Management Challenges Research Articles

Factors Influencing the Efficiency of Construction Projects in Jimma Zone, Jimma, Oromia, Ethiopia

The construction sector plays a crucial role in the Ethiopian economy, making a substantial contribution to economic growth. However, various challenges have been identified as impacting the performance and growth of the Ethiopian construction industry. Projects in the Jimma Zone face numerous issues related to cost, time, and quality. This study aimed to evaluate how factors like resource management, stakeholder management, procurement management, and quality management influence project performance in the Jimma Zone. Data was collected through a structured questionnaire distributed to employees of Jimma Zone Employers and Contractors. A total of 62 questionnaires were distributed, with an 80.65% response rate, providing sufficient data for statistical analysis. Findings were presented using charts and tables. Quality management challenges included the absence of a quality management system and insufficient management commitment. Regression analysis indicated that resource and stakeholder management factors significantly influenced project cost and time performance, while quality management factors had a positive but not significant impact. Resource, stakeholder, and quality-related factors significantly influenced project quality performance, whereas procurement management factors did not have a significant impact. The study suggests that focusing on resource and stakeholder management could enhance project performance in the Jimma Zone.

Aftermath Türkiye’s double earthquake: detailed analysis of fracture characteristics and acute management from a level I trauma center

BackgroundThis research investigated surgical interventions for the treatment of extremity and pelvic fractures and aimed to provide an analysis of management challenges under crisis conditions in a Level I Trauma Center after Türkiye’s February 6, 2023, earthquakes.MethodsThe study was a retrospective examination of the medical records of 243 fracture cases associated with the earthquakes. The age, gender, time of admission, types of extremity and pelvic fractures, anatomical localizations, and surgical treatment methods for fractures were recorded. The results of these parameters were evaluated in detail, together with the results of other surgical treatments performed in the hospital in the first week after the disaster, such as fasciotomy, amputation, and wound debridement.ResultsMost of the 243 (119 males and 124 females) patients with extremity fractures and pelvic fractures receiving surgical treatment were adults (n = 182, 74.9%). The most common lower extremity fractures among all fracture cases were tibial shaft (30.8%) and femoral shaft (20.6%) fractures. A total of 33 patients had surgical procedures for the treatment of two or more significant bone fractures involving either the extremity or the pelvic ring. The analysis showed that the median age of patients who underwent surgery due to extremity and pelvic fractures was 36 years, with a range of 1 to 91 years, which was statistically increased compared to patients who received surgery for other musculoskeletal injuries such as fasciotomy, amputation and debridement (p < 0.001).ConclusionFractures were one of the most common musculoskeletal injuries in the first days after earthquakes, and the management of fractures differs significantly from soft tissue injuries and amputation surgeries as they require implants, special instruments, and imaging devices. The delivery of healthcare is often critically impaired after a severe earthquake. Shortages of consumables such as orthopedic implants, power drills, fluoroscopy equipment, and the need for additional staff should be addressed immediately after the earthquake, ideally by the end of the first day.

Breaking the WAVE and shattering stereotypes: addressing organizational change and team dynamics with female leaders

Research methodology The research consisted of a questionnaire and in-depth interview with the CEO. Secondary research was conducted to read through various articles and literature available on the organization. Relevant courses are organizational behavior/organization development/strategic management. Case overview/synopsis In a landscape traditionally dominated by male leadership, this case study highlights the compelling narrative of a new leader with an unconventional leadership style. This purpose of this case study aims to explore the change management challenges faced by Molade, CEO of WAVE, a leading vocational education social enterprise based in Lagos, Nigeria, as she grapples with the issue of organizational culture and gender bias and their impact on team dynamics while implementing a new strategy. Her leadership journey reflects not only personal triumphs but also the broader impact of diverse perspectives at the helm of organizational decision-making. Despite having over a decade of industry experience and being well-respected in her field, Molade is met with resistance and patronizing behavior from some of the existing team members who question her authority and decision-making abilities. The case discusses leadership challenges faced by Molade, a female leader, its negative implications on her performance and her ability to implement change within the organization. Ultimately, Molade’s perseverance and strategic thinking enabled her to successfully navigate her dilemma. Complexity academic level Undergraduate business course(s) which include organizational behavior, organization development and strategic management.

