A comparison of the laryngeal tube with the laryngeal mask airway during spontaneous ventilation in paediatric anaesthesia

A randomized prospective study was conducted involving 80 premedicated paediatric patients of ASA 1 and 2, aged between 2 to 10 years. These children were divided into 2 groups, group L T (n=40) received laryngeal tube and group LMA (n=40) received laryngeal mask as airway device. After a standardized inhalational induction of anaesthesia with servoflurane followed by fentany 1.5 pg . kg· 1 , the laryngeal tube or the laryngeal mask airway was inserted and the patients breathed spontaneously throughout the surgery. Anaesthesia was maintained with nitrous oxide, oxygen, and servoflurane. The airway device was removed at the end of surgery when the patient is fully awake. We recorded the speed of insertion and the number of attempts needed to successfully secure the airway. The quality of ventilation as assessed by incidence of oxygen desaturations, frequencies of airway manipulations throughout the surgery and the end-tidal C02 at various time intervals were recorded. The haemodynamic changes such as systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate at different time intervals were recorded. We have also recorded the incidence of complications postoperatively. We found that there were significant more time required for successful insertion and more number of attempts for L T group as compared to the LMA group. The number of manipulations of device or patients after first attempt and the recordings of ETC02 recorded at various time intervals was higher with the L T and the difference was significant. However both groups had no statistical difference in episodes of desaturation and haemodynamic parameters during anaesthesia. We found no statistically significant difference in the incidence of complications postoperatively between the two groups. We conclude that during spontaneous ventilation in paediatric patients undergoing general anaesthesia the laryngeal tube-- is not as reliable in providing a satisfactory airway and we consider it is not a suitable alternative to the laryngeal mask airway

Comparison of three different target blood concentrations of propofol for induction of anaesthesia using target controlled infusion (TCI) technique

We studied three different target blood concentrations (TBC) of propofol for induction of anaesthesia using target controlled infusion (TCI) technique. One hundred and thirty five ASA I and II patients, between 18-55 years of age and undergoing any type of elective surgery were included in the study. All patients were premedicated with oral midazolam 7.5 mg in the ward an hour before induction. Patients were randomly divided into three groups. Group I (n = 45) received initial TBC of 2 J,Jg/ml, group II (n = 45) TBC of 3 J.Jg/ml and group Ill (n = 45) TBC of 4 J,Jg/ml for induction of anaesthesia. Intravenous alfentanil 30 ~g/kg bolus was given as analgesia. Patients were observed for success rate of induction, induction time, effect site concentration and haemodynamic parameters at baseline, 1 minute, 3 minutes and 5 minutes after induction. Success rate of induction was 55.6 %, 86.7% and 91.1 %in group I, 11 and 111 respectively, which showed significant difference only between group I and Ill. Effect site concentration was 0.6 ~g/ml, 0.9 J,Jg/ml and 0.8 JJQ/ml in group I, II and Ill respectively which showed significant difference only between group I and II. There was no significant difference in induction time and haemodynamic parameters among the three groups. Hence, TBC 3 J,Jg/ml was comparable with TBC 4 J.Jg/ml for induction of anaesthesia using TCI technique. However TBC 2 IJQ/ml was not recommended for rapid induction

Sustainable procurement behavior: a case of government departments

This paper discusses the concept of sustainable procurement behavior (SPB) and the effects of personal values, leadership style and awareness on SPB. As the SPB became increasingly important in implementation for sustainable procurement practices, the paper aims to present the review of the existing literature on SPB and study the factors that can influence the SPB of procurers. The paper based on review of past literature, conceptualizes that personal values, awareness, leadership are significantly related to SPB and organizational culture moderates the relationship among personal values, leadership style, awareness and SPB. The results of this conceptual paper are likely to provide important insights to managers, policy-makers and researchers to further understand the factors which effect the SPB and improve the implementation of SPP practices

Driving indicators for implementation of sustainable procurement behavior and practices

Environmental issues have been universally accepted as the greatest threat to mankind and planet. States and organisations are implementing strategies and policies to address these issues. Sustainable public procurement (SPP) is considered as one of the strategy to mitigate the adverse environmental effects.Government of Pakistan has already taken few initiatives, and despite country leadership’s will, the pace of SPP implementation is low.In Pakistan there are regulations and legal frame work for procurement but there is lack of specific guide lines for procurement officers for implementations of SPP practices in Pakistan. There are numerous driving indicators but this study has shed light on effects of awareness, organizational commitment towards change and approach to green suppliers on sustainable procurement implementation.Finding from study on procurement managers working in government departments of Pakistan indicated that awareness and organizational commitment to change and approach to green supplier and products were positively related to sustainable public procurement implementation.These results implicate the need to create and enhance more awareness and organizational commitment more over availability of green supplier is needed to implement SPP successfully.The study may provide a useful insight for procurement managers and policy makers and can enable them to be successfully implemented the SPP practices in Pakistan

A conceptual study of connectivity elements towards successful green network / Nor Hamizah Abdul Hamid, Muhamad Ezran Zainal Abdullah and Nik Hanita Nik Mohamad

