Alberta Bible College

The secondary distribution system plays a pivotal role in delivering electric power to residential consumers. Conventionally, secondary distribution systems are implemented using ac configuration. In recent years, the rapid proliferation of loads, such as electric vehicle (EV) chargers has led to significant overloading issues in ac-based secondary distribution systems. A straightforward solution involves upgrading distribution infrastructure including cables and transformers; however, this approach is often costly, requiring substantial investments in both equipment and labor. To address this issue, this article presents a cost-effective alternative: retrofitting existing ac systems into hybrid ac/dc systems using power electronic converters. This hybrid configuration not only enhances the system’s hosting capacity with minimal infrastructure modifications, but also provides additional technical benefits, including improved power quality and smart energy management. A real-world demonstrative hybrid ac/dc secondary distribution system was established in Red Deer, Alberta, Canada, with extensive testing conducted to validate its technical benefits and practical value.

Metastatic bone disease (MBD) has a substantial impact on quality of life in cancer patients. Despite the prevalence of MBD, the incidence of post-operative venous thromboembolism (VTE) including pulmonary embolism (PE) and deep vein thrombosis (DVT) remains high and is likely under-reported. Additionally, there is a paucity of guidelines for directing optimal thromboprophylaxis in this high-risk patient population. The primary objective of this study was to evaluate the use of thromboprophylaxis in patients with MBD undergoing orthopaedic surgery. The secondary objectives were to determine the incidence of VTE and identify risk factors for developing VTE post-operatively. We have conducted a retrospective, multicentre cohort study of adult patients presenting for orthopaedic surgery for MBD of the long bones or pelvis across nine hospitals between 2006 and 2021. All VTE events were identified through chart review and were defined as an image-confirmed diagnosis of a DVT or PE. Outpatient prescriptions for post-operative thromboprophylaxis or anticoagulation were obtained from the regional Pharmaceutical Information Network (PIN). The PIN data search included prophylactic and therapeutic dosages for low-molecular weight heparin and direct oral anticoagulants, as well as therapeutic dosages of warfarin prescribed up to 90 days post-operatively. A binomial logistic regression analysis was performed to identify risk factors for developing VTE. A total of 558 patients were included with a median age of 67.3 years and 52.0% of patients were female. Breast, lung, prostate, renal cell carcinoma, and multiple myeloma were the most common primary malignancies (n=461, 82.5%). Lower extremity surgery was more prevalent, with 487 patients (87.3%) undergoing surgery of the femur, tibia, or pelvis. The indication for surgery was a pathologic fracture in 344 patients (61.7%) and an impending fracture in 214 patients (38.4%). The average post-operative length of stay was 10 days (95%CI: 9–12). Median follow-up was 8.0 months (95%CI: 6.8–9.7). Outpatient thromboprophylaxis was prescribed in only 198 patients (35.5%). Median duration of thromboprophylaxis was 30 days (IQR: 10–60). Thirty-four (6.1%) patients were on anticoagulation for chronic medical comorbidities. The incidence of VTE was 5.7% in the entire cohort, and 6.0% in patients undergoing surgery of the lower extremity. There were 24 PEs and 11 DVTs diagnosed. Notably, 10 PEs and six DVTs occurred in patients who were prescribed thromboprophylaxis. VTE was diagnosed a median of nine days post-operative (IQR: 5–36). Lack of outpatient prescription of thromboprophylaxis and a pathologic fracture were identified as risk factors for developing a VTE on logistic regression (p = 0.025 and p = 0.028, respectively) while age, sex, primary malignancy, surgical technique, and fixation strategy were not significant. We have identified low rates of thromboprophylaxis prescribing in patients undergoing orthopaedic surgery for MBD with a high rate of VTE (5.7%). As patients underwent diagnostic investigations for a VTE based on clinical indications, the true rate of VTE may be greater. This research highlights the need for evidence-based guidelines to optimize post-operative protocols and improve patient care in this high-risk population.

This study examines the challenges faced by entrepreneurs during the COVID-19 pandemic, with an emphasis on their learning processes, the strategies they implemented, and the insights they earned. The research employs Interpretative Phenomenological Analysis (IPA) to provide insights into entrepreneurs’ experiences during the crisis. We used purposeful sampling to select small and medium-sized business owners on Java Island who survived the pandemic. We conducted semi-structured interviews and analyzed the data using NVIVO 12 software. This study introduces the Survival Learning Framework (SLF), a structured approach enabling entrepreneurs to navigate crises like COVID-19. SLF consists of three phases—knowing, understanding, and execution—emphasizing resilience, strategic awareness, and holistic transformation to foster adaptability and long-term sustainability. The Survival Learning Framework (SLF) offers a structured, multidisciplinary approach to entrepreneurial resilience, prioritizing transformation and long-term growth over mere recovery. By integrating adaptive resilience, experiential learning, and effectuation theories, it fills a critical literature gap, providing both theoretical advancements and practical strategies for navigating crises like COVID-19.

The purpose of this guideline is to promote recognition and preventive strategies for obstetrical anal sphincter injuries. Furthermore, it provides guidance on primary repair and immediate postpartum management for obstetrical anal sphincter tears in order to minimize further negative sequelae. All patients having a vaginal delivery and those who have sustained an obstetrical anal sphincter injury. Certain preventive strategies have been associated with lower rates of obstetrical anal sphincter injuries (e.g., fetal head flexion and control, appropriate use of mediolateral episiotomy). Management strategies, including appropriate diagnosis and repair of obstetrical anal sphincter injuries, antibiotic prophylaxis, and bowel and bladder function management can decrease associated short- and long-term complications. Implementation of the recommendations in this guideline may increase detection, prevention, and appropriate management of obstetrical anal injuries, thus limiting the future burden associated with these injuries. Implementation of the recommended classification of obstetrical anal sphincter injuries will improve national and international research efforts. Published literature was retrieved through searches of PubMed, Ovid, Medline, Embase, Scopus, and the Cochrane Library from September 1, 2014, through November 30, 2023, using appropriate MeSH terms (delivery, obstetrics, obstetric surgical procedures, obstetric labor complications, anal canal, episiotomy) and keywords (OASIS, obstetrical anal sphincter injury, anal injury, anal sphincter, vaginal delivery, suture, fecal incontinence, anal incontinence, overlap repair, end-to-end repair, bladder protocol, analgesia). Results were restricted to systematic reviews, meta-analyses, randomized controlled trials/controlled clinical trials, observational studies, and clinical practice guidelines. Results were limited to English- or French-language materials. Evidence was supplemented with references from the 2015 Society of Obstetricians and Gynaecologists of Canada guideline no.330. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (TablesA1 for definitions and A2 for interpretations of strong and conditional recommendations). Obstetrical care providers. Updated Canadian guideline on recognition, prevention and management of obstetrical anal sphincter injuries (OASIS). RECOMMENDATIONS.