Understanding Osteoporosis: Pathophysiology, Risk Factors, Diagnosis, and Management

Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and deterioration of bone architecture, resulting in reduced bone strength and, consequently, increased susceptibility to fractures which poses a significant public health concern worldwide, particularly in aging populations [1]. The health-economic impact of vertebral and hip fractures has been extensively explored and it is well known that these fractures are associated with morbidity/disability and increased mortality;they also account for a substantial portion of the direct fracture costs. This review aims to provide a comprehensive overview of osteoporosis, including its pathophysiology, risk factors, diagnostic approaches, and management strategies. By elucidating the multifaceted nature of this condition, healthcare providers can better identify individuals at risk, implement preventive measures, and optimize treatment to reduce the burden of osteoporotic fractures.

Development and Application of Integrated Indicators for Assessing Healthcare Waste Management Systems in Kenyan Hospitals

Healthcare waste management (HCWM) is an important aspect of healthcare delivery globally because of its hazardous and infectious components that have potential for adverse health and environmental impacts. The paper introduces a set of indicators for assessing HCWM systems in hospitals. These indicators are: HCWM policies and standard operating procedures, management and oversight, logistics and budget support, training and occupational health and safety, and treatment, disposal and waste treatment equipment housing. By plotting a mark on a continuum which is defined as good and poor on the extremes and is connected with all other marks in a spoke arrangement, it’s possible to describe a baseline for HCWM in any specific hospital. This baseline can be used to improve awareness of the actors and policy-makers, compare the same hospital at a different point in time, to compare observations by different evaluators and to track improvements. Results suggest that in Kenya, the application of such indicators is useful for evaluating which priorities should be addressed to improve outcomes in HCWM systems. Systematic sampling technique was used to identify and collect data by use of observational checklist, interviews, visual verification and review of documents and a HCWM assessment tool. The objective is to suggest an integrated management tool as a method to identify prevailing problems with a HCWM system. The method can be replicated in other contexts worldwide, with a focus on the developing world. The integrated indicators focus on management of HCW and not its potential impact on human health and environment, an area recognized to be critical for future research.

Testing of Decision Making Tools for Village Land Use Planning and Natural Resources Management in Kilimanjaro Region

This paper focuses on participatory testing of decision making tools (DMTs) at village level to assist in development of land use plans (LUPs) for sustainable land management (SLM) in Kilimanjaro Region, Tanzania. Data were collected using conditional surveys through key informant interviews with the project’s district stakeholders in each district, focused group discussions with selected villagers and participatory mapping of natural resources. Soil health, land degradation, carbon stock, and hydrological conditions were assessed in the seven pilot villages in all seven districts using DMTs as part of testing and validation. Results indicated soils of poor to medium health, and land degradation as portrayed by gullies and wind erosion in lowlands and better in uplands. Carbon and forest disturbance status could not be assessed using one-year data but hydrological analysis revealed that water resources were relatively good in uplands and poor in the lowlands. Challenges with regard to land use include increased gully erosion, decreased stream flow, reduced vegetation cover due to shifting from coffee with tree sheds to annual crops farming, cultivation near water sources, and overgrazing. Empowering the community with decision making tools at village level is essential to ensure that village land uses are planned in a participatory manner for sustainable land and natural resources management in Kilimanjaro and other regions in Tanzania.

Intelligent tools and techniques for modern management

In order to make decisions all companies need information. As a rule, all the informatics systems of a company contain a multitude of data and turn these data into information that has to be analyzed in order to make decisions. It is a slow process. The solution of this drawback is given by Business Intelligence （BI） applications that can help companies increase income or diminish costs by offering the executive management appropriate information on the basis of which quick and efficient decisions can be taken.The main purpose of the paper is to prove the necessity that BI tools should be used by the modem manager. Managers are aware of that by putting into practice the BI solutions, opportunities of getting control over the business process and methods are improved and better, timely analysis functions of the performance parameters can be obtained.

