On-site Visits Research Articles

Tele-Dermatology during crisis, comparison of patients’ perspective between tele and onsite clinics

Objective: To assess patients’ satisfaction with tele-dermatology versus face-to-face visits, and to identify their attitude toward the new modality. Method: The cross-sectional study was conducted from January to December 2021 at the Department of Dermatology, Aga Khan University Hospital, Karachi, and comprised patients of either gender. Those who opted to personally visit the outpatient department were placed in group A, while those opting for tele-dermatology were placed in group B. A self-designed questionnaire was used to evaluate the experiences in both the groups. Scoring was done using a Likert scale. The responses were recorded as dichotomised, and a cut-off score of 14 was identified as an expression of satisfaction. Data was analysed using SPSS 20. Results: Of the 202 patients, 100(49.5%) were in group A; 65(65%) females and 35(35%) males, with 44(44%) aged 20-30 years. There were 102(50.5%) patients in group B, with 71(69.6%) females and 31(30.4%) males, and 42(41.2%) aged 20-30 years (p>0.05). Satisfaction was expressed by 94(46.2%) patients in group B compared to 108(53.8%) in group A. More females 48(57.1%) were satisfied than males 36(42.8%) in group A, while more males 50(69.4%) expressed satisfaction in group B females 22(30.5%). Conclusion: Tele-dermatology was found to be a valuable method to deliver healthcare which could be adopted in future practices. Key Words: Tele-dermatology, Onsite visits, Pandemic, Patients’ satisfaction.

A Comparative Analysis of Data Protection in E-commerce B2C Contracts in Georgia and the European Union

Development of technologies is a great human achievement. Online portals, mobile applications and digital platforms allow citizens to receive servicies remotely, which, on the one hand, reduces necessity of on-site visits and bureauctratic procedures, however, on the other hand, increases the risk of personal data disclosure processed in such manner. Digital tools play significant role in the process of E-commerce, especially in improving efficiency and accessibility of communication between the consumer and the trader. A lot of people communicate with the extensive use of the internet and technologies, including e-procurement, which, in these relationships require the correct processing of personal data, whereas improper protection of great deal of information increases risks of using data for criminal purposes and threatens personal privacy of consumers. Hence, it is important that organizations providing the internet services, especially those involved in e-commerce business, be well aware of obligations they are imposed by law. It is worth noting, that Law of Georgia “On Personal Data Protection” was adopted by Georgia in 2011, and its renewed version is quite similar to General Data Protection Regulation of Europe (DGPR) – which was adopted on June 14, 2023 and will enter into force on March 1, 2024. Within changes, the existed standard for personal data processing/protection will be substantially improved. As for protecting personal data processed on the basis of the B2C contracts concluded in the process of E-commerce, the interest regarding these topics increased after spread of coronavirus (Covid-19), when country faced new challenges. This issue is relevant even in the present time, since staying current with technological and legal development, renewed legal regulation and Association Agreement between the European Union and Georgia, imposes additional obligations on the country in the process of perfecting the mentioned field. Accordingly, this article will discuss compliance of regulatory framework of processing/protection of Georgian consumers’ personal data in the online contracts with international standards and existing challenges, to assume obligations of the country under the Association Agreement between Georgia and the European Union to implement E-commerce in practice, best practices of European countries in this regard and the perspective, which Georgia should implement in E-commerce process, in order to insure effective protection of consumers’ data security. It is worth noting, that Law of Georgia “On Personal Data Protection” was adopted in 2011 by Georgia, and its renewed version is quite similar to General Data Protection Regulation of Europe (DGPR) – which was adopted on June 14th, 2023 and will enter into force on March 1, 2024. Within changes, the existed standard for personal data processing/protection will be substantially improved. As for protecting personal data processed on the basis of the B2C contracts concluded in the process of E-commerce, the interest regarding these topics increased after spread of Corona Virus (“Covid-19”), when country faced new challenges. This issue is relevant even in the present time, since staying current with technological and legal development, renewed legal regulation and Association Agreement between the European Union and Georgia, imposes additional obligations on the country in the process of perfecting the mentioned field. Accordingly, this article will discuss compliance of regulatory framework of processing/protection of Georgian consumers’ personal data in the online contracts with international standards and existing challenges, to assume obligations of the country under the Association Agreement between Georgia and the European Union to implement E-commerce in practice, best practices of European countries in this regard and the perspective, which Georgia should implement in E-commerce process, in order to insure effective protection of consumers’ data security.

