Business environment and changing markets are the competitive challenges of today. There is not one universal solution for this, but agility is the key of success in creating the customer responsiveness and in mastering uncertainty, which are two of the most relevant items in managing performance. The integration of agile systems in the organization structure is improving the permanently interaction with the customers wishes. The study of agility’s indicators, including also the concepts of AM are far from new, but can they contribute in constructing an agile supply chain. The constantly changing in global environment, has a directly impact in the future of the company, and one of the most important questions will be how to achieve supply chain agility. And this paper will try to find an answer to the question in how to achieve competitive advantages in the global market and to improve financial performance of the company.
Water is the most essential element in life, it is vital for our survival and it has a crucial role in our ecosystem. Water has many functions, such as firstly for human health, water makes up 2/3 of our body and we cannot survive without water. Secondly for plant health, water is necessary for the transfer nutrients facilitate the growth of plants. Thirdly for animal health, just like for human, water is necessary to maintain the life cycle and survival of the animals. Furthermore is for the earth, water keeps the earth temperature stable, finally water is also used in many sectors to support human life, such as in transportation, agriculture, industries, technologies, etc With the increasing population of the world, innovations are required to maximize the existing water resources; because as the demand for food continues to increase, the source of water remains the same. Adequate funding from Indonesian Government is required to improve access to fresh water and also for the sewage treatment to enable the recycling of water and hence an efficient usage of water. An efficient usage of water is very important and it must be socialized and made aware to the public. The role of the government is to monitor and develop a sustainable usage of water, especially for irrigation in Indonesia rural’s area. In small islands, suitable water infrastructures must be developed to give a positive impact to the people’s life.
A civil partnership is a legally recognized relationship between two people of the same sex or the opposite sex that offers many of the same benefits as a conventional marriage. Before addressing the specificities of the French civil partnership contract, designated as a civil covenant of solidarity (pacte civil de solidarité), commonly known as PACS, it is necessary to define and explain the origin of this type of contract. The conclusion of a PACS, despite the fact that it is less formal than marriage, implies the respect of certain conditions of substance and form during its formation and its modification. Recently, PACS has undergone changes on this point, through a simplification of the rules of form with the establishment of its statement and registration by the registrar, removing the court clerk’s intervention. Once the PACS is concluded, with the main purpose of organizing the couple’s common life, this contract produces personal, pecuniary and patrimonial effects between the partners. As the PACS is legally only a contract, it can be dissolved by the appearance of four events. When PACS is dissolved, consequences result for the situation of the partners because they must proceed to the liquidation of the property they own and also repay the debts incurred during the period of their living together. If the dissolution of PACS is caused by the death of one of the partners, then particular consequences will affect the situation of the surviving partner. In fact, couples who entered into a PACS are not considered heirs in the eyes of the law. However, there are alternatives preventing the application of this principle, but they must be realized during the lifetime of the partners.
This paper investigates the European Union’s IPARD funding scheme at work in the Tikveš wine region of the Republic of Macedonia. Based on anthropology fieldwork carried out in Tikveš in 2011, it argues that for most farmers, the scheme’s opportunities are unattainable. Primarily, participants must put down a substantial amount of money to take part in the program. Meanwhile, this occurs under the umbrella of post-industrialization and privatization, whereby the region’s majority grape growers are undergoing a “catastrophic” transition and have had several years of unpaid harvests, if their grapes are even bought at all. The industry is in reality transforming itself due to market pressure, but for growers it appears that to survive increasingly requires turning to other means such as barter and subsistence living. Therefore, the growing disparity between the winery owners and the grape growers combined with the uncertainty of the latter’s future means that most growers cannot imagine participating in a development scheme such as the IPARD. This paper will thus elaborate on the policies behind it and the specter of EU integration for the Tikveš region.
