Management Criteria Research Articles

Mean global field power is reduced in infantile epileptic spasms syndrome after response to vigabatrin.

Infantile epileptic spasms syndrome (IESS) is associated with abnormal neuronal networks during a critical period of synaptogenesis and brain plasticity. Hypsarrhythmia is a visual EEG biomarker used to diagnose IESS, assess response to treatment, and monitor relapse. Computational EEG biomarkers hold promise in providing unbiased, reliable, and objective criteria for clinical management. We hypothesized that computational and visual EEG biomarkers of IESS would correlate after treatment with vigabatrin and that these responses might differ between responders and non-responders. A retrospective analysis was conducted at a single center, involving children with IESS at initial diagnosis and following first-line treatment with vigabatrin. Visual EEG biomarkers of hypsarrhythmia were compared with computational EEG biomarkers, including spike and spike fast-oscillation source coherence, spectral power, and mean global field power, using retrospective analysis of EEG recorded at initial diagnosis and after vigabatrin treatment. Responders and non-responders were compared based on the characteristics of their follow-up EEGs. In this pilot study, we observed a reduction in the EEG biomarker of hypsarrhythmia/modified hypsarrhythmia from 20/20 (100%) cases at the initial diagnosis to 9/20 (45%) cases after treatment with vigabatrin, indicating a 55% (11/20) responder rate. No significant difference in spike frequency was observed after treatment (p = 0.104). We observed no significant differences after treatment with vigabatrin in the computational EEG biomarkers that we assessed, including spike source coherence at 90% (p = 0.983), spike source coherence lag range (p > 0.999), spike gamma source coherence at 90% (p = 0.177), spike gamma source coherence lag range (p > 0.999), spectral power (0.642), or mean global field power (0.932). However, when follow-up EEGs were compared, there was a significant difference in mean global field power (p = 0.038) between vigabatrin responders and non-responders. In contrast, no such difference was observed for spike source coherence at 90% (p = 0.285), spike course coherence lag range (p = 0.819), spike gamma source coherence at 90% (p = 0.205), spike gamma source coherence lag range (p > 0.999), or spectral power (p = 0.445). Finally, our treated group did not differ significantly from healthy controls at initial diagnosis or follow-up in terms of spectral power (p = 0.420) or mean global field power (0.127). In this pilot study, we show that mean global field power is a computational EEG biomarker that is significantly reduced in IESS after treatment with vigabatrin. Although computational EEG biomarkers of network connectivity using spike source coherence appear to be a promising tool, future studies should further explore their potential for assessing treatment responses in IESS.

FUNDAMENTALS OF QUALITY ASSURANCE IN THE HIGHER EDUCATION SYSTEM

This study explores the critical issue of quality assurance in higher education systems, both in Kazakhstan and globally, where universities operate in a «consumer market» with students selecting educational programs, institutions, and resources. Based on an analysis of international and domestic research, the study aims to identify the foundations of quality assurance in higher education. The authors highlight key aspects of higher education quality, including student quality, teaching characteristics, academic regulations, and administrative support. Educational quality is examined within the context of international standards as a matter of national importance, with education levels serving as a foundation for economic development of both state and society. The research analysis reveals that various approaches, methods, and criteria for quality management are employed in creating systems for ensuring and assessing the quality of higher education institutions in Kazakhstan and abroad. These include the evaluative method of university activity quality management (SWOT analysis), Total Quality Management (TQM) strategy, and an approach based on the requirements of international quality standards ISO 9000:2000. The study notes that Kazakhstan has adopted a management model based on the ISO 9000:2000 international quality standards. This comprehensive review contributes to the understanding of quality assurance mechanisms in higher education and their implications for educational policy and practice.

Enhancing referral practices: A bariatric department's education initiative to reduce unnecessary referrals to hematology oncology.

