Background and Objectives: Chronic pain is a prevalent condition that is frequently complicated by mood and anxiety disorders. Purpose of the present article is to identify differences in the management of patients with chronic pain and anxiety/mood disorders depending on the physiotherapists’ gender. Materials and Methods: An ad-hoc questionnaire was developed and sent to 327 physiotherapists by e-mail. The two groups identified by gender were compared by unpaired sample t tests for continuous variables and χ2 tests for qualitative ones. A binary logistic regression was then performed with factors resulted statistically significant at univariate analyses as independent variables and gender as dependent one. Results: Female physiotherapists exhibited a higher level of confidence than male physiotherapists in administering continued physiotherapy for patients affected by Generalized Anxiety Disorder (GAD) (p=0.01), as well as for individuals who had previously engaged with a mental health professional (p=0.01). Furthermore, female physiotherapists believed that pharmacotherapy was less associated with motor side effects (p<0.01) and more frequently recognized the importance of a training to identify affective disorders (p=0.01) and the need of more education in mental health (p=0.01). The binary logistic regression model confirmed that female professionals were less likely to work as freelance (p=0.015) and were more confident in the prosecution of physiotherapy by patients with GAD (p=0.05). Conclusions: Female physiotherapists compared to male ones seem to be more comfortable with patients affected by mental conditions and to be more aware of the need of training on mental health. Further studies are needed to confirm the results of the present study.

Understanding morphological and genetic diversity of forest trees is essential to facilitate their conservation, sustainable management and genetic improvement for addressing the economic and environmental demands and challenges. We have examined variation in morphometric seed and pod traits and seed germination of multipurpose and widely distributed forest tree Albizia lebbek (Indian siris) from 12 provenances covering the species’ range in northern India and its relationships with bioclimatic factors. Highly significant inter-provenance variation was observed in seed size (seed length (SL), seed width (SW), SW/SL, SL×SW), seed mass (1000 seed weight), pod size (pod length (PL), pod width (PW), PW/PL), seed germination, number of seeds per pod, and insect infected seeds (IIS). The provenance effect contributed a major portion to the total phenotypic variance. Morphometric variation in all traits except for IIS was not clinal related to longitude, latitude, altitude or rainfall. There was an indication of the presence of ecotypic variation. IIS showed clinal variation with significant negative correlation with latitude. Most seed size and pod size traits showed positive correlations with several temperature bioclimatic factors and negative correlations with several precipitation bioclimatic factors. Our results have significance for genetic improvement, population genetics and genomics studies and conservation and sustainable management of A. lebbek genetic resources.

NUMMI was one of the most analyzed case studies in terms of joint ventures, management dysfunction, and international globalization. NUMMI is an acronym for New United Motor Manufacturing, Inc. This manufacturer was a joint venture between automotive US titan GM and Toyota of Japan. GM wanted to further monetize its Fremont factory, but also had limited opportunities during a US economical recession. Toyota wanted to expand manufacturing operations in the US for the very first time, creating an intriguing collaborative partnership between the two. However, various problems lead to dysfunction through cultural, organizational, or managerial differences. This case study is analyzed through its historical analogical scope, ultimately leading to hypothesizing remediation through an ethical data-driven and total quality management (TQM) approach.

Buildings are subject to intrinsic and extrinsic failures at all stages of the construction process, i.e., design to occupancy (i.e., use) as several failure types can affect them. There are three basic steps for researching building failures: listing, cataloging, and solving/deciding whether highlighting the least invasive and lowest cost intervention. Therefore, this research presents some methods used in construction for the intervention prioritization and seeks to illustrate the most suitable methodology for different settings failure x diagnosis x intervention. Therefore, the most traditional tools are shown: BASICO, SWIFT, FEMEA, AAF, and GUT matrix, where a critical assessment of the strengths and weaknesses is carried out. After that, a case study on maintenance services for the moisture on the building facades was performed. Finally, the GUT matrix and the FMEA method are the best results

This study determines the management of downstream oil palm development in the technopolitan areas of Pelalawan Regency. The study object was analyzed qualitatively in stages, including the development, potential, and management of downstream oil palm. The results show that the downstream oil palm facilitates the development of various ideas, innovations, and knowledge from the use of products with high selling value. This supports the government, academia, business, and society in implementing Good Agricultural Practice (GAP). The downstream oil palm development in Pelalawan Regency is managed in an integrated, competitive, and sustainable manner. This allows all stakeholders and society (independent smallholders) to receive economic, social, and environmental benefits.

In 2023, the Bureau of Land Management (BLM) estimated that there were 68,928 mustangs living on United States public lands in 10 western states. The agency uses Appropriate Management Levels to determine the number of mustangs who need to be removed from the land. Once removed and processed, mustangs are sent to adoptions or sales events or retained in short-or long-term holding facilities. Adoptions and sales are the leading avenues for rehoming mustangs; however, the number of horses the BLM can place fluctuates annually and never approaches the greater number removed from the range. To explore opportunities for increasing the number of mustang adoptions, we conducted in-depth interviews with 23 horse trainers located on the U.S. East Coast, asking about participants’ training programs, relationships with horses, perceptions of mustangs, and challenges that mustangs face in the dressage and eventing industries. Participants had varying experiences with mustangs; however, all were willing to work with a mustang in some capacity. Participants voiced the need for more satellite adoption locations on the East Coast to decrease barriers to acquiring a mustang, notably cost and time, and for expanding existing training programs to include eventing and dressage.

Worldwide, diarrhoea in children under-five years of age is the second leading cause of death. Despite having high morbidity and mortality, diarrhoeal diseases can be averted by simple and cost-effective interventions. The Integrated Management of Childhood Illness (IMCI) has proposed the use of Oral Rehydration Salt (ORS) and zinc together with adequate food and fluid intake for the management of acute non-dysenteric watery diarrhoea in children. In the past, few studies examined the determinants of adherence to diarrhoea case management. Therefore, this study measured the determinants of therapeutic and dietary adherence to diarrhoea case management using the third and fourth wave of Pakistan Demographics & Health Surveys (PDHS) datasets. Data from 4,068 children between 0 to 59.9 months with positive history of diarrhoea were included, while data on children with dysentery, severe dehydration, and co-morbid condition was excluded. This study reported therapeutic adherence in less than 10% of children in Pakistan, while dietary adherence was reported in 39.2% of children (37.7% in 2012-2013 ~ 40.7% in 2017-2018). A significant improvement in therapeutic (0.8% in 2012-2013 ~ 8.1% in 2017-2018) and dietary adherence (37.7% in 2012-2013 ~ 40.7% in 2017-2018) was reported in the 2017-2018 survey, compared to the 2012-2013 survey. In general, children over the age of one year (compared to children <1 year) and of the richer/richest socioeconomic class (compared to poorest/poorer socioeconomic class) have showed higher therapeutic and dietary adherence. Therapeutic and dietary adherence among diarrhoeal children can be improved by increasing the awareness and accessibility of ORS, zinc, and essential foods.

Congenital heart defects (CHD) are the most common birth anomaly affecting approximately 1% of births and have a prevalence of about 5.8 per 1000 people. CHD is the most common congenital anomaly in newborn babies. Management of the newborn with CHD represents a frontier of clinical pediatric cardiology. Progress in diagnosis and surgical treatment of the individuals with a heart defect has progressed to the point that almost all heart defects can be significantly improved and treated. Cardiovascular malformations account for about 10% of infant deaths and nearly half of all deaths from malformations

The population growth and its needs, has increasingly demanded water resources, requiring managers to adopt mechanisms to guarantee the availability and quality of water from springs. Among the instruments defined by law n. 9433/1997, water charges stand out. In this sense, the objective was to evaluate the evolution of charging for the use of water resources in Brazil, with emphasis on the channel of the Hydrographic Basin of the Paranaíba River. The methodology used was based on two phases, one of reviewing the articles available in Capes journals and the other, consulting the spreadsheets of the Araguari River Basin Agency with information on charges for the use of water within the competence of the Union in the Hydrographic Basin of the Paranaiba River. The results showed that charging for the use of water resources establish a relevant instrument for disciplining and raising financial resources that will enable improvements in the planning and management of water use. It should be noted that irrigation emerges as the main user of the flow captured from the Paranaíba River. However, the main source of funds for charging comes from the public supply. Among the Federation Units, the Federal District proved to be the largest source of contributions for charging the use of the Union's water resources in the Paranaíba River Basin.

Indonesia's government anticipates waste problems by managing them through a large number of waste reduction programs. From a governance perspective in Indonesia, it is known that actors from diverse governmental levels and across sectors are involved in waste management, and their involvement largely depends on their institutional goals and problems. Hence, they are expected to coherently collaborate together by developing and implementing sustainable instruments and resources for improving waste management problems. However, it is necessary to understand how supportive and restrictive the governance of waste reduction programs is to encourage successful trash reduction. This study is designed to evaluate and examine the application of Community-Based Solid Waste Management (CBSWM) in Makassar. In this research, The Governance Assessment Tool (GAT) was applied to analyze the governance context of the waste reduction programs in Makassar qualitatively. From the assessment, contexts can be described as either supportive or restrictive of the processes of implementing public policies on waste management. As a result of such an assessment, this study shed light on some opportunities to improve the governance of waste management implementation's impact on reducing waste in Makassar, South Sulawesi, Indonesia. The conclusion of this study depicts that the most important actors are affiliated with the local government and the community. Moreover, this study shows that the assessment of contextual governance is predominantly restrictive.

Over the last few decades, many countries, especially Caribbean island ones, have been challenged by the devastating consequences of natural disasters, which pose a significant threat to human health and safety. Timely information related to the distribution of vulnerable population and critical infrastructure are key for an effective disaster relief. OpenStreetMap (OSM) has repeatedly been shown to be highly suitable for disaster mapping and management. However, large portions of the world, including countries exposed to natural disasters, remain unmapped. In this study, we propose a methodology that relies on remotely sensed measurements (e.g. VIIRS, Sentinel-2 and Sentinel-1) and derived classification schemes (e.g. forest and built-up land cover) to predict the completeness of OSM building footprints in three small island states (Haiti, Dominica and St. Lucia). We find that the combinatorial effects of these predictors explain up to 94% of the variation of the completeness of OSM building footprints. Our study extends the existing literature by demonstrating how remotely sensed measurements could be leveraged to evaluate the completeness of OSM database, especially in countries at high risk of natural disasters. Identifying areas that lack coverage of OSM features could help prioritize mapping efforts, especially in areas vulnerable to natural hazards and where current data gaps pose an obstacle to timely and evidence-based disaster risk management actions.

The efficiency success status of organization built environment assets management needs robust and comprehensive maintenance processes which depends on the efficiency of the contract information documents for the maintenance management within the assets life cycle and achieve positive return of the investments. Therefore, this paper highlights on the appropriate interactive approach to structuring information flow scope of the asset facilities management contract for construction projects based on GIS and BIM integration processes, sustainability standards, and As-built contractual documents of the project to support the organization owner and stakeholder to improve the asset management processes. Using expert interviews with comprehensive understand for the information type in several facility management contracts conducted in common Organization types based on reviewing available international facility management standards manual and contract of procedures for different services types, and required information flow inside international facility management firms. The study classify and build significant integrated information and data flow model contract drafting with measures and indicators of performance efficiency as guideline for monitoring, technically evaluating, and financially procedures for performance efficiency and quality of services provided in the facilities management contract for King Faisal University campus projects as a case study.

The problem of blood delivery has been a critical concern in past decades. However, the unsteady behavior of blood donors, along with the uncertainties associated with demands in a crisis imposes several challenges for resource management. In this research work, we analyze the blood delivery behavior in a crisis modeled by coupled queues of patients and blood sources. Using Markovian modeling and results associated with G-network, we derive two critical probabilities, namely lack of unit of blood (unit of donations) or not having any storage capacity left to accept new donors' blood. We propose a closed-form solution to calculate the optimal blood storage size, and also we suggest sufficient conditions that guarantee the feasibility of the model. Finally, we conduct a sensitivity analysis to investigate the impact of model parameters on storage size and the proportion of time that storage is full.