Hybrid Mentorship of Medical Laboratories to Achieve ISO 15189:2012 Accreditation in Malawi: The University of Maryland Malawi Experience.

As part of a laboratory strengthening program in Malawi to achieve and maintain International Organization for Standardization (ISO) 15189 accreditation, we intended to mentor selected HIV molecular laboratories to achieve this accreditation. Due to the COVID-19 pandemic, mentorship pivoted to a hybrid model using an Internet-based approach and on-site mentorships. We describe the implementation of this strategy, successes, and challenges. We conducted weekly, 1-hour virtual mentorship sessions for the 5 initial laboratories (cohort 1) selected based on their Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) performance score of 3 or more stars. Laboratories presented updates and supporting documents electronically, and trainings were conducted virtually. In September 2020, when travel restrictions were relaxed, we initiated hybrid mentorships and audits for cohort 1 laboratories. The same hybrid approach was used to mentor 4 additional laboratories in cohort 2. We performed descriptive analysis, and the Wilcoxon signed-rank test was used to compare the training pre-and post-test scores. Between March 2020 and May 2023, the team completed a total of 54 virtual mentorship sessions and 20 on-site visits across 9 laboratories. Overall, the team conducted 8 training sessions for 35 laboratory quality officers. Median score improvement (pre-test vs. post-test scores) was observed across individual trainings and across cohorts (P<.01). At the end of cohort 1, 4 of 5 (80%) laboratories were accredited. One laboratory that did not reach accreditation joined cohort 2. At the end of the mentoring period, all 5 cohort 2 laboratories were accredited. We demonstrated that using a hybrid mentorship model for accreditation was a successful strategy during the COVID-19 pandemic. For the first time in Malawi, this strategy resulted in accrediting 9 of the 10 HIV molecular laboratories in 3 years at a reduced cost. Continuous mentorship is key in the maintenance of accreditation.

Development of a tool to assess the compliance of cafeteria menus with the Mediterranean Diet

BackgroundThe Mediterranean diet (MD) has been considered one of the healthiest dietary patterns, and an excellent model of sustainability. Higher Education food services present an excellent scenario to encourage students healthy eating habits and modulate food choices. The purpose of this work was to develop an index to evaluate MD compliance with cafeteria menus.MethodsThree major axes were considered: MD key points, existing indexes on individual adherence to the MD and, existing indexes on menu assessment. The index includes four levels: (I) assesses the availability (IA), variety and frequency (IB) of food; (II) evaluates menu’s nutritional quality; (III) assesses the menu’s quality through information provided in the dishes’ technical specifications and (IV) allows a more detailed evaluation through on-site visits and documentation consultation. The components receive a score between − 2 and 3, according to the given answers. The final score may vary between − 33.5 and 41.5 points depending on the degree of compliance with the MD key points. The index was applied to 60 menus from different contexts using complete assessments of each menu, performed independently by 3 researchers, using the same pre-prepared Microsoft Excel® spreadsheet. Inter-rater reliability was assessed using Cohen’s Kappa and internal consistency with Cronbach’s alpha.ResultsAssessment for level I) returned a Cohen’s Kappa coefficient of 0.92 (p < 0.05) and a Cronbach’s alpha coefficient of 0.88. Dimension I is mostly influenced by subdimension IB (r = 0,97). The availability of non-starchy vegetables and fresh fruits has a stronger correlation with IA (availability of foods), and higher availability of fish, pulses and fruit has a strong positive correlation with IB (variety and frequency of foods).ConclusionResearchers believe that the index is a useful tool to assess compliance of menus to the MD and help identify the key points that need to be addressed and improved in cafeterias.

