Implementation and achievements of enhanced recovery after surgery program in perioperative management of gastric cancer patients

Objective:The enhanced recovery after surgery(ERAS)program is less implemented in gastric cancer patients.The purpose of this survey is to investigate the implementation status of ERAS in perioperative period in gastric cancer.Methods:This clinical observational study enrolled 329 patients between January 2020 and August 2020 in a single gastric cancer center.The questionnaire consisted of 4 par ts:basic information,preoperative status,intraoperative status,and postoperative status of ERAS implementation in gastric cancer surgery.Results:In the preoperative period,patients'education and counseling(100%)were well adopted.Smoking cessation(34.6%),drinking cessation(36.9%),avoidance of preoperative mechanical bowel preparation(24.3%),respiratory function training(11.2%),and administration of carbohydrate-rich drink before surgery(0.6%)were relatively not well adopted.During the operation,maintenance of intraoperative normothermia and fluid management(100%),as well as epidural analgesia(81.5%),were well adopted.Thromboprophylaxis was performed in 133(40.4%)patients.In the postoperative period,early active mobilization was implemented about 9.5 h,and early ambulation was implemented about 39.5 h,after surgery.A total of 140(42.5%)patients received prolonged prophylactic antibiotics;268(81.5%)patients were provided diet upon gas passage;and 320(97.3%)patients received intravenous fluid administration more than 5 d after surgery.The practice rate of early removal of urinary catheter(0%)and nasogastric tube(15.5%)was relatively low.A total of 11(3.3%)patients experienced postoperative complication,and 1(0.3%)patient received unplanned reoperation.The average costs were￥59,500,and the average hospital stay was 12(5,36)d.Conclusions:Standard perioperative management of ERAS program in gastric cancer surgery in China still requires improvement.

An integrated pest management program for managing fusarium head blight disease in cereals

Fusarium head blight(FHB)is a worldwide devastating disease of small grain cereals and Fusarium graminearum species complex(FGSC)is the major pathogen causing the disease.The epidemics of FHB lead to the reduction of grain yield and economic losses.Additionally,mycotoxins produced by the FHB pathogens are hazardous to the health of human and livestock.In this review,we summarize the epidemiology of FHB,and introduce effects of this disease on economy,environment and food safety.We focus on the integrated management approaches for controlling FHB including agronomic practices,resistant cultivars,chemical control,and biocontrol.In addition,we also discuss the potential novel management strategies against FHB and mycotoxin.

Optimal scenario balance of reduction in costs and greenhouse gas emissions for municipal solid waste management

To reduce carbon intensity, an improved management method balancing the reduction in costs and greenhouse gas(GHG)emissions is required for Tianjin's waste management system. Firstly, six objective functions, namely, cost minimization, GHG minimization, eco-efficiency minimization, cost maximization, GHG maximization and eco-efficiency maximization, are built and subjected to the same constraints with each objective function corresponding to one scenario. Secondly, GHG emissions and costs are derived from the waste flow of each scenario. Thirdly, the range of GHG emissions and costs of other potential scenarios are obtained and plotted through adjusting waste flow with infinitely possible step sizes according to the correlation among the above six scenarios. And the optimal scenario is determined based on this range. The results suggest the following conclusions. 1) The scenarios located on the border between scenario cost minimization and GHG minimization create an optimum curve, and scenario GHG minimization has the smallest eco-efficiency on the curve; 2) Simple pursuit of eco-efficiency minimization using fractional programming may be unreasonable; 3) Balancing GHG emissions from incineration and landfills benefits Tianjin's waste management system as it reduces GHG emissions and costs.

Community Pharmacist-Based Collaborative Disease Management Program for Patients with Poorly Controlled Diabetes

Objective： Patients with poorly controlled diabetes have more medical complications and are more difficult to manage. The objective of the present study was to evaluate the clinical outcomes of successful implementation of an employer initiated community pharmacist-based disease management program for diabetic patients with poorly controlled diabetes. Methods： Employees with poorly controlled diabetes （glycosylated hemoglobin （A1 C） level 〉 7.5%） were identified fi＇om a large diabetes disease management program, in a rural setting in Texas, US. A longitudinal retrospective study was conducted, analyzing clinical indicators in the diabetes patients following the community pharmacist-based disease management program. The program involved a comprehensive drug therapy assessment and individualized disease management education. Primary outcome measured in the present study was A1C levels, assessed at the baseline visit and at the end of the intervention. Results： A total of 64 patients with poorly controlled diabetes were identified. Significant improvement in mean clinical outcome scores was achieved for A1C levels （p = 0.0011）. At the end of the 1 year longitudinal intervention, targeted body mass index and A1C goals were attained by 35.9% （p 〈 0.001） and 15.6% patients, respectively. The 10 patients reaching goal levels post intervention were in the group that had baseline A1C of 7.5 to 9%. However, patients with 〉 9% A1C levels at baseline had a significant reduction （mean 2.1, p 〈 0.001） post intervention. Conclusion： The community pharmacist-based diabetes disease management program improved A1C levels of patients with poorly controlled diabetes.

