Closed Loop Supply Chain: Evaluating Ecological Footprint

Purpose:  The purpose of this research is to evaluate the success of the closed-loop E-waste supply chain operations, primarily focused on achieving sustainability objectives related to the manufacturing, distribution, reusing, and discarding of electrical components. Methodology: The supply chain operations reference model offers suggestions and benchmarking tools to monitor the performance of supply chains and enhance the processes. This study illustrates a conceptual framework to show how these standards could be used in the E-waste supply chain to link business processes, metrics, industry standards, and technology to enhance the relationship and coordination between the supply chain members and to increase sustainability throughout the supply chain. Findings: According to an assessment of the literature, insufficient attention has been paid to the SCOR model's sustainability criteria. Consequently, in the wake of portraying the structure of the Supply Chain Operation Reference model, we make sense of which credits should be included in the Supply Chain Operation Reference to reflect manageability and which cycles and practices are related to every standard or should be remembered for Supply Chain Operation Reference to lay out the connection between execution, cycles, and practices. Conclusions: When a company's supply chain has achieved a desirable degree of eco-friendliness in all regards, its performance will be improved and satisfactory from a sustainability perspectiv

PELATIHAN METODE KUANTITATIF DAN PENGGUNAAN APLIKASI SPSS PENERAPAN DALAM BIDANG KEILMUAN ADMINISTRASI PUBLIK

Secara umum metodelogi dalam penelitian di bagi dalam metode kuantitatif dan kualitatif. Dalam keilmuan adminsitrasi publik mahasiswa biasa menggunakan metode kualitatif dan jarang dengan metode kuantitatif. Meskipun jarang digunakan namun metode kuantitatif dapat digunakan dalam pelaksanaan penelitian dibidang administrasi publik. Pelatihan ini dilakukan dirancang untuk  memberikan materi yang bertujuan menambah pemahaman terhadap metode kuantitatif dan serta dilakukan praktek penggunaan aplikasi SPSS melalui perangkat laptop yang telah diinstal aplikasi untuk melakukan pengolahan data. Dengan terlaksananya pelatihan ini metodelogi kuantitatif dan penggunaan aplikasi spss bagi  mahasiswa administrasi publik tentunya meningkatan pengetahuan dan keterampilan mahasiswa di kota pontianak bermanfaat bagi kelancaaran studi dan kerja nantinya

Influence of Differential Calcification in the Descending Thoracic Aorta on Aortic Pulse Pressure

Purpose: Multiple studies have shown pulse pressure (PP) to be a strong predictor of aortic calcification. However, no studies are available that correlate PP with aortic calcification at the segmental level. Methods: We identified 37 patients with aortic PP measured during cardiac catheterization. Their noncontrast chest computed tomography scans were evaluated for the presence of calcium in different segments (ascending aorta, arch of aorta [arch], descending aorta) and quantified. Patients with calcification (Calcified Group A) were compared against patients without calcification (Noncalcified Group B) in terms of PP, calcification and compliance. Results: The mean of the total calcium score was higher in the descending aorta than the arch or ascending aorta (691 vs 571 vs 131, respectively, P < 0.0001). PP had the strongest correlation with calcification in the descending aorta (r = 0.47, P = 0.004). Calcified Group A had a much higher PP than Noncalcified Group B, with the greatest difference in the descending aorta (20 mmHg, P < 0.0001), lesser in the ascending aorta (10 mmHg, P = 0.12) and the least in the arch (5 mmHg, P = 0.38). Calcified Group A patients also had much lower compliance than Noncalcified Group B patients, with the greatest difference among groups seen in the descending aorta (0.7 mL/mmHg, P = 0.002), followed by the ascending aorta, then arch. Conclusions: These are the first data to evaluate the relative impact of aortic segments in PP. Finding the greatest amount of calcification along with greatest change in PP and compliance in the descending aorta makes a case that the descending aorta plays a major role in PP as compared to other segments of the thoracic aorta

