Search results for: technological audit

Authors: Ruth Green, Samantha Milton, Rinal Desai

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Background/Aims: Eye pain/swelling/redness is a common presentation to Barnet General Hospital (a district general hospital), pediatric emergency department, and is managed by both the pediatric and emergency teams. The management of each child differs dramatically depending on the healthcare professional who reviews them. There also appears to be confusion in diagnosis between periorbital cellulitis, pre-septal cellulitis, and orbital cellulitis. Pre septal cellulitis refers to an inflammation of the eyelids and soft tissue anterior to the orbital septum. In contrast, orbital cellulitis is a serious, rapidly progressive infection of soft tissues located posterior to the orbital septum. Pre-septal cellulitis is more prevalent and less serious than orbital cellulitis, although it may be part of a continuous spectrum if untreated. Pre-septal cellulitis should there be diagnosed and treated urgently to prevent spread to the septum. For the purpose of the audit, the term periorbital cellulitis has been used as an umbrella term for all spectrums of this infection. The audit aimed to look at, how as a whole, the department is diagnosing and managing orbital and pre-septal cellulitis. Gold Standard: Patients of the same age and diagnosis should be treated with the same medication, advice, and follow-up. Method: Data was collected retrospectively from pediatric patients ( < 18years) who attended the emergency department from June 2019 to February 2020 who had been coded as pre-septal cellulitis, periorbital cellulitis, orbital cellulitis, or eye pain/swelling/redness. Demographics, signs and symptoms, management, and follow-up were recorded for all patients with any of the diagnoses of pre-septal, periorbital, or orbital cellulitis. A Microsoft Excel spreadsheet was used to record the anonymised data. Results: There were vast discrepancies in the diagnosis, management, and follow-up of patients with periorbital cellulitis. Conclusion/Discussion: The audit concluded there is no uniform approach to managing periorbital cellulitis in Barnet General Hospital Paediatric Emergency Department. Healthcare professionals misdiagnosed conjunctivitis as periorbital cellulitis, and adequate steps did not appear to be documented on excluding red flag signs and symptoms of patients presenting. There was no consistency in follow-up, with some patients having timely phone reviews or clinical reviews for mild symptoms. Advice given by the staff was appropriate, and patients did return when symptoms got worse and were treated accordingly. Plan: Given the inconsistency, a gold standard care pathway or local easily accessible clinical guideline can be developed to help with the diagnosis and management of periorbital cellulitis. Along with this, a teaching session can be carried out for the staff of the pediatric team and emergency department to disseminate the teaching. Following the introduction of a guideline and teaching sessions, patients notes can be re-reviewed to check improvement in patient care.

Keywords: periorbital cellulitis, preseptal cellulitis, orbital cellulitis, erythematous eyelid

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Authors: Nicolas Koslover, Tamara Levene

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Aims: Tonsilitis is one of the most common presentations to the A+E department. We aimed to assess whether patients presenting with tonsilitis are being managed in-line with current guidance. We then set out to educate A+E staff about tonsilitis management and then assessed for improvement in management. Methods: All patients presenting to A+E in one fortnight with a documented diagnosis of tonsilitis were included. We reviewed the notes to assess the choice of treatment in each case and whether a clinical score (CENTOR or FEVERPain score) was used to guide choice of treatment (in accordance with NICE guideline [NG84]). We designed and delivered an educational intervention for A+E staff covering tonsilitis guidelines. The audit was repeated two weeks later. Results: Over the study period, 49 patients were included; only 35% (n=17) had either a clinical score documented or had all components of a score recorded. In total, 39% (n=19) were treated with antibiotics. Of these, 63% (n=12) should not have been prescribed an antibiotic and 37% (n=7) were prescribed an inappropriate antibiotic. At re-audit, (n=50 cases), 58% (n=29) had a clinical score documented and 28% (n=14) were treated with antibiotics. Of these, 29% (n=4) should not have been prescribed antibiotics and 21% (n=3) were prescribed an inappropriate antibiotic. Thus, after this teaching session, there was a significant improvement in antibiotic prescribing practices (63% vs. 29%, p=0.026). Conclusions: A+E assessment and management of tonsilitis frequently deviated from guidelines, but a single teaching session vastly improved clinical scoring and antibiotic prescribing practices.

Keywords: tonsilitis, education, emergency medicine, ENT

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Authors: John Kong Shan Ho

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Senior executives’ remunerations of public companies have aroused much debate and attention in the media. In the aftermath of the Global Financial Crisis (GFC), excessive executive pay arrangements were blamed for contributing to excessive risk-taking, which caused the financial meltdown. Since then, regulators and lawmakers around the world have introduced regulations to strengthen the corporate governance of listed companies. A key aspect of such reform is by strengthening regulatory intervention over executives’ remunerations and increasing the transparency of such information. This article is written against such background and examines the recent proposal by the UK BEIS to ask the FRC to amend the UK Corporate Governance Code (UKCGC) to strengthen clawback provisions for directors’ remuneration in listed companies as part of its audit reform. The article examines the background and debates regarding the possible implementation of such a measure in the UK. Contrary to the BEIS’ proposal, it argues that implementing it through the UKCGC is unlikely to enhance overall corporate governance and audit quality. It argues that the UK should follow the footsteps of its US and Dutch counterparts by enacting legislation to claw back directors’ remunerations. It will also provide some recommendations as to the key factors that need to be considered in drafting such a statutory provision.