Potential Pesticide Misuse in Agriculture Farms from Two Costa Rican Provinces

Pesticide misuse by farmers poses hazards to human, animal, and environmental health. [Objective] This study aimed to document potential pesticide formulation misuse in agricultural farms. [Methodology] Inadequate storage practices, incorrect pesticide selection, and pesticide formulation overuse were documented through interviews and photographs on 13 agricultural farms from the Cartago and Guanacaste provinces of Costa Rica between August 2022 and April 2023. [Results] Storage room characteristics in many farms do not comply with safety standards prescribed by the Costa Rican Ministry of Agriculture and Livestock. Different active ingredients with herbicidal, fungicidal, insecticidal, and bactericidal properties are used in crop species for which they are not recommended. These substances include those from the carbamate, pyridine, cyclohexanedione, pyrethroid, conazole, benzothiazinone, oxadiazine, and phthalimide chemical groups in Cartago province, and from the neonicotinoid and pyrethroid chemical groups in Guanacaste province. Many pesticide formulations are utilized in quantities exceeding the manufacturers' recommendations. Among these formulations were bifenthrin, captan, oxamyl, cypermethrin, mancozeb, dimethoate, and deltamethrin in Cartago province, and imidacloprid in Guanacaste province. [Conclusions] These substances and their secondary metabolites have the potential to move across different environmental compartments such as water, soil, and air, thereby negatively affecting the health of community members rather than just the farmers applying these formulations. Well-established pesticide education programs based on on-site visits to farmers can enhance awareness about implementing good practices and ensure rational use of these substances, with positive results in non-target organisms such as humans and ecosystem service providers as well as natural and anthropogenic ecosystems.

Project Monitoring Based on View of All Project Partners At Digital Project Management Platforms

In the dynamic landscape of digital project management, effective project monitoring is critical for successful project outcomes. The emergence of digital project management platforms has revolutionized the way projects are monitored, enabling real-time collaboration and data-driven decision-making. Periodic site visits and gathering input from all project stakeholders are crucial for ensuring clear understanding of project progress by states institutional. With digital project management systems, on-site progress should be monitored in real-time and inclusive of all project stakeholders. The research investigates how collaborative monitoring fosters project progress of transparency and active engagement among project partners. By providing real-time visibility into project progress, tasks, and milestones, these platforms empower stakeholders with up-to-date information, enabling agile decision-making and prompt risk mitigation. This study explores how digital project management platforms integrate site monitoring evaluations and reporting tools, providing valuable data-driven insights into project performance. By considering periodic analytics, project partners can improve resource allocation, decision making process against possible bottlenecks at construction stages and boost productivity and inform states institutional to monitor project progress closely. Furthermore, the research examines the influence of these platforms on communication dynamics, promoting communication and efficient information exchange among project partners. Such enhanced communication capabilities result in improved team cohesion and collaboration, driving the project forward with synchronized efforts. In this study, the focus lies on tracking the progress of contractual agreements through digital platforms, enabling all stakeholders to monitor advancements. Specifically, the investigation centers on how the designated contractor responsible for project execution and the consulting firm appointed by the project owner can effectively track project progress on a periodic basis using digital platforms. In the context of transportation projects in Türkiye, a digital project tracking system has been developed for the Ministry of Transport and Infrastructure, through which data obtained from on-site visits and consultant opinions regarding project advancements are shared with the Ministry. Subsequently, the responsible contracting authority, guided by the consultant's feedback, can respond and evaluate progress accordingly. This approach ensures that project advancements are accurately monitored by all stakeholders of the project. To do so, this study investigates the utilization of the prepared digital platform to facilitate rapid and precise contract monitoring by all project stakeholders, encompassing the opening information and assessment evaluations based on stakeholders' perspectives.

A Practical Exploration on the Teaching Reform of Integration of Production and Teaching in College Students' Labor Education Curriculum

In March 2020, the Central Committee of the Communist Party of China and the State Council issued the "Opinions on Strengthening Labor Education in Colleges and Universities in the New Era," emphasizing the "need to fully recognize the new requirements for cultivating socialist builders and successors in the new era for strengthening labor education; to build a comprehensive labor education system that reflects the times; to conduct extensive labor education practical activities; to enhance the support and guarantee capacity for labor education; and to strengthen the organization and implementation of labor education." As a result, labor education has become a required course for students majoring in Test and Control Technology and Instrumentation. The course is divided into two parts: theoretical learning and practical learning. Due to the increasing social emphasis on labor quality education and its reflection in the key role it plays in solving complex engineering problems, the traditional "walking-horse-view" theoretical teaching method and "visiting-style" practical teaching method are no longer suitable for the new teaching needs in the contemporary context. Therefore, in order to improve the teaching quality and students' learning effect of the flexible and open knowledge, Changzhou Institute of Technology's Test and Control Technology and Instrumentation major has invited the technical directors of representative enterprises in the industry to conduct case analysis in class and on-site visits, achieving the goal of joint teaching reform between schools and enterprises. Bringing the latest industrial status and development trends of Test and Control Technology and Instrumentation technology into classroom teaching, it effectively improves the teaching quality and deeply cultivates students' labor awareness.

