External Strategies Research Articles

Abstract EP55: Qualitative Evaluation Of Older Adult Participants Of A Community Outreach Telehealth Program For Covid Education And Health Promotion (Coach)

Background: Chronic diseases are prevalent in Canada’s aging population (≥65 years). Positive health behaviours (e.g., physical activity, healthy diet) are critical for the management of chronic diseases (e.g., stroke, heart disease). However, novel coronavirus (COVID-19) prevention strategies of quarantining, social isolation, and physical distancing may compromise one's ability to manage health and engage in daily activities, possibly increasing risk of adverse health events. The Community Outreach teleheAlth program for Covid education and Health promotion (COACH) program has demonstrated an increase in health promoting behaviours, but little is known about participants’ experiences in participating in the program. The program entailed six telehealth sessions over two months that focused on health coaching, behaviour change, and COVID education. The objectives of this study were to describe: (1) chronic disease prevention and management strategies of older adults (≥65 years of age) during COVID-19; and (2) participants’ experience in COACH sessions delivered by medical students at the University of British Columbia. Methods: Twenty-four COACH participants participated in semi-structured interviews that were conducted through Zoom videoconferencing. Interview questions focused on how participants managed their own health before and during COVID-19. Qualitative description was the guiding methodological framework. Interviews were transcribed verbatim and analyzed thematically. Findings: Participants’ mean age was 73.4 years (58% female) with 75% reporting two or more chronic conditions (e.g., stroke, heart disease, coronary artery disease, diabetes, heart attack). Three themes described participants’ prevention and management strategies, including: i) having a purpose for optimizing health; ii) using internal self-control strategies; and iii) leveraging external support strategies. COACH further supported participants during COVID-19, as represented through coach interactions as well as knowledge and skill development. Conclusion: Findings suggest that older adults engage in internal self-control strategies and external support means to manage current chronic conditions and promote health and well-being. Health professional program students have a potential role in health promotion and in assuming the role of coach in telehealth promotion programs for older adults.

Research on Optimized Design of In-Vessel Retention–External Reactor Vessel Cooling Strategy and Negative Effect Assessment

Due to large uncertainty, the effectiveness of in-vessel retention (IVR) with external reactor vessel cooling (ERVC) for high-power reactors cannot be fully demonstrated during the transient process. To optimize the current IVR-ERVC strategy, the concept of IVR-ERVC with in-vessel injection (IVI) is studied. Two feasible IVI designs are proposed: 1) using the passive IVR water tank to implement simultaneous water injection in-vessel and ex-vessel and 2) using the passive severe accident dedicated in-vessel injection tanks (SADITs) to implement water injection in-vessel. The research on the feasibility and effectiveness of IVI is performed, and the corresponding negative effects are analyzed. The calculation results by using MIDAC show that the two proposed IVI concepts can greatly delay the accident progression in the core and reduce the decay heat peak of the molten pool in the lower head, thereby improving the effectiveness of the current IVR-ERVC strategy. And the negative effects are within acceptable ranges.

Barriers and strategies for building information modelling implementation: a comparative study between New Zealand and China

Building Information Modelling (BIM) is a sharing platform that can present a parametric 3 D model with various project information in the form of a digital display. In recent years, BIM adoption has become increasing globally as the Architectural, Engineering, Construction (AEC) industry has recognised its benefits. Meanwhile, many challenges of BIM adoption in different countries have been well documented. To address the gap in literature, this study examines the differences and similarities of BIM adoption between New Zealand and China. A questionnaire was conducted across the two countries to investigate the barriers and strategies for the implementation of BIM. Data from 146 respondents was collected in New Zealand and China. The result shows that there is a difference in the perception of Knowledge Barrier, Technology Barrier, Internal Strategy and External Strategy (Legal/Technology viewpoint) between New Zealand professionals and Chinese professionals. The differences identified offer important implications for government agencies to promote BIM implementation and for BIM service providers to better target the end-users.