Drug-coated balloon versus drug-eluting stenting coronary angioplasty for ST-elevation myocardial infarction: a systematic review and meta-analysis of real-world studies

Abstract Funding Acknowledgements None. Introduction In the realm of ST-elevation myocardial infarction (STEMI), drug-eluting stent angioplasty (DES) is a well-established strategy for urgent revascularization. However, several challenges arise when selecting stents for these patients. These challenges include dealing with endothelial oedema and vasospasm during acute thrombotic occlusion. Moreover, there are concerns surrounding DES-related complications. These complications include the need for prolonged anti-platelet therapy, which increases the risk of bleeding, late stent thrombosis, and in-stent restenosis (ISR). In light of these issues, drug-coated balloons (DCB) have emerged as a compelling alternative. Purpose: This study aims to explore the safety and efficacy of DCB compared to conventional DES angioplasty in the management of STEMI. Methods A systematic literature search was conducted across electronic databases (PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, reference lists of relevant publications, and grey literature sources) for studies published from the inception of DCB up to 31st August 2023. Results Nine eligible studies, consisting of four randomised controlled trials and two retrospective propensity-matched studies, were included. These studies, all single-center, involved a total of 2,122 patients (934 in the DCB versus 1,188 in the DES group) over a median follow-up period of 15 months (ranging from 6 to 36 months). The meta-analysis showed no statistically significant differences between DCB and DES angioplasty in terms of technical success (OR: 1.82, 95% CI: 0.22-15.08, p = 0.58), major adverse cardiovascular events (MACE) (OR: 1.24, 95% CI: 0.60–2.56, p = 0.57), all-cause mortality (OR: 1.20, 95% CI: 0.83–1.75, p = 0.33), cardiac death (OR: 1.40, 95% CI: 0.47-4.17, p = 0.54), cardiovascular-related hospitalization (OR: 0.72, 95% CI: 0.32-1.65, p = 0.44), recurrent myocardial infarction (OR: 0.99, 95% CI:0.34-2.90, p = 0.99), target lesion revascularization (OR: 1.15, 95% CI: 0.56–2.34, p = 0.71), late luminal loss (SMD: -0.25mm, 95% CI: -1.05 to 0.54, p = 0.53), postoperative TIMI flow (OR: 1.16, 95% CI: 0.54-2.50, p = 0.71), fractional flow reserve (MD: 0.012, 95% CI -0.018 to 0.032, p = 0.27), and bleeding risk (7.2% in DCB versus 7.5% in DES). It's noteworthy that 8.2% of patients in the DCB group required bailout stenting due to coronary artery dissection type C, a rate 10 times higher than that in the DES group (p &amp;lt; 0.005). Additionally, DCB angioplasty displayed a statistically significant presence of residual stenosis compared to DES angioplasty (OR: 6.48, 95% CI: 1.13-37.2, p = 0.04). Conclusion DCB angioplasty demonstrates promise but presents unique challenges in STEMI management, particularly in complex scenarios requiring bailout stenting and residual stenosis. The study contributes to the ongoing discussion about the role of DCBs in optimizing STEMI treatment, highlighting their potential benefits and areas of concern.

Modeling an Investment Framework for BMTA Electric Bus Fleet Development

In Thailand, diesel buses are notorious for their poor energy efficiency and contribution to air pollution. To combat these issues, battery electric buses (BEBs) have emerged as a promising alternative. However, their high initial costs have posed challenges for fleet management, especially for agencies such as the Bangkok Mass Transit Authority (BMTA). This study aims to revolutionize BEB fleet management by developing an energy model tailored to the BMTA’s needs. The methodology consists of two crucial steps: analyzing BMTA bus routes and designing fleet management and charging systems. Through this process, the study seeks to determine the maximum number of BEBs that can be operated on each route with the fewest chargers possible. The results reveal exciting possibilities. Within the city bus landscape, two out of five BMTA bus routes show potential for transitioning to BEBs, provided they meet a maximum energy requirement of 200 kWh every two rounds. This analysis identifies routes ripe for BEB adoption while considering the limitations of battery size. In the next step, the study unveils a game-changing strategy: a maximum of 13 BEBs can operate on two routes with just four chargers requiring 150 kW each. This means fewer chargers and more efficient operations. Plus, the charging profile peaks at 600 kW from 4:00 to 8:00 p.m., showing when and where the fleet needs power the most. However, the real eye-opener? Significant energy savings of THB 10.44 million per year compared to diesel buses, with an initial investment cost savings of over 37%. These findings underscore the potential for BEB fleet management to revolutionize public transportation and save money in the long run. However, there is more work to be done. The study highlights the need for real-time passenger considerations, the development of post-service charging strategies, and a deeper dive into total lifetime costs. These areas of improvement promise even greater strides in the future of sustainable urban transportation.