Normal diameter of the ascending aorta in adults: the impact of stricter criteria on selection of subjects free of disease

BACKGROUND: The American Society of Echocardiography 2015 guidelines for measurement of the aorta utilized studies, including one by Devereaux et al., that suffered from smaller sample sizes and lax criteria for selection of normal subjects, using absence of clinical etiologies of aortic aneurysm without consideration of echocardiographic normalcy. This study was carried out to determine the normal dimension of the ascending thoracic aorta in a large population using stricter selection criteria. METHODS: Echocardiographic studies of patients ≥15 years of age performed at a large tertiary care hospital over the last four years were retrospectively evaluated. Only those who did not fulfill any of the 28 causes of aortic dilatation, as defined by AHA 2010 guidelines, either in their clinical records or echocardiograms were included as “normal subjects.” The dimensions of the mid-ascending thoracic aorta were measured by standardized echocardiography in a plane perpendicular to that of the long axis of the aorta, at end-diastole, using leading edge–to–leading edge technique. RESULTS: Out of 3,201 normal subjects, 974 were men and 2,227 were women. The mean age was 37.91±14.94 years. The mean diameter of the ascending aorta (Asc Ao) in men was 2.91±0.40 cm, compared with 3.34±0.34 cm in prior studies. The mean diameter of Asc Ao in women was 2.70±0.36 cm, compared with 2.98±0.34 cm in prior studies. CONCLUSIONS: These data suggest that in a larger population with more stringent criteria for normalcy, the prevalence of dilated aorta will be higher than those suggested by the current guidelines, if the suggested cutoffs are applied

Abstract P230: The influence of calcification of ascending aorta on dicrotic notch of thoracic aorta

Background: Dicrotic Notch (DN) is known to dampen with age, with increasing arterial stiffness probably due to arterial calcification. Since arterial calcification has recently been shown to predominantly involve descending thoracic aorta, we hypothesized that calcification in different segments of thoracic aorta will have a different impact on DN. Methods: A sample of 44 patients with invasive thoracic aortic pressure tracings during cardiac catheterization was selected for this study. Non-contrast CT scans were evaluated for presence of calcification in aortic segments (ascending aorta (AA), aortic arch (arch) and descending aorta (DA)) and then quantified. DN was categorized based on aortic pressure tracings into 4 grades. Grade 1 represented normal DN; grades 2, 3 and 4 represented progressively diminishing DN, where grade 4 represented absent DN. Compliance was calculated as a change in stroke volume over aortic pulse pressure with both measurements obtained from echocardiography reports done within one year of catheterization. Results: The mean age of the sample population was 64.6 ± 10.5 years. Out of the 44 patients, 14 (32%) had a calcified AA, 25 (56%) had a calcified DA and n=28 (63%) had a calcified arch. Furthermore, 14 (32%) patients had only one segment calcified, whereas 10 (23%) had two and 11 (25%) had all three segments calcified. Abnormal DN was present in 16 (36%) patients. The odds of having an abnormal DN in the presence of calcified AA were more than 3 times (OR: 3.67; p=0.05). Compliance was higher in those with a normal DN versus those with an abnormal DN (1.64 ml/mmHg vs. 1.21 ml/mmHg) (p = 0.09). There was no significant association between calcification in the DA or arch of aorta. Conclusion: There was no association between dicrotic notch and presence of calcification in the arch of the aorta and descending aorta

Prevalence of dilated mid-ascending aorta in individuals 15 years and older: In search of optimal diagnostic criteria and their effect on the burden of disease