Keywords: company law, corporate governance, agency problem, directors' remunerations, clawbacks

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Authors: Joan Edwards, J. Lawlor

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Technological innovation is frequently defined in terms of bringing a new invention to market through a relatively straightforward process of diffusion. In reality, this process is complex and non-linear in nature, and includes social and cognitive factors that influence the development of an emerging technology and its related market or environment. As recent studies contend technological trajectory is part of technological paradigms, which arise from the expectations and desires of industry agents and results in co-evolution, it may be realised that social factors play a major role in the development of a technology. It is conjectured that collective social behaviour is fuelled by individual motivations and expectations, which inform the possibilities and uses for a new technology. The individual outlook highlights the issues present at the micro-level of developing a technology. Accordingly, this may be zoomed out to realise how these embedded social structures, influence activities and expectations at a macro level and can ultimately strategically shape the development and use of a technology. These social factors rely on communication to foster the innovation process. As innovation may be defined as the implementation of inventions, technological change results from the complex interactions and feedback occurring within an extended environment. The framework presented in this paper, recognises that social mechanisms provide the basis for an iterative dialogue between an innovator, a new technology, and an environment - within which social and cognitive ‘identity-shaping’ elements of the innovation process occur. Identity-shaping characteristics indicate that an emerging technology has a performative nature that transforms, alters, and ultimately configures the environment to which it joins. This identity–shaping quality is termed as ‘performative’. This paper examines how technologies evolve within a socio-technological sphere and how 'performativity' facilitates the process. A framework is proposed that incorporates the performative elements which are identified as feedback, iteration, routine, expectations, and motivations. Additionally, the concept of affordances is employed to determine how the role of the innovator and technology change over time - constituting a more conducive environment for successful innovation.

Keywords: affordances, framework, performativity, strategic innovation

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Authors: Verónica Díaz Quezada

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Despite the wide variety of educational resources on the market and the advances produced in the technological field, the practice of teaching continues to be supported mainly by textbooks. This article reports on descriptive research with qualitative methodology carried out on secondary school mathematics teachers in a region of Chile, in order to describe the use and the indicators of appreciation that teachers have on the textbooks distributed by the official body to public educational establishments. Data were collected through an open response opinion questionnaire. According to the results, among the texts available for the annual performance of their teaching work, the expository and technological books predominate, to the detriment of comprehensive books. The exhibition structure favors master expositions and repetitive exercises, while, with the technological structure, a productive exercise is attempted, proposing numerous applications with the intention of giving meaning to the different mathematical rules and procedures. In relation to the indicators of appreciation that teachers have regarding the use of mathematics textbooks, the suitability and quality of the teaching resources are verified as the most satisfying characteristic.

Keywords: mathematics, secondary school, teachers, textbooks

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Authors: Vidya Iyer, Suresh Babu Loganathan, Yuan Hwa Lee, Kwong Fah Koh

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Introduction: It has been recommended that every patient undergoes careful preoperative evaluation in a preoperative clinic to improve theatre utilization, reduce bed occupancy and avoid unnecessary cancellation due to inadequate optimisation, communication and administrative errors. It also gives an opportunity to counsel patients regarding different aspects of anaesthesia. Methodology: A retrospective audit of all the patients seen in preoperative assessment clinic, referral letters of all the patients postponed / referred to other sub specialities in the perioperative period from June 2012 - June 2013 was done. In our clinic, we retrieved patient records who were awaiting surgery pending clearance by other sub specialities. Those patients, who could continue with their scheduled date of surgery after having been referred, were not included in the file. We also studied details of same day cancellations from the data base, during the same study period. The reasons for cancellation were examined and defined as avoidable and unavoidable. Results: Less than 0.5% was postponed from the scheduled day of surgery. Less than 0.5% was cancelled on the day of surgery. Conclusions: Patients who undergo pre anaesthetic evaluation in a well-established clinic results in adequate preoperative patient optimisation, avoids unnecessary preoperative admission, efficient theatre utilisation and greater patient satisfaction. The benefits are the result of guidelines and timely update of them which are used by the junior doctors and trainees who run the clinic and a dedicated specialist to supervise them.

Keywords: preoperative assessment, clinic, referrals, cancellation

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Authors: Fatemah Al-Baroud, Sudharani Shreenivas Kshatriya