82 Background: Bariatric surgery patients face an elevated risk of iron deficiency anemia. Referrals from the Bariatric department to Hematology Oncology for work up of these anemias strain clinic resources and delay timely care for cancer patients. We initiated a targeted education program to reduce unnecessary referrals from the Bariatric department to Hematology Oncology by raising awareness among staff about appropriate referral criteria. Methods: We developed a curriculum highlighting the differences between symptoms of bariatric surgery complications and hematologic malignancies. Interactive training sessions were held with Bariatric department staff, supplemented by informational materials. Case studies and real-world examples reinforced understanding and decision-making. Staff were also educated on managing iron deficiency anemia internally. Referral rates were tracked before and after the intervention. Results: Baseline data were collected from July 2023 to November 2023, showing an average of 17 referrals per month (85 total over 5 months). The educational initiative included three sessions in December 2023 on anemia management and referral criteria. These sessions highlighted the distinction between symptoms of bariatric complications and hematologic malignancies, as well as education to the bariatric surgery providers on management of hematologic diagnoses resulting from bariatric surgery. Post-intervention data from January 2024 to May 2024 showed a substantial reduction in referrals for bariatric-related iron deficiency anemias to an average of 4.4 referrals per month (22 total over 5 months), indicating a 74% reduction. Improved internal management of iron deficiency anemia contributed to this outcome. The percentage of cancer patients receiving a consult within 7 days of referral contemporaneously improved from 85.7% to 88.1%, indicating improved access to oncology care. Conclusions: The educational intervention significantly reduced unnecessary referrals from the Bariatric department to Hematology Oncology, improving access for cancer patients. Empowering staff with the knowledge to make informed referral decisions and manage common hematologic issues internally improved patient care and clinic efficiency, reducing healthcare costs and patient burden in both departments.

Fuzzy Analytic Hierarchy Process (FAHP) Based Performance Assessment of Textile Industry in Tirupur

Abstract: This study explores the use of Fuzzy Analytic Hierarchy Process (FAHP) to evaluate and prioritize criteria in supply chain management within the textile industry of Tirupur district. Utilizing a detailed questionnaire reviewed by experts with over 30 years of industry experience, the study conducted pairwise comparisons of key criteria: cost (C1), quality (C2), time delivery (C3), and management and organization (C4). By applying FAHP, which effectively handles uncertainties in decision-making, the study determines the relative importance of these criteria. The findings provide a structured method for improving decisionmaking in textile supply chain operations, integrating fuzzy logic with the traditional AHP framework to enhance the management and optimization of supply chain processes.

The Agnikarma(~Cauterization) - A Mastery Procedure in Susruta Samhitha.

Ayurveda is the ancient science of human civilization. Sushruta Samhita is the most important literature in surgery. Maharshi Sushruta, known as the father of surgery has also explained the Para-surgical procedures in different diseases among them Agnikarma as the greatest/superior curative treatment to avoid recurrence. We can observe Susruta has explained in detail the importance of Agnikarma, varieties, and criteria of successful cauterization, specific sites, indications, patterns, and pre and post-cautery management. Agnikarma has its Ushna Guna and Sookshma Guna it pacifies the vata and Kapha and burns the unwanted tissue done by the different materials such as Shalaka (gold, silver, panchadhatu, etc), Ajashakrut, Godanta, Madhu, Guda, Sneha (oil, Ghrita). In the present study humble attempt was made for Ayurvedic surgical practice. This study concludes that Agnikarma(cauterization) is a very effective and simple, non-occurrence and minimal invasive procedure able to be conducted at the Out Patient Department(OPD) level.

Making Living-donor Liver Transplantation a Viable Option for Patients With Portopulmonary Hypertension.

Liver transplantation (LT) in patients with significant portopulmonary hypertension (PoPH) is associated with an increased risk of several complications, including graft failure. Graft loss is one of the major reasons. Living donor LT (LDLT) is not routinely performed in the United States in this patient population. In addition, ethical considerations often preclude donation from healthy donors in the setting of a procedure associated with an elevated risk of recipient morbidity and mortality. However, LDLT allows LT to be performed electively, using a superior graft with an improved probability of a good outcome. The key to success in managing these patients is establishing a multidisciplinary team that follows an institutional protocol with clear evaluation and management criteria. These criteria include screening and early diagnosis as well as treatment of PoPH with the goal of optimizing pulmonary arterial hemodynamics and maintaining right ventricular function. Any protocol should include admitting the patient to the hospital a day before surgery for placement of a pulmonary artery catheter to measure and derive relevant hemodynamic variables. A multidisciplinary team should determine the fitness for a transplant a after a careful review of the most up-to-date clinical information. Finally, the team prescribes and executes a plan for optimization and safe perioperative management of the patient. In this report, we discuss our approach to the perioperative management of a patient with significant PoPH who safely underwent LDLT with an excellent postoperative outcome.