A multi-case study exploring the effect of interventions on food safety culture maturity

In each food business, a food safety culture (FSC) with a certain maturity level prevails. Previous research has demonstrated that the maturity level of the prevailing FSC can be assessed, but empirical proof of FSC maturity improvement remains limited especially in food processing companies. This study aimed to zoom in on the food safety culture improvement trajectory of four food processing case studies, focusing on human-organizational dimensions of food safety culture. First, a pre-assessment of the maturity of the prevailing food safety culture was executed in each case company (assessment time 1) by application of a validated mixed-methods methodology which includes three different tools (the food safety climate questionnaire, management interview, and on-site evidence collection visits). Based on this pre-assessment, underdeveloped dimensions or gaps in the prevailing food safety culture were identified to find improvement needs. In each of the 4 included distinct case companies, an intervention was implemented. In the first case company, case 1, a food safety key performance indicator (KPI) system was implemented as the intervention, with shared monitoring and shared responsibilities for KPI improvement. Coincidentally, case company 2 and case company 4 selected the same intervention. Case 2, as well as case 4, decided to implement structured group discussions with operators to collect input for collaborative action point selection, aiming for their active involvement in food safety. In case 3, a food safety culture check system was implemented for systematic reward and recognition. After intervention implementation, the post-assessment was conducted (assessment time 2), applying the exact same methodology as the pre-assessment. To investigate the extent of improvement, comparison of the pre- and post-assessment in each of the four cases was first done descriptively by comparing the means. Next, data collected via the food safety climate questionnaire was compared statistically via Mann-Whitney U tests. Analyses showed a substantial objective and subjective (employees’ perceptions) improvement of the targeted food safety culture gaps in companies 1 and 2, demonstrating that food safety culture improvement was achievable through a science-based and cocreated intervention process and implementation plan compliance. In cases 3 and 4, marginal improvements and unchanged scores were revealed. Comparison of cases’ trajectory characteristics and resulting success rates demonstrated that senior management involvement was essential for interventional success, as well as implementing culture interventions on an organizational or group level, instead of only including selected employees.

Potencial de contaminação das águas subterrâneas por necrochorume em Bragança – Pará

The objective of this research was to evaluate the potential for groundwater contamination by cemetery activity in Bragança, Pará, through geospatial analysis of the areas directly affected by the necropolises: Santa Rosa de Lima and Campo da Saudade. To prepare the geomorphological, pedological, relief, and altitude characterization of Bragança, we used free images from high-resolution satellites – Planet, Dove sensor and Alos Palsar, Alos sensor, which were processed in the ArcGis 10.5 software. Later, an on-site visit and photographic recording of the cemeteries were also conducted to check for non-compliance with current burial legislation. As the main results, it can be deduced that the current situation of the analyzed cemeteries is worrying, as they are in soils whose ability to retain trace elements (heavy metals) and humorous liquids is low, on minimum slopes and at inappropriate distances between graves and aquifers underground. Furthermore, it was observed that Bragantino cemeteries disagree with cemetery legislation, but there is an understanding that there are techniques and technologies for adaptation. It is believed that involving the population and pluralizing environmental and sanitation issues can support negotiations on how and when they will manage their burial activities to guarantee the perpetuity of the maximum quality of Bragança's water and soil resources.

Medication adherence and antithrombotic therapy outcomes: insights from a post-hoc analysis of the AFIRE trial

