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1
Growe, Anna, and Hans H. Blotevogel. "Knowledge Hubs in the German Urban System: Identifying Hubs by Combining Network and Territorial Perspectives." Raumforschung und Raumordnung 69, no. 3 (June 30, 2011): 175–85. http://dx.doi.org/10.1007/s13147-011-0087-1.
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Abstract This paper identifies hubs of knowledge-based labour in the German urban system from two perspectives: the importance of a metropolitan region as a place and the importance of a metropolitan region as an organisational node. This combination of a network perspective with a territorial perspective enables the identification of hubs. From the functional perspective, hubs are understood as important nodes of national and global networks, established by flows of people, goods, capital and information as well as by organisational and power relations. From the territorial perspective, hubs are understood as spatial clusters of organisations (firms, public authorities, non-governmental organisations). The functional focus of the paper lies on knowledge-based services. Based on data about employment and multi-branch advanced producer service firms, four main types of metropolitan regions are identified: growing knowledge hubs, stagnating knowledge hubs, stagnating knowledge regions and catch-up knowledge regions. The results show an affinity between knowledge-based work and bigger metropolitan regions as well as an east-west divide in the German urban system.
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Hanson, R. Karl. "Long-Term Recidivism Studies Show That Desistance Is the Norm." Criminal Justice and Behavior 45, no. 9 (August 13, 2018): 1340–46. http://dx.doi.org/10.1177/0093854818793382.
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A criminal history record is a valid indicator of the propensity for rule violation, and such records are rightly used in applied decision making both within and outside of the criminal justice system (e.g., employment screening). A criminal conviction, however, is a time dependent risk factor. During the past decade, researchers have examined desistance using statistical models of residual hazards. These studies find that after about 10 years offense-free (5 years for juveniles), the risk presented by most individuals with a criminal record is not meaningfully different from that of the general population. Similar time-free effects are found for both sexual and nonsexual offenses. Given that desistance is almost inevitable, record retention and access policies need to carefully consider the consequences of decisions being based on old records with little information value.
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Walker, Sue, Sheree Lloyd, Josie Parisi, and Sari Sirvio. "The Introduction of Hospital-Based Cancer Registries in Queensland." Australian Medical Record Journal 19, no. 1 (March 1989): 7–9. http://dx.doi.org/10.1177/183335838901900103.
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The management of cancer data is an expanding area of interest and employment for medical record administrators in Queensland. This is largely due to the software package and support network for hospital-based cancer registries that has been developed by the Data Management Unit of the Epidemiology and Prevention Unit in the State Health Department. The package is offered to any hospital interested in setting up and maintaining their own cancer data base and is completely compatible with the information requirements of the Queensland population-based registry. This paper describes the development of a hospital-based cancer registry system and the involvement of medical record administrators in cancer registry data management. (AMRJ 19(1), 6–8).
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Jackson, Adam M., and Gemma Louise Davies. "Making the case for ECRIS." International Journal of Evidence & Proof 21, no. 4 (February 15, 2017): 330–50. http://dx.doi.org/10.1177/1365712717692813.
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Criminal record information has various uses, including, in the detection of crime, as evidence in criminal proceedings, in consideration of an appropriate sentence after conviction and in determining the suitability of an individual for, or providing a bar to, employment. As such this information can have a high value but can also significantly interfere with a person’s right to private and family life under Article 8 of the European Convention on Human Rights. The importance of Article 8 in this area has been increasingly recognised both domestically and in Strasbourg, with such case law making clear the imperative that criminal record information is accurate, retained and disclosed only in proper circumstances and, where appropriate, is capable of being subject to proper challenge. The operation of the European Criminal Records Information System (ECRIS) for exchange of criminal records between Member States is explored and the benefits and risks of exchanging criminal records information within such an automated system are identified. The compliance of ECRIS to Article 8 ECHR is considered and suggestions made for future improvements. Evidence is provided that ECRIS constitutes a singular improvement on earlier ad hoc arrangements and should therefore be retained by the United Kingdom post-Brexit.
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Nan, Zhang, Jin Sheng, Ai Congfang, and Ding Weiye. "An integrated water-conveyance system based on Web GIS." Journal of Hydroinformatics 20, no. 3 (October 4, 2017): 668–86. http://dx.doi.org/10.2166/hydro.2017.113.
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Abstract To provide support for scientific decision-making about scheduling to keep a water-conveyance project running safely in Beijing, China, a Web geographic information system (GIS)-based conveyance system (WGCS) is proposed. The development of WGCS involves three primary modules. First, the pipe-channel hydrodynamic model with various types of hydraulic structure (reservoir, sluice, and inverted siphon) control equations is established as the engine to simulate a variety of flow regimes and hydraulic responses for different conveyance scenarios. Then, a relatively lightweight Web GIS platform without expensive mature GIS packages is implemented through rendering vector map layers based on Silverlight painting technology for model setting, simulation and data visualization. Furthermore, the employment of an asynchronous refresh mechanism facilitates the performance of particle motion animation. Finally, the database platform is used to record initial information, configuration parameters, hydraulic structure parameters converted to the hydrodynamic model for computation, result data received from the hydrodynamic model for analysis, attribute data and spatial data for map publishing and visualization. WGCS represents an effective attempt to integrate large-scale hydrodynamic numerical calculations on the web. The functionality of WGCS is illustrated through two case studies on conveyance progress. Currently, this system is successfully operating in Beijing.
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Mack, Christina D., Peter Meisel, Mackenzie M. Herzog, Lisa Callahan, Eva E. Oakkar, Taylor Walden, Joseph Sharpe, Nancy A. Dreyer, and John DiFiori. "The Establishment and Refinement of the National Basketball Association Player Injury and Illness Database." Journal of Athletic Training 54, no. 5 (May 1, 2019): 466–71. http://dx.doi.org/10.4085/1062-6050-18-19.
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The National Basketball Association (NBA; also referred to as “the league”) has established a centralized, audited electronic medical record system that has been linked with external sources to provide a platform for robust research and to allow the NBA to conduct player health and safety reviews. The system is customized and maintained by the NBA and individual teams as part of the employment records for each player and is deployed uniformly across all 30 teams in the league, thereby allowing for standardized data on injuries, illnesses, and player participation in NBA games and practices. The electronic medical record data are enriched by linkage with other league external data sources that provide additional information about injuries, players, game and practice participation, and movement. These data linkages allow for the assessment of potential injury trends, development of injury-prevention programs, and rule changes, with the ultimate goal of improving player health and wellness. The purpose of this article is to describe this NBA injury database, including the details of data collection, data linkages with external data sources, and activities related to reporter training and data quality improvement.
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Moore, Roxanne, and Laura Archer. "Red Cross and Red Crescent Health Information System (RCHIS): Functional Design and Usability Testing Protocol." Prehospital and Disaster Medicine 34, s1 (May 2019): s87. http://dx.doi.org/10.1017/s1049023x1900181x.
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Introduction:The Red Cross and Red Crescent Health Information System (RCHIS) combines the functionality of an Electronic Medical Record (EMR), Health Information System (HIS), as well as Human Resource and stock management system. Its purpose is to facilitate patient quality of care, early warning for outbreak detection, accountability/reporting, and resource management. Short-term, emergency medical teams and support staff responding to acute clinical needs in a humanitarian context are the intended end users.Aim:To explain the functional design principles and usability testing protocol implemented in initial RCHIS design and development phases to ensure technological fit within the humanitarian medical context.Methods:RCHIS development followed the patient-user journey, with each patient/staff interaction encapsulated by a microservice. The integration of multiple microservices enabled RCHIS to mimic various patient journeys. The functional scope of each microservice was designed by medical end-users and was further used for access management. The value and variable design, including validation rules, were led by health informaticians and existing medical standards. Intuitiveness and ease of use guided User Interface design, with targeted medical end-user feedback collected on a twice-monthly basis in addition to early design workshops, field immersion, and post-development pilot testing.Results:Support and implementation of RCHIS were not inherently guaranteed. As such, the process of co-designing with end users had the primary benefit of ensuring effective scope and technological fit given the humanitarian context, but also the secondary benefit of improving internal acceptability and advocacy.Discussion:The added value of digital health records as a quality assurance mechanism is well documented. However, the increased workload and reduced employment satisfaction affiliated with the rise of EMRs illustrated a need to re-evaluate current design and use within clinical settings. The design and development approach taken for RCHIS is one attempt to improve human-computer interaction in the clinical setting.
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Heponiemi, Tarja, Sari Kujala, Suvi Vainiomäki, Tuulikki Vehko, Tinja Lääveri, Jukka Vänskä, Eeva Ketola, Sampsa Puttonen, and Hannele Hyppönen. "Usability Factors Associated With Physicians’ Distress and Information System–Related Stress: Cross-Sectional Survey." JMIR Medical Informatics 7, no. 4 (November 5, 2019): e13466. http://dx.doi.org/10.2196/13466.
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Background Constantly changing and difficult-to-use information systems have arisen as a significant source of stress in physicians’ work. Physicians have reported several usability problems, system failures, and a lack of integration between the systems and have experienced that systems poorly support the documentation and retrieval of patient data. This stress has kept rising in the 21st century, and it seems that it may also affect physicians’ well-being. Objective This study aimed to examine the associations of (1) usability variables (perceived benefits, technical problems, support for feedback, and user-friendliness), (2) the number of systems in daily use, (3) experience of using information systems, and (4) participation in information systems development work with physicians’ distress and levels of stress related to information systems (SRIS) levels. Methods A cross-sectional survey was conducted among 4018 Finnish physicians (64.82%, 2572 out of 3968 women) aged between 24 and 64 years (mean 46.8 years) in 2017. The analyses of covariance were used to examine the association of independent variables with SRIS and distress (using the General Health Questionnaire) adjusted for age, gender, employment sector, specialization status, and the electronic health record system in use. Results High levels of technical problems and a high number of systems in daily use were associated with high levels of SRIS, whereas high levels of user-friendliness, perceived benefits, and support for feedback were associated with low levels of SRIS. Moreover, high levels of technical problems were associated with high levels of psychological distress, whereas high levels of user-friendliness were associated with low distress levels. Those who considered themselves experienced users of information systems had low levels of both SRIS and distress. Conclusions It seems that by investing in user-friendly systems with better technical quality and good support for feedback that professionals perceive as being beneficial would improve the work-related well-being and overall well-being of physicians. Moreover, improving physicians’ skills related to information systems by giving them training could help to lessen the stress that results from poorly functioning information systems and improve physicians’ well-being.
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Mukhi, Shamir, Jeff Aramini, and Amin Kabani. "Contributing to Communicable Diseases Intelligence Management in Canada: CACMID Meeting, March 2007, Halifax, Nova Scotia." Canadian Journal of Infectious Diseases and Medical Microbiology 18, no. 6 (2007): 353–56. http://dx.doi.org/10.1155/2007/386481.
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In the spring of 2003, the Public Health Agency of Canada (then, Health Canada) partnered with several provincial/territorial and regional public health stakeholders to improve pan-Canadian public health surveillance, communications and response through the application of new technologies. This resulted in the creation of the Canadian Network for Public Health Intelligence (CNPHI), a comprehensive framework of applications and resources designed to fill critical gaps in Canada's national public health infostructure. Over the past four years, the CNPHI has evolved into Canada's only pan-Canadian public health information management system. With over 2000 registered users, the current CNPHI environment consists of more than 30 integrated applications and systems that can be loosely categorized into four functional groups: data exchange; data analysis and integration; communication, collaboration and coordination; and knowledge management. Despite poor data repositories, legacy information management systems, and the lack of standards and agreements, the CNPHI has demonstrated that much can be accomplished in these areas. Over the next decade, significant barriers impeding additional advances will be bridged through the implementation of the Electronic Health Record, and through ongoing efforts to address gaps in standards, and data- and information-sharing agreements. Together with new technologies coming on-line, opportunities to further enhance public health surveillance and response will be limited only by one's imagination.
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Kaihlanen, Anu-Marja, Kia Gluschkoff, Hannele Hyppönen, Johanna Kaipio, Sampsa Puttonen, Tuulikki Vehko, Kaija Saranto, Liisa Karhe, and Tarja Heponiemi. "The Associations of Electronic Health Record Usability and User Age With Stress and Cognitive Failures Among Finnish Registered Nurses: Cross-Sectional Study." JMIR Medical Informatics 8, no. 11 (November 18, 2020): e23623. http://dx.doi.org/10.2196/23623.
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Background Electronic health records (EHRs) are expected to provide many clinical and organizational benefits. Simultaneously, the end users may face unintended consequences, such as stress and increased cognitive workload, due to poor EHR usability. However, whether the effects of usability depend on end user characteristics, such as career stage or age, remains poorly understood. Objective The objective of this study was to examine the associations of EHR usability and user age with stress related to information systems and cognitive failures among registered nurses. Methods A cross-sectional survey design was employed in Finland in 2017. A total of 3383 registered nurses responded to the nationwide electronic survey. Multiple linear regression was used to examine the associations of EHR usability (eg, how easily information can be found and a patient’s care can be documented) and user age with stress related to information systems and cognitive failures. Interaction effects of EHR usability and age were also tested. Models were adjusted for gender and employment sector. Results Poor EHR usability was associated with higher levels of stress related to information systems (β=.38; P<.001). The strength of the association did not depend on user age. Poor EHR usability was also associated with higher levels of cognitive failures (β=.28; P<.001). There was a significant interaction effect between age and EHR usability for cognitive failures (β=.04; P<.001). Young nurses who found the EHR difficult to use reported the most cognitive failures. Conclusions Information system stress due to poor EHR usability afflicts younger and older nurses alike. However, younger nurses starting their careers may be more cognitively burdened if they find EHR systems difficult to use compared to older nurses. Adequate support in using the EHRs may be particularly important to young registered nurses, who have a lot to learn and adopt in their early years of practice.
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Kisely, Stephen, Elizabeth Lin, Alain Lesage, Charles Gilbert, Mark Smith, Leslie Anne Campbell, and Helen-Maria Vasiliadis. "Use of Administrative Data for the Surveillance of Mental Disorders in 5 Provinces." Canadian Journal of Psychiatry 54, no. 8 (August 2009): 571–75. http://dx.doi.org/10.1177/070674370905400810.
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Objective: To evaluate the usefulness of administrative data for the surveillance of mental illness in Canada using databases in the following 5 provinces: British Columbia, Ontario, Quebec, Nova Scotia, and Alberta. Method: We used a population-based record-linkage analysis with data from physician billings, hospital discharge abstracts, and community-based clinics. The following diagnostic codes from the International Classification of Diseases, Ninth Edition, were used to define cases: 290 to 319, inclusive. Results: The prevalence of treated psychiatric disorder was similar in Nova Scotia, British Columbia, Alberta, and Ontario at about 15%. The prevalence for Quebec was slightly lower at 12%. Findings from the provinces showed remarkable consistency across age and sex, despite variations in data coding. Women tended to show a higher prevalence overall of treated mental disorders than men. Prevalence increased steadily to middle age, declining in the 50s and 60s, and then increasing again after age 70 years. Conclusions: Provincial and territorial administrative data can provide a useful, reliable, and economical source of information for the surveillance of treated mental disorders. Such a surveillance system can provide longitudinal data at little cost to support health service provision and planning.
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Piquet, Rosélia. "O emprego industrial metropolitano e a nova divisão espacial do trabalho no Brasil." Revista Brasileira de Estudos Urbanos e Regionais, no. 3 (November 30, 2000): 97. http://dx.doi.org/10.22296/2317-1529.2000n3p97.
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O texto apresenta e analisa as mudanças na estrutura industrial das Regiões Metropolitanas de Fortaleza, Porto Alegre, Rio de Janeiro e São Paulo, decorrentes das novas condições de competitividade em que se insere o País no presente. No levantamento empírico elaborado, utiliza-se o emprego formal como indicador da estrutura industrial. Os dados foram extraídos da Relação Anual de Informações Sociais – Rais, Ministério do Trabalho, em relação ao período 1986-1996, e sua interpretação baseia-se nos campos de análise da localização industrial, das cadeias produtivas, da competitividade empresarial e, ainda, da organização espacial da produção. O que se procura mostrar é que a maior abertura internacional e a fragmentação das cadeias produtivas têm fortalecido especializações regionais geradoras de focos dinâmicos, mesmo em áreas tidas como regiões-problema. As novas localizações, contudo, só se verificam nos segmentos mais leves da indústria, de menor densidade de capital e mais intensivos em mão-de-obra. Palavras-chave: localização industrial; organização territorial; regiões metropolitanas; mercado de trabalho. Abstract: The text details and analyses the changes in the industrial system of the metropolitan regions of Fortaleza, Porto Alegre, Rio de Janeiro and São Paulo arising from the new competitive conditions which this country is currently subject to. For the purposes of the empirical study carried out, formal employment was used as a measure of the industrial system. The data came from the Annual Report on Social Information (Rais) of the Ministry of Labour relating to the period 1986-1996. Interpretation of the data was based on analysis of industrial location, production chains, company competitiveness and the geographical organization of production. The intention was to show that greater openness to international connections and the fragmentation of chains of production has strengthened regional specializations, creating dynamic nuclei, even in areas said to be problem regions. This reorganisation, however, has taken place only in light industry which is labour intensive and has a lower capital concentration. Keywords: industrial location; territorial organization; metropolitan regions; labour market.
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Pavlov, A. I., S. M. Didukh, and V. D. Barvinenko. "Institutional Environment of Inclusive Development of Agroholdings." Business Inform 12, no. 515 (2020): 183–88. http://dx.doi.org/10.32983/2222-4459-2020-12-183-188.
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Launched in 2015, the reform of decentralization of power and governance has led to the formation of amalgamated territorial hromadas (ATHs) and establishing the new districts as relevant parts of the administrative-territorial structure of the country. Further success in the development of these socio-spatial formations of the agglomeration type will depend on their economic capacity and self-sufficiency. The solution of this important social task is largely derived from the efficiency of economic entities and their social responsibility to expand the productive employment of the economically active population, access of all its strata to the created public goods. Large agri-food holding companies should play a key role in this process. In view of this, the purpose of research is defined, which is to substantiate the fundamental role of the institutional environment in the inclusive development of agricultural holdings. In accordance with the purpose of the study, the following tasks are formulated: to determine the essence of the concept of institutional environment as a system and analyze its current state; to reveal the content of an integrated approach to the formation of an environment for inclusive development of agricultural holdings; identify the potential for inclusive development of agricultural holdings. To achieve the goal and objectives of the study, the authors used interdisciplinary methodology, namely – systemic, synergistic, institutional, political, economic, social approaches, methods of synthesis and analysis, deduction and induction, SWOT-analysis, comparison, analogies, statistical and sociological researches. The information base of the study consisted of scientific achievements of domestic and foreign scientists, data from the State statistics, materials from the Internet, the authors’ own observations. The scientific novelty of the study is to substantiate the concept of "institutional environment system" as a platform for inclusive development of agricultural holdings. The scientific provisions, conclusions and recommendations arising from the study can be used by businesses, ATHs, districts in the formation of welfare inclusion.