Choosing the Best Sustainable Prefabricated Building Systems Using the Analytical Network Process (ANP) Technique

Attention should be paid to prefabricated construction, as the consumption of raw materials in traditional construction is large and affects the country's resources and economy. Sustainable prefabricated building systems in Iraq suffer from a clear weakness in management due to the use of old methods and a lack of focus on important management criteria. This research addresses this issue by modeling the analytical network process (ANP) technique to select the best types of systems. By reviewing the general literature, 80 indicators were identified within the 12 relevant categories. These indicators formed the basis of a closed questionnaire distributed to 90 experienced respondents. Three prefabricated building systems were identified based on the structural composition (load-bearing wall system, frame system, and box system). The expert questionnaire was analyzed using the ANP technique and the Sustainability Index (SI) for each system was found using the Excel program and it was found that the best sustainable prefabricated building system is the box system. This research helps to improve the management of prefabricated building projects and increase speed, quality, pollution, and reduce the cost of housing in Iraq, which suffers from high costs

Factors Influencing the Success Criteria of ICT Project Management Case Study Constructions in Mogadishu

Being a developing nation, our nation's project construction is advanced in comparison to earlier years. Therefore, the overall goal of this study is to evaluate and examine the local elements influencing the success criteria of ICT project management in the construction sectors. The purpose of this study is to evaluate the technical factors that affect the success of ICT project management in the Somali construction industry. To determine the organizational factors that affect the ICT project management success in the Somali construction industry. And to investigate the cultural factors that affect the success of ICT project management in the construction industry. The most recent study to look at environmental factors influencing the performance of ICT project management in the Somali construction industry. The report focuses on construction initiatives completed in Somalia's capital city of Mogadishu. Both interviews and questionnaires were used to gather the data. The questionnaire was completed online using Google Form, and the respondents were clients, consultants, and contractors. The researchers used practical sampling to gather 100 surveys. There are four case study companies that I have chosen as an experiment construction companies are utilized as a case study for this research project. The data from the questionnaires were analyzed using SPSS to produce the average index from the study; Dalbile construction and contracting company, Bile home repair and Construction service, Qidmad Construction Company and Gaabow Construction Company. Due to the growing technological uncertainty, the building sector is dynamic. Building projects are getting easier and more advanced today. The coordination between the project participants is what has an impact on how well construction projects execute when using the design build method of procurement. The Somali government should establish and enforce strict penalties to combat fraudulence activities, the licensing of contractors and consultants should be thoroughly scrutinized to ensure that they are qualified and have the tools necessary to perform their jobs, and the contractors should enhance their estimation methods and take into account all external factors that could affect their projects.

Perfil epidemiológico, sobrevida e prognóstico materno em unidade de terapia intensiva no nordeste do Brasil

Objective. To study the epidemiologic profile and determine maternal survival and prognosis in an Intensive Care Unit (ICU) in the Northeast of the country. Methods. Analytical cross-sectional design study that evaluated pregnant women, puerperae, and women in postabortion or ectopic pregnancy admitted to an obstetric ICU in Teresina between May/2016 and May/2017. Results. Of the 11,466 occurrences in the period, 456 women were admitted to the ICU. Among the causes of hospitalization, 80.3% patients were direct obstetric causes, 16.2% indirect and 3.5% non-obstetric. A total of 159 patients met the Near Miss criteria, with statistical significance between presentation of the criteria and mortality (p<0.001; x²=30.974). The mortality rate was 3.5%, all of them being Near Miss cases. There was a statistically significant and direct correlation between survival and number of clinical (p<0.001; rp=0.270), laboratory (p<0.001; rp=0.358) and management (p<0.001; rp=0.465) criteria. It was identified that the higher the number of criteria, the longer the length of hospitalization and worse the prognosis (p<0.001). Conclusion. Women admitted to the ICU for indirect obstetric causes who met maternal Near Miss criteria had longer hospitalization and worse prognosis.

