Management System Approach Research Articles

APP (Amberg-perforation-project) - development and evaluation ofan interdisciplinary, systematic approach for endoscopic management of iatrogenic perforation in a German secondary referral center

Recently, there has been a significant change in the management of iatrogenic gastrointestinal perforation from surgery towards primary endoscopic therapy. All perforations occurring in all consecutive endoscopies from 1/1/2014 to 12/31/2017 in our hospital (Klinikum St. Marien Amberg, Germany) were recorded, evaluated and followed up prospectively. In-house SOPs were designed and communicated with all physicians within our hospital. Endoscopic closure of the perforation was primarily attempted, always in consent with the abdominal surgeon. In total, we observed 24 perforations in 18 627 consecutive endoscopies (0.13 %). There were also 24 cases of free extraluminal gas without perforation (12 post-polypectomy-syndromes und 12 post-ERCP with papillotomy). Diagnosis of perforation could be established within 12 hours in 95.8 % (23/24) (in 20 cases during endoscopy). Initial therapeutic approach was surgical in 3 cases, conservative in 3cases and interventional-endoscopic closure of perforation in 17 cases (4 × Clips, 10 × OTSC, 3 × SEMS). In 1 case, no therapy was performed. Mortality was 4.2 % (1/24). In 3 cases, the patient had to be operated on secondary to endoscopic therapy. In summary, surgical therapy was necessary in 6 of 24 cases (25 %). Interventional-endoscopic therapy was successful technically in 94.1 % (16/17) and clinically in 87.5 % (14/16). Primary interventional-endoscopic closure of iatrogenic gastrointestinal perforation is a safe and successful option in the everyday practice of a secondary referral hospital. The most important factor is prevention of delay until closure of perforation. Also, interdisciplinary consensus between endoscopist and surgeon is essential. Based on our own data, we developed and introduced a system for documentation and management of all endoscopic complications in endoscopy called "KEMS", which could be successfully integrated in our IT-system.

Time Temperature Superposition Evaluation and Modeling for Container Closure System's Seal Performance at Low Temperatures.

There has been a growing interest in the assessment of container closure systems (CCS) for cold storage and shipment. Prior publications have lacked systematic considerations for the impact of dynamic time temperature transition on sealing performance associated with the viscoelastic characteristics of rubber stoppers used in container closure systems (CCSs). This paper demonstrates that sealing performance changes inherently and is fundamentally both time- and temperature-dependent. Our research results display this critical time temperature transition impact on CCS sealing performance by applying compression stress relaxation (CSR) on a rubber stopper for experimental data collection and modeling evaluation. The experimental results agree with modeling evaluation following Maxwell-Wiechert theory and the time temperature superposition based on the Arrhenius and Williams-Landel-Ferry methods. Both testing and modeling data show good consistency, demonstrating that the sealing force inevitably changes over time together with temperature transition because of the viscoelastic nature of the rubber stoppers. Our results show that compression seal force decreases quickly as temperature decreases. The significant loss of rubber stopper sealing force at lower temperature transitions could contribute significant risk to CCI at low storage and transport temperatures. Modeling evaluation, with a powerful capability to handle actual testing data, can be employed as a predictive tool to evaluate the time- and temperature-dependent sealing force throughout the entire sealed drug product life span. The present study is only applicable before reaching the rubber glass transition temperature Tg - a critical transition phase that can not be skipped/separated from real time temperature transition, and it will further determine the CCS sealing performance while approaching cryogenic temperature. The present work provides a new, integrated methodology framework and some fresh insights to the parenteral packaging industry for practically and proactively considering, designing, setting up, controlling, and managing stopper sealing performance throughout the entire sealed drug product life span.

