Search results for: quality and outcomes framework

Authors: Hassan Y. Kikhia, Jin P. Zhang, Khaldoon G. Albiatr

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The Enron and Arthur Andersen scandal has raised concerns internationally about auditor independence and audit quality. Furthermore, the debate continues about the relationship between audit fees, auditor tenure and audit quality in spite of extensive empirical evidence examining audit failures and earnings management. Therefore, the purpose of current research is to determine the effect of audit fee and audit tenure both partially and simultaneously on the audit quality. Using a sample of Chinese firms, an environment where we believe it provides us with an opportunity to test whether the development of market and legal institutions affects the impact of audit fees and auditor tenure on audit quality. We employ the standard deviation of residuals from regressions relating current accruals to cash flows as proxy for audit quality. The paper documents statistically significant negative association between audit fees and audit quality. These findings are consistent with economic bonding being a determinant of auditor behavior rather than auditor reputational concerns. Further, the current paper shows a positive association between auditor tenure and audit quality in the earlier years of audit tenure. These results support the proposition that when the Learning Effect dominates the Bonding Effect in the earlier years of tenure, then audit quality is likely to be higher. Taken audit fees and audit tenure together, the results suggest that there is positive association between audit fees and audit quality in the earlier years of auditor tenure. Interestingly, the findings of our study have important implications for auditors, policymakers, multinational firms, and users of financial reports. As the rapid growth of China's economy gains global recognition, the Chinese stock market is capturing the attention of international investors. To a lesser extent, our paper also differs from the prior studies in methodology and findings in the investigation of audit quality.

Keywords: audit quality, accruals quality, audit fees, auditor tenure

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Authors: Andhiani Sharfina Arnellya, Mochammad Indra Permana, Dika Pramita Destiani, Ellin Febrina

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Health Research Data, Ministry of Health of Indonesia in 2007, showed coronary heart disease (CHD) or coronary artery disease (CAD) was the third leading cause of death in Indonesia after hypertension and stroke with 7.2% incidence rate. Antiplatelet is one of the important therapy in management of patients with CHD. In addition to therapeutic effect on patients, quality of life is one aspect of another assessment to see the success of antiplatelet therapy. The purpose of this study was to determine the quality of life of patients on oral antiplatelet therapy in outpatient cardiac department Dr. Hasan Sadikin central general hospital, Bandung, Indonesia. This research is a cross sectional by collecting data through quality of life questionnaire of patients which performed prospectively as primary data and secondary data from medical record of patients. The results of this study showed that 54.3% of patients had a good quality of life, 45% had a moderate quality of life, and 0.7% had a poor quality of life. There are no significant differences in quality of life-based on age, gender, diagnosis, and duration of drug use.

Keywords: antiplatelet, quality of life, coronary artery disease, coronary heart disease

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Authors: Mohamed Raouf Benmakrelouf, Joseph Rynkiewicz

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Targeted maximum likelihood estimation (TMLE) is well-established method for causal effect estimation with desirable statistical properties. TMLE is a doubly robust maximum likelihood based approach that includes a secondary targeting step that optimizes the target statistical parameter. A causal interpretation of the statistical parameter requires assumptions of the Rubin causal framework. The causal effect of binary variable, E, on outcomes, Y, is defined in terms of comparisons between two potential outcomes as E[YE=1 − YE=0]. Our aim in this paper is to present an adaptation of TMLE methodology to estimate the causal effect of a non-binary categorical variable, providing a large application. We propose coding on the initial data in order to operate a binarization of the interest variable. For each category, we get a transformation of the non-binary interest variable into a binary variable, taking value 1 to indicate the presence of category (or group of categories) for an individual, 0 otherwise. Such a dummy variable makes it possible to have a pair of potential outcomes and oppose a category (or a group of categories) to another category (or a group of categories). Let E be a non-binary interest variable. We propose a complete disjunctive coding of our variable E. We transform the initial variable to obtain a set of binary vectors (dummy variables), E = (Ee : e ∈ {1, ..., |E|}), where each vector (variable), Ee, takes the value of 0 when its category is not present, and the value of 1 when its category is present, which allows to compute a pairwise-TMLE comparing difference in the outcome between one category and all remaining categories. In order to illustrate the application of our strategy, first, we present the implementation of TMLE to estimate the causal effect of non-binary variable on outcome using simulated data. Secondly, we apply our TMLE adaptation to survey data from the French Political Barometer (CEVIPOF), to estimate the causal effect of education level (A five-level variable) on a potential vote in favor of the French extreme right candidate Jean-Marie Le Pen. Counterfactual reasoning requires us to consider some causal questions (additional causal assumptions). Leading to different coding of E, as a set of binary vectors, E = (Ee : e ∈ {2, ..., |E|}), where each vector (variable), Ee, takes the value of 0 when the first category (reference category) is present, and the value of 1 when its category is present, which allows to apply a pairwise-TMLE comparing difference in the outcome between the first level (fixed) and each remaining level. We confirmed that the increase in the level of education decreases the voting rate for the extreme right party.