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Wang, Michael, Anissa Cyhaniuk, David L. Cooper, and Neeraj N. Iyer. "Identification of Persons with Acquired Hemophilia in a Large Electronic Health Record Database." Blood 126, no. 23 (December 3, 2015): 3271. http://dx.doi.org/10.1182/blood.v126.23.3271.3271.
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Abstract Background: Electronic health records (EHR) capture rich clinical information on a patient's encounter with their health care system. Studying national EHRs has the potential to provide epidemiological and granular clinical insights of the patient's diagnosis, treatment patterns and clinical outcomes. Acquired hemophilia (AH) occurs in 1:1-1.5 million people and is characterized by anti-factor VIII autoantibodies, and bleeding in elderly and post-partum patients often in the absence of prior bleeding history. The AH literature includes case reports and registries of known patients; no study to date has attempted to extract population-level information using a large EHR. Objective: This study aimed to identify patients with AH using a large EHR for the purposes of studying treatment patterns. Methods: This retrospective study attempts to identify AH patients by combining standard identification methods used in secondary database analysis along with clinical information from the EHR, and a text search of physician notes using Natural Language Processing (NLP) output. Records were accessed from a large, national, de-identified, longitudinal EHR database (Humedica) between January 1, 2007 and July 31, 2013. Given the rare nature of the disease, broader selection criteria were initially applied by using an ICD-9 code for hemorrhagic disorder due to intrinsic circulating anticoagulants (286.5 and all sub-codes), and confirmation of records in the EHR, 6 months before and 12 months after first (index) diagnosis. Additional selection criteria were: no anticoagulant use, not having a diagnosis of systemic lupus erythematosus, accessible physician notes, membership in an integrated delivery network (IDN), mention of "bleeding" within physician notes, and a normal prothrombin test (PT) but an elevated activated partial thromboplastin time (aPTT). Results: From 6,348 patients with a diagnosis code of 286.5 or any sub-codes, there were 20 males and 18 females who met selection criteria. The median age was 78.5 years (age top coded at 89 years). Table 1.Total usable patients13,000,000100%ICD-9 286.5*6,3480.049%With pre/post diagnosis records4,2120.032%Without anticoagulant1,1670.009%Without lupus/SLE1,1250.009%With physician notes and IDN3990.003%NLP "Bleeding"2550.002%NLP "Bleeding" and PT/aPTT1140.001%NLP "Bleeding" and normal PT/elevated aPTT380.0003% All 38 had a note for "pain" (most commonly chest [66%] and back [50%]), 21 (55%) had a note for "bruising", while none of the females had an ICD-9 code for abnormal menstruation or pregnancy. All 286* diagnoses for the 38 patients included: Table 2.286.0Congenital hemophilia A3 (8%)286.5Hemorrhagic disorder due to intrinsic circulating anticoagulants26 (68%)286.52Acquired hemophilia1 (3%)286.59Other intrinsic anticoagulant, antibody or inhibitor5 (13%)286.7Acquired factor deficiency3 (8%)286.9Other and unspecified5 (13%) No patients received typical AH treatment for bleeding (factor VIII, bypassing agent or DDAVP). The most common prescriptions were azithromycin (34%) and prednisone (32%). Data review: Individual Signs, Diseases, and Symptoms (SDS) associated with the patient via NLP key word extracts were randomly reviewed to validate if the identified cohort indeed had AH. (1) >89-year-old male; ~6 months of bruising and ecchymoses, "suspect" "clotting factor deficiency". (2) 70-year-old female breast cancer patient; isolated mention of hematemasis from Mallory-Weiss tear, multiple mentions of hematuria, hemorrhagic cystitis, and paradoxically a renal pelvis blood clot in the SDS on the same date. (3) A 32-year-old pregnant female reports bruising and irregular menses, and conflicting mention of venous thrombosis and blot clots. NLP output included FVIII deficiency, and there was mention of congenital and FVIII inhibitor. All 3 had bleeding symptoms, normal PT and elevated aPTT, but none had AH diagnosis or hemostatic treatment. Conclusions: NLP approaches to analysis of EHRs hold promise and have demonstrated utility in population-based studies for some disorders. However, in this study, ICD-9 codes, lab results, NLP output, and treatments were not consistently aligned. This study highlights that in ultra-rare disorders, ICD-9 coding alone may not be sufficient to identify cohorts, and multimodal analysis combined with in-depth reviews of physician notes might be more effective. Disclosures Wang: Novo Nordisk: Membership on an entity's Board of Directors or advisory committees; CSL Behring: Membership on an entity's Board of Directors or advisory committees; Biogen: Membership on an entity's Board of Directors or advisory committees; Baxalta: Membership on an entity's Board of Directors or advisory committees. Cyhaniuk:Novo Nordisk Inc.: Consultancy. Cooper:Novo Nordisk Inc.: Employment. Iyer:Novo Nordisk Inc.: Employment.
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Кудряшов, В. С., М. В. Алексеев, А. В. Иванов, В. В. Портнов, Е. В. Князева, and О. А. Орловцева. "DEVELOPMENT AND APPLICATION OF A GEOGRAPHIC INFORMATION SYSTEM FOR MONITORING THE WORK OF SALES REPRESENTATIVES IN THE “EFKO” GROUP OF COMPANIES." ВЕСТНИК ВОРОНЕЖСКОГО ГОСУДАРСТВЕННОГО ТЕХНИЧЕСКОГО УНИВЕРСИТЕТА, no. 1 (April 19, 2021): 14–20. http://dx.doi.org/10.36622/vstu.2021.17.1.002.
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Статья посвящена решению задач разработки геоинформационной системы (ГИС), позволяющей использовать данные GPS на карманных персональных компьютерах (КПК) сотрудников для формирования отчета посещений ими торговых точек, заданных по плану, и просмотра отклонений от маршрута. В структуре АО «Управляющая компания «ЭФКО» для работы в отделе продаж и логистики используется система KPI (на базе 1С), позволяющая организовать деятельность ее торговых сотрудников путем сбора и анализа различных показателей. В частности, организована работа супервайзеров, мерчендайзеров, а также территориальных и региональных менеджеров. Для того чтобы территориальные менеджеры и супервайзеры могли работать не только за компьютером, но и непосредственно во время посещения самих торговых точек, делать заказ для контрагента не на бумаге, а сразу внося в программу, необходимо реализовать связь между 1С KPI и мобильным приложением ST-Mobile, разработанным специально для этих целей. Сотрудники должны иметь возможность записывать текущие данные в систему по посещаемым торговым точкам, заполнять документы по предзаказам торговых точек для дальнейшей поставки, проверять наполнение полок продукцией компании. Целью разработки ГИС является организация оперативного обмена данными между учетной системой и КПК сотрудников. Данные GPS с КПК сотрудника сравниваются с данными GPS, установленными в справочнике «Торговые точки», для создания отчета «Фактический маршрут агента», из которого будет понятно, посещал сотрудник торговую точку из своего маршрута или нет и насколько большим было отклонение от маршрута. Приводится краткое описание корректировки программного обеспечения в режиме «Конфигуратор 1С», разработанных процедур и функций на java-script. Предложенные решения позволяют выбирать на карте торговую точку, а также формировать задание на маршрут сотрудника по торговым точкам, прорисовывать на карте (по данным GPS) фактический маршрут сотрудника и указатели посещаемости торговых точек. Разработанная ГИС внедрена на АО «Управляющая компания «ЭФКО» в отделе продаж и логистики The article is devoted to solving the problems of developing a geographic information system (GIS), which allows the use of GPS data on pocket personal computers (PPC) of employees to generate a report of their visits to outlets specified according to the plan, and to view deviations from the route. In the structure of EFKO Management Company, the KPI system (based on 1C) is used for work in the sales and logistics department, which allows organizing the activities of its sales staff by collecting and analyzing various indicators. In particular, the work of supervisors, merchandisers, as well as territorial and regional managers was organized. In order to provide the work of territorial managers and supervisors not only at the computer but also directly during visiting the outlets, to place an order for the counterparty not on paper but immediately enter into the program, it is necessary to implement a connection between 1C KPI and the ST-Mobile application, developed specifically for this purpose. Employees should be able to record current data into the system on visited outlets, fill out documents for pre-orders of outlets for further delivery, check the filling of the shelves with the company's products. The purpose of the GIS development is to organize the operational data exchange between the accounting system and the employees' PPC. The GPS data from the employee's PPC is compared with the GPS data set in the “Outlets” directory to create the “Agent's actual route” report, from which it will be clear whether the employee visited the outlet from his route or not, and how large the deviation from the route was. The paper provides a brief description of the software correction in the 1C Configurator mode, the developed procedures and functions in java-script. The proposed solutions allow one to select a point of sale on the map, as well as form a task for an employee's route to points of sale, to draw on the map (according to GPS data) the actual route of the employee and indicators of attendance at retail outlets. The developed GIS was implemented at EFKO Management Company in the sales and logistics department
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Santos, Leonardo Sousa, Orleno Marques da Silva Junior, and Shirley Capela Tozi. "SISTEMA DE INFORMAÇÃO GEOGRÁFICA APLICADO NOS REGISTROS DE INCÊNDIOS DA CIDADE DE BELÉM, ESTADO DO PARÁ." InterEspaço: Revista de Geografia e Interdisciplinaridade 3, no. 10 (December 29, 2017): 65. http://dx.doi.org/10.18764/2446-6549.v3n10p65-79.
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GEOGRAPHICAL INFORMATION SYSTEM APPLIED IN THE FIRE RECORDS OF THE CITY OF BELÉM, STATE OF PARÁSISTEMA DE INFORMACIÓN GEOGRÁFICA APLICADO EN LOS REGISTROS DE INCENDIOS DE LA CIUDAD DE BELÉM, ESTADO DEL PARÁO Corpo de Bombeiros do Estado do Pará possui um banco de dados de suas atividades denominado Sistema de Cadastro de Ocorrências de Bombeiros, no entanto, essas informações são utilizadas apenas nas elaborações planilhas, gráficos, tabelas e relatórios. Este estudo objetiva aplicar um Sistema de Informação Geográfica para análise espacial das ocorrências de incêndios na cidade de Belém. Fez-se o levantamento, tratamento, tabulação e geocodificação dos dados de ocorrências de incêndios urbanos, localização dos hidrantes e Grupamento de Bombeiros Militar. Foram identificados 96 hidrantes na área de estudo de um total de 80 relacionados pela companhia de água. Com os resultados identificaram-se oito zonas de densidade de incêndio que necessitam de atenção preventiva do Corpo de Bombeiros. A zona 1 teve a maior extensão territorial (1,35 km²) e a zona 8 a menor (29.671,26 m²). As oito zonas de densidade de incêndio correspondem a 3% da área em estudo.Palavras-chave: SIG; Incêndios Urbanos; Atividades de Bombeiros Militar; Zoneamento de Incêndio Urbano.ABSTRACTThe Fire Department of the State of Pará has a database of its activities called Firemen's Record System, however, this information is used only in the worksheets, charts, tables and reports. This study aims to apply a Geographic Information System for spatial analysis of fire occurrences in the city of Belém. Data collection, treatment, tabulation and geocoding of occurrences of urban fires, location of fire hydrants and Military Fire Brigade were performed. 96 hydrants were identified in the study area of a total of 80 related by the water company. With the results, we identified eight fire density zones that require preventive attention from the Fire Department. Zone 1 had the largest territorial extension (1.35 km²) and the 8th lowest zone (29,671.26 m²). The eight zones of fire density correspond to 3% of the study area.Keywords: GIS; Urban Fires; Activities Military firefighters; Fire Urban Zoning.RESUMENEl Cuerpo de Bomberos del Estado de Pará posee un banco de datos de sus actividades denominado Sistema de Registro de Ocurrencias de Bomberos, sin embargo, esas informaciones se utilizan sólo en las elaboraciones hojas, gráficos, tablas e informes. Este estudio objetiva aplicar un Sistema de Información Geográfica para el análisis espacial de las ocurrencias de incendios en la ciudad de Belém. Se hizo el levantamiento, tratamiento, tabulación y geocodificación de los datos de ocurrencia de incendios urbanos, localización de los hidrantes y Grupaje de Bomberos Militar. Se identificaron 96 hidrantes en el área de estudio de un total de 80 relacionados por la compañía de agua. Con los resultados se identificaron ocho zonas de densidad de incendio que necesitan atención preventiva del Cuerpo de Bomberos. La zona 1 tuvo la mayor extensión territorial (1,35 km²) y la zona 8 más pequeña (29.671,26 m²). Las ocho zonas de densidad de incendio corresponden al 3% del área en estudio.Palabras clave: SIG, Incêndios Urbanos; Actividades de Bomberos Militares; Zonificación de Incendios Urbanos.
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Mikhnenko, P. A. "Information Modeling and Analysis of Labour Productivity Dynamics at Enterprises-Leaders." Vestnik of the Plekhanov Russian University of Economics, no. 4 (July 21, 2021): 118–32. http://dx.doi.org/10.21686/2413-2829-2021-4-118-132.
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Serious growth in labour productivity is an essential task of Russian economy today, which was formulated in the national goals of the Russian Federation and the national project ‘Labour Productivity and Employment Support'. Current mathematic models and methods of analyzing the given problem cannot identify key factors affecting the capacity of the enterprise to provide a considerable growth in productivity in the short-term and medium-term perspective. The article puts forward a mathematic model for analyzing labour productivity dynamics, which was designed on the informational approach to system analysis. Specific features of the model are the use of the hypothesis theorem to get estimation of relative probability of achieving the target indicator and 2 variants of interpretation of probability to realize the situation factor. The research object is representative sample of industrial enterprises in Russia included in the top-100 leaders by labour productivity growth. The authors set and resolved the task to estimate relative steps of target information that determine the degree of conformity of an increase in key finance and economic parameters with attaining the goal, i.e. growth in labour productivity at the enterprise in 3-year perspective. As a result of modeling it was shown that the degree of relative expediency of high rates of proceed rise tend to decline as the ranges of labour productivity grow. At the same time the degree of relative of high rates of asset turn-over growth steps up in line with decreasing durability of operative cycle of the enterprise. In contrast to many works dealing with this problem it was shown that relative expediency of fundequipment at the enterprise is more noticeable for medium and high rates of labour productivity growth and extremely low in the record range. The obtained results demonstrate applied opportunities to use logic-mathematic tools of the information approach to analyze indicators of economic efficiency of business.
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Noone, Declan, Gabriel Pedra, Sohaib Asghar, Jamie O'Hara, Eileen K. Sawyer, and Nanxin (Nick) Li. "Prophylactic Treatment in People with Severe Hemophilia B in the US: An Analysis of Real-World Healthcare System Costs and Clinical Outcomes." Blood 134, Supplement_1 (November 13, 2019): 2118. http://dx.doi.org/10.1182/blood-2019-126576.
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Introduction The treatment paradigm for people with severe hemophilia B in the US typically involves prophylaxis with factor IX (FIX) replacement therapy, the primary aim of which is to provide sufficient FIX levels to reduce the frequency of bleeding events. The clinical benefits of FIX prophylaxis are well understood, however the cost of FIX products as well as costs associated with healthcare resource utilization present a significant burden to the healthcare system. Substantive costs may also accrue in patients who continue to bleed while on prophylaxis, due to the impact on both short and long-term joint-related outcomes. In the absence of existing data in the US, the 'Cost of Hemophilia Across the USA: a Socioeconomic Survey' (CHESS US) study was conducted to establish a population-based estimate of the real-world US healthcare system burden associated with severe hemophilia. Using data drawn from the CHESS US study, this analysis examines the real-world healthcare system costs and clinical outcomes of people with severe hemophilia B on FIX prophylaxis. Methods CHESS US, a retrospective, cross-sectional dataset of adults with severe hemophilia in the USA, gathered information on patient cost via a patient record form. Data on the following parameters are included in this analysis: FIX consumption, annualized bleeding rate (ABR), the presence of one or more chronically damaged joints ("problem joint"), as well as costs associated with annual (prophylactic) factor consumption and hospitalizations (i.e., number of admissions, number of day cases, total inpatient days, and total intensive care unit [ICU] days). All variables report retrospective data of the 12 months prior to enrolment in the study. Results are presented as mean (± standard deviation) or N (%). Results In total, 132 of 576 patients profiled in the CHESS US study had severe hemophilia B. Among them, 77 patients were on FIX prophylaxis, of whom 44 patients reported FIX dosing regimen and were included in the current analyses. Among them, 20 patients were treated with conventional FIX and 24 patients with extended half-life (EHL) FIX products. The cohort has a mean age of 27.64 (± 11.05) and mean weight (kg) of 75.71 (± 13.41). In the last 12 months, the mean number of international units (IU) prescribed for FIX prophylaxis across the full cohort was 257,216 IU (± 213,591), with an associated annual cost of $610,966 (± $495,869). Among patients treated with conventional FIX, mean prescribed FIX was 287,141 IU (± 264,906) at an annual cost of $397,491 (± $359,788), while patients treated with EHL FIX reported a mean prescribed FIX of 232,278 IU (± 160,914) at an annual cost of $788,861 (± $529,258). The cohort reported a mean ABR of 1.73 (± 1.39); 8 (18%) were reported to have a target joint meeting the International Society on Thrombosis and Haemostasis (ISTH) definition; and 11% were reported to have had at least one chronically damaged joint (i.e., problem joint). Healthcare resource utilization associated with bleed events were reported as follows: hospital admissions days [0.18 (± 0.62)]; inpatient days [0.34 (± 1.22)]; and ICU days [0.23 (± 0.86)]. The direct medical cost to the healthcare system was $2,885 (± $7,857; excluding FIX cost) and $614,886 (± $498,839; including FIX cost). Discussion Data from the CHESS US study showed substantial costs and resource utilization among patients with severe hemophilia B receiving FIX prophylaxis, of which the cost of FIX replacement therapy constituted most of the total cost to healthcare system. Although the ABR observed in the analysis population was low, bleed-related hospitalizations comprised a significant non-drug cost to the healthcare system. A proportion of patients also still experienced joint arthropathy. Such substantial clinical and economic burden highlights that unmet needs remain in patients with severe hemophilia B on FIX prophylaxis in the US. Disclosures Noone: HCD Economics: Employment. Pedra:HCD Economics: Employment. Asghar:HCD Economics: Employment. O'Hara:HCD Economics: Employment, Equity Ownership. Sawyer:uniQure Inc.: Employment. Li:uniQure Inc.: Employment.