Abstract Background The AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial established noninferiority in efficacy and superiority in safety endpoints of rivaroxaban monotherapy over rivaroxaban plus antiplatelet therapy (combination therapy) in patients with atrial fibrillation (AF) and stable coronary artery disease (CAD). However, the impact of medication adherence to rivaroxaban on AFIRE study outcomes remains unclear. Purpose This post-hoc analysis aimed to explore the influence of medication adherence on AFIRE trial results. Methods Among 2,120 patients, participants were classified into adherent and non-adherent groups based on self-reported measures, which were further verified through on-site visits to the facilities. Adherent patients were defined as those who reported consistently taking their medication as prescribed. The primary efficacy endpoint comprised stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or all-cause death, including cerebral events. Analysis also examined differences in the primary efficacy endpoint between adherent and non-adherent patients. Results Of the 2,120 patients, 2,012 (94.9%) were adherent to rivaroxaban, while 108 (5.1%) were non-adherent. Among adherent patients, rivaroxaban monotherapy showed significantly better efficacy outcomes compared to combination therapy (hazard ratio [HR] 0.73; 95% confidence interval [CI] 0.54–0.98; p=0.04, Figure 1A). However, primary efficacy outcomes did not significantly differ among non-adherent patients (HR 0.64, 95% CI 0.23–1.81, p=0.40, Figure 1B). Adherent patients exhibited improved outcomes relative to non-adherent patients, though this difference was not statistically significant (HR 1.68; 95% CI 0.99–2.85; p=0.05, Figure 2A). In clinically high-risk patients with a history of angina pectoris, those who demonstrated adherence to medication (n=1281) exhibited significantly better efficacy outcomes compared to non-adherent patients (n=68) (HR 1.97; 95% CI 1.09–3.56; p=0.03, Figure 2B). Conclusions Rivaroxaban monotherapy versus combination therapy showed favorable efficacy outcomes in patients with good adherence, consistent with the overall AFIRE trial. However, these benefits were not observed in non-adherent patients. Adherence to rivaroxaban is crucial for achieving its maximum therapeutic effect as monotherapy.Figure1Figure2

“Filling the void”: the diversified grassroots disaster narratives of the 2023 riverine flood in Z City, China

PurposeDisaster narratives constitute a crucial and unique element in disaster understanding, recovery and communication. Along with facing various severe disasters, China’s dominant official disaster narratives have played an indispensable role in promoting post-disaster social solidarity. However, the consequences of “weak” official disaster narratives remain unknown.Design/methodology/approachIn 2023, during a riverine flood in northern China’s Z City, diversified grassroots disaster narratives emerged, “filling the void” when the official narratives were comparatively “weak”. This paper uses this riverine flood in Z City as an uncommon case to analyze the official-grassroots disaster narrative interaction. During fieldwork, first-hand and second-hand data from in-depth interviews, on-site visits and public information were collected.FindingsBased on fieldwork, this paper first introduced the “weak” official disaster narratives in Z City. Second, this paper organized and classified these grassroots disaster narratives into three interconnected stages: the flood’s causes, government and social responses, and recovery. In “filling the void,” “sacrifice” and “betrayed” sensemaking are detected and functions of these diversified grassroots disaster narratives become clear.Originality/valueOfficial and grassroots disaster narratives are not simply competing, but complementary. As a unique soft lens to interpret disasters, this paper further discussed grassroots disaster narratives’ underlying connotations and potential impacts on social resilience building. Also, this paper provides insights into the disaster narrative dynamics, especially in China’s political and cultural context.

Feasibility of a complex psychosocial intervention for families with parental cancer: acceptability, suitability, implementability, and perceived support

PurposeThis study aimed to assess the feasibility of a comprehensive psychosocial intervention for families coping with parental cancer.MethodsA quasi-experimental trial with intervention and control group, employing a mixed-methods approach, was conducted. A total of 472 families affected by parental cancer participated. The feasibility of the intervention was evaluated based on study monitoring measures (on-site visits, team supervision meeting observations, case conference observations, best practice workshops, coordinating information exchange between intervention sites, and reviewing intervention documentation), process evaluation (semi-structured interviews, focus group discussion) and survey data. Data analysis involved thematic coding and descriptive statistics.ResultsThe intervention was well-received by the participating families, with a high degree of acceptance observed. The feasibility of the intervention was found to be associated with specific dynamics within each family system and the motivation of the family members. The success of the intervention was described as dependent on the family-centered arrangement of the encounters, including factors such as frequency, duration, and mode, which greatly influenced its overall acceptability.ConclusionThe family-scout intervention demonstrates its feasibility as an effective intervention to reduce the burden experienced by families coping with parental cancer. Psychosocial oncology services should continue to develop and implement family-centered interventions to offer support to families during their cancer journey.Trial registrationClinicalTrials.gov, NCT04186923. Retrospectively registered on 4 December 2019.