Developing a smart green supplier risk assessment system integrating natural language processing and life cycle assessment based on AHP framework: An empirical study

Global carbon reduction drives the transformations of corporations, emphasizing carbon and environmental impact within supply chains. A critical challenge in risk management is converting unstructured data into quantifiable information, and ruining the conversion often leads to ineffective risk assessments. While artificial intelligence is increasingly used in supply chain risk management, previous studies seldom integrate text analysis for risk extraction and lack accurate risk assessment methods. This study pioneers an intelligent green supplier risk assessment system integrating natural language processing (NLP) and life cycle assessment (LCA) based on an analytic hierarchy process (AHP) framework. The proposed approach utilizes NLP keyword extraction to identify and assess risk and uses LCA to uncover environmental risks, minimizing negative impacts. The text classification model attains 81.7 % accuracy, ensuring a trustworthy risk assessment system. The proposed method could significantly improve risk analysis efficiency, foster sustainable procurement, and elevate enterprise competitiveness in sustainable business practices.

The adaptive prowess of the lesser mealworm Alphitobius diaperinus (Coleoptera: Tenebrionidae): Insights from mouthpart morphology and mitogenomic analysis

The lesser mealworm, Alphitobius diaperinus (Panzer, 1797), is a pervasive pest known to infest stored products and poultry facilities worldwide, posing significant challenges for pest management. Understanding its adaptability to diverse environments is crucial for devising effective control strategies. This study investigated adult mouthparts and analyzed the mitogenome of A. diaperinus using specimens obtained from a cat litter box. The examination of mouthparts revealed notable intraspecific variations, suggesting potential adaptations to different ecological conditions. Analysis of the mitogenomes unveiled nucleotide variations in protein-coding genes (PCGs), ribosomal RNA genes (rRNAs), and the control region, with all mutations in PCGs being nonsynonymous, primarily occurring at the second codon positions. Evaluation of Ka/Ks ratios indicated purifying selection acting on the PCGs of A. diaperinus. Phylogenetic analyses consistently placed the newly sequenced sample within the same clade as previously sequenced A. diaperinus samples. The presence of A. diaperinus in cat litter highlights its remarkable adaptability to diverse habitats. Furthermore, intraspecific variation in mouthpart morphology and the mitogenome suggests ongoing adaptations to various food sources and environmental niches. These findings underscore the dynamic nature of A. diaperinus adaptations and emphasize the importance of continued research for effective pest management strategies.

Cardio-Oncology: A New Discipline in Medicine and Its Relevance to Hematology.

Cardio-oncology, a burgeoning subspecialty, addresses the complex interplay between cardiology and oncology, particularly in light of increased cardiovascular (CV) disease mortality in cancer patients. This review provides a comprehensive overview of cardio-oncology with a focus on the therapies used in hematological malignancies. We explore the bidirectional relationship between heart failure and cancer, emphasizing the need for collaborative care. The review discusses risk stratification, highlighting the importance of baseline CV risk assessment and personalized surveillance regimens. Primary and secondary prevention strategies, including pharmacological interventions, are outlined. The review also delves into the cardiotoxicity associated with hematological cancer therapies, focusing on anthracyclines, Bruton kinase inhibitors, BCR-ABL tyrosine kinase inhibitors, CAR-T cell therapy, immune checkpoint inhibitors, multiple myeloma treatments, and hematopoietic stem cell transplantation. We then highlight the high risk of venous and arterial thromboembolisms in cancer patients and the challenges of anticoagulation management in cardio-oncology. Finally, the review touches on the importance of long-term follow-up and appropriate screening in cancer survivors at high risk of CV morbidity and mortality, based on their CV risk profile and the type and dose of cardiotoxic therapies they received such as anthracyclines or high radiation doses.