Intelligent Tool Management Strategies for Automated Manufacturing Systems

With the increase in automation and use of computer control in machine tools, the number of cutting tools per machining setup is on the increase. On one hand, such multi-tool setups offer the advantages of reduced down-time and cost of production and require less space and in-process inventory, and on the other hand, require proper tool management for economic operations. A number of strategies have been devised to solve the tool selection problems and a number of tool replacement policies have been proposed in the past. These strategies have been solved in isolation, whereas, a comprehensive algorithm for proper selection of tools out of those available in the tool magazine for performing operation and for replacement of tools on failure/wear is necessary. In this paper, taking cue from the computer memory management policies, four tool selection strategies have been presented and their performance in tandem with various tool replacement policies has been studied. The effect of important parameters such as reduction of tool life due to regrinding, limited number of regrindings, catastrophic failures etc. have been considered. Cost has been computed for each combination of tool selection and replacement policy. Also, the number of machine stoppages has been worked out in each case. The results indicate that the combination of various selection strategies with suitable replacement policies affects the overall cost.

Postoperative pain assessment and management among nurses in selected hospitals in Benin City,Edo State,Nigeria

Objective:This study was designed to determine the nurse assessment of postoperative pain and its management in selected hospitals,Benin City,Edo State,Nigeria.Materials and Methods:A descriptive cross-sectional survey was adopted.The target population consist of 222 purposely nurses who are in the cadre of nursing officer II to chief nursing officer who works in the various surgical wards/units of the selected health facilities.The data were collected from the participants using the pretested structured questionnaire developed by the researcher.Results:Results showed that 66.2%of nurses had a poor level of knowledge on postoperative pain assessment.The McGill Pain Questionnaire was the most used pain assessment tool with a mean score of 2.84 whereas the Dallas Pain Questionnaire was the least used with a mean score of 1.90.“Providing clean,calm,and well-ventilated ward environment”(3.69±0.61)was the most used nonpharmacological method for postoperative pain management,followed by“distraction,relaxation,and guided imagery”(3.52±0.50),“dressing,bandage,splint,and reinforce wound sites postoperatively”(3.39±0.54),and“early ambulation/exercise”(3.20±0.62).The most used pharmacological interventions were“acetaminophen”(3.63±0.55),“topical anesthetic”(2.92±0.62),“nonselective nonsteroidal anti-inflammatory drugs”(2.87±0.43),and“mixed opioid agonist-antagonist”(2.56±0.56).Conclusion:There is a poor level of knowledge on postoperative pain assessment among nurses in this study setting.It is,therefore,pertinent for hospitals to organize continuous in-service training for postoperative pain assessment and management,especially on nonpharmacological approaches among nurses.

Review of construction and demolition waste management tools and frameworks with the classification,causes,and impacts of the waste

This review looks over the current construction and demolition waste management(C&DWM)situations by scrutinizing the definition,classification,components,compositions,generated sources and causes,impacts of generated construction and demolition wastes(C&DWs),waste management hierarchy(WMH),3R principles(Reduce,Reuse,and Recycle),Circular Economy(CE),frameworks,tools,and approaches of C&DWM.After reviewing the literature this study contributes to the literature by the following means:(a)suitable working definitions of C&DW and C&DWM are provided,(b)an expanded WMH for construction and demolition operations is presented,(c)frameworks of C&DWM are identified and listed as follows:frameworks based on WMH,including 3R principles and CE concept,frameworks focusing on the quantification,estimation,and prediction of generated C&DW,frameworks focusing on effective and sustainable C&DWM,frameworks focusing economic,social,and environmental performance assessment,frameworks based on multi-criteria analysis(MCA),frameworks based on post-disaster recovery period,and other miscellaneous frameworks,and(d)four categories of tools utilized in C&DWM are identified and explained,namely,approaches employed in C&DWM,information technology(IT)tools employed in C&DWM,multi-criteria decision analysis(MCDA)tools employed in C&DWM,and C&DWM technologies.Moreover,this study also found that CE,and green rating system(GRS)are widely used approaches,Building Information Modeling(BIM),Radio Frequency Identification(RFID),Geographic Information System,and Big Data are the extensively used IT tools,Analytical Hierarchy Process,FUZZY,TOPSIS(Technique for Order Preference by Similarity to the Ideal Solution),Weighted Summation,Elimination and Choice Expressing the Reality II,Elimination and Choice Expressing the Reality III,Evaluation of Mixed Data,and REGIME(REG)are the widely used MCA tools in C&DWM,and Prefabricated Construction and Modular Construction are broadly used C&DWM technologies.Furthermore,it has been observed that the application of the Analytic Networking Process(ANP)and hybridization of ANP,FUZZY,and TOPSIS tools do not catch considerable attention in the literature for conducting MCA,although it yields more precise outcomes.Additionally,most previous research has focused on the estimation of generated C&DW,but less attention has been given to forecasting the generated C&DW due to inadequate available C&DW data.This review article also assists C&DWM practitioners,academics,stakeholders,and contractors in choosing appropriate frameworks and tools for C&DWM while managing C&DW.