Techno-economic and environmental analysis of hybrid energy system for industrial sector of Pakistan

The industrial sector of Pakistan is currently facing severe load-shedding, which ultimately affects its unit production. The greater dependency on conventional energy resources (Thermal, Nuclear, etc.) results in higher production costs and environmental pollution. A sustainable, cost-effective, and environment-friendly solution can help the industrial growth of Pakistan. This article proposes an optimal hybrid energy system (HES) for the industrial sector of Pakistan to overcome the mentioned challenges. The proposed HES is developed in HOMER Pro. Three different energy cases (Case I: Existing energy system including a utility grid and diesel generator, Case II: On-grid Biogas system, and Case III: On-grid PV system with batteries) are considered for the Gourmet food Industry in the Sundar Industrial estate, Pakistan. The Load profile of the selected site was calculated through on-site visits and data provided by the designated utility grid feeder. The analysis shows that Case III is more effective than other cases, indicating reduced Net Present Cost (NPC), Cost of Energy (COE), and Operating Cost (OC) to $ 19.2 million, $0.034/kWh, and $ 573,371/year respectively. Moreover, the On-grid PV system with batteries (Case III) provides an environmentally friendly solution by reducing 63.82% \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:C{O}_{2}$$\\end{document} by and 62.22% \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:{NO}_{x}$$\\end{document}. Comparing the sensitivity analysis for various grid sell-back prices ($0/kWh, $0.043/kWh, $0.061/kWh, and $0.09/kWh), Case III is more cost-effective than Case II. The revenue generation in Case III is $128,499.41/yr, considering the supply of excess electricity into nearby small industrial loads at $0.065/kWh, this indicates that installing optimal HES in industries will not only help in overall cost reduction but also support in mitigating environmental pollution and load shedding.

Patients' experience of telehealth clinics during the COVID-19 pandemic: Cross-sectional study.

Globally, the Coronavirus disease (COVID-19) pandemic in 2019 has accelerated the adoption of telehealth technologies. The implementation of the Saudi Telemedicine Network (STN) and other digital health initiatives, such as the telehealth clinic (THC) at King Abdullah bin Abdulaziz University Hospital (KAAUH), exemplifies this trend in Saudi Arabia. The aim of this study was to explore the patients' experience of THC in KAAUH during the COVID-19 pandemic and their' beliefs about their readiness to replace the traditional onsite clinical visits with THC from March to September 2020. A cross-sectional study targeted all 1398 patients who utilized THC at KAAUH. A self-administrated, validated survey collected the data. The survey used a Likert scale and included questions on satisfaction with THC services and the perceived effectiveness of telehealth as a substitute for in-person visits. The collected data was analyzed using frequency and percentage. A total of 252 patients responded to the THC postvisit survey. Overall, 217 patients (86%) were satisfied, 32 patients (13%) were dissatisfied, and only 3 patients (1%) were neutral about THC. Most patients (65.5%) agree that THC provided enough information about their health conditions, which can substitute for clinical visits. About 18.3% of patients were neutral, while 16.3% disagreed with the effectiveness of THC services and believed that they could not replace onsite visits. During the COVID-19 pandemic, most patients were satisfied at KAAUH-THC in Saudi Arabia and believed that it could replace the onsite visit to a physician's clinic. The 2 main causes of the patient's belief that THC could not replace an onsite clinical visit were: First, nonadherence to appointments led to missed calls and a complete medical service. Second, the patient's perception is that a physical examination and lab investigation cannot be completed through THC.

Pathway to Excellence: One Institution's Experience Obtaining the Joint Commission's Advanced Total Hip and Total Knee Replacement Certification.

As the prevalence of total hip and total knee arthroplasty procedures increase over the next decades, hospitals seek opportunities to improve quality outcomes while simultaneously limiting costs and mitigating risks of complications. The Joint Commission's Advanced Total Hip and Total Knee Replacement (THKR) certification is one of the highest quality standard certification programs in the nation and is the only one that collaborates with the American Academy of Orthopedic Surgeons. To obtain THKR certification, several requirements based on evidence-based clinical practice guidelines must be met. The process is described from initial identification of stakeholders to ongoing efforts to retain certification. Joint Commission THKR certification was awarded after rigorous review and on-site visit. Compliance with advanced care standards from the time of orthopedic consultation through postsurgical follow-up was reviewed. Joint Commission THKR certification provides supporting evidence of the institutions journey in processes toward delivering high quality clinical care. A multidisciplinary team with ongoing collaboration is necessary to obtain and retain certification.

