Managing pregnancy in a spinal muscular atrophy type III patient in Indonesia: a case report

Background Spinal muscular atrophy is a genetic disorder characterized by degeneration of lower motor neurons, leading to progressive muscular atrophy and even paralysis. Spinal muscular atrophy usually associated with a defect of the survival motor neuron 1 (SMN-1) gene. Classification of spinal muscular atrophy is based on the age of onset and maximum motor function milestone achieved. Although spinal muscular atrophy can be screened for in newborns, and even confirmed earlier genetically, this remains difficult in Third World countries such as Indonesia. Case presentation A 28-year-old Asian woman in the first trimester of her second pregnancy, was referred to the neurology department from the obstetric department. Her milestone history showed she was developmentally delayed and the ability to walk independently was reached at 26 months old. At 8 years old, she started to stumble and lose balance while walking. At this age, spinal muscular atrophy was suspected because of her clinical presentations, without any molecular genetic testing. She was married at the age of 25 years and was soon pregnant with her first child. At the gestational age of 32 weeks, her first pregnancy was ended by an emergency caesarean section because of premature rupture of the membranes. In this second pregnancy, she was referred early to the general hospital from the district hospital to receive multidisciplinary care. She and her first daughter underwent genetic testing for spinal muscular atrophy, which has been readily available in our institution since 2018, to confirm the diagnosis and prepare for genetic counseling. Conclusions Managing pregnancy in a patient with spinal muscular atrophy should be performed collaboratively. In this case, genetic testing of spinal muscular atrophy and the collaborative management of this patient allowed the clinical decision making and genetic counseling throughout her pregnancy and delivery.

Responses and Impacts of COVID-19 on East Africa’s Tourism Industry

The COVID-19 pandemic has affected all economies and life support systems world-wide. Owing to the pandemic's unpredictable nature, experts and policymakers struggle to find a headway to slow infections and further economic deterioration. The purpose of this study is to assess East African Community (EAC) states’ early responses and the pandemic’s impacts on the tourism industry. Data were collected through a review of secondary data, including academic and media reports. Special attention was paid to respective policy responses during the early stages of the pandemic outbreak. Findings show that Kenya, Uganda, and Rwanda employed more robust measures to curb the spread of COVID-19, whereas Tanzania and Burundi resorted to censorship and protectionism. The EAC should quickly learn from the current crisis and devise strategies to handle future shocks to the tourism-system. The states should prioritize economic diversification, retraining of the workforce, global engagement, and collaborative management.

Design and Development of an eHealth Service for Collaborative Self-Management among Older Adults with Chronic Diseases: A Theory-Driven User-Centered Approach

The increasing prevalence of chronic conditions and multimorbidity poses great challenges to healthcare systems. As patients’ engagement in self-managing their chronic conditions becomes increasingly important, eHealth interventions are a promising resource for the provision of adequate and timely support. However, there is inconclusive evidence about how to design eHealth services to meet the complex needs of patients. This study applied an evidence-based and theory-informed user-centered design approach in three phases to identify the needs of older adults and healthcare professionals in the collaborative management of multimorbidity (phase 1), develop an eHealth service to address these needs (phase 2), and test the feasibility and acceptance of the eHealth service in a clinical setting (phase 3). Twenty-two user needs were identified and a web-based application—ePATH (electronic Patient Activation in Treatment at Home)—with separate user interfaces for patients and healthcare professionals was developed. The feasibility study with two nurses and five patients led to a redesign and highlighted the importance of adequately addressing not only varying user needs but also the complex nature of healthcare organizations when implementing new services and processes in chronic care management.

Fusion of horizons: Realizing a meaningful understanding in qualitative research

This paper explores a case example of qualitative research that applied productive hermeneutics and the central concept, fusion of horizons. Interpretation of meaning is a fusing of the researchers’ and subjects’ perspectives and serves to expand understanding. The purpose is to illustrate an exemplar of qualitative research without establishing a rigid recipe of methodology. The illustration is based on in-depth observational and textual data from an applied anthropological study conducted in western Alaska with Yup’ik hunters and fishers and government agency employees as they worked towards collaborative management. The metaphor of the hermeneutical circle is showcased to help the reader understand the philosophical underpinnings and the analytical processes used to realize a meaningful interpretation. A series of organizing systems for the interpretation is described, culminating in a final organizing system to communicate a fully realized understanding of collaborative management at the time.