Revisiting Spatial Justice and Urban Parks in the Post-COVID-19 Era: A Systematic Literature Review

Urban parks, integral to city life, have long contributed to the well-being of residents through various ecosystem services. Previous studies consistently highlighted unequal park distribution and access, and the COVID-19 pandemic has exacerbated these disparities. From a spatial justice perspective, this review examines urban parks’ roles during the pandemic, the impact on equity and access, and how evolving park usage characteristics inform future management challenges. Analysing 53 peer-reviewed studies and 11 online materials from January 2020 to April 2023, this review reveals a significant increase in park visitors during the pandemic, causing challenges in accommodating the surge due to lockdown measures. The findings underscore physical and social justice dimensions, revealing disparities in park access during COVID-19. These challenges prompt reevaluating urban parks’ potential for well-being and ecosystem benefits, advocating for inclusive decision-making to enhance community resilience and socialisation. The COVID-19 crisis highlighted planning and management challenges, emphasising the need for a more sustainable, liveable, and responsive approach to urban park planning.

A Novel Approach for Dynamic Analysis of Wind-Integrated Multi-Machine Power Systems

Indeed, the rapid expansion of Renewable Energy Sources (RES) in recent years has brought about numerous benefits, including reduced carbon emissions, increased energy independence, and the creation of new economic opportunities. However, integrating these variable and intermittent sources into existing power systems poses several challenges for power system management. Faults in electrical networks are among the key factors and sources of network disturbances. Control and automation strategies are among the key fault clearing techniques responsible for the safe operation of the system. In recent years, the increasing penetration of wind energy in multi-machine power systems has posed unique challenges to power grid stability and reliability. Accurate assessment methodologies are required to ensure the effective integration of wind energy sources while maintaining grid stability. Several researchers have revealed various constraints of control and automation strategies such as a slow dynamic response, the inability to switch the network on and off remotely, a high fault clearing time and loss minimization. It's important to note that the impact of wind energy on system inertia is a complex and dynamic aspect of power system operation. Ongoing research and technological advancements aim to improve the integration of wind and other renewable energy sources while ensuring grid stability and reliability. As the energy transition continues, addressing these technical challenges is crucial for building a sustainable and resilient power system. In this paper, the influence of doubly-fed induction generator (DFIG) penetration is analyzed to examine the transient stability of power system networks. The concept of a Coupling Strength Index (CSI) derived from Network Structural Characteristics Theory sounds intriguing, especially in the context of identifying critical elements susceptible to the impact of a three-phase fault in a network. The investigation involves studying the transient stability of a power system under different conditions, specifically with and without doubly-fed induction generators (DFIGs) connected to a weak bus. Additionally, a three-phase fault is applied at the middle of the identified weakest line for both the IEEE 9 and 39 bus systems. The investigation of generator speed, rotor angle, and electric power during transient stability analysis provides a holistic view of how a power system responds to disturbances. This information is crucial for ensuring the reliability and stability of the system, especially when studying the integration of renewable energy sources and addressing potential challenges associated with faults and weak buses. This paper presents a pioneering non-iterative framework for dynamically assessing wind energy dominated multi-machine power systems. The proposed framework aims to address the shortcomings of traditional iterative methods, providing a more efficient and reliable approach to power system analysis.

Mechanics and permeability properties of ecological concrete mixed with recycled engineering muck particles

The excavation of construction foundation pits, tunnels, channels, and other projects generates a significant volume of engineering muck, posing challenges in management. Prolonged accumulation of this muck can lead to environmental pollution. The effective recycling of this type of construction waste is crucial for the advancement of a circular economy, necessitating immediate attention to research and solutions. In this study, a novel method is introduced for the preparation of low-carbon and environmentally friendly ecological concrete. This method involves the utilization of recycled engineering muck particles to substitute a portion of the natural aggregate and enables the comprehensive recycling of engineering muck. Subsequently, the mechanical and permeability properties of ecological concrete under varying muck particle content and porosity conditions are analyzed through experiments, taking into account the impact of relative average pore diameter and pore tortuosity. A predictive model has been developed for the tortuosity of pore channels in ecological concrete, taking into account effective porosity and average pore diameter. The enhanced Kozney-Carman model is employed to describe the correlation between pore properties and hydraulic conductivity. The findings indicate that a composite curing agent is formed by combining ordinary Portland cement with a hydrophilic polyurethane solution. This composite curing agent demonstrates superior performance compared to pure cement in the solidification of engineering muck. As the replacement rate of unsintered recycled residue particles increases, the porosity of concrete may increase by up to 29.7 %. This results in enhanced permeability characteristics but a decrease in compressive strength. In contrast to lightweight aggregates manufactured through the sintering process, the carbon emissions of unsintered recycled residue particles are reduced by 57.7 %. This study provides suggestions for the repurposing of construction waste and contributes to the advancement of sustainable practices within the concrete production sector.

