Digital Commons Network^™

Review Of Outcomes: Quality Improvement Of Upper-Extremity Necrotizing Soft Tissue Infections, Cailey A. England Bs, Ryan A. Reinhart Bs, Tien Do Do, Maame A. Effirim Bs, Dylan Bezzini Md

Summer Research Program Abstracts

No abstract provided.

Endocranial Lesions: A Paleopathological Study Of Late Medieval Skeletal Remains From Żelewo Poland, Francesca Aleen Meyer

Cal Poly Humboldt theses and projects

The site of Żelewo is located in a rural area of northwestern Poland, a region historically known as Pomerania. Skeletal remains from the cemetery associated with the archaeological site Żelewo 1-3, dating mostly to the 13th-15th centuries, are likely associated with a nearby Cistercian monastery. Numerous individuals from this site show evidence of endocranial lesions. To evaluate potential factors associated with the lesions, a differential diagnosis was performed based on macroscopic observations of endocranial lesion morphology and distribution. This study takes into account estimated age at death, biological sex, and other signs of pathology in the body. Potential confounding factors, …

From Reactionary To Anticipatory Integrated Action: Novel Environmental Health Surveillance For Mass Gatherings, Benjamin J. Ryan, Michael Donahoo, Danielle Esler, Paul Barach, Benjamin Coghlan, Shelby Garner, Laura M. Langan, John Piispanen, Bryan W. Brooks

College of Population Health Faculty Papers

Advances in AI-driven analytics, human-in-the loop techniques, and wastewater monitoring provide the foundation needed to shift from reactive to anticipatory actions for mass gatherings. Traditional surveillance systems focus on clinical and laboratory-based notification pathways, which often result in tardy actions being implemented. Thus, traditional surveillance is becoming outdated. Mass gatherings pose heightened public health risks and hazards, including trauma; injury and substance misuse; deliberate poisoning; and infectious diseases such as food and waterborne illnesses, sexually transmitted infections, and respiratory diseases. There is also a heightened concern due to reduced vaccination coverage. As a result, future international events such as the …

Preparing For Long-Acting Technologies: A Multistate Analysis Of Prep Persistence And Hiv And Sti Lab Coverage Among Oral Prep Initiators In St. Louis, Missouri (2014-2021), Lindsey M Filiatreau, Rupa Patel, Kate Curoe, Ashley Underwood, Joseph Cherabie, Elvin H Geng, Aditi Ramakrishnan, Rachel Presti, Aaloke Mody

2020-Current year OA Pubs

BACKGROUND: Engagement in pre-exposure prophylaxis (PrEP) care and routine screening for HIV and sexually transmitted infections (STIs) is critical to realizing the full benefits of this HIV prevention strategy.

METHODS: We enrolled a cohort of individuals seeking PrEP services in two clinics in Missouri, an Ending the HIV Epidemic priority state, from June 2014 to November 2021. We used electronic health record and survey data to explore outcomes in the 2 years following linkage to care using multistate methods. We assessed transitions between eight mutually exclusive care states differentiated by receipt of a prescription, lab coverage status, and retention. We …

Evaluation Of Mycoplasma Genitalium Positivity And Co-Infection With Chlamydia Trachomatis And/Or Neisseria Gonorrhoeae At Various Care Sites Across The United States, Rebecca Lillis, Stacey House, Et Al.

2020-Current year OA Pubs

OBJECTIVES: We evaluated Mycoplasma genitalium (MG) positivity and co-infection with Chlamydia trachomatis (CT) and/or Neisseria gonorrhoeae (NG), based on results from a trial assessing clinical performance of the Cobas® Liat CT/NG/MG point-of-care test.

METHODS: A prospective, US, multicenter, noninterventional study assessed MG positivity in prospective urine samples (male) and clinician-collected vaginal swabs (female) from symptomatic/asymptomatic patients aged ≥14 years attending various clinical settings. Participants were designated positive or negative for MG, CT, and NG based on combined results from three US Food and Drug Administration-approved assays and one laboratory-developed test. MG co-infection with CT and/or NG was assessed.