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Clay, E. Leila Jerome, Miranda Bailey, Dan Drozd, Jincy Paulose, Nicholas Ramscar, Kieran Mace, and David Wormser. "A Patient-Centric Approach to Improve the Understanding of Sickle Cell Disease Using Real-World Data." Blood 136, Supplement 1 (November 5, 2020): 27–28. http://dx.doi.org/10.1182/blood-2020-139148.
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Background: Sickle cell disease (SCD) comprises a group of inherited blood disorders, and is a complex, multi-system, disease. SCD is associated with a variety of clinical complications that affect multiple organ systems. These complications are driven primarily by vaso-occlusion and hemolytic anemia, and can result in end-organ damage and early death. Painful vaso-occlusive crises (VOCs) are a characteristic feature of SCD and can require healthcare intervention. Despite recent advances in the screening, management and treatment of SCD, gaps remain in our understanding of the disease in the real-world setting. These include how best to transition from pediatric to adult care and how to manage specific complications. Currently, most real-world evidence (RWE) is generated from information captured in payer databases, which is not as comprehensive as the information recorded in electronic medical records (EMRs). Despite being potentially valuable sources of real-world, clinical information, EMRs for individual patients in the USA are not centralized, often being held by multiple healthcare providers using different EMRs. This fragmented system prevents generation of clear, comprehensive RWE, both in general and for SCD specifically. Furthermore, there is a lack of harmonization between EMR companies/systems in the types of information included and how it's recorded. A separate approach that collates all available data from EMRs into a single, comprehensive record prior to RWE analysis would therefore greatly improve the accessibility of the available information and the quality of subsequent data analysis. Aims: In contrast to existing RWE, this study explores the value of collating EMRs for each patient into a single, consistently structured format, with the aim of developing richer RWE to complement existing data on SCD. It is hypothesized that the resulting longitudinal overview of each patient's care will contribute to an improved understanding of SCD in the real-world setting: firstly, by better capturing how many VOCs patients with SCD experience, with an indication of the proportion of VOCs that are being home-managed; secondly, by gaining deeper insights into the prevalence and progression of end-organ damage and any association with VOCs; and finally, by highlighting the type and site of care of SCD in the real world (eg medications, treating healthcare professional [HCP] specialties and the type of clinic visited). Study design: The study population will comprise 400 patients with SCD from the USA. Patient recruitment occurs directly via social media and indirectly through a variety of partnerships including HCPs and patient advocacy groups. To enroll, patients sign an informed consent form allowing their de-identified medical information to be shared with third-party organizations to advance SCD research. Enrolled patients gain access to their medical records via a dashboard. The key inclusion criteria are: a confirmed SCD diagnosis (irrespective of phenotype); aged ≥16 years at enrollment; and ≥1 inpatient admission for a VOC in the 12 months prior to enrollment. The key exclusion criterion is the absence of medical records. Components of EMRs collected include doctors' notes, laboratory and test results, clinical imaging and treatment records. Human-curated natural language processing and machine learning is used to extract, structure and code data from the structured sections and unstructured narrative text of the EMR. All medical records, from all visits, will be collected where possible and are expected to comprise ≥7 years of retrospective data for each patient. Results: Between 1 December 2019 and 24 June 2020, a total of 46 patients with a mean age of 36 years (SD 9.7) were enrolled. For each patient, a median of 6.8 years of data from a median of 32.5 providers were obtained. Conclusions: The evidence derived from this study aims to advance the understanding of real-world practices in the management of SCD. It may also provide further learnings regarding the prevalence of complications and any association between VOCs and end-organ damage. Generating a single, structured overview of all EMRs for each patient allows for richer insight generation and a more comprehensive analysis of RWE, compared with existing approaches. The insights gained from this RWE may inform future studies and clinical trials in SCD, with the ultimate aim of improving the quality of life of patients. Disclosures Clay: Novartis: Consultancy; GBT: Consultancy. Bailey:Novartis Pharmaceuticals Corporation: Current Employment. Drozd:F. Hoffmann-La Roche Ltd: Other: All authors received support for third party writing assistance, furnished by Scott Battle, PhD, provided by F. Hoffmann-La Roche, Basel, Switzerland.; PicnicHealth: Current Employment, Current equity holder in private company. Paulose:Novartis Pharma AG: Current Employment. Ramscar:Novartis Pharma AG: Current Employment. Mace:Roche/Genentech: Ended employment in the past 24 months; PicnicHealth: Current Employment. Wormser:Novartis Pharma AG: Current Employment, Current equity holder in publicly-traded company.
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Majeed, Jaber H., and Qais Aish. "A remote patient monitoring based on WBAN implementation with internet of thing and cloud server." Bulletin of Electrical Engineering and Informatics 10, no. 3 (June 1, 2021): 1640–47. http://dx.doi.org/10.11591/eei.v10i3.1813.
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A healthcare employment is the mainly domain in emergent technology of WBAN, and an e-health system created of cloud computing in addition to a WSN considers an important part of this field. An implementation of remotely system for monitoring the patient's vital signs require continuous observation to form low-cost networks with the ability of portability and flexibility and may be applied with separate position and long-term intensive care of peoples in the absence of disturbance of their everyday activities. The patient carries body sensor's patches to get transmitted vital signs continuously to the cloud environment, and a website is designed for presenting and analyzing the data based on designed algorithm. A comparison is made every received measurement with a that stored in the algorithm. In remote specialist care, the execution of confidence and confidentiality conservation is critical, as essential restrictions were being communicating with remote locations. To ensure reliability, the implemented system offers real time monitoring and certification to the patient's condition by means of a medical record, with rapid medical data delivery to the medical staff and can also increase the service delivery ratio of hospital capacity and monitoring of large number of patients with concentrated average delay.
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Sharman, Jeff, Shaum Kabadi, Jamyia Clark, E. Susan Amirian, and David J. Andorsky. "Treatment Patterns and Outcomes of 159 Ibrutinib-Treated MCL Patients in the United States: A Retrospective Electronic Medical Record Database and Chart Review Study." Blood 132, Supplement 1 (November 29, 2018): 4163. http://dx.doi.org/10.1182/blood-2018-99-118848.
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Abstract Introduction Ibrutinib, a Bruton's tyrosine kinase inhibitor, was approved in the U.S. for the treatment of relapsed or refractory mantle cell lymphoma (MCL) in November of 2013. However, real-world data on ibrutinib use for the treatment of MCL is limited. The purpose of this study was to examine ibrutinib use, dosages, and reasons for treatment discontinuation among MCL patients treated in a community oncology practice setting. Methods The study population consisted of adult (≥18 year old) MCL patients treated with ibrutinib between November 1, 2013 and October 31, 2016, who were not enrolled in a clinical trial and had at least 2 visits to a US Oncology Network (USON) clinic. Patients with other primary cancers were excluded. Patient data were sourced from the USON's electronic health records system, iKnowMed (iKM)™. The structured iKM database provided information on demographics and clinical and treatment characteristics. Manual chart review was used to confirm ibrutinib treatment patterns. Duration of ibrutinib therapy (DOT), overall survival (OS), and progression-free survival (PFS) from systemic treatment initiation were estimated using Kaplan-Meier methods. Events were defined as death in the OS analysis, and progression or death in the PFS analysis. Patients were censored if their treatment was ongoing for DOT. Censors for OS and PFS were patients lost to follow up or those who did not experience a failure event within the study period. Results 159 eligible MCL patients were identified through iKM. The majority of patients were Caucasian (n=141, 88.7%), male (n=121, 76.1%), and diagnosed with Stage IV disease (n=117, 73.6%). Median follow-up for the population was 16.1 months. Approximately 7.5% (n=12) of patients received ibrutinib as first-line therapy (1L), compared to 54.1% (n=86) in 2L and 38.4% (n=61) in 3L or beyond. Median ibrutinib dose at initiation was 560mg (range: 140-700). During ibrutinib treatment, 16.4% (n=26) of patients experienced a dose reduction. Dose holds occurred in 30.2% (n=48), 66.7% (n=32) due toxicities. The overall discontinuation rate was 83.6% The primary reason for discontinuation was disease progression (n=46, 34.6%) followed by toxicities (n=34, 25.6%). Median DOT was higher for patients initiating treatment in 3L+ (14.9: 95% CI 8.8-17.1) compared to other lines. Median PFS was 19.6 (95% CI: 16.5-24.3) for the overall population and median OS was 25.8 months (95% CI: 19.9-not reached). Conclusions Our real-world findings on survival are consistent with those from clinical trials on ibrutinib in relapsed/refractory MCL, although our observed discontinuation rate (~84%) was higher than that of the trial (~58%), which had a similar median follow-up time (16.1 months vs. 15.3 months, respectively). Our findings provide additional data on MCL treatment patterns and patient outcomes in clinical practice. Disclosures Sharman: Acerta: Consultancy, Research Funding; Pharmacyclics, an AbbVie Company: Consultancy, Research Funding. Kabadi:AstraZeneca: Employment. Clark:McKesson Specialty Health: Employment, Equity Ownership. Amirian:McKesson Specialty Health: Employment. Andorsky:Celgene: Research Funding; CTI BioPharma: Consultancy, Research Funding; AstraZeneca: Consultancy; Genentech: Consultancy.
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Fleming, Michael, Catherine A. Fitton, Markus F. C. Steiner, James S. McLay, David Clark, Albert King, Daniel F. Mackay, and Jill P. Pell. "Educational and health outcomes of children and adolescents receiving antidepressant medication: Scotland-wide retrospective record linkage cohort study of 766 237 schoolchildren." International Journal of Epidemiology 49, no. 4 (February 19, 2020): 1380–91. http://dx.doi.org/10.1093/ije/dyaa002.
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Abstract Background Childhood depression is relatively common, under-researched and can impact social and cognitive function and self-esteem. Methods Record linkage of routinely collected Scotland-wide administrative databases covering prescriptions [prescribing information system (PIS)], hospitalizations (Scottish Morbidity Records 01 and 04), maternity records (Scottish Morbidity Records 02), deaths (National Records of Scotland), annual pupil census, school absences/exclusions, special educational needs (Scottish Exchange of Educational Data; ScotXed), examinations (Scottish Qualifications Authority) and (un)employment (ScotXed) provided data on 766 237 children attending Scottish schools between 2009 and 2013 inclusively. We compared educational and health outcomes of children receiving antidepressant medication with their peers, adjusting for confounders (socio-demographic, maternity and comorbidity) and explored effect modifiers and mediators. Results Compared with peers, children receiving antidepressants were more likely to be absent [adjusted incidence rate ratio (IRR) 1.90, 95% confidence interval (CI) 1.85–1.95] or excluded (adjusted IRR 1.48, 95% CI 1.29–1.69) from school, have special educational needs [adjusted odds ratio (OR) 1.77, 95% CI 1.65–1.90], have the lowest level of academic attainment (adjusted OR 3.00, 95% CI 2.51–3.58) and be unemployed after leaving school (adjusted OR 1.88, 95% CI 1.71–2.08). They had increased hospitalization [adjusted hazard ratio (HR) 2.07, 95% CI 1.98–2.18] and mortality (adjusted HR 2.73, 95% CI 1.73–4.29) over 5 years’ follow-up. Higher absenteeism partially explained poorer attainment and unemployment. Treatment with antidepressants was less common among boys than girls (0.5% vs 1.0%) but the associations with special educational need and unemployment were stronger in boys. Conclusions Children receiving antidepressants fare worse than their peers across a wide range of education and health outcomes. Interventions to reduce absenteeism or mitigate its effects should be investigated.
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Dmytryszyn, Mark, and Matthew Crook. "Distant Blocking of Celestial Lines of Communications Using Electromagnetic Pulse." Applied Physics Research 12, no. 4 (July 31, 2020): 92. http://dx.doi.org/10.5539/apr.v12n4p92.
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The potentially imminent and existential threat from a nuclear electromagnetic pulse are arguably inflated, voiced to garner attention to the true issue, that today’s microelectronics are incredibly vulnerable to electromagnetic damage caused by sudden voltage spikes from the electromagnetic pollution. Additionally, a nuclear electromagnetic pulse does not need to be detonated in outer space to cause signification disruption to communications systems’ data and information flow across the celestial domain. High altitude electromagnetic pulse (HEMP) detonations do not need to occur in outer space to have wide ranging effects; in describing electromagnetic pulses, the high-altitude moniker is tied to any detonation above nineteen miles (thirty point-five kilometers). High altitude electromagnetic pulse detonations ranging from fifty to one hundred kilometers can project wave effects into outer space and affect spacecraft through both direct damage (contemporary views regarding electromagnetic pulse) and radiation-induced torques on the solar arrays, misaligning satellite antennas and sensors. If an actor – state or otherwise – wished to compete or contest another along the congested celestial lines of communications (CLOCs), it can be done at great distance from the affected entity by use of a high altitude electromagnetic pulse on the ‘far side’ of the orbit. Additionally, the historic maritime tactic of blockade has applicability in space; yesterday’s ships are today’s gamma ray damage to microelectronics. Furthermore, the employment of a nuclear weapon-delivered high-altitude electromagnetic pulse remains a treaty violation, for those who are a party to. However, greater jurisprudence study is lacking regarding this matter, and the accompanying concern of transboundary harm as it relates to territorial sovereignty. In summary, an actor can contest another’s use of the celestial lines of communications by detonating a nuclear weapon, at high-altitude but within the atmosphere (i.e., below one hundred kilometers), and within the lateral boundaries of their sovereign territory and associated territorial waters, and allow wave’s effects to radiate widely to interrupt operations and possibly inflict permanent damage, all without being in violation of treaty or customary law. This manuscript substantiates the prequel baseline for follow-on research on mitigation of the deleterious effects on communication system circuits in attempts to void the blockage on celestial lines of communications, and the sequel is briefly introduced with a short description of the state-of-the-art research.
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Benwell, Nicola, Kathryn Hird, Nicholas Thomas, Erin Furness, Mark Fear, and Greg Sweetman. "Effectiveness and efficiency of training in digital healthcare packages: training doctors to use digital medical record keeping software." Australian Health Review 41, no. 5 (2017): 479. http://dx.doi.org/10.1071/ah16090.
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Objective Fiona Stanley Hospital (FSH) is the first hospital in Western Australia to implement a digital medical record (BOSSnet, Core Medical Solutions, Australia). Formal training in the use of the digital medical record is provided to all staff as part of the induction program. The aim of the present study was to evaluate whether the current training program facilitates efficient and accurate use of the digital medical record in clinical practice. Methods Participants were selected from the cohort of junior doctors employed at FSH in 2015. An e-Learning package of clinically relevant tasks from the digital medical record was created and, along with a questionnaire, completed by participants on two separate occasions. The time taken to complete all tasks and the number of incorrect mouse clicks used to complete each task were recorded and used as measures of efficiency and accuracy respectively. Results Most participants used BOSSnet more than 10 times per day in their clinical roles and self-rated their baseline overall computer proficiency level as high. There was a significant increase in the self-rating of proficiency levels in successive tests. In addition, a significant improvement in both efficiency and accuracy for all participants was measured between the two tests. Interestingly, both groups ended up with similar accuracy on the second trial, despite the second group of participants starting with significantly poorer accuracy. Conclusions Overall, the greatest improvements in task performance followed daily ward-based experience using BOSSnet rather than formalised training. The greatest benefits of training were noted when training was delivered in close proximity to the onset of employment. What is known about the topic? Formalised training in the use of information and communications technology (ICT) is widespread in the health service. However, there is limited evidence to support the modes of learning typically used. Formalised training is often costly and there is little other than anecdotal evidence that currently supports its efficacy in the workplace. What does the paper add? Assessment of accuracy when using the BOSSnet system over time revealed that daily use rather than formalised training appeared to have the most impact on performance. Formalised training was rated poorly, and this appeared to correlate with time between training and use. The present study suggests that formalised training, if required, should be delivered close in time to actual use of the system to benefit end-users. The study also shows that daily experience is more effective than formalised training to improve accuracy. What are the implications for practitioners? Formalised training for ICT needs to be scheduled in close proximity to end-user use of the ICT. Current scheduling may be beneficial for ease of delivery, but unless it is delivered at a suitable time the benefits are minimal. Formalised training programs may not be critical for all staff and all staff improve with contextualised experience given time. Training may be better suited to optional rather than compulsory delivery programs with ongoing delivery to suit user schedules.
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Bamufleh, Dalal. "Modelling the Acceptance and Use of Electronic Medical Records from Patients’ Point of View: Evidence from Saudi Arabia." International Journal of Business and Management 16, no. 7 (May 19, 2021): 12. http://dx.doi.org/10.5539/ijbm.v16n7p12.
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Background: The employment of IT in healthcare reflects a need to meet the increasing demands of patients and to upgrade the quality and productivity of the provided services. However, the literature demonstrates many failures in systems and IT technology implementation. One of the reasons behind these failures is users’ resistance. The ministry of health (MOH) in Saudi Arabia (SA) has prioritized the embracing of new technologies that could improve the healthcare services, such as electronic medical record (EMR) systems. On the other hand, studies that address the acceptance and use of hospital information systems (HIS) and EMRs in SA from patients’ standpoint are scarce. The aim of this study was to explore patients’ acceptance of an EMR system by proposing a model adapted from the technology acceptance model (TAM) and the unified theory of acceptance and use of technology (UTAUT).
Methods: An online questionnaire was used where questions were based on the proposed model constructs (facilitating conditions (FC), perceived ease of use (PEOU), perceived usefulness (PU), attitude (ATT), and behavioral intention (BI)). 116 patients responded to the questionnaire. The model was then tested to identify the factors that affect patients’ intention to use the online services of the EMR.
Results: The analysis of the research model suggested that (1) FCs influenced the degree of system’s PEOU. (2) PEOU affected the EMR’s PU. (3) PU affected patients’ ATT toward using the EMR. (4) A positive effect is found between ATT and BI to use EMR.
Conclusion: The study has implications for healthcare IT acceptance research and efforts in SA, as to date patients’ perspectives have received little attention. The research also makes a theoretical contribution as it validated the proposed model.
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Licandro, Oscar. "Relationship between general CSR management practices and the development of internal social responsibility." Journal of Business 12, no. 2 (2020): 2–29. http://dx.doi.org/10.21678/jb.2020.1453.
