Small And Medium Sized Enterprises Management And Business In Crisis Conditions

Background: This study examines the management of small and medium-sized enterprises (SMEs) in crisis conditions, with a focus on the impact of the COVID-19 pandemic. It aims to identify strategies and best practices for enhancing SME resilience and sustainability. Methods: The research adopts a comprehensive literature review approach, analyzing previous studies and reports on SME management during crises. It also incorporates case studies and empirical data to provide practical insights. Results: The analysis reveals that SMEs face unique challenges during crises, such as disrupted supply chains, reduced consumer demand, and financial constraints. However, innovative solutions, collaboration among stake-holders, and supportive government policies have played a crucial role in enabling SMEs to adapt and recover. Conclusions: Based on the findings, it is evident that effective management practices, including adaptation, digital transformation, financial management, and crisis planning, are vital for SME survival and growth in crisis conditions. Collaboration and networking among SMEs, along with supportive government policies, contribute to collective recovery and sustainability. The study underscores the importance of ongoing research and development in SME crisis management, with a focus on resilience-building strategies, sustainable business models, and addressing the psychological well-being of SME stakeholders

Data placement in HPC architectures with heterogeneous off-chip memory

The performance of HPC applications is often bounded by the underlying memory system's performance. The trend of increasing the number of cores on a chip imposes even higher memory bandwidth and capacity requirements. The limitations of traditional memory technologies are pushing research in the direction of hybrid memory systems that, besides DRAM, include one or more modules based on some of the higher-density non-volatile memory technologies, where one of them will provide the required bandwidth, while the other will provide the required capacity for the application. This creates many challenges with data placement and migration policies between the modules of such hybrid memory system. In this paper, we propose an architecture with a hybrid memory design that places two technologically different memory modules in a flat address space. On such system, we evaluate several HPC workloads against different data placement and migration policies, compare their performance by means of execution time and the number of non-volatile memory writes, and consider how it can be applied to the future HPC architectures. Our results show that the hybrid memory system with dynamic page migration and limited DRAM capacity, can achieve performance that is comparable to a hypothetical, hard to implement, DRAM-only system.Postprint (published version

Effects of capacity sharing on delays and re-routings in European ATM

In this paper we analyse the effects of capacity sharing between Area Control Centres on delays and re-routings. We assume two different design options for capacity sharing (within Air Navigation Service Providers and within Functional Airspace Blocks) and compare them to a baseline scenario. Using the CADENZA optimization and simulation model, we build a case study of a busy day in the ECAC area, using 100 different scenario runs in order to capture traffic variability as well as capacity reductions. Results show that capacity sharing leads to a decrease of delay and re-routing costs that outweighs the additional costs of enabling capacity sharing even if we assume relatively high additional costs per shared sector-hour. Moreover, it can be shown that capacity sharing within ANSPs already delivers 3/4 of the benefits that can be achieved via capacity sharing within FABs.This project has received funding from the SESAR Joint Undertaking within the framework of SESAR 2020 and the EU's Horizon 2020 research and innovation programme under the Grant Agreement Number 893380.Peer ReviewedPostprint (published version

Effective reduction of fluoroscopy duration by using an advanced electroanatomic-mapping system and a standardized procedural protocol for ablation of atrial fibrillation: ‘the unleaded study'

Aims It is recommended to keep exposure to ionizing radiation as low as reasonably achievable. The aim of this study was to determine whether fluoroscopy-free mapping and ablation using a standardized procedural protocol is feasible in patients undergoing pulmonary vein isolation (PVI). Methods and results Sixty consecutive patients were analysed: Thirty consecutive patients undergoing PVI using Carto3 were treated using a standardized procedural fluoroscopy protocol with X-ray being disabled after transseptal puncture (Group 1) and compared with a set of previous 30 consecutive patients undergoing PVI without a specific recommendation regarding the use of fluoroscopy (Group 2). The main outcome measures were the feasibility of fluoroscopy-free mapping and ablation, total fluoroscopy time, total dose area product (DAP), and procedure time. Sixty patients (age 60 ± 10 years, 73% male, ejection fraction 0.55 ± 0.09, left atrium 42 ± 8 mm) were included. In Group 1, total fluoroscopy time was 4.2 (2.6-5.6) min and mapping and ablation during PVI without using fluoroscopy was feasible in 29 of 30 patients (97%). In Group 2, total fluoroscopy time was 9.3 (6.4-13.9) min (P < 0.001). Total DAP was 13.2 (6.2-22.2) Gy*cm2 in Group 1 compared with 17.5 (11.7-29.7) Gy*cm2 in Group 2 (P = 0.036). Total procedure time did not differ between Groups 1 (133 ± 37 min) and 2 (134 ± 37 min, P = 0.884). Conclusion Performing mapping and ablation guided by an electroanatomic-mapping system during PVI without using fluoroscopy after transseptal puncture using a standardized procedural protocol is feasible in almost all patients and is associated with markedly decreased total fluoroscopy duration and DA

Air traffic control capacity planning under demand and capacity provision uncertainty