Keywords: statistical inference, causal inference, super learning, targeted maximum likelihood estimation

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Authors: Mariam Kutateladze

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In the twenty-first century, in the customer service settings for hospitality institution’s employee management and their well-being have become a core issue since it is linked to the customers' increased demand for high-quality service. Employees' positive attitude to customers plays an essential role in the serving process; for this reason, in the hospitality institutions service with a smile is a job requirement. This research is devoted to the issues of employee management systems improvement and its effect of the genuine smile as a positive attitude expressed by the employees to the customer. Different researchers work about the effect of the genuine smile, which is analyzed in the present paper. Based on it, the link between satisfied employees from service climate and their genuine smile is determined. An investigation in local resort hotels which are located in the regions of Georgia is conducted. In the methodology of the paper, we have used linkage research, which stated that employee satisfaction in a working place depends on the existing service climate in an organization. We have prepared questioners according to eight dimensions of good service climate by linkage research, and extra questions about the effect of the smile on customers were added. Questionnaires were distributed among employees, and the results have shown that dissatisfaction from organizations’ service climate led to employees' false smile toward customers. Demanding positive emotions from frustrated employees was the mistake of the hotel management. The false smile was easily recognized by the customers, and the frustrated employee with a false smile could not provide high-quality service. The findings of the paper will help managers to realize the importance of forming the positive service climate within the institutions since it is linked to employees' well-being who are the creators of high-quality service. The conclusion drawn from this study indicates there are core issues those managers need to take into account when planning their organizations’ profit. Managers should know their employees very well, their feelings and attitudes toward work before asking them expressing a smile since forced smile does not have a good result and quite often has bad outcomes; therefore, first of all, managers should investigate service climate in the organization. Managers should take into consideration employees’ opinions about the service climate in the organization, motivate their employees, and respect their ideas. Also, they should satisfy employees' basic needs and stress more value on extrinsic goals such as competence, relatedness, and autonomy. Managers should create a positive working environment, positive service climate, which will lead to employee satisfaction and genuine feelings, as well as improve the working environment since negative working climate will cause customers disappointment because of low-quality service provided by the unsatisfied employees.

Keywords: employee management, hotel, quality of service, service climate

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Authors: Herbert Ntuli, Edwin Muchapondwa

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This study used a sample of 336 households and community level data from 30 communities around the Gonarezhou National Park in Zimbabwe to analyse the association between ability to self-organize or cooperation and institutions on one hand and the relationship between success of biodiversity outcomes and cooperation on the other hand. Using both the ordinary least squares and instrumental variables estimation with heteroskedasticity-based instruments, our results confirmed that sound institutions are indeed an important ingredient for cooperation in the respective communities and cooperation positively and significantly affects biodiversity outcomes. Group size, community level trust, the number of stakeholders and punishment were found to be important variables explaining cooperation. From a policy perspective, our results show that external enforcement of rules and regulations does not necessarily translate into sound ecological outcomes but better outcomes are attainable when punishment is rather endogenized by local communities. This seems to suggest that communities should rather be supported in such a way that robust institutions that are tailor made to suit the needs of local condition will emerge that will in turn facilitate good environmental husbandry. Cooperation, training, benefits, distance from the nearest urban canter, distance from the fence, social capital average age of household head, fence and information sharing were found to be very important variables explaining the success of biodiversity outcomes ceteris paribus. Government programmes should target capacity building in terms of institutional capacity and skills development in order to have a positive impact on biodiversity. Hence, the role of stakeholders (e.g., NGOs) in capacity building and government effort should complement each other to ensure that the necessary resources are mobilized and all communities receive the necessary training and resources.

Keywords: institutions, self-organize, common pool resources, wildlife, conservation, Zimbabwe

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Authors: Moon-Soo Kim

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In order to cope with the increasing demand for multidisciplinary learning between academy and industry, a collaborative teaching and learning model and related operational tools enabling applications to engineering education are essential. This study proposes a web-based collaborative framework for interactive teaching and learning between academy and industry as an initial step for the development of a web- and mobile-based integrated system for both engineering students and industrial practitioners. The proposed web-based collaborative teaching and learning framework defines several entities such as learner, solver and supporter or sponsor for industrial problems, and also has a systematic architecture to build information system including diverse functions enabling effective interaction among the defined entities regardless of time and places. Furthermore, the framework, which includes knowledge and information self-reinforcing mechanism, focuses on the previous problem-solving records as well as subsequent learners’ creative reusing in solving process of new problems.

Keywords: collaborative teaching and learning model, academy and industry, web-based collaborative framework, self-reinforcing mechanism

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Authors: Fatima Saeed, Abdullah Mudassar