Enablers of and Barriers to Perinatal Mental Healthcare Access and Healthcare Provision for Refugee and Asylum-Seeking Women in the WHO European Region: A Scoping Review.

Perinatal mental health is a growing public health concern. Refugee and asylum-seeking women are particularly susceptible to experiencing perinatal mental illness and may encounter a range of challenges in accessing healthcare. This scoping review sought to identify the enablers of and barriers to healthcare access and healthcare provision for refugee and asylum-seeking women experiencing perinatal mental illness in the WHO European Region. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was applied. Nine databases and six grey literature sources were initially searched in April 2022, and an updated search was completed in July 2023. The search identified 16,130 records, and after the removal of duplicates and the screening process, 18 sources of evidence were included in this review. A data extraction table was used to extract significant information from each individual source of evidence, which was then mapped to the seven dimensions of the candidacy framework. Empirical (n = 14; 77.8%) and non-empirical (n = 4; 22.2%) sources of evidence were included. The literature originated from seven countries within the WHO European Region, including the United Kingdom (n = 9; 50%), Germany (n = 3; 16.7%), Denmark (n = 2; 11.2%), Norway (n = 1; 5.6%), Greece (n = 1; 5.6%), Sweden (n = 1; 5.6%), and Switzerland (n = 1; 5.6%). The results indicate that, although enablers and barriers were apparent throughout the seven dimensions of candidacy, barriers and impeding factors were more frequently reported. There was also a notable overall lack of reported enablers at the system level. Unaddressed language barriers and lack of attention to the diversity in culturally informed perceptions of perinatal mental illness were the main barriers at the individual level (micro-level) to identifying candidacy, navigating healthcare systems, and asserting the need for care. The lack of culturally appropriate alignment of healthcare services was the key organizational (meso-level) barrier identified. The wider structural and political contexts (macro-level factors), such as lack of funding for consultation time, focus on Western diagnostic and management criteria, and lack of services that adequately respond to the needs of refugee and asylum-seeking women, negatively influenced the operating conditions and wider production of candidacy. It can be concluded that there are multilevel and interconnected complexities influencing access to and provision of perinatal mental healthcare for refugee and asylum-seeking women.

Could low prolactin levels after radiotherapy predict the onset of hypopituitarism?

Both local and external cranial radiotherapy (RT) can induce neurotoxicity and vascular damage of the hypothalamic-pituitary area, which can promote neuroendocrine alterations. While anterior pituitary insufficiency after RT has been extensively characterized, data on the effect of RT on prolactin (PRL) secretion are limited and heterogeneous, with different patterns of PRL behavior described in the literature. A progressive decline in PRL levels, reflecting a time-dependent, slowly evolving radiation-induced damage to the pituitary lactotroph cells has been reported. To date, the association between hypopituitarism and hypoprolactinemia in patients undergoing RT has not yet been fully investigated. The few available data suggest that lower PRL levels can predict an extent damage of the pituitary tissue and a higher degree of hypothalamic dysfunction. However, most studies on the effect of RT on pituitary function do not properly assess PRL secretion, as PRL deficiency is usually detected as part of hypopituitarism and not systematically investigated as an isolated disorder, which may lead to an underestimation of hypoprolactinemia after RT. In addition, the often-inadequate follow-up over a long period of time may contribute to the non-recognition of PRL deficiency after RT. Considering that hypoprolactinemia is associated with various metabolic complications, there is a need to define appropriate diagnostic and management criteria. Therefore, hypoprolactinemia should enter in the clinical investigation of patients at risk for hypopituitarism, mainly in those patients who underwent RT.

Reassessing Halm's clinical stability criteria in community-acquired pneumonia management.