Background:Controversy regarding the definition of the upper limit of normal (ULN) for dilated mid-ascending aorta (mAA) stems from variation in criteria, based on several small-sized studies with small datasets of normal subjects (DONS). The present study was carried out to demonstrate this variation in the prevalence of mAA dilation and to identify the optimal definition by creating the largest DONS. Methods:Echocardiographic studies of patients ≥ 15 years of age performed at a large tertiary care center over 4 years ( n = 49,330) were retrospectively evaluated. The leading-edge-to-leading-edge technique was used to measure the mAA in diastole. The largest-to-date DONS ( n = 2334) was created, including those who were normal on medical record review, did not have any of the 28 causes of dilated aorta, and had normal echocardiograms. Because age had the strongest correlation with mAA (multivariate adjusted R2 = 0.26), as compared with sex, height, and weight, we created a new ULN based on the DONS with narrow age stratification (10-year intervals). Results:The prevalence of dilated mAA varied between 17% and 23% when absolute criteria were used with sex stratification, and it varied between 6% and 11% when relative criteria (relative to age, body surface area, and sex) were used. Based on new criteria from the DONS, it was 7.6%, with a ULN of 3.07-3.64 cm in women and 3.3-3.91 cm in men. Conclusions:These data demonstrate the undesirable variation in the prevalence of dilated mAA based on prior criteria and propose a new ULN for dilated mAA

Refining the upper limit of normal for the ascending aorta: In search of optimal criteria -- a large database study of normal individuals

Objectives: The cutoff for dilated mid-ascending aorta (mAA) is controversial and has several definitions. The present study was carried out to determine the prevalence of mAA dilation based on published definitions and to identify the optimal cutoff. Methods: Echocardiographic studies of patients \u3e15 years of age performed at a large tertiary care center over 4 years, n = 49,330, were retrospectively evaluated. Leading-edge-to-leading-edge technique was used to measure the mAA in diastole. Several cutoff criteria were included. In addition, we defined normals in our database as those who, after 28 causes of dilated aorta were excluded, were normal both clinically and echocardiographically (n = 2334). Results: The mean age was 64.2 ± 17.1 years, and 31.5% were men. The prevalence of dilated mAA based on absolute criteria with sex stratification varied between 17% and 23% and based on relative criteria (to age, body surface area, and sex) varied between 6% and 11%. It further decreased to 7.6% on the addition of narrow age stratification (10 year intervals) performed on normals in our database. The multivariate adjusted R2 (for variation in mAA diameter) was 0.25 for age, decreasing to 0.12 for weight and 0.07 for sex and height. Conclusions: The lowest prevalence of 7.6% probably represents the optimal cutoff for dilated mAA because it includes age, which explains most of the variation in mAA, in narrow (10 year) intervals only performed in our normals, which represents the largest sample size to date

Distal dicrotic notch in the coronary artery. Is it a function of stenosis vs. stiffness? A computed tomography and angiography correlation study

Background: A single small study (n=97) has suggested that absence of dicrotic notch (DN) in the coronary artery, distal to an intermediate stenosis, may indicate a significant stenosis, proven by an abnormal fractional flow reserve (FFR). This finding has neither been evaluated by other studies nor compared against other, more established, non hyperemic indices like Pd/Pa. It is unclear if DN is representative of coronary stenosis or coronary stiffness. Methods: Of the 926 FFR measurements performed in a large tertiary care center over last 4 years, we included 405 measurements after excluding tracings with inadequate baseline data and absent aortic DN. Tracings with pre-adenosine measurement with 8 cardiac cycles were printed and distal dicrotic notch (DDN) was characterized visually into four types, i.e., full notch, partial notch, definite change in angle of descending limb at the end of systole, and absent DN, by two different observers. Operating test characteristics of DDN were measured against the criterion standard of FFR ≤0.8 to detect significant ischemia. Coronary calcium score (CaSc), as a marker for coronary stiffness of the vessels, was evaluated by CT. Results: Out of 405 patients, 52 had absent DDN. The mean FFR in those with absent DDN was significantly lower (0.79 versus 0.86; p= \u3c0.0001) compared to those with a DDN. The receiver operating area under the curve (AUC) for predicting FFR \u3c0.80 was 0.59 (p\u3c0.0001) for DDN, as compared to 0.89 (p= \u3c0.0001) for baseline Pd/Pa. The sensitivity, specificity, PPV and NPV of DDN were 26%, 92%, 56%, 76%, respectively as compared to 79%, 82%, 63% and 91% for Pd/Pa \u3c 0.93. Those with absent DDN (n=5) had a much higher CaSc (897 vs. 463; p=0.11) than those with DDN (n=32). The AUC to predict absence of DDN by CaSc was 0.62. A CaSc of 82 or lower successfully ruled out an absent DDN. Conclusion: While DDN is associated with an abnormal FFR, our data suggest meaningfully lower performance in prediction of an abnormal FFR as compared to Pd/Pa, indicating that Pd/Pa should be preferred over DDN in clinical practice. DDN appears to be partially explained by coronary stiffness. Further studies to define the relative role of stenosis vs stiffness in regression of DDN are underway