Reframing Corporate Social Responsibility and Sustainability in the Aftermath of United Nations 2030 Agenda: An Empirical Study into the Tanker and Dry Bulk Maritime Sector

Corporate social responsibility (CSR) and sustainable development constitute an integral component of organization's strategy. Nowadays, growing environmental concerns have triggered a plethora of social initiatives and regulatory regimes. In view of United Nations 2030 Agenda, the International Maritime Organization (IMO) and the European Union (EU) have stressed the leading and efficient attributes of shipping transport and committed themselves to the achievement of global sustainability mandates. Similarly, CSR has been identified as a strategic approach to manage sustainability challenges. However, with the exception of few shipping segments, CSR refers to a, relatively, newly introduced notion to the shipping business. Based on a survey questionnaire sent to tanker and /or bulk maritime companies this study aims to investigate CSR and sustainability configurations, as they have been shaped in the light of United Nations 2030 Agenda. Developed hypotheses are tested using Pearson chi-square independence test and Spearman's correlation coefficient measure. Findings illustrate CSR as a strategic management tool to integrate sustainability challenges. Thereafter, the integrated management system (IMS) approach is, highly, indicated as the most effective business model to address sustainability into maritime operations. Though, the lack of a non-legally binding CSR regime is not found to influence companies' decision to adopt CSR.

An Integrated Event Summarization Approach for Complex System Management

Event mining is a useful way to understand computer system behaviors. The focus of recent works on event mining has been shifted to event summarization from discovering frequent patterns. Event summarization seeks to provide a comprehensible explanation of the event sequence on certain aspects. Previous methods have several limitations such as high time complexity, a low precision especially with the presence of noise and phase shifts, and providing a summary which is difficult for a human to understand. In this paper, we propose an integrated event summarization approach toward the understanding of the chaotic temporal data. Our approach focuses on two kinds of temporal relationships, the periodic pattern and the correlation pattern, hidden in event sequences of at most two event types. For the periodic patterns, we propose an event periodicity detection algorithm to discover them directly. For the correlation patterns, we make a simple statistical test based on low order statistics to check temporal dependency of events of two types and to eliminate event correlation candidate space dramatically, and then apply inter-arrival histograms to summarize an event sequence and capture the correlation patterns. In order to balance between accuracy and brevity, the minimum description length principle is used to guide the summarization process. Further, the event relationship network is built to describe discovered patterns. We conduct several groups of experiments on synthetic and real data. Experimental results show our approach is capable of producing usable event summarization, robust to noises, and scalable. The average compression ratio of event sequences reaches 99.7%.

Comparative Analysis Between Deterministic And Systemic Management Approach For Improved Effectiveness In Public Investment In Peru

Comparative Analysis Between Deterministic And Systemic Management Approach For Improved Effectiveness In Public Investment In Peru

Implementing the systems approach in rice pest management : India context

A basic IPM module for basmati rice as a part of integrated crop management accounting the pest prevalence and the information available from literature has been developed. As the module is location specific and dynamic, therefore needs regular updating and fine tuning depending on the location and pest prevalence. The technology has been successfully validated and implemented during 1998 to 2019 in Pusa Basmati 1, Taraori Basmati, Dehraduni Basmati, Pusa Basmati 1121 in Haryana, Uttar Pradesh and Uttarakhand with little modification and fine tuning. Implementation of the technology resulted in increase in rice grain yield i.e., 21.6% in Pusa Basmati 1 at Shikohpur, in Uttar Pradesh 21.5% in Taraori Basmati at Chhajpur in Haryana, 19.5% in Type 3 in Uttarakhand, 14.5 to 22.7% in Pusa Basmati 1121 in Haryana and 38.2% in Pusa Basmati 1121 in Uttar Pradesh over farmer's practices (FP). In all the basmati rice trials, higher yield as well as Benefit - Cost (B-C) ratio was obtained in IPM as compared to FP. Implementation of IPM led to significant reduction in uses of chemical pesticides. In case of IPM, only 1.46 application of chemical pesticides (103.2 g a.i./ha) were undertaken in Pusa Basmati 1121 against 2.8 application in FP (1214.4 g a.i./ha) at Bambawad, Uttar Pradesh. ICAR-NRRI, Cuttack developed and validated IPM module at Sigmapur (Cuttack, Odisha) non-Basmati rice variety Pooja for four kharif seasons i.e 2010-2013 using standard agronomic practices. The trial resulted in an enhancement of 47.1% yield and 26.47 % B-C ratio over FP. Additional income of Rs. 9857/- per ha was also obtained in IPM over FP. On-Farm trial on validation of IPM module in non-Basmati rice (Pooja variety) under semi deep water conditions conducted in 10 ha during rabi 2017 at Nagapur and Basudeipur villages in Khurda district of Odisha resulted in reduction in the incidence of insect pests and diseases with higher population of natural enemies as compared to FP. Rice yield was recorded 5600 kg ha-1 in IPM as against 4900 kg ha-1 in FP. Recently, ICT based e-pest monitoring and advisory has become an important component for area wise implementation of IPM at state and national level. The programme has been successfully implemented in Odisha during 2010 and 2011 under RKVY. Implementation of the programme had resulted successful management of swarming caterpillar in 13 rice growing districts of Odisha during kharif 2010 and 2011.