Active Asset Management

Robust and real‐time asset management is crucial for distribution utilities to operate their infrastructure efficiently. The importance and challenge of asset management has also grown significantly in response to new regulatory requirements, growing customer expectations, and rapid technological advancements. While the importance of actively managing assets is understood within the utility industry, the application of “best practices” in asset management varies based on the asset's criticality to the business. Issues surrounding the management of system critical assets have significant implications for distribution system operations. The strategies and technologies used to maintain critical infrastructure, and an examination of how other industries like commercial real estate manage assets, can shed light on how utilities could improve their approach to managing both critical and non‐critical assets.

A Pilot Study on the Assessment of the Knowledge, Practice, and Challenges of Pharmaceutical Inventory Management among Community Pharmacists

Pharmacies and related supplies must always be available at the required location, in the requisite amount, and with the necessary quality for health facilities to offer comprehensive care. Efficient inventory management improves pharmaceutical product profitability by reducing procurement costs and preventing long-term storage, while poor inventory management hinders essential drug availability. The current study aims to assess the knowledge, practice, and challenges in applying inventory management methods. A mixed-method study design with sampling techniques of purposive and snowball methods was used. A semi-structured questionnaire was implemented for quantitative data and an open-ended question was employed to explore more information as qualitative data. The collected qualitative data were transcribed and identified as five major themes knowledge about inventory management, challenges faced by pharmacists in managing inventory, purchasing methods, stocking, and expiry, and the purpose of inventory control management. Most pharmacists employ the inventory management method based on their experience and the customer needs. Among the basic inventory management tools like ABC, VED, FSN, or XYZ, the use of VED and FSN methods for purchasing and stocking is high. It is noted that they lack professional training but gained more knowledge and skills through the experience. When they were asked about the inventory control methods, about 70% of them were not aware, and of those who said yes 20 % were able to answer at least 1 method and 10 % were not able to correctly mention the name. To conclude the pharmacist should start considering the modern methods along with the current methods for effective marginal profit and competitive management of the pharmacies.

Fire Resistance of Lightweight Aggregate Concrete Containing Spent Garnet as Partial Fine Aggregate Replacement

Introduction The escalating demand for concrete, driven by global infrastructure development, poses significant challenges to environmental sustainability due to the depletion of natural resources and the accumulation of waste materials. This paper explores the potential of utilizing waste materials, particularly palm oil clinker (POC) and spent garnets, as sustainable alternatives in concrete production. The depletion of natural aggregates, such as river sand, coupled with the environmental hazards associated with waste disposal, underscores the urgent need for eco-friendly solutions in construction materials. POC, derived from palm oil production waste, and spent garnets from abrasive industries offer promising avenues for reducing environmental impact and enhancing sustainability in concrete production. By addressing the dual challenges of resource depletion and waste management, this research aims to contribute to developing greener construction practices and mitigating environmental degradation. Aims This study aims to investigate the effects of incorporating spent garnet as a partial fine aggregate replacement on the fire resistance of POC LWAC. By examining the interplay between spent garnet inclusion and fire resistance, the research contributes to developing more sustainable concrete formulations and aids in industrial waste management practices, addressing critical societal and environmental challenges. Methods This study investigates the effects of elevated temperatures on the compressive strength and durability of POC LWAC specimens. Concrete specimens were demoulded after 24 hours of curing and submerged in water for 28 days. Compressive strength and water absorption tests were conducted at the end of the curing period. Subsequently, specimens were subjected to temperatures of 300 °C, 500 °C, and 700 °C for 1 hour in a furnace. After cooling naturally for 24 hours, visual inspection, mass reduction analysis, and evaluation of residual compressive strength were performed. Results Results indicate that 20% garnet replacement yields the highest compressive strength due to pore filling and denser structure. Higher garnet levels lead to reduced strength and increased water absorption. Visual assessment post-heating shows surface alterations, with 20% garnet exhibiting the lowest mass loss and strength reduction at elevated temperatures. Conclusion Notably, specimens containing 20% spent garnet in POC LWAC performed better in a fire than others, enhancing their fire-resistant properties. In summary, this research introduces a hopeful approach to improve the sustainability of concrete and mitigate the environmental repercussions of industrial waste.