Ilze Rubeniņa, Muza Kirjušina, Aivars Bērziņš, Olga Valciņa and Inese Jahundoviča
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Matz, C., Webb, J. S., Schupp, P. J., Phang, S. Y., Penesyan, A., Egan
Linda Brīdiņa, Angelika Krūmiņa, Oļegs Šuba, Vinita Cauce, Indulis Vanags and Ludmila Vīksna
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Jēkabs Krastiņš, Aigars Pētersons and Aivars Pētersons
Acute kidney injury (AKI) is a serious complication in the perioperative period and is consistently associated with increased morbidity and case fatality rate. This has been best studied in the cardiac surgery setting where it has been shown that up to 11.5–86.0% of patients exposed to cardiopulmonary bypass (CPB) will develop AKI, with 2.0–18.9% requiring renal replacement therapy (RRT). A prospective uncontrolled cohort study was conducted between 2011 and 2015, in which 93 children with various congenital heart lesions undergoing CPB were enrolled. Serum creatinine (SCr) level was determined by Jaffé’s method (Cobas 6000 analyser, Roche). Postoperative fluid balance was estimated as the difference between fluid intake and output. Data for further processing were retrieved from anaesthesia and intensive care data management system flowsheets (IntelliView, Philips). AKI developed in 42 patients (45.6%) by meeting at least KDIGO (Kidney Disease: Improving Global Outcomes) stage I criteria (with SCr rise by more than 50% from the baseline). Thirty eight patients complied with the 1st stage of AKI, three with 2nd stage and two with 3rd stage, according the KDIGO classification and staging system. One patient having severity stage II and two patients having severity stage III of AKI required initiation of RRT using peritoneal dialysis. Two patients from the RRT group survived, one died. The median intraoperative urine output was 2.32 ml/kg/h, (range from 0.42–5.87 ml/kg/h). Median CPB time was 163 min., median aortic cross-clamping time was 97.9 min., cooling during CPB to 29.5 °C. The diagnosis of AKI using SCr was delayed by 48 hours after CPB. Median fluid balance (FB) on the first postoperative day in non-AKI patients was 13.58 ml/kg (IQR 0–37.02) vs 49.38 ml/kg (IQR 13.20–69.32) in AKI patients, p < 0.001. AKI is a frequent complication after open heart surgery in children with congenital heart lesions. From 93 patients included in the study, 42 (45.2%) met at least KDIGO Stage I criteria for AKI. FB is a sensitive marker of kidney dysfunction. Median FB in the 1st postoperative day significantly differed between AKI patients: 49.38 ml/kg (13.20–69.32) versus 13.58 ml/kg in patients with intact kidney function (AUC = 0.84; p = 0.001). Thus it can be used as a marker of AKI.
A retrospective patient record analysis of the Emergency Medial Service’s Rîga City Regional Centre was provided from January 2012 through December 2013. 1359 adult patients were CPR treated for out-of-hospital cardiac arrest according to ERC Guidelines 2010. A total of 490 patients were excluded from the study. The main outcome measure was survival to hospital admission. Of 869 CPR-treated patients, 60% (n = 521) were men. The mean age of patients was 66.68 ± 15.28 years. The survival rate to hospital admission was 12.9% (n = 112). 54 of survived patients were women. Mean patient age of successful CPR was 63.22 ± 16.21 and unsuccessful CPR 67.20 ± 15.09. At least one related illness was recorded with 63.4% (n = 551) patients. There were 61 survivors in bystander witnessed OHCA and nine survivors in unwitnessed OHCA. The rate of bystander CPR when CA (cardiac arrest) was witnessed was 24.8%. Ventricular fibrillation (VF) as initial heart rhythm was significantly associated with survival to hospital admission in 54 cases (p < 0.0001). Age and gender affected return of spontaneous circulation. Survival to hospital admission had rhythm-specific outcome. Presence of OHCA witnesses improved outcome compared to bystander CPR. The objective of this study was to report patient characteristics, the role of witnesses in out-of-hospital cardiac arrest (OHCA) and outcome of adult cardiopulmonary resuscitation
Tālis Kauliñš, Natālija Proñina, Henrik Rüffert, Markus Wehner, Māris Mihelsons, Oksana Osipova and Aleksejs Miščuks
., Glauber, V., Gonano, E. F., Halsall, P. J., Hartung, E., Heffron, J. J., Heytens, L., Kozak-Ribbens, G., Kress, H., Krivosic-Horber, R., Lehmann-Horn, F., Mortier, W., Nivoche, Y., Ranklev-Twetman, E., Sigurdsson, S., Snoeck, M., Stieglitz, P., Tegazzin, V., Urwyler, A., Wappler, F. (1997). In vitro contracture test for diagnosis of malignant hyperthermia following the protocol of the European MH Group: Results of testing patients surviving fulminant MH and unrelated low-risk subjects. The European Malignant Hyperthermia Group. Acta Anaesthesiol. Scand. , 41(8), 955
Linda Bāra, Jeļena Eglīte, Pēteris Ošs, Vinita Cauce, Vilnis Lietuvietis, Ludmila Vīksna, Elvīra Hagina and Angelika Krūmiņa
Levy, M. M., Dellinger, R. P., Townsend, S. R., Linde-Zwirble, W. T., Marshall, J. C., Bion, J., Schorr, C., Artigas, A., Ramsay, G., Beale, R., Parker, M. M., Gerlach, H., Reinhart, K., Silva, E., Harvey, M., Regan, S., Angus, D. C. (2010). The Surviving Sepsis Campaign: Results of an international guideline-based performance improvement program targeting severe sepsis. Intensive Care Med ., 36 (2), 222–231.
Mato, A. R., Fuchs, B. D., Heitjan, D. F., Mick, R., Halpern, S. D., Shah, P. D., Jacobs, S., Olson, E., Schuster, S. J., Ujjani, C