Primary Management Objective Research Articles

SONOGRAPHIC IMAGING OF ACUTE SCROTAL PAIN

Background: An acute scrotum is defined as acute pain with or without scrotal swelling, may be accompanied by local signs or general symptoms. Acute scrotal pain is a medical emergency. Depending on cause, the management is entirely different. Torsion of testis and strangulated hernia are surgical emergency; whereas, epididymo-orchitis is treated by medicines. Testicular trauma and obstructed hernia can be differentiated by taking history from patient. Clinical /Physical examination adds only a little information. Color Doppler ultrasound is the modality of choice to differentiate testicular torsion from inflammatory conditions.
 Aim of Study: The aim of this study is to observe the epidemiology of acute scrotum and their presentation, there by facilitating a systematic approach in identifying those patients who need early intervention to decrease associated morbidity and mortality.
 Conclusion: Acute scrotum is a common case seen in the today's scenario with considerable mortality and morbidity. In our study acute epididymo-orchitis was the commonest cause followed by torsion of testis the primary objective of management of acute scrotum is to avoid testicular loss. Acute scrotal swellings are common in younger & middle age individuals with variable symptoms. These cases need careful examination, proper evaluation and prompt treatment. The likelihood of testicular salvage in torsion depends on the interval between onset of pain and surgical intervention. Routine clinical examination gives only a little information. Doppler ultrasound assessment of patients at intermediate clinical risk of testicular torsion significantly reduced the frequency of negative surgical explorations without increased rate of missed testicular torsions.(1) In the imaging algorithm for testicular torsion in childhood, we differentiate between the two main entities, the peri- and neonatal torsion and torsions in children and infants older than 1 month. Imaging should not cause any delay in diagnosis but contribute to increase the specificity of diagnosis of testicular torsion in order to avoid unnecessary surgical explorations. (2)
 Keywords: Sonographic Imaging in Acute Scrotal Pain.

Pemanfaatan Teknologi Informasi dan Manajemen Perubahan Organisasi dalam Mendukung Bisnis Berkelanjutan Pasca Covid-19 pada UMKM di Kota Bengkulu

Abstract The purpose of this study is to examine how information technology and organizational change management can be used to support sustainable business in Bengkulu City MSMEs following Covid-19. To survive the COVID-19 pandemic, the role of information technology and organizational change management is critical, as information technology serves as a manager of the information available at the time. Change management provides a structured approach for assisting individuals within an organization in transitioning from their current state to their desired state. Organizational change management is concerned with identifying groups and individuals who must change. Not only that, organizational change management entails the development of customized plans for successfully implementing the change. The primary objective of change management is to prepare for a smooth, successful transition.

A framework for the assessment of qualitative and quantitative sustainable development of groundwater system

AbstractThe groundwater mitigation issues and moving toward sustainable quality and quantity conditions of the aquifers are primary water resources management objectives in arid and semi‐arid regions. A framework is required to assess groundwater restoration strategies' impacts on the aquifer's qualitative and quantitative sustainability. In this study, two new indices are introduced to evaluate the state of aquifer sustainability. The aquifer quantity restoration index was determined by using the results of the MODFLOW, considering the differences between the simulated and the desired water levels and the storage volumes for restoration scenarios, and the percentage of obtaining the desired level at the end of the simulated period. The aquifer quality restoration index was defined based on the DRASTIC‐LU aquifer vulnerability and the percentage of the desired total dissolved solids (TDS) goals at the end of the simulated period using the Bayesian networks model. Six restoration groundwater scenarios in 10 years were assessed to examine both proposed indices. Scenarios are comprised of a one to 3.5% reduction in agriculture groundwater withdrawal. The aquifer quantitative restoration index resulting from the MODFLOW simulation indicated that 2.5% of the decrease in groundwater withdrawal satisfied the aquifer's sustainability. Furthermore, the qualitative sustainability index showed that the reduction in groundwater withdrawal has enormous impacts on the aquifer's central area and marginal parts, where the groundwater is dramatically over‐exploited. Indices proposed can be utilized for the assessment of achieving sustainable management in groundwater by restoration scenarios.

