Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p<0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p<0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

Teachers’ recruitment process via MCDM methods: A case study in Bangladesh

Evaluation of faculty members is very significant for educational organization to prompt reputation of the organization and to provide quality education. Teaching staff, the pillars of the educational institution, can change the whole nation stimulating the magnet of interest, knowledge, and wisdom in the pupils. Selecting a better academic staff among the others is very crucial for Human Resources Management (HRM) as the success of any organization solely depends on how well it selects its manpower. Institute managing committee must have a reliable technique to judge a teachers’ ranking through multiple conflicting criteria because different teachers have various capabilities. In Bangladesh, it is a common practice in public engineering universities to select teachers only having good academic records. But teaching staff selection problem is a multi-staged decision-making problem having both quantitative and qualitative criteria. It is evident that it has become challenging as the number of alternatives and conflicting criteria increases. In this paper, a structured framework has been developed using MCDM methods both in fuzzy as well as non-fuzzy environments in the renowned engineering university of Bangladesh, where seven candidates under fifteen different sub-criteria are evaluated and ranked. The study helps the recruitment panel of educational organization in Bangladesh select the most eligible academic staff for required posts

Customer driven quality improvement of a specific product through AHP and entropy-based QFD: A case study

Understanding the voice of the customers (VOCs) and properly incorporating their preferences and perceptions into the conceptual design process is the core step of customer-driven product development. To improve customer satisfaction and market profitability, the design team should have a customer-driven quality management and product development system. Quality function deployment (QFD) is an important customer-driven quality management tool that helps identify customer requirements and translate them into proper technical measures. This paper focuses on the application of the AHP and an entropy-based QFD approach on a manufacturing company to improve the quality of its product (blender) and determine the priorities for further improvement. The paper shows how customer requirements can be identified and applied to prioritize the design requirements for improving the quality of a blender. The Analytic Hierarchy Process (AHP) is integrated to determine the final importance of the weights of the customer needs, and entropy is used to determine the set of priority ratings. This integrated framework can help achieve an effective evaluation of the final design solution for product development by overcoming the pitfalls of the traditional QFD approach. An application in a Bangladeshi company that produces blenders is presented to illustrate the performance of the proposed approach

The Just Transition in Japan: Awareness and desires for the future

As with many advanced economies, Japan is currently undergoing an energy transition, aiming to deploy the maximum amount of renewable energy in order to reduce reliance on energy imports from abroad. Ideally, this transition will not only increase energy security for Japan, but will also improve the living standards of its people and be representative of a ‘just’ transition. In order to determine the nature of the Japanese energy transition, it is important to recognize the awareness of concepts such as the Just Transition, and to understand people's desires for the future. This research investigates the relationship between these factors, i.e., uncovering whether or not awareness of the Just Transition concept affects peoples desired outcomes, personal behaviors or preferences toward energy policies which engender a transition. Here we analyze a large sample survey (n = 6000) of the Japanese public to understand desires, behaviors and preferences, to attempt to extract policy implications and effective strategies to promote desirable behaviors which promote a Just Transition. Our results show that demographics impact upon Just Transition knowledge levels, and that these knowledge levels themselves then impact upon propensity to undertake desirable behaviors, or to allow for the deployment of conducive technologies at the local or regional level. A greater level of understanding of the concept of a Just Transition, perhaps via targeted education may help to align people's behavior, desires and expectations toward the development of a fairer future energy system in Japan and more broadly for other advanced economies

Ergonomic considerations for designing truck drivers' seats: The case of Bangladesh

Objectives: The purpose of this work was to investigate the fitness of the existing truck seats for Bangladeshi truck drivers and suggest a guideline for drivers' seats based on their anthropometry. Methodology: In this study, eight anthropometric measurements of 120 Bangladeshi truck drivers and seven seat dimensions of ninety trucks of three brands namely, TATA, ASHOK LEYLAND, and ISUZU were considered for investigating the considerable mismatch between seat dimensions and drivers' anthropometry. The data were analyzed using two-sample t-tests to identify the relationship between existing seat dimensions and drivers' anthropometry. Results: The results showed a mismatch in seat dimensions and anthropometric measurements for nearly all truck brands and the existing seat dimensions were found to be inappropriate for Bangladeshi drivers. For all the truck brands, the percentage mismatch of seat height, seat depth, seat width, backrest height, and steering wheel clearance varied between 71% and 98%, 23% and 79%, 33% and 84%, 28% and 65%, and 53% and 100% respectively. Subsequently, an attempt was made to provide ergonomically correct seat dimensions for Bangladeshi truck drivers. Further, generalized equations to design the appropriate seat dimensions were developed using the least square regression technique. The recommended seat height, depth and width, backrest height, and steering wheel clearance were found to be appropriate for 82%, 79%, 76%, 98%, and 100% of drivers respectively. Conclusion: The analysis and results of this study can be useful in developing guidelines for design and manufacture of truck driver seats in Bangladesh