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Kuwait Oil Company (KOC) is one of the companies for gas & oil production in Kuwait. The oil and gas industry is truly global; with operations conducted in every corner of the globe, the global community will rely heavily on oil and gas supplies. KOC has made many commitments to protect all due to KOC’s operations and operational releases. As per KOC’s strategy, the substantial increase in production activities will bring many challenges in managing various environmental hazards and stresses in the company. In order to handle those environmental challenges, the need of implementing effectively the health, safety, and environmental management system (HSEMS) is significant. And by implementing the HSEMS system properly, the environmental aspects of the activities, products, and services were identified, evaluated, and controlled in order to (i) Comply with local regulatory and other obligatory requirements; (ii) Comply with company policy and business requirements; and (iii) Reduce adverse environmental impact, including adverse impact to company reputation. Assessments for the Jurassic Production Facilities are being carried out as a part of the KOC HSEMS procedural requirement and monitoring the implementation of the relevant HSEMS procedures in the facilities. The assessments have been done by conducting series of theme audits using KOC’s audit protocol at JPFs. The objectives of the audits are to evaluate the compliance of the facilities towards the implementation of environmental procedures and the status of the KEPA requirement at all JPFs. The list of the facilities that were covered during the theme audit program are the following: (1) Jurassic Production Facility (JPF) – Sabriya (2) Jurassic Production Facility (JPF) – East Raudhatian (3) Jurassic Production Facility (JPF) – West Raudhatian (4)Early Production Facility (EPF 50). The auditing process comprehensively focuses on the application of KOC HSE MS procedures at JPFs and their ability to reduce the resultant negative impacts on the environment from the operations. Number of findings and observations were noted and highlighted in the audit reports and sent to all concerned controlling teams. The results of these audits indicated that the facilities, in general view, were in line with KOC HSE Procedures, and there were commitments in documenting all the HSE issues in the right records and plans. Further, implemented several control measures at JPFs that minimized/reduced the environmental impact, such as SRU were installed for sulphur recovery. Future scope and monitoring audit after a sufficient period of time will be carried out in conjunction with the controlling teams in order to verify the current status of the recommendations and evaluate the contractors' performance towards the required actions in preserving the environment.

Keywords: assessment of the environmental compliance, environmental and social impact assessment, kuwait environment public authority regulations, health, safety and environment management procedures, jurassic production facilities

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Authors: Yael Dubinsky, Orit Hazzan

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There is a constant need for hi-tech innovation to be decentralized to peripheral regions. This work describes how we applied design science research (DSR) principles to define what we refer to as the Sea of Galilee (SoG) method. The goal of the SoG method is to harness existing and new technological initiatives in peripheral regions to create a socio-technological network that can initiate and maintain hi-tech activities. The SoG method consists of a set of principles, a stakeholder network, and actual hi-tech business initiatives, including their infrastructure and practices. The three cycles of DSR, the Relevance, Design, and Rigor cycles, layout a research framework to sharpen the requirements, collect data from case studies, and iteratively refine the SoG method based on the existing knowledge base. We propose that the SoG method can be deployed by regional authorities that wish to be considered smart regions (an extension of the notion of smart cities).

Keywords: design science research, socio-technological initiatives, Sea of Galilee method, periphery stakeholder network, hi-tech initiatieves

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Authors: Tamika Gordon

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As technology continues to progress every second, educational institutions attempt to stay abreast of the latest developments through the acquisition of technological devices. Within schools, soft and hard technologies have assisted with reaching more students and expedient communication. As schools continue to grow, the need for simultaneous communication and efficient feedback has grown, and technology has allowed for these avenues to be explored and incorporated within a variety of daily operations. With the rapid inclusion of technology comes the potential for less face-to-face interactions among stakeholders. Although technology plays an integral role in education, the elements of both soft and hard technological devices must be proportionally utilized and coexist for the overall advancement and longevity of organizations. Over 20 articles were referenced to obtain a multitude of views on technology reflecting effects for students and teachers. Throughout this literature review, the effects of technology in the workplace will be discussed including views of current researchers, pros and cons surrounding technological inclusion, and implications for future research and further consideration. Upon the completion of the literature review, the benefits and necessity of technology remained high, however, low availability of resources, limited exposure to technological devices, and decreasing soft skills remained high as well. Recommendations are made for proportionate balances of technology and face-to-face interactions in order to minimize societal, educational, and organizational gaps.

Keywords: communication, devices, education, organizations, technology

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Authors: Rachael Andrews, Viktoria McMillan, Shuaib Nasser, Christopher M. Roberts

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Background and objective: The National Review of Asthma Deaths (NRAD) found that asthma management and care was inadequate in 26% of cases reviewed. Major shortfalls identified were adherence to national guidelines and standards and, particularly, the organisation of care, including supervision and monitoring in primary care, with 70% of cases reviewed having at least one avoidable factor in this area. 5.4 million people in the UK are diagnosed with and actively treated for asthma, and approximately 60,000 are admitted to hospital with acute exacerbations each year. The majority of people with asthma receive management and treatment solely in primary care. This has therefore created concern that many people within the UK are receiving sub-optimal asthma care resulting in unnecessary morbidity and risk of adverse outcome. NRAD concluded that a national asthma audit programme should be established to measure and improve processes, organisation, and outcomes of asthma care. Objective: To develop a primary care dataset enabling extraction of information from GP practices in Wales and providing robust data by which results and lessons could be drawn and drive service development and improvement. Methods: A multidisciplinary group of experts, including general practitioners, primary care organisation representatives, and asthma patients was formed and used as a source of governance and guidance. A review of asthma literature, guidance, and standards took place and was used to identify areas of asthma care which, if improved, would lead to better patient outcomes. Modified Delphi methodology was used to gain consensus from the expert group on which of the areas identified were to be prioritised, and an asthma patient and carer focus group held to seek views and feedback on areas of asthma care that were important to them. Areas of asthma care identified by both groups were mapped to asthma guidelines and standards to inform and develop primary and secondary care datasets covering both adult and pediatric care. Dataset development consisted of expert review and a targeted consultation process in order to seek broad stakeholder views and feedback. Results: Areas of asthma care identified as requiring prioritisation by the National Asthma Audit were: (i) Prescribing, (ii) Asthma diagnosis (iii) Asthma Reviews (iv) Personalised Asthma Action Plans (PAAPs) (v) Primary care follow-up after discharge from hospital (vi) Methodologies and primary care queries were developed to cover each of the areas of poor and variable asthma care identified and the queries designed to extract information directly from electronic patients’ records. Conclusion: This paper describes the methodological approach followed to develop primary care datasets for a National Asthma Audit. It sets out the principles behind the establishment of a National Asthma Audit programme in response to a national asthma mortality review and describes the development activities undertaken. Key process elements included: (i) mapping identified areas of poor and variable asthma care to national guidelines and standards, (ii) early engagement of experts, including clinicians and patients in the process, and (iii) targeted consultation of the queries to provide further insight into measures that were collectable, reproducible and relevant.