Resource-Based Quality Performance Estimation Method for Construction Operations

Construction quality is one of the primary management objectives relating to duration and cost for construction projects. Project managers struggle with minimizing duration and cost while maximizing quality for construction projects. In construction projects, duration and cost have management priorities. On the other hand, quality is considered a matter of achievement only when it reaches a certain level. Although the importance of quality control in construction management has been constantly discussed, it has still been sacrificed under the goal of shortening construction duration and reducing costs. This study presents a method for estimating the quantitative quality performance of construction operations in which the level of detail is breaking into the work task level for intuitive quality performance evaluation. For this purpose, quality weights of resources that have a proportional quality importance weight and quality performance indexes of resources are utilized for estimating the quantitative quality performance of construction operations. Quality performance estimation and the resource allocation optimization system is presented and validated using a construction simulation model.

Enabling conditions for community-based comanagement of marine protected areas in the United States

Comanagement is recognized, practiced, and recommended as an effective, equitable approach to place-based protection of marine resources. Despite acknowledged benefits and its potential for improved management outcomes, in the U.S., comanagement of marine protected areas (MPAs) is a relatively new approach, with limited applications. This paper reveals social, ecological and institutional conditions that enabled, or hindered, development of comanagement as an outcome of collaborative processes undertaken by community-based actors and state-based resource managers in three U.S. MPA case studies. A mixed method design, consisting of a literature review, in-depth interviews and document analysis was used to analyze MPAs in Hawai‘i, California and Florida where: (1) comanagement systems have developed between state government and community-based partners, (2) protected area boundaries and objectives are clearly defined, and, (3) marine habitat protection is a primary management objective. Eight enabling conditions were present in all three cases. Four of these conditions were consistent with preconditions identified in a published conceptual framework for comanagement arrangements synthesized from the literature and direct observations – an opportunity for negotiation, a legally mandated or brokered incentive, a willingness by local users to contribute, and leadership. Four more enabling conditions emerged from this study – connection to place, a capacity crisis, government willingness to partner, and a clear and just process. As managers strive to protect marine ecosystem function in the face of chronic environmental stressors and limited government support for environmental protection, applying these findings to leverage conditions that enable comanagement can help build community-based capacity to effectively manage MPAs.

АНТИКРИЗОВЕ УПРАВЛІННЯ В УМОВАХ ПАНДЕМІЇ

In conditions of global pandemic, implementation of efficient crisis management system should be among crucial tasks of enterprise management. The research is targeted at processes of enterprise crisis management system control in conditions of pandemic. The economic essence of crisis management is the subject of the research.The paper deals with the issue of crisis management implementation at the enterprise in conditions of pandemic, theoretical substantiation and development of practical recommendations for enterprise management in crisis conditions. Differences between conventional crisis phenomena and pandemic-related business disruption are identified. Parameters of entrepreneurial activity support by world countries’ government institutions are analyzed. The primary objective of crisis management in the context of pandemic is highlighted. The three key cycles of crisis management introduction in pandemic conditions are defined: the shock – personnel protection, situation understanding and business continuity control; the waiting – personnel and business management during the crisis; and the recovery – business recovery, loss assessment and rapid rehabilitation. Key issues of personnel management at crisis-stricken enterprise and challenges facing human potential management at crisis-stricken enterprise are reviewed. The need in crisis management system implementation at homeland enterprises to ensure economic development is substantiated. It was determined that crisis management in pandemic conditions must provide for evaluation of quarantine mode’s advisable time limits in the context of all the risks identified and for adequate adaptation of crisis response measures. It has been proven that implementation of proposed actions will make it possible to prevent and overcome the crisis situation and to maintain the enterprise’s sustainable marketplace position, to stabilize the enterprise’s viability in challenging economic situations. A number of problematic issues associated with crisis management in conditions of global pandemic were also highlighted.