RESULTS: Among …

Spatial Variation In Socio-Economic Vulnerability To Influenza-Like Infection For The Us Population, Shrabani S. Tripathy, Joseph V. Puthussery, Taveen S Kapoor, John R. Cirrito, Rajan K. Chakrabarty

2020-Current year OA Pubs

This study aims to quantify environmental health impacts and assess risk by understanding the disproportionate burden of infectious diseases, specifically Influenza-like Illness (ILI), across regions with varying socio-economic characteristics. We introduce a novel vulnerability-based approach to better understand the complex relationship between socio-economic factors and ILI burden. We develop a machine-learning-driven framework to assess and map state-level socio-economic vulnerability to ILI in the United States. A vulnerability index was created by integrating 39 diverse socio-economic and health indicators from the latest CENSUS. A Random Forest Regression model then weighed these indicators to quantify each state's vulnerability for the ILI values …

Harmonizing Hope: An Idea Of Music Therapy Interventions For Schizophrenia, Dominikus David Biondi Situmorang

Buletin Konseling Inovatif

Schizophrenia is typified by a wide range of symptoms, such as delusions, hallucinations, cognitive decline, and social disengagement. Even with improvements in pharmaceutical and psychosocial therapy, many people with schizophrenia still require supplementary treatment methods due to their chronic symptoms and functional limitations. Utilizing music's therapeutic capacity to address a variety of symptoms and enhance general well-being, music therapy has emerged as a possible supplementary intervention for schizophrenia. In this study, the author used a literature review with a Critically Appraised Topic (CAT); this research is a summary of the best available evidence regarding the focused aims. This CAT looks …

Balancing Diagnostic Sensitivity And Operational Efficiency In Mrsa Screening: A Study Of Pooled Multi-Site Swabs With And Without Viral Transport Media Using Genexpert®, Basem A. Jawa, Khulud A. Alhazmi, Khalid M. Alquthami, Ghazi S. Alkhaldi, Afnan O. Baharthi, Abdullah A. Marzogi, Saeed A. Badhdah, Eman A. Mulla, Daee M. Almalki, Atif A. Jahri, Ahmed A. Khan, Atiyah A. Alzahrany, Eman A. Bukhari, Tahani O. Roomy, Noha K. Alqurashi, Rehab G. Alqurashi, Rabab H. Moaminah, Fahd A. Alhejili, Majed M. Shaikh, Lamia H. Mohammed, Salwa N. Andejani, Mansour H. Alqasmi, Salman S. Alsharif, Fawaz F. Qasim, Ghadeer S. Areeshi, Abeer S. Alqarni, Baidaa S. Basudan

Journal of King Abdulaziz University: Medical Sciences

Methicillin-resistant Staphylococcus aureus (MRSA) remains a significant cause of healthcare-associated infections. Early identification of colonized individuals upon hospital admission is essential for effective infection control. This study aimed to evaluate the performance of pooled MRSA screening using the GeneXpert®system (Cepheid) under two conditions: with and without viral transport media (VTM). The goal was to assess the sensitivity of pooling strategies while minimizing reagent use, processing time, and laboratory workload. Swabs were collected from three anatomical sites, the axilla, groin, and nares, from newly admitted patients. Samples were pooled either with VTM or without VTM and then tested using the Xpert®MRSA …

Annual Dui Defense Update, Indiana Continuing Legal Education Forum (Iclef)

Indiana Continuing Legal Education Forum 2025

Meeting proceedings of a seminar by the same name, held November 5, 2025.

Pet Shops And Preemption, Genevieve Schaaf

Georgia Law Review

In December 2019, the Georgia Office of the Attorney General released an Opinion stating that the City of Canton Code of Ordinances, Chapter 18, Article XIV restricting the sale of pets by retail pet shops was in direct conflict with the Georgia Animal Protection Act and therefore preempted under the Georgia Constitution’s Uniformity Clause.

This Note seeks reconsideration of the Attorney General’s Opinion and argues that despite the Attorney General’s Opinion, local ordinances restricting the kinds of animals available at pet shops should remain a legally viable way for local governments to reduce the retail sale of cats and dogs.

