Development Of Methodology Research Articles

Exploring cost changes with time-driven activity-based costing after service delivery redesign in Dutch maternity care.

The implementation of Value-Based Healthcare (VBHC) has spread across international healthcare systems, aiming to improve decision-making by combining information about patient outcomes and costs of care. Time-Driven Activity-Based Costing (TDABC) is introduced as a pragmatic yet accurate method to calculate costs of care pathways. It is often applied to demonstrate value-improving opportunities, such as interventions aimed at service delivery redesign. It is imperative for healthcare managers to know whether these interventions yield the expected outcome of improving patient value, for which TDABC is also suitable. However, its application becomes more complex and labour intensive if the intervention extends beyond activity-level changes in existing care pathways, to the implementation of entirely new care pathways. The complexity arises from the potential influence of such interventions on the costs of related care pathways. To fully comprehend the impact of such interventions on organizational costs, it is important to include these factors in the cost calculation. Given the substantial effort required for this analysis, this may explain the limited number of prior TDABC studies with similar objectives. This methodological development paper addresses this gap by offering a pragmatic enrichment of the TDABC methodology. This enrichment is twofold. First, it provides guidance on calculating a change in costs without the need for a total cost calculation. Second, to secure granularity, a more detailed level of cost-allocation is proposed. The aim is to encourage further application of TDABC to conduct financial evaluations of promising interventions in the domain of VBHC and service delivery redesign.

Lived-through Experience, Multi-perspective Methodology, Contentious Polysemy: Challenges in the Study of Vulnerability

AbstractThe article concludes the special section on vulnerability. By reflecting on the arguments in and the convergences between the contributions to the preceding trialogue, it outlines three key challenges in vulnerability research. Across disciplinary, theoretical, and methodological boundaries, the contributions agree in their criticism of negative, individualistic, and/or essentialist conceptualizations of vulnerability; instead, they call for a non-dualist, pluralist, and participative approach to vulnerability that takes the lived-through experience of individuals as its starting point. Based on this decision, the challenges arise of (1) how to conceptualize and identify the structures of lived-through experiences of vulnerability and of (2) how the experiences of individuals and groups in different social positions can be collected, understood, and interpreted. The trialogue texts, we argue, provide important impulses for the development of a multi-perspective methodology, which permits to analyze vulnerability in a way that is theoretically, ethically, and methodologically appropriate. Finally, by taking lived-through experience as a starting point, the articles in this special section (3) contribute to a better understanding of the contentious polysemy of the term vulnerability. By analyzing the constitutive ambivalence and ambiguity of experiences of vulnerability as well as the difficulties of intersubjective communicability, the contributions help to understand why articulations of vulnerability are often vague and why vulnerability can be politically instrumentalized. In this way, the comprehensive understanding of vulnerability (e.g., as positive and negative, enabling and inhibiting), promoted in the trialogue, also becomes a means of moral and political criticism.

Exploring Sustainable VR Use Cases for Startup Business Models: A Customized Customer Development Approach

Startups often face uncertainty and the potential Valley of Death. To address these challenges, Sustainable Development Goals (SDGs) can serve as a starting point to identify business opportunities in markets driven by SDG-related issues. In this case, we propose using virtual reality (VR) technology as a “painkiller”. This study aims to explore VR use cases and their implications for startup business models and discover a problem–solution fit, i.e., identify the degree to which VR applications effectively address actual problems as “killer applications”. The study employs a customized customer discovery technique, an essential process in the Customer Development methodology. By exploring VR’s applicability in various domains such as entertainment, training, education, and tourism, this study unveils compelling use cases that align with SDG aspects, thus validating the hypothesis on startups’ potential to harness VR for SDG contributions. Furthermore, the study produces VR business model designs based on solutions to SDG-related problems. Thus, startups can function effectively as “painkillers”, offering solutions that are not only desired but urgently needed (problem–solution fit). The implications of these findings extend globally, underlining VR’s role in addressing SDG issues and offering practical insights for startup business model development that are applicable to broader technology adoptions.

Impact of Thoracic Duct Resection on Long-Term Survival After Esophagectomy: Individual Patient Data Meta-analysis.