Expected Economic and Biological Impacts of Recreational Atlantic Striped Bass Fishing Policy

Understanding how recreational angling effort responds to regulatory adjustment is important for rebuilding overfished stocks such as Atlantic striped bass Morone saxatilis. In this paper, we use stated preference choice experiment data to evaluate how individual angler participation may respond to changes in fishing trip characteristics, particularly the number of small, medium-sized, and trophy striped bass kept and released. We use these results to simulate the aggregate effect of alternative fishing policies in Massachusetts, Rhode Island, and Connecticut on angler welfare, angler effort, recreational fishing mortality, and female spawning stock biomass. We find that a wide range of economically efficient policies are available if the primary management objective is to control recreational fishing mortality. In contrast, we find that the range of efficient policies is quite narrow if the primary management objective is to protect female spawning stock biomass. Additionally, only one of the 36 alternative policies analyzed; a one-fish harvest slot of 28” to 36”, is expected to achieve a nontrivial reduction in both total and female spawning stock removals relative to the actual 2015 policy of one fish, 28” or longer. Implementing a one-fish harvest slot of 28” to 36” comes with minimal costs in terms of foregone angler welfare due to the relatively low rate at which trophy striped bass in excess of 36” are encountered.

Protecting timberland RMZs through carbon markets: A protocol for riparian carbon offsets

Riparian Management Zone (RMZ) allocations can place a burden on landowners due to restrictions (sometimes prohibitions) on harvesting. The opportunity cost for the landowner may be minimized by shifting the primary management objective in RMZs from timber production to compensation for above-ground carbon. Our primary objective was to compare long-term net revenue generating potential of RMZs under three scenarios: (I) compensation for carbon credits without harvesting; (II) partial harvesting using Best Management Practices (BMP) guidelines without carbon credits; (III) partial harvesting combined with carbon credits as per the California Compliance Offset Protocol. Basic stand data on trees of 2.5 cm and higher were collected in riparian forest plots along headwater streams within two experimental forests in the northeast US. The USFS Forest Vegetation Simulator was used to simulate growth and yield and schedule management activities over 20-year cutting cycles. Timber volumes and registry offset credits along with their market values were calculated for the respective scenarios and a Net Present Value (NPV) and Equal Annual Equivalent (EAE) analysis was performed under assumptions of constant prices and costs. The initial aboveground carbon stocks at both locations were 32% and 140% higher than the average value for their assessment areas. Having above-average carbon stocks and basal areas between 30 and 33 m2/ha, all scenarios returned positive NPVs and EAEs. The hardwood riparian forest had a higher NPV and EAE by not participating in the carbon markets and pursuing partial harvesting as per BMP guidelines (Scenario II) at lower discount rates but had higher NPVs and EAEs under carbon markets at higher discount rates (Scenario I and III). The conifer/mixed species riparian forest provided greater positive net revenue flows by participating in the carbon markets either in a no harvesting scenario or under partial harvesting as per guidelines in the Protocol (Scenarios I and III). Our results indicate that a protocol for compensating landowners with large forest holdings for riparian carbon offsets provides an opportunity to generate positive net revenues in scenarios in which state BMP guidelines may restrict harvesting in RMZs. Given the high density of ecologically critical headwater streams in the Northeast and potential RMZ restrictions, the carbon offset option provides landowners with the opportunity to remain economically viable.

Economics of integrated harvests with biomass for energy in non-industrial forests in the northeastern US forest

Economic drivers explaining the harvest of biomass for energy use in northeastern forests in the United States are not well understood. However, knowledge of these drivers is essential for bioenergy policy development, biomass supply estimates, and assessments of harvesting impacts on forest ecosystems and carbon stocks. Using empirical data from 35 integrated harvest sites in northeastern US non-industrial forests, we analyzed the economics of mixed wood product logging operations that included biomass for energetic use from both landowner and logging contractor perspectives. Results were highly variable but indicate that biomass harvest removal intensities were not explained by primary forest management objectives, harvest area, or harvested wood product quantity. Rather than harvest area or choice of machinery, we identified biomass harvest intensity as a main driver of profits for a harvest operation, as measured in hourly and total net income to the logging contractor. While biomass stumpage payments to the landowner were marginal, tree bole biomass constituted more than half (54%) of the extracted volume by weight, far outweighing biomass derived from tops and limbs only. Biomass harvests, therefore, might encourage logging contractors to intensify harvest removals rather than increase harvest area or choose a specific harvest type or method. Such intensification could have beneficial or detrimental impacts on a stand and needs to be addressed through further studies of potential consequences for biodiversity and various ecosystem services.