The Study of Zodiac Culture on the Development and Management of Cultural Brands in Jingdezhen Ceramics

Background and Aim: Based on the Chinese zodiac culture, this paper explores the brand management of contemporary zodiac ceramics in Jingdezhen. The zodiac culture is one of the most widespread traditional cultures in China, intimately related to every Chinese individual and permeating various fields of Chinese cultural and artistic expression. Regardless of the occasion or form of expression, zodiac patterns exhibit distinct local characteristics and artistic styles. The zodiac accompanies individuals throughout their lives, serving as a symbol used for age counting while also imbuing auspicious meanings and hopeful aspirations. Belonging to the realm of excellent folk art, zodiac culture shines as a brilliant gem in the treasure trove of Chinese culture. Through the study of zodiac ceramics, it is hoped not only to gain a systematic understanding of Chinese zodiac culture but also to reflect the artistic charm of Jingdezhen ceramics. This endeavor aims to inspire ceramic artists and designers, fostering their enthusiasm for creation to produce better works. Consequently, it will lead to a new development for Jingdezhen's zodiac ceramics and ultimately establish a brand for zodiac ceramics. Materials and Methods: This study adopts the methods of literature review and questionnaire survey to provide a theoretical basis and ideological foundation for the application of zodiac culture in ceramic product design. Relevant journals, academic papers, books, magazines, and online information related to zodiac culture and ceramics are reviewed and organized. Experts, enterprises, and designers are grouped for interviews, and surveys are conducted to understand the clear context of the development of zodiac ceramics and the market trends of ceramic cultural and creative products. In terms of expert selection, we will interview Professor Cao Chunsheng, a doctoral supervisor at Jingdezhen Ceramic University; Zhang Jinghui, president of Jingdezhen Sculpture Association, engaged in the production of zodiac products; and Yu Zhichao, founder of Ceramic Gift Brand, and product designer. We use interview forms and on-site visits to comprehensively understand the current development status and trends of the zodiac in Jingdezhen from academic, production, and design perspectives. Results: The research findings indicate that zodiac culture is a significant component of traditional Chinese culture. Zodiac ornamentation is frequently utilized in the design and production of ceramics in Jingdezhen as a traditional cultural symbol in China. With the continuous attention to zodiac culture and the persistent pursuit of creative design, the development prospects of zodiac ceramic cultural and creative products will continue to expand, bringing forth more market opportunities and cultural value. The establishment of zodiac brands plays a crucial role in driving the development of zodiac culture. Building a zodiac ceramic brand is not only about product sales but also about cultural expression and the transmission of values. Establishing a zodiac ceramic brand is not only a commercial necessity but also a practical endeavor to inherit and promote traditional culture. Conclusion: Zodiac ceramics serve as one of the carriers of the zodiac culture. By incorporating zodiac elements into ceramic brands, products can be endowed with richer cultural connotations, attracting cultural enthusiasts and collectors. There is a close connection between the promotion of zodiac culture and the management of zodiac ceramic brands, which mutually promote each other. Through the inheritance and promotion of zodiac culture, we can not only promote traditional culture but also provide new opportunities for creative industries and brand management. By combining creative design, cultural education, and marketing strategies, zodiac ceramic brands can achieve greater commercial success while playing a positive role in the inheritance of cultural traditions.

Authenticity matters: investigating virtual tours’ impact on curiosity and museum visit intentions

PurposeThis study aims to investigate the impact of virtual museum tours on intentions to visit on-site museums. Furthermore, the role of an authentic virtual tour experience and its drivers is examined.Design/methodology/approachThe results of two studies, a field study in collaboration with one of the most renowned museums in Austria (n = 227) and an online survey (n = 153), were analyzed with a series of mediation models.FindingsVisual appeal and narrative quality were significant drivers of an authentic virtual tour experience. Curiosity mediated the positive effect of virtual tour usage intention on on-site museum visit intention.Originality/valueAlthough virtual reality has been considered a promising marketing tool in tourism, no research has explored the drivers of an authentic virtual tour experience. The findings of this study not only add new insights into the role of a virtual tour’s visual appeal and narrative quality in generating authentic experience and thus prompting virtual tour usage intentions but also demonstrate that virtual tours positively impact on-site visit intentions driven by curiosity.

