Search results for: audit fee lagrange multiplier test

Authors: Aarti M. Shetty, Estela Davoodi, Subrata Gangooly, Anita Rao-Coppisetty

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Background: Testing Patency of Fallopian Tubes is among one of the several protocols for investigating Subfertile Couples. Both, Hysterosalpingogram (HSG) and Laparoscopy and dye test have been used as Tubal patency test for several years, with well-known limitation. Hysterosalpingo Contrast Sonography (HyCoSy) can be used as an alternative tool to HSG, to screen patency of Fallopian tubes, with an advantage of being non-ionising, and also, use of transvaginal scan to diagnose pelvic pathology. Aim: To determine the indication and analyse the performance of transvaginal scan and HyCoSy in Broomfield Hospital. Methods: We retrospectively analysed fertility workup of 282 women, who attended HyCoSy clinic at our institution from January 2015 to June 2016. An Audit proforma was designed, to aid data collection. Data was collected from patient notes and electronic records, which included patient demographics; age, parity, type of subfertility (primary or secondary), duration of subfertility, past medical history and base line investigation (hormone profile and semen analysis). Findings of the transvaginal scan, HyCoSy and Laparoscopy were also noted. Results: The most common indication for referral were as a part of primary fertility workup on couples who had failure to conceive despite intercourse for a year, other indication for referral were recurrent miscarriage, history of ectopic pregnancy, post reversal of sterilization(vasectomy and tuboplasty), Post Gynaecology surgery(Loop excision, cone biopsy) and amenorrhea. Basic Fertility workup showed 34% men had abnormal semen analysis. HyCoSy was successfully completed in 270 (95%) women using ExEm foam and Transvaginal Scan. Of the 270 patients, 535 tubes were examined in total. 495/535 (93%) tubes were reported as patent, 40/535 (7.5%) tubes were reported as blocked. A total of 17 (6.3%) patients required laparoscopy and dye test after HyCoSy. In these 17 patients, 32 tubes were examined under laparoscopy, and 21 tubes had findings similar to HyCoSy, with a concordance rate of 65%. In addition to this, 41 patients had some form of pelvic pathology (endometrial polyp, fibroid, cervical polyp, fibroid, bicornuate uterus) detected during transvaginal scan, who referred to corrective surgeries after attending HyCoSy Clinic. Conclusion: Our audit shows that HyCoSy and Transvaginal scan can be a reliable screening test for low risk women. Furthermore, it has competitive diagnostic accuracy to HSG in identifying tubal patency, with an additional advantage of screening for pelvic pathology. With addition of 3D Scan, pulse Doppler and other non-invasive imaging modality, HyCoSy may potentially replace Laparoscopy and chromopertubation in near future.

Keywords: hysterosalpingo contrast sonography (HyCoSy), transvaginal scan, tubal infertility, tubal patency test

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Authors: Amel Osman, Stewart McKenna

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Aim: Fever may present as the sole sign of a serious underlying infection in young infants. Febrile Infants aged less than 90 days are at an elevated susceptibility to invasive bacterial infections, thus presenting a challenge in ensuring the appropriate management of these cases. This study aims to ensure strict adherence to NICE guidelines for the management of fever in infants between 0 and 90 days presenting to Tallaght Hospital ED. A comprehensive audit, followed by a re-audit, was conducted to enhance the quality of care delivered to these patients. In accordance with NICE guidelines, all febrile infants should undergo blood tests. Additionally, LP should be performed in all neonates under 28 days, infants displaying signs of illness, and those with WCC below 5 or above 15. Method: A retrospective case review was performed, encompassing all patients aged between 0 to 90 days who presented with fever at Tallaght ED. Data retrieval was conducted from electronic records on two separate occasions, six months apart. The evaluation encompassed the assessment of body temperature as well as both partial and full septic workups. Results: Over the study period, 150 infants presented to the ED with fever in the initial audit, and 120 in the re-audit. In the first study, 81 patients warranted a full septic workup as per NICE, but only 48 received it. Conversely, 40 patients met criteria for a partial septic workup, with 12 undergoing blood tests. In the second study, 73 patients qualified for a full septic workup, of which 52 were completed. Additionally, 27 patients were indicated for a partial workup, with 20 undergoing blood tests. Conclusion: Managing febrile infants under three months of age presenting to Tallaght ED remains a persistent challenge, underscoring the need for continuous educational initiatives to guarantee that these patients receive the requisite assessments and treatments.