Influence of Human Resource Management on Work Performance at Vietnam Higher Education Institutions

The purpose of the paper is to examine the impact of human resource management on employee performance in Vietnam universities. In addition to empirically testing the hypotheses in the context of university autonomy in Vietnam, the research has attempted to further examine the achieved results and challenges for human resource management in Vietnam's higher education institutions through the variable regulating University autonomy. The findings in the research have provided empirical support for the correlation between human resource management and employee performance in higher education institutions. The author asked for the opinions of several experts on the questionnaire. Then send the test questionnaire to 10 agencies in higher education institutions. The author has adjusted the questionnaire to make it easier to understand to get the most accurate and reliable answers. The author sent the questionnaire during the period from April 2023 to June 2023, the total number of survey questionnaires distributed was 370 questionnaires, of which 350 votes are eligible for analysis.

Diagnostic value of 18F-FDG PET/CT versus diffusion-weighted MRI in detection of residual or recurrent tumors after definitive (chemo) radiotherapy for laryngeal and hypopharyngeal squamous cell carcinoma: A prospective study.

Despite advances in treatment, residual or recurrent tumors after definitive (chemo) radiotherapy for laryngeal and hypopharyngeal squamous cell carcinoma (SCC) remain a challenge in clinical management and require accurate and timely detection for optimal salvage therapy. This study aimed to compare the diagnostic value of Fluorine 18 (18F) fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) and diffusion-weighted magnetic resonance imaging (DW-MRI) in detecting residual or recurrent tumors after definitive (chemo) radiotherapy for laryngeal and hypopharyngeal SCC. A prospective study was conducted on 30 patients who presented with new symptoms after definitive (chemo) radiotherapy for laryngeal (n = 21) and hypopharyngeal (n = 9) carcinoma. Both 18F-FDG PET/CT and DW-MRI were performed and histopathologic analysis served as the standard of reference. Histopathology showed 20 patients as positive and 10 as negative for tumors. 18F-FDG PET/CT detected all tumors correctly but was falsely positive in one case. DW-MRI detected tumors in 18 out of 20 positive patients and correctly excluded tumors in all negative patients. The sensitivity and specificity of 18F-FDG PET/CT were 100% and 90%, respectively, while the values for DW-MRI were 90% and 100%, respectively. The study concludes that 18F-FDG PET/CT is slightly superior to DW-MRI in detecting residual or recurrent tumors after definitive (chemo) radiotherapy for laryngeal and hypopharyngeal SCC. The combined use of 18F-FDG PET/CT and DW-MRI can potentially improve specificity in therapy response evaluation.

Assessment of veterinary pharmaceutical warehouse management practices and its associated challenges in four selected zones and Bahir Dar city of Amhara regional state, Ethiopia.

A pharmaceutical warehouse is part of the pharmaceutical supply chain and is essential to maintaining the quality and efficacy of veterinary pharmaceuticals for successful animal health service delivery. However, poor storage conditions, improper handling, and inappropriate use and disposal constitute challenges for veterinary supplies in animal health services. Therefore, this study aimed to assess the existing practices and challenges in warehouse management in government veterinary clinics and private veterinary drug wholesalers in Ethiopia. A cross-sectional study was conducted on 37 veterinary health facilities in four selected zones (south Gondar, west Gondar, central Gondar, and west Gojam zones) and Bahir Dar administrative city. Zones were selected using a simple random sampling technique. Data was collected using a structured questionnaire, pre-defined and tested observational checklists, and semi-structured interview guides. Descriptive statistics were used to analyze the quantitative data, while qualitative data was analyzed using a thematic approach. The study revealed the presence of poor stock management practices, such as the absence of standard operating procedures for warehouse activities in ~59.5% of facilities surveyed. In none of the surveyed facilities, bin cards and system software utilization were satisfactory. The absence of disposal guidelines was detected in 83.8% of the facilities, and the practice of timely disposal of expired drugs was not satisfactory. Compared to the government veterinary clinics, private veterinary drug wholesalers had better storage practices (86.25%) following theoretical recommendations. The storage conditions in government clinics were rated poor at 48.3% (>80%, which is the limit to the acceptable rate for good storage conditions). The challenges of inadequate infrastructure, a lack of qualified staff, problems with the availability and affordability of pharmaceutical products, insufficient regulatory practice, and budget constraints were identified. A holistic approach involving related stakeholders should be followed to improve the existing challenges and the sector's efficiency.