Coral reef ecosystem functioning: eight core processes and the role of biodiversity

Coral reefs are in global decline. Reversing this trend is a primary management objective but doing so depends on understanding what keeps reefs in desirable states (ie “functional”). Although there is evidence that coral reefs thrive under certain conditions (eg moderate water temperatures, limited fishing pressure), the dynamic processes that promote ecosystem functioning and its internal drivers (ie community structure) are poorly defined and explored. Specifically, despite decades of research suggesting a positive relationship between biodiversity and ecosystem functioning across biomes, few studies have explored this relationship in coral reef systems. We propose a practical definition of coral reef functioning, centered on eight complementary ecological processes: calcium carbonate production and bioerosion, primary production and herbivory, secondary production and predation, and nutrient uptake and release. Connecting research on species niches, functional diversity of communities, and rates of the eight key processes can provide a novel, quantitative understanding of reef functioning and its dependence on coral reef communities that will chart the transition of coral reefs in the Anthropocene. This will contribute urgently needed guidance for the management of these important ecosystems.

An Enhanced Approach of Artificial Bee Colony for Energy Management in Energy Efficient Residential Building

The residential sector consumes the largest amount of total energy produced by different energy production resources. Therefore, an effective energy management and control system is required for residential buildings to utilize the energy resources in an efficient manner. The primary objective of energy management and control system is to improve the energy efficiency and achieve the occupant’s preferred indoor environmental comfort. Many approaches have been proposed in the literature to effectively manage the energy systems in residential buildings. In this paper, a new approach of Artificial Bee Colony with Knowledge Base (ABC-KB) is proposed for the management of power and occupant’s preferred environment inside the residential building. The complete energy efficient and user-friendly model has different components in which ABC-KB was used for the optimization purpose, whereas the status of different actuators was controlled using fuzzy controllers. The experimental results show that the developed system significantly enhances the energy efficiency and occupant’s comfort inside the residential building as compared to some previously proposed approaches. The model has shown efficiency in achieving high comfort index along with the minimized energy consumption.

The Shaping of Knowledge: Communication of meaning through museum exhibition design

The primary objective of museum management in the shaping of knowledge can be achieved by a communication of meaning through quality displays of the permanent collection or temporary exhibitions, the specimens of a continent or the interactive apparatus of science. This paper looks at research derived primarily from museum scholars and experts with academics working in the field of visitor studies towards developing exhibits that facilitated visitor learning. These findings recast the approach in order to offer an integrated framework for visitor behaviour that has implications for service management of the service encounter at the museum in Malaysia.

Who owns and is responsible for the elephant in the room? Management plans for free-roaming elephant in South Africa

In 2008, South Africa adopted its ‘National Norms and Standards for the Management of Elephants in South Africa’. Concern has subsequently been raised as to whether these norms and standards apply to free-ranging elephant on land, which had not been enclosed with a fence with the express purpose of containing these animals and other game on the property. The application of these norms and standards pivots on whether the owner(s) of the property have taken possession of these animals in accordance with common law applicable to game, or have given effect to the provisions of the Game Theft Act. To address this concern, this article briefly explores the evolution of South African regulatory jurisprudence applicable to game, including elephant, and analyses the norms and standards in relation to international and national legislation and common law applying to elephants. The norms and standards are not applicable to unowned, free-roaming elephant. These norms and standards, therefore, do not fulfil their primary objective of uniform management of elephant across South Africa. This limitation of the norms and standards, therefore, needs to be considered when they are revised.

Anesthesiologist perspectives for the transoral approach

Thyroidectomy is the main endocrine surgical procedure carried out in the world. Recently, transoral endoscopic thyroidectomy vestibular approach (TOETVA) has showed its beneficial results. The main intraoperative challenges are to avoid events such as pneumothorax and pneumomediastinum due to air insufflation. The anesthetist has to be aware about intraoperative alarming signals and promptly alert surgical staff. Additionally, an adequate preoperative assess is essential to investigate and to treat uncontrolled health status. The primary objective of postoperative pain management is to diminish patient discomfort guarantying an optimal analgesia during speech, chewing and swallowing into postoperative period. A practical approach is described in this manuscript.