Cytomegalovirus As A Potential Trigger For Acute Coronary Syndrome: A Case Of Nstemi In A Previously Healthy Patient, Hussam Al Hennawi, Muhammad Sabri, David Teng, Maxwell Berman, Botros Shenoda

Abington Jefferson Health Papers

Cytomegalovirus (CMV) infection has been implicated in endothelial dysfunction and atherogenesis, yet its role as a potential trigger for acute coronary syndrome (ACS) remains underrecognized. We present a case of a 32-year-old male with no prior medical history who developed non-ST elevation myocardial infarction (NSTEMI) and was subsequently found to have active CMV infection. The patient had no known history cardiovascular disease, though subsequent testing did reveal additional underlying risk factors. This case highlights the need to consider infectious etiologies, including CMV, as contributors to ACS in young, otherwise apparently healthy individuals. Understanding the interplay between viral infections and atherosclerotic …

Inflammatory Co-Regulation Of Voltage-Gated Sodium Channels And Na,K-Atpase In Metastatic Breast Cancer, Steven D. Scahill, Kelly Jean Sherman, Dennis Paul

School of Graduate Studies Faculty Publications

Sodium regulation is a potentially major driver of cancer metastasis. Voltage-gated sodium channels (VGSCs) and Na,K-ATPase are sodium transporters that are upregulated in many advanced carcinomas and are implicated as metastatic drivers. However, little is known about what drives this overexpression, how these proteins influence metastatic behavior, or whether these complementary sodium transporters are co-regulated in cancer. Using sodium transporter regulation in healthy neurons as a model, the present study demonstrated that the inflammatory mediator tumor necrosis factor alpha (TNFα) affects the expression of VGSCs and Na,K-ATPase in an in vitro model of metastatic breast cancer. Acute TNFα challenge increased …

Analysis Of The Relationship Between Stunting And Dental Caries Patterns In Children Aged 6–12 Years, Adam M. Hamudeng, Fajriani, Nurhaeda, Qaroba A. Yasa, Andi S. Permatasari

Journal of Dentomaxillofacial Science

Objective. This study aims to determine the relationship of stunting to the pattern of dental caries in elementary school children aged 6-12 years in Gowa Regency. Material and method. This type of research is an observational analytical study using a cross-sectional approach. This study is divided into several stages, namely 1) Measurement of weight and height 2) Interviews using questionnaires and 3) Examination of the oral cavity to determine the pattern of dental caries in children based on the ICDAS classification. Result. The results showed that stunting and nonstunting children in the right permanent first molar of maxilla were dominant …

Prevalence And Etiological Bacterial Nosocomial Infections In Pediatric Patients In Al-Diwaniyah Hospitals, Shaimaa Shakir Jawad, Yahya Falih Mohamed

Muthanna Medical Journal

Background: Nosocomial infection is one significant factor influencing a patient's outcome. Patient safety is at risk since they are the most frequent adverse occurrences in healthcare. They have a major impact on patients, their families, and healthcare systems regarding mortality, morbidity, and economic hardship. Aims: Screening the prevalence and etiological bacteria of nosocomial infections in pediatric patients in Al-Diwaniyah hospitals, Iraq. Methods: In this cross-sectional descriptive study, a total of 105 different clinical samples were collected from hospitalized pediatric patients in Al-Diwaniyah hospitals who aged from 10 days till the age of 14 years old during August 2025 to December …

Patterns Of Rifampicin And Isoniazid Resistance In Pulmonary Rr/Mdr-Tb With Or Without T2dm, May Ira Sopha, Laksmi Wulandari, Musofa Rusli, Dominicus Husada, Susantina Prodjosoewojo

Folia Medica Indonesiana

Tuberculosis (TB) causes approximately[-12pc]AU: Please provide ORCID ID for all authors. 1.6 million deaths each year. The incidence of drug-resistant TB has continued to rise, primarily due to multidrug-resistant tuberculosis (MDR-TB). Drug-resistant TB remains a primary concern in various parts of the world, especially in Eastern Europe, Russia, Asia, and sub-Saharan Africa. This study aimed to analyze the correlation between first-line anti-tuberculosis drug resistance and the presence or absence of T2DM comorbidity in patients with pulmonary RR/MDR TB. This research employed a cross-sectional design, which used secondary data from 2023, obtained from medical records, the Tuberculosis Information System (SITB), and …

Construction And Data-Driven Analysis Of A Stochastic, Individual-Based Opioid Epidemiology Network Model, Leigh Bennett Pearcy, Owen Queen, Vincent Jodoin, Suzanne Lenhart, Christopher Strickland