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Companies that embrace corporate social responsibility (CSR) tend to adopt certain general practices, such as: establishing social responsibility areas, preparing codes of ethics, publishing social or sustainability reports, joining organizations that promote social responsibility, or starting their own foundations. The question then arises as to whether these general practices actually influence the responsible behavior of companies. This article explores the relationship between the application of these general CSR practices and the level of development of internal social responsibility (ISR). To study this relationship, information was drawn from the system of CSR indicators (CSRI) overseen by the Cristian Association of Business Managers (Asociación Cristiana de Dirigentes de Empresas, a self-evaluation system in which Uruguayan companies participate annually. The CSRI uses 25 indicators to measure the level of ISR development and record the application of eight general CSR practices. After carrying out a review of the literature, the 25 indicators were organized into nine dimensions of ISR: employees’ human rights; informing employees about issues that affect them; occupational health and safety; internal environment; personal and professional development; employment protection; voluntary provision of benefits; union relations; and fair pay. After analyzing the statistical correlation between the application of general CSR practices and the level of development of social responsibility across the nine dimensions, the results indicate the following: three general practices positively correlate with the development of ISR in all its dimensions (including CSR in strategic planning, involving the management team in CSR issues, and joining an organization that promotes CSR); one practice (preparing a code of ethics) correlates with half of the dimensions; and the other four practices (publishing a social or sustainability report, assigning a full-time employee to CSR management, having a CSR team or area, and possessing a foundation) correlate with none or almost none of the dimensions.
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Dolynska, O. O. "RURAL TOURISM OF KHMELNYTSK REGION: CURRENT STATE AND DEVELOPMENT PROSPECTS." Odesa National University Herald. Geography and Geology 26, no. 1(38) (September 4, 2021): 105–16. http://dx.doi.org/10.18524/2303-9914.2021.1(38).234683.
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Problem Statement and Purpose. The article deals with the peculiarities of rural tourism development in Khmelnytskyi region. The purpose of our research is to study the current state, problems and prospects of rural tourism in Khmelnytskyi region. To achieve this goal we have performed the following tasks. For example, the development peculiarities of Khmelnytskyi regional tourist complex are revealed; identified spatial aspects of Khmelnytskyi region rural tourism development; the problems of Khmelnytskyi region rural tourism development are investigated; the perspective development directions of Khmelnytskyi region rural tourism are named. The essence of the concept of “rural” tourism is defined. The available tourist and recreational resources necessary for the development of rural tourism in Khmelnytskyi region are analyzed. The advantages and factors influencing the development of rural tourism in this region are identified. According to many scientists, due to the spread of COVID‑19 and the pandemic, rural tourism is the most developed, as this type of tourism is one of the most secluded types. Data & Methods. To achieve the goal of the study, general scientific and special methods of geographical science were used. The negative and positive impact of green tourism on rural areas and the solution of socio-economic problems of the village are analyzed. Given the rich tourist and recreational resources of Khmelnytskyi region (favorable natural and climatic conditions, historical, cultural and ethnic heritage), the development of rural tourism is one of the ways to solve economic, social and environmental problems. Results. Rural tourism promotes the development of the rural population employment, not only in the production sphere, but also in the service sector and promotes the development of rural areas, as well as stimulating the development of services: transport, communications, trade, services, recreation and other institutions in the countryside. The article deals with the ways to increase the efficiency of green tourism in Khmelnytskyi region. It is substantiated that the available resource potential of Khmelnytskyi region is not rationally used, due to the lack of sufficient information on this form of tourism. The study of the of green tourism development prospects in Khmelnytskyi region is very relevant in the context of decentralization. In accordance with the principles of reforming the system of governance in Ukraine, local governments should become the basis for decentralization, taking full account of local development and needs. The newly formed rural united territorial communities have great difficulties in filling local budgets with funds from economic activities on their territory. It is believed that rural tourism can become an industry that will actively fill the budget of rural united territorial communities.
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Yang, Fei, Anup Abraham, Ju Zhang, Yan Xiao, Richard D. Hammer, Donald C. Doll, and Matthew S. Prime. "Identification and Reporting of Cell of Origin, Double-/Triple-Hit and Double Expressor Lymphoma in a Real-World Cohort of Diffuse Large B-Cell Lymphoma Patients." Blood 136, Supplement 1 (November 5, 2020): 29. http://dx.doi.org/10.1182/blood-2020-134674.
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Background The distinction of diffuse large B-cell lymphoma (DLBCL) into cell-of-origin (COO) subgroups (germinal center B-cell-like [GCB] or activated B-cell-like [ABC]) based on gene expression profiling is associated with prognosis and has potential therapeutic implications to mitigate the worse outcome for patients with DLBCL. Other phenotypic and molecular/cytogenetic features such as concurrent translocations of oncogene MYC and BCL2 and/or BCL6 (so-called double-/triple-hit lymphoma, DHL/THL) and coexpression of MYC and BCL2 proteins (so-called double-expressor lymphoma, DEL) are also recognized to have great prognostic impact (Swerdlow SH et al. Blood 2016;127(20):2375-2390). This study investigated the prevalence of COO, DHL/THL and DEL in a real-world cohort of patients with DLBCL who had documented results of diagnostic testing. Methods This study used the Flatiron Health electronic health record-derived de-identified database to abstract information on patients diagnosed with DLBCL between 2011-2019. Information on diagnostic testing from immunohistochemistry (IHC) for expression of MYC, BCL2, BCL6, CD10 or MUM1, and from fluorescence in situ hybridization (FISH) or karyotype analysis for rearrangement of MYC, BCL2 or BCL6 was abstracted from pathology reports or clinical visit notes, where available. We calculated the proportions of COO subgroups (GCB vs. ABC) that were derived from IHC testing results according to Hans algorithm (Hans C et al., Blood 2004;103(1):275-282), DHL/THL, and DEL. We also examined concordance of COO classification derived from IHC testing results with that directly reported by the healthcare providers. Differences in patient characteristics between IHC testing results-derived COO subgroups (GCB vs. ABC) were assessed using chi-square tests. Results 4400 patients had documented results of IHC and 73% (n=3194) can be classified into either GCB or ABC DLBCL (GCB/ABC ratio of 1.38). 3205 patients had documented results of FISH or karyotype analysis and 8% (n=245) were DHL/THL; only 33 patients were DEL. Within the GCB DLBCL patients derived from IHC testing results (n=1854), 163 patients were DHL/THL and 11 were DEL, whereas 24 DHL/THL and 18 DEL were identified within the ABC type (n=1340). When comparing COO classification derived from IHC testing results (n=3194) with that directly reported by the healthcare providers (n=2765), additional 695 and 439 patients can be classified as GCB and ABC DLBCL by IHC, respectively (Table). Univariate analysis showed that patients who were non-White ethnic group, diagnosed in academic centers, with lower body mass index but elevated serum lactate dehydrogenase levels and worse ECOG performance status, and without transformation from a prior indolent lymphoid malignancy, were more likely to be associated with ABC DLBCL (for all variables, p<0.05). There were no clinically meaningful and/or statistically significant differences in IHC testing results-derived COO classification (GCB vs. ABC) by age, gender, year of DLBCL diagnosis, geographic location of residency, type of insurance plan, tumor group stage, documentation of extranodal site or any other primary cancer history at the time of diagnosis. Discussion In this large real-world DLBCL cohort, a lower-than-expected proportion of DEL patients were identified vs. the 20-35% reported in the literature (Karube K and Campo E. Hematology 2015;52(2):97-106). This is likely due to our cohort of patients requiring clear evidence of coexpression for MYC and BCL2 (≥40% and >50%, respectively) that are not related to underlying chromosomal rearrangements, and few pathologists reported levels of percent staining for IHC testing among those with documented positive results of MYC/BCL2 protein coexpression. In addition, results from this study showed that only half of cases had COO classification documented by healthcare providers, despite available IHC results. Although this study indicated lack of details in the reporting of diagnostic testing (e.g. COO identification, levels of percent staining, methods for DLBCL subgroup identification), findings should be interpreted with caution, as patients with DLBCL might have been tested but not documented in the electronic health record system or might have biomarker testing performed at sites outside of the Flatiron Health network. Disclosures Yang: F. Hoffmann-La Roche: Current Employment. Zhang:F. Hoffmann-La Roche: Current Employment. Xiao:F. Hoffmann-La Roche: Current Employment. Hammer:Roche: Consultancy, Honoraria, Research Funding; Caris Lifesciences: Honoraria; PER Med education: Honoraria; PathEdEx: Current equity holder in private company. Prime:F. Hoffmann-La Roche: Current Employment.
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Leonov, S. N. "Influence of the Ports of the Northern Sea Route on the Formation of Focal Zones for the Development of the Eastern Arctic." Arctic: Ecology and Economy 11, no. 1 (March 2021): 6–18. http://dx.doi.org/10.25283/2223-4594-2021-1-6-18.
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The authors consider propulsive potential of the ports of the eastern section of the Northern Sea Route (NSR) and indicate the influence of the NSR on increasing the efficiency of the key zones formation for the development of the Far Eastern Arctic. They base the work methodology on the theory of cumulative growth, in which the ideas of the “growth poles” formation occupy a decisive position. The authors use the grouping methods, logical and comparative analysis. The Rosstat data serves as an information base of the study. It is shown that the state’s activity on the development of the NSR stimulates the development of the North Yakutsk and Chukotka support zones, enhancing the transport and raw materials specialization of the Eastern Arctic as a whole. At the same time, the authorities proceed from the assumption that the development of ports should reduce the costs of trade, increase employment, and have a multiplier effect both on the port system itself and on the sectors of the region interacting with it. The paper substantiates that in the Far Eastern Arctic, the traditional view of ports as the most important infrastructure assets, which are the business and economic center of territorial development, is insufficient for the recognition of transport infrastructure as a propulsion industry. The propulsive effect of the port economy is low and is mainly of an induced nature, when capacities for processing products are created in the port areas, or when the transport infrastructure stimulates the emergence of transport-intensive extractive industries, which is provided in the western part of the NSR. For the development of the North Yakutsk and Chukotka Arctic support zones, the transport infrastructure will be a backbone project that “connects” these regions in an economically sustainable spatial formation — the Far Eastern Arctic. Transport is a necessary but insufficient condition for the emergence and accelerated development of local “growth poles” in the Eastern Arctic.
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Ohniev, V. A., and K. G. Pomohaibo. "DEFINITION OF MEASURES TO REDUCE THE OBESITY LEVEL IN CHILDREN BASED ON RESEARCH RESULTS OF PREVALENCE AND RISK FACTORS." Вісник соціальної гігієни та організації охорони здоров'я України, no. 3 (December 23, 2020): 51–55. http://dx.doi.org/10.11603/1681-2786.2020.3.11622.
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Purpose: to study prevalence and main risk factors for overweight and obesity in children and adolescents aged 6–17 and develop appropriate prevention measures.
Materials and Methods. Bibliographic, statistical and sociological methods.
Results. It is noted an insufficient level of registration of obesity among children. During the study it was found that true prevalence of obesity and overweight in children and adolescents in Kharkiv is significantly different from the official statistics in Kharkiv region ((151.0±5.2)‰). 22 factors of risk had a reliable impact on the development of overweight in children and adolescents. The main risk factors for the formation of the overweight were biological and social and hygienic. Based on the results of the research it was proved that the key measures to reduce the prevalence of obesity and its consequences should be aimed at modifying risk factors, namely: changing stereotypes and habitats that contribute to pathology and at improving the quality of health care, basically at the primary level. Thus priority measures for improvement the quality of health care for children and adolescents with obesity should include: mandatory monitoring of body mass index among children from the age of 3 and assessment of the harmony of physical development; introduction of an information system for accounting, monitoring of obesity and overweight and the main risk factors (electronic medical record of the patient); introduction of patient registers at the territorial and regional level; preferential supervision by the family doctor, involvement of all experts; raising public awareness at the group, individual level; timely identification of risk factors, formation of risk groups, organization of dynamic monitoring, creation of differentiated prevention programs and study of public awareness of the main risks of overweight; advanced training of doctors, conducting training seminars on nutrition.
Conclusions. Thus, to solve the problem of obesity in children such structures as local governments, educational institutions, healthcare institutions and public organizations should be obligatory involved. Special attention is paid to measures to optimize medical care at the primary level for such children.
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Skrypko, Tetyana, and Mariya Harasymlyuk. "Intellectual specialization of entrepreneurship as a way of solving social and economic problems." Socio-Economic Problems of the Modern Period of Ukraine, no. 1(135) (2019): 10–14. http://dx.doi.org/10.36818/2071-4653-2019-1-2.
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Ukraine lags behind the developed countries in technological and economic spheres, by average income per capita, by renovation of production equipment, etc. Instead, comparatively high level of labour resources’ qualification and intellectual capacity remain to be the competitive advantage. Based on the theory of competitive advantages and current EU smart specialization strategy, it is possible to focus on technology-intensive industries oriented on exports to secure the countries’ sustainable development. The state of innovation activity of enterprises of industry, entrepreneurship sectors and regions is considered. The structure of the types of innovative activities of Ukrainian industrial enterprises for 2010-2017 includes internal and external impacts, such as the purchase of equipment and software, training of employees, etc. Statistical, table, questionnaire, factor analysis methods were used. The comparative analysis provides an innovative index of Ukraine and its 10 components (human resources, attractive research systems, innovation friendly environment, finance and support, firm investments, innovators, linkages, intellectual assets, employment impacts, sales impacts) calculated by EU economic experts according to the methodology The European Innovation Scoreboard. Based on the answers of the managers of small businesses, the bottlenecks of innovation management are grounded: internal (qualifications of managers and specialists), limited financial resources, risk of activities diversification) and external (corruption, formal approach of authorities and institutional infrastructure). The paper proves the reasonability of the state policy of further investment development and stimulation of the IT sector due to its low material resources, proper system of education of specialists, legal support and fiscal policy. The record high growth rate of the information services market and the corresponding high-intellectual cluster of specialists allows predicting the integration of the national industry into the international division of labor from the angle of geopolitical smart specialization.
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Hampton, Roger J., Pablo Katz, Aijing Shang, Harpal Dhillon, and Hayley Hubberstey. "Trial in Progress: Quantifying the Humanistic and Socioeconomic Burden of Paroxysmal Nocturnal Hemoglobinuria in the COMMODORE Burden of Illness Study." Blood 136, Supplement 1 (November 5, 2020): 26–27. http://dx.doi.org/10.1182/blood-2020-140679.
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Background Paroxysmal nocturnal hemoglobinuria (PNH) is a rare disease associated with major complications such as thrombotic events and impaired renal function. Prior to the introduction of C5 inhibitors in 2007, PNH had been fatal in about 35% of patients within 5 years of diagnosis; yet, this fatality rate continues in countries without access to these medications. Worldwide access to the C5 inhibitor eculizumab is hindered by the unavailability of treatment, and in places where treatment is approved, cost of treatment, reimbursement issues, infrastructure, or patient restrictions may further impede access (Risitano et al, Am J Hematol. 2018; Risitano et al, Front Immunol. 2019). PNH treatment places a significant economic burden on healthcare systems. In a number of countries, this has resulted in negative health technology appraisals (HTAs), indicative that optimal care and resource utilization are not being achieved (Coyle et al, Med Decis Making. 2014). New therapies with more convenient modes of administration may have the potential to improve how PNH is clinically treated and may have a positive effect on the economic burden and access to C5 inhibitors globally. Robust data on the real-life burden and cost of PNH are therefore needed to assess the impact of current therapies and establish a baseline for new therapeutic approaches. The data derived from this study will be used to support HTA processes and inform the value of new therapies for PNH. Objectives The COMMODORE Burden of Illness (BOI) study will quantify the direct medical costs (eg, treatment and hospitalization), direct nonmedical costs (eg, travel), and indirect costs (eg, impact on work productivity and family burden) associated with PNH for patients and care providers and determine the impact of PNH on health-related quality of life (HRQoL). Study Design and Methods This is an international, prevalence-based, bottom-up, burden of illness study containing both retrospective and prospective data collection. The study will be overseen by an expert reference group consisting of multidisciplinary stakeholders. The study protocol and materials will be submitted for ethical approval to the University of Chester in the United Kingdom. Physicians will provide information on sociodemographic, clinical, and medical resource utilization using an electronic case record form (eCRF). Through patient and public involvement and engagement, patients, after giving informed consent, will provide further information on the economic and HRQoL impact of PNH by completing patient-reported outcome surveys. Patients from France, Germany, United Kingdom, and China will be included. The study aims to recruit 94 physicians reporting 350 patient eCRFs with an expected return of 140 patient surveys and longitudinal data collection after 6 to 12 months for each patient. Mean per-patient costs, including direct medical and nonmedical costs, and indirect resource utilization will be calculated by multiplying the individual resource utilization with country-specific unit costs. National economic burden will be extrapolated by applying national prevalence estimates of PNH. Additionally, the impact of PNH on HRQoL in patients will be assessed within this study. Summary The COMMODORE BOI study aims to characterize current PNH treatment via quantification of the humanistic and socioeconomic burden at the patient, healthcare system, and societal level to enhance the evidence base for treatment and decision-making in this community. Final results are expected be available by the second quarter of 2022. Disclosures Hampton: F. Hoffmann-La Roche Ltd: Current Employment, Current equity holder in publicly-traded company, Other: All authors received support for third party writing assistance, furnished by Scott Battle, PhD, provided by F. Hoffmann-La Roche, Basel, Switzerland.. Katz:F. Hoffmann-La Roche Ltd: Current Employment, Other: All authors received support for third party writing assistance, furnished by Scott Battle, PhD, provided by F. Hoffmann-La Roche, Basel, Switzerland.. Shang:F. Hoffmann-La Roche Ltd: Current Employment, Current equity holder in publicly-traded company, Other: All authors received support for third party writing assistance, furnished by Scott Battle, PhD, provided by F. Hoffmann-La Roche, Basel, Switzerland.. Dhillon:F. Hoffmann-La Roche Ltd: Other: All authors received editorial support for this abstract, furnished by Scott Battle, funded by F. Hoffmann-La Roche Ltd, Basel, Switzerland. ; HCD Economics: Current Employment. Hubberstey:HCD Economics: Current Employment; Huntingdon's Disease Youth Organization: Membership on an entity's Board of Directors or advisory committees; F. Hoffmann-La Roche Ltd: Other: All authors received editorial support for this abstract, furnished by Scott Battle, funded by F. Hoffmann-La Roche Ltd, Basel, Switzerland. .
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Ulcickas Yood, Marianne, Susan Jick, Catherine Vasilakis-Scaramozza, Bonnie M. K. Donato, Ioannis Tomazos, Gilbert L'Italien, Nicholas Sicignano, and Brian L. Feldman. "Baseline Characteristics of Patients with Paroxysmal Nocturnal Hemoglobinuria Identified in the Department of Defense Database." Blood 132, Supplement 1 (November 29, 2018): 5830. http://dx.doi.org/10.1182/blood-2018-99-113478.