A mixed integer linear programming approach for municipal solid waste management

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The Role of Blockchain in E-Governance and Decision-Making in Project and Program Management

This paper discusses the impact of e-governance powered by blockchain in the project and program management industry. With the rise in technological innovations, many countries have turned to e-governance for efficiency in service delivery, transparency, and decision-making. E-governance backed by blockchain technology entails improving the public services provision by implementing structures of information and communication technologies. There are many challenges with the traditional project management approach that causes organizations and its stakeholders’ cost and time. Thus, the introduction of blockchain has given many organizations a new approach to adopt in order to eliminate the challenges associated with the typical project management approach. In spite of the cutting-edge technology of blockchain and its broad applications in program management and e-governance, there are still many challenges that restrain its adoption on a broader scale. The research discusses the challenges of the blockchain deployment in the program management field and e-governance in private and government sectors and it highlights the efforts put by both sectors to make use of the technology. Also, the research covers the opportunities and the advantages of a blockchain adoption in various segments. The paper uses various case studies in the UAE, in both private and government sectors, and a qualitative research approach was implemented. The case studies were on government entities such as Smart Dubai and the Ministry of Health Prevention and also private entities like DP World and Emirates NBD. The paper concludes with recommendations and solutions on how to maximize the benefit of blockchain in the program management industry and how it is improving the decision-making process.

The Strategy of Widespread Fatigue Damage in FMP System

As is known, widespread fatigue damage （WFD） is a common phenomenon of aging aircraft being a negative impact on safety and reliability. The current FAR 25. 571 （b） requires that ＂An LOV （ Limit of Validi- ty） must be established, during which it is demonstrated that widespread fatigue damage will not occur in the air- craft structures＂. The FAA issued AC 91-82A in August 2011 providing guidance on developing and implemen- ting a Fatigue Management Program （FMP） system to address in-service issues for metallic fatigue critical struc- tures. This action brings new challenges to aircraft manufacturers in China. This paper introduces the problem of widespread fatigue damage including the MSD（ multiple site damage） and MED（ multiple element damage） and the differences between them and the steps to establish the LOV/ELOV（ Extended limit of validity）. Authors in this paper is also proposing some management indicators to control WFD during the design phase and mainte- nance. Developing and implementing the management indicators to address WFD which are involved in the FMP system may provide guidance on the estimation and management to address WFD for present and future aircraft. Finally, some suggestions are put forward to provide the theoretical basis for large civil aircraft design and airwor- thiness.

Penalty model for delay of bidding section construction period in South-to-North Water Diversion Eastern Route Project from perspective of programs

According to the multi-project and program management theory, this paper analyzes the program generation principle and establishes a program based on progress goals. On the basis of the present situation of calculation of penalty for delay of the bidding section construction period with the critical path method, we studied the effects of contractor-induced delay of the bidding section construction period in detail, including the effects on the construction period of the bidding section itself, the earliest start times of the next bidding section and other subsequent bidding sections, and the construction period of the program, and then constructed a penalty model for delay of the bidding section construction period from the perspective of programs. Using the penalty model, we conducted a practical analysis of penalty for delay of the construction period of the Baoying station program in the South-to-North Water Diversion Project. The model can help determine the amount of penalty for delay of the construction period in bidding sections scientifically and reasonably,

U. S. Academic Medical Centers Under the Managed Health Care Environment

This research investigates the impact of managed health care on academic medical centers in the United States. Academic medical centers hold a unique position in the U. S. health care system through their missions of conducting cutting-edge biomedical researeh, pursuing clinical and technological innovations, Providing state-of-the-art medical care and producing highly qUalified health professionals. However, policies to control costs through the use of managed care and limiting resources are detrimental to academic medical centers and impede the advancement of medical sciTo survive the threats of managed care in the health care environment, acadendc medical centers must rely on their upper level managers to derive successful strategies. The methods used in this study include qualitative approaches in the form of key informants and case studies. In addition, a survey questionnaire was sent to 1h8 CEOs in all the academic medical centers in the U. S. The findings revealed that managers who perform the liaison, monitor, entrepreneur and resource allocator roles are crucial to ensure the survival of academic medical centers, so that academic medical centers can continue their missions to serve the general public and promote their well-being.

Celanese Joins U.S.-China Energy Cooperation Program as Founding Management Board Member

Celanese Corporation has become a foundingcorporate member of the U.S.-China EnergyCooperation Program (ECP) and joined theentity’s founding management board.Celaneseannounced on December 23rd,2009.This reaffirms the company’s commitmentto environmentally sustainable growth inChina,the company’s fastest-growingregion.The mission of ECP,a private-sectorinitiated,managed and financedorganization,is to facilitate the adoption

Differentiation and dynamism within the IT development program

Information technology(IT)developments of large magnitude organize as collections of multiple projects into a single program,especially under dynamic conditions of market uncertainty that frequently change requirements or solutions midstream.Successful completion of an IT development program requires that the multiple teams work effec-tively together as well as independently in response to changes by relying on the differ-entiation of talent and knowledge available to the program manager.We consider and empirically support a model derived from principles in the multi-team systems(MTS)literature to determine the influence of differentiation among the IT program in the sharing of knowledge and information.The relationship from differentiation to program success is mediated by knowledge and information sharing,showing how to manage change through the dissemination of information and knowledge.Uncertainty of the market positively moderates the relation from differentiation among projects to infor-mation sharing.These findings contribute to the literature by empirically validating that MTS frameworks are exceptionally well suited for dealing with complex environments in the context of IT development.