In air traffic management, a fundamental decision with large cost implications is the planning of future capacity provision. Here, capacity refers to the available man-hours of air traffic controllers to monitor traffic. Airspace can be partitioned in various ways into a collection of sectors, and each sector has a fixed maximum number of flights that may enter within a given time period. Each sector also requires a fixed number of man-hours to be operated; we refer to them as sector-hours. Capacity planning usually takes place a long time ahead of the day of operation to ensure that sufficiently many air traffic controllers are available to manage the flow of aircrafts. However, at the time of planning, there is considerable uncertainty regarding the number and spatiotemporal distribution of nonscheduled flights and capacity provision, the former mainly due to business aviation, and the latter usually stemming from the impact of weather, military use of airspaces, etc. Once the capacity decision has been made (in terms of committing to a budget of sector-hours per airspace to represent long-term staff scheduling), on the day of operation, we can influence traffic by enforcing rerouting and tactical delays. Furthermore, we can modify which sectors to open at a given time (the so-called sector-opening scheme) subject to the fixed capacity budgets in each airspace. The fundamental trade-off is between reducing the capacity provision cost at the expense of potentially increasing displacement cost arising from rerouting or delays. To tackle this, we propose a scalable decomposition approach that exploits the structure of the problem and can take traffic and capacity provision uncertainty into account by working with a large number of traffic scenarios. We propose several decision policies based on the resulting pool of solutions and test them numerically using real-world data

A giant exulcerated phyllodes breast tumor a case report

© 2020, University of Kragujevac, Faculty of Science. All rights reserved. Phyllodes tumors of the breast can be benign, malignant, or borderline. Benign and borderline tumors are rare tumor types that have a positive outlook and high survival rate, while the risk of recurrence is typical for malignant breast tumors. Giant phyllodes tumors are larger than 10 cm in diameter and demand a serious diagnostic and treatment approach. In this study we present a case of a female patient treated for an exulcerated breast carcinoma-a giant borderline phyllodes tumor of the breast. The patient presented to the department for the right breast lump with ulcerated skin and nipple abnormalities. The core biopsy was performed and the patient was diagnosed with a benign tumor. Simple mastectomy was performed and final histopathological report revealed a borderline phyllodes tumor. Diagnosis and treatment of a giant phyllodes tumor remain a great challenge for the surgeons. Establishing the preoperative diagnosis based on histopathological findings is imperative to disease management. Surgery is the mainstay of treatment and mastectomy has been the traditional procedure; in cases where suspicious findings in the axilla are revealed, radical mastectomy is performed and the axilla is to be dissected

Adherence to the 4S-AF Scheme in the Balkan region:insights from the BALKAN-AF survey

BackgroundThe 4S-AF scheme includes stroke risk, symptoms, severity of burden, and substrate severity domain.AimWe aimed to assess the adherence to the 4S-AF scheme in patients classified according to stroke risk in post hoc analysis of the BALKAN-AF dataset.MethodsA 14-week prospective enrolment of consecutive patients with electrocardiographically documented atrial fibrillation (AF) was performed in seven Balkan countries from 2014 to 2015.ResultsLow stroke risk (CHA2DS2-VASc score, 0 in males or 1 in females) was present in 162 (6.0%) patients. 2 099 (77.4%) patients had CHA2DS2-VASc score ≥3 in females or ≥2 in males (high stroke risk), and 613 (22.6%) had CHA2DS2-VASc score ConclusionsOAC overuse was observed in patients with low stroke risk, whilst OAC underuse was evident in those with high risk of stroke. The percentage of highly symptomatic patients with high risk of stroke who were offered a rhythm control strategy was low

Stroke in women — from evidence to inequalities

Stroke is the second largest cause of disability-adjusted life-years lost worldwide. The prevalence of stroke in women is predicted to rise rapidly, owing to the increasing average age of the global female population. Vascular risk factors differ between women and men in terms of prevalence, and evidence increasingly supports the clinical importance of sex differences in stroke. The influence of some risk factors for stroke — including diabetes mellitus and atrial fibrillation — are stronger in women, and hypertensive disorders of pregnancy also affect the risk of stroke decades after pregnancy. However, in an era of evidence-based medicine, women are notably under-represented in clinical trials — despite governmental actions highlighting the need to include both men and women in clinical trials — resulting in a reduced generalizability of study results to women. The aim of this Review is to highlight new insights into specificities of stroke in women, to plan future research priorities, and to influence public health policies to decrease the worldwide burden of stroke in women

Initial rhythm control with cryoballoon ablation vs drug therapy: Impact on quality of life and symptoms

Background Cryoballoon ablation (CBA) as a first-line rhythm control strategy is superior to antiarrhythmic drugs (AADs) for preventing atrial fibrillation (AF) recurrence; the impact of first-line CBA on quality of life (QoL) and symptoms has not been well characterized. Methods Patients aged 18 to 75 with symptomatic paroxysmal AF naïve to rhythm control therapy were randomized (1:1) to CBA (Arctic Front Advance, Medtronic) or AAD (Class I or III). Symptoms and QoL were assessed at baseline, 1, 3, 6, 9, and 12 months using the EHRA classification and Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) and SF-36v2 questionnaires. Symptomatic palpitations were evaluated via patient diary. Results Overall, 107 patients were randomized to CBA and 111 to AAD; crossovers occurred in 9%. Larger improvements in the AFEQT summary, subscale and treatment satisfaction scores were observed at 12 months with CBA vs AAD (all P <0.05). At 12 months, the mean adjusted difference in the AFEQT summary score was 9.9 points higher in the CBA group (95% CI: 5.5 –14.2, P <0.001). Clinically important improvements in the SF-36 physical and mental component scores were observed at 12 months in both groups, with no significant between group differences at this timepoint. In the CBA vs AAD group, larger improvements in EHRA class were observed at 6, 9 and 12 months (P <0.05) and the incidence rate of symptomatic palpitations was lower (4.6 vs 15.2 days/year post-blanking; IRR: 0.30, P <0.001). Conclusions In patients with symptomatic AF, first-line CBA was superior to AAD for improving AF-specific QoL and symptoms.publishedVersio