact mechanism of pneumothorax is currently unknown. Awareness of this complication and timely recognition are important to prevent life-threatening sequelae. Surgeons should have a low threshold to obtain diagnostic plain radiographs in the event of clinical suspicion.

Keywords: rotator cuff repair, decompression, pressure, complication

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1635 Characteristics of the Long-Term Regional Tourism Development in Georgia

Authors: Valeri Arghutashvili, Mari Gogochuri

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Tourism industry development is one of the key priorities in Georgia, as it has positive influence on economic activities. Its contribution is very important for the different regions, as well as for the national economy. Benefits of the tourism industry include new jobs, service development, and increasing tax revenues, etc. The main aim of this research is to review and analyze the potential of the Georgian tourism industry with its long-term strategy and current challenges. To plan activities in a long-term development, it is required to evaluate several factors on the regional and on the national level. Factors include activities, transportation, services, lodging facilities, infrastructure and institutions. The major research contributions are practical estimates about regional tourism development which plays an important role in the integration process with global markets.

Keywords: regional tourism, tourism industry, tourism in Georgia, tourism benefits

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1634 Comparison Between Bispectral Index Guided Anesthesia and Standard Anesthesia Care in Middle Age Adult Patients Undergoing Modified Radical Mastectomy

Authors: Itee Chowdhury, Shikha Modi

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Introduction: Cancer is beginning to outpace cardiovascular disease as a cause of death affecting every major organ system with profound implications for perioperative management. Breast cancer is the most common cancer in women in India, accounting for 27% of all cancers. The small changes in analgesic management of cancer patients can greatly improve prognosis and reduce the risk of postsurgical cancer recurrence as opioid-based analgesia has a deleterious effect on cancer outcomes. Shortened postsurgical recovery time facilitates earlier return to intended oncological therapy maximising the chance of successful treatment. Literature reveals that the role of BIS since FDA approval has been assessed in various types of surgeries, but clinical data on its use in oncosurgical patients are scanty. Our study focuses on the role of BIS-guided anaesthesia for breast cancer surgery patients. Methods: A prospective randomized controlled study in patients aged 36-55years scheduled for modified radical mastectomy was conducted in 51 patients in each group who met the inclusion and exclusion criteria, and randomization was done by sealed envelope technique. In BIS guided anaesthesia group (B), sevoflurane was titrated to keep the BIS value 45-60, and thereafter if the patient showed hypertension/tachycardia, an opioid was given. In standard anaesthesia care (group C), sevoflurane was titrated to keep MAC in the range of 0.8-1, and fentanyl was given if the patient showed hypertension/tachycardia. Intraoperative opioid consumption was calculated. Postsurgery recovery characteristics, including Aldrete score, were assessed. Patients were questioned for pain, PONV, and recall of the intraoperative event. A comparison of age, BMI, ASA, recovery characteristics, opioid, and VAS score was made using the non-parametric Mann-Whitney U test. Categorical data like intraoperative awareness of surgery and PONV was studied using the Chi-square test. A comparison of heart rate and MAP was made by an independent sample t-test. #ggplot2 package was used to show the trend of the BIS index for all intraoperative time points for each patient. For a statistical test of significance, the cut-off p-value was set as <0.05. Conclusions: BIS monitoring led to reduced opioid consumption and early recovery from anaesthesia in breast cancer patients undergoing MRM resulting in less postoperative nausea and vomiting and less pain intensity in the immediate postoperative period without any recall of the intraoperative event. Thus, the use of a Bispectral index monitor allows for tailoring of anaesthesia administration with a good outcome.