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Introduction: Patient safety remains a global priority in the ever-evolving healthcare landscape. At the forefront of this endeavor are the International Patient Safety Goals (IPSGs), a standardized framework designed to mitigate risks and elevate the quality of care. Doctors, positioned as primary caregivers, wield a pivotal role in upholding and adhering to IPSGs, underscoring the critical significance of their knowledge and understanding of these goals. This research embarks on a comprehensive exploration into the depth of Doctors ' comprehension of IPSGs, aiming to unearth potential gaps and provide insights for targeted educational interventions. Established by influential healthcare bodies, including the World Health Organization (WHO), IPSGs represent a universally applicable set of objectives spanning crucial domains such as medication safety, infection control, surgical site safety, and patient identification. Adherence to these goals has exhibited substantial reductions in adverse events, fostering an overall enhancement in the quality of care. This study operates on the fundamental premise that an informed Doctors workforce is indispensable for effectively implementing IPSGs. A nuanced understanding of these goals empowers Doctors to identify potential risks, advocate for necessary changes, and actively contribute to a safety-centric culture within healthcare institutions. Despite the acknowledged importance of IPSGs, there is a growing concern that nurses may need more knowledge to integrate these goals into their practice seamlessly. Methodology: A Comprehensive research methodology covering study design, setting, duration, sample size determination, sampling technique, and data analysis. It introduces the philosophical framework guiding the research and details material, methods, and the analysis framework. The descriptive quantitative cross-sectional study in teaching care hospitals utilized convenient sampling over six months. Data collection involved written informed consent and questionnaires, analyzed with SPSS version 23, presenting results graphically and descriptively. The chapter ensures a clear understanding of the study's design, execution, and analytical processes. Result: The survey results reveal a substantial distribution across hospitals, with 34.52% in MTIKTH and 65.48% in HMC MTI. There is a notable prevalence of patient safety incidents, emphasizing the significance of adherence to IPSGs. Positive trends are observed, including 77.0% affirming the "time-out" procedure, 81.6% acknowledging effective healthcare provider communication, and high recognition (82.7%) of the purpose of IPSGs to improve patient safety. While the survey reflects a good understanding of IPSGs, areas for improvement are identified, suggesting opportunities for targeted interventions. Discussion: The study underscores the need for tailored care approaches and highlights the bio-socio-cultural context of 'contagion,' suggesting areas for further research amid antimicrobial resistance. Shifting the focus to patient safety practices, the survey chapter provides a detailed overview of results, emphasizing workplace distribution, patient safety incidents, and positive reflections on IPSGs. The findings indicate a positive trend in patient safety practices with areas for improvement, emphasizing the ongoing need for reinforcing safety protocols and cultivating a safety-centric culture in healthcare. Conclusion: In summary, the survey indicates a positive trend in patient safety practices with a good understanding of IPSGs among participants. However, identifying areas for potential improvement suggests opportunities for targeted interventions to enhance patient safety further. Ongoing efforts to reinforce adherence to safety protocols, address identified gaps, and foster a safety culture will contribute to continuous improvements in patient care and outcomes.

Keywords: infection control, international patient safety, patient safety practices, proper medication

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Authors: Arezoo Sadrinezhad, Kallol Sett, S. I. Hariharan

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In this paper, a probabilistic framework based on Fokker-Planck-Kolmogorov (FPK) approach has been applied to simulate triaxial cyclic constitutive behavior of uncertain soils. The framework builds upon previous work of the writers, and it has been extended for cyclic probabilistic simulation of triaxial undrained behavior of soils. von Mises elastic-perfectly plastic material model is considered. It is shown that by using probabilistic framework, some of the most important aspects of soil behavior under cyclic loading can be captured even with a simple elastic-perfectly plastic constitutive model.

Keywords: elasto-plasticity, uncertainty, soils, fokker-planck equation, fourier spectral method, finite difference method

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Authors: Mohammed S. Bhader, Abdullah A. Ghaddaf, Anas Alamoudi, Amal Abualola, Renad Kalantan, Noura Alkhulaifi, Ibrahim Halawani, Mohammed Alhindi

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Background: Noninvasive neurally adjusted ventilatory assist (NAVA) is a relatively new mode of noninvasive ventilation with promising clinical and patient-ventilator outcomes for preterm infants. The aim of this systematic review was to compare NAVA to nasal continuous or positive airway pressure (NCPAP) or intermittent positive airway pressure (NIPP) for preterm infants. Methods: We searched the online databases Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared NAVA to NCPAP or NIPP for preterm infants < 37 weeks gestational age. We sought to evaluate the following outcomes: noninvasive intubation failure rate, desaturation rate, the fraction of inspired oxygen (FiO2), and length of stay in the neonatal intensive care unit (NICU). We used the mean difference (MD) to represent continuous outcomes, while the odds ratio (OR) was used to represent dichotomous outcomes. Results: A total of 11 RCTs that enrolled 429 preterm infants were deemed eligible. NAVA showed similar clinical outcomes to NCPAP or NIPP with respect to noninvasive intubation failure (RR for NAVA versus NCPAP: 0.82, 95% confidence interval (CI): 0.49 to 1.37), desaturation rate (RR for NAVA versus NCPAP: 0.69, 95%CI: 0.36 to 1.29; RR for NAVA versus NIPP: 0.58, 95%CI: 0.08 to 4.25), FiO2 (MD for NAVA versus NCPAP: –0.01, 95%CI: –0.04 to 0.02; MD for NAVA versus NIPP: –7.16, 95%CI: –22.63 to 8.31), and length of stay in the NICU (MD for NAVA versus NCPAP: 1.34, 95%CI: –4.17 to 6.85). Conclusion: NAVA showed similar clinical and ventilator-related outcomes compared to the usual care noninvasive respiratory support measures NCPAP or NIPP for preterm infants.

Keywords: preterm infants, noninvasive neurally adjusted ventilatory assist, NIV-NAVA, non-invasive ventilation, nasal continuous or positive airway pressure, NCPAP, intermittent positive airway pressure ventilation, NIPP, respiratory distress syndrome, RDS

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Authors: Yizhen Zhao, Adam S. Z. Belloum, Goncalo Maia Da Costa, Zhiming Zhao

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Machine learning has evolved from an area of academic research to a real-word applied field. This change comes with challenges, gaps and differences exist between common practices in academic environments and the ones in production environments. Following continuous integration, development and delivery practices in software engineering, similar trends have happened in machine learning (ML) systems, called MLOps. In this paper we propose a framework that helps to streamline and introduce best practices that facilitate the ML lifecycle in an industrial setting. This framework can be used as a template that can be customized to implement various machine learning experiment. The proposed framework is modular and can be recomposed to be adapted to various use cases (e.g. data versioning, remote training on cloud). The framework inherits practices from DevOps and introduces other practices that are unique to the machine learning system (e.g.data versioning). Our MLOps practices automate the entire machine learning lifecycle, bridge the gap between development and operation.