Keywords: infants, fever, septic workup, tallaght

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Authors: Ashana Gupta

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Aim: In the UK, Botulinum Toxin (botox) is authorised for treating chronic myofascial pain secondary to masseter muscle hypertrophy (Fedorowicz et al. 2013). This audit aimed to ensure the Maxillofacial Unit is meeting the trust guidelines for the safe storage and disposal of botox. Method: The trust upholds a strict policy for botox handling. The audit was designed to optimise several elements including Staff awareness of regulations around botox handling A questionnaire was designed to test knowledge of advised storage temperatures, reporting of adverse events, disposal procedures and regulatory authorities. Steps taken to safely delivertoxin and eliminate unused toxin. A checklist was completed. These include marks for storagetemperature, identification checks, disposal of sharps, deactivation of toxin, and disposal. Results: All staff correctly stated storage requirements for toxin. 75% staff (n=8) were unsure about reporting and regulations. Whilst all staff knew how to dispose of vials, 0% staff showed awareness for the crucial step of deactivating toxin. All checklists (n=20) scored 100% for adequate storage, ID checks, and toxin disposal. However, there were no steps taken to deactivate toxin in any cases. Staff training took place with revision to clinical protocols. In line with Trust guidelines, an additional clinical step has been introduced including use of 0.5% sodium hypochlorite to deactivate botox. Conclusion: Deactivation is crucial to ensure residual toxin is not misused. There are cases of stolen botox within South-Tees Hospital (Woodcock, 2014). This audit was successful in increasing compliance to safe handling and disposal of botox by 100% and ensured our hospitalmeets Trust guidance.

Keywords: botulinum toxin, aesthetics, handling, disposal

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Authors: Yasir Ramadhan

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This study aims to investigate tax avoidance practices when a financial crisis occurs due to the effects of the COVID-19 pandemic. This study also finds out how the influence of independent commissioners and external auditors on tax avoidance practices during the COVID-19 pandemic. Tax avoidance practices are measured by the current ETR. The role of the independent board of commissioners is measured by the proportion of independent commissioners in the composition of the board of commissioners, while the external auditor is measured by audit quality. In this study, there were 342 observations of companies listed on the Indonesia Stock Exchange from 2019 to 2020. This study used the difference-in-differences (DiD) method in data analysis. The results of this study indicate that companies do tax avoidance during the COVID-19 pandemic. Meanwhile, independent commissioners and qualified audits are not proven to be able to negate tax avoidance practices during the COVID-19 Pandemic. These results also show that a higher proportion of independent commissioners and audit quality are not sufficient for countries with low levels of auditor litigation and investor protection and weak regulatory frameworks.

Keywords: audit, commissioner, tax avoidance, COVID-19 pandemic

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Authors: M. Fakharian, M. I. Khodakarami

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In this paper, a new trend for improvement in semi-analytical method based on scale boundaries in order to solve the 2D elastodynamic problems is provided. In this regard, only the boundaries of the problem domain discretization are by specific sub-parametric elements. Mapping functions are uses as a class of higher-order Lagrange polynomials, special shape functions, Gauss-Lobatto -Legendre numerical integration, and the integral form of the weighted residual method, the matrix is diagonal coefficients in the equations of elastodynamic issues. Differences between study conducted and prior research in this paper is in geometry production procedure of the interpolation function and integration of the different is selected. Validity and accuracy of the present method are fully demonstrated through two benchmark problems which are successfully modeled using a few numbers of DOFs. The numerical results agree very well with the analytical solutions and the results from other numerical methods.

Keywords: 2D elastodynamic problems, lagrange polynomials, G-L-Lquadrature, decoupled SBFEM

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Authors: E. A. Tkachenko, E. M. Rogova, A. S. Osipenko

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The problems of technological development for the Russian Federation take on special significance in the context of modernization of the production base. The complexity of the position of the Russian economy is that it cannot be attributed fully to developing ones. Russia is a strong industrial power that has gone through the processes of destructive de-industrialization in the conditions of changing its economic and political structure. The need to find ways for re-industrialization is not a unique task for the economies of industrially developed countries. Under the influence of production outsourcing for 20 years, the industrial potential of leading economies of the world was regressed against the backdrop of the ascent of China, a new industrial giant. Therefore, methods, tools, and techniques utilized for industrial renaissance in EU may be used to achieve a technological leap in the Russian Federation, especially since the temporary gap of 5-7 years makes it possible to analyze best practices and use those technological transfer tools that have shown the greatest efficiency. In this article, methods of technological transfer are analyzed, the role of technological audit is justified, and factors are analyzed that influence the successful process of commercialization of technologies.

Keywords: technological transfer, productivity, technological audit, commercialization of technologies

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Authors: Lan Luo

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In China’s construction industry, it is a normal practice to separately subcontract the decoration engineering part from construction engineering, and Building Information Modeling (BIM) is also done separately. Application of BIM in decoration engineering should be integrated with other disciplines, but Chinese current practice makes this very difficult and complicated. Currently, there are three barriers in the auditing of BIM application in decoration engineering in China: heavy workload; scarcity of qualified professionals; and lack of literature concerning audit contents, standards, and methods. Therefore, it is significant to perform research on what (contents) should be evaluated, in which phase, and by whom (professional qualifications) in BIM application in decoration construction so that the application of BIM can be promoted in a better manner. Based on this consideration, four principles of BIM auditing are proposed: Comprehensiveness of information, accuracy of data, aesthetic attractiveness of appearance, and scheme optimization. In the model audit, three methods should be used: Collision, observation, and contrast. In addition, BIM auditing at six stages is discussed and a checklist for work items and results to be submitted is proposed. This checklist can be used for reference by decoration project participants.