Keywords: bispectral index, depth of anaesthesia, recovery, opioid consumption

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1633 Key Factors for a Smart City

Authors: Marta Christina Suciu, Cristina Andreea Florea

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The purpose of this paper is to highlight the relevance of building smart cities in the context of regional development and to analyze the important factors that make a city smart. These cities could be analyzed through the perspective of environment quality, the socio-cultural condition, technological applications and innovations, the vitality of the economic environment and public policies. Starting with these five sustainability domains, we will demonstrate the hypothesis that smart cities are the engine of the regional development. The aim of this paper is to assess the implications of smart cities, in the context of sustainable development, analyzing the benefits of developing creative and innovative cities. Regarding the methodology, it is used the systemic, logical and comparative analysis of important literature and data, also descriptive statistics and correlation analysis. In conclusion, we will define a direction on the regional development and competitiveness increasing.

Keywords: creativity, innovation, regional development, smart city, sustainability, triple helix

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1632 Influential Elements Shaping Intra-Regional Migration Within the Higher Education Landscape of Kashmir

Authors: Tasaduk Musood

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In the dynamic landscape of higher education, intra-regional migration within Kashmir represents a complex interplay of influential elements. This qualitative research study aims to explore and analyze the multifaceted factors that significantly shape the patterns and motivations driving students' migration within the region. The study employed a qualitative research approach. The research is carried out with a sample of 60 participants, consisting of 30 male and 30 female students selected from various higher education institutions in the Punjab region. Through self-structured interviews and thematic analysis, the research unravels the underlying drivers, aspirations, challenges, and opportunities that underpin the phenomenon of intra-regional migration in the Kashmiri higher education landscape. The results of this study are expected to offer valuable insights for policymakers, educational institutions, and stakeholders to better understand, address, and potentially enhance the experiences and outcomes of shareholders of students engaged in intra-regional mobility within Kashmir's higher education domain. This study's findings aim to contribute significantly to the existing body of knowledge surrounding intra-regional migration within Kashmir's higher education landscape, offering a nuanced understanding of the drivers behind student mobility. Ultimately, this research endeavors to facilitate more informed and effective decision-making in addressing the evolving dynamics of intra-regional migration in Kashmir's higher education sector.

Keywords: intra-regional migration, student migration patterns, student mobility, higher education, kashmir

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1631 An Assessment into Impact of Regional Conflicts upon Socio-Political Sustainability in Pakistan

Authors: Syed Toqueer Akhter, Muhammad Muzaffar Abbas

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Conflicts in Pakistan are a result of a configuration of factors, which are directly related to the system of the state, the unstable regional setting, and the geo-strategic location of Pakistan at large. This paper examines the impact of regional conflict onto the socio-political sustainability of Pakistan. The magnitude of the spillover from a conflicted region is similar in size of the equivalent increase in domestic conflict. Pakistan has gone at war three times with India; the border with India is named as the tensest borderlines of the world. Disagreements with India and lack of dispute settlement mechanisms have negatively effected the peace in the region, influx of illegal weapons and refugees from Afghanistan as an outcome of 9/11 incidence, have exasperated the criticality of levels of internal conflict in Pakistan. Our empirical findings are based on the data collected on regional conflict levels, regional trade, global trade, comparative defence capabilities of the region in contrast to Pakistan and the government regime (Autocratic, Democratic) over 1972-2007. It has been proposed in this paper that the intent of domestic conflict is associated with the conflict in the region, regional trade, global trade and the government regime of Pakistan. The estimated model (OLS) implies that domestic conflict is effected positively and significantly with long term impact of conflict in the region. Also, if defence capabilities of the region are better than that of Pakistan it effects domestic conflict positively and significantly. Conflict in neighbouring countries are found as a source of domestic conflict in Pakistan, whereas the regional trade as well as type of government regimes in Pakistan lowered the intensity of domestic conflict significantly, while globalized trade imply risk of domestic conflict to be reduced but not significantly.