Keywords: cloud computing, continuous development, data versioning, DevOps, industrial setting, MLOps

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Authors: Abongile Zweni

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As a post-apartheid strategy to redress the social imbalances of the past, local governments are tasked with the role of delivering crucial services to their constituents. Apart from political instability, evidence shows that managers in South African municipalities lack effective financial management skills and competencies. This resulted in a failure to fulfill its administrative obligations, particularly municipal financial management. Most municipalities have, however, failed in this role, which has led them to be placed under administration by the provincial government in terms of Section 139 of the constitution of the Republic of South Africa. Thus, this study proposed a leadership conceptual framework for effectively managing ever-eroding municipal finances in South Africa. The study adopted a desktop research approach to explore the key components of leadership and municipal financial management toward the development of the conceptual framework. The study fostered a better understanding of the need for transformation in relation to the current financial management practices and sustainability of a municipality. Moreover, the conceptual framework applies not only to municipalities but also to other government departments and public authorities in the country for financial management.

Keywords: leadership, municipal finance, financial performance, management skills, municipality

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Authors: Aman Kaur, Colin Ribton, Wamadeva Balachandaran

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Electron beam welding due to its inherent advantages is being extensively used for material processing where high precision is required. Especially in aerospace or nuclear industries, there are high quality requirements and the cost of materials and processes is very high which makes it very important to ensure the beam quality is maintained and checked prior to carrying out the welds. Although the processes in these industries are highly controlled, however, even the minor changes in the operating parameters of the electron gun can make large enough variations in the beam quality that can result in poor welding. To measure the beam quality a simple device has been designed that can be used at high powers. The device consists of two slits in x and y axis which collects a small portion of the beam current when the beam is deflected over the slits. The signals received from the device are processed in data acquisition hardware and the dedicated software developed for the device. The device has been used in controlled laboratory environments to analyse the signals and the weld quality relationships by varying the focus current. The results showed matching trends in the weld dimensions and the beam characteristics. Further experimental work is being carried out to determine the ability of the device and signal processing software to detect subtle changes in the beam quality and to relate these to the physical weld quality indicators.

Keywords: electron beam welding, beam quality, high power, weld quality indicators

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Authors: Kimberley K. Whyte-Jones

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Public participation may improve the quality of environmental management decisions. However, the quality of such a decision is strongly dependent on the quality of the process that leads to it. In order to ensure an effective and efficient process, key features of best practice in participation should be carefully observed; this would also combat disillusionment of citizens, decision-makers and practitioners. The overarching aim of this study is to determine what constitutes an effective public participation process relevant to the Newfoundland and Labrador, Canada context, and to discover whether the public participation process that led to the 2014-2024 Provincial Sustainable Forest Management Strategy (PSFMS) met best practices criteria. The research design uses an exploratory case study strategy to consider a specific participatory process in environmental decision-making in Newfoundland and Labrador. Data collection methods include formal semi-structured interviews and the review of secondary data sources. The results of this study will determine the validity of a specific public participation best practice framework. The findings will be useful for informing citizen participation processes in general and will deduce best practices in public participation in environmental management in the province. The study is, therefore, meaningful for guiding future policies and practices in the management of forest resources in the province of Newfoundland and Labrador, and will help in filling a noticeable gap in research compiling best practices for environmentally related public participation processes.

Keywords: best practices, environmental decision-making, forest management, public participation

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Authors: Duran Fiack, Jeremy Cumberbatch, Michael Sutherland, Nadine Zerphey

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Civic leaders have increasingly relied upon local climate adaptation plans to identify vulnerabilities, prioritize goals, and implement actions in order to prepare cities for the present and projected effects of global climate change. The concept of sustainability is central to these efforts, as climate adaptation discussions are often framed within the context of economic resilience, environmental protection, and the distribution of climate change impacts across various socioeconomic groups. For urban centers, the climate change issue presents unique challenges for each of these dimensions; however, its potential impacts on marginalized populations are extensive. This study draws from the ‘just sustainabilities’ framework to perform a qualitative analysis of climate adaptation plans prepared by 22 of the 100 largest U.S. cities and examine whether, and to what extent, such initiatives prioritize social equity improvements. Past research has found that the integration of sustainability in urban policy and planning often produces outcomes that favor environmental and economic objectives over social equity improvements. We find that social equity is a particularly prominent theme in local-level climate adaptation efforts, relative to environmental quality and economic development. The findings contribute to the literature on climate adaptation and sustainability within the urban context and offer practical insight for local-level stakeholders concerning potential obstacles and opportunities for the integration of social equity initiatives into climate adaptation planning. Given the likelihood that climate changes will continue to impose unique challenges for marginalized communities in urban areas, advancing our understanding of how social equity concerns are integrated into adaptation efforts is likely to become an increasingly critical area of inquiry.

Keywords: climate adaptation plan, climate change, social equity, sustainability

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Authors: Rizwan Ali, Hammad Zafar

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The purpose of this research is to investigate the mediation effect of customer satisfaction in the relationship between service quality, corporate image to customer loyalty, in Pakistan banking sector. The population of this research is banking customers and sample size of 210 respondents. This research uses the SPSS, Correlation, ANOVA and regression analysis techniques along with AMOS methods. The service quality and corporate image applied by the banks are not all variables can directly affect customer loyalty, but must first going through satisfaction. Which means that banks must first need to understand what the customer basic needs through variable service quality and corporate image so that the customers feel loyal when the level of satisfaction is resolved. The service quality provided by the banking industry needs to be improved in order to improve customer satisfaction and loyalty of banking services, especially for banks in Pakistan.