Mathematical Modelling and Numerical Simulation with Applications

While substance use epidemiology has been an active area of mathematical research in recent years, the social and mental processes that are involved in the development of substance use disorders have presented challenges to advancing the epidemiological theory and how they differ from the contraction of pathogenic disease. Such distinction is especially pertinent in the context of the current United States opioid epidemic and its intersection with the recent COVID-19 pandemic, as both prescription drugs and social influence play major roles in the development of opioid use disorder. In this paper, we construct a stochastic network model capturing how individual …

Hepatitis B Surface Antigen And Liver Function Tests As Prediction Markers For Patients Infected With The Hepatitis B Virus., Maitham N. Madhi, Wissam Salih Abood

Al-Qadisiyah Medical Journal

Background: The infection with the hepatitis B virus represents a significant global health challenge with serious complexities like the failure of the liver and hepatocellular carcinoma. It results in an estimated mortality of 1.12 million cases in 2022. Aim of Study: This study aimed to use hepatitis B surface antigen and liver function tests as prediction markers for patients infected with the hepatitis B virus and compare them with viral load in Wasit Province, Iraq. Materials and Methods: This study involved 75 patients, both male and female, who made up the study population. Hepatitis B virus (HBV)-positive patients' samples were …

Factors Contributing To Intestinal Parasitic Infestations In Children Attending Primary Private And Public Schools In Central Benghazi, Asmaa A. Alfarisi, Samira S. Garboui, Fawzeia H. Elmhalli, Maha A. Kattou, Suhaila Elabbar, Hajir A. Alabede, Zahrah A. Alawami

Journal of King Abdulaziz University: Medical Sciences

Background: Intestinal parasitic infections (IPIs) among school-aged children are a significant public health issue in many parts of the world, with high prevalence rates in many regions. The study aims to investigate the prevalence and associated risk factors of IPIs among school children.

Materials and Methods: A cross-sectional study was conducted among randomly selected primary school children aged 6 to 9 years in central Benghazi from April to September 2021. Stool samples were collected from 700 schoolchildren and analyzed using the wet-mount technique. Also, questionnaires were distributed, and general information on each child was recorded.

Results: The study revealed a …

An Arabic Version Of The Intuitive Eating Scale-2: Translation And Validation Among The Saudi Population, Eram Albajri, Manal Naseeb

Journal of King Abdulaziz University: Medical Sciences

Background: Eating is a complex behavior in humans, shaped by an interplay of biological, psychological, and sociocultural factors. Tools like the Intuitive Eating Scale-2 (IES-2) offer valuable insights into eating behaviors, but their effectiveness depends on cultural and linguistic adaptability.Objective: In this study, we translated the IES-2 into Arabic and validated its psychometric properties among a large Arabic-speaking sample in Saudi Arabia.Methods: The IES-2 was translated using the forward-backward translation approach. The final translated version was distributed online to a convenient sample of the Saudi population. Exploratory factor analysis was performed to examine the construct validity of the …

Anti-Cancer Effects Of Chicken Cathelicidin Peptides On Breast, Colon, And Liver Carcinoma Cells, Maryam M. Hamed, Mohammed Alkhaled, Yousef Almoghrabi, Aliaa A. Alamoudi, Hussam Daghistani, Abdulwahab Noorwali

Journal of King Abdulaziz University: Medical Sciences

Cancer remains a threat to human life, affecting millions of people. Limitations associated with conventional tumor therapies motivate the search for new, effective, and non-toxic therapies. Cathelicidin peptide (CATH) is a host defense peptide with anti-microbial and immunomodulatory activity. Moreover, cumulative studies have revealed its anti-cancer properties. While several studies have explored their antimicrobial and anti-tumor potential, further research is needed to elucidate their specific mechanisms across different tumor types. Our study aimed to investigate the anti-cancer effects of two types of Chicken CATH, 1 and 2, on breast MCF-7, colon HCT-116, and liver HEPG-2 carcinoma cells, and to examine …

Evaluating The Reasons For Cancellations Of Scheduled Elective Surgeries Requiring Postoperative Pediatric Icu Care: An Observational Study, Khouloud A. Al-Sofyani

Journal of King Abdulaziz University: Medical Sciences

Background: Pediatric intensive care units (PICUs) are essential for managing critically ill children who require advanced airway, respiratory, and hemodynamic support. Disease patterns vary across regions and over time, making regular reviews necessary for improving patient care. Auditing admissions and outcomes provides insights for refining clinical practices.Objective: This study aims to investigate the reasons for pediatric surgical admissions and the frequency and causes of surgical cancellations across specialties. This study aims to identify modifiable factors that could improve surgical efficiency and patient outcomes.Methods: A retrospective chart review was conducted at the Pediatric Department, King Abdulaziz University Hospital, from …