The compelling effects of climate change on forests may have been underestimated in the past few decades in practical forestry. Although the first attempts to draw attention to this complex problem appeared almost half a century ago, the debate has been conceptual rather than experimental and applicative. At first glance, the con-cerns were mainly related to sustainable forest management (SFM) issues, which obviously needed attention. Over time, the effects of climate change have been mainly considered in the context of the SFM; they started from various and somewhat different scales and goals. Over time, more research and awareness of the im-portance of SFM under the pressure of climate change have led to the development of a clearer field that can be defined as ‘adaptive forest management’ - to climate change. One of the characteristics of this discipline is to be featured by the absence of univocal methods and / or objectives to be pursued but to identify, verify, and adapt methods to the various climatic and forest types and conditions found in the field. Therefore, this work shows some phases of forest planning and management concepts and criteria over time and recalls some innovative and / or adaptive methods related to the approach to forest planning and management under climate change

Cloud infrastructure provides computing services where computing resources can be adjusted on-demand. However, the adoption of cloud infrastructures brings concerns like reliance on the service provider network, reliability, compliance for service level agreements (SLAs), etc. Software-defined networking (SDN) is a networking concept that suggests the segregation of a network’s data plane from the control plane. This concept improves networking behavior. In this paper, we present an SDN-enabled resource-aware topology framework. The proposed framework employs SLA compliance, Path Computation Element (PCE) and shares fair loading to achieve better topology features. We also present an evaluation, showcasing the potential of our framework.

This article delves into the pro-cyclicality of Loan Loss Provisions (LLPs) and earnings management, along with equity management, in Portuguese banks against the backdrop of implementing the IFRS 9's Expected Credit Loss (ECL) model. It concentrates on how LLPs mirror economic cycles and financial management practices, providing valuable insights into the operational dynamics of the Portuguese banking sector, marked by distinct economic and regulatory challengesThe research examined a sample of five Portuguese commercial banks, chosen from a group of seventeen in the Portuguese Banking Association. Data spanning from 2013 to 2022 were manually gathered. A multiple linear regression model was employed to scrutinize the relationship between LLPs and variables indicative of economic cycles and the earnings and equity management. The methodology aligns with the approaches of Araújo et al. (2018), Beatty and Liao (2014), and Casta et al. (2019). The analysis indicates a pro-cyclicality in LLPs within the Portuguese context, with a positive response of LLPs to economic indicators like unemployment. Contrarily, the extent of earnings and equity management under the ECL model was less marked compared to the Incurred Credit Loss (ICL) model, suggesting the impact of more stringent regulatory measures. The research corroborates the pro-cyclicality of LLPs in Portuguese banks under the ECL framework, underscoring the necessity for ongoing monitoring and refinement of models for forecasting and recognizing credit losses. The findings point to an area for improvement in financial management practices, despite regulatory enhancements, to promote transparency and ensure financial stability.

Ocean temperatures are increasing. Little work has been done to examine the effects that these changes will have on fishery production. The study at hand seeks to incorporate the influence of climate change into established bioeconomic fishery models. Stock biomass is approximated to be a function of sea surface temperature. Following a feasible generalized least squares regression using data from the Western and Central Pacific, the interaction between fishery effort and temperature is found to be statistically significant. From this model, various functional forms relating effort, catch, and temperature are specified. In particular, a function that returns an effort requirement given a target catch level and temperature forecast is generated.The importance of these tools for fishery management is explored through application to Western and Central Pacific tuna fisheries. Recommendations for extensions into future research are made and the foundation for a model of efficient effort allocation across time and the entirety of a management area, given changing temperatures, is specified.

Lombok earthquake that occurred in July 2018 has three large magnitude earthquakes that caused huge losses; 564 victims died, 1684 injured, 445 343 refugees, and 215 628 houses were damaged. The role of anesthesiology is very important to give prompt therapy for injured victims. This research gave an overview of the important role of Anesthesiologist and the selection of anesthesia techniques during the natural disasters’ victims’ management. This study was conducted by collecting data of all earthquake victims treated at the emergency room (ER) of RSUD NTB on August 6^th and 7^th 2018 and all victims operated during August 5 – 25^th 2018. All data were recorded, analyzed, and presented in descriptive form using frequency, pie chart, and bar diagrams. The result shown that the highest number of patients treated in ER are during the first seven days after the earthquake and reduced to several weeks. The majority of patients treated are trauma patients who need orthopedic surgery. Since limited number of anesthesiologist should be considered with the right selection of anesthesia techniques, so that the disaster preparedness could be prepared well and the disaster management could run well. General anesthesia was widely used than regional anesthesia, but the different is not significant. The type of regional anesthetic drug usually used is lidodex in combination with catapres. The role of anesthesiologist during disaster is important to handle a safe and optimal surgical condition.

Software project estimating (SPE) is a powerful but necessary step in the production of projects for software. Software project estimating includes several components, estimating software time, software resources, software costs, and software effort estimation (SEE). SEE seeks to estimate the number of "hours-person" and "months-person" of work required for developing or managing a software program. During the initial phase of the development of software, future efforts are impossible to predict. To estimate effort, many deep learning (DL) and machine learning (ML) models were previously created. For estimate, single-model techniques and ensemble methods were investigated in this research. Ensemble methods involve a combination of multiple separate models. Bagging, boosting, and voting were the ensemble methods looked into for estimation. Datasets considered for estimation were COCOMO81, COCOMONasa I, COCOMONasa II, Albrecht, Maxwell, China, Desharnais, Desharnais_1_1, Kitchenham, Boehm, and Belady. The evaluation criteria used MAE, RAE, RMSE, RRSE, and CC. The result from previous studies is that the total size of the set of data utilized is small in predicting the effort, as the largest size of the set of data used is the China dataset containing only 499 projects. So, in this study, the dataset has been merged to increase the total size of the set of data and increase the accuracy of prediction. The results indicated that the suggested merged dataset increased effort estimation accuracy.

The shift towards Personalized Cancer Medicine (PCM) represents a significant transformation in cancer care, emphasizing tailored treatments based on genetic understanding of cancer at the cellular level. This review draws on recent literature to explore key factors influencing PCM implementation, highlighting the role of innovative leadership, interdisciplinary collaboration, and coordinated funding and regulatory strategies. Success in PCM relies on overcoming challenges such as integrating diverse medical disciplines, securing sustainable investment for shared infrastructures, and navigating complex regulatory landscapes. Effective leadership is crucial for fostering a culture of innovation and teamwork, essential for translating complex biological insights into personalized treatment strategies. The transition to PCM necessitates not only organizational adaptation but also the development of new professional roles and training programs, underscoring the need for a multidisciplinary approach and the importance of team science in overcoming the limitations of traditional medical paradigms. The conclusion underscores that PCM's success hinges on creating collaborative environments that support innovation, adaptability, and shared vision among all stakeholders involved in cancer care.

Decision tables have been used for many years in data processing and business applications to simulate complex rule sets. Several computer languages have been developed based on rule systems and they are easily programmed in several current languages. Land management and river-reservoir models simulate complex land management operations and reservoir management in highly regulated river systems. Decision tables are a precise yet compact way to model the rule sets and corresponding actions found in these models. In this study, we discuss the suitability of decision tables to simulate management in the river basin scale Soil and Water Assessment Tool (SWAT+) model. Decision tables are developed to simulate automated irrigation and reservoir releases. A simple auto irrigation application of decision tables was developed using plant water stress as a condition for irrigating corn in Texas. Sensitivity of the water stress trigger and irrigation application amounts were shown on soil moisture and corn yields. In addition, the Grapevine Reservoir near Dallas, Texas was used to illustrate the use of decision tables to simulate reservoir releases. The releases were conditioned on reservoir volumes and flood season. The release rules as implemented by the decision table realistically simulated flood releases as evidenced by a daily NSE (Nash-Sutcliffe Efficiency) of 0.52 and a percent bias of -1.1%. Using decision tables to simulate management in land, river and reservoir models was shown to have several advantages over current approaches including: 1) mature technology with considerable literature and applications, 2) ability to accurately represent complex, real world decision making, 3) code that is efficient, modular and easy to maintain, and 4) tables that are easy to maintain, support, and modify.

The last decade was characterized by the reduction of hospital beds throughout Europe. When facing Covid pandemic, this has been an issue of major importance as hospitals were seriously overloaded with an unexpected growth in demand. The dichotomy formed by the scarcity of beds and the need for acute care was handled by the Bed Management (BM) function. This study explores how BM was able to help the solidness of the healthcare system, managing hospital beds at best and recruiting others in different set-tings as intermediate care, in a large Local Health Authority (LHA) in central Italy. Ad-ministrative data show how the provision of appropriate care was achieved recruiting approximately 500 beds belonging to private healthcare facilities affiliated with the re-gional healthcare system and exercising at best the BM function. The ability of the system to absorb the extra demand caused by Covid was made possible using intermediate care beds, which allowed to stretch the logistic boundaries of the hospitals, and by the promptness of Bed Management in converting beds in Covid beds and reconverting them and timely managing internal patient logistic, thus creating space according to the healthcare demand.

IKEA is a massive international conglomerate company, and the purpose of this exploratory qualitative research is to investigate how the burgeoning academic field known as "artificial intelligence" (AI) could assist IKEA in resolving some of the challenges that it is currently dealing with in relation to its efforts to source sustainable materials. According to the conclusions of this study, artificial intelligence has the potential to aid in the resolution of at least some of the issues associated with sustainable sourcing, at least to some degree. This was developed by mapping the issues, analyzing the potential for adopting artificial intelligence as a solution, and defining the components that are required for efficient adoption of the technology. A number of prerequisites need to be satisfied by businesses before artificial intelligence may be used in the area of sustainable sourcing. In addition, a number of artificial intelligence's constraints need to be addressed before the technology can be put into practice by the same businesses. In conclusion, the findings of this study offer some management implications and ideas for businesses that have the goal of sourcing in a way that is less harmful to the environment by making use of technological breakthroughs such as artificial intelligence. This can be accomplished through the utilization of innovative technologies.

Given the importance of the development of urban infrastructure and environmental impacts produced by the civil construction waste (CCW), it is important to correct the handling of CCW with objective solutions that are more environmentally friendly. In that sense the present study aimed to determine indicators that make it possible to estimate the amount of CCW generated from construction sites in the city of Londrina, Parana State, Brazil. The generation of CCW was estimated in a general way, regarding the composition of its mixture, correlated to the gross areas of the buildings studied and their generated volumes of RCC. This generating rate was evaluated in a general way and specifies two types of sites: the new residential and new non-residential constructions. The data required for the development of these indicators was obtained through extensive survey and interviews carried out at the environment secretariat of the City Hall. The generating rate of CCW obtained for non-residential buildings was 0.2052m3/m2 or 170.44kg/m2, for new residential sites was 0.2054m3/m2 or 170.60kg/m2 and for new commercial or non-residential construction sites, it was 0.20453 m3/m2 or 169.85kg/m2. It was also possible to estimate the amount generated annually per inhabitant in the municipality, which is 0.60m3/inhabit.year or 498.55kg/inhabit.year.

The outbreak of COVID-19 has brought unprecedented risks and challenges to everyone in the world. Myasthenia gravis is an autoimmune disease of the nervous system. Infection can worsen it and cause severe symptoms such as myasthenia crisis and respiratory failure. At present, the pandemic of COVID-19 may promote the aggravation of patients with MG. This article focuses on the respiratory management of MG patients during the epidemic of COVID-19.

Background: Although Tuberculosis (TB) is one of the oldest diseases known to mankind, many practitioners are still unaware of various aspects of management of TB including drug resistant TB. To be able to make an impact on the disease burden we need to understand the knowledge, attitude and practices (KAP) of practitioners, both in government and private sector, towards TB case management. Methodology: A random cross-sectional survey of 99 respondents to assess the KAP towards TB case management using a digital semi-structured questionnaire which was pre-tested and administered to allopathic practitioners from across States in North and Central India. Results: 77% responders were government doctors and 23% were private practitioners. Chest physicians accounted for 61% of the responders. 26% of government and 78% of private doctors relied on sources which are difficult to validate for their knowledge on drug resistant TB management. There were large variations seen in knowledge on modes of transmission, standard precautions, extent of drug resistant TB, diagnostics as well as treatment regimen for drug resistant TB. Conclusion: The knowledge of both sector doctors especially amongst private practitioners with respect to the awareness of extent, diagnosis, and treatment and infection control measures for drug resistant TB is suboptimal which translates to poor diagnostic, therapeutic and infection control choices amongst private practitioners. If India has to achieve the targets for TB Elimination by 2025, serious work needs to be done to upgrade the knowledge of the private sector doctors on drug resistant tuberculosis. The Ministry of Health and Family Welfare, GoI needs to have regular educational programs for the private practitioners coupled with awareness campaigns and frequent surveys to assess the knowledge, attitude and practices being followed in the private sector for TB management including drug resistant TB.