Introducing BIM to Construction Management Students:A Case Study of Using Lego Blocks as Instructional Tool

As the construction industry is transitioning into the building information modeling(BIM)era,many construction management(CM)programs are actively integrating BIM into their curriculum.For new CM students who are unfamiliar with the BIM concept,a connection is desired to link 2D drawings with 3D models.This paper presents a case study that uses Lego blocks as an innovative instructional tool to introduce BIM to new CM students.The approach employs a physical Lego model house as the connection between the 2D and 3D worlds in an introductory BIM course and aims to demonstrate the benefits of BIM over 2D CAD through a hands-on session.CM students are instructed to build a Lego house first with a set of typical 2D construction drawings,including plan,elevation,and section sheets,and then with a 3D model in a BIM program.Students are guided to navigate the model and then use it as a 3D reference to complete the Lego house.Through the hands-on session,students will naturally establish the connection between 2D drawings and 3D models.In addition,by comparing the efforts needed to complete the Lego house with both methods,students can easily recognize the benefits of using BIM in CM.This case study demonstrates the procedures of using Lego blocks as an instructional tool in a hands-on session of an introductory BIM course.

On the Application of IPRA Tool in Risk Assessment and Management of International Construction Projects

Construction companies face threats from competition and must be able to adjust to modem technology and changes in customer expectations. These issues require efficient risk management techniques. The success of construction companies running projects in international markets depends on how the risks arise from the host country conditions as well as the project specific risk factors. Successful management of risks requires identification of risks, construction of a risk model which can be used to assess the magnitude of risks, and implementation of response strategies so that an acceptable risk-return balance can be achieved. The project success usually depends on the combination of all risks, response strategies used to mitigate risks, and a company＇s ability to manage them. There exists a need to develop risk models containing the risks of doing business in international markets and factors that affect manageability of these risks. One of the market＇s critical challenges is scheduled management and the understanding and application of program management. This paper uses systematic risk identification, classification and analysis, and measurement and response methodologies to help international contractors quantify the risks of project development and accomplishment.

The comparison and integration analysis of Strategic Performance Management assessment tool

Performance appraisal is one of the commonly used modern human resource management tools. Many companies which developed to a certain stage began to introduce performance management. But a lot of friends in human resources circles always hold a controversy on the effectiveness of performance management. In fact, there are problems on the methods and assessment scales. I personally think that a lot of companies use performance appraisal problem mainly occurs due to the presence misunderstanding the purpose of business resulting from the introduction of performance appraisal. For example： taking the wrong assessment methods, there is no breakdown of the work in advance, nor performed posts and responsibilities ; performance appraisal way to take a negative incentive, the employees complained of performance ; lack of strategic height of human resource management, performance appraisal that can not be linked with the actual situation. The following analysis of several performance evaluation methods and its influence is from the perspective of human resources. Each has its advantages and disadvantages, and also has different emphases. I want to share it with everyone and hope everyone can learn something from it.

Exploration of University English Teachers’Acceptance and Willingness to Use Learning Management System Data Analysis Tools

This study investigates university English teachers’acceptance and willingness to use learning management system(LMS)data analysis tools in their teaching practices.The research employs a mixed-method approach,combining quantitative surveys and qualitative interviews to understand teachers’perceptions and attitudes,and the factors influencing their adoption of LMS data analysis tools.The findings reveal that perceived usefulness,perceived ease of use,technical literacy,organizational support,and data privacy concerns significantly impact teachers’willingness to use these tools.Based on these insights,the study offers practical recommendations for educational institutions to enhance the effective adoption of LMS data analysis tools in English language teaching.