Keywords: customer loyalty, service quality, corporate image, customer satisfaction

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Authors: Rizwan Iqbal

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Introduction: Re-TURBT has been recommended by international guidelines for patients with non-muscle invasive bladder cancer (NMIBC) who are deemed high-risk. Indications for re-TURBTs remain controversial and studies show mixed outcomes. It should be performed when the initial TURBT specimen lacks detrusor muscle, has tumor stage pT1 or G3/high-grade, or where resection is deemed incomplete. This ensures complete resection of tumors that have a high risk of recurrence as well as accurately identifying any tumors which have been upstaged. The aim of this audit was to evaluate the quality of re-TURBTs in a district general hospital. Method: Data were retrospectively collected from 31 patients who had re-TURBTs between April 2021 and September 2022. Data included baseline demographics, time from initial to re-TURBT, quality of operation note, presence of residual tumor, complications, and administration of chemotherapy within 24 hours of the initial TURBT. Data collection remains ongoing at the time of writing. Results: The mean age was 76 years old and 71.0% of patients were male. 32.3% of patients had their re-TURBT within six weeks and 32.3% had intravesical chemotherapy administered within 24 hours of the initial TURBT. 74.2% of initial TURBTs had detrusor muscle present in the specimen. 48.4% of patients had residual disease following re-TURBT. Just one patient had their pathology upstaged at re-TURBT. The use of the TURBT proforma on the operation note was variable, with 51.6% and 38.7% of surgeons using the proforma after the initial and re-TURBT. Conclusion: Re-TURBT improves bladder cancer staging and is necessary in patients who are deemed high-risk in order to identify any upstaging or recurrence of the disease.

Keywords: urology, bladder cancer, turbt, cancer

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Authors: Bernard Owusu Asare

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This study investigates the implementation and efficacy of community policing within the Ghana Police Service, with a focus on its impact on local communities. Emphasizing the goal of creating safer environments and improving the overall quality of life, the research engages opinion leaders from selected communities in Ghana, as well as members of the police force stationed within these communities. Employing a semi-structured interview guide as the primary research instrument, data collection involves face-to-face interviews conducted at respondents' residences and policing centers. The preliminary findings underscore the pivotal role of collaborative efforts between community elders and police personnel in the successful execution of community policing initiatives. Furthermore, the study identifies gainful employment for the youth as a key determinant of effective policing, highlighting the interconnectedness of socioeconomic factors with law enforcement outcomes. The study further reveals that access to the internet emerges as a factor influencing both policing practices and the overall quality of life within these communities. By contextualizing the dynamics of community policing in the local Ghanaian context, this research aims to contribute valuable insights to the ongoing discourse on effective law enforcement strategies and their impact on community well-being.

Keywords: community, policing, police service, Ghana

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Authors: Hsin-Hung Lai, Wei Lo

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Whether it is in virtue or vice for a construction quality of public construction project, it is one of the important indicators for national economic development and overall construction, the impact on the quality of national life is very deep. In recent years, a number of scandal of public construction project occurred, the requirements of the government agencies and the public require the quality of construction of public construction project are getting stricter than ever, the three-level public construction project construction quality of quality control system implemented by the government has a profound impact. This study mainly aggregated the evolution of ISO 9000 quality control system, the difference between the practice of implementing management of construction quality by many countries and three-level quality control of our country, so we explored and found that almost all projects of enhancing construction quality are dominated by civil organizations in foreign countries, whereas, it is induced by the national power in our country and develop our three-level quality control system and audit mechanism based on IOS system and implement the works by legislation, we also explored its enhancement and relevance with construction quality of public construction project that are intervened by such system and national power, and it really presents the effectiveness of construction quality been enhanced by the audited result. The three-level quality control system of our country to promote the policy of public construction project is almost same with the quality control system of many developed countries; however our country mainly implements such system on public construction project only, we promote the three-level quality control system is for enhancing the quality of public construction project, for establishing effective quality management system, so as to urge, correct and prevent the defects of quality management by manufacturers, whereas, those developed countries is comprehensively promoting (both public construction project and civil construction) such system. Therefore, this study is to explore the scope for public construction project only; the most important is the quality recognition by the executor, either good quality or deterioration is not a single event, there is a certain procedure extends from the demand and feasibility analysis, design, tendering, contracting, construction performance, inspection, continuous improvement, completion and acceptance, transferring and meeting the needs of the users, all of mentioned above have a causal relationship and it is a systemic problems. So the best construction quality would be manufactured and managed by reasonable cost if it is by extensive thinking and be preventive. We aggregated the implemented results in the past 10 years (2005 to 2015), the audited results of both in central units and local ones were slightly increased in A-grade while those listed in B-grade were decreased, although the levels were not evidently upgraded, yet, such result presents that the construction quality of concept of manufacturers are improving, and the construction quality has been established in the design stage, thus it is relatively beneficial to the enhancement of construction quality of overall public construction project.

Keywords: ISO 9000, three-level quality control system, audit and review mechanism for construction implementation, quality of construction implementation

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Authors: Abdullah Alshehab

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Governments worldwide are intensely focused on digitizing public transactions to establish reliable e-government services. The advent of new digital technologies and ongoing advancements in ICT have profoundly transformed business operations. Citizen engagement and participation in e-government services are crucial for the system's success. However, it is essential to measure and enhance citizen satisfaction levels to effectively evaluate and improve these systems. Citizen satisfaction is a key criterion that allows government institutions to assess the quality of their services. There is a strong connection between information quality, service quality, and system quality, all of which directly impact user satisfaction. Additionally, both system quality and information quality have indirect effects on citizen satisfaction. A causal map, which is a network diagram representing causes and effects, can illustrate these relationships. According to the literature, the main factors influencing citizen satisfaction are trust, reliability, citizen support, convenience, and transparency. This paper investigates the causal relationships among these factors and identifies any interrelatedness between them.