Keywords: asthma, primary care, general practice, dataset development

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Authors: Mahmoud Tarek, Alaa Obeida, Mai Magdy, Khalid Hussein, Aly Shalaby

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Background: More doctors are complaining of burnout than before, Burnout is a state of physical and mental exhaustion caused by the doctor’s lifestyle, unfortunately, Medical errors are also more likely in those suffering from burnout and these may result in malpractice suits. Methodology: It is a retrospective audit of burnout response on all neonatologists over a 9 months period. We gathered data using burnout questionnaire, it was obtained from 23 physicians, the physicians divided into 5 categories according to the final score of the 28 questions in the questionnaire. Category 1 with score from 28-38 with almost no work stress, category 2 with score (38-50) who express a low amount of job related stress, category 3 with score (51-70) with moderate amount of stress, category 4 with score (71-90) those express a high amount of job stress and begun to burnout, category 5 with score (91 and above) who are under a dangerous amount of stress and advanced stage of burnout. Results: 33 neonatologists have received the questionnaire, 23 responses were sent back with a response rate of 69.6%. The results showed that 61% of physicians fall in category 4, 31% of the physician in category 5, while 8% of physicians equally distributed between category 2 and 3 (4% each of them). On the other hand, there is no physician present in category 1. Conclusion: Burnout is prevalent in SNICUs, So interventions to minimize burnout prevalence may be of greater importance as this may be reflected indirectly on medical conditions of the patients and physicians, efforts should be done to decrease this high rate of burnout.

Keywords: Cairo, work overload, exhaustion, surgery, neonatal ICU

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Authors: Juraj Camaj, Anna Dolinayova, Jana Lalinska, Miroslav Bariak

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Planning of infrastructure and processes in logistic center within the frame of various kinds of logistic hubs and technological activities in them represent quite complex problem. The main goal is to design appropriate layout, which enables to realize expected operation on the desired levels. The simulation software represents progressive contemporary experimental technique, which can support complex processes of infrastructure planning and all of activities on it. It means that simulation experiments, reflecting various planned infrastructure variants, investigate and verify their eligibilities in relation with corresponding expected operation. The inducted approach enables to make qualified decisions about infrastructure investments or measures, which derive benefit from simulation-based verifications. The paper represents simulation software for simulation infrastructural layout and technological activities in marshalling yard, intermodal terminal, warehouse and combination between them as the parts of logistic center.

Keywords: marshalling yard, intermodal terminal, warehouse, transport technology, simulation

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Authors: Prashant Neupane, Sumitra Kafle, Asmi Pandey, Laura Mitchell

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Pain following caesarean section can influence recovery, patient satisfaction, breast feeding success and mother-child bonding. Since the introduction of enhanced recovery protocols, mothers are often discharged 24 hours later. We identified concerns within our hospital with mothers tolerating poorly controlled pain in order to achieve earlier discharge and subsequently suffering significant pain at home with inadequate analgesia. Methods: We conducted a prospective audit of analgesic prescribing and post-operative pain scores after caesarean section. Mothers were seen on post-operative day one, their pain score recorded on a verbal analogue score from 0-10, and their prescription chart reviewed. A follow-up phone call was then made on post-operative day 3-7 to enquire about pain scores and analgesia use at home. Following this, a standardized proforma for prescribing after the caesarean section was introduced, including the addition of dihydrocodeine that patients can take home following discharge. There were educational update sessions for anesthetists and midwifes, and then a re-audit was conducted months later. Results: Data was collected from 50 women before and after the introduction of the change. Initial audit showed that there was considerable variation in prescribing, with four women prescribed no regular analgesia at all and inconsistency in the dose of oral morphine prescribed. Women were not given any form of analgesia to take home after discharge and were advised to take regular paracetamol and ibuprofen. However, 31/50 (62%) reported that they needed additional analgesia and eight women (16%) even sought prescription for additional analgesia from elsewhere. After the introduction of the change, prescribing was more consistent with all patients prescribed regular analgesia. 46/50 patients were given dihydrocodeine on discharge. Mean pain scores on post-operative day one improved from 5.16 to 3.9, and at home improved from 6.18 to 2.58. Use of dihydrocodeine at home significantly improved patients reporting of severe pain at home from 24% to zero. Discussion: Lack of strong analgesia out of the hospital and the increased demands on activity levels means that women are frequently in more pain at home after discharge. Introduction of a standardized prescription proforma, including the use of to-take-out dihydrocodeine, was successful in improving patient pain scores and the requirement for additional analgesia, both in hospital and at home.