Radical esophagectomy, including thoracic duct resection (TDR), has been proposed to improve regional lymphadenectomy and possibly reduce the risk of locoregional recurrence. However, because of its impact on immunoregulation, some authors have expressed concerns about its possible detrimental effect on long-term survival. The purpose of this review was to assess the influence of TDR on long-term survival. PubMed, MEDLINE, Scopus, and Web of Science databases were searched through 15 March 2024. Overall survival (OS), cancer specific survival (CSS), and disease-free survival (DFS) were primary outcomes. Restricted mean survival time difference (RMSTD), risk ratio (RR), standardized mean difference (SMD), and 95% confidence intervals (CI) were used as pooled effect size measures. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology was employed to evaluate the certainty of evidence. The analysis included six studies with 5756 patients undergoing transthoracic esophagectomy. TDR was reported in 49.1%. Patients' ages ranged from 27 to 79 years and 86% were males. At 4-year follow-up, the multivariate meta-analysis showed similar results for the comparison noTDR versus TDR in term of OS [- 0.8 months, 95% confidence interval (CI) - 3.1, 1.3], CSS (0.1 months, 95% CI - 0.9, 1.2), and DFS (1.5 months, 95% CI - 2.6, 5.5). TDR was associated with a significantly higher number of harvested mediastinal lymph nodes (SMD 0.57, 95% CI 0.01-1.13) and higher risk of postoperative chylothorax (RR = 1.32; 95% CI 1.04-2.23). Anastomotic leak and pulmonary complications were comparable. TDR seems not to improve long-term OS, CSS, and DFS regardless of tumor stage. Routine TDR should not be routinely recommended during esophagectomy.

FOREIGN ECONOMIC ACTIVITY IN THE SYSTEM OF ACCOUNTING AND ANALYTICAL MANAGEMENT SUPPORT

The article decomposes the foreign economic activity of enterprise through the prism of accounting and analytical support of management. It has been determined that current trends in the development of the domestic and world economy, specificity and peculiarities of activities of individual business entities in the field of foreign economic relations, the need for further development of methodology and methods of accounting and analysis of foreign economic activity, taking into account the objectively arising needs for the development of information support for management, determine the relevance of decomposition of foreign economic activity in the system of accounting and analytical support for management. It is substantiated that the basis for the decomposition of foreign economic activity in the system of accounting and analytical support of management is the concept of the type of activity. The organisation of accounting of foreign economic activity at a particular enterprise is largely determined by the type of foreign economic activity inherent in this enterprise. In the process of production and economic activity, enterprises, as a rule, face several types of foreign economic operations simultaneously. The accounting and analytical aspects of management of foreign economic activity of enterprise are systematised. A model of decomposition of the foreign economic activity of enterprise has been developed. It is proposed that the model of decomposition of foreign economic activity of enterprise should include types of foreign economic activity and accounting and analytical aspects, grouped into blocks: key aspects; characteristics of types of foreign economic activity, organisational and legal conditions, purpose, directions and results of functioning, accounting approaches and basic analytical criteria, performance indicators, structural construction and functioning, etc. The developed model provides for the reflection and determination of performance results by types, subtypes, segments and other classification features of foreign economic activity in order to obtain analytical, detailed, transparent and relevant information based on financial, management and strategic accounting data. Formation of an integrated system of accounting and analysis of foreign economic activity is based on consideration of regulatory, contractual, structural, accounting, analytical, control and software and hardware support of foreign economic activity.

Risk assessment in production of functional food products by means of RCA method

According to the results of review of the regulatory legal acts and standardization documents, the necessity has been determined to develop a methodology for risk assessment in production of functional food products and its introduction into operation for implementation of the quality control system of food products fortified with iodine. This article represents the description of development of risk assessment methodology assigned for assessing the quality control system for functional foods fortified with iodine. The hazardous event in this case is the non-compliance of the food product with the regulatory requirements, in particular the decrease of iodine content in the functional foods down to a level below 30 mcg/100g of the product, which is less than 15% of an adult person's daily requirement. To assess the probable risks that can affect the peculiar features of the functional foods, RCA root cause mapping system was proposed that includes the standard methods: Ishikawa cause and effect diagram, fault tree analysis FTA, failure mode and effect analysis FMEA, and Pareto analysis. The technology of producing of the cooked sausages fortified with iodine-containing food ingredients was chosen as the object of research, as this technology is associated with a wide variety of technological modes and methods of raw materials processing, as well as the storage conditions of the ready products. The results of the study included a review of the collected data, consideration of the hypothesis, expert opinion on the most probable root causes of failures and losses, and the recommended preventive and corrective actions.