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Abstract Background: Rare diseases are often characterized by misdiagnosis resulting in delays in critical and potentially lifesaving treatment. Awareness of first signs and symptoms of rare diseases can provide clinical evidence for early and accurate diagnosis. Medical records are the primary source of clinical information from first signs and symptoms to key clinical disease related events, yet access to records can be difficult and time consuming. We conducted a study using a large electronic medical record (EMR) and claims database to identify and describe characteristics of Paroxysmal Nocturnal Hemoglobinuria (PNH) patients at the time of their PNH diagnosis. We present baseline findings of the PNH population identified in the Department of Defense (DOD) healthcare system, where all clinical details were readily available. The DOD healthcare system is a US-based, longitudinal EMR and claims database with health information on approximately 10 million active beneficiaries throughout the country. Methods: We identified all people in the DOD database from January 01, 2007 through May 31, 2017 who had an ICD-10-CM code for PNH or a NDC or HCPCS code for eculizumab, the drug used to treat PNH. There is no ICD-9-CM code for PNH. Cases had no other indication for eculizumab use and had to have appropriate symptoms, comorbidities or lab results to be considered a case. We reviewed the electronic record for each patient and classified each as definite/likely, probable/possible or unlikely PNH based on attributes of the available health data including codes for eculizumab, flow cytometry, lab results, hemoglobinuria, aplastic anemia, pancytopenia and other comorbidities. Our ruling was validated by medical record review by a clinical expert for all equivocal cases and a sample of definite/likely cases. Individuals classified as unlikely PNH were excluded. Patient characteristics at PNH diagnosis are presented using descriptive statistics. Results: We identified 73 PNH patients (55% female) after review of all available electronic data; 41 had a diagnosis of PNH and received eculizumab, 17 had a diagnosis of PNH only, and 15 received eculizumab only. From these, 61 patients were determined to have definite/likely PNH and 12 had probable/possible PNH. The use of eculizumab ranged from 0 to 378 (median=18) prescriptions, dependent in part on the amount of follow-up in the database. There were 19 patients (26%) who had prevalent PNH and 54 (74%) who were newly diagnosed with PNH during the study period. Among newly diagnosed patients, the median age at PNH diagnosis was 46 years (range 13 - 86). Most patients had codes for hemoglobinuria at or before the PNH diagnosis date (69%), and many had codes for aplastic anemia (46%), thrombocytopenia (56%), and pancytopenia (28%). At any time after the PNH diagnosis, 85% had unspecified anemia, 52% had aplastic anemia, 53% had thrombocytopenia, and 33% had pancytopenia codes in their records. See table. Conclusion: From a population of around 10 million actively enrolled patients, across a 10-year study period, we identified 73 patients with PNH. Data from these patients will be used to identify patterns of health encounters leading up to diagnosis and relevant outcomes following diagnosis. This information can be used to help diagnose other patients with this rare disease and to improve their medical outcomes. Disclaimer Statement: Research data were derived from an approved Naval Medical Center, Portsmouth, VA IRB protocol (NMCP.2017.0080). The views expressed in this abstract are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense or the United States Government. Copyright Notice: CAPT Brian Feldman is a military service member. This work was prepared as part of his official duties. Title 17 U.S.C. 105 provides that 'Copyright protection under this title is not available for any work of the United States Government.' Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person's official duties. Table. Table. Disclosures Ulcickas Yood: Alexion Pharmaceuticals, Inc.: Other: Employee of EpiSource, LLC, which was contracted by Alexion Pharmaceuticals, Inc. EpiSource had the final decision on content. . Jick:Alexion Pharmaceuticals, Inc.: Other: Employee of the Boston Collaborative Drug Surveillance Program, which was contracted and paid by Alexion Pharmaceuticals, Inc. to work on a study of PNH using DOD data. . Vasilakis-Scaramozza:Alexion Pharmaceuticals, Inc.: Other: Employee of the Boston Collaborative Drug Surveillance Program, which was contracted and paid by Alexion Pharmaceuticals, Inc. to work on a study of PNH using DOD data.. Donato:Alexion Pharmaceuticals Inc: Employment, Equity Ownership. Tomazos:Alexion Pharmaceuticals, Inc.: Employment, Equity Ownership. L'Italien:Alexion Pharmaceuticals, Inc.: Equity Ownership, Other: Former employee and current stockholder of Alexion Pharmaceuticals, Inc. . Sicignano:Alexion Pharmaceuticals, Inc.: Other: Employee of Health ResearchTx, which has a business relationship with Alexion Pharmaceuticals, Inc.. Feldman:Alexion Pharmaceuticals, Inc.: Other: Employee, Department of Navy, United States Government..
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Makwae, Evans Nyanyu. "Legal frameworks for personnel records management in support of accountability in devolved governments: a case of Garissa County Government." Records Management Journal 31, no. 2 (June 16, 2021): 109–33. http://dx.doi.org/10.1108/rmj-05-2019-0024.
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Purpose Accountability in personnel records management is to a large extent, dependent on the availability of personnel records, there has been very little recognition of the need to address the management of personnel records as evidence for accountability either in relation to Freedom of Information (FOI) or Open Data. It is in this regard, therefore, the purpose of this study is to investigate the legal frameworks for personnel records management in support of accountability. The study used a descriptive design which combined both qualitative and quantitative approaches where both qualitative and quantitative information was involved in the study. Founded on the records life cycle and the records continuum, the study aimed to fulfil its main objective: establishing legal frameworks for personnel records management at Garissa County Government (GCG). Purposive sampling was used to select 11 Human Resource Management Officers (HRMO), 11 Personnel Record Management Officers (PRMO) and 11 Personnel Records Management Clerks (PRMC) and 55 staff members who made the total sample of 88 respondents. Data collected were analysed using descriptive statistics with the help of a Statistical Package for Social Scientists (version 17) was used to perform the analysis of quantitative data and presented through frequency tables, percentages, means and standard deviations. Results indicated that the County Government does not have legal frameworks in personnel records management. Several challenges were identified including lack of personal records management policy, lack of integrity, lose of documents/file and poor communication system. Generally, the study shows that legal frameworks in personnel records management is very important in accountability, therefore, GCG management needs to take measure to improve legal frameworks in personnel records management infrastructure and develop personnel records management policy. Design/methodology/approach The study was conducted using a descriptive design. This design ensures that data collected are analysed and findings are reported to establish a better understanding of a physical or social phenomenon. The descriptive design combined both qualitative and quantitative approaches where both qualitative and quantitative information was involved in the study. The study was conducted at the County Government of Garissa’s Head Quarters; it targeted staff involved in personnel records management. Garissa town was selected because it is a centre of various activities in County Government of Garissa. The target population comprising HRMO, PRMO, PRMC and staff from different ministries who depended on the personnel records management activities. Purposive sampling was used to select 11 HRMO, 11 PRMO, 11 PRMC and 55 staff members who made the total sample of 88 respondents from the population. Questionnaire method was used to collect data from HRMO, PRMO, PRMC and staff members quickly and give more freedom (in terms of time and flexibility) to the respondents. Interviews were used to obtain more in-depth information from the PRMO, HRMO and PRMC being the individuals’ in-charge of personnel records were to provide information on legal frameworks for personnel records management at GCG. Findings Lack of a policy signifies a lack of accountability and awareness of the personnel records management standards, meaning that the staffs are not aware of their responsibilities towards the management of the County’s records. This is therefore likely to contribute significantly to poor performance (Mampe and Kalusopa, 2012). This then puts the County in a precarious position regarding personnel records due to lack of guidelines on classing and handling of personnel records. Lack of a policy also shows a lack of commitment in the area, purporting neglect, where responsibilities are not clearly assigned and remain unclear. Weak institutional capacity and the absence of, for example, comprehensive personnel records management policies have been cited as one of the main causes of archival (as well as records management) underdevelopment in Africa (Ngulube and Tafor 2006). From the reactions of the existence of a draft policy, the staff indicated that it covered among other things: a policy statement, scope, definition of terms, applicable legislation and procedures, mail management encompassing both incoming and outgoing mail, filing classification, retention and disposal, as well as a statement of responsibilities. The study revealed that: personnel records management in Kenya operates under the framework and guidance of the Kenya National Archives and Documentation Services – KNADS which is supported by the Public Archives and Documentation Services Act, Cap 19. Besides the Cap 19, of 1965 of the Laws of Kenya, there are also various legislations that support the management of records in Kenya including the Ministry of State for Public Service (MSPS) (DPM) Circular on personnel records reference number DPM. 12/6A Vol. I (71) of 12th March 2008, the Records Management Procedure Manual for the Public Service, May 2010, prepared by the MSPS in consultation with the KNADS to provide guidelines and procedures to be followed in the day to day management of records in the public service. It is meant to be used alongside existing laws and legislation governing records management in the service. The effective utilization of the manual as stated by the Ministry is to contribute towards the government’s quest to achieve good governance and accountability in the Public Service. Adherence to the Manual is also meant to streamline personnel records management practice leading to effectiveness and efficiency in service delivery and the Government Financial Regulations and Procedures, chapter 23, section 4:2–5 give guidelines on the retention period for financial records. The management of personnel records is guided by various legislations and circulars such as Public Archives and Documentation Service Act, (Cap.19, Laws of Kenya) revised 1991, The Employment Act Chapter 226, revised in 1977 and 2007, The Regulation of Wages and Conditions of Employment Act Chapter 229, Income Tax Act Chapter 470 revised 1989, The National Social Security Fund Act Chapter 258 revised 1989, The Service Commission Act Chapter 185 of 1967 and DPM.12/6A VOL. I (71) dated 12th March 2008 on the destruction of personnel records. Compliance to all the above legal frameworks will ensure that personnel records management in support of accountability at GCG is achieved. Research limitations/implications The lack of effective personnel records management programme in a county agency was in itself non-conformity to the requirements and guidelines issued by the public services, thus leading to a lot of caution on how much could be revealed regarding the same. The focus of the study was on the assessment of paper-based and electronic personnel records management within the County Government. The assessment excluded other electronic records, such as online databases, with only personnel records being considered. Practical implications Nonexistence of personnel records management legal frameworks implies that the responsibilities for cooperate record management to GCG plans and guidelines of managing personnel records were inefficient. As a result of the absence of written personnel records management policy, there was also a lack of guidelines for appraisal, disposition and schedules of records. On legal frameworks for personnel records management at GCG, the findings revealed that there were many policies in GCG but personnel records management policy was missing which is very crucial. Record management policy will also enhance human resource management policy. The missing of the personnel records management policy reduces the accountability to people who deal with records management in general, increases lack of integrity and indicate that there is a presence of irrational decision. Social implications The missing of the personnel records management policy reduce the accountability to people who deal with records management, in general, increases lack of integrity and indicate that there is a presence of irrational decision. Originality/value The purpose of the study was to investigate the management of personnel records in support of accountability in devolved governments: A case of GCG.
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Halwani, Ahmad S., Kelli M. Rasmussen, Vikas Patil, Catherine Li, Christina Young, Zachary Burningham, Mathias Schulz, et al. "Treatment Practices and Outcomes in Older Adults with Relapsed/Refractory Diffuse Large B-Cell Lymphoma Treated in the Veterans Health Administration." Blood 132, Supplement 1 (November 29, 2018): 4205. http://dx.doi.org/10.1182/blood-2018-99-116695.
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Abstract Background: Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive Non-Hodgkin lymphoma, with approximately one third of patients not responding (or relapsing) after receiving first-line (1L) therapy, typically a multi-agent chemoimmunotherapy regimen containing rituximab and doxorubicin. These patients may be treated with a second-line (2L) chemotherapy (CT) or chemoimmunotherapy (CIT) regimen, with the intention to proceed to a high-dose therapy followed by an autologous stem cell transplant (SCT). Unfortunately, a significant proportion of older patients are unable to tolerate such treatment. There is little data on treatment practices and outcomes in older DLBCL patients receiving 2L CT or CIT after failure of 1L therapy. Using electronic healthcare record data from the largest integrated health system in the United States, the Veterans Health Administration (VHA), we examined real-world outcomes of DLBCL patients ≥ 65 years of age receiving 2L CT or CIT following 1L therapy with rituximab and doxorubicin containing regimens. Methods: DLBCL patients diagnosed from 2001-2015 and treated at the VHA were identified by linking information from the VA Clinical Registry System (VACRS) in the VHA Corporate Data Warehouse (CDW) to administrative, laboratory and pharmacy data, and clinical notes in the CDW. Patients were included in the analysis if they: had no evidence of a prior malignancy, were diagnosed with DLBCL, received 1L therapy containing rituximab and doxorubicin for ≥ 21 days, then subsequently received a 2L CT or CIT, and were ≥ 65 years of age at time of 2L treatment. Patient age, gender, race/ethnicity; stage at diagnosis, lactate dehydrogenase (LDH), and Charlson Comorbidity Index (CCI) were extracted from VACRS and/or CDW. Patients were censored at end of study observation period (Dec 31, 2016) or if a second cancer diagnosis occurred following their DLBCL diagnosis. Patients were divided into 2 groups: Group 1 included patients receiving a 2L regimen that, per the National Comprehensive Cancer Network (NCCN) guidelines, is typically used with intention to proceed to high-dose therapy; Group 2 included patients receiving a regimen that, per NCCN, is used in non-candidates for high-dose therapy. Receipt of SCT was identified using ICD codes and/or clinical notes. Results: 230 DLBCL patients met our inclusion criteria. Of these, 223 (97%) were male and 171 (74%) were of non-Hispanic, white ethnicity. Baseline characteristics (at time of 1L) were as follows: 156 (68%) had stage III-IV disease, 154 (67%) had LDH > ULN, and median CCI was 4 (IQR:2-5). The majority of patients (217, 94%) received RCHOP as 1L, with the remaining receiving RCHOP + etoposide (13, 6%). Two thirds of patients, (151, 66%) started 2L within 1 year of starting 1L with a median of 10.6 months between start of 1L and start of 2L. Patients were almost equally divided between the two groups, with Group 1 (109, 47%) and Group 2 (121, 53%). Of the 109 Group 1 patients, 68 (62%) received ifosfamide, carboplatin, etoposide (ICE) +/- rituximab (R), and 22 (20%) received etoposide, methylprednisolone, cytarabine, cisplatin (ESHAP) +/- R. Of the 109 Group 1 patients, 14 (13%) proceeded to SCT within VHA (SCT outside VHA was not extracted for this study). The remaining 121 Group 2 patients received 2L therapy with the following: bendamustine (B) +/- R (28, 23%), gemcitabine, oxaliplatin (Gem-Ox) +/- R (21, 17%), cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) +/- R (17, 14%), cyclophosphamide, etoposide, vincristine, prednisone (CEOP) +/- R (14, 12%), cyclophosphamide, etoposide, prednisone, procarbazine (CEPP) +/- R (12, 10%); CHOP + etoposide +/- R (6%), lenalidomide +/- R (6%). Fewer than 10 of these patients proceeded to SCT. The median OS of all patients was 8 months. Conclusions: This is the first study that details treatment practices and outcomes in a nationwide cohort of older adult patients (≥ 65 years old) with relapsed/refractory DLBCL. Approximately half of these older patients did not receive or were not candidates for regimens typically used with intent for high-dose therapy and autologous transplant. OS for the entire cohort was less than a year. Despite significant advances in available treatments for DLBCL, there remains an unmet need in treatment of relapsed/refractory DLBCL, especially in older patients who have difficulty tolerating high-dose regimens. Disclosures Halwani: Takeda: Research Funding; Seattle Genetics: Research Funding; Pharmacyclics: Research Funding; Miragen: Research Funding; Kyowa Hakko Kirin: Research Funding; Immune Design: Research Funding; Genentech, Inc.: Research Funding; Bristol-Myers Squibb: Research Funding; Amgen: Research Funding; Abbvie: Research Funding. Schulz:Genentech: Employment, Equity Ownership; Roche: Equity Ownership. Li:Roche: Equity Ownership; Genentech: Employment. Masaquel:Genentech: Employment, Equity Ownership; Roche: Equity Ownership. Halloran:Genentech, Inc.: Employment, Equity Ownership; Janssen Pharmaceuticals, Inc: Employment, Equity Ownership. Delong-Sieg:Roche: Equity Ownership; Genentech, Inc.: Employment. Sauer:Genentech: Research Funding; Abbvie: Research Funding; Pharmacyclics: Research Funding; COHRDATA: Research Funding; Amgen: Research Funding.
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Penderetsky, O. "PROSPECTS FOR THE DEVELOPMENT OF INDUSTRIAL TOURISM ZAKARPATSK REGION." Bulletin of Taras Shevchenko National University of Kyiv. Geography, no. 70-71 (2018): 98–102. http://dx.doi.org/10.17721/1728-2721.2018.70.18.
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Along with the folk crafts of the Transcarpathian region, an industrial tour is being developed in conjunction with industrial and natural objects that make up its resource potential. In the context of reforming economic relations, the emphasis is on the development of priority economic sectors – the forest and wood industry, light and food industries, the development of cross-border cooperation, recreation and tourism, etc. The main attention is paid to the further restructuring of the entire national economic complex, the involvement of domestic and foreign investments in the economy, the development of small and medium-sized businesses, and the effective use of natural resource potential. It is proved that the condition of full awareness of tourists is the creation of a passport of an industrial tour, which includes ecological, technical, and cadastral. Tours on mines from salt mining, precious metals, sulfur mines, oil wells, mineral water, ozocerite, objects of the former military complex – rocket mines, storage facilities, warehouses, enterprises for processing raw materials and materials, folk crafts are promising the direction of development of industrial tourism in Transcarpathia. Industrial tourism, as part of the overall tourist process in Ukraine, can be directed at solving many socio-economic tasks of local communities, the most important among them is increase of employment, growth of its welfare, provision of socio-cultural development of the region and improvement of quality of life of people. Today, in order to increase the competitiveness of the region in the tourism industry, the cluster method, which was previously used only in industrial production, is used. A tourist cluster [5] is a key organizational framework that combines tourism and other related industries into a single system that enables the enterprises, institutions and organizations to meet the priority objectives and enhance the competitive advantages of the region. By creating such an association, financing and implementation of even very ambitious projects in the tourism sector could be provided, which would otherwise be impossible for each individual participant. The developed map of the territorial placement of centers of industrial tourism in the Transcarpathian region greatly simplifies the creation of an informative cadastral system and on its basis industrial tours. At the same time, the improvement of this system requires the systematic introduction of new information indicators, taking into account the change in structural and functional relationships between different departments. In general, Transcarpathia has an all-Ukrainian significance in the economic plan as a region with significant potential of the forest and wood industry, winemaking, vegetable growing, dairy industry, tobacco production, mineral waters.