Ankle joint salvage and reconstruction by limited ORIF combined with an Ilizarov external fixator for complex open tibial pilon fractures (AO 43-C3.3) with segmental bone defects

BackgroundOpen pilon fractures combined with sizeable segmental bone defects are rare, difficult to treat, and often result in the loss of ankle joint function. The purpose of this study was to determine clinical outcomes in patients with open pilon fractures and sizeable segmental bone defects treated by limited ORIF combined with an Ilizarov external fixator.MethodsWe conducted a retrospective analysis of open pilon fractures with sizeable segmental bone defects treated by limited ORIF combined with the Ilizarov external fixator strategy between July 2014 and August 2019. All patients were included for assessments of fracture healing and infection rates. Ankle functional outcomes were assessed in all patients according to the Paley criteria and American Orthopedic Foot and Ankle Society Score (AOFAS) at least 24 months post-injury.ResultsAll patients were followed up for a mean of 41.09 months. The mean bone defect size was 5.64 ± 1.21 cm. The average EFI and BTI were 1.56 ± 0.28 months/cm and 11.12 ± 0.74 days/cm, respectively. According to the Paley evaluation system, the success rate of ankle joint reconstruction was 64% (7/11). The mean score based on the AOFAS functional assessment was 77.73 ± 8.87. Five patients showed posttraumatic arthritis, one of whom required ankle arthrodesis. Three patients developed pin site infections, and one patient developed a deep infection after bone grafting.ConclusionThe strategy of limited ORIF combined with an Ilizarov external fixator can restore ankle function in most patients with complex open tibial pilon fractures. Ankle stiffness, pin tract infection, and traumatic arthritis were the most common complications associated with this therapy.

Industrial clustering as a barrier and an enabler for deep emission reduction: a case study of a Dutch chemical cluster

ABSTRACT Industrial clusters are considered more resource- and greenhouse gas-efficient than stand-alone industrial plants, but clustering may also act as a barrier to radical changes required for deep greenhouse gas emission reductions. Here we explore how clustering in an energy-intensive chemical industry cluster may influence attainability of the deep emission reduction targets. Chemelot, located in the southeast of the Netherlands, was willing to collaborate and we adopt a qualitative system dynamics approach based on expert interviews and group model building sessions. We found that clustering may hinder reaching deep emission reductions by three reinforcing feedback mechanisms, or ‘traps’, related to: incremental changes; short-term focus; and companies acting alone. The system dynamics analysis also identified potential mechanisms to escape from these traps, notably: (1) increasing cluster autonomy; (2) activating public support; (3) promoting changes in the supply chain; and (4) attracting long-term investors. The findings can inform policymakers on how to steer industrial clusters towards deep emission reductions, and support industrial cluster decision-makers on both internal and external strategies. Key policy insights Industrial clustering may offer opportunities to accelerate deep greenhouse gas emission reductions, but it could also cause carbon lock-in because of increased physical and organizational interdependency, which favours incremental changes, short-term focus, and solitary actions rather than collective actions, at the cost of deep greenhouse gas emission reductions. To fully exploit the potential benefits of industrial clustering for greenhouse gas emission reductions, policies need to take into account the causal relations that operate in a self-reinforcing way to lock the cluster into high greenhouse gas emissions, and that can help escape them. A coordinating authority operating across the cluster is necessary to ensure effective collaboration within a chemical cluster so as to escape carbon lock-in. Policies addressing emissions along the full value chain (i.e. to include scope 3) might be mutually beneficial with the circularity and low-emission ambitions of the chemical industry.

Studi kasus prospek usaha kerupuk ikan di Kampung Semanting Kabupaten Berau

Semanting village is well known for its natural resources. Fishing and its related produce has been identified as the main home industry in this village. One of the most popular fish produce is fish cracker managed by Hj. Asfiah. The main ingredient of this product is milk fish (chanos-chanos) and otek fish (Osteogeneiosus militaris). In order to identify the internal and external strategy of this business, the SWOT analysis was applied to evaluate strength, weakness, opportunity and threat that might affect the business sustainability. The analysis indicated that the strength and opportunity (S-O) is essential and need to be managed. Based on the estimation values, this business is feasible and scale improvement is necessary.

Limiting control: vocabularies and strategies of unpredictability in contemporary art

ABSTRACT Contemporary artists utilise a variety of methods which allow unpredictable forces, such as randomness, chance, chaos, the subconscious, participation, and others, to influence their creative process. These sources of unpredictability are situated against the artist’s control in the creative process. We developed a system of control-limiting strategies that enable the simultaneous study of different methods with similar sources of unpredictability. Through examples – including works by other artists and works by one of the authors – we introduce Internal, External, Relational/Interactive and Mechanical strategies. We analyse the way control is limited in the creative process and draw conclusions on how this affects the artwork.