Sources are classified into two depending upon the factor of reviving. These sources, which cannot be revived into their original shape once they are consumed, are considered as nonrenewable energy resources, i.e., (coal, fuel) Moreover, those energy resources which are revivable to the original condition even after being consumed are known as renewable energy resources, i.e., (wind, solar, hydel) Renewable energy is a cost-effective way to generate clean and green electrical energy Now a day’s majority of the countries are paying heed to energy generation from RES Pakistan is mostly relying on conventional energy resources which are mostly nonrenewable in nature coal, fuel is one of the major resources, and with the advent of time their prices are increasing on the other hand RES have great potential in the country with the deployment of RES greater reliability and an effective power system can be obtained In this thesis, a similar concept is being used and a hybrid power system is proposed which is composed of intermixing of renewable and nonrenewable sources The Source side is composed of solar, wind, fuel cells which will be used in an optimal manner to serve load The goal is to provide an economical, reliable, uninterruptable power supply. This is achieved by optimal controller (PI, PD, PID, FOPID) Optimization techniques are applied to the controllers to achieve the desired results. Advanced algorithms (Particle swarm optimization, Flower Pollination Algorithm) will be used to extract the desired output from the controller Detailed comparison in the form of tables and results will be provided, which will highlight the efficiency of the proposed system.

Water management can improve the quality of valuable ecosystem services but can be costly to implement and the management costs are covered by national taxes collected by water users. Based on 30 valuation studies of water quality improvement from the Environmental Valuation Information System (EVIS) database provided by Korea Environment Institute (KEI), a meta-regression analysis was employed to measure the benefits that major river basins provided to the society. We compare these benefits to the costs, namely River Management Funds (RMFs) which are financial resources to support a variety of projects for managing and improving upstream water quality. Based on benefit-cost comparison, this study evaluates the efficiency of water resource management in South Korea. This study also provides policy options that are helpful to maintain the sustainability of water resource by improving the planning and performance of water management in the long run.

Enterprise risk management (ERM) was introduced in the 1990s and has become an expectation by boards of directors and regulators as a sign of good management and good corporate governance. However, many organizations struggle to implement ERM, and still seek practical ad-vice on ERM implementation. This article explains many of the reasons why organizations are unsuccessful in their efforts at implementation and provides practical solutions by an experienced risk manager and consultant, an ex-Chief Risk Officer, and an academic, all who has writ-ten extensively in the subject. This article should be of interest to practitioners involved in implementing ERM, to consultants in ERM, and to academics teaching courses on ERM, risk management, and related topics. This article also provides a base against which further future re-search can be done as ERM best practices continue to evolve.

Solid-state lighting has been replacing conventional lighting in the market, raising concerns for implementing an efficient end-of-life management system. Since LED waste streams have not been quite dominant, characterization studies (product-level characteristics, component-wise information, bill of materials, diversity, and differences) are inconsistent and having substantial gaps. This study investigates the end-of-life LED lamp literature, focusing on the bill-of-materials, and reveals that the characterization procedure suffers from a severe lack of sample representativeness. Consequently, characterization results are widely varied and not generalizable. Moreover, most of the studies did not inform and document the detailed sample characteristics, precluding the possibility of identifying reasons for variation. Combining available information from the recent studies, we present a mass distribution at the component level, exemplifying the prospect for meeting EU regulatory limit and the need for more insight at the lamp and component level. To fill the disconnection between lamp level characteristics and component and material content, we propose a characterization protocol that carefully documents lamp, component, and material level information by establishing a lamp-component–material composition nexus. The protocol may help researchers, policymakers, and industrial stakeholders conduct a systematic characterization, analyze complexities and prepare for a sustainable solution.

In the contemporary construction management, poor project performance, cost overrun, and low-quality construction have become a central point of attention for improving project performance including information, interaction and communication management. virtual design and construction and building information modelling play indispensable role in improving the project performance. The aim of this study is to propose a Virtual Information Modeling as a novel information and communication technology method with potential to overcome problems in the construction industry. Using one-sample t test with Kolmogorov-Smirnov approach, we analysed data collected from structured questionnaire survey involving project managers working at architecture, engineering and construction industries in Tehran, Iran. The results suggest that the most important benefits and challenges of using Virtual Information Modeling are related to the area of integration, and implementation of Virtual Information Modeling has the greatest impact on this area of project management knowledge. Thus, integration should be considered a top priority for construction companies implementing Virtual Information Modeling in their projects. Policymakers should understand that careful management of virtual information is essential for improving the performance of projects and enhancing the process efficiency.

The Aviation industry in Malaysia is categorized as highly regulated and dominated by Government Linked Companies (GLCs) via monopolistic concessions due to its nature of strategic national importance and security. Connectivity is an essential component of economic activity and a catalyst for business growth. Since the invention of aircraft, air connectivity has expanded businesses and markets, facilitating trade, encouraging Foreign Direct Investment (FDI) and enabling tourism. This case study aims to provide a holistic analysis of the Malaysia Airport Holdings Berhad (MAHB) strategic planning framework and discuss its effectiveness towards its strategy formulation to address its market dynamics, both domestically and abroad. From military superiority to economic connectivity, aviation, one of humanity's greatest inventions, has advanced human civilization over the past 150 years. With the emergence of low-cost carriers, air travel patterns have shifted dramatically, with the increase of travel and trade, due to its time efficiency. With the trend of globalization and the liberation of airspace in recent decades, aviation enables the movement of people and goods that foster a borderless marketplace at an exponential growth rate. With technological innovation, pressure over climate change and the shift in travelers' behavior and patterns, strategic planning becomes more crucial and complex for aerodrome operators to create a sustainable competitive advantage among their regional rivals. However, strategic planning is dependent on several critical success factors. The role of management leadership and an inclusive strategy to adapt to the changes in market dynamics are essential for survival in business competition.

The prevalent use of synthetic chemical rodenticides (both 1st or 2nd generation anticoagulants and acute rodenticides) is the primary method for managing rodents in sub-Saharan Africa. However, this practice poses substantial health and environmental risks and often fails to yield significant, sustainable reductions in rodent pest populations. In this paper, the second one of a two-part series, we advocate for a more responsible and sustainable approach to rodent management in urban and agricultural settings in sub-Saharan Africa. We propose a shift towards environmentally friendly rodent management strategies, specifically emphasizing the adoption of Ecologically-Based Rodent Management (EBRM) as a viable alternative to synthetic chemical rodenticides. EBRM relies on a comprehensive understanding of pest rodent biology, ecology, and behavior, along with the implementation of a range of community-based interventions. These actions are designed to ensure the consistent reduction of rodent pest populations to economically and hygienically acceptable levels. By embracing EBRM, we not only anticipate a reduction in the social impacts of pest rodents in a cost-effective manner but also a significant decrease in the risks posed by rodents and synthetic chemical rodenticides to human health and the environment. This paradigm shift towards EBRM promises a more sustainable and responsible approach to rodent management in sub-Saharan Africa.

We explore, for the first time in the literature, how the revenues of the ship-management companies respond to macroeconomic exogenous shocks. Using data for ship-management companies in Cyprus, we find evidence that a demand shock has the largest impact on revenues, exhibiting an almost one-for-one relationship. If the demand shock is permanent, we observe a ceteris paribus permanent effect on revenues. Similarly, this occurs irrespective of the final effect that demand has on the relevant freight rate, proxied via the Baltic dry and tanker (dirty and clean) indices. The BDI and the BDTI indices have smaller effect on revenues, standing at approximately 0.05% for every 1% shock, while the clean tanker index does not have an effect, most likely due to their fleet composition. In accordance with the literature, we find that a shock in the price of Brent oil increases revenues. Our results bear importance not only for ship-management companies per se, but also for countries that are ship-management hubs.

Product introductions play a pivotal role in the success and competitiveness of manufacturing, particularly in the context of new product development. Low-volume manufacturing companies exhibit distinct characteristics that significantly influence the product introduction process. Notably, the quality of information exchange between product design and production interfaces becomes paramount in this high-mix and low-volume industry. Consequently, there exists a pressing need to explore various methods for adapting and customizing management mechanisms and strategies to align with the unique requirements and characteristics of low-volume manufacturing and its associated product introduction processes. While the need for this knowledge is critical in the context of low-volume manufacturing, a majority of existing studies predominantly focus on the management aspects within high-volume manufacturing. Therefore, the primary aim of this study is to investigate the customization of product introduction management strategies to enhance the quality of information content within the realm of low-volume manufacturing. Drawing upon a longitudinal analysis of new product introductions within a low-volume manufacturing company, this study narratively elucidates how the examined company implemented product introduction management strategies to facilitate the enhancement of information content quality during the product introduction phase. The study presents its findings on management strategies across three key stages: pre-implementation, post-implementation, and subsequent modification and refinement of strategies following the initial round of implementation. By shedding light on these strategies, this study offers a comprehensive understanding of management approaches in the context of low-volume product introduction. As a result, it makes a valuable contribution to the discourse on information management and interface management in the high-mix, low-volume manufacturing literature.

This article provides a comprehensive exploration of the electric vehicle (EV) business, investigating its current state, market dynamics, and pivotal role in sustainable transportation. It delves into factors driving EV adoption, challenges faced by the industry, and the landscape of key players. The discussion extends to investments, infrastructure development, consumer trends, and the technological innovations shaping the future. The article concludes with insights into the anticipated growth and transformative impact of EVs, emphasizing their significance in fostering a cleaner, more sustainable future for global transportation.

This work investigates the utility of the National Oceanic and Atmospheric Administration’s National Water Model (NWM) for water management operations by assessing the total inflow into a select number of reservoirs across the Central and Western U.S. Total inflow is generally an unmeasured quantity, though critically important for anticipating both floods and shortages in supply over a short-term (hourly) to sub-seasonal (monthly) time horizon. The NWM offers such information at over 5,000 reservoirs across the U.S., however, its skill at representing inflow processes is largely unknown. The goal of this work is to understand the drivers for both well performing and poor performing NWM inflows such that managers can get a sense of the capability of NWM to capture natural hydrologic processes and in some cases, the effects of upstream management. We analyzed the inflows for a subset of Bureau of Reclamation (BoR) reservoirs within the NWM over the long-term simulations (retrospectively, seven years) and for short, medium and long-range operational forecast cycles over a one-year period. We utilize ancillary reservoir characteristics (e.g. physical and operational) to explain variation in inflow performance across the selected reservoirs. In general, we find that NWM inflows in snow-driven basins outperform those in rain-driven, and that assimilated basin area, upstream management, and calibrated basin area all influence the NWM’s ability to reproduce daily reservoir inflows. The final outcome of this work proposes a framework for how the NWM reservoir inflows can be useful for reservoir management, linking reservoir purposes with the forecast cycles and retrospective simulations.

The global transport sector of the world economy contributes about 15% of the Greenhouse Gas (GHGs) emissions in the world today. The University of Saskatchewan has pursued the green energy transition over the years. They have spearheaded diverse sustainability projects and agendas, due to the importance of curbing climate change and advancing sustainability. The transport system in the university campus is one area of focus where the Sustainability Office plans to introduce some innovations, as a way of curbing GHG emissions while also advancing sustainability practice in the university campus. The study carried out an economic benefit analysis on the campus fleet (consisting of 91 ICE vehicles) to determine if it is economically or financially feasible to transition from Internal Combustion Engine (ICE) or PVs (Petrol Vehicles) to Electric Vehicles (EVs). The analysis used RETScreen Expert software for analyzing renewable energy technology projects. The variables of Payback Period (PBP), cash flow projections, savings made from transitioning (fuel cost savings and energy cost savings), Benefit-Cost-ratio, GHG emission reduction potential, etc. were analyzed. The findings revealed that the GHG emission from the campus fleet will be reduced by 100% (this will result in the removal of about 298.1 tCO₂ from the environment). Also, the fleet manager will save approximately $129,049 (88.9%) in fuel costs. Apart from these, the return on investment will be achieved in year 5 (all things being equal), but can be reduced to year 2 if the vehicles are put into constant and active use (eliminating most idle times. Also, the Sustainability Office will be making a GHG reduction revenue of $14,906.

The objective of this study is to identify how demographic characteristics (gender, age, seniority at work, and educational level) are related to the entrepreneurial behavior of companies. To comply with the above, a quantitative, transversal, and non-experimental research was carried out, which consisted in applying an instrument to 262 managers of Small and Medium Enterprises (SMEs) in a northern city in Mexico. The collected information was analyzed in the software SPSS, version 26 with statistical testing by the Mann-Whitney and Kruskal-Wallis. The main findings dermore highly educated managers are those who contribute to this behavior of the studied companies, while gender and seniority at work are not differentiating elements in relation to the above. This research generates different possibilities of studies to be carried out in large companies from other sectors, as well as to include behavioral characteristics as study variables.