Keywords: audit, evaluation, dimensions, methods, standards, BIM application in decoration engineering projects

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Authors: Mohd Iskandar Illyas Tan, Zuhra Junaida Mohamad Husny, Farawahida Mohd Yusof

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The potentials of Muslim-friendly hospitality services bring huge opportunities to operators (hoteliers, tourist guides, and travel agents), especially among the Muslim countries. In order to provide guidelines that facilitate the operations among these operators, standards and manuals have been developing by the authorities. Among the challenges is the applicability and complexity of the standard to be adopted in the real world. Mobile digital technology can be implemented to overcome those challenges. A prototype has been developed to help operators and authorities to assess their readiness in complying with MS2610:2015. This study analyzes the of mobile digital technology characteristics that are suitable for the user in conducting sharia’ compliant hospitality audit. A focus group study was conducted in the state of Penang, Malaysia that involves operators (hoteliers, tourist guide, and travel agents) as well as agencies (Islamic Tourism Center, Penang Islamic Affairs Department, Malaysian Standard) that involved directly in the implementation of the certification. Both groups were given the 3 weeks to test and provide feedback on the usability of the mobile applications in order to conduct an audit on their readiness towards the Muslim-friendly hospitality services standard developed by the Malaysian Standard. The feedbacks were analyzed and the overall results show that three criteria (ease of use, completeness and fast to complete) show the highest responses among both groups for the mobile application. This study provides the evidence that the mobile application development has huge potentials to be implemented by the Muslim-friendly hospitality services operator and agencies.

Keywords: hospitality, innovation, audit, compliance, mobile application

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Authors: Kala Bharathan, R. Seshasayanan

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In this paper, a 1-bit Embedded Logic Full Adder (EFA) circuit in transistor level is proposed, which reduces logic complexity, gives low power and high speed. The design is further extended till 64 bits. To evaluate the performance of EFA, a 16, 32, 64-bit both Linear and Square root Carry Select Adder/Subtractor (CSLAS) Structure is also proposed. Realistic testing of proposed circuits is done on 8 X 8 Modified Booth multiplier and comparison in terms of power and delay is done. The EFA is implemented for different multiplier architectures for performance parameter comparison. Overall delay for CSLAS is reduced to 78% when compared to conventional one. The circuit implementations are done on TSMC 28nm CMOS technology using Cadence Virtuoso tool. The EFA has power savings of up to 14% when compared to the conventional adder. The present implementation was found to offer significant improvement in terms of power and speed in comparison to other full adder circuits.

Keywords: embedded logic, full adder, pdp, xor gate

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Authors: Joshua Abraham, Craig Wales

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Abstract—SIGN Guideline 122 recommends that all patients who are admitted to hospital are assessed for venous thromboembolism risk within 24 hours of admission. NHS Greater Glasgow and Clyde provide guidance on this in the form of a proforma. Patients are then subsequently prescribed either thrombo-embolic-deterrent stockings (TEDS)/low molecular weight heparin (LMWH) for the prevention of VTE based on their score. A retrospective casenote audit of a random sample of fifty oncology and trauma inpatients at the QEUH in December 2019 was performed. 90% of patients had a risk assessment conducted as evidenced by a completed proforma. In 78% of these patients, the proforma fully completed. Overall 94% of patients had some for of thromboprophylaxis prescribed in the form of TEDS or LMWH. A lack of 100% compliance against the given standards highlighted potential implications for patient safety, but also medico-legal ramifications for staff. Clinical judgement can only be relied upon if there is written documentation as evidence. Further staff education and the suggestion of a written prompt to the clerk-in documentation will hopefully improve compliance, whilst a repeat audit should demonstrate any improvement.