Keywords: analgesia, caesarean section, post-operative pain, standardised

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Authors: Asma Moomal, Maslin Masrom

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The literature has identified that the competition among the business firms has been intensified due to the change in operating environment such as; knowledge diffusion, amount of R&D investments, and the adoption of technological innovation. Correspondingly, the E-business has potential to add a higher value to business and consumers in developed countries than in developing countries. However, the technological innovation (such as e-readiness) also considered as the major influential element on the firms competitiveness and development, Yet most of the developing countries including Pakistan failed to reap the benefits offered by modern information and communication technologies adoption (e-readiness), e-business and other innovative technologies. Thus, this paper reviewed the relevant literature in order to examine the barriers to the adoption of e-readiness and e-business in the organizations of Pakistan. The data collection technique used in this study was done through the secondary data resources (i.e. the existing literature analysis). The result of the study reveals that the most of the organizations of Pakistan like other developing countries are lagging behind in terms of adoption of e-readiness and e-business as compared to the developed countries of the world.

Keywords: e-readiness, e-business, potential, technological innovation

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Authors: Radim Farana, Bogdan Walek, Michal Janosek, Jaroslav Zacek

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This paper presents the advantages of fuzzy control use in technological processes control. The paper presents a real application of the Linguistic Fuzzy-Logic Control, developed at the University of Ostrava for the control of physical models in the Intelligent Systems Laboratory. The paper presents an example of a sensitive non-linear model, such as a magnetic levitation model and obtained results which show how modern information technologies can help to solve actual technical problems. A special method based on the LFLC controller with partial components is presented in this paper followed by the method of automatic context change, which is very helpful to achieve more accurate control results. The main advantage of the used system is its robustness in changing conditions demonstrated by comparing with conventional PID controller. This technology and real models are also used as a background for problem-oriented teaching, realized at the department for master students and their collaborative as well as individual final projects.

Keywords: control, fuzzy logic, sensitive system, technological proves

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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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Authors: Anne Theresa Eidhoff, Sarah E. Stief, Markus Voeth, Sarah Gundlach

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With digitalization increasingly changing the rules of competition, firms face the need to adapt and assimilate digital technologies in order to remain competitive. Firms can choose from various possibilities to integrate digital technologies including the option to embed digital technologies aiming to innovate products or to develop digital products. However, the question of which specific factors influence a firm’s decision to pursue digital product innovation remains unanswered in research. By adopting the Technology-Organization-Environment (TOE)-framework we have designed a qualitative exploratory study including eleven German practitioners to investigate relevant contingency factors. Our results indicate that the most critical factors for a company’s decision to pursue digital product innovation can be found in the technological and environmental dimensions, namely customers, competitive pressure, technological change, as well as digitalization fit. 

Keywords: digital innovation, digitalization, product innovation, TOE-framework

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Authors: Heesu Kim

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This paper determines the varieties of state roles played in East Asia’s telecommunication market, regarding broadband industry. Technological capacity and the relationship between state and market affect the varieties of state role. In explaining the state’s engagement in the market, technology has always been considered as a necessary and sufficient condition. However technology variable has been useful in only explaining the extent of state’s involvement. This paper contributes by bringing in the political-economic factor, which is the relationship between state and market. This factor aids in distinguishing the varieties of state role played in emerging industries. Interaction between these two variables distinguishes 4 types of state roles played in the broadband industry. These roles are distinguished and characterized by the intensity of state’s intervention and the existence of technological capacity. This paper classifies four types of state role through the case of Singapore, China, Taiwan and Korea’s broadband industrial policy.

Keywords: East Asia, entrpreneurial state, industrial policy, regulatory state, technological capacity

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Authors: Luca Martignoni

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The increasing usage of clinical decision support systems in healthcare and the demand for software that enables doctors to take informed decisions is changing everyday clinical practice. However, as technology advances not only are the benefits of technology growing, but so are the potential risks. A growing danger is the doctors’ over-reliance on the proposed decision of the clinical decision support system, leading towards deskilling and rash decisions by doctors. In that regard, identifying doctors' requirements for software and developing approaches to prevent technological over-reliance is of utmost importance. In this paper, we report the results of a design science research study, focusing on the requirements and design principles of ultrasound software. We conducted a total of 15 interviews with experts about poten-tial ultrasound software functions. Subsequently, we developed meta-requirements and design principles to design future clinical decision support systems efficiently and as free from the occur-rence of technological over-reliance as possible.