The projected economic and health burden of sub-optimal asthma control in Canada.

Achieving optimal control is the primary objective of asthma management. However, despite the existence of effective treatments, many patients experience periods of sub-optimal asthma control. The objective of this study was to quantify and project the future economic and health burden of sub-optimal asthma control in Canada. A probabilistic time-in-state model of asthma was created with inputs from published studies on the prevalence of asthma, levels of asthma control, and the impact of asthma control on costs and quality of life. In the primary analysis, we modeled the 20-year total direct costs (in 2014 Canadian dollars) and quality-adjusted life years (QALYs) from 2014 to 2033 in Canada. In the secondary analysis, we also incorporated indirect costs. The undiscounted projected 20-year direct costs and QALYs lost attributable to sub-optimal asthma control were $24.40 billion and 1.82 million, respectively, from 2014 to 2033. The corresponding discounted values (at 3%) were $18.54 billion and 1.38 million. When indirect costs were considered, the total undiscounted and discounted costs of sub-optimal control were projected to be $280.49 billion, and $213.10 billion, respectively. A 10% reduction in prevalence of sub-optimal control in asthma was associated with 18% reduction in the economic and health burden of asthma over this time period. Sub-optimal asthma control is associated with a substantial economic and health burden. Given that with evidence-based disease management asthma can be controlled in the majority of patients, strategies towards improving asthma management can be associated with a significant return on investment. not applicable.

A Novel Non-Invasive Selection Criterion for the Preservation of Primitive Dutch Konik Horses.

The Dutch Konik is valued from a genetic conservation perspective and also for its role in preservation of natural landscapes. The primary management objective for the captive breeding of this primitive horse is to maintain its genetic purity, whilst also maintaining the nature reserves on which they graze. Breeding selection has traditionally been based on phenotypic characteristics consistent with the breed description, and the selection of animals for removal from the breeding program is problematic at times due to high uniformity within the breed, particularly in height at the wither, colour (mouse to grey dun) and presence of primitive markings. With the objective of identifying an additional non-invasive selection criterion with potential uniqueness to the Dutch Konik, this study investigates the anatomic parameters of the distal equine limb, with a specific focus on the relative lengths of the individual splint bones. Post-mortem dissections performed on distal limbs of Dutch Konik (n = 47) and modern domesticated horses (n = 120) revealed significant differences in relation to the length and symmetry of the 2nd and 4th Metacarpals and Metatarsals. Distal limb characteristics with apparent uniqueness to the Dutch Konik are described which could be an important tool in the selection and preservation of the breed.

Offsetting Externalities in Estimating MEY in Multispecies Fisheries

The Australian federal fisheries policy identifies maximising net economic returns as the primary objective of fisheries management. This has largely been interpreted as maximising the net economic yield (MEY) in fisheries. More recently, the influence of reducing yields to achieve MEY on prices and the transfer of consumer surplus to producers has been raised as a potential issue. Achieving fishery MEY may result in a reduction in net economic returns in a broader sense if the loss to consumers exceeds the gain to the industry. The transfer of consumer surplus to producers is also potentially undesirable, and may result in a dead weight loss. Similarly, the disutility associated with bycatch in fisheries may also affect our interpretation of “optimal” yields if non-monetary values are considered. These externalities are generally not considered in determining MEY. In this paper, we develop a generic multispecies bioeconomic model that is used to estimate the impact of broadening the consideration of net economic returns to include changes in consumer surplus as well as the inclusion of non-market values associated with bycatch. We find that traditional measures of MEY may not achieve maximum returns to society overall if these externalities exist.

Towards a Safe and Efficient Motorway System: Literature Review on Variable Speed Limits

Variable speed limits (VSL) is an emerging ITS tool, which can help to improve safety and efficiency of motorway systems through a better harmonization of traffic flow. It can reduce variation in speed of vehicles travelling along the controlled section. The implementation of VSL encourages a uniform driving behaviour and thus resulting in a better distribution of traffic over the motorway network, and better utilization of the road infrastructure. The primary objective of motorway traffic management is to improve mobility benefits of motorways under acceptable safety standards; this is also the main purpose of applying VSL. This paper reviews the existing VSL methods from view points of safety and mobility gains or losses due to VSL on motorway systems. A systematic review of the literature of empirical as well as simulation-based studies is presented.