Keywords: Maxillofacial , Thromboembolism, Thromboprophylaxis , Prescription

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Authors: Abhishek Oswal

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Background: Inconsistencies between the guidelines for childhood asthma can pose a diagnostic challenge to clinicians. NICE guidelines are the most commonly followed guidelines in primary care in the UK; they state that to be diagnosed with asthma, a child must be more than 5 years old and must have objective evidence of the disease. When diagnoses are coded in general practice (GP), these guidelines may be superseded by communications from secondary care. Hence it is imperative that diagnoses are correct, as per up to date guidelines and evidence, as this affects follow up and management both in primary and secondary care. Methods: A snapshot audit at a general practice surgery was undertaken of children (less than 16 years old) with a coded diagnosis of 'asthma', to review the age at diagnosis and whether any objective evidence of asthma was documented at diagnosis. 50 cases of asthma in children presenting to the emergency department (ED) were then audited to review the age at presentation, whether there was evidence of previous asthma diagnosis and whether the patient was discharged from ED. A repeat audit is planned in ED this winter. Results: In a GP surgery, there were 83 coded cases of asthma in children. 51 children (61%) were diagnosed under 5, with 9 children (11%) who had objective evidence of asthma documented at diagnosis. In ED, 50 cases were collected, of which 4 were excluded as they were referred to the other services, or for incorrect coding. Of the 46 remaining, 27 diagnoses confirmed to NICE guidelines (59%). 33 children (72%) were discharged from ED. Discussion: The most likely reason for the apparent low rate of a correct diagnosis is the significant challenge of obtaining objective evidence of asthma in children. There were a number of patients who were diagnosed from secondary care services and then coded as 'asthma' in GP, without having objective documented evidence. The electronic patient record (EPR) system used in our emergency department (ED) did not allow coding of 'suspected diagnosis' or of 'viral induced wheeze'. This may have led to incorrect diagnoses coded in primary care, of children who had no confirmed diagnosis of asthma. We look forward to the re-audit, as the EPR system has been updated to allow suspected diagnoses. In contrast to the NICE guidelines used here, British Thoracic Society (BTS) guidelines allow for a trial of treatment and subsequent confirmation of diagnosis without objective evidence. It is possible that some of the cases which have been classified as incorrect in this audit may still meet other guidelines. Conclusion: The diagnosis of asthma in children is challenging. Incorrect diagnoses may be related to clinical pressures and the provision of services to allow compliance with NICE guidelines. Consensus statements between the various groups would also aid the decision-making process and diagnostic dilemmas that clinicians face, to allow more consistent care of the patient.

Keywords: asthma, diagnosis, primary care, emergency department, guidelines, audit

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Authors: Govind Sharma, Bahni Ray

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Ubiquitous nature of particle settling is governed by the presence of the surrounding fluid medium. Thermally stratified fluid alters the settling phenomenon of particles as well as their interactions. Direct numerical simulation (DNS) is carried out with an open-source library Immersed Boundary Adaptive Mesh Refinement (IBAMR) to quantify the fundamental mechanism based on Distributed Lagrangian Multiplier (DLM). The presence of background density gradient due to thermal stratification replaces the drafting-kissing-tumbling in a homogeneous fluid to drafting-kissing-separation behavior. Simulations are performed with a varying range of particle-fluid density ratios, and it is shown that the stratification effect on particle interactions varies with density ratio. It is observed that the combined role of buoyancy and inertia govern the physical mechanism of particle-particle interaction.

Keywords: direct numerical simulation, distributed lagrangian multiplier, rigidity constraint, sedimentation, stratification

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Authors: Tooraj Karimi, Mohammadreza Sadeghi Moghadam

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Grey set theory has the advantage of using fewer data to analyze many factors, and it is therefore more appropriate for system study rather than traditional statistical regression which require massive data, normal distribution in the data and few variant factors. So, in this paper grey clustering and entropy of coefficient vector of grey evaluations are used to analyze energy consumption in buildings of the Oil Ministry in Tehran. In fact, this article intends to analyze the results of energy audit reports and defines most favorable characteristics of system, which is energy consumption of buildings, and most favorable factors affecting these characteristics in order to modify and improve them. According to the results of the model, ‘the real Building Load Coefficient’ has been selected as the most important system characteristic and ‘uncontrolled area of the building’ has been diagnosed as the most favorable factor which has the greatest effect on energy consumption of building. Grey clustering in this study has been used for two purposes: First, all the variables of building relate to energy audit cluster in two main groups of indicators and the number of variables is reduced. Second, grey clustering with variable weights has been used to classify all buildings in three categories named ‘no standard deviation’, ‘low standard deviation’ and ‘non- standard’. Entropy of coefficient vector of Grey evaluations is calculated to investigate greyness of results. It shows that among the 38 buildings surveyed in terms of energy consumption, 3 cases are in standard group, 24 cases are in ‘low standard deviation’ group and 11 buildings are completely non-standard. In addition, clustering greyness of 13 buildings is less than 0.5 and average uncertainly of clustering results is 66%.

Keywords: energy audit, grey set theory, grey incidence matrixes, grey clustering, Iran oil ministry

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Authors: Y. Yang, Dian Ming Xing, Qiu Hua Du

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Based on the Motorized Momentum Exchange Tether (MMET), with the principle of momentum exchange, the three dimension flexible dynamics of continuous cislunar payloads transferring system (CCPTS) is built by Lagrange method and its numerical solution is solved by Mathematica software. In the derivation precession of potential energy, this paper uses the Tylor expansion method to simplify the Lagrange equation. Furthermore, the tension coming from the centripetal load is considered in the elastic potential energy. The comparison simulation results between the 3D rigid model and 3D flexible model of CCPTS shows that the tether flexibility has important influence on CCPTS’s orbital parameters (such as radius of CCPTS’s COM and the true anomaly) and the tether’s rotational movement, the relative deviation of radius and the true anomaly between the two dynamic models is about 0.00678% and 0.00259%, the relative deviation of the angle of tether-span and local gravity gradient is about 3.55%. Additionally, the external torque has an apparent influence on the tether’s axial vibration.