WJD 5^(th) Anniversary Special Issues(2): Type 2 diabetes Structured SMBG in early management of T2DM: Contributions from the St Carlos study

Diabetes mellitus type 2(T2DM)is a global pandemic that will affect 300 million people in the next decade.It has been shown that early and aggressive treatment of T2DM from the onset decreases complications,and the patient’s active role is necessary to achieve better glycemic control.In order to achieve glycemic control targets,an active attitude in patients is needed,and selfmonitoring of blood glucose(SMBG)plays a significant role.Nowadays,SMBG has become an important component of modern therapy for diabetes mellitus,and is even more useful if it is performed in a structured way.SMBG aids physicians and patients to achieve a specific level of glycemic control and to prevent hypoglycemia.In addition,SMBG empowers patients to achieve nutritional and physical activity goals,and helps physicians to optimize the different hypoglycemic therapies as demonstrated in the St Carlos study.This article describes the different ways of using this educational and therapeutic tool from the medical point of view as well as from the patient’s perspective.

Management of hepatitis C infection before and after livertransplantation

Healthcare systems throughout the world continueto face emerging challenges associated with chronicdisease management. Due to the likely increase inchronic conditions in the future it is now vital thatcooperation and support between specialists, generalistsand primary health care physicians is conducted.Inflammatory bowel disease （IBD） is one such chronicdisease. Despite specialist care being essential, muchIBD care could and probably should be delivered inprimary care with continued collaboration betweenall stakeholders. Whilst most primary care physiciansonly have few patients currently affected by IBD intheir caseload, the proportion of patients with IBDrelatedhealthcare issues cared for in the primarycare setting appears to be widespread. Data suggestshowever, that primary care physician＇s IBD knowledgeand comfort in management is suboptimal. Currenttreatment guidelines for IBD are helpful but they arenot designed for the primary care setting. Few nonexpertIBD management tools or guidelines existcompared with those used for other chronic diseasessuch as asthma and scant data have been publishedregarding the usefulness of such tools including IBDaction plans and associated supportive literature. Thepurpose of this review is to investigate what nonspecialisttools, action plans or guidelines for IBD arepublished in readily searchable medical literature andcompare these to those which exist for other chronicconditions.

Analysis of Water Resources Vulnerability Assessment Tools

Water resources face many pressures and stresses around the world.Assessing the vulnerability of water resources is,therefore,increasingly an essential practice in water resources management.Several studies of water resources vulnerability have been carried out around the world during the last three decades.Thus,the main objective of this study was to analyze water resources vulnerability assessment tools and identify the methodological trend of water resources vulnerability assessment at the local level in existing literature.To achieve this objective,the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)method has been applied to include or exclude articles.Articles on water vulnerability numbering 374 were preselected in the ScienceDirect and the Google Scholar databases.Only 32 out of the 374 articles met the inclusion criteria defined for the analysis.The results show that China(21.9%),U.S.A.(9.4%)and Canada(6.3%)are the most active countries publishing water resources vulnerability assessments.Some 191 vulnerability indicators from the 32 articles were classified into five categories of factors:physical factors(33.5%),socio-economic factors(28.3%),environmental or eco-environmental factors(25.1%),institutions and governance factors(7.3%)and infrastructure factors(5.8%).This study shows that almost half of the studies(47%)considered all five categories of factors,9.4%considered four categories of factors,6.3%considered three categories of factors,28%used two types of factors and 9.4%considered only one category.Researchers have used several methods to assess water resources vulnerability:overlay and index methods(59.4%),process-based models(12.5%),statistical methods(9.4%),overlay and index methods plus process-based model(9.4%),overlay and index methods plus statistical methods(6.3%)and statistical methods plus process-based models(3.1%).Geographic information system(GIS)is an important tool in assessing the vulnerability of water resources with almost 60%of the studies using it at some stage of the assessment.In recent years,there is an increasing trend toward conceptualizing the vulnerability of water resources in a holistic way.