THE STRATEGIC CHOICES IN ACHIEVING TOURISM'S COMPETITIVENESS AND PERFORMANCE AMONG HOTELS IN INDONESIA

The current debate between external strategy and a resource-based approach as a driver of competitiveness is rarely investigated in a developing region. This study investigates whether an external focus or a resource-based strategy is better for leveraging the hotel industry's competitiveness and performance in a developing area in Indonesia. The authors obtained saturated responses from 204 managers and analyzed them with PLS-SEM's two-stage and repeated indicator approach while interviewing some of them. This study developed a formative model in PLS-SEM as a better method for investigating an organization's performance than a reflective approach. Quantitative analysis revealed the resource-based view as a better basis for supporting hotels' competitiveness and performance; however, the interview revealed considerable concerns over arising externalities. This paper suggests that hotel managers improve their internal core competence instead of wasting resources and worrying about external issues.

The Impact of External Communication Strategy on Blockchain Startups: Analysing the Case of Credits Blockchain Platform

Communication is always an important part of establishing a business’ sense of direction and growth; information needs to be accessed by the receiver in an appropriate way and put across in a clear, impactful and engaging way so that it will have an effect on the user. This research paper gives a detailed review of external communication strategies in the blockchain industry and how startups could revise their strategies over time to build trust and reputation. Even if the blockchain industry is becoming the preferred choice for businesses to securely conduct transactions, not many blockchain projects find acceptance amongst investors. Blockchain projects focus on raising funds for their ventures at a stage where they seldom have a viable product and using unregulated means of fundraising like initial coin offerings (ICO) or initial exchange offerings (IEO) have in turn been used to accumulate capital for such projects. With trust depleting in these means of fundraising, blockchain are becoming increasingly aware of the need to tailor their communication with potential investors. In this study, we’ve conducted cross-sectional studies across two separate times, once in 2017-18 at the time ICOs found prominence and then later in 2021, exploring how external communication strategies were revised and improved upon over time to ensure success and favour amongst users and investors.

The Role of Age, Religion/Spirituality, and Humor in the Optimism of Community-Dwelling Older Adults

Current literature reveals that perceived optimism decreases with age (D’Argembeau et al., 2011; Newby-Clark & Ross, 2003). However, replication of these studies is limited. In particular, a lack of investigations exists in examining optimism as individuals transition across older adulthood. Considering the dearth of literature that examines the influence of religion/spirituality and humor on the optimism of older adults, 203 members of Osher Lifelong Learning Institutes, age 65 years and older, from Idaho and California completed pen and paper or electronic surveys. The study used hierarchical multiple regression analysis to examine the impact of age, positive religion/spirituality coping skills, and humor on the optimism of community-dwelling older adults. The participant’s gender significantly explained a 19.3% variance in the optimism scores, whereas age did not significantly contribute to the model (R Change =.000). Positive religious or spiritual coping skills and humor significantly contributed to the variance in optimism scores, explaining a 2.3% and 21.6% variance, respectively. In the final model (F (1, 202, = 13.78, p = .000), all variables except age significantly contributed to the model with humor revealing the highest beta value (beta = .467, p = .000). The findings suggest that optimism is perceived differently by gender but does not change with age. While positive religious coping skills influence optimism, internal or external humor strategies may be more helpful to instill, promote or maintain optimism in older adults. The addition of humor assessment items in wellness evaluations and humor-infused interventions may foster optimism in community-dwelling older adults.

Young children spontaneously devise an optimal external solution to a cognitive problem.

Metacognition plays an essential role in adults' cognitive offloading decisions. Despite possessing basic metacognitive capacities, however, preschool-aged children often fail to offload effectively. Here, we introduced 3- to 5-year-olds to a novel search task in which they were unlikely to perform optimally across trials without setting external reminders about the location of a target. Children watched as an experimenter first hid a target in one of three identical opaque containers. The containers were then shuffled out of view before children had to guess where the target was hidden. In the test phase, children could perform perfectly by simply placing a marker in a transparent jar attached to the target container prior to shuffling, and then later selecting the marked container. Children of all ages used this external strategy above chance levels if they had seen it demonstrated to them, but only the 4- and 5-year-olds independently devised the strategy to improve their future performance. These results suggest that, when necessary for optimal performance, even 4- and 5-year-olds can use metacognitive knowledge about their own future uncertainty to deploy effective external solutions.