Keywords: cislunar transfer, dynamics, momentum exchange, tether

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Authors: Sijuade A. A., Oguntoye J. P., Awodoye O. O., Adedapo O. A., Wahab W. B., Okediran O. O., Omidiora E. O., Olabiyisi S. O.

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Electronic voting systems have been introduced to improve the efficiency, accuracy, and transparency of the election process in many countries around the world, including Nigeria. However, concerns have been raised about the security and integrity of these systems. One way to address these concerns is through the implementation of electronic forensic election audit systems. This study aims to evaluate voters' intention to the adoption of electronic forensic election audit systems using the Unified Theory of Acceptance and Use of Technology (UTAUT) model. In the study, the UTAUT model which is a widely used model in the field of information systems to explain the factors that influence individuals' intention to use a technology by integrating performance expectancy, effort expectancy, social influence, facilitating conditions, cost factor and privacy factor to voters’ behavioural intention was proposed. A total of 294 sample data were collected from a selected population of electorates who had at one time or the other participated in at least an electioneering process in Nigeria. The data was then analyzed statistically using Partial Least Square Structural Equation Modeling (PLS-SEM). The results obtained show that all variables have a significant effect on the electorates’ behavioral intention to adopt the development and implementation of an electronic forensic election audit system in Nigeria.

Keywords: election Audi, voters, UTAUT, performance expectancy, effort expectancy, social influence, facilitating condition social influence, facilitating conditions, cost factor, privacy factor, behavioural intention

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Authors: Benjamin Bae

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This study investigates the relationship between the adoption of International Financial Reporting Standards (IFRS) and the performance of banks in a number of Middle East countries. We examine whether performance levels and audit qualities play any role in adopting the International Financial Reporting Standards (IFRS) in Middle East banks. This study hypothesizes that, in general, banks with high performance and audit quality measures tend to adopt the IFRS than low-performing banks, as the adoption of a new standard takes lots of time and expenses, which could be an additional burden to them. The results show that three hypotheses are strongly supported whereas the cultural factor hypothesis is not. Banks with high ROA and ROE tend to adopt IFRS than low-performing banks. Big banks are also more likely to adopt IFRS than small or medium-sized banks. Contrary to the hypothesis, the Islamic bank status as a cultural factor has some positive impact on the adoption of the banks in the region. Overall, this research adds to our understanding of the bank’s performance. First, evidence on the relationship between the adoption of IFRS and the bank’s performance should be useful to investors. Second, the findings of this study provide financial statement users with useful information about the bank’s performance measures.

Keywords: IFRS, financial performance, audit quality, culture, firm size

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Authors: Divya Pathak, James Sloane

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Surgical treatment of midface fractures should ideally occur within two weeks of injury, after which bony healing and consolidation make the repair more difficult for the operating surgeon. The oral and maxillofacial unit at the Royal Surrey Hospital is the tertiary referral center for maxillofacial trauma from five regional hospitals. This is a complete audit cycle of midface trauma referrals managed over a one year period. The standard set was that clinical assessment of the midface fracture would take place in a consultant led outpatient clinic within 7 days, and when indicated, surgical fixation would occur within 10 days of referral. Retrospective data was collected over one year (01/11/2018 - 31/12/2019). Three key changes were implemented: an IT referral mailbox, standardization of an on-call trauma table, and creation of a trauma theatre list. Re-audit was carried out over six months completing the cycle. 283 midface fracture referrals were received, of which 22 patients needed surgical fixation. The average time from referral to outpatient follow-up improved from 14.5 days to 8.3 days, and time from referral to surgery improved from 21.5 days to 11.6 days. Changes implemented in this audit significantly improved patient prioritization to appropriate outpatient clinics and shortened time to surgical intervention.

Keywords: maxillofacial trauma, midface trauma, oral and maxillofacial surgery, surgery fixation

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Authors: Debarati Bhaumik, Diptish Dey

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Multilevel models, increasingly deployed in industries such as insurance, food production, and entertainment within functions such as marketing and supply chain management, need to be transparent and ethical. Applications usually result in binary classification within groups or hierarchies based on a set of input features. Using open-source datasets, we demonstrate that popular explainability methods, such as SHAP and LIME, consistently underperform inaccuracy when interpreting these models. They fail to predict the order of feature importance, the magnitudes, and occasionally even the nature of the feature contribution (negative versus positive contribution to the outcome). Besides accuracy, the computational intractability of SHAP for binomial classification is a cause of concern. For transparent and ethical applications of these hierarchical statistical models, sound audit frameworks need to be developed. In this paper, we propose an audit framework for technical assessment of multilevel regression models focusing on three aspects: (i) model assumptions & statistical properties, (ii) model transparency using different explainability methods, and (iii) discrimination assessment. To this end, we undertake a quantitative approach and compare intrinsic model methods with SHAP and LIME. The framework comprises a shortlist of KPIs, such as PoCE (Percentage of Correct Explanations) and MDG (Mean Discriminatory Gap) per feature, for each of these three aspects. A traffic light risk assessment method is furthermore coupled to these KPIs. The audit framework will assist regulatory bodies in performing conformity assessments of AI systems using multilevel binomial classification models at businesses. It will also benefit businesses deploying multilevel models to be future-proof and aligned with the European Commission’s proposed Regulation on Artificial Intelligence.