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Ulcickas Yood, Marianne, Susan Jick, Catherine Vasilakis-Scaramozza, Bonnie M. K. Donato, Ioannis Tomazos, Gilbert L'Italien, Nicholas Sicignano, and Brian L. Feldman. "The Value of Population Based Data to Study Rare Diseases: An Example Using the Department of Defense Healthcare System." Blood 132, Supplement 1 (November 29, 2018): 5829. http://dx.doi.org/10.1182/blood-2018-99-113497.
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Abstract Background: For patients suffering from rare diseases, accurate and early diagnosis is critical and often lifesaving, whereas misdiagnosis can be fatal. While patient registries are useful and necessary, they may not provide reliable patient population denominators or sufficient longitudinal clinical follow-up. Access to complete and integrated patient records necessary to capture full clinical history can be challenging. Commonly, there is a lack of centralized and continuous care in the health care systems of many countries, including the United States (US). It is also challenging to identify a sufficient number of cases to provide robust results because of the rare nature of these diseases. We describe a healthcare system that can identify patients for research purposes, who have rare diseases, by accessing de-identified electronic clinical details. We used Paroxysmal Nocturnal Hemoglobinuria (PNH) as an example of a rare disease for this abstract. Methods: The Department of Defense (DOD) healthcare system is a US-based, longitudinal electronic health record (EHR) and claims database with health information on approximately 10 million active beneficiaries across the country. We evaluated the feasibility to conduct studies of rare diseases in the DOD healthcare system by assessing the capability to identify patients with PNH and to describe their course of disease and treatment. We used ICD 9/10 diagnosis codes, NDC and HCPCS codes, laboratory data and PNH treatment codes to identify patients with a clinical course consistent with PNH. Patients were classified as definite/likely, probable/possible or unlikely PNH based on the available clinical evidence and then findings were validated against review of patient records by a clinical expert. Individuals classified as unlikely PNH were excluded from the study. The clinical information on these patients will be used to understand the course of PNH in patients with and without treatments and to describe their treatment adherence and disease activity over time. Results: We identified 244 people with a diagnosis or treatment code that was indicative of PNH during years 2007-2017; 71% of the patients had electronic records that covered 10 or more years starting as early as 2003 and extending as far as 2017. From these 244 patients, we identified 73 patients with a definite/likely or probable/ possible PNH diagnosis. An ICD-10 code for PNH or a prescription for eculizumab (PNH treatment) were required, but not sufficient to confirm the presence of PNH. There is no ICD-9 code for PNH. Cases had no other indication for eculizumab use and had to have appropriate symptoms, comorbidities or lab results to be considered a case. Patients with only 1 code for PNH and no treatment were assumed to have unconfirmed disease and were excluded. 27 cases, including those with no eculizumab and a random sample of likely cases, were reviewed to validate the PNH diagnoses in collaboration with DOD treating physicians. Conclusion: The DOD healthcare system is a valuable and cost effective resource for the study of rare diseases in a timely manner. We have demonstrated the ability to identify a validated series of PNH cases that will provide important clinical insights for identifying and treating new PNH cases. This healthcare system provides long patient follow-up, demographics similar to the US population, and access to records in an integrated inpatient, outpatient and ER system that encompasses all patient care. Disclaimer Statement: Research data were derived from an approved Naval Medical Center, Portsmouth, VA IRB protocol (NMCP.2017.0080). The views expressed in this abstract are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense or the United States Government. Copyright Notice: CAPT Brian Feldman is a military service member. This work was prepared as part of his official duties. Title 17 U.S.C. 105 provides that 'Copyright protection under this title is not available for any work of the United States Government.' Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person's official duties. Disclosures Ulcickas Yood: Alexion Pharmaceuticals, Inc.: Other: Employee of EpiSource, LLC, which was contracted by Alexion Pharmaceuticals, Inc. EpiSource had the final decision on content. . Jick:Alexion Pharmaceuticals, Inc.: Other: Employee of the Boston Collaborative Drug Surveillance Program, which was contracted and paid by Alexion Pharmaceuticals, Inc. to work on a study of PNH using DOD data. . Vasilakis-Scaramozza:Alexion Pharmaceuticals, Inc.: Other: Employee of the Boston Collaborative Drug Surveillance Program, which was contracted and paid by Alexion Pharmaceuticals, Inc. to work on a study of PNH using DOD data.. Donato:Alexion Pharmaceuticals Inc: Employment, Equity Ownership. Tomazos:Alexion Pharmaceuticals, Inc.: Employment, Equity Ownership. L'Italien:Alexion Pharmaceuticals, Inc.: Equity Ownership, Other: Former employee and current stockholder of Alexion Pharmaceuticals, Inc. . Sicignano:Alexion Pharmaceuticals, Inc.: Other: Employee of Health ResearchTx, which has a business relationship with Alexion Pharmaceuticals, Inc.. Feldman:Alexion Pharmaceuticals, Inc.: Other: Employee, Department of Navy, United States Government..
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Vyas, A. "Geomatics Education: Need Assessment." ISPRS - International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences XL-8 (November 28, 2014): 1265–67. http://dx.doi.org/10.5194/isprsarchives-xl-8-1265-2014.
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Education system is divided in to two classes: formal and informal. Formal education establishes the basis of theory and practical learning whereas informal education is largely self-learning, learning from real world projects. Generally science and technology streams require formal method of education. The social and related aspects can be taught through the other methods. Education is a media through which the foundation of the knowledge and skill is built. <br><br> The statistics reveals the increase in the trend of the literate population. This may be accounted due to the level of urbanization and migration to the cities in search for the "white-collar jobs". As a result, a shift in the employment structure is observed from a primary sector to a secondary and tertiary sector. <br><br> Thomas Friedman in his book ‘The World is Flat’ quotes the impact of globalization on adaptation of science and technology, the world has become large to tiny. One of the technologies to mention here is geospatial technology. With the advancement in the satellite remote sensing, geographical information system, global positioning system, the database management system has become important subject areas. The countries are accounting hugh budget on the space technology, which includes education, training and research. <br><br> Today many developing countries do not have base maps, they are lacking in the systemic data and record keeping, which are essential for governance, decision making and other development purpose. There is no trained manpower available. There is no standard hardware and software identified. An imbalance is observed when the government is promoting the use of geospatial technology, there is no trained manpower nor the availability of the experts to review the accurateness of the spatial data developed. There are very few universities which impart the degree level education, there are very few trained faculty members who give standard education, there exists a lack of standard syllabus. On the other hand, the industry requires high skilled manpower, high experienced manpower. This is a low equilibrium situation. <br><br> Since the need is enhancing day by day, the shortage of the skilled manpower is increasing, the need of the geomatics education emerges. This paper researches on the need assessment of the education in geospatial specialization. It emphasises on the challenges and issues prevail in geospatial education and in the specialized fields of remote sensing and GIS. This paper analyse the need assessment through all the three actors: government, geospatial industry and education institutions.
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Ojo, Funke, Leighann Litcher-Kelly, Iyar Mazar, Brittany Klooster, Sarah Ollis, Emily Chaston, Adam Roeder, Marsha J. Treadwell, and David Reasner. "Measurement of Sickle Cell Disease Symptoms from the Patient Perspective: Considerations for Clinical Trials." Blood 132, Supplement 1 (November 29, 2018): 3571. http://dx.doi.org/10.1182/blood-2018-99-116682.
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Abstract OBJECTIVES: Sickle cell disease (SCD), a group of inherited blood disorders, can impact multiple organs and can lead to variable clinical presentations. In addition to severe pain crises, patients may experience chronic symptoms (e.g. pain, tiredness). Assessing treatment benefit using a patient-reported outcome (PRO) measurement strategy can be critical for supporting clinical SCD research. We conducted qualitative research activities to inform considerations for PRO measurement strategies to assess daily chronic symptoms in regulated SCD clinical trials in patients 16 years and older. METHODS: Research activities aimed to identify the relevant and important signs/symptoms of SCD and determine their potential for measurement via existing PRO instruments. A literature review, meetings with clinical experts (N=5), and interviews with adolescent and adult SCD patients (N=20) were conducted. Trained researchers conducted semi-structured qualitative interviews. Results were analyzed to develop a synthesized SCD conceptual model describing the literature, expert, and patient perspectives of SCD. Five instruments used in SCD research were selected for review: Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-MeSM), Pediatric Quality of Life Inventory (PedsQL™) sickle cell disease module, the Patient-Reported Outcomes Measurement Information System (PROMIS) Fatigue and Pediatric Pain Interference measures, and Scribe Sickle Cell Record of Daily Symptom Burden™ (SSCRDSB). Signs/symptoms in the SCD conceptual model were compared to those assessed in these instruments and measurement properties were reviewed. Considerations for concept selection (e.g. suitability of measuring a symptom via PRO instrument) and item development (e.g. selection of recall period) in developing a PRO measurement strategy were evaluated. Instruments developed to assess SCD concepts should have documented evidence of content validity (i.e., qualitative data confirming the instrument measures concepts important, relevant and understandable to the target patient population) and should include clear instructions, a short recall period, items that measure dimensions of importance to patients (e.g., symptom intensity), and well-defined response options that are sufficiently sensitive to detect change. RESULTS: Patients reported 22 signs/symptoms that they experienced generally with SCD and/or during pain episodes, which were largely endorsed by the literature and/or clinical experts. Pain was reported by all patients and tiredness was reported by 80.0% of patients; both were cited as the most important to improve with treatment. Patients reported 29 impacts of SCD across 9 domains. Across the 5 instruments, pain was the most frequently measured SCD symptom concept, measured in different ways by 3 instruments. None of the reviewed instruments assessed more than 5 of the signs/symptoms included in our SCD conceptual model with the SSCRDSB assessing the greatest number of signs/symptoms (n=5/22 concepts, 22.7%). The remaining 4 instruments assessed 3 or fewer of the signs/symptoms reported by patients. Physical impacts were the most frequently measured impact domain, assessed to varying degrees by all 5 instruments evaluated. The PedsQL™ SCD module assessed the greatest number of impact domains in our SCD conceptual model (n=7/9 domains, 77.8%). The reviewed instruments were determined to have limitations in the context of assessing SCD signs/symptoms daily as part of regulated clinical trials. CONCLUSIONS: The research activities conducted as part of this work suggest that (1) patients experience numerous SCD signs/symptoms regularly and intermittently and (2) existing instruments, while perhaps suitable for other contexts of use or in conjunction with other tools, may be inadequate for evaluating the most important symptoms in a way that can demonstrate treatment benefit when measured daily in regulated clinical research. A de novo instrument developed for these purposes may better assess treatment benefit from the patient perspective in the context of measuring variable SCD symptoms daily in a regulated clinical trial setting. Disclosures Ojo: Ironwood Pharmaceuticals: Employment. Litcher-Kelly:Ironwood Pharmaceuticals: Consultancy. Mazar:Ironwood Pharmaceuticals: Consultancy. Klooster:Ironwood Pharmaceuticals: Consultancy. Ollis:Ironwood Pharmaceuticals: Consultancy. Chaston:Ironwood Pharmaceuticals: Consultancy. Roeder:Ironwood Pharmaceuticals: Consultancy. Treadwell:Global Blood Therapeutics: Consultancy; Ironwood Pharmaceuticals: Consultancy; Pfizer: Consultancy. Reasner:Ironwood Pharmaceuticals: Employment, Equity Ownership.
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Rifkin, Robert M., David Singer, Kathleen M. Aguilar, Bismark Baidoo, and Eric M. Maiese. "Safety of Split First Dosing Vs Standard Dosing Administration of Daratumumab Among Multiple Myeloma Patients Treated in a US Community Oncology Setting: A Real-World Observational Study." Blood 132, Supplement 1 (November 29, 2018): 4846. http://dx.doi.org/10.1182/blood-2018-99-116808.
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Abstract INTRODUCTION: Daratumumab (DARA) is a human IgGκ monoclonal anti-CD38 antibody for treatment of multiple myeloma (MM). In clinical trials, median durations for the 1st, 2nd and subsequent infusions were 7.0, 4.3 and 3.5 hours, respectively. To optimize the first infusion duration of DARA, the US Oncology Network (USON), a community oncology practice network, implemented a split first dose protocol. The USON split first dose protocol requires 2 IV bags, one for Day 1 and one for Day 2 of consecutive days. On each day, DARA is diluted with normal saline to a total volume of 500 mL. On each day, DARA is administered at 50 mL/hour for one hour. If no infusion events occur, the infusion rate can be increased in 50 mL/hour increments every hour to a maximum of 200 mL/hour. While the split first dose may increase convenience, limited information is available on the safety of split first dose DARA. METHODS: This was a retrospective, observational study of adult MM patients who initiated DARA in routine care within USON between 11/01/2015 - 06/30/2017 to compare infusion times and safety of DARA split first dose vs DARA standard dose schedule (i.e., 1 infusion of 16 mg/kg per FDA-approved prescribing information). In this study, patients were grouped into either the split first dose cohort or the standard dose schedule cohort according to the dosing schedule that they had experienced. Data were sourced from USON's electronic healthcare record system. Information on infusion reactions was available only through chart review, which was conducted among a random sample of patients in each study cohort. Descriptive analyses were conducted to compare demographic, clinical and treatment characteristics of MM patients who received split first dose schedule vs standard dosing schedule. Chi-square tests or Fisher's exact tests were used to assess associations between categorical variables. ANOVA/t-tests or Kruskal-Wallis tests were used to assess associations for continuous variables. A p-value of <0.05 was considered as statistically significant. RESULTS: Of the 622 patients included in the landscape analysis, 365 (58.5%) had received the split first dose schedule and 258 (41.5%) had received the standard dosing schedule. Overall, the median age was 63.6 years, 54.2% male and 78.3% Caucasian. The utilization of the split first dose schedule increased significantly over time with more patients in 2017 Q2 having received split dose vs standard dose (p< 0.0001). Karnofsky performance status (KPS) scores differed significantly between patients treated with split first dose vs standard dose (p=0.02). No other baseline differences between groups were found. The median infusion duration was 4.5 hours for Day 1 of split first dose and 6.5 hours for standard dose (p<0.0001). Among patients selected for chart review (n = 302), 47.8% (88/184) of split first dose patients and 48.3% (57/118) of standard dose patients experienced at least one infusion reaction. The most common infusion reactions included lower-respiratory (26.1%), upper-respiratory (17.2%) and gastrointestinal reactions (12.5%), chills (8.9%), flushing (6.6%), with no statistically significant differences between study groups for any infusion reaction. Among patients treated with split first dose DARA, 3.8% experienced an infusion reaction during Day 2 of the split dose schedule. CONCLUSIONS: As a retrospective observational study at community-based oncology clinics, these findings provide real-world evidence on the infusion time and safety of the first infusion of DARA. This study found that the utilization of split first dose has increased over time. Interestingly, more patients in the split dose group had higher KPS scores than patients in the standard dose group, which may be due to selection of patients, at least initially, for the split first dose. This study found also that the length of the first day of the split first dose schedule is shorter than the length of the standard dosing schedule. Additionally, although determination of severity or grade was not feasible in this study, the proportion of patients in split first and standard dosing schedule groups who experienced infusion reactions was equal. This study suggests that the split first dose is comparable to the standard dose schedule and may be a practical option for patients and institutions seeking options to manage the operational considerations of DARA administrations. Table. Table. Disclosures Rifkin: Takeda: Consultancy; EMD Serono: Consultancy; Sandoz: Consultancy; Celgene: Consultancy; McKesson: Equity Ownership; Boehringer Ingelheim: Consultancy; Amgen: Consultancy. Singer:Janssen Scientific Affairs, LLC: Research Funding. Aguilar:McKesson Specialty Health: Employment. Baidoo:McKesson Specialty Health: Employment. Maiese:Janssen Scientific Affairs,LLC: Employment, Equity Ownership.
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Sawas, Ahmed, Constance Lau, Michael Thomson, and Kathleen Maignan. "Real-World Outcomes of Patients with Diffuse Large B-Cell Lymphoma Receiving Second Line Therapy in the United States." Blood 136, Supplement 1 (November 5, 2020): 29–30. http://dx.doi.org/10.1182/blood-2020-141274.
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Background: In the rituximab era, outcome data from patients (pts) receiving second-line therapy (2L) for diffuse large B-cell lymphoma (DLBCL) are derived mostly from randomized controlled trials or selected cohorts from specialized care centers. As new salvage strategies emerge, there is a need to reevaluate the landscape of 2L DLBCL (treatments and outcomes) in real-world (rw) patient cohorts. We investigated the timing of 2L in a cohort of US pts with DLBCL, the utilization of autologous stem cell transplantation (ASCT) as consolidation, and the overall survival (OS) in these pts. Methods We included patients from the Flatiron Health electronic health record (EHR) derived, de-identified database, with a first incident DLBCL diagnosed after January 2011, and with documented 2L therapy receipt (n=524). All pts received ≥4 doses of an anthracycline-based immune-chemotherapy in the frontline therapy (1L) setting and initiated 2L active immune-chemotherapy (anti-CD20 monoclonal antibody monotherapy was excluded) prior to December 2019 to allow for at least 6 m of potential follow-up through May 31 2020. Patients with central nervous system disease at diagnosis were excluded. Real-world overall survival (rwOS) probabilities, indexed to the start of 2L, were estimated in the entire cohort using the Kaplan-Meier method. Hazard ratios (HR) comparing rwOS were estimated using Cox regression models. Baseline covariates included demographic information, DLBCL histologic subtypes, cell of origin (COO) classified by the Hans' algorithm, cytogenetics, and the time interval in months (m) from end of 1L therapy to initiation of 2L therapy. Analyses were also re-indexed to 1 and 3 years post-2L, comparing unadjusted rwOS in pts who had received ASCT on or prior to these timepoints versus those who did not. Results In the study sample of 524 pts (57% men), median age at 2L initiation was 68 years (range 59 to 76) and 63% had stage III or IV disease at diagnosis. Initiation of 2L happened within 6 m of 1L completion for a majority of pts, 276/524 (53%), and within 2 months for one quarter, 137/524 (26%); for the rest, 92 pts (18%) initiated between 6-<12 m after 1L completion, 72 pts (14%) between ⩾12-24 m and 84 pts (16%) after 24 m. Consolidation with ASCT was documented for 115 pts (22%) and 17 pts (3%) received chimeric antigen receptor T-cells therapy. Unadjusted median rwOS in the entire cohort was 22 m [95% CI: 17, 38] (Figure 1A). This varied by interval between 1L completion and 2L initiation; for pts with shorter interval (<12 m) from 1L, median rwOS was 17 m [95% CI: 12, 30], while it was 43 m [95% CI: 22, 54] for those with a ⩾12 m interval (Figure 1B). The presence of MYC translocation alone or in combination with other cytogenetic abnormalities was associated with a shorter unadjusted median rwOS vs. absence of MYC: 9.3 m [95% CI: 8.2, 32, n=33] vs. 26 m [95% CI: 18, 43, n=491] (Figure 1C). In the adjusted model controlling for baseline covariates, older age (⩾ 70) appears to be associated with increased hazard of death (HR: 1.48 [95% CI: 1.14, 1.91]). Unadjusted rwOS analyses at 1 year following start of 2L showed better survival for patients receiving ASCT versus those who did not (HR: 0.40 [0.21, 0.76]). This association was sustained at 3 years (HR: 0.17 [0.04, 0.75]. Conclusion In a contemporary cohort of rw pts with DLBCL receiving 2L immune-chemotherapy, the majority did not receive ASCT. In this setting, age ⩾70, shorter intervals between 1L completion and 2L initiation, presence of MYC translocations, and no ASCT were factors associated with shorter survival. It may be important to address the implications of these clinical features in the investigation of 2L therapy options for pts with DLBCL. Disclosures Sawas: Daiichi Sankyo: Speakers Bureau; Affimed: Research Funding; Roche: Current equity holder in publicly-traded company; Flatiron Health: Current Employment; Gilead: Speakers Bureau; Seattle Genetics: Speakers Bureau. Lau:Flatiron Health, Inc: Current Employment; Roche: Current equity holder in publicly-traded company. Thomson:Flatiron Health, Inc: Current Employment; Roche: Current equity holder in publicly-traded company. Maignan:Flatiron Health, Inc: Current Employment, Current equity holder in publicly-traded company; Roche: Current equity holder in publicly-traded company.