Implementing the systems approach in rice pest management : India context

A basic IPM module for basmati rice as a part of integrated crop management accounting the pest prevalence and the information available from literature has been developed. As the module is location specific and dynamic, therefore needs regular updating and fine tuning depending on the location and pest prevalence. The technology has been successfully validated and implemented during 1998 to 2019 in Pusa Basmati 1, Taraori Basmati, Dehraduni Basmati, Pusa Basmati 1121 in Haryana, Uttar Pradesh and Uttarakhand with little modification and fine tuning. Implementation of the technology resulted in increase in rice grain yield i.e., 21.6% in Pusa Basmati 1 at Shikohpur, in Uttar Pradesh 21.5% in Taraori Basmati at Chhajpur in Haryana, 19.5% in Type 3 in Uttarakhand, 14.5 to 22.7% in Pusa Basmati 1121 in Haryana and 38.2% in Pusa Basmati 1121 in Uttar Pradesh over farmer's practices (FP). In all the basmati rice trials, higher yield as well as Benefit - Cost (B-C) ratio was obtained in IPM as compared to FP. Implementation of IPM led to significant reduction in uses of chemical pesticides. In case of IPM, only 1.46 application of chemical pesticides (103.2 g a.i./ha) were undertaken in Pusa Basmati 1121 against 2.8 application in FP (1214.4 g a.i./ha) at Bambawad, Uttar Pradesh. ICAR-NRRI, Cuttack developed and validated IPM module at Sigmapur (Cuttack, Odisha) non-Basmati rice variety Pooja for four kharif seasons i.e 2010-2013 using standard agronomic practices. The trial resulted in an enhancement of 47.1% yield and 26.47 % B-C ratio over FP. Additional income of Rs. 9857/- per ha was also obtained in IPM over FP. On-Farm trial on validation of IPM module in non-Basmati rice (Pooja variety) under semi deep water conditions conducted in 10 ha during rabi 2017 at Nagapur and Basudeipur villages in Khurda district of Odisha resulted in reduction in the incidence of insect pests and diseases with higher population of natural enemies as compared to FP. Rice yield was recorded 5600 kg ha-1 in IPM as against 4900 kg ha-1 in FP. Recently, ICT based e-pest monitoring and advisory has become an important component for area wise implementation of IPM at state and national level. The programme has been successfully implemented in Odisha during 2010 and 2011 under RKVY. Implementation of the programme had resulted successful management of swarming caterpillar in 13 rice growing districts of Odisha during kharif 2010 and 2011.

Challenges in diagnosing and managing adult patients with urea cycle disorders.

Urea cycle disorders (UCD) are a group of rare inherited metabolic conditions of amino acid catabolism caused by an enzyme deficiency within the hepatic ammonia detoxification pathway. The presentation of these disorders ranges from life-threatening intoxication in the neonate to asymptomatic status in adults. Late-onset UCDs can present for the first time in adulthood and may mimic other causes of acute confusion or psychiatric diseases, and are often associated with neurological symptoms. Late-onset UCDs may become apparent during periods of metabolic stress such as rapid weight loss, gastric bypass surgery, chronic starvation or the postpartum period. Early diagnosis is critical for effective treatment and to prevent long-term complications of hyperammonemia. The challenges of management of adults include for example: (a) poor compliance to dietary and medical treatment which can result in recurrent hospital admissions; (b) severe neurological dysfunction; (c) the management of pregnancy and the postpartum period; and (d) access to multidisciplinary care peri-operatively. In this review, we highlight a number of challenges in the diagnosis and management of adult patient with late-onset UCDs and suggest a systematic management approach.