Creating shared value: the case of innovability at Suzano in Brazil

PurposeThis study aims to investigate how Suzano implemented shared value (SV) strategies to reconcile profitability and social welfare by joining innovation and sustainability.Design/methodology/approachThe authors use an exploratory, descriptive qualitative approach using the interactive qualitative analysis (IQA) method. IQA procedures and protocols were operationalized to get to Suzano's SV system. Primary data were collected through in-depth interviews. Content analyses were conducted with the support of Atlas.ti software.FindingsThe most relevant findings of this research are (1) Suzano developed a unique strategy to spread collaborative and innovation mindset throughout the organization called “innovability”; (2) Suzano's effort to understand local community's demands and a collaborative work raised the companies' profitability and enabled prosperity for the community; (3) the IQA procedures and protocols enabled the development of a Suzano's SV system, composed of nine elements and their relationships. They are purpose-driven leadership, materiality matrix, social welfare, profitability, ecosystem, business results, social results, impact and sustainable economic development, (4) purpose-driven leadership is the system's driver.Research limitations/implicationsThis study was limited to studying the implementation of the SV as a strategy to reconcile profitability and welfare. Despite the findings about the company's conflicts with local communities and the strategy with small family producers, other studies could evaluate the strategy of different stakeholders, such as the supply chain since Suzano is one of the leading companies of paper sales in Brazil.Practical implicationsBy using IQA protocols and the nine elements of this study, other researchers may replicate it to investigate the adoption of SV strategies in other organizations. The SV system developed in this study may be used by business leaders to disseminate the SV policies and practices in their organization.Social implicationsThe company adopts the three forms of SV -reconceiving products and markets, redefining productivity in the value chain and developing clusters with the local community-as strategies for sustainable and collaborative management. Suzano was led to get involved with the problems and conflicts' root causes. By doing so, the company unlocked innovation as a driver to achieve sustainable and responsible management. For them, innovation is in service of sustainability, creating innovability. Both concepts are part of the whole organization culture and practice. Innovability is Suzano's essence, and SV strategies are the means to scale it.Originality/valueThe originality of the paper relies on the method and techniques used to gather and analyze primary data, in which the unit of analysis (Suzano's SV strategy) was considered a system. Major findings were validated with research participants. By using IQA protocols and the nine elements of this study, other researchers may replicate it to investigate the adoption of SV strategies in other organizations.

Research on the Management Optimization of Industry-University-Research Cooperation Projects in Colleges and Universities from the Perspective of Collaborative Management

Actively launching industry-university-research cooperation projects in colleges and universities is an effective way to build an innovative country. The optimization of collaborative management of industry-university-research cooperation projects in colleges and universities determines whether scientific and technological achievements can be quickly transformed into real productive forces and whether the construction of an innovative country can be accelerated. Formulating scientific and reasonable policies, optimizing incentive strategies, risk management and benefit distribution, as well as optimizing personnel management, production management, and collaborative innovation knowledge management are conducive to improving the management efficiency of industry-university-research collaborative innovation and promoting the process of building an innovative country.

Smart and Agile Turnaround Management

Oil&Gas facilities operators are looking for safe and efficient Turnaround cycles with minimum downtime. However planning such project, ensuring availability of materials, of equipment and of skilled personnel, as well as orchestrating the hundreds of processes and stakeholders involved in the execution to keep it on schedule and on budget is a huge and complex challenge. How to handle and take into account what is planned and what is unplanned? A Turnaround project can be managed with similar approach than an EPC (Engineering Procurement Construction) project. It should leverage collaborative best practices developed to handle capital projects. Those practices allow to plan more productively, to execute with agility while taking into account unplanned changes "on the fly" without affecting on-going activities. A digital collaborative platform enables integrated knowledge as well as real-time visibility into every aspect of the Turnaround. It provides seamless collaboration for productive planning and intelligent execution. This is a strategy, which eliminates unproductive tasks and brings stakeholders together in a dynamic, collaborative management system. With better orchestration, plant owners and operators can reduce their planning and preparation workload by around 30% with also positive impact on all subcontractors. With a better seamless execution, plant owners and operators can get things done right the first time and recover to unplanned events. They can reduce the risk to be out of schedule and keep on track with more margin. They can even reduce the execution time by up to 5% in some situation. Finally, it enforces the reuse of insights that are gathered along Turnarounds to improve safety and extend by 20% the cycle in future Turnaround. A 3D collaborative platform provides an easy to use single source of truth to manage and monitor a Turnaround. Using such 3D environment, one can quickly identify the location of an issue where potential bottlenecks occur, and get access to any relevant vendor's specification, inspection or maintenance history report. Such 3D platform can also help to easily track with color-coding the leak test results of the many joints and their potential disturbances after Turnaround inspection.