Doorstop: Text-Based Requirements Management Using Version Control

Effectively managing the requirements and traceability in a complex software project can be a challenging task. Many tools exist to support the initial creation and management of changes to text-based requirements. The most popular commercial solutions use a centralized server to host a database with a front-end desktop or web interface. Some downsides to this approach include user interface bloat, server costs, and an inherent disconnection from the project’s source files. To provide an alternative to traditional requirements management, Doorstop was created as a tool to allow requirements to be stored as text files in version control. This solution allows a project to utilize its existing development tools to manage versions of the requirements using a lightweight, developer-friendly interface.

Collaborative Tools and Techniques of Knowledge Sharing: A Literature Review

Nowadays, the world is frequently referred to as the “information world”. Companies rely on knowledge to differentiate themselves and get a competitive advantage. As a result, businesses pay close attention to knowledge management and devote a significant amount of time and resources to ensuring that knowledge is appropriately owned and exploited. Individual knowledge transfer is also a factor. The paper examines knowledge transfer and sharing, with the goal of determining the most effective internal communication tool for information transfer. The research findings should aid company management in organizing internal communication in a way that allows them to carry out their knowledge management plan.

道阻且长,“行”者将“治”:公共事务的行为治理之道

行为治理是将行为科学洞见应用于公共治理场域而发展出的治理新模式。行为治理关注政府、组织和公民三类核心治理主体在互动过程中的心理、认知及行为规律,并分析治理主体互动关系的元素特征如何影响主体行为,同时更全面地考虑环境因素对微观行为的影响,以及个体行为汇聚为集体行动并产生更广泛治理结果的机制。行为治理呼吁治理工具的组合运用,强调“助推”和“助力”两大行为工具的内部融通,重视行为工具与传统工具的外部联动。行为治理脱胎于行为公共管理和行为公共政策,更强调各主体间的互动性,更重视环境的复杂性,更主张治理工具在内外部及各层次上的融会贯通。行为治理紧扣治理主体的行为要素,自下而上、从微观到宏观,丰富国家治理现代化的思想库和工具箱。

某院药品不良反应上报工作改进实践

目的为建立医院药品不良反应(ADR)上报管理模式提供参考。方法收集四川省邛崃市医疗中心医院2016年ADR上报情况,利用质量管理工具进行第1轮上报工作改进(2017年1月至2019年12月);运用触发管理工具进行第2轮上报工作改进(2020年1月至2022年12月)。分析改进后的效果。结果2016年,该院ADR上报125例,2017年至2019年分别升至163例、236例、149例。2016年上报新的+严重ADR比例和严重ADR比例分别为31.20%和8.80%,2022年分别大幅升至74.65%和57.94%。结论运用质量管理工具及触发管理工具,能促进医院ADR上报数量增加及质量的提升。

国际数据管理计划工具比较研究

采纳一定的标准,特别是以主流、用户量大的数据管理计划(DMP)工具作为代表,遴选出6种研究数据管理计划工具作为研究对象,结合实际试用、前人研究和专家访谈,从科研人员使用和体验视角采用综合性研究方法,厘清工具比较评估的核心要素,构建工具比较评估的三级指标体系,就基本功能、DMP模板内容、用户体验开展比较分析,研究结果呈现通用DMP工具的典型特性和未来发展趋势,供我国出台相关政策和研发工具借鉴参考。

参与式健康教育工具包在2型糖尿病患者中的应用

目的:通过参与式糖尿病健康教育工具包的构建与实施,分析其对2型糖尿病患者疾病知识和健康行为的影响,从而提高患者的自我管理能力。方法:通过工具包设计、参与式研究、可行性评估、开发适合本土文化的糖尿病参与式健康教育工具包,并对此工具包进行验证。采用随机数字表法,将81例2型糖尿病患者随机分成对照组40例、干预组41例。对照组接受常规健康教育,干预组接受基于“参与式健康教育工具包”的“3-PR”健康教育管理,比较干预3个月后,两组患者糖化血红蛋白、糖尿病知识得分、糖尿病自我管理行为得分情况。结果:干预后,干预组患者糖化血红蛋白水平、糖尿病知识得分、糖尿病自我管理行为评分均明显优于对照组,差异均有统计学意义(P<0.05)。结论:采用参与式健康教育工具包能显著提高患者自我管理水平,改善血糖控制水平,值得未来在临床进一步推广。