Keywords: audit, multilevel model, model transparency, model explainability, discrimination, ethics

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Authors: Michael Adebayo, Saheed Lawal

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The Comprehensive Geriatric Assessment (CGA) is the multidimensional tool used to assess elderly, frail patients either on admission to hospital care or at a community level in primary care. It is a tool designed with the aim of using a holistic approach to managing patients. A Cochrane review of CGA use in 2011 found that the likelihood of being alive and living in their own home rises by 30% post-discharge. RCTs have also discovered 10–15% reductions in readmission rates and reductions in institutionalization, and resource use and costs. Past audit cycles at King’s College Hospital, Denmark Hill had shown inconsistent evidence of CGA completion inpatient discharge summaries (less than 50%). Junior Doctors in the Health and Ageing (HAU) wards have struggled to sustain the efforts of past audit cycles due to the quick turnover in staff (four-month placements for trainees). This 7th cycle created a multi-faceted approach to solving this problem amongst staff and creating lasting change. Methods: 1. We adopted multidisciplinary team involvement to support Doctors. MDT staff e.g. Nurses, Physiotherapists, Occupational Therapists and Dieticians, were actively encouraged to fill in the CGA document. 2. We added a CGA Document Pro-forma to “Sunrise EPR” (Trust computer system). These CGAs were to automatically be included the discharge summary. 3. Prior to assessing uptake, we used a spot audit questionnaire to assess staff awareness/knowledge of what a CGA was. 4. We designed and placed posters highlighting domains of CGA and MDT roles suited to each domain on geriatric “Health and Ageing Wards” (HAU) in the hospital. 5. We performed an audit of % discharge summaries which include CGA and MDT role input. 6. We nominated ward champions on each ward from each multidisciplinary specialty to monitor and encourage colleagues to actively complete CGAs. 7. We initiated further education of ward staff on CGA's importance by discussion at board rounds and weekly multidisciplinary meetings. Outcomes: 1. The majority of respondents to our spot audit were aware of what a CGA was, but fewer had used the EPR document to complete one. 2. We found that CGAs were not being commenced for nearly 50% of patients discharged on HAU wards and the Frailty Assessment Unit.

Keywords: comprehensive geriatric assessment, CGA, multidisciplinary team, quality of life, mortality

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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: Tony Feng, Rea Thomson, Kathryn Greenslade, Ross Medine, Jennifer Easterbrook, Calum Arthur, Matilda Powell-bowns

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There are clear guidelines on taking group and screen samples (G&S) for elective arthroplasty and major trauma. However, there is limited guidance on blood grouping for other trauma patients. The purpose of this study was to review the level of blood grouping at a major trauma centre and validate a protocol that limits the expensive processing of G&S samples. After reviewing the national guidance on transfusion samples in orthopaedic patients, data was prospectively collected for all orthopaedic admissions in the Royal Infirmary of Edinburgh between January to February 2023. The cause of admission, number of G&S samples processed on arrival and need for red cells was collected using the hospital blood bank. A new protocol was devised based on a multidisciplinary meeting which limited the requirement for G&S samples only to presentations in “category X”, including neck-of-femur fractures (NOFs), pelvic fractures and major trauma. A re-audit was completed between April and May after departmental education and institution of this protocol. 759 patients were admitted under orthopaedics in the major trauma centre across two separate months. 47% of patients were admitted with presentations falling in category X (354/759) and patients in this category accounted for 88% (92/104) of those requiring post-operative red cell transfusions. Of these, 51% were attributed to NOFs (47/92). In the initial audit, 50% of trauma patients outwith category X had samples sent (116/230), estimated to cost £3800. Of these 230 patients, 3% required post-operative transfusions (7/230). In the re-audit, 23% of patients outwith category X had samples sent (40/173), estimated to cost £1400, of which 3% (5/173) required transfusions. None of the transfusions in these patients in either audit were related to their operation and the protocol achieved an estimated cost saving of £2400 over one month. This study highlights the importance of sending samples for patients with certain categories of orthopaedic trauma (category X) due to the high demand for post-operative transfusions. However, the absence of transfusion requirements in other presentations suggests over-testing. While implementation of the new protocol has markedly reduced over-testing, additional interventions are required to reduce this further.

Keywords: blood transfusion, quality improvement, orthopaedics, trauma

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Authors: C. H. Shashikanth, M. J. Davidson, V. Suresh Babu

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The formability of metals depends on a number of variables such as strain, strain rate, and temperature. Though most of the metals are formable at room temperature, few are not. To evaluate the workability of such metals at elevated temperatures, thermomechanical experiments should be carried out to find out the forming temperatures and strain rates. Though a number of constitutive relations are available to correlate the material parameters and the corresponding formability at elevated temperatures, the constitutive rule proposed by Arrhenius has been used in this work. Thus, in the present work, the material constants such as A (constant), α (stress multiplier), β (constant), and n (stress exponent) of AA 2017 has been found by conducting a series of hot compression tests at different temperatures such as 400°C, 450°C, 500°C, and 550°C and at different strain rates such as 0.16, 0.18, and 0.2. True stress (σt), true strains (εt) deformation activation energy (Q), and the Zener-Hollomon parameter (Z value) were also calculated. The results indicate that the value of ln (Z) decreases as the temperature increases and it increases as the strain rate increases.