The Role Of Artificial Intelligence In Enhancing Infection Control In Hospitals: A Systematic Review, Khalid M. Alquthami, Ali M. Alahdal, Sadiq A. Serdar, Mazin M. Kheyami, Mohammed A. Alwadani, Razaz A. Barashi, Mohammad M. Alkhozaee, Basem A. Jawa

Journal of King Abdulaziz University: Medical Sciences

Hospital-acquired infections represent a critical global healthcare challenge, affecting 7–10% of hospitalized patients worldwide with 1.4 million annual deaths. This systematic review examines the transformative potential of artificial intelligence in infection control through predictive analytics, real-time surveillance, and antimicrobial stewardship. Analyzing 50 peer-reviewed studies, we demonstrate the effectiveness of AI tools in reducing infection rates by 35% and improving antibiotic utilization by 90%. We identify key implementation barriers, including data integration challenges, algorithmic bias, and ethical concerns. By synthesizing real-world case studies and proposing a three-phase implementation model, this review bridges the gap between technological capabilities and hospital infection control …

Molecular Docking And Antibacterial Activity Of Sesterterpenoids From Hyrtios Erectus, Hajer S. Alorfi, Nawal A. Albalawi

Journal of King Abdulaziz University: Marine Science

The search for new antibiotics remains urgent due to the continuous evolution of microbes and their resistance to currently available antibiotics. The organic extract of a specimen of the Red Sea sponge Hyrtios erectus collected off Jeddah coast was subjected to sequential chromatographic fractionation. Three sesterterpenoids (1–3) along with an indole alkaloid (4) were isolated from H. erectus. Structure elucidation of the isolated was accomplished using NMR, UV, and IR spectroscopy along with MS spectrometry. The antibacterial activity of the isolated sesterterpenoids (1–3) was assessed against a set of Gram-positive and negative …

Pseudoaneurysm Developing After Extraction Of The Mandibular Third Molar Requiring Transcatheter Arterial Embolization: A Case Report And Literature Review, Tomoya Soma, Terumi Takeuchi, Kentaro Nishi, Kanako Munakata, Hiroki Nagamine, Taneaki Nakagawa, Seiji Asoda

Journal of Dentomaxillofacial Science

Introduction: Post-extraction bleeding, which is difficult to stop, is rare. However, arterial hemorrhage may lead to a state in which hemostasis is difficult to obtain. We herein report a case in which arterial embolization effectively stopped hemorrhagic bleeding due to mandibular third molar extraction.

Case Report: The patient was a 24-year-old man who suffered from abnormal bleeding during left mandibular third molar extraction (tooth no. 48). As hemostasis via compression with gauze would be difficult, the patient was referred to our department for emergency treatment to stop the bleeding. There was nothing special to note in terms of his vital …

Ethnic Diversity In Uk Bioscience: Structural Biases And Recommendations For Action, Yusra Siddiqui, Prachi Stafford, Emmanuel Adukwu, Nicholas Freestone, Tina Lovleen Joshi, Emma Yhnell, Katharine Hubbard

Peninsula Dental School

Scientific research is more innovative and impactful when scientists are drawn from diverse backgrounds. However, the scientific community does not reflect the demographics of wider society. Global Majority communities remain underrepresented within science, particularly within senior leadership roles. Here we explore ethnic diversity within UK academic biosciences, using publicly available staff and student demographic data from the UK Higher Education Statistics Authority. We use the Simpson index as a quantitative measure of diversity within the biosciences and construct linear mixed effect models to identify significant predictors of both student and staff ethnic diversity. For staff, there were significant negative effects …

Preliminary Laboratory Evaluation Of Rapid Diagnostic Test Prototype To Detect Hbsag In Whole Blood And Serum, Ema Qurnianingsih, Citrawati Dyah Kencono Wungu, Mochammad Amin, Dewi Setyawati, Yanna Debby Restifanny Yasan, Lina Lukitasari, Maria Inge Lusida, Soetjipto Soetjipto