Research on software reliability enhancement methods based on iterative development

Iterative development is an agile software development methodology that speeds up the development process and increases the flexibility of software delivery. However, the current software requirements change extremely fast, which leads to its increasing uncertainty, and iterative development also faces the challenge of software reliability. The software reliability enhancement method based on iterative development is researched and discussed for the current situation of insufficient reliability in the traditional software development process. In traditional software development, one-time delivery pressure and overall design complexity often lead to software functional defects and instability, affecting software reliability. The iterative development method, on the other hand, improves software reliability by decomposing the software development process into multiple iterative cycles, each of which contains requirements analysis, design, coding, and testing, updating the software functionality in smaller increments, and gradually improving the software product. This study proposes a software reliability improvement methodology by exploring and analyzing the key factors related to reliability in the iterative development process. This dissertation can establish a reliable and high-quality software development process through the steps of meticulous requirements planning and management, iterative development and testing, automated testing and continuous integration, code quality control, defect management and continuous improvement, user feedback and user engagement, and continuous learning and technology enhancement.

DEVELOPING AN ENGLISH E-BOOK FOR YOUNG LEARNERS BY USING FLIPBOOK MAKER APPLICATION AT SDN 001 SAMBALIUNG

This research aims to develop an English e-book for young learners at SDN 001 Sambaliung using the Flipbook Maker application. The study addresses potential challenges in creating English e-books, such as engaging students with short attention spans and limited early literacy skills. Additionally, it explores the need for teacher and student training to use the Flipbook Maker technology. The research utilizes a qualitative approach combined with the ADDIE (Analysis, Design, Development, Implementation, Evaluation) model and Research and Development (R&D) methodology. Participants include students and teachers at SDN 001 Sambaliung. The findings reveal that using interactive e-books through Flipbook Maker offers advantages, including increased student interest and engagement. Moreover, the e-books can be adapted for other foreign language materials and provide easy accessibility for teachers, facilitating effective learning activities. This research successfully achieves its goal of developing an interactive and effective English e-book for young learners, integrating ADDIE principles and an R&D approach. The results can serve as a foundation for further development in utilizing Flipbook Maker technology in education.

European Society of Cardiology quality indicators update for the care and outcomes of adults with heart failure. The Heart Failure Association of the ESC.

To update the European Society of Cardiology (ESC) quality indicators (QIs) for the evaluation of the care and outcomes of adults with heart failure. The Working Group comprised experts in heart failure including members of the ESC Clinical Practice Guidelines Task Force for heart failure, members of the Heart Failure Association, and a patient representative. We followed the ESC methodology for QI development. The 2023 focused guideline update was reviewed to assess the suitability of the recommendations with strongest association with benefit and harm against the ESC criteria for QIs. All the new proposed QIs were individually graded by each panellist via online questionnaires for both validity and feasibility. The existing heart failure QIs also underwent voting to 'keep', 'remove' or 'modify'. Five domains of care for the management of heart failure were identified: (1) structural QIs, (2) patient assessment, (3) initial treatment, (4) therapy optimization, and (5) patient health-related quality of life. In total, 14 'main' and 3 'secondary' QIs were selected across the five domains. This document provides an update of the previously published ESC QIs for heart failure to ensure that these measures are aligned with contemporary evidence. The QIs may be used to quantify adherence to clinical practice as recommended in guidelines to improve the care and outcomes of patients with heart failure.