Tax governance: how the EU supports third countries

Abstract This paper aims to provide an analysis of the legislative framework that regulates the inclusion of clauses on good governance in tax matters, in the agreements concluded between the European Union, with its Member States, and third countries. We provide a representation of the regulatory pathway from a set of standards on tax good governance according to the principles of transparency, exchange of information and fair tax competition towards a common EU external strategy for effective taxation. Agreements that the European Union has either in place or negotiating with countries and regions around the world are an excellent tool in fighting unfair trade practices and promoting international standards on good governance in the tax area, and set the basis for a fair competition in the economy of developing countries: a strong tax administration and institutions responsible for fighting illicit financial flows in developing countries can contribute to erase poverty and inequalities while promoting good governance and state-building.

Assessing the effectiveness of an app-based child unintentional injury prevention intervention for caregivers of rural Chinese preschoolers: protocol for a cluster randomized controlled trial

BackgroundCompared to urban children, children living in rural areas of most countries, including China, are at higher risk of suffering unintentional injuries. Most proven injury prevention interventions, however, are rarely implemented in rural China due to lack of resources. Mobile health interventions are low-cost and easy-to-implement, facilitating implementing injury prevention in resource-limited areas (e.g., rural areas). This study is designed and implemented to examine the effectiveness of an app-based intervention for unintentional injury prevention among rural preschoolers in China.MethodsA single-blind, 18-month, parallel-group cluster randomized controlled trial with 1:1 allocation ratio will be implemented in 2 rural areas of China (Yang County, Shaanxi Province, and Shicheng County, Jiangxi Province). In total, at least 3508 rural caregivers of preschoolers aged 3–6 years old who own a smartphone will be recruited from 24 preschools. Clusters will be randomized at the preschool level and allocated to the control group (receiving routine school-based education plus app-based parenting education excluding unintentional injury prevention) or the intervention group (receiving routine school-based education plus app-based parenting education including unintentional injury prevention). External support strategies will be adopted by local partners to minimize user fatigue, non-compliance, and attrition. Data collection will be conducted at baseline and then every 3 months during the 18-month follow-up time period. Intention-to-treat data analysis will be implemented. Missing values will be imputed by using the Expectation Maximization algorithm. Generalized estimating equation will test the overall effectiveness of the app-based intervention. A per-protocol sensitivity analysis will be conducted to test the robustness of results. Subgroup analyses will follow the strategies for primary analyses. The primary outcome measure is the incidence rate of unintentional injury among preschoolers during the study period. Secondary outcome measures comprise longitudinal changes in caregiver’s attitudes, caregiver-reported supervision behaviors, and caregiver-assessed home environment safety surrounding child unintentional injury prevention in the last week using a standardized audit instrument.DiscussionThe app-based intervention is expected to be feasible and effective over the 18-month intervention period. If the app is demonstrated effective as hypothesized, we will initiate processes to generalize and popularize it broadly to rural child caregivers across China.Trial registrationChiCTR2000037606, registered on August 29, 2020.

Perceptions of Weight Loss in Older Adults Following a 6-Month Weight Loss Program: A Qualitative Research Study

BackgroundObesity in older adults contributes to increasing comorbidities and decreased quality of life. There is limited research that includes older adults’ perspectives on weight loss. ObjectiveThe purpose of this qualitative study was to gain a better understanding of older adults’ perceptions and experiences related to weight loss immediately after a 6-month weight loss intervention. DesignA qualitative research design using semi-structured interviews conducted as part of a larger research study exploring weight loss and/or aerobic exercise on muscle inflammation. Participants/settingA sample of community-based older adults (n = 11) in Southwestern Ohio were recruited from September 2018 through August 2019 after completion of a 6-month weight loss intervention. Eligible participants were older than 58 years, with a body mass index (calculated as kg/m2) >27, and sedentary with no cognitive deficits. Exclusions included cancer, heart disease, diabetes, and tobacco use. AnalysisInterviews were recorded, transcribed verbatim, and analyzed using thematic analysis. Descriptive statistics were used for demographic data. ResultsThree emergent themes included barriers and challenges to weight loss, which included caregiving roles, challenges with increasing protein intake, and ambivalence to change; personal strategies for success (eg, portion control and meal flexibility); and external strategies for success (eg, visual graphs as feedback measures, alternate measures of success, and social support). ConclusionsThe results of this qualitative study provide insight into older adults’ experiences with weight loss, which may be considered when designing weight management interventions. However, more research is needed to examine strategies to address the challenges identified by participants in this research study. Future qualitative research should also focus on weight loss perspectives of older adults in other racial and ethnic groups.