Keywords: e-government services, e-satisfaction, citizen satisfaction, causal map.

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Authors: Emily Purdom, Rachel Robinson

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As the number of students worldwide requiring speech-language therapy, occupational therapy and mental health services during their school day increases, innovation is becoming progressively more important to meet the demand. Telepractice can be used to reach a greater number of students requiring specialized therapy while maintaining the highest quality of care. It can be provided in a way that is not only effective but ultimately more convenient for student, teacher and therapist without the added burden of travel. Teletherapy eradicates many hurdles to traditional on-site service delivery and helps to solve the pervasive shortage of certified professionals. Because location is no longer a barrier to specialized education plans for students with disabilities when teletherapy is conducted, there are many advantages that can be deployed. Increased frequency of engagement is possible along with students receiving specialized care from a clinician that may not be in their direct area. Educational teams, including parents, can work together more easily and engage in face-to-face, student-centered collaboration through videoconference. Practical strategies will be provided for connecting students with qualified therapists without the typical in-person dynamic. In most cases, better therapy outcomes are going to be achieved when treatment is most convenient for the student and educator. This workshop will promote discussion in the field of education to increase advocacy for remote service delivery. It will serve as a resource for those wanting to expand their knowledge of options for students with special needs afforded through innovation.

Keywords: education technology, innovation, student support services, telepractice

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Authors: Mohammad Abdullah Almalki

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Background: Despite the frequent usage of ankle arthroscopy, there is limited medical literature regarding its indications, patterns of admissions, surgical outcomes, and associated complicated at Saudi Arabia. Hence, this study would highlight the surgical outcomes of such surgical approach that will assist orthopedic surgeons to detect which surgical procedure needs to be done as well as to help them regarding their diagnostic workups. Methods: At the Orthopedic Division of King Abdul‑Aziz Medical City in Riyadh and through a cross‑sectional design and convenient sampling techniques, the present study had recruited 20 subjects who fulfill the inclusion and exclusion criteria between 2016 and 2018. Data collection was carried out by a questionnaire designed and revised by an expert panel of health professionals. Results: Twenty patients were reviewed (11M and 9F) with an average age of 40.1 ± 12.2. Only 30% of the patients (5M, 1F) have no comorbidity, but 70% of patients (7M, 8F) were having at least one comorbidity. The most common indications were osteochondritis dissecans (n = 7, 35%), ankle fracture without dislocation (n = 4, 20%), and tibiotalar impingement (n = 3, 15%). Patients recorded pain in all cases (100%). The top four symptoms after pain were instability (30%, n = 6), muscle weakness (15%, n = 3) swelling (15%, n = 3), and stiffness (5%, n = 1). Two‑third of cases reached to their full healthy status and toe‑touch weight‑bearing was seen in two patients (10%). Conclusion: Ankle arthroscopy improved the rehabilitation rates in our tertiary care center. In addition, the surgical outcomes are favorable in our hospital since it has a very short length of stay, unexpended surgery, and fewest physiotherapy sessions.

Keywords: ankle, arthroscopy, indications, patterns

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Authors: Roghayeh Karami, Ahmad Gharaei

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Backgrounds and objectives: This study was undertaken at four different sites (north polluted, south polluted, south healthy and north healthy) in Tehran, in order to examine whether there was a relationship between publicly available air quality data and the public’s perception of air quality and to suggest some guidelines for reducing air pollution. Materials and Methods: A total of 200 people were accidentally filled out the research questionnaires at mentioned sites and air quality data were obtained simultaneously from the Air Quality Control Department. Data was analyzed in Excel and SPSS software. Results: Clean air and secure job were of great importance to people comparing to other pleasant aspect of life. Also air pollution and fear of dangerous diseases were the most important of people concerns. The Indies bored /news paper services on air quality were little used by the public as a means of obtaining information on air pollution. Using public transportation and avoid unessential journeys are the most important ways for reducing air pollution. Conclusion: The results reveal that the public’s perception of air quality is not a reliable indicator of the actual levels of air pollution. Current earths to down actions are not effective and enough in reducing air pollution, therefore it seems participatory management and public participation is suitable guideline.

Keywords: air pollution, quality of life, opinion poll, public participation

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Authors: Christian Neunzig, Simon Fahle, Jürgen Schulz, Matthias Möller, Bernd Kuhlenkötter

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The increasing use of deep learning applications in production is becoming a competitive advantage. Predictive quality enables the assurance of product quality by using data-driven forecasts via machine learning models as a basis for decisions on test results. The use of real Bosch production data along the value chain of hydraulic valves is a promising approach to classifying the leakage of directional valves.