Keywords: conflict, regional trade, socio-politcal instability

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1630 Remote Sensing and Gis Use in Trends of Urbanization and Regional Planning

Authors: Sawan Kumar Jangid

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The paper attempts to study various facets of urbanization and regional planning in the framework of the present conditions and future needs. Urbanization is a dynamic system in which development and changes are prominent features; which implies population growth and changes in the primary, secondary and tertiary sector in the economy. Urban population is increasing day by day due to a natural increase in population and migration from rural areas, and the impact is bound to have in urban areas in terms of infrastructure, environment, water supply and other vital resources. For the organized way of planning and monitoring the implementation of Physical urban and regional plans high-resolution satellite imagery is the potential solution. Now the Remote Sensing data is widely used in urban as well as regional planning, infrastructure planning mainly telecommunication and transport network planning, highway development, accessibility to market area development in terms of catchment and population built-up area density. With Remote Sensing it is possible to identify urban growth, which falls outside the formal planning control. Remote Sensing and GIS technique combined together facilitate the planners, in making a decision, for general public and investors to have relevant data for their use in minimum time. This paper sketches out the Urbanization modal for the future development of Urban and Regional Planning. The paper suggests, a dynamic approach towards regional development strategy.

Keywords: development, dynamic, migration, resolution

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1629 Characteristics of Regional Issues in Local Municipalities of Japan in Consideration of Socio-Economic Condition

Authors: Akiko Kondo, Akio Kondo

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We are facing serious problems related to a long-term depopulation and an aging society with a falling birth rate in Japan. In this situation, we are suffering from a shortfall in human resources as well as a shortage of workforce in rural regions. In addition, we are struggling with a protracted economic slump and excess concentration of population in the Tokyo Metropolitan area. It is an urgent national issue to consider how to live in this country and what kind of structure of society and administration policy is needed. It is necessary to clarify people’s desire for their way of living and social assistance to be provided. The aim of this study is to clarify the characteristics of regional issues and the degree of their seriousness in local municipalities of Japan. We conducted a questionnaire survey about regional agenda in all local municipalities in Japan. We obtained responses concerning the degree of seriousness of regional issues and degree of importance of policies. Based on the data gathered from the survey, it is apparent that many local municipalities are facing an aging population and declining population. We constructed a model to analyze factors for declining population. Using the model, it was clarified that a population’s age structure, job opportunities, and income level affect the decline of population. In addition, we showed the way of the evaluation of the state of a local municipality.

Keywords: evaluation, local municipality, regional analysis, regional issue

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1628 Impacts on Regional Economy by the Upgrade of Railway Infrastructure

Authors: Dimitrios J. Dimitriou, Maria F. Sartzetaki

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Transport is often the key driver for growth, especially for regions providing key opportunities for connectivity between busy areas and mature markets. Even though the benefits of transports are essential, limited research is published regarding the linkage of inland transport systems and other business sectors, the spillover effects on regional economy and the overall contribution to regional development. This paper deals with the determination of the key socioeconomic benefits on regions caused by the upgrade and the modernization of a railway corridor. The analysis framework is following a four-step analysis, providing key messages to planners, managers and decision makers. The provided case study is the upgrade of the railway corridor in North Greece, which is a very sensitive region suffering long time from economic stress. The application results are essential for comparisons with other destinations and provide key messages regarding the relationship of railway and economic development.

Keywords: regional development, economic impact assessment variables, railway infrastructure, strategic planning

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1627 Effects on Inflammatory Biomarkers and Respiratory Mechanics in Laparoscopic Bariatric Surgery: Desflurane vs. Total Intravenous Anaesthesia with Propofol

Authors: L. Kashyap, S. Jha, D. Shende, V. K. Mohan, P. Khanna, A. Aravindan, S. Kashyap, L. Singh, S. Aggarwal