Machine Learning for Threat Detection in Softwares

The paper examines the application of machine learning (ML) techniques in the field of cybersecurity with the aim of enhancing threat detection and response capabilities. The initial section of the article provides a comprehensive examination of cybersecurity, highlighting the increasing significance of proactive defensive strategies in response to evolving cyber threats. Subsequently, a comprehensive overview of prevalentonline hazards is presented, emphasizing the imperative for the development of more sophisticated methodologies to detect and mitigate such risks. The primary emphasis of this work is to the practical use of machine learning in the identification and detection of potential dangers inside real-world contexts. This study examines three distinct cases: the detection of malware, attempts to breach security, and anomalous behavior shown by software. Each case study provides a detailed breakdown of the machine learning algorithms and approaches employed, demonstrating their effectiveness in identifying and mitigating risks. The paper further discusses the advantages and disadvantages associated with employing machine learning techniques for threat detection. One advantage of this approach is its ability to facilitatethe examination of extensive datasets, identification of intricate patterns, and prompt decision-making. However, discussions also revolve around difficulties like as erroneous discoveries, adversarial attacks, and concerns over privacy.

The development of a set of key points to aid clinicians and researchers in designing and conducting n-of-1 trials

Introductionn-of-1 trials are undertaken to optimise the evaluation of health technologies in individual patients. They involve a single patient receiving treatments, both interventional and control, consecutively over set periods of time, the order of which is decided at random. Although n-of-1 trials are undertaken in medical research it could be argued they have the utility to be undertaken more frequently. We undertook the National Institute for Health Research (NIHR) commissioned DIAMOND (Development of generalisable methodology for n-of-1 trials delivery for very low volume treatments) project to develop key points to assist clinicians and researchers in designing and conducting n-of-1 trials.MethodsThe key points were developed by undertaking a stakeholder workshop, followed by a discussion within the study team and then a stakeholder dissemination and feedback event. The stakeholder workshop sought to gain the perspectives of a variety of stakeholders (including clinicians, researchers and patient representatives) on the design and use of n-of-1 trials. A discussion between the study team was held to reflect on the workshop and draft the key points. Lastly, the stakeholders from the workshop were invited to a dissemination and feedback session where the proposed key points were presented and their feedback gained.ResultsA set of 22 key points were developed based on the insights from the workshop and subsequent discussions. They provide guidance on when an n-of-1 trial might be a viable or appropriate study design and discuss key decisions involved in the design of n-of-1 trials, including determining an appropriate number of treatment periods and cycles, the choice of comparator, recommended approaches to randomisation and blinding, the use of washout periods and approaches to analysis.ConclusionsThe key points developed in the project will support clinical researchers to understand key considerations when designing n-of-1 trials. It is hoped they will support the wider implementation of the study design.

Advances from R2CA project on reactor simulations for burst rod number evaluation during LOCA

In the frame of the “Reduction of Radiological Consequences of design basis and extension accidents” European Union’s Horizon 2020 project, a specific effort was focused on the update and the development of methodologies to assess the radiological consequences of loss-of-coolant accidents. Evaluation of the radiological consequences associated to this accident is strongly linked to the prediction of the rod burst ratio and new approaches were investigated through research and development associated to accident simulation software. Complementarily to approaches chaining system thermalhydraulic simulation to fuel performance code, approaches with integral codes ASTEC, DRACCAR and ATHLET-CD were developed respectively by ENEA, IRSN and HZDR. These applications were demonstrated on LOCA simulation for PWR and highlighted the capabilities of the tools. The ASTEC PWR model was extended by ENEA, which proposes a 2D core model with an increased number of representative fuel rods. HZDR and IRSN proposes approaches based on 3D core model which are able to capture distinctive fuel assembly responses and predict the rod burst ratio according to the distribution of rod behaviors within the core. This work highlighted several possible core models to predict the rod burst ratio and which can be used in integral tools abled to couple thermal hydraulics and thermomechanics. Advanced core models simulating the thermomechanical response of several representative rods per fuel assemblies and using 3D thermal hydraulics model are recommended due to the heterogeneities on power distribution, which impacts flow distribution. The need to model RPV in 3D was underlined by ATHLET-CD large break loss-of-coolant demonstrative case, which exhibits non-symmetric core heat-up.In addition, demonstrative cases proposed by ENEA and IRSN compared predictions obtained with the specific burst criteria developed in the frame of R2CA project and more classical one devoted to the core coolability assessment. The strong sensitivity of the rod burst ratio prediction to the burst criteria was highlighted. The need to handle uncertainties within a global methodology for rod burst ratio evaluation was underlined.Finally, throughout the development of loss-of-coolant accident applications with ASTEC, DRACCAR and ATHLET-CD, some prospects of development were identified for the codes and should bring advances for LOCA simulation and RBR predictions.