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Bieliaieva, N. M., O. B. Yavorovenko, I. V. Kurylenko, L. V. Prysiazhniuk, O. V. Dziuniak, O. F. Proskurina, and M. F. Yavorovenko. "Modern aspects of social protection of combatants depending on the severity of disability." Biomedical and Biosocial Anthropology, no. 36 (July 10, 2020): 35–40. http://dx.doi.org/10.31393/bba36-2019-06.
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The urgency of the problem is due to the significant increase in recent years in the number of young and middle-aged people who have passed the war, the need to develop adequate measures of social assistance and protection. An important task in the organization of the rehabilitation process is to determine the structure of the needs of servicemen with disabilities in various types of medical and social care and the development of individual rehabilitation programs (IRP) based on them. The purpose of the study: to determine the structure of the needs of servicemen with disabilities in medical and social rehabilitation depending on the severity of disability. Statistical data from 25 administrative territories of Ukraine for 2018 are analyzed, the needs of participants of military service with disabilities in medical and social rehabilitation measures, their structure are calculated. The data of the information base of the centers and the bureau of medical and social examination of the regions were used. Processing of the primary material was performed using the universal statistical package "Excel". In 2018, medical and social expert commissions (MSEC) of Ukraine for the first time and re-certified and recognized persons with disabilities 7843 combatants. Of these, disability of group I (IA and IB) was established in 2.6 %, II – in 29.2 %, III – in 68.2 % of cases. All victims for MSEC were formed IRP. The dependence of the needs of combatants in medical and social rehabilitation measures on the severity of disability has been established. For persons with disabilities of groups II and III, priority is given to medical and professional rehabilitation, group I – social rehabilitation and technical means of rehabilitation with medical support. Of the medical rehabilitation services for persons with II and III groups of disability, sanatorium treatment is significant, and group I – rehabilitation therapy. Among vocational rehabilitation services, employment in production conditions is important – for persons with group III disabilities, in specially created conditions – for persons with group II disabilities, at home – for persons with group I disabilities. Vocational training was offered to a small number of people with disabilities of all groups. Among social rehabilitation services and technical means of rehabilitation, the services of social workers of territorial social service centers were significant for representatives of all disability groups, simpler means of transportation for persons of group III disability and more complex means for persons of group I. Determining the characteristics of the needs of servicemen with disabilities depending on its severity allows MSEC specialists to better form the IRP, develop targeted rehabilitation programs at the regional level, assess shortcomings in the organization of the rehabilitation process and build a rehabilitation system for combatants.
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Ailawadhi, Sikander, Meghna Ailawadhi, Srilekha Bodepudi, Mays F. Abdulazeez, Zan Tahir Shareef, Ashna Grover, Maria J. Fernandez, et al. "Disparities and Their Impact on the Adoption of Health Information Technology (HIT) in Minority Cancer Patients and Caregivers." Blood 134, Supplement_1 (November 13, 2019): 411. http://dx.doi.org/10.1182/blood-2019-125722.
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Background: HIT has the potential to improve the health of individuals and the performance of providers, yielding improved quality, cost savings, and greater engagement by patients. Minorities face a variety of financial and nonfinancial barriers to obtaining appropriate and timely health care. Studying the behavior of minority patients will help understand the specific challenges to HIT adoption and engagement in patients and their caregivers. We undertook a patient-reported survey to explore these factors and understand any underlying disparities. Methods: A 21-question paper-based anonymous questionnaire addressing the responder's attitudes, understanding and needs of the electronic medical record (EMR) was used. This was administered to adult patients with lymphoid malignancies and their caregivers at two campuses of Mayo Clinic in Florida (San Pablo and inner-city; Riverside). Categorical and continuous variables between white and minority responders as well as minority responders from the two campuses were compared using the Chi-square test and U Mann Whitney with a significance level of 0.05. Results: The survey was completed by 1004 patients and caregivers. Average time taken to complete the survey was approximately 11 minutes. Of the responders, 716 (71%) were whites and 271 (27%) were minorities, with race-ethnicity not reported by 17 (2%). Among minorities, 30% (n=80) were seen at San Pablo and 64% (n=173) at the Riverside campus, with 6% at a multiple myeloma patient-caregiver symposium. Whites were older (median age 66 vs. 62 years, p<0.001) and had higher education (undergraduate or higher 60% vs. 52%, p=0.023) as compared to minorities. Minority survey responders had lesser access to a computer (84% vs. 92%, p<0.001) or a smartphone (85% vs. 89%, p=0.08). (Figure 1a) Exploring HIT awareness showed that only 51% of minorities were registered to use the EMR as compared to 72% whites (p<0.001) and a lesser number of minorities even knew that they could access their medical records electronically (81% vs. 92%, p<0.001). even among those registered to use the EMR, 13% minorities reported never using the EMR as compared to 4% whites (p<0.001). Encouragingly, a higher willingness to learn about and use the EMR was noted among minorities who were more interested in knowing how to access the EMR (43% vs. 36%, p=0.04), would increase the use of EMR if someone explained how to use it (17% vs. 10%, p=0.002), and if someone explained about test results (14% vs. 6%, p<0.001). (Figure 1b) Comparing minorities among the two campuses, those from the San Pablo campus were older (67.5 yrs. vs. 57 yrs., P<0.001), had higher level of education (undergraduate or higher in 66% vs. 47%, p=0.005) and a higher number had access to a computer (94% vs. 78%, P=0.001) as compared to those from the inner-city Riverside. (Figure 2a) Minorities from the Riverside campus were less likely to be aware of the current HIT EMR (75% vs. 93%, p<0.001), were significantly less likely to have registered for the patient EMR portal (38% vs. 76%, p<0.001) and never used the EMR even if registered for it (22% vs. 7%, p=0.01) as against those from the San Pablo campus. Minorities at the Riverside campus had a higher interest in knowing how to access the EMR (47% vs. 33%, p=0.03). Linguistic barriers were more striking in the inner-city Riverside campus where a higher proportion of minority survey responders noted that it would help if the EMR was in their primary language (66% vs. 48%, p=0.006). (Figure 2b) Conclusions: Minorities continue to struggle with suboptimal utilization of healthcare system including that of HIT. There are barriers related to access, awareness, language and understanding of HIT that prevent the integration and participation of racial-ethnic minorities in the healthcare system to a full extent. It is important to qualify the minorities better, since there exist HIT utilization disparities even within the minorities from different areas representing socioeconomic and demographic differences. Efforts need to be made at several levels to help the minorities overcome educational, access and linguistic barriers so that they can benefit from advancements in the healthcare system. Disclosures Ailawadhi: Celgene: Consultancy; Amgen: Consultancy, Research Funding; Janssen: Consultancy, Research Funding; Pharmacyclics: Research Funding; Cellectar: Research Funding; Takeda: Consultancy. Manochakian:Novocure: Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Membership on an entity's Board of Directors or advisory committees; Guardant Health: Membership on an entity's Board of Directors or advisory committees. Chanan-Khan:AbbVie: Research Funding; Xencor: Research Funding; Pharmacyclics: Research Funding; Merck: Research Funding; Jansen: Research Funding; Mayo Clinic: Employment; Ascentage: Research Funding; Millennium: Research Funding.
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Corbacioglu, Selim, Enric Carreras, Mohamad Mohty, Antonio Pagliuca, Maria Ballabio, Robin L. Hume, Valeria Bandiera, Giorgia Finetto, and Paul G. Richardson. "Defibrotide for the Treatment of Hepatic Veno-Occlusive Disease: An Update from the International Compassionate Use Program in 710 Patients." Blood 124, no. 21 (December 6, 2014): 1138. http://dx.doi.org/10.1182/blood.v124.21.1138.1138.
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Abstract Introduction: Hepatic veno-occlusive disease (VOD; also called sinusoidal obstruction syndrome) is a potentially fatal complication of hematopoietic stem cell transplantation (HSCT). Severe VOD (sVOD) is usually characterized by multi-organ failure (MOF) and >80% mortality. sVOD may develop in a substantial number of high risk patients (pts) and is often unpredictable. Defibrotide is an oligonucleotide that protects endothelial cells from transplant-induced damage and restores the thrombotic-fibrinolytic balance. Defibrotide is now approved in the EU for the treatment of severe hepatic VOD in HSCT. We report here the final results of a large, international compassionate use program (CUP), open from 1998-2009. Methods: Defibrotide was provided on a compassionate basis or via single pt emergency-use requests (collectively, the CUP) to 312 sites in Europe, the US, Asia and the Middle East. There was no protocol; however, eligibility data, defibrotide use, safety and outcome data were requested using case record forms. In the US, pts were required to meet Baltimore criteria for VOD and have MOF. At all other sites, pts who met Seattle criteria for VOD, ultrasound, or histological criteria were eligible. The program included pts diagnosed with VOD as a complication of HSCT as well as chemo-/radiotherapy. Defibrotide was recommended to be administered IV in 4 divided doses daily, each dose infused over 2 hours. The initial dosing recommendations were 10 mg/kg/day with incremental dose increases of 10 mg/kg every 24 to 48 hours to a maximum daily dose of 60 mg/kg, depending on tolerability and response to treatment. Following results of a US Phase 2 study, the dose recommendation was 25 mg/kg/day. Duration of treatment was at the discretion of the investigator. Reported data included adverse events (AEs) and survival at Day+100 post HSCT or chemo-/radiotherapy. Results: Enrollment data were provided for 1129 pts. Safety and outcome data (submitted voluntarily) were provided for 710 pts reported to have received ≥1 dose of defibrotide (433 male [61%]). Of these, 628 (89%) developed VOD following HSCT (499 [71%] allogeneic; 112 [16%] autologous; 17 [2%] other/missing) and 79 (11%) developed VOD following chemo-/radiotherapy alone; information on the index event that led to VOD was missing for 3 pts. The median age was 25 (range, 0.2-70) years; 303 (43%) were <18 years. In the 710 pts, median time to onset of VOD from HSCT or start of chemo-/radiotherapy was 13 days. A total of 623 (88%) had bilirubin >2 mg/dL, 584 (82%) had weight gain >5%, 548 (77%) had hepatomegaly, 477 (67%) had ascites, 455 (64%) had right upper quadrant pain, and 292 (41%) had MOF. Per Bearman criteria or MOF, 429 (60%) had sVOD. The median daily dose of defibrotide was 25 mg/kg given for a median of 15 days. The most common doses were 25 or 40 mg/kg/day (498 of 638 pts with dosing information, 78%). AEs were reported in 378 pts (53%); most were serious (364/710, 51%) and fatal (350/710, 49%). Causes of death were generally reported as AEs, hence the most common new or worsening AEs were recorded as MOF (n=144 [20%], all fatal) and VOD (n=79 [11%], 78 fatal). Among the other AEs, sepsis (n=49 [7%], 48 fatal) was the most common. Incidence of serious AEs and fatalities was generally similar across dose subgroups. At least one hemorrhage event was reported by 85 (12%) pts (55 serious, including 37 fatal), most commonly gastrointestinal (n=33, 5%) or respiratory (n=24, 3%). Central nervous system (CNS) hemorrhage was reported in 10 pts (1%). Respiratory tract hemorrhage was highest in the 60/80 mg/kg/day dose group (9%) vs lower doses (<5%), but gastrointestinal and CNS hemorrhages were similar across dose groups (4%-6% and 0%-2%, respectively). Sixty three (9%) pts withdrew due to an AE, most due to hemorrhage (n=50, 7%), which was primarily gastrointestinal (n=22, 3%). Across all doses in the 710 pts evaluated, the Kaplan-Meier (KM) estimate of survival at Day+100 was 54%. Figure shows KM estimated survival by dose group; in the 25 mg/kg/day subgroup (the approved EU dose) it was 58% at Day+100. Conclusions: This large compassionate-use experience demonstrated that defibrotide was generally well tolerated and AEs were typical for this population. The overall KM estimated survival rate of 54% at Day+100 is consistent with prior studies. Results from subgroup analyses support the 25 mg/kg/day dosing as an optimal approach. Support: Jazz Pharmaceuticals Figure 1 Figure 1. Disclosures Corbacioglu: Gentium: Consultancy, Honoraria. Off Label Use: Defibrotide is an investigational treatment for veno-occlusive disease in the United States.. Carreras:Gentium S.p.A.: Expert Testimony Other, Research Funding, Speakers Bureau. Mohty:Gentium S.p.A./Jazz Pharmaceuticals Inc.: Honoraria, Research Funding. Pagliuca:Gentium S.p.A.: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Ballabio:Jazz Pharmaceuticals Inc.: Employment, Equity Ownership. Hume:Jazz Pharmaceuticals Inc.: Employment. Bandiera:Gentium S.p.A.: Employment. Finetto:Gentium S.p.A.: Employment. Richardson:Gentium S.p.A.: Membership on an entity's Board of Directors or advisory committees; Jazz Pharmaceuticals Inc.: Research Funding.
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TRUSHKINA, N. V., and N. S. RYNKEVICH. "PROPOSALS FOR THE CREATION OF THE APPROPRIATE INSTITUTIONAL CONDITIONS OF THE FORMATION AND DEVELOPMENT OF LOGISTIC CLUSTERS IN THE ECONOMIC REGIONS OF UKRAINE." Economic innovations 21, no. 3(72) (September 20, 2019): 138–49. http://dx.doi.org/10.31520/ei.2019.21.3(72).138-149.
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Topicality. One of the dynamic and rapid lines of development of modern regional ecosystems is transport logistics as an effective source of competitive advantages. This requires the use of new tools to improve the competitive ability of regions, including the cluster approach, the essence of which is the formation and development of logistic clusters by consolidating the efforts of the state, business, science, education in priority fields of economic activity. As international practice shows, the implementation of the cluster model of logistic activities will contribute to the reduction of total logistic costs by 12-35% as a result of reducing transport costs by 7-20% and the cost of handling operations by 20-30%, as well as accelerating the speed of circulation of material resources by 20-40%. Therefore, the creation of logistic clusters will create favorable conditions for the growth of the volume and quality of transport and logistics services and create a qualitatively new model of the regional economy.Aim and tasks. The aim of the article is to analyze the current state and problems of the formation of the institutional environment of functioning of logistic clusters in the economic regions of Ukraine, as well as to develop proposals for the creation of the appropriate institutional conditions for the development of logistic clusters as illustrated by the Prydniprovsky and Sloboda economic regions.Research results. It was found that the formation and effective functioning of logistic clusters in the regions of Ukraine is hampered by many key barriers that can be conditionally classified into the following groups, such as political, foreign economic, institutional, investment and financial, infrastructure, logistics. It was proved that for the effective development of logistic clusters in the economic regions of Ukraine it is reasonable to develop proposals for the creation of appropriate institutional conditions, which are to finalize the Strategies of the regional development in terms of institutional, investmen and financial, organizational and economic and information support of the functioning of logistic clusters using the cluster approach, as well as the Concepts of creating logistic clusters and Strategies for the integrated development of logistic clusters as a component of the regional transport and logistic system; implementation of the financial support mechanism, which includes exogenous and endogenous factors affecting the development of the regional transport and logistic system; the principles on which the formation of logistic clusters should be based; management functions (forecasting, planning, organization, accounting, control, analysis, regulation); a set of tools governing the organization and implementation of logistic activities, as well as the provision of transport services; financial instruments (venture investment, crowdinvesting, factoring, public-private partnership on the basis of attracting private investments, funds of credit institutions, foreign investment resources, grants of international financial organizations); means (digital, information and communication technologies, software, regulatory documents).Combination of modern cluster policy, mechanism of institutional support for the development of an integrated transport and logistic system and strategies of smart industry specializations in the context of decentralization will create the appropriate conditions for the formation of a logistic cluster as an effective form of partnership, strengthen the competitive advantages of the Prydniprovsky and Sloboda economic regions and increase the economic capacity of territorial communities.Conclusion. It was substantiated that the introduction of proposals for the creation of the appropriate institutional conditions for the formation and development of logistic clusters will contribute to a synergetic effect, the components of which are to increase the level of investment attractiveness of economic regions; increase revenues due to economic growth of territories; creation of new jobs and growth of employment; increase in the volume of cargo transportation and turnover; optimization of movement of logistic flows; cost reduction for the organization of logistic activities for the reduction of transport component in the cost of services, reduction in time to complete customs procedures for clearance of goods; provision of favourable conditions for the functioning of logistic market; creating objects of the appropriate logistic infrastructure (transport, trade, service, etc); improvement of the technology of transportation with the use of modern digital information and communication technologies.
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STAVSKA, Yulia. "THE DIRECTIONS OF INNOVATIVE CHANGES IN THE DEVELOPMENT OF TOURISM IN UKRAINE." "EСONOMY. FINANСES. MANAGEMENT: Topical issues of science and practical activity", no. 2 (42) (February 2019): 45–57. http://dx.doi.org/10.37128/2411-4413-2019-2-4.