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Obesity is associated with a chronic inflammatory state. During surgery, there is an interplay between anaesthetic and surgical stress vis-a-vis the already present complex immune state. Moreover, the postoperative period is dictated by inflammation, which is crucial for wound healing and regeneration. An excess of inflammatory response might hamper recovery besides increasing the risk for infection and complications. There is definite evidence of the immunosuppressive role of inhaled anaesthetic agents. This immune modulation may be brought into effect directly by influencing the innate and adaptive immunity cells. The effects of propofol on immune mechanisms in has been widely elucidated because of its popularity. It reduces superoxide generation, elastase release, and chemotaxis. However, there is no unequivocal proof of one’s superiority over the other. Hence, an anaesthetic regimen with lesser inflammatory potential and specific to the obese patient is needed. OBESITA trial protocol (2019) by Sousa and co-workers in progress aims to test the hypothesis that anaesthesia with sevoflurane results in a weaker proinflammatory response compared to propofol, as evidenced by lower IL-6 and other biomarkers and an increased macrophage differentiation into M2 phenotype in adipose tissue. IL-6 was used as the objective parameter to evaluate inflammation as it is regulated by both surgery and anesthesia. It is the most sensitive marker of the inflammatory response to tissue damage since it is released within minutes by blood leukocytes. We hypothesized that maintenance of anaesthesia with propofol would lead to less inflammation than that with desflurane. Aims: The effect of two anaesthetic techniques, total intravenous anaesthesia (TIVA) with propofol and desflurane, on surgical stress response was evaluated. The primary objective was to compare serum interleukin-6 (IL-6) levels before and after surgery. Methods: In this prospective single-blinded randomized controlled trial undertaken, 30 obese patients (BMI>30 kg/m2) undergoing laparoscopic bariatric surgery under general anaesthesia were recruited. Patients were randomized to receive desflurane or TIVA using a target-controlled infusion for maintenance of anaesthesia. As a marker of inflammation, pre-and post-surgery IL-6 levels were compared. Results: After surgery, IL-6 levels increased significantly in both groups. The rise in IL-6 was less with TIVA than with desflurane; however, it did not reach significance. IL-6 rise post-surgery correlated positively with the complexity of procedure and duration of surgery and anaesthesia, rather than anaesthetic technique. Both groups did not differ in terms of intra-operative hemodynamic and respiratory variables, time to awakening, postoperative pulmonary complications, and duration of hospital stay. The incidence of nausea was significantly higher with desflurane than with TIVA. Conclusion: Inflammatory response did not differ as a function of anaesthetic technique when propofol and desflurane were compared. Also, patient and surgical variables dictated post-operative inflammation more than the anaesthetic factors. Further, larger sample size is needed to confirm or refute these findings.

Keywords: bariatric, biomarkers, inflammation, laparoscopy

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1626 Considerations When Using the Beach Chair Position for Surgery

Authors: Aniko Babits, Ahmad Daoud

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Introduction: The beach chair position (BCP) is a good approach to almost all types of shoulder procedures. However, moving an anaesthetized patient from the supine to sitting position may pose a risk of cerebral hypoperfusion and potential cerebral ischaemia as a result of significant reductions in blood pressure and cardiac output. Hypocapnia in ventilated patients and impaired blood flow to the vertebral artery due to hyperextension, rotation, or tilt of the head may have an impact too. Co-morbidities that may increase the risk of cerebral ischaemia in the BCP include diabetes with autonomic neuropathy, cerebrovascular disease, cardiac disease, severe hypertension, generalized vascular disease, history of fainting, and febrile conditions. Beach chair surgery requires a careful anaesthetic and surgical management to optimize patient safety and minimize the risk of adverse outcomes. Methods: We describe the necessary steps for optimal patient positioning and the aims of intraoperative management, including anaesthetic techniques to ensure patient safety in the BCP. Results: Regardless of the anaesthetic technique, adequate patient positioning is paramount in the BCP. The key steps to BCP are aimed at optimizing surgical success and minimizing the risk of severe neurovascular complications. The primary aim of anaesthetic management is to maintain cardiac output and mean arterial pressure (MAP) to protect cerebral perfusion. Blood pressure management includes treating a fall in MAP of more than 25% from baseline or a MAP less than 70 mmHg. This can be achieved by using intravenous fluids or vasopressors. A number of anaesthetic techniques could also improve cerebral oxygenation, including avoidance of intermittent positive pressure ventilation (IPPV) with general anaesthesia (GA), using regional anaesthesia, maintaining normocapnia and normothermia, and the application of compression stockings. Conclusions: In summary, BCP is a reliable and effective position to perform shoulder procedures. Simple steps to patient positioning and careful anaesthetic management could maximize patient safety and avoid unwanted adverse outcomes in patients undergoing surgery in BCP.