Rapid urbanization has resulted in the loss of natural setting of urban spaces. Fusing the gap between nature andthe city development can generate both common cause and conflict. Green network is a significant shift in linking urban green spaces that will lay out over the coming decades. At present, this green network is not successfully applied due to many open spaces that are not well connected. Hence, connectivity elements provided by the green network plays an important role in helping to conserve urban sustainability. Furthermore, green network is recognized as an effective urban conservation strategy to mitigate the effects of urbanization while maintaining healthy living and sustainability for urban area. However, the opportunity for green network to function as a linkage has not been optimized. Therefore, this research investigates on visitors‟ responses to different dimension of their needs for natural connectivity in the context of sustainable living. Data were collected using interviews and surveys on the scope of connectivity elements towards successful green network. This research offers input on green network by addressing visitors strong preferences towards natural connectivity elements compared to man-made landscape elements

Enhancing the accountability of malaysian government linked companies through sustainable competitive advantage and value creation / Nur Nadiah Zulkarnain … [et al.]

Value creation is an essential element needed in every organization for sustainability in the global market. Value creation can be reflected through continuous improvement in the organization’s earnings per share and the high level of operational effectiveness and competitiveness. Government linked companies (GLCs) are organizations in which the government contributes more than fifty percent of capital and is expected to be actively involved in value creation to reflect high level accountability to taxpayers’ money. However, despite many efforts by the government to improve the performance of GLCs, several studies have found a lack of value creation among GLCs that led to their closure. The resource-based view argues that an organization that possesses capabilities often create more value. This study aims to test resource-based view’s proposition by examining whether companies with high sustainable competitive advantage can create high value. This study examines four components of sustainable competitive advantage: innovation, entrepreneurship, learning, and market orientation. Results show that the existence of the significant relationship among learning orientation, entrepreneurship orientation, and market orientation on value creation. However, this study finds that high innovation does not lead to better value creation in the context of Malaysian GLCs

Analysis of MPV dashboard using solidworks and ABAQUS.

The study is intended to measure the reliability of MPV dashboard to endure interior impact by using finite element analysis (FEA) method. A model which represents MPV dashboard was made using Solidworks and the impact simulation was done using ABAQUS. Current material being used for dashboard is ABS-GF40 and this material was proven to be reliable to withstand interior impact through the simulation that has been done in this study. Besides, this study also serve the purpose to reduce manufacturing cost using alternative materials with no less reliability compared to ABS-GF40. Similar simulation routines were applied for ABS copolymer, PP copolymer, and PVC copolymer. The simulation results showed that ABS-CF40 performance is similar to ABS-GF40, whereas the PP-CF10, PP-GF10, and PVC-GF30 exhibit almost identical behavior under impact loading. Cost assessment was carried out for all materials to assist in selecting alternative material for replacement of ABS-GF40. Hence, it was found that PP-GF10 can be used as an alternative material with cost reduction up to RM33.17 on each dashboard

A comparative study of dexmedetomidine and propofol for sedation in the cardiothoracic intensive care unit

Introduction and Objectives: The intensive care unit (ICU) is an uncomfortable and stressful environment for patients. The use of adequate sedation and analgesia is important to reduce stress to patients. The aim of this study was to compare a relatively new sedative agent, dexmedetomidine to current sedative agent used, propofol in the provision of sedation and analgesia, their effects on haemodynamic and respiratory parameters and cost involved on post open heart surgery patients. Materials and Methods: A prospective, randomized single-blinded trial was conducted on post open heart surgery patients in the ICU of the Hospital Universiti Sains Malaysia (HUSM). Thirty two patients were randomized to dexmedetomidine or propofol groups. Analgesic requirement, haemodynamic and respiratory parameters, and extubation time were measured and compared. Mean rate of infusion to achieve adequate sedation were used to calculate the cost involved in the use of these two agents. Results: Patients sedated with dexmedetomidine required significantly lower dose of morphine compared to propofol [mean (sd): 12.80 (2.61) versus 15.86 (1.87) mg/kg/min, p=0.00]. Mean heart rate was also significantly lower in dexmedetomidine group compared to propofol group [mean (CI): 74.48 (70.38,78.59) versus 83.85 (79.61,88.09) per minutes, p=0.00]. However there were no significant differences in the other parameters between the two groups. Cost involved the use of dexmedetomidine was slightly higher compared to propofol (RM 9.57 versus RM8.94 per hour). Discussion and Conclusions: Dexmedetomidine is comparable to propofol in the provision of sedation, and its effect on haemodynamic and respiratory parameters. However it has added advantages in the provision of analgesia, and caused a significant reduction in heart rate. This is beneficial in these patients by reducing myocardial oxygen demand, and hence subsequent ischaemia and infarction. However, further larger studies are needed to evaluate the effect of dexmedetomidine on perioperative cardiac morbidity and mortality

The competitive advantage of Malaysian SME's: the impact of uncertainity avoidance - A missing element in Porter's analysis

This article is based on criticizing Michael Porter's model of national 'diamond' to explore the role of Malaysian uncertainty avoidance factor in the competitive position of SMEs andfirms.It is believed; however, that the influence of uncertainty avoidance on the competitive advantage of SME S or firms is too weakly elaborated in Porter's Diamond.In particular, the Porter's Diamond has neglected to discuss strong or weak uncertainty avoidance behavior among the firm's or SME's.This paper is looking Porter's Diamond weakness in term of Malaysian SMES uncertainty avoidance factor