This study explores the transformative impact of e-commerce technologies on supply chain management within the retail sector. Through a thematic analysis of current literature and qualitative research findings, the study examines how technologies such as real-time monitoring, predictive analytics, AI, blockchain, and IoT are reshaping inventory management, procurement, logistics, and customer service. The research highlights significant improvements in operational efficiency, decision-making, and customer experience driven by these technologies. However, challenges such as system integration complexities, cybersecurity risks, and regulatory compliance issues are also identified. The study emphasizes the strategic adoption and integration of e-commerce technologies to enhance supply chain resilience, sustainability, and competitiveness. Insights from the analysis underscore the evolving role of technology in driving innovation and efficiency across supply chain functions, while also necessitating careful management of risks and complexities. Looking forward, the study discusses future trends including AI advancements, IoT connectivity, and blockchain applications, which are poised to further revolutionize supply chain dynamics. By addressing these trends and challenges strategically, retailers can leverage e-commerce technologies to optimize operations, mitigate risks, and meet evolving consumer demands in a digital-first marketplace.

Telehealth has been playing a progressively major role in the management of the NCOVID-19 crisis. The enforcement of social distancing measures has had the consequence of reduced technology distance in almost every walk of life. In this paper, based primarily on the still unfolding experiences of deploying it during the current situation, we argue that telehealth has finally come of age and that it is time to move it from the peripheries to the center of the 21st century healthcare. To provide a live context to the discussion, several instances of how telehealth strengthened our healthcare systems during the NCOVID-19 crisis are presented.

In modern times, sustainability in supply chain management is one of the keys to boosting the performance of the supply chain, and it enables the accomplishment of SSCM. It has been found in recent years that SSCM with assist of industry 4.0 applications, can benefit splendid productivity and efficiency in the supply chain. The numerous industry 4.0 applications that are involved are Artificial intelligence (AI), Machine Learning (ML), Internet of Things (IoT) Big Data Analytics (BDA), etc. Industry 4.0 with SSCM has gained a lot of interest from various authors and scholars across the world. Healthcare is one of the most critical sectors due to its importance in handling public health. More recently, the COVID-19 pandemic and other viruses (SARS and Ebola) have highlighted supply chain vulnerabilities that are further mitigated by their lean and globalized structures. Covid-19 underlined the need for supply chain visibility problems within the healthcare sector. When the need for medical supplies became urgent and global distribution was disrupted, companies faced the consequences of needing the technology, systems, and plans in place to correctly predict the onslaught. One report shows that about 94 percent of Fortune 1000 companies reported supply chain disruptions due to the COVID-19 global outbreak. Existing studies have discussed supply chain issues and the importance of AI in addressing these challenges. AI, like Industry 4.0 in the healthcare supply chain, is proving to be a game-changer. This paper aims to review and present the various aspects of SSCM and industry 4.0 applications to get a comprehensive literature review, which contains the analysis of multiple articles published from 2010-2020. In addition, the various challenges SSCM and industry 4.0 applications face are identified and discussed. Also, the impact of Industry 4.0 and sustainable practices brings together the healthcare supply chain. This study will help in getting a good understanding of the different industry 4.0 technologies that are important for setting up SSCM.

Roadway accidents significantly contribute to intermittent congestion and increased CO2 emissions on freeways. This research introduces a statistical approach designed to predict the rise in CO2 emissions resulting from traffic disturbances or jams triggered by such incidents. It also assesses the influence of varying levels of accident management effectiveness in different situations. To construct these scenarios, the study employs VISSIM, a traffic modeling software, incorporating diverse factors such as traffic volume, vehicle types, incident durations, and freeway lane counts. It then produces traffic flow characteristics in the form of vehicle paths. The emission estimates are derived by correlating these simulated vehicle paths with emission rates from the MOVES model. The study then applies a regression analysis to examine the connection between the increase in emissions and various influencing factors. The findings indicate that this approach efficiently reflects the impact of variables like accident duration, vehicle mix, and traffic volume on CO2 emissions across different lane configurations. The accuracy of these predictions is also confirmed. The outcomes suggest the model's potential usage in guiding efforts to lower emissions and determining the optimal duration of incident management, particularly in terms of lane closure, to mitigate emission impacts. This paper also discusses the limitations of the model and the future improvement direction.

Japanese encephalitis virus is a mosquito-borne member of the Flaviviridae family. JEV is the leading cause of viral encephalitis in Asia and is characterized by encephalitis, high lethality and neurological sequelae in survivors. The virus also causes severe disease in swine, which are an amplifying host in the transmission cycle, and in horses. US agricultural authorities have recently recognized the threat to the swine industry and initiated preparedness activities. Other mosquito-borne viruses exotic to the Western Hemisphere have been introduced and established in in recent years, including West Nile, Zika, and chikungunya viruses, and JEV has recently invaded continental Australia for the first time. These events amply illustrate the potential threat of JEV to US health security. Susceptible indigenous mosquito vectors, birds, feral and domestic pigs, and possibly bats, constitute the receptive ecological ingredients for spread of JEV in the US. Fortunately, unlike the other virus invaders mentioned above, an inactivated whole virus JE vaccine (IXIARO®) has been approved by the US Food & Drug Administration for human use in advance of a public health emergency, but there is no veterinary vaccine. This paper describes the risks and potential consequences of introduction of JEV in the US, the need to integrate planning for such an event in public health policy and the requirement for additional countermeasures, including antiviral drugs and an improved single dose vaccine that elicits durable immunity in both humans and livestock.

With the evolution of technology over the years, it has become possible to develop intelligent environments based on the concept of the Internet of Things, distributed systems, and machine learning. Such environments are incorporated with various solutions to solve user demands from services. One of these solutions is UBIPRI middleware, whose central concept is to maintain privacy in smart environments and to receive notifications as one of its services. However, this service is freely performed, disregarding the privacy that the environment employs. Another consideration is that based on the researched related works, it was possible to identify that the authors do not use statistical hypothesis tests in their solutions developed in the presented context. This work proposes an architecture for notification management in smart environments, composed by a notification manager named PRIPRO to assign it to UBIPRI and to aim to perform tests and comparisons between classification algorithms to delimit which one is most feasible to implement in the PRINM decision-making mechanism. The experiments showed that the J48 algorithm obtained the best results compared to the other algorithms tested and compared.

Gliomas are central nervous system (CNS) derived tumors that originate from glial cells and affect six per 100,000 people in the United States. They are the most common form of CNS neoplasm and are highly diffusely infiltrative to surrounding brain tissue. Gliomas of diffusive nature are classified into different subcategories: astrocytomas, oligodendrogliomas, and ependymomas. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) are used to determine tumor category and spread which may dictate treatment options. This paper focuses on emerging treatments of chemotherapy management with temozolomide and Avastin as well as emerging immune modulation treatment with vaccinations, manipulation of cellular checkpoints CTLA-4 and PD-1, co-receptor modulation of neuropilin-1, CAR-T cell therapy, and CRISPR-Cas9 gene editing. The employment of TMZ and BEV has been supported in the literature, however, more research is necessitated to fully optimize regimens and to avoid immune- and toxicity-related effects of these drugs. Moreover, an even closer consideration is warranted for current immunotherapies as they are in their infancy compared to TMZ and BEV. Thus, although promising emerging treatment options, therapies involving cancer vaccines, ICIs, immune modulation of neuropilin-1, CAR-T, and CRISPR-Cas9 technology require further investigation into their long-term efficacy and utility in treating gliomas.

Due to the upward trend in the globalization of sustainability issues and the intense competitive environment, it is evident that higher education institutions need new strategic approaches to succeed. To this end, the inquiry for this paper has been made into the debate about student relationship management. Going through the literature indicates that institutions have mainly perceived the concept as a technological initiative for solving the problems in individual domains, accompanied by uncoordinated efforts. Thus, the aims of this study are to theoretically present critical success factors of this strategic approach and to empirically examine the recognized factors. To do so, confirmatory factor analysis that is a quantitative analytic method was performed. The results and analyses revealed that there has been a significant correlation between the four critical success factors including knowledge management, student relationship management technology, student orientation, and employees’ involvement. It was also found that these factors are significantly correlated with the construct of student relationship management success. The findings have consequently highlighted that in addition to the technological tool, the role of knowledge management, employees’ involvement, and student orientation appeared to be particularly important for the implementation of the application.

In the semi-arid region of Brazil, it is common to use saline or brackish water for crop production. However, this practice can negatively affect the soil, nutrient balance, and fruit quality and production. From this perspective, this study aimed to evaluate the effect of fertilization combinations with nitrogen (N), phosphorus (P), and potassium (K) on the production and quality of West Indian cherry grown under salt stress in the second year of production. The study was conducted in a protected environment following a randomized block design with treatments distributed in a 2 x 10 factorial arrangement referring to two levels of electrical conductivity of irrigation water (ECw) (0.6 and 4.0 dS m-1) and 10 NPK fertilization combinations (80-100-100; 100-100-100; 120-100-100; 140-100-100; 100-80-100; 100-120-100; 100-140-100; 100-100-80; 100-100-120 e 100-100-140% of the recommendation in the second year of production), with three replicates and one plant per lysimeter. The results indicate that irrigation of West Indian cherry crop irrigation at the water salinity of 4.0 dS m-1 negatively affected all fruit production variables. The interaction between the ECw of 0.6 dS m-1 and the 100-80-120 NPK fertilization combination increased the total number of fruits and the total fruit weight of West Indian cherry.

Offsite construction is increasingly being presented as a way to increase housing delivery and reduce the housing crisis. Housing Associations play a pivotal role in the delivery of affordable homes and therefore offsite construction could be beneficial in alleviating the crisis. For offsite construction uptake to increase, the conceptual and pragmatic advantages and challenges surrounding offsite housing in relation to evolving social domestic needs to be explored and understood. The purpose of this paper is to discuss the viability of offsite construction as not only a full-service solution to social housing provision, but an integral strategic partner for meeting the range of specialised fabrication needs for these new properties. A literature review is carried out to explore the conceptual and pragmatic advantages and challenges encountered by HAs adopting offsite construction methods. The paper also investigates which the housing tenures are most suited to offsite construction technology. The paper highlighted that whilst individual case studies and example homes offer one mode of justification for Housing Associations to move forward, it is the cumulative effect of cost savings, sustainability, specialised skill sets, labour reduction, structural innovation, and rate of construction that should be weighed and incorporated into this consideration-making process.

A disaster wrecks those affected. It spares many in the affected areas, yet those spared may be indirectly impacted. Specific risks are often inherent within a social system or physical location, but they can also be created due to unavoidable natural or technological hazards. The consequences, however, can be similar in that they wreak havoc in communities and destroy economic systems. The analytical framework of deterrence and coping has ascertained beneficial in many circumstances, but a cost benefit calculation is a must to infer the feasibility of planning strategy and resource allocation. This study points to the Cost-Benefit Analysis (CBA) of flood management by District Disaster Management Kulgam. The assessment is established on secondary pooled data collected from administration offices, NGOs, published Journals, and local and national newspapers. It also characterised the strategy, the technique adopted, and the sources of flood damage cost information. The totalled benefits report for 78686.18 lakh of rupees, and that of total costs account for 2218.75lakh of rupees. The Benefit-Cost ratio greater than one (>1) indicates that Flood Management in District Kulgam was economically feasible and successfully governed. The State of Jammu and Kashmir put up with necessary prevention and administration measures to break the spell of devastation due to floods to significant status.

Introduction: Data on peri-operative management of direct-acting oral anticoagulants (DOACs) during transcatheter pacing leadless system (TPS) implantation remain limited. This study aimed to evaluate a standardized DOAC management regime consisting in interruption of a single dose prior to implantation and reinitiation within 6-24 hours; also, patient clinical characteristics associated with this approach were identified. Method Consecutive patients undergoing standard TPS implantation procedure from two Swiss tertiary centers were included. DOAC peri-operative management included the standardized approach (Group 1A) or other different approaches (Group 1B). Results Three hundred and ninety two pts (mean age 81.4±7.3 years, 66.3% male, left ventricular ejection fraction 55.5±9.6%) underwent TPS implantation. Two hundred and eighty two pts (71.9%) were under anticoagulation therapy: 192 pts were treated with DOAC; 90 pts were under vitamin-K antagonist. Patients treated with DOAC less often had structural heart disease, diabetes mellitus, and advanced renal failure. The rate of major peri-procedural complications did not differ between Groups 1A (n=115) and 1B (n=77) (2.6% and 3.8%, p=0.685). Compared to 1B, 1A patients were implanted with TPS for slow ventricular rate atrial fibrillation (AF)(p=0.002), were in better overall clinical status, and were implanted electively (<0.001). Conclusions Standardized peri-procedural DOAC management was more often implemented for elective TPS procedure and did not seem to increase bleeding or thromboembolic adverse events.