Keywords: hot compression test, aluminium alloy, flow stress, activation energy

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Authors: Adhinarayanan Venkatasubramanian

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For design of high speed digital circuit wave pipeline is the best approach this can be operated at higher operating frequencies by adjusting clock periods and skews so as latch the o/p of combinational logic circuit at the stable period. In this paper, there are two methods are proposed in automation task one is BIST (Built in self test) and second method is Reconfigurable technique. For the above two approaches dedicated AND gate (multiplier) by applying wave pipeline technique. BIST approach is implemented by Xilinx Spartan-II device. In reconfigurable technique done by ASIC. From the results, wave pipeline circuits are faster than nonpipeline circuit and area, power dissipation are reduced by reconfigurable technique.

Keywords: SOC, wave-pipelining, FPGA, self-testing, reconfigurable, ASIC

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Authors: T. Suleiman, C. Mchugh, H. Ranu

Abstract:

Background; Asthma continues to be associated with poor patient outcomes, including mortality. An audit of the management of acute asthma admissions in our hospital in 2020 found poor compliance with National Asthma and COPD Audit Project (NACAP) standards which set out to improve inpatient asthma care. Clinical nurse specialists have been shown to improve patient care across a range of specialties. In September 2021, an asthma Nurse Specialist (ANS) was employed in our hospital. Aim; To re-audit management of acute asthma admissions using NACAP standards and assess for quality improvement post-employment of an ANS. Methodology; NACAP standards are wide-reaching; therefore, we focused on ‘specific elements of good practice’ in addition to the provision of inhaled corticosteroids (ICS) on discharge. Medical notes were retrospectively requested from the hospital coding department and selected as per NACAP inclusion criteria. Data collection and entry into the NACAP database were carried out. As this was a clinical audit, ethics approval was not required. Results; Cycle 1 (pre-ANS) and 2 (post-ANS) of the audit included 20 and 32 patients, respectively, with comparable baseline demographics. No patients had a discharge bundle completed on discharge in cycle 1 vs. 84% of cases in cycle 2. Regarding specific components of the bundle, 25% of patients in cycle 1 had their inhaler technique checked vs. 91% in cycle 2. Furthermore, 80% of patients had maintenance medications reviewed in cycle 1 vs. 97% in cycle 2. Medication adherence was addressed in 20% of cases in cycle 1 vs. 88% of cases in cycle 2. Personalized asthma action plans were not issued or reviewed in any cases in cycle 1 as compared with 84% of cases in cycle 2. Triggers were discussed in 30% of cases in cycle 1 vs. 88% of cases in cycle 2. Tobacco dependence was addressed in 44% of cases in cycle 1 vs. 100% of cases in cycle 2. No patients in cycle 1 had community follow-up requested within 2 days vs. 81% of the patients in cycle 2. Similarly, 20% of the patients in cycle 1 vs. 88% of the patients in cycle 2 had a 4-week asthma clinic follow-up requested. 75% of patients in cycle 1 were the recipient of ICS on discharge compared with 94% of patients in cycle 2. Conclusion; Our quality improvement project demonstrates the utility of an ANS in improving performance in the management of acute asthma admissions, evidenced here through concordance with NACAP standards. Asthma is a complex condition with biological, psychological, and sociological components; therefore, ANS is a suitable intervention to improve concordance with guidelines. ANS likely impacted performance directly, for example, by checking inhaler technique, and indirectly as a safety net ensuring doctors included ICS on discharge.

Keywords: asthma, nurse specialist, clinical audit, quality improvement

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Authors: Charlie Jeffkins

Abstract:

Sickle cell disease is a serious life-limiting condition which can reduce the quality of life for many patients. Public Health England (PHE), in partnership with the Sickle Cell Society (SCS), has created guidelines to prevent severe complications from sickle cell disease. Data was collected from Children’s Hospital for Wales between 15/03/21-26/03/21. Methods: A manual search of patient records for children under the care of Rocket Ward and a key term search of online records was used. Results: Penicillin prophylaxis was given at 90 days for 89%, 77% of TCDs scans were done at 2-3 years, and 72% have had a scan in the last year. 53% of patients have had discussions about hydroxycarbamide, whilst 65% have started it. PPV vaccination was documented for 19%. Conclusion: Overall, none of the four standards were reached; however, TCD uptake has improved. There is a need for better documentation of treatment and annual re-audits.