Keywords: beach chair position, cerebral oxygenation, cerebral perfusion, sitting position

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1625 Rural Tourism Planning from the Perspective of Development and Protection of the River and Regional Integration: Taking Nanliangdu Village as an Example

Authors: Yadi Xu, Qingping Luo

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Currently, there is a great tendency that more and more villages in China are trying to increase income by development of tourism. 'Beautiful Rural Construction' provides an excellent opportunity for the development of tourism. In this context, development orientation, transportation routes, and tourism service facilities are analyzed under the perspective of existing landscape utilization and regional integration based on the development tourism industry of the Nanliangdu Village in Jingxing Town, Shijiazhuang Province as a research object. In the program, the biggest issue is the contradiction between the ecological development and protection of the river and the development of economy. How to deal with the relationship between protection and development is the key to the design of this case. Furthermore, the streets and courtyard space, existing buildings, public environment, specific landscape of the ancient village with a history of thousands of years have strong regional characteristics. The article is actively exploring for suggestions and countermeasures to promote the development premised on protection and based on a regional view.

Keywords: development, integration, protection, rural tourism

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1624 Regional Pole Placement by Saturated Power System Stabilizers

Authors: Hisham M. Soliman, Hassan Yousef

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This manuscript presents new results on design saturated power system stabilizers (PSS) to assign system poles within a desired region for achieving good dynamic performance. The regional pole placement is accomplished against model uncertainties caused by different load conditions. The design is based on a sufficient condition in the form of linear matrix inequalities (LMI) which forces the saturated nonlinear controller to lie within the linear zone. The controller effectiveness is demonstrated on a single machine infinite bus system.

Keywords: power system stabilizer, saturated control, robust control, regional pole placement, linear matrix inequality (LMI)

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1623 Regional Identity Construction of Acehnese English Teachers in Professional Practice

Authors: Ugahara Bin Mahyuddin Yunus

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In English Language Teaching, it cannot be denied that the backgrounds of English teachers do affect the way they teach English to their students, which in turn will affect their students’ English learning itself. Thus, it is very important to understand who the English teachers are so that how they teach English to their students can be understood. One of their backgrounds that is essential to be highlighted is their culture. Certainly, they wittingly or not will bring the perspectives and values of their culture into their daily teaching practices. In other words, their cultural identities do shape how they teach their students. Cultural identities themselves actually consist of some elements, one of which is regional identity. Indeed, the culture of the region in which English teachers identify with has impact on their beliefs and actions during teaching. For this reason, this study aims to understand how the regional identity of English teachers influence the way they teach English to their students. This study is a qualitative study conducted in a multilingual and multicultural setting, namely Aceh, Indonesia. Here, four Acehnese English teachers were involved as the research participants. In addition, this study adopted poststructuralist perspective to identity as the theoretical framework. Three research instruments were used in this study, namely semi-structured interviews, classroom observation, and teacher journal. The data gained from these instruments were then analyzed by using thematic analysis. Obviously, the research about the regional identity of English teachers in English Language Teaching has been studied worldwide. However, little is still known about it in Indonesian context, let alone Indonesia itself is a super diverse country with 34 regions. As a result, this study presents a good opportunity to advance the knowledge of how the regional identity construction of English teachers in this setting is. The findings of the study revealed that their regional identity construction in teaching was highly influenced by their indigenous language and religious faith. Even, how they teach English in classroom, in fact, is related to these two things. The conclusion that can be drawn from this study is for these English teachers, in fact, their regional identity itself constitutes their use of local language and religious identity, which are considered by them as their core identity.