Characteristics and predictors of adult frequent emergency department users in the United States: A systematic literature review.

We conducted a systematic literature review to identify and to update patient characteristics and contextual factors for adult frequent emergency department users (FEDUs) compared with non-FEDU in an era where the US health care system underwent substantial changes. We searched MEDLINE, CINAHL, and EMBASE to identify all relevant articles after 2010 through July 2018 that describe FEDU. We included US studies on adult FEDU only and excluded studies on specific subgroups of FEDU. We included demographic, clinical, and health care utilization information, and two reviewers independently evaluated the studies using the Joanna Briggs Institute Critical Appraisal tool. The 11 studies included in the review indicated that FEDU were 4% to 16% of total ED users but accounted for 14% to 47% of ED visits, with six to nine visits per year on average. The majority of FEDU were young or middle-aged adults, females, of low socioeconomic status and high school or less education, with public insurance, multiple primary care provider visits, and chronic conditions. Fair or poor self-perceived health status, unemployment, unmet needs from primary care providers (PCPs), mental health, and substance abuse were predictors of FEDU. FEDUs are disproportionally sicker and are also heavy users of non-ED health care service providers. The limited data for non-ED health services use in facility-specific studies of FEDU may contribute to findings in such studies that complex and unmet needs from PCPs contributed to ED visits. This suggests the need for more comprehensive data analysis beyond a few sites that can inform systemic management approaches.

Regional Engagement Program: Supporting Local Leadership and Building Local Skills and Knowledge in Order to Develop a Systematic Approach to Disaster Medical Management

Introduction:One of the key components in any effective disaster response is the capacity of local communities to respond in a timely and efficient manner. Over the last 3 years, the National Critical Care and Trauma Response Centre in Darwin has been involved in building regional capacity across the Asia-Pacific, supporting local leadership and building local skills and knowledge in order to develop a systematic approach to disaster medical management.Aim:This presentation is to describe the Regional Engagement Program, its strengths, weaknesses, and outcomes.Methods:We will describe the background to the program, the process for regional engagement and the Results of our evaluation. The program used the Major Incident Medical Management Systems (MIMMS) approach which was delivered in-country and included identifying and using local personnel to deliver the program. The program was conducted across the region in Myanmar, Fiji, Tonga, Vanuatu, Samoa, Timor, and Indonesia. Initially the courses were run by personnel from Australia but through engagement with local Ministries of Health and collaboration with identified key stakeholders, we have been able to build local faculty to ensure sustainability and local ownership.Results:Thirty-six personnel have been trained across four countries. Thirty-six candidates are now instructors, with a further 36 identified for future development as instructors. The evaluation illustrates the long-term partnerships that have been developed and the ongoing capacity development of key regional partners.Discussion:The Regional Engagement program demonstrates that prolonged engagement with key regional stakeholders and adequate and sustained mentoring will successfully build local capacity to the level needed to mount a successful response to a disaster. Personnel trained through this program helped guide the response to the Lombok earthquake and in Fiji, a MIMMS Team Member training program was conducted with minimal external support.

Environmental impact of carbon cross-media metabolism in waste management: A case study of municipal solid waste treatment systems in China