Halm's clinical stability criteria have long guided antibiotic treatment and hospital discharge decisions for patients hospitalised with community-acquired pneumonia (CAP). Originally introduced in 1998, these criteria were established based on a relatively small and select patient population. Consequently, our study aims to reassess their applicability in management of CAP in a contemporary real-world setting. This cohort study included 2918 immunocompetent patients hospitalised with CAP from three hospitals in Denmark between 2017-2020. The primary outcome was time to achieve clinical stability as defined by Halm's criteria. Additionally, we examined recurrence of clinical instability and severe complications. Cumulative incidence function or Kaplan-Meier survival curves were used to analyse these outcomes, considering competing risks. The study population primarily comprised elderly individuals (median age: 75 years) with significant comorbidities. The median time to clinical stability according to Halm's criteria was 4 days, with one-fifth experiencing recurrence of instability after early clinical response (stability within 3 days). Severe complications within 30 days mainly comprised mortality, with rates of 5.1% (64/1257) overall in those with early clinical response, 1.7% (18/1045) in the subgroup without do-not-resuscitate orders, and 17.3% (276/1595) among the rest. Halm's clinical stability criteria effectively classify CAP patients with different disease courses, yet achieving stability required more time in this aging population with substantial comorbidities and more severe disease. Early clinical response indicates reduced risk of complications, especially in those without do-not-resuscitate orders.

Management of Ileosigmoid Knotting: A Literature Review

Ileosigmoid knotting (ISK) is a rare double-segment intestinal obstruction form. Urgent surgery is the unique solution in the management of ISK. In surgical treatment, detorsion alone is generally used in patients with viable bowel, while cases with gangrenous bowel require resection. ISK recurrence is uncommon. However, due to the recurrence risk of sigmoid volvulus, the role of recurrence-reducing procedures is unclear. In this review, urgent treatment of ISK as well as the techniques and patient selection criteria of recurrence-reducing management are discussed.

Comparison of the preclinical quality of analgesia of emergency physicians and paramedics based on trauma patients

Adequate prehospital pain management is acritical component of emergency medical services. With the introduction of the paramedic profession and the Paramedics Act in Germany, the basis for more extensive competencies of paramedics was established. In many emergency medical service areas it is thus possible for paramedics to perform analgesia and sedation with esketamine/midazolam according to pre-established instructions and/or standard operating procedures. This study assessed the quality of analgesia administered to trauma patients by paramedics compared to emergency medical service physicians. The study included trauma patients who received prehospital administration of analgesia by either emergency medical service physicians or paramedics and were subsequently admitted to the central emergency department of the Saarland University Hospital. Astandardized data collection form was used to collect information from the emergency service protocol and initial emergency department assessment. The evaluation employed descriptive statistical methods and a total of 207 completed records were analyzed. Both professional groups achieved significant pain reduction and fulfilled the criteria for effective pain management (pain reduction: emergency medical service physicians 5.5 ± 2.0/paramedic 4.4 ± 2.1, p < 0.001). Emergency medical service physicians, however, more frequently attained ahigher reduction in numerical rating scale scores and administered oxygen. Notable differences were observed in the range of medications used and the dosages. This study could show that prehospital analgesia is comparable between emergency medical service physicians and paramedics in terms of effectiveness for trauma patients if the indications are correctly set, while observing pre-existing instructions. With their competencies paramedics are able to perform an effective and safe analgesic treatment within the framework of preformulated procedural instructions, which can be equal to that of an emergency medical service physician.

Decision Support System For Manager Placement In The Plantation Industry Using Topsis Method

Accuracy in placing employees determines the performance of a company. Likewise done by PT XYZ in determining the placement of managers in the plantation industry by using a decision support system. This is done in order to minimize the level of subjectivity of the manager placement determination system at PT XYZ. This research aims to provide alternative preference values to prospective employees who will occupy manager positions in the plantation industry. The method used in the placement of managers with a decision support system is the technique for Order Preference by Similarity to the Ideal Solution (TOPSIS) method. The criteria used in this method are 7 criteria taken based on the criteria for BUMN talent management according to the Regulation of the Minister of BUMN Number PER-3 / MBU / 03/2023, these criteria are Professional Work Period, Variety of Work Experience, Managerial Competence, Technical Competence, Educational Strata, Performance Assessment Results, Level of Punishment that has been received. The results of this study are from the results of the calculation analysis through the TOPSIS method on 7 alternatives, then there is name number 5 managed to get the best score of 0.80 and was determined as a preference to be placed in class A garden.