Corporate social responsibility, cost structures, and COVID-19: Impact of passenger behavior on business models

The present work is concerned with the distinction between low-cost and network carriers within the airline industry. These distinct business models follow different approaches in their external strategy and, thus, in their communication, marketing, and internal cost structure. The differences between the two models are discussed in general and in light of the ongoing trend toward more sustainable and transparent business models, thus focusing on the customer perspective. A quantitative empirical study was conducted to assess the perception of the two airline business models. Additionally, an analysis of changing flyer behavior owing to the COVID-19 crisis was conducted, and the importance of corporate social responsibility (CSR) in the airline industry was evaluated. Using a sample of self-reported frequent flyers (n = 99), the present study used a correlative approach to evaluate the relationship between the individual variables. Among the core findings of the study were that CSR plays an important role in the mindset of passengers, especially with respect to philanthropic and legal responsibility, and that during the COVID-19 pandemic, concerns about ecological responsibility gained momentum. Apparently, COVID-19 did not cause a demand shift within business models, and no differences in passengers’ perceptions regarding CSR were detected among models. However, significant differences between low-cost and full-service airlines were found regarding their respective perceived cost structures. Passengers are aware of this difference, which implies that they might see fare differences up to 30% as reasonable.

Development of decision making based on internal and external information: A hierarchical Bayesian approach

AbstractIn decision making, people may rely on their own information as well as on information from external sources, such as family members, peers, or experts. The current study investigated how these types of information are used by comparing four decision strategies: 1) an internal strategy that relies solely on own information; 2) an external strategy that relies solely on the information from an external source; 3) a sequential strategy that relies on information from an external source only after own information is deemed inadequate; 4) an integrative strategy that relies on an integration of both types of information. Of specific interest were individual and developmental differences in strategy use. Strategy use was examined via Bayesian hierarchical mixture model analysis. A visual decision task was administered to children and young adolescents (N=305, ages 9–14). Individual differences but no age-related changes were observed in either decision accuracy or strategy use. The internal strategy was dominant across ages, followed by the integrative and sequential strategy, respectively, while the external strategy was extremely rare. This suggests a reluctance to rely entirely on information provided by external sources. We conclude that there are individual differences but not developmental changes in strategy use pertaining to perceptual decision-making in 9- through 14-year-olds. Generalizability of these findings is discussed with regard to different forms of social influence and varying perceptions of the external source. This study provides stepping stones in better understanding and modeling decision making processes in the presence of both internal and external information.

Nurses’ experiences, coping and support in the death of a child in the emergency department: A qualitative descriptive study

BackgroundA child’s death in the Emergency Department (ED) is usually unexpected and traumatic. Understanding nurses’ experiences encountering such death is crucial in determining how they cope to provide quality nursing care to dying children and their families. PurposeTo report ED nurses’ experiences with children’s death, coping strategies and support needs. ProceduresA qualitative descriptive design. Twenty-four registered nurses who had cared for a child who died in the ED took part in semi-structured interviews. Interviews were audiorecorded, and analyzed using thematic analysis. FindingsThree themes were generated: ‘nature of emergency department work’, ‘working with families’ and ‘coping and support’. This paper reports on the theme ‘coping and support’.Although children’s deaths were traumatizing and affected nurses personally and professionally, constant time pressure allowed limited reflection time. Common individual coping mechanisms used by participants included external strategies through support from other staff members including peer-support and informal supervision, and internal strategies through personal coping strategies. Participants expressed need for greater support and education/training to effectively deal with pediatric death, children’s families, and their own grief. ConclusionsChildren’s deaths and nature of ED care affected nurses. Adequate support and deathrelated education were urged by participants to promote high-quality care provision.