Keywords: English language teaching, English teachers, identity construction, regional identity

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1622 Examining the Possibility of Establishing Regional Environmental Governance in the Middle East

Authors: Somayeh Bahrami, Seyed Jalal Dehghani Firoozabadi

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Environmental governance is an interdisciplinary concept in political ecology and environmental policy focusing on the necessity of embedding the environmental issues in all levels of decision-making and act of states. Similar to sustainable development the concept of environmental governance believes that economic and political life of societies and countries need to be considered as a subset of the environment. This concept has been accepted by North Countries, those that have done the most irreparable environmental damage since the Industrial Revolution. Although North Countries are more responsible for damage to the environment, considering the global fluidity logic of environmental challenges, such an impression doesn’t cause developing countries to disavow responsibility for regional and international cooperation to protect the environment. Establishing an environmental governance at all levels of local, national, regional and global is one of the most significant ways to improve sustainable development. Given to the various political and economic difficulties developing countries including the Middle East face, building environmental governance in these countries is difficult but feasible, as these difficulties have not impeded their mutual partnership for confronting joint environmental issues. However, the environmental issues wouldn’t be solved only by mutual partnership but by establishing environmental governance, establishing regional environmental institutions (an introduction to building Regional Environmental Governance) and delegation of some environmental authorities to the mentioned institutions. The research is aimed at examining necessities, opportunities, and barriers to establishing Regional Environmental Governance in the Middle East. Therefore, this research seeks to answer the question of whether establishing Regional Environmental Governance is possible in the Middle East and if so then why. This study used descriptive-analytical methods and the inferential methodology has been used to reach the goals. Data has been collected by using library and internet sources as well as news sources on the basis of objective-historical data.

Keywords: environmental democracy (ED), environmental governance (EG), middle east (ME), regional environmental governance (REG)

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1621 Studying in the Outback: A Hermeneutic Phenomenological Study of the Lived Experience of Women in Regional, Rural and Remote Areas Studying Nursing Online

Authors: Keden Montgomery, Kathie Ardzejewska, Alison Casey, Rosemarie Hogan

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Research was undertaken to explore the question “what is known about the experiences of regional, rural and remote Australian women undertaking a Bachelor of Nursing program delivered online?”. The findings will support future research aimed at improving the retention and completion rates of women studying nursing in regional, rural and remote areas.  There is a critical shortage of nurses working in regional, rural and remote (RRR) Australia. It is well supported that this shortage of nurses is most likely to be addressed by nursing students who are completing their studies in RRR areas. Despite this, students from RRR Australia remain an equity group and experience poorer outcomes than their metropolitan counterparts. Completion rates for RRR students who enrol in tertiary education courses are much less than students from metropolitan areas. In addition to this, RRR students are less likely than students from metropolitan areas to gain a tertiary level qualification at all, and even less likely to gain a Bachelor level degree which is required for Registered Nurses. Supporting students to remain in regional, rural and remote areas while they study reduces the need for students to relocate to metropolitan areas and to continue living and working in RRR areas after graduation. This research holds implications for workforce shortages internationally.

Keywords: nurse education, online education, regional, rural, remote, workforce

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1620 The Stage and Cause of Regional Industrial Specialization Evolution in China

Authors: Cheng Wen, Zhang Jianhua

Abstract:

This paper aims to probe into the general rules of industry specialization or diversification in a region during its process of economic growth and the specific reasons for the difference of industry specialization development in the eastern, central and western regions of China. It is found in this paper that the changes of regional industry specialization in China, like most of countries in the world, also present the U-shaped curve. Regional industrial structure is diversified in the first place. And when the per capita income exceeds a certain level, distribution of economic resources in this region will be concentrated again. From the perspective of rising total factor productivity and falling of transaction cost in the process of economic development, this paper comes up with a theoretical model to explain the U-shaped curve. Through the empirical test of China's provincial panel data, this paper explains the factors that cause the inequality of the industry specialization development in the eastern, central and western regions of China.