Waste treatment is a metabolic process that incurs pollutants migration across environmental media (i.e., air, water, and soil) and involves various conversions of physicochemical forms of carbon. Multiple forms of carbon compounds, such as CO2, CH4, CO, VOCs, and other organic matter can contribute to a series of transboundary environmental problems. However, current strategies targeting pollution reduction in single medium may cause pollution transfer to other environmental media, leading to comparatively large difficulty in assessing the related environmental impact on integrated ecosystems. This paper develops an analysis framework of carbon cross-media metabolism in municipal solid waste (MSW) treatment systems that include landfilling, composting, incineration, and anaerobic digestion. Life cycle impact analysis and sensitivity analysis methods are used to recognize the essential technologies in promoting the carbon cross-media migration and decreasing the integrated environmental impacts. The framework is implemented in a case study of the MSW treatment systems of 2013 in China. Results show that 86%–98% of carbon pollutants generated through landfilling, composting, and incineration ended up in the natural environment, while anaerobic digestion achieved an 87% pollution removal rate. Co-generation technology applied in incineration flue gas treatment, biochemical + membrane treatment technology in wastewater treatment, and co-processing of sludge in cement kilns were identified as the essential technologies affecting carbon migration across the gas-liquid, liquid-solid, and solid-gas interface, respectively. The relatively high environmental impacts of landfilling and incineration can be decreased by optimizing their technological compositions and applications. This study can provide support to replace the traditional environmental practice aiming at pollution control in single environmental medium independently by a systematic management approach that considers carbon cross-media metabolism and integrated environmental impact.

Impact of household air pollution on human health: source identification and systematic management approach

Household air pollution (HAP) is one of the most important global environmental and public health issues. As a result of changes in air composition due to rapid industrialization and urbanization, air quality is deteriorating and outdoor pollution is increasing daily. Simultaneously, poor ventilation, microbial growth, tobacco smoke, solid fuel use, and different toxic chemicals are causing deterioration in household air quality, which contributes significantly to the global burden of disease. This paper reviews the available literature to examine the impact of HAP on human health, comprehensively identifies the sources of HAP, and synthesize management approaches to reducing the severity of HAP. The English language databases PubMed, Google Scholar, Web of Science, and Science Direct were searched using the key terms: HAP, particulate matter, health risks, public health, pollutant sources, burden of diseases, and management approach. Bibliographies of all relevant articles were also screened to find further useful articles. This review addresses all possible sources of HAP that are categorized as biological or chemical (organic and inorganic) and are associated with grave public health threats, such as lung function reduction, respiratory illness, asthma, pneumonia, tuberculosis, eye diseases, pregnancy complications, cardiovascular diseases, and cancer. Suggested approaches, including compliance with international guidelines and regulatory frameworks, pollutant source reduction methods, and fulfillment of international environmental laws, conventions, agreements, protocols, and treaties, can be effectively adopted to mitigate household air pollutants, reduce the global burden of disease, and promote household environments that support better human health. The sources of HAP and its health impacts should be considered in the development of future policies concerning reduction in all household air pollutants worldwide. Therefore, this review establishes the groundwork for future studies assessing the effectiveness of strategies aimed at creating sound household environments to promote better human health.

Optimal Resource Utilization in a Multi-Microgrid Network for Tamil Nadu State in India

The emerging multi-microgrid technology owes its popularity to its ability to reduce the main grid burden congestion through optimal utilization of clean energy generating sources. Integration of a multi-microgrid network with the main grid acts as a major boost to the overall reliability of the power system. A novel energy management system approach is proposed in this work which exhaustively caters to all possible situations which may arise in a grid-connected multi-microgrid network during the scheduling of power exchange, a day ahead of the actual dispatch. A multi-agent control system is implemented in this work in order to facilitate information exchange in a multi-microgrid network for a deregulated framework of electricity market. The novelty of the research lies in the manner, the available renewable energy sources are utilized optimally, while maximizing social benefit of the overall multi-microgrid network. Also, the feasibility of the grid-connected multi-microgrid network is justified in the results obtained where the MGCC (Micro Grid Central Controller) decisions are presented, based on the optimization results. The developed approach is successfully implemented on two test microgrids proposed to be located in the Tuticorin city of Tamil Nadu state, India. The test microgrids are a modification of the standard PJM 5 bus system. Indian utility 62 bus system for Tamil Nadu state is utilized as the main grid interconnected with the proposed multi-microgrid network for power sharing purposes.

Spontaneous Intracranial Hypotension: A Systematic Imaging Approach for CSF Leak Localization and Management Based on MRI and Digital Subtraction Myelography.