Lived experience of neuropsychiatric symptoms among females with mild cognitive impairment: A phenomenological study.

To explore the lived experience of neuropsychiatric symptoms (NPS) among females with mild cognitive impairment (MCI). A phenomenological study using individual, semi-structured, telephone-based interviews was conducted to explore how the NPS are aroused, evolve, and affect the overall well-being, illness perception and the corresponding coping responses adopted by females with MCI. Twenty-nine participants with MCI were recruited from the community setting in Hong Kong between March and October 2020. Interviews were audio-recorded, transcribed verbatim, and analysed using an interpretative phenomenological analysis approach and constant comparison strategy. Three themes were identified: (1) living vigilant lives with threats and uncertainty, (2) snowballing into further negative emotions and (3) seeking outlets for negative emotions. Our findings suggested that the participants' cognitive, functional and social challenges aroused intense emotional responses such as depression, agitation and anxiety. These noting negative emotions were further perpetuated by maladaptive coping responses, unrealistic expectations from coping strategies and overwhelming disease burden. Various internal and external strategies were adopted to enhance emotional adaptation, of which adopting a positive attitude appeared to be the most promising strategy. This study shed light on the challenging experience of MCI. The cognitive afflictions and the resultant impacts on various life domains evoked a cluster of NPS. Support services need to enhance emotional adjustment through alleviating the various life stressors and strengthening the coping resources. Elucidating the lived experience of NPS provides important insights into the development of a more effective, comprehensive and person-centred care planning for the population with MCI. Holistic care planning should extend beyond cognitive health optimization into enhancing disease knowledge, improve emotional coping, rebuild self-identity and bolstering social supports among this preclinical cohort.

Development strategy for marine conservation area of Mare Island, Tidore Islands City

Mare Island is a strategic small island, both in its location and its natural resources. In the Regional Regulation of North Maluku Province Number 2 of 2018 concerning Zoning Plans for Coastal Areas and Small Islands of North Maluku Province for 2018-2038, Mare Island is designated as Coastal and Small Islands Conservation Areas. Furthermore, through the Decree of the Minister of Marine and Fisheries Affairs Number 66/KEPMEN-KP/2020, Mare Island has been designated as a Marine Conservation Area. The research aims to formulate a strategy for developing marine conservation areas on Mare Island. Field data collection was carried out in the form of observations, interviews and questionnaires, analysis of existing spatial conditions using the Geographic Information System (GIS), for strategy formulation using SWOT analysis tools after identifying various internal and external factors. external strategy, while the alternative strategy is continued by determining the priority of the strategy using the Analytical Hierarchy Process (AHP). The results showed that there were 11 alternative formulations of strategies for development of Mare Island marine conservation areas in order of priority: Improved conservation area management, Capacity building for government and community organizations, Implementation of Zoning Plans and Preparation of Detailed Spatial Plans, Economic empowerment and development of alternative livelihoods, Partnership network improvement, Improvement of tourism facilities and infrastructure, Collaboration of programs among local government offices, Structuring residential areas, Limiting the use of SDKP, Law enforcement and Development of sea and land transportation facilities.

An Analysis on Performance Evaluation and Coordination Strategies of Transformation and Upgrading of Manufacturing Small and Micro Enterprises: An Empirical Study Based on AHP-Regression

Transformation and upgrading are the key to the development of manufacturing industry.Through the questionnaire survey, we designed 17 observation indicators and used the Analytic Hierarchy Process(AHP) to calculate the two levels of transformation and upgrading, and found that small and micro enterprises paid most attention to internal management and industrial chain upgrading. When we using multiple regression analysis to analyze the impact of internal and external promotion strategies on transformation and upgrading, it is found that the combination strategy of assets, information management level and the overall quality of employees had the best effect, which is consistent with the most important transformation and upgrading indicators of enterprises.In terms of government support and tax policy promotion strategies, tax policy has a relatively good independent impact, but when combined with other indicators, the impact will not be significant. This shows that the conversion efficiency of the policy is low, and the applicability and pertinence need to be optimized. In addition, in terms of the promotion strategy of innovation input for transformation and upgrading, the effect is not good, indicating that the innovation efficiency of Chinese small and micro enterprises is not high, and the ability to transform innovation resources into innovation output is insufficient. This has also formed evidence support for internal management indicators in transformation and upgrading.