Threats of tropical cyclone on cropping systems and crop calendar of rice in India: Issues, policy practice gap and adaptation strategies

The Food and Agriculture Organization (FAO) has calculated that by 2050, we will need to grow 60 % more food to provide for a population of 9.3 billion people worldwide. India must increase its yearly food grain production from the current level of 252–333 million tonnes by 2050 in order to fulfil its expanding population demand. India is one of the nations most at risk from climate change due to its geophysical location and variability. This research explored the impact of cyclonic storm surges on crop calendars (‘Aman’ and ‘Boro’ rice) and also suggested adaption strategies during these conditions. This study showed that alteration of contemporary rice sowing and harvesting dates significantly impacts achieving sustained yields, surpassing all other crop management, soil, and other criteria. The origin and landfall of the cyclone of the Bay of Bengal (BoB) in pre- and post-monsoon season impede the goal of optimal rice production in Eastern and south-eastern India. We have estimated that ‘Rabi’ and ‘Kharif” rice production potential will increase by about 29 % with attainable changes to rice sowing and harvesting dates incorporating the severe cyclonic storm (SCS) landfall and rainfall in the study area. Our results also show that transformational benefits in rice yields are only possible in India if the convectional crop calendar changes with the modern scientific crop calendar. Managing the seasonal cropping calendar more effectively can benefit food security, economic success, and climate adaptability rice seed as a method for adaptation to ongoing climate change.

Eligibility Criteria for Different Platinum-Based Chemotherapy Regimens in Metastatic Urothelial Carcinoma.

Introduction Bladder cancer is one of the most prevalent cancers worldwide, with significant morbidity and mortality rates. Treatment options for metastatic urothelial carcinoma (mUC) primarily include platinum-based chemotherapy. Cisplatin-based chemotherapy is conventionally used for treating mUC, but many patients are ineligible due to various factors such as poor performance status, creatinine clearance, neuropathy, and cardiac function. Carboplatin-based therapy is another alternative, which typically yields less favorable outcomes. Some centers use split-dose cisplatin for treating patients with comorbidities and impaired renal function, broadening cisplatin's spectrum. While eligibility criteria for full-dose cisplatin are well-established, those for split-dose cisplatin and carboplatin lack strong evidence. This study aims to assess the recommended criteria for full-dose cisplatin, split-dose cisplatin, and carboplatin regimens in real-world settings, including hematological parameters for patients with mUC. Methods A cross-sectional web-based survey was conducted among 136 oncologists from 21 countries, assessing criteria such as creatinine clearance, Eastern Cooperative Oncology Group (ECOG) performance status (PS), neurotoxicity, hearing loss, heart failure classification, and hematological parameters. Results The survey revealed diverse preferences among 113 oncologists treating mUC, regarding the eligibility criteria for each chemotherapy regimen with 81% prioritizing full-dose cisplatin, 21% split-dose cisplatin, and 14% carboplatin regimens. Criteria for all three regimens included specific thresholds. For full-dose cisplatin, the preferred criteria included creatinine clearance ≥60 mL/min, ECOG PS ≤1, grade 1 neuropathy, grade 1 deafness, New York Heart Association (NYHA) heart failure ≤class II with ≥50% cardiac ejection fraction, and normal blood parameters. Split-dose cisplatin criteria were creatinine clearance ≥40 mL/min, ECOG PS ≤2, grade 1 neuropathy, grade 1 deafness, NYHA heart failure ≤class II with ≥50% cardiac ejection fraction, and normal blood parameters. Carboplatin eligibility criteria were creatinine clearance ≥30, ECOG PS ≤2, grade ≤2 neuropathy, grade ≤2 deafness, NYHA heart failure ≤class II with ≥50% cardiac ejection fraction, and normal blood parameters. Hematological parameters were deemed crucial for all regimens, particularly stringent for carboplatin-based chemotherapy. Conclusion The study underscores the importance of renal function and hematological parameters in determining chemotherapy eligibility for patients with mUC. It highlights the importance of precise treatment criteria in mUC management, with hematological factors playing a significant role. Standardized criteria and further research are warranted to optimize treatment outcomes and minimize adverse events associated with chemotherapy regimens. Understanding the preferences of oncologists globally can facilitate tailored treatment approaches and improve patient care in the management of mUC.