From Institution to Community: Implementing the Pathway Home Approach for High-Risk Members With Behavioral Health Needs Transitioning From an Adult Home.

Coordinated Behavioral Care began using its Pathway Home program to serve a subset of New York State Adult Home Settlement class members. Through its multidisciplinary team approach, Pathway Home is utilizing its multiphase model in assisting individuals with Serious Mental Illness leaving an Adult Home to successfully transition and remain in the community. The Pathway Home program is a community-based service and serves class members wherever is needed to assist in their recovery and transition from an Adult Home. This includes meeting class members in Adult Homes and various settings in the community. The New York State Adult Home Settlement presents a variety of systemic, care management, and individual member challenges. Adding the Pathway Home approach to an already existing, yet insufficient care management model strengthens the initiative's goal to transition and retain members safely into the community. Through the approach's adaptability and flexibility in providing community-based care, Pathway Home's successful cross-system collaboration is worthy of replication for other high need populations. A programmatic review for Pathway Home Adult Home+ teams gleaned the following key points for the field to consider in future care management practices. Class member self-efficacy and cross-system collaboration are essential in facilitating a class member's move into the community. Member choice and educating class members on their rights to move and options as well as community exposure prior to transition are important in assessing how a member fares outside of the Adult Home. Members determining their own care can reduce the risk of adverse outcomes and reinstitutionalization. Current low-touch care management programs are insufficient for members with complex needs living in institutions. These care management programs need to be augmented with a whole person approach, delivered by a multidisciplinary team.

Spontaneous thrombosis with a conservative approach to posterior spinal artery pseudoaneurysm management: A case series.

In this study, we address the rarity and management challenges associated with ruptured spinal artery pseudoaneurysms, which comprise < 1% of subarachnoid hemorrhage cases. With our limited understanding of their natural history, the prevailing consensus leans towards surgical clipping, contrasting with the typically benign symptoms of sudden back pain and lower extremity weakness. Despite reported low morbidity and mortality, fatal re-ruptures underscore the need for effective management strategies. In this context, we present the largest case series to date, featuring five patients with spinal subarachnoid hemorrhage from isolated posterior spinal artery pseudoaneurysms. All cases achieved spontaneous thrombosis and resolution through conservative management, challenging the prevailing surgical emphasis. The patients, aged 58-81, exhibited varied symptoms, including back pain, paresthesia, confusion, and seizures, with hypertension as a common comorbidity. The results of these cases lead us to tender a "hybrid" management strategy, combining conservative measures with short-term follow-up angiograms, fostering a paradigm shift and warranting further investigation into individualized patient care within larger clinical cohorts.

Ultrasound-assisted resection of insular gliomas

BackgroundInsular gliomas’ management challenges are attributed to their complex shape, proximity to critical vasculature, and organization. However, cytoreductive surgery's role in maximal extent of resection (EOR) improves survival. Intraoperative ultrasound (IOUS) aids in defining tumor border, detecting residual, and guiding access.AimThe aim of this study was to assess the impact of using intraoperative ultrasound on the extent of resection of insular gliomas, and the postoperative outcomes in a prospective cohort of 20 patients operated at Alexandria main university hospital and followed up for a period of at least 3 months.ResultsThe Near total resection rate was 45% with 70% of patients having no neurological morbidity postoperatively. The median EOR was 81% with a range of 44 to 96%. The mean duration of IOUS setup was 19.6 ± 5.04 min, while the additional resection rate following IOUS assessment for residual tumor was 65% (n = 13). In addition, there was a significant increase in Karnofsky Performance Status (KPS) from the preoperative through to the 90-day follow-up period (p = 0.012). Finally, following multivariate linear regression analysis, the EOR was identified as having a statistically significant correlation with the postoperative KPS (p = 0.004).ConclusionIntraoperative ultrasonography is a valuable modality for strategizing the most efficient route to the tumor, promptly detecting any remaining tumor tissue, and optimizing the extent of resection for insular gliomas, while taking into consideration the phenomenon of brain shift.