Influence of Differential Calcification in the Descending Thoracic Aorta on Aortic Pulse Pressure

Purpose: Multiple studies have shown pulse pressure (PP) to be a strong predictor of aortic calcification. However, no studies are available that correlate PP with aortic calcification at the segmental level. Methods: We identified 37 patients with aortic PP measured during cardiac catheterization. Their noncontrast chest computed tomography scans were evaluated for the presence of calcium in different segments (ascending aorta, arch of aorta [arch], descending aorta) and quantified. Patients with calcification (Calcified Group A) were compared against patients without calcification (Noncalcified Group B) in terms of PP, calcification and compliance. Results: The mean of the total calcium score was higher in the descending aorta than the arch or ascending aorta (691 vs 571 vs 131, respectively, P \u3c 0.0001). PP had the strongest correlation with calcification in the descending aorta (r = 0.47, P = 0.004). Calcified Group A had a much higher PP than Noncalcified Group B, with the greatest difference in the descending aorta (20 mmHg, P \u3c 0.0001), lesser in the ascending aorta (10 mmHg, P = 0.12) and the least in the arch (5 mmHg, P = 0.38). Calcified Group A patients also had much lower compliance than Noncalcified Group B patients, with the greatest difference among groups seen in the descending aorta (0.7 mL/mmHg, P = 0.002), followed by the ascending aorta, then arch. Conclusions: These are the first data to evaluate the relative impact of aortic segments in PP. Finding the greatest amount of calcification along with greatest change in PP and compliance in the descending aorta makes a case that the descending aorta plays a major role in PP as compared to other segments of the thoracic aorta

Influence of differential calcification in the descending thoracic aorta on aortic pulse pressure

Purpose: Multiple studies have shown pulse pressure (PP) to be a strong predictor of aortic calcification. However, no studies are available that correlate PP with aortic calcification at the segmental level. Methods: We identified 37 patients with aortic PP measured during cardiac catheterization. Their noncontrast chest computed tomography scans were evaluated for the presence of calcium in different segments (ascending aorta, arch of aorta [arch], descending aorta) and quantified. Patients with calcification (Calcified Group A) were compared against patients without calcification (Noncalcified Group B) in terms of PP, calcification and compliance. Results: The mean of the total calcium score was higher in the descending aorta than the arch or ascending aorta (691 vs 571 vs 131, respectively, P < 0.0001). PP had the strongest correlation with calcification in the descending aorta (r = 0.47, P = 0.004). Calcified Group A had a much higher PP than Noncalcified Group B, with the greatest difference in the descending aorta (20 mmHg, P < 0.0001), lesser in the ascending aorta (10 mmHg, P = 0.12) and the least in the arch (5 mmHg, P = 0.38). Calcified Group A patients also had much lower compliance than Noncalcified Group B patients, with the greatest difference among groups seen in the descending aorta (0.7 mL/mmHg, P = 0.002), followed by the ascending aorta, then arch. Conclusions: These are the first data to evaluate the relative impact of aortic segments in PP. Finding the greatest amount of calcification along with greatest change in PP and compliance in the descending aorta makes a case that the descending aorta plays a major role in PP as compared to other segments of the thoracic aorta