Clinical guidance based on MRI for the management of temporomandibular joint synovial chondromatosis: One institution's experience

The aim of this retrospective observational study was to introduce a comprehensive MRI evaluation criterion for the clinical management of synovial chondromatosis of the temporomandibular joint (TMJ-SC). Patients received different treatments according to the MRI evaluation system: bone erosion, extent, articular disc condition, location, maturity, and size of loose body. At least a 2-year follow-up was completed to assess tumor recurrence, visual analogue scale score for pain (VAS) and maximum interincisal opening (MIO). Of the 195 patients included for TMJ-SC, 34 received arthroscopy and 161 received open surgery. Among the patients with significant extent of SC, 32 received temporary resection of the condylar neck or zygomatic arch and 2 received treatment combined with ear, nose and throat(ENT). 28 received articular disc reconstruction and 56 received disc repositioning. Patients showed good recovery of joint function with only two cases of tumor recurrence at an average follow-up of 75.1 months after surgery. The MIO had improved from 30.2 mm to 40.0 mm(P < 0.0001) and VAS had decreased from 5.1 to 0.78(P < 0.0001).The preoperative MRI evaluation principles has been effective in selecting appropriate surgical options.

Environmental assessment of hospital waste management practices: A study of hospitals in Kermanshah, Iran

This research aims to identify current procedures of hospital waste management in educational hospitals, in western Iran. This study examined upon to be current procedures of medical waste management focusing on the management of hazardous medical waste, under a circular economy. Three criteria environmental situation, environmental management, and environmental performance. The environmental assessment was done by pair matrixes between criteria and sub-criteria, and between scale levels of the indicators were done. The questionnaire structure adopted in the Romero and Carnero study. The Analytic Hierarchy Process method indicates that aspect of the hazardous waste improvement program is essential. The results demonstrated that 56 % of the total environmental criteria score was VERY DEFICIENT in the scale factors classification. The lowest values indicated in the environmental management aspect and 63 % of the total score was VERY DEFICIENT. The results indicated a deficient value in environmental criteria based on the values received for the commitment to environmental policy standards and waste management procedures. The results of environmental performance criteria have shown; that no data was on atmospheric emission. The lack of rules in green purchasing and renewable energy was indicated. In waste management criteria, the total value was reasonable, but there weren't comprehensive rules for redefining waste types and staff training obligations. However, the redefinition of rules, public and staff training, using new technologies, and determination of specific budgets and green teams by proper supervising cycle can be essential to improve hazardous waste management.

Digital twin and fuzzy framework for supply chain sustainability risk assessment and management in supplier selection

Risks in the supply chain can damage many companies and organizations due to sustainability risk factors. This study evaluates the supply chain risk assessment and management and then selects the best supplier in a gas company in Egypt. A comprehensive methodology can use the experts' opinions who use the linguistic variables in the spherical fuzzy numbers (SFNs) to evaluate the criteria and suppliers in this study based on their views. Selecting the best supplier is a complex task due to various criteria related to supply chain risk assessment, such as supply risks, environmental risks, financial risks, regularity risks, political risk, ethical risks, and technology risks and their sub-criteria. This study suggested a new combined model with multi-criteria decision-making (MCDM) under a spherical fuzzy set (SFS) environment to overcome uncertainty and incomplete data in the assessment process. The MCDM methodology has two methods: the Entropy and COmbinative Distance-based Assessment (CODAS) methods. The SFS-Entropy is used to compute supply chain risk assessment and management criteria weights. The SFS-CODAS method is used to rank the supplier. The main results show that supply risks have the highest importance, followed by financial and environmental risks, and ethical risks have the lowest risk importance. The criteria weights were changed under sensitivity analysis to show the stability and validation of the results obtained from the suggested methodology. The comparative analysis is implemented with other MCDM methods named TOPSIS, VIKOR, MARCOS, COPRAS, WASPAS, and MULTIMOORA methods under the SFS environment. This study can help managers and organizations select the best supplier with the lowest sustainability risks.