Analysis of user acceptance of information and communications technology for electrical safety inspection based on a choice experiment and hierarchical Bayesian model

The development of information and communications technology has resulted in changes in electrical safety inspection. Electrical safety inspectors plan to introduce smart devices that detect causes of extensive electrical fires in real time without problems of power disconnections and on-site visits. However, smart inspection is expected to encounter acceptance issues because users are unaccustomed to it and obligated to pay additional costs for device installation and data communications. This study aims to investigate smart inspection acceptance using survey data. A hierarchical Bayesian model is employed to explore the effects of users' characteristics on its acceptance. The respondents prefer attributes of smart inspection to those of the prevailing method of on-site inspection, excluding monthly inspection costs. They prefer more frequent and extensive inspections, and prefer to avoid power disconnections and physical interaction. Accordingly, the government should inform users that smart inspection is convenient and accurate. It is also attractive to users who wish to avoid on-site visits because of privacy issues. The acceptance rate can increase if the government reduces inspection costs using the existing smart devices and communications infrastructure, and offers real-time electrical safety information using smart phones and in-home displays.

Long-term and low-dose rituximab treatment for chronic inflammatory demyelinating polyneuropathy.

To evaluate the efficacy and safety of a low-dose, long-term rituximab regimen in the treatment of idiopathic CIDP. This study included 15 CIDP patients treated with rituximab. Patients were administered 600 mg of rituximab intravenously every 6 months. Baseline evaluation was conducted before the initiation of rituximab treatment and subsequent evaluations were conducted 6 months after each rituximab infusion at on-site visits. Clinical improvement was objectively determined by improvement of scale score at least decrease ≥1 INCAT or mRS or increase ≥4 MRC or ≥8 cI-RODS after each infusion compared to baseline evaluation. Fifteen CIDP patients were included and 10 of them were typical CIDP and five were distal CIDP. Nine in 15 (60%) patients after first infusion and three in six (50%) patients after second infusion exhibited significant clinical improvement compared to baseline evaluation. Additionally, rituximab facilitated a reduction or cessation of other medications in 73% of patients at last visit. The safety profile was favorable, with no reported adverse events. Rituximab presents a promising therapeutic option for idiopathic CIDP, offering both efficacy and safety with a low-dose, long-term regimen.

The Breeding colonies, population growth and breeding success of the Dalmatian pelican Pelecanus crispus in Greece: a country-wide perspective, 1967-2021

Greece holds the third larger breeding population of Dalmatian Pelican in the world. We present data about the establishment and growth, breeding performance and conservation status for all six colonies of the species in Greece for 40 years. Main features of wetlands and colonies are described. We discuss the local, regional and global natural and anthropogenic factors that may have affected colony growth. After 1982 colony surveys were carried out with various methods, adapted to the particularities of each wetland and availability of resources, and targeted estimating number of nests and number of near-fledged young via direct counting either during on-site visits or from vantage points, and recently, counts on photos taken by drones flown one or more times during breeding. Number of nests in Lake Mikri Prespa rose from ca. 100 to 1200-1500 and levelled-off. DPs from Prespa started breeding successfully in Kerkini in 2004 after placement of artificial nesting rafts. The Karla Reservoir was colonised in 2011, just two years after it started filling with water. The DP colony on Lake Chimaditis, an important stop over and feeding site, probably initiated around 2016 and continues growing. The two colonies at the western coastline have limited exchanges with those in the eastern part of the country. Amvrakikos increased and levelled off recently as conservation and management measures restricted disturbance, whilst emigrants re-established the old colony at Messolonghi in 2011 which continues to grow. The overall breeding population in Greece grew from ca 100 to over 2000 br pairs showing an annual growth rate of 7.9%. Younger colonies show high annual growth rates clearly attributed to immigration, while older colonies have growth rates less than 10%. Interacting natural and anthropogenic factors are assumed to have contributed to pelican increase in Greece the last 40 years: better legal protection status, increasingly effective protection, patrolling and conservation measures; public awareness campaigns; provision of artificial nesting structures; increased winter survival due to higher temperatures owed to climate change; less disturbance and persecution due to decline of fisheries; increasing abundance and availability of fish due to eutrophication and climate change; increasing numbers of sympatric great cormorants rendering pelican fishing more efficient; appearance of new wetlands and change of wetlands due to human intervention works.