Web-based skin disease diagnosis expert system

. In tropical nations, such as Indonesia, skin diseases are a common ailment. Skin conditions are typically not lethal illnesses, thus patients frequently disregard them and don't take them seriously. Skin conditions can, however, become uncomfortable and threaten the sufferer's survival if they are left untreated for an extended period of time. The result of this research is the creation of a web-based expert system for identifying skin disorders, which can aid in more accurate and timely diagnosis of skin diseases as well as offer treatment advice. The development of a web-based expert system for diagnosing skin diseases uses the forward chaining method. While the development methodology uses ESDLC (Expert System Development Life Cycle), with the phases of Assessment, Knowledge Acquisition, Design, Test, Documentation, and Maintenance

Copper-Catalyzed Remote Regio- and Enantioselective Yne-Allylic Substitution of Coumarins.

Chiral coumarins and their derivatives are prominent bioactive structural units present in a wide range of natural products and pharmaceutical candidates. Therefore, the development of straightforward and efficient methodologies for the synthesis of readily functionalized chiral coumarins is of significant interest. Herein we report an enantioselective copper-catalyzed yne-allylic substitution of coumarins, resulting in a highly regioselective synthesis of diverse new classes of chiral coumarin derivatives with high efficiency and excellent functional group tolerance. Subsequent versatile transformations further demonstrate the substantial synthetic potential of this strategy in the field of biochemical research.

Copper-Catalyzed Remote Regio- and Enantioselective Yne-Allylic Substitution of Coumarins.

Chiral coumarins and their derivatives are prominent bioactive structural units present in a wide range of natural products and pharmaceutical candidates. Therefore, the development of straightforward and efficient methodologies for the synthesis of readily functionalized chiral coumarins is of significant interest. Herein we report an enantioselective copper-catalyzed yne-allylic substitution of coumarins, resulting in a highly regioselective synthesis of diverse new classes of chiral coumarin derivatives with high efficiency and excellent functional group tolerance. Subsequent versatile transformations further demonstrate the substantial synthetic potential of this strategy in the field of biochemical research.

Upcoming Italian clinical practice guidelines on endoscopic bariatric treatment of overweight and obesity: design and methodological aspects.

Obesity/overweight and its complications are a growing problem in many countries. Italian Society of Bariatric and Metabolic Surgery for Obesity (Società Italiana di Chirurgia dell'Obesità e delle Malattie Metaboliche-SICOB) decided to develop the first Italian guidelines for the endoscopic bariatric treatment of obesity. The creation of SICOB Guidelines is based on an extended work made by a panel of 44 members and a coordinator. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology has been used to decide the aims, reference population, and target health professionals. Clinical questions have been created using the PICO (patient, intervention, comparison, outcome) conceptual framework. We will perform systematic reviews, formal meta-analyses, and network meta-analyses for each PICO and critical outcomes aimed at assessing and rating the efficacy and safety of endoscopic bariatric procedures in comparison with either no interventions, lifestyle interventions, or approved anti-obesity treatments in trials with a follow-up of at least 52 weeks. For PICO on temporary endoscopic bariatric treatments, we will also consider RCT with a minimum duration of 6 months. The panel proposed 8 questions, organized into four domains: A. Indication for endoscopic bariatric surgery; B. Revisional surgery; C. Temporary gastric and duodenal-jejunal procedures; D. Endoscopic diagnosis/treatment of bariatric and metabolic surgery complications. These guidelines will apply to patients aged ≥ 14 years) with body mass index (BMI) ≥ 27 kg/m2 and requiring endoscopic bariatric surgery or endoscopic diagnostic and/or therapeutic procedures. The areas covered by the clinical questions included indications of endoscopic bariatric surgery, types of surgery, revisional surgery, and management of bariatric and metabolic surgery complications.