Keywords: clinical decision support systems, technological over-reliance, design principles, design science research

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Authors: Eashwari Dahoe, Jody Scheuer, Harm-Jan Vink

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Alzheimer's disease is a progressive brain condition and is the most common form of dementia. Dementia is a global concern. It is an increasing crisis due to the worldwide aging population. The disease alters the body in different stages leading to several issues. The most common issues result in memory loss, responsive decline, and social decline. During the various stages, the dementia patient must be supported more in performing daily tasks. Eventually, the patient will have to be cared for entirely. There are many efforts in various domains to support this brain condition. This study focuses on the connection between three generations of solutions in the domain of technology and the struggles they tackle. To gather information regarding the struggles seniors with dementia face data has been acknowledged through reading scientific articles. The struggles are extracted from these articles and classified into various category struggles. To gather information regarding the three generations of technology data has been acknowledged through reading scientific articles regarding the generations. After understanding the difference between the three generations, international technological solutions from the past 20 years are connected to the generation they fit. This info is mainly collected through research on companies that aim to improve the lives of senior citizens with early stages of dementia. Eventually, the technological solutions (divided by generations) are linked to the struggles they tackle. By connecting the struggles and the solutions , it is hoped that this paper contributes to an informative overview of the currently available technological solutions and the struggles they tackle.

Keywords: Alzheimer’s disease, technological solutions to support dementia, struggles of seniors with dementia, struggles of dementia

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Authors: Karolina Wieczorek, Zofia Przypaśniak

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Climate change is a rapidly growing threat to global health, and part of the responsibility to combat it lies within the healthcare sector itself, including adequate education of future medical professionals. To mitigate the consequences, the General Medical Council (GMC) has equipped medical schools with a list of outcomes regarding sustainability teaching. Students are expected to analyze the impact of the healthcare sector’s emissions on climate change. The delivery of the related teaching content is, however, often inadequate and insufficient time is devoted for exploration of the topics. Teaching curricula lack in-depth exploration of the learning objectives. This study aims to assess the extent and characteristics of climate change and sustainability subjects teaching in the curriculum of a chosen UK medical school (Barts and The London School of Medicine and Dentistry). It compares the data to the national average scores from the Climate Change and Sustainability Teaching (C.A.S.T.) in Medical Education Audit to draw conclusions about teaching on a regional level. This is a single-center audit of the timetabled sessions of teaching in the medical course. The study looked at the academic year 2020/2021 which included a review of all non-elective, core curriculum teaching materials including tutorials, lectures, written resources, and assignments in all five years of the undergraduate and graduate degrees, focusing only on mandatory teaching attended by all students (excluding elective modules). The topics covered were crosschecked with GMC Outcomes for graduates: “Educating for Sustainable Healthcare – Priority Learning Outcomes” as gold standard to look for coverage of the outcomes and gaps in teaching. Quantitative data was collected in form of time allocated for teaching as proxy of time spent per individual outcomes. The data was collected independently by two students (KW and ZP) who have received prior training and assessed two separate data sets to increase interrater reliability. In terms of coverage of learning outcomes, 12 out of 13 were taught (with the national average being 9.7). The school ranked sixth in the UK for time spent per topic and second in terms of overall coverage, meaning the school has a broad range of topics taught with some being explored in more detail than others. For the first outcome 4 out of 4 objectives covered (average 3.5) with 47 minutes spent per outcome (average 84 min), for the second objective 5 out of 5 covered (average 3.5) with 46 minutes spent (average 20), for the third 3 out of 4 (average 2.5) with 10 mins pent (average 19 min). A disproportionately large amount of time is spent delivering teaching regarding air pollution (respiratory illnesses), which resulted in the topic of sustainability in other specialties being excluded from teaching (musculoskeletal, ophthalmology, pediatrics, renal). Conclusions: Currently, there is no coherent strategy on national teaching of climate change topics and as a result an unstandardized amount of time spent on teaching and coverage of objectives can be observed.

Keywords: audit, climate change, sustainability, education

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Authors: S. Arias

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New housing developments and the technological changes that this implies, adapt the styles of living of its residents, as well as new family structures and forms of work due to the particular needs of a specific group of people which involves different techniques of dealing with, organize, equip and use a particular territory. Currently, own their own space is increasingly important and the cities are faced with the challenge of providing the opportunity for such demands, as well as energy, water and waste removal necessary in the process of construction and occupation of new human settlements. Until the day of today, not has failed to give full response to these demands and needs, resulting in cities that grow without control, badly used land, avenues and congested streets. Buildings and dwellings have an important impact on the environment and on the health of the people, therefore environmental quality associated with the comfort of humans to the sustainable development of natural resources. Applied to architecture, this concept involves the incorporation of new technologies in all the constructive process of a dwelling, changing customs of developers and users, what must be a greater effort in planning energy savings and thus reducing the emissions Greenhouse Gases (GHG) depending on the geographical location where it is planned to develop. Since the techniques of occupation of the territory are not the same everywhere, must take into account that these depend on the geographical, social, political, economic and climatic-environmental circumstances of place, which in modified according to the degree of development reached. In the analysis that must be undertaken to check the degree of sustainability of the place, it is necessary to make estimates of the energy used in artificial air conditioning and lighting. In the same way is required to diagnose the availability and distribution of the water resources used for hygiene and for the cooling of artificially air-conditioned spaces, as well as the waste resulting from these technological processes. Based on the results obtained through the different stages of the analysis, it is possible to perform an energy audit in the process of proposing recommendations of sustainability in architectural spaces in search of energy saving, rational use of water and natural resources optimization. The above can be carried out through the development of a sustainable building code in develop technical recommendations to the regional characteristics of each study site. These codes would seek to build bases to promote a building regulations applicable to new human settlements looking for is generated at the same time quality, protection and safety in them. This building regulation must be consistent with other regulations both national and municipal and State, such as the laws of human settlements, urban development and zoning regulations.