Folia Medica Indonesiana

Chronic hepatitis B virus (HBV) remains a major global health issue,[-10pc]AU: Please provide ORCID ID for all authors.[-7pc]AU: Please provide affiliation’s for all authors. with over 250 million people affected worldwide. In Indonesia, HBV prevalence has declined from high to moderate endemicity, but challenges persist due to regional disparities, risk of mother-to-child transmission, and the predominance of B3 and C1 sub-genotype. Despite available preventive measures and diagnostic tools, approximately 90% of cases remain undiagnosed, particularly in low-resource settings, indicating the need for improved screening and control strategies. Therefore, this study aims to conduct preliminary performance tests of KODC hepatitis B …

Evaluation Of Impact Of Some Epidemiologic Factors On The Bronchiolitis Caused By Respiratory Syncytial Virus (Rsv) In Infants And Young Children Under 5 Years Old In Al- Diwaniyah Province, Rajaa Abd Hamaadi Chaloob, Wissam Salih Abood

Al-Qadisiyah Medical Journal

Background:. The biggest viral cause of bronchiolitis and one of the major agents behind respiratory-tract infections globally is the Human Respiratory Syncytial Virus (HRSV). RSV is transmitted through airborne droplets or close contact with contaminated objects. Objective: The purpose of this research is to detect major risk factors associated with susceptibility to and severity of bronchiolitis in infants and young children under the age of five caused by respiratory syncytial virus (RSV).  study design to detect antibodies Immunoglobulin M (IgM) for human RSV in serum samples by using specific enzyme-linked immunosorbent assay (ELISA) kits as a diagnostic test Methods: This …

Gut Microbiome Metagenomics In Clinical Practice: Bridging The Gap Between Research And Precision Medicine, Henok Ayalew Tegegne, Tor C Savidge

Faculty, Staff and Students Publications

Gut microbiome metagenomics is emerging as a cornerstone of precision medicine, offering exceptional opportunities for improved diagnostics, risk stratification, and therapeutic development. Advances in high-throughput sequencing have uncovered robust microbial signatures linked to infectious, inflammatory, metabolic, and neoplastic diseases. Clinical applications now include pathogen detection, antimicrobial resistance profiling, microbiota-based therapies, and enterotype-guided patient stratification. However, translation into routine care is hindered by significant barriers including methodological variability, limited functional annotation, lack of bioinformatics standardization, and underrepresentation of global populations. This review synthesizes current translational strategies, emphasizing the need for hypothesis-driven designs, multi-omic integration, longitudinal and multi-center cohorts, and mechanistic validation. …

Prevalence And Risk Factors And Efforts To Reduce Dengue Fever And Dengue Hemorrhagic Fever Infections At Pku Muhammadiyah Gamping Hospital, Yogyakarta, Kusbaryanto Kusbaryanto, Abdurrasyid Bin Abdurrahman, Ekorini Listiowati, Yusuf Alam Romadhon, Aisyah Rosyida

Media Kesehatan Masyarakat Indonesia

The incidence of Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF) has increased sharply in recent decades, making these infections endemic in several parts of the world. The purpose of this study was to analyze the prevalence, risk factors, and efforts to reduce DF and DHF infections at PKU Muhammadiyah Gamping Hospital, Yogyakarta. This study employed an observational cross-sectional design. The study sample consisted of patients diagnosed with DF or DHF at general hospitals in Yogyakarta between January 2019 and December 2023 who met the inclusion and exclusion criteria. Patients with a DF or DHF diagnosis but incomplete data were …

Optimising Drugs And Vaccines Management Utilizing 5 M Method: The Case Of Riau Islands, Indonesia, Erwin Sutejo, Yosi Irawati Wibowo, Indri Ayu Ningsih, Bruce Sunderland, Adji Prayitno Setiadi

Media Kesehatan Masyarakat Indonesia

A resilient health system should include the ability to access essential drugs and vaccines in all locations. This study aims to perform root cause analysis and develop recommendations to optimize drugs and vaccines management for Riau Islands Province, Indonesia. This study used qualitative approaches which included interviews and group discussions with key stakeholders (n=6) as well as an expert panel (n=4). Data on the underlying causes of problems and recommendations were structured into 5M (Man, Money, Machine, Method, Material). Problems related to Man (limited human resources) were identified for most management stages. Other problems reported: Planning – Money (inefficient budget …