2023 Brazilian Society of Rheumatology guidelines for the treatment of systemic sclerosis

BackgroundSystemic sclerosis (SSc) is a rare chronic autoimmune disease with heterogeneous manifestations. In the last decade, several clinical trials have been conducted to evaluate new treatment options for SSc. The purpose of this work is to update the recommendations of the Brazilian Society of Rheumatology in light of the new evidence available for the pharmacological management of SSc.MethodsA systematic review including randomized clinical trials (RCTs) for predefined questions that were elaborated according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) strategy was conducted. The rating of the available evidence was performed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. To become a recommendation, at least 75% agreement of the voting panel was needed.ResultsSix recommendations were elaborated regarding the pharmacological treatment of Raynaud’s phenomenon, the treatment (healing) and prevention of digital ulcers, skin involvement, interstitial lung disease (ILD) and gastrointestinal involvement in SSc patients based on results available from RCTs. New drugs, such as rituximab, were included as therapeutic options for skin involvement, and rituximab, tocilizumab and nintedanib were included as therapeutic options for ILD. Recommendations for the pharmacological treatment of scleroderma renal crisis and musculoskeletal involvement were elaborated based on the expert opinion of the voting panel, as no placebo-controlled RCTs were found.ConclusionThese guidelines updated and incorporated new treatment options for the management of SSc based on evidence from the literature and expert opinion regarding SSc, providing support for decision-making in clinical practice.

Integration of Sustainable Development Goals in university STEM courses

The objectives of this study are: (1) to provide an overview of the validity of learning tools for STEM Method courses based on the Sustainable Development Goals Curriculum, (2) to assess the practicality of these learning tools, and (3) to evaluate their effectiveness in enhancing students' problem-solving abilities. This research employs the Research and Development (R&D) methodology. Data collection methods include interviews, product validation, questionnaires, and tests. Data analysis techniques encompass qualitative analysis, product validity testing, practicality testing, and effectiveness testing. The findings indicate that: (1) learning tools for STEM Method courses based on the Sustainable Development Goals curriculum comprise a Learning Plan and teaching materials, both of which are highly valid (scores of 3.4 and 3.5 respectively), (2) the practicality test of the teaching materials scored 3.73, indicating high practicality, and (3) these tools effectively improve students' problem-solving abilities, as evidenced by the experimental class outperforming the control class. In conclusion, the study demonstrates that the designed learning tools aligned with the Sustainable Development Goals Curriculum not only show strong validity and practicality but also significantly enhance students' problem-solving skills in STEM education contexts.

Experimental research of the effect of manufacturing holes and defects on the mechanical characteristics of laminated polymer composite

The paper presents a developed methodology for experimental research of the mechanical characteristics of a laminated polymer composite, taking into account manufacturing holes and defects. The results of experimental determination of mechanical characteristics are presented, the influence of the filler material, the type of fabric fiber weave, holes and manufacturing defects on the mechanical characteristics of laminated carbon fiber reinforced plastic are analyzed. The test specimens were made from carbon fiber 200T, 200P, ACM C300X and binder “Inject SL(B)”. Static tests of specimens for uniaxial tension, compression and three-point bending were performed.

Efficient standardization of clinical T2-weighted images: Phase-conjugacy e-CAMP with projected gradient descent.

To standardize T -weighted images from clinical Turbo Spin Echo (TSE) scans by generating corresponding T maps with the goal of removing scanner- and/or protocol-specific heterogeneity. The T map is estimated by minimizing an objective function containing a data fidelity term in a Virtual Conjugate Coils (VCC) framework, where the signal evolution model is expressed as a linear constraint. The objective function is minimized by Projected Gradient Descent (PGD). The algorithm achieves accuracy comparable to methods with customized sampling schemes for accelerated T mapping. The results are insensitive to the tunable parameters, and the relaxed background phase prior produces better T maps compared to the strict real-value enforcement. It is worth noting that the algorithm works well with challenging T w-TSE data using typical clinical parameters. The observed normalized root mean square error ranges from 6.8% to 12.3% over grey and white matter, a clinically common level of quantitative map error. The novel methodological development creates an efficient algorithm that allows for T map generated from TSE data with typical clinical parameters, such as high resolution, long echo train length, and low echo spacing. Reconstruction of T maps from TSE data with typical clinical parameters has not been previously reported.