Current Understanding and Management of Parathyroid Carcinoma

Parathyroid adenomas are a very common endocrine entity, whereas parathyroid carcinomas (PC) are extremely rare. With an estimated incidence of 0.015 per 100,000 population and an estimated prevalence of 0.005% in the United States, parathyroid cancer is one of the rarest of all human malignancies. PC is an extremely rare cause of primary hyperparathyroidism (PHPT). Men and women are equally affected, usually in the fourth or fifth decade of life. The exact etiology has not been identified, but mutations in the CDC73 gene appear to have a critical role in its pathogenesis. The morbidity and mortality of PC is secondary to the hypercalcemia resulting from tumor overproduction of PTH. The primary management objectives are complete removal of the cancer and prevention of recurrences. This review will talk about the epidemiology, etiology, clinical manifestations, and management of PC.

Interval Appendectomy Operative vs. Non-Operative Management of Appendicitis in Saudi Arabia

The goal of this review is to analyze the perfect mechanism for managing acute appendicitis. Both surgical and non-operative approaches are in contention as the best remedies for the appendix complications. To draw a better comparative analysis, the strengths and weaknesses of each proposed mechanism are analyzed. In the Kingdom of Saudi Arabia (KSA), both immediate and interval surgical procedure remain debatable as best remedies for acute appendicitis. To determine the suitability of both immediate and interval appendectomy against non-operative management in KSA, vast literature is analyzed to portray the strengths of each medical maneuver. Background: The primary objective of appendicitis management is to ensure early diagnosis and prevent operative management, which is risky and costly [1]. However, this goal has remained elusive due to delayed diagnosis, a characteristic that is prevalent for most people. In an analysis concerning the changing trends of appendicitis management over the past 30 years, surgery is not the only remedy for appendicitis patients [2]. Some individuals, as exhibited by numerous studies, have been able to recover without the need for surgical procedures, currently conceptualized as appendectomy. However, concentrating on the analysis by a number of scholars, it becomes evident that some delayed attention to symptoms, mainly due to patient’s ignorance, makes appendectomy inevitable. As such, the most common cause of abdominal surgical emergency is appendicitis [3]. Narrowing down to the ground situation in America, not much difference is exhibited. Appendectomy remains the most significant tool at the physicians disposal when faced with relatable appendicitis dilemmas. By the time patients seek medical attention, it is already late, an aspect that motivates physicians to put into use prompt surgical procedures. The growing attention to appendicitis management is proportional to its prevalence rate. Appendicitis accounts for approximately 40,000 hospital admissions each year in England [2]. Similarly, early studies performed by English medical scholars indicated that close to 150 people from England and Wales die from acute appendicitis [4]. The prevalence rate of appendix complications is approximately seven to eight percent of the global population. Regardless of the advanced diagnostic and surgical technology, morbidity of the complication is 10%, and the mortality rate is between 1% and 5%. Despite its high prevalence, acute appendicitis is decreasing the in the US and the European region while proportionally increasing in the developing countries, mainly due to changing lifestyles [5,6,7].Consequently, a histopathological study on KSA in 2015 revealed that diagnosis rate of acute appendicitis was 52% while acute suppurative, acute gangrenous appendicitis and acute perforated appendicitis remained at 28%, 12.5% and 2% respectively [8]. However, it is important to acknowledge that the study was limited to one geographical area, but scientifically, the figures represent a consistent pattern. Significantly, the prevalence rate of subhepatic acute appendicitis accounted for 0.054% of Saudi Arabia’s hospital population [9]. With much research being carried on the best way of handling appendicitis, this next segment of the review covers a summary of current research’s perception concerning the effective medical procedure (operative vs. non-operative). The summary section is not conclusive but rather shows a sample of analyses approaching the best way of handling appendix complications in the general population. Methods:A review of the literature was made using the most common electronic sources including: electronic database, EMBASE, MEDLINE search using