Keywords: artificial neural networks, classification, hydraulics, predictive quality, deep learning

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Authors: Jane E. Hill

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Quality of life is an important component for many. With that in mind, everyone will experience some type of loss within his or her lifetime. A person can experience loss due to break up, separation, divorce, estrangement, or death. An individual may experience loss of a job, loss of capacity, or loss caused by human or natural-caused disasters. An individual’s response to such a loss is unique to them, and not everyone will seek services to assist them with their grief due to loss. Counseling can promote positive outcomes for clients that are grieving by addressing the client’s personal loss and helping the client process their grief. However, a lack of understanding on the part of counselors of how people grieve may result in negative client outcomes such as poor health, psychological distress, or an increased risk of depression. Education and training in grief counseling can improve counselors’ problem recognition and skills in treatment planning. The purpose of this study was to examine whether the Council for Accreditation of Counseling and Related Educational Programs (CACREP) master’s degree counseling students view themselves as having been adequately trained in grief theories and skills. Many people deal with grief issues that prevent them from having joy or purpose in their lives and that leaves them unable to engage in positive opportunities or relationships. This study examined CACREP-accredited master’s counseling students’ self-reported competency, training, and education in providing grief counseling. The implications for positive social change arising from the research may be to incorporate and promote education and training in grief theories and skills in a majority of counseling programs and to provide motivation to incorporate professional standards for grief training and practice in the mental health counseling field. The theoretical foundation used was modern grief theory based on John Bowlby’s work on Attachment Theory. The overall research question was how competent do master’s-level counselors view themselves regarding the education or training they received in grief theories or counseling skills in their CACREP-accredited studies. The author used a non-experimental, one shot survey comparative quantitative research design. Cicchetti’s Grief Counseling Competency Scale (GCCS) was administered to CACREP master’s-level counseling students enrolled in their practicum or internship experience, which resulted in 153 participants. Using a MANCOVA, there was significance found for relationships between coursework taken and (a) perceived assessment skills (p = .029), (b) perceived treatment skills (p = .025), and (c) perceived conceptual skills and knowledge (p = .003). Results of this study provided insight for CACREP master’s-level counseling programs to explore and discuss curriculum coursework inclusion of education and training in grief theories and skills.

Keywords: counselor education and training, grief education and training, grief and loss, quality of life

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Authors: Fateme Hadadian, Behnam Khaledi Paveh, Hosein Feizi

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Background: High number of patients with end-stage renal disease worldwide, and Iran and the patients required hemodialysis, As well as symptoms and treatment process and its impact on quality of life The researcher had to take a step towards solving these problems. Methods: In randomized clinical trial in 60 hemodialysis patients admitted to hospital hemodialysis Imam Reza (AS) were studied. Using questionnaires dialysis patients' QOL, quality of life was measured in patients and controls were divided randomly into two groups. Benson's relaxation method for the experimental group and two months at home, once per day, respectively and the control group received no special action. Immediately after the end of the period with was used for evaluating the quality of life in both the experimental and control groups were survey and data using independent t-test were used for statistical analysis. Results: The general dimensions of quality of life scores before and after intervention, there was significant difference (P=0/001). But this difference was not significant after QOL (P=0/2). Between QOL scores before and after treatment between the two groups was statistically significant (P=0/02). Conclusion: Benson relaxation has the desired effect on quality of life in hemodialysis patients and can be used as a useful method to enhance the quality of life in hemodialysis patients, implementation and training will be given.

Keywords: hemodialysis, quality of life, Benson muscle relaxation, biomedicine

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Authors: Mariela Edith Arboit

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The main goal of the project is to explore the evolution possibilities of the morphological indicators of the built environment, including those resulting from progressive soil occupation, due to the relentless growth of the city’s population and subsequent increase in building density and solar access reduction per built unit. Two alternative normative proposals, Conventional Proposal (CP) and Alternative Proposal (AP), are compared. In addition, temporal scenarios of the city’s evolution process are analyzed, starting from the reference situation of existing, high-density built-up areas, and simulating their possible morphological outcomes on theoretical medium (30 yr.) and long (60 yr.) terms, as a result of the massive implementation of either regulation in the long run. The results obtained demonstrate that the Alternative Proposal (AP) presents higher mean values of predicted solar potential expressed by the Volumetric Insolation Factor total (VIFtot) for both time periods and services. Regarding environmental aspects, the different impacts of either alternative on the urban landscape quality seem to favor the AP proposal. Its deserved detailed assessment is also presently being developed through a quanti-qualitative methodology.

Keywords: building morphology, environmental quality, solar energy, urban sustainability

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Authors: Taylor Harris

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Gustilo-anderson grade III tibial fractures are exquisitely difficult injuries to manage as they require extensive soft tissue repair in addition to fracture fixation. These injuries are best managed collaboratively by Orthopedic and Plastic surgeons. While utilizing an Orthoplastics approach has decreased the rates of adverse outcomes in these injuries, there is a large amount of variation in exactly how an Orthoplastics team approaches complex cases such as these. It is sometimes recommended that definitive bone fixation and soft tissue coverage be completed simultaneously in a single-stage manner, but there is a paucity of large scale studies to provide evidence to support this recommendation. It is the aim of this study to report the outcomes of a single-stage "fix-and-flap" approach through a systematic review of the available literature. Hopefully, this better informs an evidence-based Orthoplastics approach to managing open tibial fractures. Systematic review of the literature was performed. Medline and Google Scholar were used and all studies published since 2000, in English were included. 103 studies were initially evaluated for inclusion. Reference lists of all included studies were also examined for potentially eligible studies. Gustilo grade III tibial shaft fractures in adults that were managed with a single-stage Orthoplastics approach were identified and evaluated with regard to outcomes of interest. Exclusion criteria included studies with patients <16 years old, case studies, systemic reviews, meta-analyses. Primary outcomes of interest were the rates of deep infections and rates of limb salvage. Secondary outcomes of interest included time to bone union, rates of non-union, and rates of re-operation. 15 studies were eligible. 11 of these studies reported rates of deep infection as an outcome, with rates ranging from 0.98%-20%. The pooled rate between studies was 7.34%. 7 studies reported rates of limb salvage with a range of 96.25%-100%. The pooled rate of the associated studies was 97.8%. 6 reported rates of non-union with a range of 0%-14%, a pooled rate of 6.6%. 6 reported time to bone union with a range of 24 to 40.3 weeks and a pooled average time of 34.2 weeks, and 4 reported rates of reoperation ranging from 7%-55%, with a pooled rate of 31.1%. A few studies that compared a single stage to a multi stage approach side-by-side unanimously favored the single stage approach. Outcomes of Gustilo grade III open tibial fractures utilizing an Orthoplastics approach that is specifically done in a single-stage produce low rates of adverse outcomes. Large scale studies of Orthoplastic collaboration that were not completed in strictly a single stage, or were completed in multiple stages, have not reported as favorable outcomes. We recommend that not only should Orthopedic surgeons and Plastic surgeons collaborate in the management of severe open tibial fracture, but they should plan to undergo definitive fixation and coverage in a single-stage for improved outcomes.