Localization of the culprit CSF leak in patients with spontaneous intracranial hypotension can be difficult and is inconsistently achieved. We present a high yield systematic imaging strategy using brain and spine MRI combined with digital subtraction myelography for CSF leak localization. During a 2-year period, patients with spontaneous intracranial hypotension at our institution underwent MR imaging to determine the presence or absence of a spinal longitudinal extradural collection. Digital subtraction myelography was then performed in patients positive for spinal longitudinal extradural CSF collection primarily in the prone position and in patients negative for spinal longitudinal extradural CSF collection in the lateral decubitus positions. Thirty-one consecutive patients with spontaneous intracranial hypotension were included. The site of CSF leakage was definitively located in 27 (87%). Of these, 21 were positive for spinal longitudinal extradural CSF collection and categorized as having a ventral (type 1, fifteen [48%]) or lateral dural tear (type 2; four [13%]). Ten patients were negative for spinal longitudinal extradural CSF collection and were categorized as having a CSF-venous fistula (type 3, seven [23%]) or distal nerve root sleeve leak (type 4, one [3%]). The locations of leakage of 2 patients positive for spinal longitudinal extradural CSF collection remain undefined due to resolution of spontaneous intracranial hypotension before repeat digital subtraction myelography. In 2 (7%) patients negative for spinal longitudinal extradural CSF collection, the site of leakage could not be localized. Nine of 21 (43%) patients positive for spinal longitudinal extradural CSF collection were treated successfully with an epidural blood patch, and 12 required an operation. Of the 10 patients negative for spinal longitudinal extradural CSF collection (8 localized), none were effectively treated with an epidural blood patch, and all have undergone (n = 7) or are awaiting (n = 1) an operation. Patients positive for spinal longitudinal extradural CSF collection are best positioned prone for digital subtraction myelography and may warrant additional attempts at a directed epidural blood patch. Patients negative for spinal longitudinal extradural CSF collection are best evaluated in the decubitus positions to reveal a CSF-venous fistula, common in this population. Patients with CSF-venous fistula may forgo further epidural blood patch treatment and go on to surgical repair.

Evaluation of the Conceptual Theories, Elements, and Processes of Knowledge Management in Modern Day Organisations

AbstractThe objective of this paper is to evaluate the conceptual theories, elements, strategies along with the prospects and challenges of knowledge management (KM). The findings indicated that KM is a complex yet important process that requires organisations to create, process, disseminate and apply of knowledge. The findings also revealed knowledge is one of the most valuable resources of any organization. Therefore, effective KM is critical to the growth, performance, and survival of organisations. Furthermore, the many definitions of KM serve as a theoretical framework and empirical basis for multidisciplinary applications and prospects for organisations. Furthermore, the proper adoption and implementation of KM provides a systematic management approach for organisations to create, store, disseminate and apply knowledge critical to organizational performance and decision-making processes. Furthermore, KM can minimize the time, operational costs and material losses during product design, lifecycle, and quality assurance. Despite its merits, KM has numerous challenges. Most notable is the lack of an acceptable definition and understanding of KM concepts and practices. This can result in poor adoption and implementation thereby affecting sustainable organisational growth and development. Therefore, the paper concludes that KM adoption and implementation is critical to organisational goals, growth and performance.

Acute flaccid myelitis caused by enterovirus D68: Case definitions for use in clinical practice.

Acute flaccid myelitis (AFM) was increasingly detected in recent years, coinciding with upsurges of enterovirus D68 (EV-D68) infections. We reviewed the evidence for a causal relationship between both. Based on reported cases, we provide case definitions for AFM caused by EV-D68 infections to enable a standard procedure for affected patients. Current case definitions are focussing on epidemiological aspects but clinical case definitions are still missing. We propose the following case definitions to be used in clinical practice in order to mirror clinical realities and facilitate a common systematic approach in case management: A possible case is defined as a person presenting with either acute myelitis/paralysis or Guillain-Barré Syndrome (GBS), particularly during periods of EV-D68 circulation. A probable case is defined as a person presenting with symptoms of either acute myelitis/paralysis or GBS and at least one of the following criteria: i) MRI abnormality representing with T2 hyperintensity in spinal cord grey matter with or without hyperintensity at dorsal brain stem, ii) investigations showing an axonal neuropathy including reduced compound motor action potentials with normal conduction velocities and absence of conduction blocks compatible with anterior horn cell disease or iii) detection of enteroviruses in a respiratory specimen obtained from the lower respiratory tract during periods of EV-D68 circulation. A confirmed case is defined as a person presenting with acute flaccid myelitis/paralysis, MRI abnormality and detection of enterovirus-D68-specific nucleic acids in a respiratory specimen using a validated PCR assay targeting the VP1 gene with subsequent sequencing and typing.