Keywords: paediatric, haematology, sickle cell, audit

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Authors: A. Duncan, A. Blake, A. O'Gara, J. Fitzgerald

Abstract:

Introduction: Acute traumatic rib fractures have significant morbidity and mortality and are a commonly seen injury in trauma patients. Rib fracture pain can often be acute and can prove challenging to manage. We performed an audit on patients with acute traumatic rib fractures with the aim of composing a referral and treatment pathway for such patients. Methods: From January 2021 to January 2022, the pain medicine service encouraged early referral of all traumatic rib fractures to the pain service for a multi-modal management approach. A retrospective audit of analgesic management was performed on a select cohort of 24 patients, with a mean age of 67, of which 19 had unilateral rib fractures. Results: 17 of 24 patients (71%) underwent local, regional block as part of a multi-modal analgesia regime. Only one regional complication was observed, seen with hypotension occurring in one patient with a thoracic epidural. The group who did not undergo regional block had a length of stay (LOS) 17 days longer than those who did (27 vs. 10) and higher rates of pneumonia (29% vs. 18%). Conclusion: Early referral to pain specialists is an important component of the effective management of acute traumatic rib fractures. From our audit, it is evident that regional blocks can be effectively used in these cases as part of a multi-modal analgesia regime and may confer benefits in terms of respiratory complications and length of stay.

Keywords: rib fractures, regional blocks, thoracic epidural, erector spina block

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Authors: S. M. Ahuja

Abstract:

There are about 12000 stone crusher units in India and are located in clusters around urban areas to the stone quarries. These crushers create lot of fugitive dust emissions and noise pollution which is a major health hazard for the people working in the crushers and also living in its vicinity. Ambient air monitoring was carried out near various stone crushers and it has been observed that fugitive emission varied from 300 to 8000 mg/Nm3. A number of stone crushers were thoroughly studied and their existing pollution control devices were examined. Limitations in the existing technology were also studied. A technology consisting of minimal effective spray nozzles to reduce the emissions at source followed by a containment cum control system having modular cyclones as air pollution control device has been conceived. Besides preliminary energy audit has also been carried out in some of the stone crushers which indicates substantial potential for energy saving.

Keywords: stone crushers, spray nozzles, energy audit

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Authors: Mojtaba Valinataj

Abstract:

Reversible logic as a new favorable design domain can be used for various fields especially creating quantum computers because of its speed and intangible power consumption. However, its susceptibility to a variety of environmental effects may lead to yield the incorrect results. In this paper, because of the importance of multiplication operation in various computing systems, some novel reversible logic array multipliers are proposed with error detection capability by incorporating the parity-preserving gates. The new designs are presented for two main parts of array multipliers, partial product generation and multi-operand addition, by exploiting the new arrangements of existing gates, which results in two signed parity-preserving array multipliers. The experimental results reveal that the best proposed 4×4 multiplier in this paper reaches 12%, 24%, and 26% enhancements in the number of constant inputs, number of required gates, and quantum cost, respectively, compared to previous design. Moreover, the best proposed design is generalized for n×n multipliers with general formulations to estimate the main reversible logic criteria as the functions of the multiplier size.

Keywords: array multipliers, Baugh-Wooley method, error detection, parity-preserving gates, quantum computers, reversible logic

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Authors: M. Iruleswari, A. Jeyapaul Murugan

Abstract:

Most fundamental part used in many Digital Signal Processing (DSP) application is a Finite Impulse Response (FIR) filter because of its linear phase, stability and regular structure. Designing a high-speed and hardware efficient FIR filter is a very challenging task as the complexity increases with the filter order. In most applications the higher order filters are required but the memory usage of the filter increases exponentially with the order of the filter. Using multipliers occupy a large chip area and need high computation time. Multiplier-less memory-based techniques have gained popularity over past two decades due to their high throughput processing capability and reduced dynamic power consumption. This paper describes the design and implementation of highly efficient Look-Up Table (LUT) based circuit for the implementation of FIR filter using Distributed arithmetic algorithm. It is a multiplier less FIR filter. The LUT can be subdivided into a number of LUT to reduce the memory usage of the LUT for higher order filter. Analysis on the performance of various filter orders with different address length is done using Xilinx 14.5 synthesis tool. The proposed design provides less latency, less memory usage and high throughput.

Keywords: finite impulse response, distributed arithmetic, field programmable gate array, look-up table

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Authors: Youn-Sung Kim, Jin-Ho Jo, Mi-Sung Kim, Jae-Kun Lee

Abstract:

Accelerated life cycle test is applied to various products or components in order to reduce the time of life cycle test in industry. It must be considered for many test conditions according to the product characteristics for the test and the selection of acceleration parameter is especially very important. We have carried out the general life cycle test and the accelerated life cycle test by applying the acceleration factor (AF) considering the characteristics of brushless DC (BLDC) motor for washing machine. The final purpose of this study is to verify the validity by analyzing the results of the general life cycle test and the accelerated life cycle test. It will make it possible to reduce the life test time through the reasonable accelerated life cycle test.

Keywords: accelerated life cycle test, reliability test, motor for washing machine, brushless dc motor test

Procedia PDF Downloads 585