Background There is increasing awareness of problems associated with global warming but a lack of a systematic approach on how to deliver more environmentally sustainable dental care. A sustainable world aims to ensure that basic needs and quality of life of everyone are met, now and for future generations. The carbon footprint is an indicator of environmental sustainability. Aim The aim is to suggest an environmental management change for the dental practice focusing on the objective of carbon footprint reduction. Environmental management change design The management change is based on the concept of “Plan-Do-Check-Act”, as recommended by the International Organisation for Standardisation (ISO) and described through the environmental aspects of the dental practice. The approach focuses on establishing and implementing environmental objectives, followed by monitoring results and taking actions to improve continually. The environmental aspects considered for the dental practice are activities causing an impact on the carbon footprint: energy use, travel, product purchasing, waste production, emission to air, water use, and contamination of land. Conclusions The “Plan-Do-Check-Act” ISO 14100-2015 model can be effectively integrated into the dental practice setting for its environmental management. A reduction of the carbon footprint of the dental practice is achieved by applying the environmental management change described for each activity.

This study investigates how the determinants including risk preference affect farmers’ decision to adopt SLM practices in upland areas of Vietnam. Empirical data collected through in-depth interviews with 200 farmers in Na Ri district, Bac Kan province were used. The factors affecting SLM adoption of farmers in Na Ri district were examined by the 2SLS or IV-Probit model. The estimated 2SLS regression indicated that there is a set of factors affecting SLM adoption, namely, relative risk aversion, farming experience, farm size, knowledge of SLM, membership in farmers’ organization, number of labors, and slope of farm land. Specifically, relative risk aversion had a negative effect on SLM practices adoption. The farmers who are less risk averse are more likely to adopt more SLM practices. This implies that reducing farmer’ risk exposure could promote SLM practices. This result is also helpful for policymakers to understand farmers’ behaviors and promote the diffusion of SLM practices across regions on a large scale.

The stress testing methodology should be implemented and applied to the entity's overall financial system at least annually, and if the organization operates in a volatile economy, it should be performed at least twice a year. Finally, managers should include regular training and development sessions for relevant employees of their organization to be fully informed and more informed and informed, considering the evolving science, theory and practicality of a discrete range of stress testing mechanisms that can be appropriately applied to overall financial framework and system of multiple financial institutions and banks. In addition, stress testing is essentially a methodology that collects and analyzes certain future macro-prudential and micro-prudential economic drivers and indicators, the primary purpose of which is to assess the future financial and economic well-being, level of growth and status quo of a financial institution, bank, organization, credit institution or economy or the nation as a whole. In addition, several of these reviews were specifically focused and incorporated into the paper, which substantially and broadly discussed and summarized the importance, feasibility and implementation and conclusions of different stress testing approaches for financial institutions and banks, especially in European and Chinese countries. region. with the primary intention of assessing the future financial and economic well-being, level of growth and status quo of a group of financial institutions, banks, organizations, credit institutions or the economy or the nation as a whole. In addition, several of these reviews were specifically targeted and incorporated into a paper that substantially and broadly discussed and summarized the importance of the feasibility and implementation and conclusions of different stress testing approaches for financial institutions and banks, especially in European and Chinese countries. region. with the primary intention of assessing the future financial and economic well-being, level of growth and status quo of a group of financial institutions, banks, organizations, credit institutions or the economy or the nation as a whole. In addition, several of these reviews were specifically focused and incorporated into the paper, which substantially and broadly discussed and summarized the importance, feasibility and implementation and conclusions of different stress testing approaches for financial institutions and banks, especially in European and Chinese countries. region. the level of growth and status quo of the financial institutions, banks, organizations, credit institutions or the economy or the nation as a whole. In addition, several of these reviews were specifically focused and incorporated into the paper, which substantially and broadly discussed and summarized the importance, feasibility and implementation and conclusions of different stress testing approaches for financial institutions and banks, especially in European and Chinese countries. region. the level of growth and status quo of the financial institutions, banks, organizations, credit institutions or the economy or the nation as a whole. In addition, several of these reviews were specifically focused and incorporated into the paper, which substantially and broadly discussed and summarized the importance, feasibility and implementation and conclusions of different stress testing approaches for financial institutions and banks, especially in European and Chinese countries.

Soil naturally contains fluorine, but concerns arise when its levels or bioavailability are increased by human activities or specific compounds. South Korea faces challenges in regulating soil fluorine pollution despite implementing stricter total fluorine standards than many developed countries. Moreover, these regulations can be economically unfeasible because of the naturally high background levels of fluorine in the soil in Korea. This review explores the global landscape of soil fluorine management strategies and examines potential solutions that reconcile environmental protection with economic concerns. We recommend a shift towards regulating specific and hazardous fluorine compounds rather than total content, and prioritizing remediation efforts based on assessments of bioavailable fluorine. This approach may help Korea establish a more effective and sustainable strategy for managing soil fluorine pollution.

The Thrace region in Turkey is an important region where production suitable for irrigated agriculture such as sugar beet, paddy, sunflower and corn is widely carried out. Producers in the region have to decide on the product they will produce every year. A large number of factors that can affect decision-making in agricultural production can affect the outcome of the farmers. Therefore, it is necessary to have a decision-making process that can facilitate access to information and decision-making. Analytical Hierarchy Process (AHP) is a valuable decision-making methodology that can be applied not only in agricultural production but also in many other areas. This study evaluates four products with the AHP method according to the criteria by surveying 271 producers in the area. The aim is to determine the most suitable products for planting in these areas. We found that rice is the product that provides the highest profit. The AHP model used in this study primarily serves to determine the importance levels of various criteria and demonstrates its effectiveness as a decision-making tool in product selection when the correct criteria are applied

Purpose: To explore parents’ perceptions of the educational intervention programme regarding their children’s postoperative pain management. Design and Methods: A qualitative descriptive study was conducted. Thirty-two parents whose children underwent inpatient elective surgery were recruited from the two intervention groups (received an educational booklet and a video, with or without an hour of face-to-face teaching session) for this qualitative evaluation of the intervention. Participants were asked to comment on the content and delivery methods of the intervention via individual face-to-face semi-structured interviews. Thematic analysis was used to identify themes from the data. Results: Three themes were generated from 32 participants’ interview data: current pain management practices, experiences and benefits of the educational intervention, and suggestions to improve pain management. Conclusions: Our findings suggested that the educational intervention in children’s postoperative pain management was helpful for parents and their children. However, it is necessary to improve educational materials and equip healthcare professionals with non-pharmacological pain relief methods. Practice Implications: Our findings reveal the current challenges in extensively adopting non-pharmacological pain relief methods. Healthcare professionals can do more to routinely integrate pharmacological and non-pharmacological pain management strategies in relieving pain effectively. Future research could develop technology-based programmes to increase ease of access. Trial Registration Number: ISRCTN24910957.

This article works on the three questions: “How can libraries make an effective contribution to resolving the sustainability challenges we are collectively facing?”; “When are libraries truly sustainable?”; and “How can library management support this shift?”. Looking across libraries and their history of the last decades, the author discerns different stages of development leading to sustainability. In line with the work of Dyllick and Muff (2016) the author describes Sustainability Levels 0.0 to 3.0. The highest level requires a quantum leap and shifts from thinking inside-out to outside-in. This article addresses the need that there is virtually no academic management literature on the topic of sustainability in libraries. It shows that whilst there are many examples of individual projects or activities, there is a serious lack of methodology senior management level.

Species of Acacia have been extensively entrenched in the tropical, and semi-arid regions as well as in the southern hemisphere. Acacia species have been bounteous faces the pest and pathogenic pressure. Integrated Pest Management (IPM) is an immensely important aspect of producing a healthy Acacia plantation without harmful impacts on the environment. Here an attempt was made to determine the possibilities of integrated pest management for Acacia. Overall, this information will be helpful to increase awareness about the integrated pest management of the members of the genus Acacia.

This study presents virtual reality (VR) videos as an effective technique for delivering extension educational materials on manure and mortality management. Virtual reality is a technology that can enable immersive distance learning. Using VR tours can enable the public to learn manure and mortality management technologies without in-person farm visits, thus saving traveling time and money and avoiding exposure to pathogens and noxious odors in farms. As the first part of this project, 360° VR tours were created on multiple aspects of manure management, including composting, anaerobic digestion, and preliminary wastewater treatment. These videos were presented to a diverse audience of agricultural producers, extension specialists, and researchers through in-person and online extension events and the Texas Manure YouTube channel. The effectiveness of videos was evaluated using surveys, which measured the audience's awareness of the topics before and after watching VR videos. Statistical analysis revealed that the increase in awareness after watching the videos was statistically significant, with a p-value of less than 0.0001. Statistical analysis also revealed that job classification and professional experience significantly impacted the change in awareness. Researchers, extension specialists/agents, and participants with less experience in manure and mortality management experienced a greater change in awareness than agricultural producers and participants with more experience. Interest and impression of the audience on the VR videos was also evaluated. According to survey data, the majority of the audience rated these videos as an effective technique for educating the public about manure and mortality management, found the VR videos interesting, were willing to learn more content through VR videos, and were likely to recommend them to their colleagues. A statistically significant correlation could be observed between the awareness change and the effectiveness rating given to the videos by the participant.

Cork oak mortality has reached alarming proportions in the last decades, exacerbated by climate change. Understanding this phenomenon is crucial in finding mitigation or adaptation strategies. This study conducts a diachronic analysis of cork oak mortality over 10 years using GIS tools, focusing on Portugal's Tagus Lezíria region. Topographic, edaphic and climatic variables were employed to create maps of edaphoclimatic aptitude for cork oaks. Dead trees were identified using remote sensing techniques and crown coverage was determined to calculate the mortality index. The diachronic analysis aimed to explore climate change effects on cork oak mortality. A decrease in precipitation was observed, significantly impacting stands with canopy cover below 40%. Furthermore, a negative effect of solar radiation identified only in stands with canopy cover of 40% suggested its role in cork oak decline. This study introduces a novel perspective, highlighting the protective effect of denser canopy cover (above 40%) against excessive solar radiation and the impact of reduced precipitation. The integrated and diachronic approach provides valuable information for adapting management strategies to climate change challenges.

We examine how external triggers, including the digital imperative and the need for more sustainable resource and stakeholder employment, spark the development of transformative sustainable business models. Drawing on the resource-based view and the shared value approach we conceptualize a multifaceted framework that helps to identify key determinants and coherent layers of transformative sustainable businesses models. Our theoretical arguments integrate recent research findings on external dynamics, such as digital technological advances and rising global competitive dynamics, with internal capabilities on both the organizational and the individual level, allowing for a more complete understanding of transformative potentials on the firm level. We propose that key determinants of sustainable transformative business models adhere to both, innovative value-creating reconstructionist and sustainable shared-value logic, and include elements such as co-creation with customers, usage-based pricing, agile and adaptive behavior, closed-loop resource employment, asset-sharing, and collaborative business ecosystems. At the same time, organizational, economic, and environmental layers encompassing sustainable business models need to be both horizontally and vertically coherent to unfold their full potential.

This study investigates the impact of governance variables on the earnings quality based on the industry the firm is in. it has been identified that earnings management have been practised differently by different industries. Most of the research under earnings management have focussed on holistic impacts of corporate governance variables on discretionary accruals while this study has categorised the firms based on what industry they fall on while identifying the impacts of the variables of corporate governance on discretionary accruals. Initially, this paper has studied the estimation of the value of discretionary accruals and identified that performance matched discretionary accruals as the best model as per the explanatory power of the model is higher than other models. Hence, the estimation of the earnings management has been calculated based on performance matched discretionary accruals in this research. This research has studied the impacts of the governance attributes on the earnings management categorising the firms based on the industry they are in; hence, the value of earnings management has been categorically separated; hereafter, the impact of the corporate governance factors on the value of categorically separated earnings management have been statistically analysed. This study has considered the descriptive study to compare the means, medians and standard deviations of the earnings management of various industries. Moreover, Pearson correlations and Spearman rank correlation have been used as a research tool to examine the correlation coefficients.

The emergence of digital twins (DTs) represents a recent advancement in technological processes that support the planning, construction, and oversight of constructed assets. A DT is essentially a digital model that facilitates simulations and two-way information exchange with its real-world counterpart (a physical twin), creating opportunities for data-driven decision-making. Despite the promising prospects of DTs, both the technology and the methodologies for developing them, as well as their potential applications, remain not fully understood in both academic and industrial contexts. This research explores the applications of DTs for the management of existing assets within the AEC/FM industry. The study presents the results of a comprehensive literature review that explores existing knowledge in this domain. The findings reveal that procedures for creating DTs are still in their early stages, emphasizing potential applications in asset management throughout their lifespan, facilitating sustainability upgrades, and supporting the maintenance and restoration of heritage assets. The review concludes by providing recommendations for future research in this evolving field.