Keywords: building regulations, housing, sustainability, technology

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Authors: Shuofen Hsu, Ya-Yi Chao, Chao-Wei Li

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This paper investigates the factors of whether firms’ quarterly consolidated financial statements to be voluntary reviewed by auditor. To promote the information transparency, the Financial Supervisory Commission of Executive Yuan in Taiwan ruled the Taiwanese listed companies should announce the first and third quarterly consolidated financial statements since 2008 to 2012, while the Commission didn’t require the consolidated financial statements should be reviewed by auditors. This is a very special practice in emerging market, especially in Taiwan. The valuable data of this period is suitable for us to research the determinants of firms’ voluntary review decision in emerging markets. We collected the auditors' report of each company and each year of Taiwanese listed companies since 2008 to 2012 for our research samples. We use probit model to test and analyze the determinants of voluntary review decision of the first and third quarterly consolidated financial statements. Our empirical result shows that the firms whose first and third quarterly consolidated financial statements are voluntary to be reviewed by auditors have better ranking of information transparency, higher audit quality, and better corporate governance, suggesting that voluntary review is a good signal to firms’ better information and corporate governance quality.

Keywords: voluntary review, information transparency, audit quality, quarterly consolidated financial statements

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Authors: Zebiniso Mukhsinova

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This article discusses the dynamics of the historical development of the Bukhara school of copper-stamped products. Copper embossing is one of the leading crafts of Uzbek decorative and applied art. A critical and analytical assessment of innovative ideas, artistic and technological features, which arose as a result of the inter-regional synthesis of a local school, is presented. The article includes a detailed analysis of exhibits in museum collections, a research of the scientific papers of leading art critics and differs from previous studies in this area.

Keywords: applied art, copper embossing, metalwork, ewer, tray, Bukhara school

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Authors: Klara Krizova, Rudolf Hela

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The topic of the article focuses on the evaluation of selected technological factors and their influence on resulting elasticity modulus of concrete. A series of various factors enter into the manufacturing process which, more or less, influences the elasticity modulus. This paper presents the results of concrete in which the influence of water coefficient and the size of maximum fraction of the aggregate on the static elasticity modulus were monitored. Part of selected results of the long-term programme was discussed in which a wide scope of various variants of proposals for the composition of concretes was evaluated.

Keywords: mix design, water-cement ratio, aggregate, modulus of elasticity

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Authors: Teimuraz Manjapharashvili, Ketevani Manjaparashvili

Abstract:

Fuzzy logic is a modeling method for complex or ill-defined systems and is a relatively new mathematical approach. Its basis is to consider overlapping cases of parameter values and define operations to manipulate these cases. Fuzzy logic can successfully create operative automatic management or appropriate advisory systems. Fuzzy logic techniques in various operational control technologies have grown rapidly in the last few years. Fuzzy logic is used in many areas of human technological activity. In recent years, Fuzzy logic has proven its great potential, especially in the automation of industrial process control, where it allows the form of a control design based on the experience of experts and the results of experiments. The engineering of chemical technological processes uses fuzzy logic in optimal management, and it is also used in process control, including the operational control of continuous cycle chemical industrial, technological processes, where special features appear due to the continuous cycle and correct management acquires special importance. This paper discusses how intelligent systems can be developed, in particular, how Fuzzy logic can be used to build knowledge-based expert systems in chemical process engineering. The implemented projects reveal that the use of Fuzzy logic in technological process control has already given us better solutions than standard control techniques. Fuzzy logic makes it possible to develop an advisory system for decision-making based on the historical experience of the managing operator and experienced experts. The present paper deals with operational control and management systems of continuous cycle chemical technological processes, including advisory systems. Because of the continuous cycle, many features are introduced in them compared to the operational control of other chemical technological processes. Among them, there is a greater risk of transitioning to emergency mode; the return from emergency mode to normal mode must be done very quickly due to the impossibility of stopping the technological process due to the release of defective products during this period (i.e., receiving a loss), accordingly, due to the need for high qualification of the operator managing the process, etc. For these reasons, operational control systems of continuous cycle chemical technological processes have been specifically discussed, as they are different systems. Special features of such systems in control and management were brought out, which determine the characteristics of the construction of control and management systems. To verify the findings, the development of an advisory decision-making information system for operational control of a lime kiln using Fuzzy logic, based on the creation of a relevant expert-targeted knowledge base, was discussed. The control system has been implemented in a real lime production plant with a lime burn kiln, which has shown that suitable and intelligent automation improves operational management, reduces the risks of releasing defective products, and, therefore, reduces costs. The special advisory system was successfully used in the said plant both for the improvement of operational management and, if necessary, for the training of new operators due to the lack of an appropriate training institution.