Keywords: u-shaped curve, regional industrial specialization, technological progress, transaction costs

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1619 Regional Flood-Duration-Frequency Models for Norway

Authors: Danielle M. Barna, Kolbjørn Engeland, Thordis Thorarinsdottir, Chong-Yu Xu

Abstract:

Design flood values give estimates of flood magnitude within a given return period and are essential to making adaptive decisions around land use planning, infrastructure design, and disaster mitigation. Often design flood values are needed at locations with insufficient data. Additionally, in hydrologic applications where flood retention is important (e.g., floodplain management and reservoir design), design flood values are required at different flood durations. A statistical approach to this problem is a development of a regression model for extremes where some of the parameters are dependent on flood duration in addition to being covariate-dependent. In hydrology, this is called a regional flood-duration-frequency (regional-QDF) model. Typically, the underlying statistical distribution is chosen to be the Generalized Extreme Value (GEV) distribution. However, as the support of the GEV distribution depends on both its parameters and the range of the data, special care must be taken with the development of the regional model. In particular, we find that the GEV is problematic when developing a GAMLSS-type analysis due to the difficulty of proposing a link function that is independent of the unknown parameters and the observed data. We discuss these challenges in the context of developing a regional QDF model for Norway.

Keywords: design flood values, bayesian statistics, regression modeling of extremes, extreme value analysis, GEV

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1618 The Relationship between Urbanization and the Rapid Development of Real Estate Industry in China: Taking Chongqing as an Example

Authors: Deng Tingting

Abstract:

There is a very close interaction between the rapid development of the real estate industry and regional urbanization. The real estate problem can be boiled down to the problem of urbanization, in essence. The growth of hundreds of millions of people in the future will determine the development of low-level demand in the real estate market. At the same time, the practical problems of urbanization also seriously restrict the healthy development of real estate itself. The latter two interact with each other by adjusting the industrial structure, economic aggregate, regional population flow, and many other linkage factors. Through the case analysis of Chongqing, this paper finds that the urbanization of Chongqing and the overall development level of the real estate industry are still in the stage of development and upgrading, and its development potential and future development and application space are still very large. Therefore, from the perspective of the regional economy, studying the interaction between the two is of great significance to accelerate the process of urbanization in Chongqing, promote the healthy development of the real estate industry, and promote the rapid growth of the regional economy.

Keywords: urbanization, demographics, real estate, interrelationships

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1617 The Analysis of Language Shift, Accommodation, Attrition and Effects On Minority Languages In Pakistan

Authors: Afsheen Kashifa, Muhammad Saad Khan

Abstract:

The present study examines the linguistic use of English as a permanent part of the regional languages of Pakistan. This research has delimited its investigation to the language used by the students of English language who speak different regional languages. It deals with the attitudes, causes, and effects of the language shift from regional and minority languages to English. It further gets insights from the feedback provided by the students as respondents that English is replacing the minority languages for being the language of prestige, convenience, and rich vocabulary. These concepts have been achieved through the use of questionnaires and semi-structured interviews. The findings of this research exhibit that the respondents speak English because of its vocabulary and easy way of communication; therefore, they enjoy a high place in society. This research also shows that the speakers of the regional languages are encouraged by their parents to speak English. Eventually, the words and expressions of English, the dominant language, have become a permanent part of the minority languages. Therefore, the minority languages are becoming endangered languages.

Keywords: language shift, language accommodation, language attrition, effects on minority languages

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1616 The Evaluation of Event Sport Tourism on Regional Economic Development

Authors: Huei-Wen Lin, Huei-Fu Lu

Abstract:

Event sport tourism (EST) has become an especially important economic sector around the world. As the magnitude continues to grow, attracting more tourists, media, and investment for the host community, and many local areas/regions and states have identified the expenditures by visitors as a potential source of economic or employment growth. The main purposes of this study are to investigate stakeholders’ insights into the feature of hosting EST and using them as a regional development strategy. Continuing the focus of previous literature on the regional development and economic benefits by hosting EST, a total of fıve semi-structured interview questions are designed and a thematic analysis is employed to conduct with eight key sport and tourism decision makers in Atlanta during July to August 2016. Through the depth interviews, the study will contribute to a better understanding of stakeholders’ decision-making, identifying benefits and constraints as well as leveraging the impacts of hosting EST. These findings have provided stakeholders’ perspectives of hosting EST and using them as a reference of regional development in emerging sport tourism markets in the US. Additionally, this study examines key considerations and issues that affect and are critical to reliable understanding of the economic impacts of hosting EST on the regional development, and it will be able to benefit future management authorities (i.e. governments and communities) in their sport tourism development endeavors in defining and hosting successful EST. Furthermore, the insights gained from the qualitative analysis could help other cities/regions analyzing the economic impacts of hosting EST and using it as an instrument of city development strategy.

Keywords: economic impacts, event sport tourism, regional economic development, longitudinal analysis

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1615 International Trade and Regional Inequality in South America: A Study Applied to Brazil and Argentina

Authors: Mónica Arroyo

Abstract:

South America shows increasing decline in regional export values in the last years, after a strong growth of trade flows especially with China up to 2013. This change is due to the end of the commodity price boom, the slowing of the Chinese economy and the effects of the 2008 economic crisis. This paper examines the integration of regional economies in this context, particularly the situation in Brazil and Argentina. Based on transformations over the last two decades, the analysis is focused on the spatial circuits of production linked to foreign markets, contributing to the understanding of the different uses of territory and the within-country inequality. The South American regional exports, consisting basically of raw materials, are concentrated in a few companies. Large areas are intended for the production of agriculture and mining commodities, under the command of major economic groups, both domestic and foreign, relegating the local population to less productive places or, in most cases, forcing them to change their activity and to migrate to other regions in search of some source of income. On the other hand, the dynamics of these commodities’ spatial circuits of production print requirements in territories in terms of infrastructure and regulation. Capturing this movement requires understanding businesses and government’s role in territorial regulation, and consequently how regional systems are changing – for instance, economic specialisation, growing role of services, investment in roads, railways, ports, and airports. This paper aims to highlight topics for discussion on regional economic dynamics and their different degrees of internationalisation. The intention is to contribute to the debate about the relations between trade, globalization, and development.

Keywords: regional inequality, international trade, developing world, South America

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1614 Economic Integration vs. Conflicts in Northeast Asia

Authors: Heeho Kim, Byeong-Hae Sohn

Abstract:

This study has examined the culture commonality of Northeast Asian countries based on Confucian values, and their relations to institutional economic integration. This study demonstrates that Confucian values inherent in the Northeast Asian countries have served as the cultural ethos for the rapid economic growth of this region since the 1960s and will be able to form the foundation of Northeast Asian values in the future. This paper re-appreciates these cultural values as a necessary condition for regional integration to catalyze the stagnated discussions about economic integration and extends its inter-weaving connection role for intra-regional transaction among China, Japan and Korea.

Keywords: Confucianism, Northeast Asia, economic integration, economic growth, regional conflicts

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1613 Preparation of Regional Input-Output Table for Fars Province in 2011: GRIT1Method

Authors: Maryam Akbarzadeh, F. Esmaeilzadeh, A. Poostvar, M. Manuchehri

Abstract:

Preparation of regional input-output tables requires statistical methods combined with high costs and too much time. Obtained estimates by non-statistical methods have low confidence coefficient. Therefore, integrated methods for this purpose are suggested by recent input–output studies. In this study, first GRIT method is introduced as an appropriate integrated method for preparation of input-output table of Fars province. Next, input-output table is prepared for Fars province using this method. Therefore, this study is based on input-output table of national economy in 2001. Necessary modifications performed in the field of changes at level of prices and differences of regional trade compared with other areas at national level. Moreover, up to date statistics and information and technical experts view on the various economic sectors along with input-output table 33 was used in 2011 followed by investigation of general structure of the province economy based on the amounts of added value obtained from this table.

Keywords: grit, input-output, table, regional

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