Keywords: orthoplastic, gustilo grade iii, single-stage, trauma, systematic review

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Authors: Sedigheh Salemi, Mahnaz Sanjari, Maryam Aalaa, Mohammad Mirzabeigi

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Clinical governance is the framework within which the health service provider is required to ongoing accountability and improvement of the quality of their services. This cross-sectional study was conducted in 661 nurses who work in government hospitals from 35 hospitals of 9 provinces in Iran. The study was approved by the Nursing Council and was carried out with the authorization of the Research Ethics Committee. The questionnaire included 24 questions in which 4 questions focused on clinical governance defining from the nurses' perspective. The reliability was evaluated by Cronbach's alpha (α=0/83). Statistical analyzes were performed, using SPSS version 16. Approximately 40% of nurses correctly answered that clinical governance is not "system of punishment and rewards for the staff". The most nurses believed that "clinical efficacy" is one of the main components of clinical governance. A few of nurses correctly responded that "Evidence Based Practice" and "management" is not part of clinical governance. The small number of nurses correctly answered that the "maintenance of patient records" and "to recognize the adverse effects" is not the role of nurse in clinical governance. Most "do not know" answer was to the "maintenance of patient records". The most nurses unanimously believed that the implementation of clinical governance led to "promoting the quality of care". About a third of nurses correctly stated that the implementation of clinical governance will not lead to "an increase in salaries and benefits of the medical team". As a member of the health team, nurses are responsible in terms of participation in quality improvement and it is necessary to create an environment in which clinical care will flourish and serve to preserve the high standards.

Keywords: clinical governance, nurses, salary, health team

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Authors: Fakhruddin Esa, Yusri Yusof

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The confirmatory of Total Quality Management (TQM) implementation is most vital in quality management. This paper focuses on employees' perceptions towards TQM implementation in a local automotive company supplier. The objectives of this study are first and foremost to determine the perception of TQM implementation among the staff, and secondly to ascertain the correlation between the variables, and lastly to identify the relative influence of the 10 TQM variables on the cost of poor quality (COPQ). The TQM implementation is perceived to be moderate. All correlation is found to be significant and five variables having positively moderate to high correlation. Out of 10 variables, quality system improvement, reward and recognition and customer focus influence the perceived COPQ. This study extended a discussion on these three variables contribution to TQM in general and the human resource development in the organization. A significant recommendation to lowering costs of internal error, such as trouble shooting and scraps are also discussed. Certain components of further research that would add value to this study have also been suggested and perhaps could be implemented at policy-level initiatives.

Keywords: cost of poor quality (COPQ), correlation, total quality management (TQM), variables

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Authors: Kamal Kaushik, Trisha, Dandapni, Sambit Nanda, A. Mukherjee, S. Pradhan

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INTRODUCTION: As complexity in radiotherapy practice and processes are increasing, there is a need to assure quality control to a greater extent. At present, no international literature available with regards to the optimal quality control indicators for radiotherapy; moreover, few clinical audits have been conducted in the field of radiotherapy. The primary aim is to improve the processes that directly impact clinical outcomes for patients in terms of patient safety and quality of care. PROCEDURE: A team of an Oncologist, a Medical Physicist and a Radiation Therapist was formed for weekly clinical audits of patient’s undergoing radiotherapy audits The stages for audits include Pre planning audits, Simulation, Planning, Daily QA, Implementation and Execution (with image guidance). Errors in all the parts of the chain were evaluated and recorded for the development of further departmental protocols for radiotherapy. EVALUATION: The errors at various stages of radiotherapy chain were evaluated and recorded for comparison before starting the clinical audits in the department of radiotherapy and after starting the audits. It was also evaluated to find the stage in which maximum errors were recorded. The clinical audits were used to structure standard protocols (in the form of checklist) in department of Radiotherapy, which may lead to further reduce the occurrences of clinical errors in the chain of radiotherapy. RESULTS: The aim of this study is to perform a comparison between number of errors in different part of RT chain in two groups (A- Before Audit and B-After Audit). Group A: 94 pts. (48 males,46 female), Total no. of errors in RT chain:19 (9 needed Resimulation) Group B: 94 pts. (61 males,33 females), Total no. of errors in RT chain: 8 (4 needed Resimulation) CONCLUSION: After systematic periodic clinical audits percentage of error in radiotherapy process reduced more than 50% within 2 months. There is a great need in improving quality control in radiotherapy, and the role of clinical audits can only grow. Although clinical audits are time-consuming and complex undertakings, the potential benefits in terms of identifying and rectifying errors in quality control procedures are potentially enormous. Radiotherapy being a chain of various process. There is always a probability of occurrence of error in any part of the chain which may further propagate in the chain till execution of treatment. Structuring departmental protocols and policies helps in reducing, if not completely eradicating occurrence of such incidents.

Keywords: audit, clinical, radiotherapy, improving functionality

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