Fungal pathogens pose a major threat to food production worldwide. Traditionally, chemical fungicides have been the primary means of controlling these pathogens, but many of these fungicides have recently come under increased scrutiny due to their negative effects on the health of humans, animals, and the environment. However, the use of fungicides with less of an environmental impact tends to result in the development of resistance in populations of phytopathogenic fungi. Therefore, new environmentally friendly alternatives that provide adequate levels of disease control are needed to replace chemical fungicides—if not completely, at least partially. A number of alternatives to conventional chemical fungicides have been developed, including plant defence elicitors (PDEs), biological control agents (fungi, bacteria and mycoviruses), biofungicides, RNA interference (RNAi) methods, and resistance breeding. This article reviews the conventional and alternative methods available to manage fungal pathogens, discusses their strengths and weaknesses, and identifies potential areas for future research.

The establishment of thresholds is integral to environmental management. This paper introduces the use of thresholds in the context of deep-seabed mining, a nascent industry for which an exploitation regime of regulations, standards and guidelines is still in the process of being developed, and for which the roles and values of thresholds have yet to be finalised. There are several options for integrating thresholds into the International Seabed Authority’s regulatory regime, from being stipulated in regulations to being part of a mining contract, each option having its own advantages and disadvantages. Here we explore the range of ways that thresholds can be derived, set out the challenges in translating ecological and management data into thresholds, highlight factors for acceptance and operationalisation of thresholds in deep-seabed mining, and explain the necessity of refining thresholds as knowledge on impacts to features improves. Some comparable marine industries already use thresholds and these could potentially be used as starting points for the development of thresholds for deep-seabed mining. In order to be acceptable to the wide range of deep-seabed mining stakeholders, thresholds need to strike a balance among levels of harm acceptable by society, levels of environmental precaution justifiable by governments, scientific robustness, and operational practicality.

In this paper, we are proposing a bio-inspired location management (LM) technique for personal communication system (PSC). It is based on artificial immune system (AIS), with self-adaptation and self-updates attributes in order to perform the location management, and work helps to achieve the better quality of service (QoS) and quality of experience (QoE) for the mobile users. Here, we are suggesting a modified mobile switching center (MSC) architecture, and an adaptive self-modified location management procedure. The proposed mobile switching centre architecture has an advantage of rule-based and fact-based system to store the rules and fact related to location management procedure, and it shows the intelligent behavior of system. The mobile switching centre calculates the best method for location management and rule-base system trigged the rules to perform the techniques. The system stores the result (techniques for location management) in fact-base system for future use. The efficiency and effectiveness of the proposed techniques been analyzed, and it observed that the proposed system has 45-50% improvement in performance over the current location management techniques. Here, we are taking the performance parameters such as signaling cost, database update cost, overhead measurement, mobility management cost.

The American leafhopper Erasmoneura vulnerata, detected in Europe in early 2000s, has recently become a pest in North-Italian vineyards. Issues were recorded in organic and conventional vine-yards despite the application of insecticides devoted to the control of other pests. Erasmoneura vulnerata completes three generations, and the second generation is frequently associated to large populations. The selection of appropriate active ingredients and the timing of their application is crucial for effective pest control. Field trials were carried out in North-eastern Italy, using a randomized design, to evaluate the impact of insecticides applied against other grapevine leafhoppers on E. vulnerata populations. The beginning of the second generation was selected as best timing for insecticide application. For a number of natural products, two applications were planned. Among the selected insecticides, the most effective were acetamiprid, flupyradifurone and lamb-da-cyhalothrin. Regarding natural products, the most effective was kaolin that could represent an alternative to pyrethrins in organic vineyards. The identification of pest threshold levels and the evaluation of side effects of the most effective insecticides on key natural enemies occurring in vineyards are required

A claim management office (CMO) is a new intra-organisation fit based on an organisational project management (OPM) approach and deals specifically with improving claim performance. However, CMO is either misunderstood or often overlooked in construction companies, mainly due to ignorance of the OPM context but further exacerbated by a lack of real case study research on how to adopt CMO in these organisations. This study addresses this prevailing knowledge gap by investigating the nature of the construction industry from the CMO viewpoint and developing an extensive framework through which to improve organisational claims performance. Organisational ambidexterity theory integrated with X-inefficiency theory is adopted for claims performance outcomes, due to organisation intra-firm irrational decisions when managing such claims. Data was obtained and analysed from a international large construction company (which used CMOs) and its internal focus group discussion (as a multi-method approach). The reference framework provides new perspectives on how construction-related companies can adopt a CMO structure, which enables them to improve claims performance by planning in three interrelated activities viz. function-, process- and performance-based-. Furthermore, findings contribute to researchers and practitioners by providing a true understanding of the CMO-related mechanism and plausible roadmap for future work.

This paper makes a theoretical contribution by exploring the integration of sustainability principles into project management. It compares two recent methodologies, PM² and PRiSM^TM, and provides a practical contribution by advocating for the adoption of these sustainability-driven practices among practitioners. Sustainability remains relatively unknown in the realm of project management, and this research aims to bridge that gap. The study follows an interpretivist philosophy and employs a combination of interviews and archival data analysis. PM², created by the European Commission, provides a project management methodology free to organizations and includes best practices from other bodies of knowledge. However, it doesn't include sustainability, because it aims to be generic. PRiSM^TM, based on the P5™, aims to make the project management process more sustainable. PRiSM^TM has P5 Impact Analysis and Sustainability Management Plan as the main differentiating deliverables and is an extension of the Triple Bottom Line, also including product and process. The PM² Alliance CEO believes that PM² aims to be generic, so a focus on sustainability would remove the methodology's "elasticity". However, users wishing to use PM² and consider sustainability can include it in the additional objectives and use PRiSM^TM differentiating deliverables.

The VUCA world is the epitome of the challenges linked with some of the undercurrents currently shaping businesses in the projectified society. The terms volatility, uncertainty, complexity and ambiguity (VUCA) are used as descriptive for the continuous flux project managers and project planners are forced to keep at bay. In this article, the authors present an idea to connect the VUCA concept as a risk identification platform to access, identify and isolate low-probability but high-impact events often called black swans or fat tail events. It is argued that the assumptions of conventional risk assessment in the domain of project management can lead to skewed general outcomes due to limitations of the intellect to assess probability. The outline of the VUCA meter is drafted and argued that the meter can augment the conventional risk assessment

The COVID-19 pandemic affected the perinatal emotional landscape in Italy, a country with high mortality and strict lockdown. This study explored the emotions and challenges of pregnant and post-partum women during the pandemic, using AI-based mixed-methods. The study analyzed 1774 women from the national survey COVID-ASSESS: 1136 pregnant and 638 post-partum. The survey had qualitative questions on emotions and feelings related to birth, communication with healthcare professionals, media, and peers and family. We used natural language processing and machine learning to classify emotions, identify themes, and extract citations from the data. Fear and anxiety replaced joy as dominant emotions during the pandemic: trust and joy decreased by 49.3% and 36.4%, respectively, while sadness and fear increased by 52.3% and 49.3%, respectively. The pandemic also induced loneliness, isolation, frustration, and anger. Women faced challenges related to birth, communication with HCPs, media, and peers and family. They also used coping strategies such as self-care, news limitation, and tried to cultivate gratitude and hope. The study provides a comprehensive exploration of the perinatal emotional landscape of Italian women during the pandemic. The findings underscore the significant psychological impact of the pandemic, and also highlights women’s resilience and coping strategies.

Purpose: To evaluate nursing leaders' perception towards communication and relationship management competencies while using digital platforms during the COVID-19 pandemic. Background: Communication and relationship management competencies among nursing leaders will ensure healthcare models are successfully implemented. Nursing leaders can achieve effective leadership by mastering these competencies leading to an overall improvement in the quality of nursing care. However, digital platforms have been rapidly evolving in the healthcare ecosystem and have been significant during the battle with COVID-19. It is crucial to ensure that nursing leaders can use digital platforms to communicate and practice efficient management in their op-erations, especially during a crisis when their services are vital. Design: Descriptive, comparative study. Methods: The study was conducted between February to March 2021. A 5-item Linkert-type questionnaire was adopted from the American Organization for Nursing Executives (2005) and was sent to identified nursing leaders in Hamad Medical Corporation through the official email. Results: Two hundred fifty nurse leaders were invited to participate, but only 116 responded positively, translating to a response rate of 46.4%. The male participants represented a larger proportion of 64.10%, while the female was 35.90%. Regarding the questionnaire, the Cronbach alpha was α ˃ 0.987, indicating that all items revealed a sufficient level of internal consistency. The respondents had a minimum of 0 and a maximum of 52.6n in the communication and relationship management items. Influencing behavior, relationship management, and effective communica-tion had the lowest scores, which indicate low competency. The F value in ANOVA analysis was close to 1.0, implying that the null hypothesis is true. The significance value is <0.5 implying that there is a difference in response on effective communication proficiency of nurse leaders. Conclusions: Digital platforms are communication tools that are widely adopted to engage and reach nurses on numerous topics. Nurse leaders should capitalize on their benefits and generate critical discussions. The continued need to research nursing leadership competencies is critical as healthcare continues to change and evolve. Educational institutions and healthcare organizations must understand that nursing leaders should strive for professional development and knowledge acquisition to improve their communication and management.

Effective solid waste management is crucial for protecting public health and the environment. Global concentration on finding sustainable methods of handling waste continue to top the list of most governmental-related project checklists. This paper provides a case study on the management of municipal solid waste in the cities of Karlsruhe, Germany and Navrongo, Ghana as developed and developing countries respectively. This study aimed at comparing and drawing lessons from how these two different cities manage their solid waste. The waste management system in Karlsruhe prioritizes waste separation, recycling, and a pay-as-you-throw system has led to an efficient and sustainable waste management system that minimizes waste and protects the environment. Karlshrue's adoption of a continual developmental plan structure focused on integrated WM concepts is credited with safeguarding the long-term viability of waste management in the city. In contrast, Navrongo's waste management system faces several challenges, including inadequate resources and infrastructure, traditional waste disposal practices, and the lack of well-planned waste management strategies. To improve effective solid waste management systems in Ghana, a collaborative approach involving the government, local organizations, and the community is necessary. This can include investing in infrastructure, implementing waste separation and recycling programs, and educating the public on the benefits of sustainable waste management practices. Learning from successful models like Karlsruhe can help accelerate the development of sustainable waste management practices in Ghana, and ultimately protect public health and the environment.

Introduction: The management performance of hospitals in emergency departments in coping with clinical hazards is necessary for their success in providing quality services. The purpose of this study is to provide an optimization procedure and applying management performance in health and medical emergency on the rate of emergency preparedness of the suburb city hospitals. Research method: A semi-experimental and interventional descriptive study in the emergency department of Shahid Motahari Hospital in 2015-2016. Data was collected through the standard checklist of hospital emergency responsiveness test to WHO disasters with 90 questions in 9 domains which is codified by the World Health Organization, in the form of interviews and observing evidences , and if necessary a numerical analysis. Initially, the situation was measured according to this checklist. In the next stage, a set of solutions was developed and then the solutions were implemented according to the obtained information. Data analysis before and after proposing the procedure and its application in order to improve the quality of health management performance and emergency preparedness was performed using central indices, and for describing and presenting the survey results, tables and graphs were used. Results: The highest and lowest emergency preparedness rates for disasters and emergencies before the proposed procedure were the Communication Factor (%77/8) and Human resource factor (%2/8) respectively. The degree of preparedness of the medical center was measured in the management performance according to the model (WHO) before proposing the procedure (%77.98). The researcher's procedure provided and applied based on the information obtained from survey environment, location and type of hospital structure. After providing the procedure, the maximum and minimum rates were the continuity of service factor (%58.3) and post-accident rebuilding factor (%100), respectively. Generally, the rate of emergency preparedness of studied medical center in management performance for coping with disasters and medical emergencies was measured (%97.2) according to hospital emergency responsiveness test for accidents and (WHO). The significance level is less than 0.05, so we can say that the effectiveness with confidence (95%) was effective. Conclusion: According to the statistics of accidents and disasters in the suburb cities, the results of the research and the importance of the role of emergency departments in interurban hospitals in controlling accidents, the need for planning and implementation of practical measures such as conducting training courses on health management in disasters and emergencies, having an estimate of critical and essential resources, changing the structure, providing manpower (emergency management) in order to more precise control and ease of service, maintenance and repair of equipment, timely triage and retrofitting of hospitals were effective in improving their preparedness.

The best business relationships are built as relationships between people and organizations that work together to achieve common goals. In the current digital era, B2B collaboration relationships are essential for business success. The response time to customer requests can be a key factor in maintaining these relationships and obtaining a competitive advantage. The use of VBA automation for repetitive tasks can help speed up this process, but it is important that computer operators have medium knowledge about using VBA macros. This work deals with issues related to improving response times to requests received by email, using a macro program for repetitive tasks. The empirical study was conducted on an average of 50 daily emails for order confirmation, with an average writing time of 68 s per email, resulting in a potential reduction in working time for the operator of approximately 1 h/day, only for order confirmation. The results show a significant improvement in working time for computer operators, using VBA buttons for repetitive tasks.