Two Sides of a Coin: Case Report of Unilateral Synangiosis and Contralateral Stroke Highlighting Consequences of Disease Progression and Efficacy of Revascularization in Sickle Cell Disease Associated Moyamoya Syndrome

Moyamoya syndrome increases the risk of stroke in sickle cell disease, but revascularization surgery can modify this risk. Collaborative management between hematology and neurosurgery offers effective strategies to reduce stroke risk in these patients. We describe a challenging case where a patient with sickle cell disease undergoing standard of care management as prescribed by the Stroke Prevention Trial in Sickle Cell Anemia (STOP) and revascularization with pial synangiosis subsequently developed rapidly progressive disease in other cerebral vessels and suffered ischemic hemispheric stroke. This case demonstrates the success of management in accordance with American Heart Association (AHA) and American Stroke Association (ASA) guidelines, but also demonstrates critical areas where we lack understanding of disease progression.

An ecosystem services perspective of Lake Wairarapa: Insights from the past, present, and toward the future

<p>Ecosystem services encompass the wide range of intrinsic and extrinsic benefits that humans derive from ecosystems and how such services contribute to community wellbeing. The delivery of effective and efficient provisioning, regulating, and cultural ecosystem services at Lake Wairarapa (a shallow, super-trophic, coastal lake in the lower North Island) has been heavily impacted through current land use. Using a pragmatic epistemology and mixed methods approach, this research sought to understand the past, present, and future delivery of ecosystem services at Lake Wairarapa through three distinct, yet complementary, studies. Firstly, a palaeo-environmental reconstruction using five proxies was completed to build an understanding of past environmental conditions at Lake Wairarapa. Prior to human arrival, the lake was stable and resilient in response to environmental perturbations. However, alteration of the landscape following human arrival has reduced ecosystem service effectiveness, prompting a transition into an entirely new environmental state at Lake Wairarapa. This chapter highlighted the abrupt removal of mānuka and centennial shift from a forest catchment into one dominated by agriculture so a field trial was conducted to assess the ability of mānuka to reduce nitrogen leaching and E. coli contamination. Mānuka can significantly reduce the conversion of ammonium to nitrate compared to pasture, thus regulating nitrate leaching; however, the impact on E. coli counts was less conclusive. Finally, cultural services present at Lake Wairarapa and future community aspirations were assessed through seven semi-structured interviews of Wairarapa community members. Place attachment was recognised as the underlying factor that facilitated strong cultural service delivery. Social and environmental restoration was identified as the key vision for the future, underpinned by collaboration within resource management. From this research, four recommendations were made to enhance ecosystem service delivery at Lake Wairarapa: establishment of ecologically appropriate restoration plans, facilitated collaborative management, further investigation of environmental and economic properties of mānuka, and development of community engagement programmes. This multi-disciplinary and holistic approach outlines a pathway towards a positive and inclusive future for Lake Wairarapa and its communities.</p>

An ecosystem services perspective of Lake Wairarapa: Insights from the past, present, and toward the future

<p>Ecosystem services encompass the wide range of intrinsic and extrinsic benefits that humans derive from ecosystems and how such services contribute to community wellbeing. The delivery of effective and efficient provisioning, regulating, and cultural ecosystem services at Lake Wairarapa (a shallow, super-trophic, coastal lake in the lower North Island) has been heavily impacted through current land use. Using a pragmatic epistemology and mixed methods approach, this research sought to understand the past, present, and future delivery of ecosystem services at Lake Wairarapa through three distinct, yet complementary, studies. Firstly, a palaeo-environmental reconstruction using five proxies was completed to build an understanding of past environmental conditions at Lake Wairarapa. Prior to human arrival, the lake was stable and resilient in response to environmental perturbations. However, alteration of the landscape following human arrival has reduced ecosystem service effectiveness, prompting a transition into an entirely new environmental state at Lake Wairarapa. This chapter highlighted the abrupt removal of mānuka and centennial shift from a forest catchment into one dominated by agriculture so a field trial was conducted to assess the ability of mānuka to reduce nitrogen leaching and E. coli contamination. Mānuka can significantly reduce the conversion of ammonium to nitrate compared to pasture, thus regulating nitrate leaching; however, the impact on E. coli counts was less conclusive. Finally, cultural services present at Lake Wairarapa and future community aspirations were assessed through seven semi-structured interviews of Wairarapa community members. Place attachment was recognised as the underlying factor that facilitated strong cultural service delivery. Social and environmental restoration was identified as the key vision for the future, underpinned by collaboration within resource management. From this research, four recommendations were made to enhance ecosystem service delivery at Lake Wairarapa: establishment of ecologically appropriate restoration plans, facilitated collaborative management, further investigation of environmental and economic properties of mānuka, and development of community engagement programmes. This multi-disciplinary and holistic approach outlines a pathway towards a positive and inclusive future for Lake Wairarapa and its communities.</p>