Keywords: chemical process control systems, continuous cycle industrial technological processes, fuzzy logic, lime kiln

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Authors: Hsin-Yi Lo, Huang-Ju Jiun, Yu-Chiao Chu

Abstract:

Hemodynamic monitoring is an important in the intensive care unit. Advances in medical technology in recent years, more diversification of intensive care equipment, there are many kinds of instruments available for monitoring of hemodynamics, Edwards Lifesciences Hemodynamic Monitoring (FloTrac) is one of them. The recent medical safety incidents in parameters were changed, nurses have not to notify doctor in time, therefore, it is hoped to analyze the current problems and find effective improvement strategies. In August 2021, the survey found that only 74.0% of FloTrac correctness of operation, reasons include lack of education, the operation manual is difficulty read, lack of audit mechanism, nurse doesn't know those numerical changes need to notify doctor, work busy omission, unfamiliar with operation and have many nursing records then omissions. Improvement methods include planning professional nurse education, formulate the secret arts of FloTrac, enacting an audit mechanism, establish FloTrac action learning, make「follow the sun」care map, hold simulated training and establish monitoring data automatically upload nursing records. After improvement, FloTrac correctness of operation increased to 98.8%. The results are good, implement to the ICU of the hospital.

Keywords: hemodynamic monitoring, edwards lifesciences hemodynamic monitoring, multiple strategies, intensive care

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Authors: Dorra Gherib

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This article explores in depth the technological innovations by the Top Managements of banks in the Tunisian banking sector. The framework of this research is based on an amalgamation of four theories related to the decision of adopting technological innovations: The Theory of Reasoned Action (TRA), the Theory of Planned Behaviour (TPB), Technology Acceptance Model (TAM), and Diffusion of Innovation (DI). The result of our qualitative study highlights four variables which influence the attitude of the Top Managements towards the adoption of internet banking: Relative advantage, Perceived Ease of Use, compatibility and Perceived risk.

Keywords: top management, attitude, internet banking, TRA, TAM, TPB, DI

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Authors: Ayami Umemura

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The purpose of this paper is to examine the meaning of verbalization in clinical practice using the keywords silence and singularity. A patient's experience of illness and treatment is singular, irreplaceable, and irreproducible and ultimately cannot be compared with that of others. In his book Difference and Repetition, Gilles Deleuze positioned irreplaceable singularity as the opposite concept of particularity as a generalizable and substitutable property and matched the former with universality. He also said that singularity could not be represented because of its irreplaceable nature. Representation or verbalization is a procedure that converts an irreplaceable, idiosyncratic reality into something that can be substituted. Considering the act of verbalizing medical diagnosis based on this, it can be said that diagnosis is the practice of decontextualizing and generalizing the suffering embedded in the patient's irreplaceable life history as a disease. This paper examines the above with the key concept of the practice of "non-verbalization" in traditional medical practices in Sri Lanka. In the practice of Sri Lankan traditional medicine and the inheritance of medical knowledge and care techniques, there is a tendency to avoid verbalizing specific matters or stating them aloud. Specifically, the following should be avoided. The healer informs the patient of the name of the disease, mentions the name of the herb used in front of the patient, explains the patient's condition to the healer, and referring the names of poisonous animals, such as poisonous snakes that have been damaged. And so on. Furthermore, when passing on medical knowledge and skills, it is also possible to avoid verbalizing knowledge of medicinal herbs and medical treatment methods and explaining them verbally. In addition to the local belief that the soul of language in Sri Lanka is deeply involved in this background, Sri Lankan traditional medicine has a unique view of the human body and personality that is rooted in the singularity that appears in the relationship with the movement of celestial bodies and the supernatural realm. It can be pointed out that it is premised on the view. In other words, the “silence” in Sri Lankan indigenous medicine is the reason for emphasizing specificity. Furthermore, we can say that "non-verbalization" is a practice aimed at healing. Based on these discussions, this paper will focus on the unique relationships between practitioners and patients that become invisible due to verbalization, which is overlooked by clinical medicine, where informed consent, ensuring transparency, and audit culture is dominant. We will examine the experience of treatment and aim to relativize clinical medicine, which is based on audit cultures.

Keywords: audit cultures, indigenous medicine, singularity, verbalization

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Authors: Alvaro Aguinaga, Carlos Avila, Edgar Cando

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This article proposes a n-layer architecture, with a web client as a front-end, for the development of a virtual platform for process simulation on CNC machines. This Open-Source platform includes a CAD-CAM interface drawing primitives, and then used to furnish a CNC program that triggers a touch-screen virtual simulator. The objectives of this project are twofold. First one is an educational component that fosters new alternatives for the CAD-CAM/CNC learning process in undergrad and grade schools and technical and technological institutes emphasizing in the development of critical skills, discussion and collaborative work. The second objective puts together a research and technological component that will take the state of the art in CAD-CAM integration to a new level with the development of optimal algorithms and virtual platforms, on-line availability, that will pave the way for the long-term goal of this project, that is, to have a visible and active graduate school in Ecuador and a world wide Open-Innovation community in the area of CAD-CAM integration and operation of CNC machinery. The virtual platform, developed as a part of this study: (1) delivers improved training process of students, (2) creates a multidisciplinary team and a collaborative work space that will push the new generation of students to face future technological challenges, (3) implements industry standards for CAD/CAM, (4) presents a platform for the development of industrial applications. A protoype of this system was developed and implemented in a network of universities and technological institutes in Ecuador.

Keywords: CAD-CAM integration, virtual platforms, CNC machines, multi-layer based architecture

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