Design changes seem inevitable in engineering, procurement and construction EPC projects. Such changes create a need for a proactive approach to adjusting project scope, cost and time (the triple constraints) for efficiency and effectiveness in overall delivery. This study investigates the causes and implications of design changes in order to improve design change management practices. Data for the study was obtained through online interviews with New Zealand industry practitioners. Thematic analysis was used to collate the results into meaningful data. The study found that design changes were predominantly caused by clients' inadequate strategic planning, insufficient attention to design, EPC contractors' inadequate design ability, and on-site variations. There were three categories of such design changes: direct impact on the project, the reciprocal and complementary effect on stakeholders, and the far-reaching impact on the community. The study concludes by suggesting improvements, such as strengthening the integration of project teams to enhance design quality, strategic alignment of stakeholders at the planning stage, early contractor involvement (ECI) between the planning and design phases, and improving collaboration between design and construction teams. Further, a combination of high technical skills (e.g. design ability) and soft skills (can-do attitude, interpersonal skills, problem-solving skills, documentation skills, etc.) are needed to effect the desired improvement in design change management.

Fibromyalgia is a complex and often misunderstood chronic pain disorder. It is characterized by widespread musculoskeletal pain, fatigue, and heightened sensitivity, and has evolved in diag-nostic criteria and understanding over the years. Initially met with skepticism, fibromyalgia is now recognized as a global health concern affecting millions of people, with a prevalence trans-cending demographic boundaries. The clinical features and diagnosis of fibromyalgia encompass a range of symptoms beyond pain, including sleep disturbances and cognitive difficulties. The study emphasizes the importance of a comprehensive evaluation for accurate diagnosis, considering the shift from tender point reliance to a more holistic approach. Etiology and pathophysiology involve genetic predisposition, neurotransmitter dysregulation, central sensitization, and immune system involvement. Risk factors such as gender, age, family history, and comorbid conditions contribute to susceptibility. The impact on quality of life is profound, affecting physical and social aspects, often accompanied by mood disorders. Management approaches include pharmacological interventions, non-pharmacological therapies, lifestyle modifications, and alternative treatments. The study also delves into emerging research, exploring advances in neurobiological understanding, brain imaging, genetic markers, glutamate modulation, cannabinoids, gut microbiome, and digital health tools for fibromyalgia manage-ment. Overall, this study provides a nuanced and up-to-date overview of the complexities sur-rounding fibromyalgia, aiming to enhance understanding and support for individuals grappling with this challenging condition.

The focus of research has mainly been on the life cycle approach to project development, while limited attention has been given to the ageing construction companies that make all these activities/processes happen. This paper examines the organisational factors determining the sustainability and growth of building and civil engineering contractors in South Africa. The paper explores whether there are specific organisational factors that aid the sustainable development and growth of contractors in the South African construction industry. The paper analyses data gathered from face-to-face interviews conducted with four established and twelve upgraded and successful building and civil engineering contractors listed on the Construction Industry Development Board’s (cidb) Register of Contractors. The aim of the study is to identify the organisational factors critical for sustainable contractor development and growth in South Africa. The study found that organizational factors responsible for the sustainable development and growth of construction contractors include the size of the founding team members, management capabilities, strategic decisions made by founders/leaders and the ability of the company to constantly evolve, adapt and respond effectively to threats/challenges whenever they surface, amongst other findings. Capacity to generalise the results of the study to the large cidb registered contractor group is limited by the smallness of the sample size. Future research should make use of a larger sample size to obtain more general findings. The results of the study imply that the founding team size, experience, entrepreneurial and managerial capabilities, capacities and organisational structures that enable the efficient response of companies to external and internal challenges are key components of the definable arrangements that will support the sustainability and growth of construction organisations. The paper is of value to government departments and agencies such as the cidb and contracting firms in the construction industry.

The main objective of this research was to analyze the relationship between socioeconomic and demographic indicators and the level of transparency of municipalities in the state of Maranhão. The transparency index was constructed based on the LRF and LAI and consisted of 32 items. Subsequently , for To identify which factors explain the level of transparency, a multiple linear regression was carried out, comparing the explanatory variables for the level of transparency adopted in this study. The sample consisted of municipalities in the State of Maranhão, totaling 211 municipalities, as 7 did not have a website. The results of the multiple linear regression model indicate that the IDHM, the log of total GDP, the GDP per capita and the variable log of POP explain the NT of the municipalities surveyed to the point of explain the level of transparency of the municipalities of Maranhão, only the IFDM did not show a relationship with the NT among the variables analyzed.

Background: The last-mile delivery phase, the final stage where goods move from a distribution center to customers, is pivotal but faces significant inefficiencies and high costs due to its complexity. Recent advancements in Edge AI or Edge Intelligence (EI) offer promising solutions to these challenges. Methods: This study explores how AI-driven technologies and real-time data processing, combined with EI, can enhance last-mile delivery operations. A thorough literature review was conducted to assess technological advancements, and a Delphi method was used to systematically and empirically assess the impact of EI solutions on both operational efficiency and customer satisfaction. Results: Although EI technologies offer substantial benefits, EU companies are hesitant to adopt these innovations due to high implementation costs. However, firms that have embraced these technologies report significant improvements, including better route optimization, reduced delivery times, and enhanced service reliability. These findings highlight the need for a culture of innovation and the recruitment of experts with advanced qualifications to drive technological advancement in last-mile logistics. Conclusions: The integration of EI represents a significant step towards more efficient, cost-effective, and customer-focused last-mile delivery solutions. Future research should aim to refine these technologies and explore their long-term impacts on the logistics industry.

Combined sewer overflow (CSO) is a significant environmental concern and public health (e.g., water contamination, eutrophication, and beach closure). The Environmental Protection Agency (EPA) has introduced the National Pollutant Discharge Elimination System (NPDES) permitting program to regulate and address this matter. This program mandates the control of CSOs for more than 700 municipalities obligated to devise Long-term Control Plans (LTCPs) to curb combined sewer overflows and bring them down to safe levels. LTCP involves diverse strategies, including sewer separation, green infrastructure improvements, and conventional gray infrastructure upgrades. This study investigates several municipalities’ solutions for CSO problems in conventional methods and wireless sensor technology as real-time control. The investigation mainly focuses on a comparative analysis of two cities, Richmond, Virginia, and South Bend, Indiana, such as average rainfall, the frequency of overflows, and the capacity of treatment plants. The findings indicate that integrating sensor technology could significantly enhance modeling endeavors, bolster the capacity of existing structures, and substantially enhance preparedness for storm events. The EPA’s Storm Water Management Modeling (SWMM) software is utilized. Through an analysis of SWMM data, the study suggests the potential for leveraging wireless sensor technology to achieve more robust control over CSOs as a part of LTCPs.

The guthi, an ancient institution deeply embedded in Nepal's social, cultural, and economic fabric, has long overseen the maintenance of temples, shrines, festivals, and heritage sites since the Lichchhavi era (400-750). Since 1960, however, this system has been challenged by government land reforms, which has impacted its influence on sustainable heritage conservation. Nevertheless, there's compelling evidence that land nationalization and the guthi's declining authority have harmed local heritage conservation. Nevertheless, the guthi system has endured, serving as an important informal means of heritage conservation and highlighting the adaptability of traditional institutions. These community-based trusts, originally established for social and religious purposes, have played a pivotal role in preserving cultural practices, monuments, and temples for future generations. This article aims to demonstrate the central role of the guthi as the cornerstone of Nepal's efforts to conserve and manage both tangible and intangible cultural treasures. Using observational techniques, case studies, and a qualitative approach, it explores the historical evolution of heritage conservation through the lens of the guthi, taking into account subjective, valued, and constructed realities. The paper concludes by urging policymakers to recognize the significant contribution of indigenous systems such as the guthi in achieving sustainable heritage conservation. Embracing such traditional strategies can mitigate multifaceted problems and effectively preserve Nepal's cultural heritage through the guthi.

In Burkina Faso, the infant flours produced are intended for weaning-age and malnourished children. This study was to evaluate the management of infant flour production in Ouagadougou. A survey was conducted among the production units to determine the raw materials used in the production of infant flours, the production processes, the methods of conservation of raw materials and infant flours, the types of infant flours produced as well as their packaging. The results showed that 45.45% of the production units surveyed were of the semi-industrial type against 54.54% from the artisanal and CREN types. Among the raw materials, the most used cereals were millet, sorghum and maize. As for legumes, peanuts and soybeans were the most used at respectively 35% and 31%. For the conservation of raw materials, 85.71% of infant flour producers had storage warehouses and 66% used storage pesticides. These flours produced were intended for children of wean age (37.14%) and children in nutritional recovery (62.86%). Flours were stored in an airy (94.29%), dry area/environment (88.57%) and in the presence of light (91.43%). All the results of this survey reflect that efforts are still expected to further improve the nutritional and sanitary quality of the infant flours produced.

Introduction: The imbalance between technological development and ideological strengthening has resulted in the fading of the Pancasila ideological values of millennials. Technology that accompanies everyday life seems to be the main character in human life. Yet if humans themselves do not use technology wisely, technology can be a threat to both individuals and the life of the nation and state. If technology is increasingly out of control, threats to the Pancasila ideology are very likely to occur, such as in the G 30S PKI incident. Therefore, it is necessary to take action both from the government and the community as individuals to safeguard the development of technology to be used wisely. That way, we can prevent the threat to the Pancasila ideology together. Writing this article aims to analyze how the role and influence of the Pancasila ideology on the millennial generation in the 4.0 industrial revolution and to find solutions so that the values of Pancasila remain attached to the next generation of the Indonesian nation. Method: Writing This article uses a qualitative method by using literature reviews from the results of related research journals that have been published online through websites and other online media. Results: Thirteen journals and one book have met the criteria for the inclusion of a predetermined review. Research is based on the stigma of society regarding technological developments in the Industrial revolution 4.0. Therefore, the government is expected to be more severe in implementing human capital management. Conclusion: By procuring human capital management, it will be possible that Human Resources (HR) in Indonesia will be able to carry out the ideals of a golden Indonesian generation with Pancasila values inherent in the hearts of the people and the nation's future generations.

Cacao (Theobroma cacao L.) is an important woody species for production in Ecuador. Woody species have the potential to incorporate soil organic carbon (SOC) into the soil. The province of Manabí is known for its cocoa plantations and several cocoa species, which generates interest in their analysis. This study aimed to determine the concentration and accumulation of SOC in three cocoa species (EET95, EET103 and EET116) 15 years old, both under the tree and in the rows, at different depths 0-5, 5-10, 10-20 and 20-30 (cm). The results showed that soil SOC concentration was higher in the row for EET116 (2.51%) and significantly different under the tree for EET103 (1.57%) at 0-5 cm. No significant differences were found in the other sections. In the whole profile analyzed (0-30 cm), the EET116 species accumulated 41 t ha-1 and 54 t ha-1 under the tree and in the row, respectively. The species EET103 in the row presented 47 t ha-1 with no significant differences. Species EET95 and EET103 had the lowest values, but without significant differences between sampling locations, with 36 t ha-1, 37 t ha-1, and 47 t ha-1 under the tree and in the windrow, respectively. In conclusion, the species EET116 accumulated more organic carbon due to several factors, possibly a higher decomposing biomass, not only from the tree but also from other trees in the area, which contributes to the incorporation of organic matter throughout the soil profile.

Environmental perception is a powerful tool for identifying community needs and potential within their surroundings. This study assessed tourists' environmental perception regarding solid waste and its impact on the Hurtado balneary, located in Valledupar, Colombia. From May to July 2023, the investigation delved into the environmental attitudes and behaviors of 769 balneary users by employing a combination of observation, photographic documentation, and a comprehensive 21-question online survey. The findings unveiled compelling insights: an overwhelming 98.8% of participants acknowledged the adverse effects of solid waste on the environment, with an impressive 98% demonstrating a willingness to participate in waste management efforts. Alarmingly, 42.13% exhibited limited awareness of waste management practices, reflecting a lack of public interest and commitment (41.61%). Statistically significant disparities emerged: 59% of waste items were not appropriately disposed of in designated receptacles. Reasons for this included a lack of a sense of belonging (50.2%) and inadequate environmental education (45.6%). 96% expressed the need for river conservation signage, while 59.8% had not engaged in environmental training. The implications of these results extend beyond the Hurtado balneary, potentially informing solid waste management strategies in other aquatic environments. Furthermore, this investigation aligns with three critical Sustainable Development Goals: SDG 12, emphasizing responsible consumption and production; SDG 13, addressing climate action; and SDG 15, advocating for life on land and below water. Keywords: Tourism; solid waste; surface water; environmental management.