Risk Assessment and Risk Perception of Trees: A Review of Literature Relating to Arboriculture and Urban Forestry

In the presence of a target, tree failures have the potential to damage property, disrupt services, or threaten public safety. Worldwide, several qualitative methods have been developed to provide a systematic approach for tree risk assessment and management. The consistency and accuracy of these methods, the values placed on the tree in question and its potential targets, and the risk perceptions and levels of acceptance of the evaluator and tree owner all influence how risk is managed. This review explores the concept of risk, examines and contrasts the most commonly referenced tree risk assessment methods, and summarizes research on public perceptions of trees and the risk of trees and greenspaces in built environments. The review identifies general summarized themes and gaps in the available literature to guide future research.

Systematic approach in identification and management of multiple alloantibody: A case of triple alloantibody

Alloimmunization is an adverse consequence of exposition to red blood cell antigens through transfusion, pregnancy, or transplantation. Alloimmunization to red cell antigens creates problem not only in immunohematological testing but also causes difficulty in finding compatible blood for those patients who develop multiple alloantibodies. Moreover, the development of multiple alloantibodies can significantly complicate transfusion therapy and/or provokes hemolytic transfusion reactions, the severity of which can vary from mild to extremely severe. We are presenting an interesting case with multiple alloantibodies. Patient's samples were investigated for antibody screening using commercially available three cell panels, and the antibody was identified using different lots of identification panel. Red cell phenotyping was done with minor blood group antisera. After workup, antigen-negative compatible blood was provided for transfusion.

La gestione del bosco come sistema biologico complesso: una questione di teoria e di metodo

For a long time, forest practice has been characterized by a linear paradigm: forest cultivation and management have been centred on the volume/regeneration relationship, considered respectively source of income and basis for sustained production. According to this paradigm, forest management has worked out a series of forest regulation methods with the aim of obtaining the “fully regulated forest”. These methods are firmly anchored to the mechanistic view of nature. Considering the forest as a complex adaptive system means overcoming the reductionist and mechanist paradigm and entails a shift towards a systemic approach in silviculture and forest management. The objectives and theoretical assumptions of classical forest regulation methods are discussed according to the new systemic paradigm. Managing forests as complex adaptive systems and sustaining their ability to adapt to future changes is possible only if there is also a change in forest management methods so that they are consistent with the new theoretical approach.

Considerations on United States Navy Infrastructure Readiness

The purpose of this qualitative grounded theory study was to examine the definition of infrastructure readiness in terms of Navy laboratories, and to define the best criteria or approach for effectively managing readiness to meet changing technical mission requirements. Through semi structured interviews with leadership about their perceived definition of infrastructure readiness and perceived adequacy of the current model, clarity emerged on the criteria for adequately defining, measuring, and assessing Navy laboratory infrastructure readiness. This will allow further evaluation of the existing system and identification of any gaps or risks. The primary goal of this study was to create an accurate definition of Navy laboratory infrastructure readiness, and subsequently, the key attributes to that readiness. The second goal of the study was to research other readiness systems to assess their readiness elements, and measures to determine the applicability to Navy laboratories and the feasibility of adaption of their systems for Navy laboratory use. The third and the final goal of the study was to further research on how to utilize existing models and systems in other areas to apply to any gaps identified through the interview process of the qualitative study. The study found that infrastructure readiness is viewed holistically as an environment to perform work, and includes items outside the technical definition of infrastructure, to include items like space, laboratory equipment, and processes, and that there are significant gaps in the existing Navy infrastructure readiness systems to manage many of these areas. In addition, two management system approaches emerged, tactical and strategic. Tactical management is focused on real-time management of systems to ensure a readiness state, while strategic management is more of a capacity management system to ensure adequate capacity when needed.