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In the context of globalization, the sphere of tourism becomes more and more important, since it is one of the most profitable and dynamic branches of the world economy of the country. Tourism contributes to the growth of employment, accelerates the diversification of the economy, because this sphere covers more than 50 branches of the national economy, therefore the innovation of the tourist sphere should become its constant component. In addition, tourism not only preserves, but also develops the cultural potential of the country and the population, harmonize relations between different peoples and contributes to the friendly use of the environment. Indicators of its profitability indicate the importance of tourism for the development of economy, namely: 8% of world exports and 30% of world services sales, as well as annual growth of world tourist flows by 4-5%. However, Ukraine loses significantly in the competition, lagging behind the leading countries of the world in terms of development of tourist infrastructure and the quality of tourist services. Financial and economic crisis that has been continuing in recent years, the events associated with annexation of the Autonomous Republic of Crimea and anti-terrorist operation on the territory of Donetsk and Luhansk regions had a negative impact on the tourism flows, the tourism structure and tourist opportunities of the country both on the domestic and the external tourism market. In addition, Ukrainians have recently received the possibility of visa-free travel to the countries of the European Union, which will also lead to the increase in outbound tourism, and a reduction in the entrance. In this regard, it is necessary to introduce innovations in the development of tourism in Ukraine in order to attract visitors. Innovation in tourism "involves developing an original approach, developing new ways to use existing resources while seeking new ones";. Typization of innovation in tourism is developed by Abernathy and Clark, who distinguish 4 types of innovations: regular, niche, revolutionary and architectural. Regular innovations refer to the continuous improvement of the quality of services, the improvement of personnel skills and productivity. Niches innovations usually change the structure of cooperation, but not basic knowledge and skills; they combine existing services in a new way. Revolutionary innovations are associated with the use of new technologies in firms, the development of new methods; they have a radical impact on the key knowledge and skills of the staff up to the appearance of new occupations in the sector. Architectural innovations change the structure, business model and rules in tourism; they create new events and objects that require reorganization, chang physical or institutional infrastructure, research and training facilities. One of the main directions of innovation is the development of sustainable tourism. Destination (tourist areas) are beginning to create a management system for tourism resources and use them in the planning of territorial development. Recently, it became clear that the directions of innovation in tourism are increasingly becoming a systemic nature, when tourism turns from the industry into a "public enterprise";, which involves a variety of institutional stakeholders: government, business, local communities, science and education. At the same time, the remarkable thing is that the more the system of tourism management varies from industrial to post-industrial, the greater the innovative potential has the sphere of tourism, the greater the extent of tourism shifts from mass to individualized. This is due to the smaller segmentation of the market and the emergence of many niche, specialized services and tourist products. There is adaptation of tourism infrastructure, buildings and equipment for the needs of such new, growing groups of tourists as children, the elderly and the disabled. The innovations in the tourism industry, according to Novikov V.S., “are the result of actions aimed at creating a new or changing existing tourist product, developing new markets, using advanced information and telecommunication technologies, improving the provision of tourist, transport and hotel services, creating strategic alliances for realization of tourist business, introduction of modern forms of organizational and managerial activity of tourist enterprises”. In general, tourism is a multi-vector industry, which can create some difficulties in introducing innovations. At the same time, certain areas of tourism activity are impossible without the use of innovative technologies, in particular, information and computer technologies. Effective administrative work of tourism enterprises involves the application of various facilities, as Ukrainian travel agencies are widely using the information sector, in the form of messages, and the virtual sector of travel in global networks. Studies conducted in the field of tourism demonstrate the "consumer nature" of information innovation, while tourism is not a producer in this field. According to preliminary estimates, the cost of the initiative tour operators in Ukraine for maintaining an on-line booking system is about 2% of the cost of services sold. Sales of entertainment and recreation tours provide about 3.3 million dollars. US annually spent money on developing, maintaining and filling in the information support system. Common directions of the use of innovative technologies in tourism are: mobile Internet, catalogs of electronic offers, on-line booking not only for retail agencies, but also directly for clients. Further development of innovation activity is the development of new ideas for promotion of tourist product, development of new tourist routes, availability of information to the consumer, software, etc.
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Chao, Chun R., Lanfang Xu, Nancy Cannizzaro, Angie Mae Rodday, Joseph Feliciano, Anita J. Kumar, Andrew M. Evens, and Susan K. Parsons. "The Development and Validation of an Electronic Health Record (EHR)-Based Algorithm for Identifying Treatment Failure in Newly Diagnosed Hodgkin Lymphoma (HL) Treated in a US Community Oncology Setting." Blood 132, Supplement 1 (November 29, 2018): 2261. http://dx.doi.org/10.1182/blood-2018-99-112225.
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Abstract Introduction Most existing cancer registries do not fully capture relapse or progression of cancer. Further, clinical trials for upfront treatment typically withdraw patients from study at the time of treatment failure and only collect minimal information about approaches to and outcomes with salvage therapy. As such, patient outcomes other than mortality often are available only through formal chart review, which is resource intensive. For HL, although many patients are successfully cured, a sizeable subset of patients experience treatment failure. Most of the data describing failure arises from prospective clinical trials, despite most patients receiving treatment in the community setting. Therefore, data from the community setting are needed to understand the experience of real-world patients and to inform and improve the quality of care in oncology practices. To facilitate observational research and quality improvement projects on HL treatment failure, we examined an EHR-based algorithm for identifying treatment failure in HL. Methods All HL patients who initially presented with advanced stages II-IV disease between 2007-2012 at Kaiser Permanente Southern California (KPSC) were identified using KPSC's cancer registry. An algorithm for identifying treatment failure was proposed by study oncologists. Treatment failure was defined as relapse after complete remission of > 60 days' duration or disease progression on active treatment. The algorithm was defined as meeting one of the following: (1) Initiation of any second chemotherapy regimen, including use of brentuximab vedotin, or PD-1 inhibitor beyond initial regimen; or (2) stem cell transplantation (SCT). Data needed to construct the algorithm were collected from KPSC's EHR, including the chemotherapy database and transplant registry. The algorithm was applied to all HL cases up to 4 years after diagnosis, as most HL relapses occur within this timeframe. Manual chart reviews were performed for all potential treatment failure cases identified by the algorithm, and for one-third of randomly-selected HL cases not captured by the algorithm. Each case was abstracted by trained study staffed and reviewed for quality control by two study oncologists. Results Of the 470 HL patients newly diagnosed during the study period (91% diagnosed at age 18 and older, 57% male), the algorithm identified 80 as potential treatment failure cases. Chart review confirmed 75 of 80 as actual treatment failure. The algorithm misclassified relapse for 5 cases who had emergence of a second malignancy for which therapy was instituted after the completion of initial therapy for HL. The positive predictive value (PPV) was 94% (95% confidence interval: 89%-99%). The negative predictive value (NPV) based on the review of 127 patients not captured by the algorithm was 100%. Based on the high PPV and NPV, our review suggested both a high sensitivity and specificity of the algorithm. Conclusion This EHR-based algorithm, based on receipt of second-line therapy beyond initial treatment and SCT, was highly effective in capturing relapse or disease progression cases among HL patients in this integrated health care delivery system. Application of this algorithm will allow for better long-term follow up for novel agents in observational studies, which is critical for understanding the cost-effectiveness of therapeutic agents in real-world patients. External validation using data from other health care settings or sources such as claims data will be useful to further confirm the generalizability of this algorithm. Altogether, this algorithm could assist practices in the identification and prospective tracking of the relapsed/refractory HL patient population for clinical and non-clinical outcomes, such as cost, health-related quality of life, and sequelae of treatment. Disclosures Chao: Seattle Genetics: Research Funding. Xu:Seattle Genetics: Research Funding. Cannizzaro:Seattle Genetics: Research Funding. Rodday:Seattle Genetics: Research Funding. Feliciano:Seattle Genetics: Employment, Equity Ownership. Kumar:Seattle Genetics: Research Funding. Evens:Seattle Genetics, Inc.: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pharmacyclics International DMC: Membership on an entity's Board of Directors or advisory committees; Tesaro: Research Funding; Abbvie: Consultancy; Janssen: Consultancy; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Affimed: Consultancy; Novartis: Consultancy; Acerta: Consultancy; Bayer: Consultancy. Parsons:Seattle Genetics: Research Funding.
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Gouveia, Andréa Barbosa, Marcos Alexandre dos Santos Ferraz, and Marcus Quintanilha da Silva. "O direito à aposentadoria como uma dimensão da luta pela valorização dos professores: perfil das redes municipais brasileiras a partir da RAIS." Revista Educação e Emancipação 12, no. 3 (September 30, 2019): 138. http://dx.doi.org/10.18764/2358-4319.v12n3p138-156.
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O artigo argumenta que o direito à aposentadoria especial de professores da educação básica pode ser compreendido como uma dimensão da valorização profissional (FERREIRA JR, 2013; GROCHOSKA, 2017; GOUVEIA, 2018). Esta perspectiva amplia dimensões já contempladas na literatura, como as de formação, remuneração, carreira e condições de trabalho (OLIVEIRA, 2010; CAMARGO; JACOMINI, 2011; GROCHOSKA, 2015; DARLING-HAMMOND, 2017). A partir da análise dos dados de perfil dos professores que efetivaram a aposentadoria nos anos de 2008 e 2016 cotejados por idade, tempo de serviço e formação, problematiza-se a ideia de mudanças no direito à aposentadoria especial dado que os professores, sob efeito das últimas reformas da previdência, já sofreram impactos não avaliados devidamente e têm apresentado maior tempo de permanência no sistema e, portanto, maior média de idade. A fonte de informações de perfil é a Relação Anual de Informações Sociais (RAIS), registro administrativo anual de empregos formais do Ministério do Trabalho e Emprego. Apresentam-se também alguns elementos do debate sindical recente sobre o direito à aposentadoria especial no Brasil.Palavras-chave: Políticas Educacionais, Remuneração Docente, Aposentadoria The retirement right as dimension of teachers’ appreciation figth: profile of brazilian municipal systems from RAISABSTRACTThe article argues that rigth to special retirement for teachers in basic education can be understood how a dimension of profissional appreciattion ((FERREIRA JR, 2013; GROCHOSKA, 2017; GOUVEIA, 2018). This perspective expands dimensions already contemplated in the literature such as trainning, remuneration, career and working conditions (OLIVEIRA, 2010; CAMARGO; JACOMINI, 2011; GROCHOSKA, 2015; DARLING-HAMMOND, 2017). Based on the analysis of the profile data of the teachers who made the retirement in the years 2008 and 2016, based on age, length of service and trainning, the idea of changes in the right to special retirement is problematized since the teachers, pension reforms, have already had an impact that has not been duly assessed and has been shown to be longer in the system and, therefore, a higher average age. The source of profile information is the Annual Social Information Relation (RAIS), the annual administrative record of formal jobs from Ministry of Labor and Employment. It also presents some elements of the recent trade union debate on the right to special retirement in Brazil.Keywords: Education Policies. Teachers’ remuneration. Retirement. El derecho a la jubilación como una dimensión de la lucha por la valorización de los profesores: perfil de las redes municipales brasileñas a partir de la RAIS. RESUMENEl artículo argumenta que el derecho a la jubilación especial de profesores de la educación básica puede ser comprendido como una dimensión de la valorización profesional (FERREIRA Jr, 2013, GROCHOSKA, 2017, GOUVEIA, 2018). Esta perspectiva amplía dimensiones ya contempladas en la literatura como las de formación, remuneración, carrera y condiciones de trabajo (OLIVEIRA, 2010; CAMARGO; JACOMINI, 2011; GROCHOSKA, 2015; DARLING-HAMMOND, 2017). A partir del análisis de los datos del perfil de los profesores que efectuaron la jubilación en los años 2008 y 2016 cotejados por edad, tiempo de servicio y formación, se problematiza la idea de cambios en el derecho a la jubilación especial dado que los profesores, bajo efecto de las últimas reformas de la previsión, ya han sufrido impactos no evaluados debidamente y han presentado mayor tiempo de permanencia en el sistema y, por lo tanto, mayor edad media. La fuente de información de perfil es la Relación Anual de Información Social (RAIS), registro administrativo anual de empleos formales del Ministerio de Trabajo y Empleo. Se presentan también algunos elementos del debate sindical reciente sobre el derecho a la jubilación especial en Brasil.Palabras-clave: Politicas Educativas. Remuneracion Docente. Jubilación.
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Warsame, Rahma M., Angela Dispenzieri, and Amylou C. Dueck. "Financial Toxicity and Impact on Health-Related Quality of Life in Patients with Plasma Cell Disorders." Blood 136, Supplement 1 (November 5, 2020): 20–21. http://dx.doi.org/10.1182/blood-2020-140826.
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BACKGROUND: Advances in novel therapies and supportive care have contributed to improved outcomes for patients with Multiple myeloma (MM) and Light Chain Amyloidosis (AL). This progress comes at a high price; with high financial costs to patients increasing distress, decreasing compliance, and even decreasing survival. Our aim was to screen patients for financial distress and understand its impact on various domains of health-related quality of life (HRQOL). METHODS: We conducted a prospective study of adult patients with MM or AL that received follow-up care at Mayo Clinic, Rochester, MN. Financial distress was measured using the validated COmprehensive Score for financial Toxicity (COST) questionnaire; high financial distress was defined as a score of 23 or less. HRQOL was measured using the Patient Reported Outcome Measurement Information System (PROMIS)-29 questionnaire. Baseline demographic information and clinical characteristics were abstracted from the medical record. Statistical analysis included descriptive statistics, Spearman correlations, and comparison of COST scores between groups by Jonckheere-Terpstra, Kruskal-Wallis, and Wilcoxon rank-sum tests for ordered, unordered, and binary categorical variables, respectively. RESULTS: Patients: To date 77 patients (MM 64 [83%], AL 13 [17%]) have been enrolled, 55% male, 53% age 65 or older (18% <55), 91% White (5% Black), 92% non-Hispanic, 56% at least some college, 47% income at least US$75K/year (25% <US 50K/year), 36% employed (49% retired), 73% married (14% divorced) and 22% traveled at least 300 miles to clinic. Clinical characteristics included 45% newly diagnosed, 55% relapsed/refractory disease. 66% had been transplanted previously. Insurance types included 52% Medicare (44% private insurance) with 27% overall reporting supplemental insurance. Financial Distress: The mean COST score was 26.5 (SD 10.0) with 42% reporting high financial distress. PROMIS-29 domain descriptive statistics appear in Table 1. Higher financial distress was significantly associated with higher anxiety, depression, and pain (all p<0.05). Group Differences: Financial distress significantly differed by gender, education, marital status, employment status, income, insurance type, and distance traveled reported in Table 2. Financial distress was higher: in women than men (p=0.003); in high school graduates vs those who attended some college or more (p=0.03); in divorced versus married individuals (p=0.02); among unemployed or disabled versus employed versus retired people (p=0.04); in those with income <US$50K/year versus US$50K-<$75K/year versus at least US$75K/year (p<0.001); among those with Medicaid vs private insurance versus Medicare (p=0.02); and for those whose distance from Mayo was at least 300 miles vs < 300 miles (p=0.03). Differences in age neared but failed to reach strict statistical significance (age 35-54: mean 22.4, SD 12.1; age 55-64: mean 26.5, SD 9.5; age 65+: mean 28.0, SD 9.2; p=0.051). Financial distress did not significantly differ by race, ethnicity, diagnosis, disease status (newly diagnosed/relapsed), prior transplant, or supplemental insurance, though some subgroups were small. CONCLUSION: Financial distress was prevalent in this well-educated and high earning MM and AL cohort that is able to receive tertiary care at Mayo Clinic. This financial distress was moderate to strongly associated with anxiety and pain intensity, and mild to moderately associated with depression and pain interference. Longitudinal assessment is ongoing. Disclosures Dispenzieri: Takeda: Research Funding; Celgene: Research Funding; Janssen: Research Funding; Pfizer: Research Funding; Alnylam: Research Funding; Intellia: Research Funding.
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Kartika, Lindawati. "Strategies for Developing Sustainable and Competitive Cluster For Handycrafts –Based Small Medium Enterprise (SME)." Transactions on Machine Learning and Artificial Intelligence 8, no. 3 (June 30, 2020): 11–20. http://dx.doi.org/10.14738/tmlai.83.8218.
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The SME Assist concept was formulated in August 2009 in line with the philosophy of university-industry engagement. Small Medium Enterprises (SMEs) are important economic driving force in many countries. Previous researches show that efforts taken by various parties and governments of different countries have helped improve and transform SMEs to be competitive in the fast changing global economy. In Indonesia specifically in Bogor regency, West Java, there are different models or approaches adopted and implemented by various parties. However, competitiveness of SME remains an area of concern. For Handycrafts-based SME, in order to meet these expectations and fulfil their contributions to the development process, it is absolutely important that they have high productivity. It is essential that these industries provide productive and remunerative employment and, for their survival and growth, offer products and services at competitive quality and price. The Handycrafts-based SME has a potential to develop in Bogor Regency which is located in tourism area and divided into Villages (Cilember, Leuwimalang, Cisarua, Cibeireum, Kopo and Jogjogan) in Cisarua District.
Handycrafts is the dominant cluster that can generate earning sources and give role of economics which is very significant. Unfortunately, the existence of the Handycrafts-based SME is not as good as most people expected, because there are many constraints faced. In the mean time, the infrastructure and access information concerning capital, technology, management and marketing are limited. Therefore, it is essential to formulate strategy to develop handycrafts-based SME based on internal and external factors. The objectives of this research are to identify the characteristics of handycrafts-based SME in Bogor Regency to have actual conditions, and to analyze the SME’s internal-external environment and to select the alternative strategies for development .
The development strategies of handycrafts-based SME are proposed according to external and internal factors. These factors influence and determine the development dynamic and growth of handycrafts-based SME. The combination of strength and weaknesses together with external situation will determine the development posibility of SME. The score analysis method was used to analyze the internal external environment used for generating strategy using analytical Hierarchy Process (AHP) method. Hierarcy decisions was based on interpretation of secondary data concerning external and internal factors which influence the growth of SME and early discussion with experts from the SME entrepeneurs, academics, and local government. The prioritation of alternatives strategy was determined synchronization of literature and opinion of expert responder, then the result was processed with AHP.
The results of this research show that the characteristics of handycrafts-based SME in Bogor Regency are: using traditional management, simple record-keeping administration, having local market and regional sale, utilize local or regional raw material, perform continous production system, having good quality awareness, using self or family capital resource, utilize simple equipments and technology and also having good innovation capability. According to the score assessment of AHP, the main strategy for the development of handycrafts-based SME in Bogor Regency is give more or better attention for policy formulation and based on socialpreneurship. This strategy means that the government policy should enhance or at least not constraining the development of handycrafts-based SME. The policy should also accommodate the necessity of all stakeholders related to handycrafts-based SME