The resource curse indicates that economic growth performs poorly in countries with significant natural resources. Nevertheless, certain countries rich in energy managed to protect their resource riches in the long run. It is necessary to enforce effective policies in resource-rich countries to fully leverage the advantages which can come from the abundance of natural resources. This study aimed to evaluate how oil-rich countries would avoid resource flows by successful fiscal and management policies. By taking the guidance of Norway and implementing fiscal policy focused on tax rules on its oil management, it is proposed that oil-exporting countries benefit significantly. The framework attempts to mitigate this resource curse and utilise oil revenues in the interest of the country.

In this work, an algorithm for the scheduling of household appliances to reduce the energy cost and the peak-power consumption is proposed. The system architecture of a home energy management system (HEMS) is presented to operate the appliances. The dynamics of thermal and non-thermal appliances is represented into state-space model to formulate the scheduling task into a mixed-integer-linear-programming (MILP) optimization problem. Model predictive control (MPC) strategy is used to operate the appliances in real-time. The HEMS schedules the appliances in a dynamic manner without any a priori knowledge of the load-consumption pattern. At the same time, HEMS responds to the real-time electricity market and the external environmental conditions (solar radiation, ambient temperature etc). Simulation results exhibit the benefits of proposed HEMS by showing the reduction of up to 47% in electricity cost and up to 48% in peak power consumption.

There is increasing demand from stakeholders for tools to support outcome-based approaches in environmental management. For such tools to be useful, understanding user requirements is key. In Scotland, UK, stakeholders were engaged in the development of an Environmental Decision Support System (EDSS) to support the management of land and freshwater resources for multiple policy outcomes. A structured participatory engagement process was employed to determine stakeholder requirements, establish development principles to fulfil these requirements and road-test prototypes. The EDSS specification that emerged from this bottom-up process was spatially-explicit, free at the point of use, and touch and mobile device compatible. This application, which is under development, does not closely resemble most existing published EDSS. We suggest that there is a mismatch between the way scientists typically conceptualise EDSS and the kinds of applications that are likely to be useful to decision-makers on the ground. Interactive mobile and web-based geospatial information services have become ubiquitous in our daily lives, but their importance is not reflected in current literature on EDSS. The current focus in environmental management on adaptive, stakeholder-centred strategies based on outcomes offers an opportunity to make better use of these new technologies to aid decision-making processes.

Euschistus heros (Hemiptera: Pentatomidae) is one of the main pests of soybean. Egg parasitoids such as Telenomus podisi (Hymenoptera: Scelionidae) can be highly effective in attacking E. heros eggs, preventing the establishment at levels of economic damage. This study evaluated two re-lease methods of T. podisi in soybean. The treatments compared results from release of T. podisi adults fed with honey in cardboard capsules and the release of pupae in bulk. Four aerial releas-es per area were carried out via drone (7,500 females/ha) distributed at 10 points. The population density of E. heros, productivity and reproductive aspects of soybean were evaluated. Total pop-ulation of E. heros was lower in adult release treatment and male population was lower with pupae release. Thousand grain weight had higher values in fed adults treatments compared to release of pupae and control. Number of damage grains was lower in both release treatments compared with the control area. Therefore, the use of biological control with inundative release of T. podisi, regardless of the release method, is recommended within IPM programs, supporting production parameters and benefiting the sustainability of the agroecosystem.

The link between the world of communication and the world of racing is provided by telemetry systems in electric racing cars. These systems send real-time data about the vehicle’s behavior and systems to enable informed decisions during the race. The aim of this research was to integrate telemetry into the battery bank of a racing electric vehicle to find the optimal values of current and voltage that optimize the charging process, thus improving the vehicle’s performance in competition using Response Surface Analysis. Particularly, the telemetry system consisted of an Arduino Mega, a digital wattmeter, and temperature sensors, all installed in the vehicle. Once the telemetry data was obtained, a response surface design was adapted with current, voltage, and temperature as factors, varying from low to high values, with the objective function being to minimize the battery’s charging time. Applying the response surface methodology and the steepest descent algorithm, it was found that all factors significantly affect the charging time, with the minimum charge time being 6961 seconds, obtained with a current of 2.4 amps and voltages of 50.5 volts and 43.6 volts.

This study focuses on the creation and implementation of a platform to improve personal financial management for scholarship students of the National Program of Scholarships and Educational Credit (Pronabec) in Peru. Using a mixed methodology that combines qualitative and quantitative techniques, the effectiveness and user satisfaction with the platform were evaluated. The results indicated that 50\% of users found the tool useful, 55\% considered it easy to use, 70\% reported a positive impact on their personal budget planning, and 85\% expressed high overall satisfaction. In addition to providing tools for financial recording and analysis, the platform promotes financial education among its users, significantly contributing to improving their financial management skills.

Tropical forests provide habitats for diverse flora and fauna. In addition, they are essential in regulating the climate while at the same time millions of people depend on them for their livelihoods. As seen by rising political commitment and worldwide promises to reduce rates of deforestation and boost restoration of degraded forest ecosystems, forests are becoming more widely acknowledged for their role as a nature-based solution to many sustainable development concerns. Understanding tropical forest dynamics and their conservation have so become more important. This study analyzed, the forest stand structure, tree species composition, abundance and diversity and the regeneration status of Londiani Forest. Londiani Forest is divided into three blocks, namely Kedowa, Chebewor and Londiani and from each of these blocks belt transects 25 m wide and 1 km long were established 100 m from the edge of the forest to reduce edge effects. At every 200 m along the transect, 25 m × 25 m quadrats were set up in which, an inventory of all tree species was done. For tree species that could not be identified in the field, the local name was provided by para-taxonomists who participated in the data collection and the species name was later identified with the help of a taxonomist or a manual of woody tree species of Londiani Forest. The diameter at breast height (DBH) was measured at 1.3 m from the ground using a diameter tape. Tree height was measured using a Suunto angular clinometer. A nested quadrat 5 m x 5 m quadrat within the 25 m x 25 m quadrat was used to sample saplings while a 1 m x 1 m quadrat was used for sampling seedlings. Regeneration status was assessed using the number of seedlings and saplings. Stumps of trees cut were counted including identifying tree species from which the tree stump was derived. Data from the quadrats were entered into Microsoft Excel. Total stem density, species density, basal area, species basal area, relative density and species diversity were determined. A total of 1,308 individual trees belonging to 34 different species from 24 families were recorded. Kedowa had the highest (27) species richness followed by Chebewor (19) then Londiani (14). There was a statistically significant difference in species richness among the three forest blocks (p<0.05). There were no statistically significant differences in the mean DBH (F=0.560; p=0.729) and height class distribution (F= 0.821, p=.558) among the three forest blocks. There was a statistically significant difference in stem density (F=12.22; p=0.005) and woody species diversity (F=0.32; p=0.001) within the three forests blocks. There was no statistically significant difference in the basal area distribution within the three forest blocks p>0.005. The similarity index ranged from 0.34 to 0.47. In all the forest blocks, there was evidence of seedlings and saplings indicating that there was regeneration. Results clearly show that while the Londiani Forest shows variation in characteristics, there is clear evidence that it is regenerating.

(1) Background: Show caves are unique natural attractions and touristic traffic can trigger their degradation within a very short time. There are no universal solutions to counter the effects of the touristic impact upon cave environment and both protection protocols and management plans have to be established on a case-by-case basis; (2) Methods: The study includes four show caves from the Romanian Carpathians, where monitoring of the number of visitors, paralleled by the monitoring of the main physico-chemical parameters of the air and water (CO2, temperature, humidity, drip rate, conductivity, and pH) was implemented; (3) Results and Conclusions: The results of the study has: (i) established a monitoring protocol to be applied to each of the four show caves; (ii) established a set of basic principles to be enforced by the management of show caves; (iii) issued a set of preventive measures and instructions to be followed by the personnel and stakeholders of the caves.

The management of existing water distribution system (WDS) is challenged by ageing of infrastructure, population growth, increasing of urbanization, climate change impacts and environmental pollution. Therefore, there is a need for integrated solutions that support decision makers to plan today, while taking into account the effect of these factors in the mid and long term. The paper is part of a more comprehensive project, where advanced hydraulic analysis for WDS is coupled with a dynamic resources input-output analysis model. The proposed modeling solution can be used to optimize the performance of a water supply system while considering also the energy consumption and consequently the environmental impacts. Therefore, as a support tool in the management of a water supply system also in the intervention planning. Here a possible application is presented for rehabilitation/replacement planning while maximizing the network mechanical reliability and minimizing risk of unsupplied demand and pressure deficit, under given economic constraints.

Although energy management of a microgrid is generally performed using a day-ahead scheduling method, its effectiveness has been questioned by the research community due to the existence of high uncertainty in renewable power generation, power demand and electricity market. As a result, real-time energy management schemes are recently developed to minimise the operating cost of a microgrid while high uncertainty presents in the network. This paper develops modified particle swarm optimisation (MPSO) algorithms to solve optimisation problems of energy management schemes for a community microgrid and proposes a scheduling approach after taking into consideration high uncertainty to effectively minimise the operational cost of the microgrid. The optimisation problems are formulated for real-time and scheduling approaches, and solution methods are developed to solve the problems. It is observed that the scheduling program demonstrates superior performance in all the cases, including uncertainty in prediction, as compared to the other energy management approaches, although solutions have significant deviations due to prediction errors.

Background: Caregivers of asthmatic children have poor knowledge of proper asthma man-agement practices in Nigeria. The objective of this study was to examine the knowledge, attitudes, and practice behaviors of caregivers in the management of asthma in children under age 5 in Oyo State, Nigeria, using the Health Belief Model. Methods: While a mixed method was used in the original research, this brief describes the quantitative method used in this study to evaluate caregiver’s asthma management practices A 55-item questionnaire investigating childhood asthma knowledge, attitude, and practice was administered during child welfare clinic visits to 118 caregivers. To gain insights into caregivers’ beliefs about asthma management practice behavior, focus group discussions were conducted among two groups of 10 caregivers. Data were analyzed using the IBM SPSS Version 25.0. Statistical significance was set at p < 0.05 and 95% CI. Result: More than 70% of caregivers knew that asthma is associated with airway inflammation and about 90% knew that Flu infections triggered asthma attacks in their children. Overall, 70% of caregivers from the focus group discussions found preventive measures including avoidance of common triggers like dust and smoke, wearing warm clothes in cold weather, environmental sanitation, regular visits to the clinic, and medication adherence helpful. Similarly, caregivers reported the use of quick-to-relieve OTC drugs rather than seeking medical attention. Caregivers with higher income (OR = 3.0; 95% CI = 1.558-5.778; P = 0.001) were 3.0 times more likely to practice proper asthma behavior than those with a lesser income. Conclusion: Despite having moderate knowledge of asthma, caregivers of asthmatic children had wrong perceptions and inadequate knowledge about preventive and treatment options. An optimal public health approach is needed to identify and target underserved communities that suffer poorer asthma outcomes and improve caregivers’ knowledge and skills in asthma management practices. The need to pay more attention to the proper management of childhood asthma among caregivers in underserved populations cannot be overemphasized.

The main aim of this study is to examine the effects of Total Quality Management (TQM) practices (leadership of management, decision making, continuous improvement, customer focus, employee involvement, process management and relations with suppliers) on the financial and operational performance of hospitals in service industry. The data of the study were collected by the questionnaire prepared in the light of published studies and the suggestions of medical and administrative staff. Medical and administrative staff were chosen as target participants that reflect perspectives of hospitals. 1069 questionnaires were answered in 6 private and 26 public hospitals in the Marmara region in Turkey. The results claim that “customer focus” affects both operational performance as well as the financial performance of hospitals more than other TQM practices. While “process management” and “customer focus” explain the variance of financial performance significantly. “Process management” does not explain variance of operational performance.

The aim of this study as to determine the relationship between the factors of demography, comor-bidity, medication, lifestyle, and access to health services related to the QoL of people with hy-pertension and its complications in Sleman Regency, Yogyakarta. The study was conducted in a cross-sectional manner using data from Sleman HDSS (Health and Demographic Surveillance System) from 2015 to 2018 in cycles 3 and 2 with the inclusion criteria of hypertensive patients and their complications aged 25 years or older obtained by using a total sampling of 532 people. Measurement of QoL using Short Form 12v2 2a and 2b questionnaires presented in the Physical Component Summary (PCS) and Mental Component Summary (MCS). Data analysis using Mann-Whitney test and Kruskal Wallis test. The results showed factors related to the QoL in PCS were variables of gender, age, diagnosis of hypertension and its complications, the presence of comorbidities, fatty foods, drug consumption in the last two weeks, while factors related to the mental component (MCS) were education and occupation seen from the p-value <0.05. QoL with hypertension and its complications influence and decrease the physical than the patient's mental condition.