Ongoing Improvement Research Articles

Environmental sustainability in stadiums: harnessing industry drivers and priorities for improved outcomes

PurposeThis paper aims to identify industry drivers and priorities that influence decision-making towards adopting environmentally sustainable (ES) features in stadiums. An “Environmentally Sustainable Stadium (ESS) Process Model” is proposed to track ES features throughout their life cycle, guiding planning, designing, construction, operation and management.Design/methodology/approachData were collected through 20 online semi-structured interviews with experts from sustainability, built environment, stadium management, mega-event planning and management and researchers. The experts’ project experiences spanned across Oceania, North America, South America, Asia and Europe. The data were recorded and transcribed through Teams and analysed using NVivo 11 application software.FindingsStadium’s ES features predominantly focus on energy, waste and materials management with some emphasis on carbon emission reductions and renewable energy sources. Emerging focus areas include flexible designs, audience (or fans) and community engagement, circular economy principles and integration with nature. Key drivers for adopting ES features include legislation and other sector-based requirements, competitive advantages and stakeholder pressures. ES feature success depends on owner support, budget, partnerships, expertise and opportunities. Major barriers include stakeholder diversity, infrastructure limitations and limited stadium-specific requirements.Practical implicationsThis paper proposes a six-step “ESS Process Model” to support the stadium industry to holistically integrate ES features, from the initial decision-making to the implementation, ongoing improvement and stakeholder engagement. The model helps stakeholders to identify opportunities, navigate challenges and achieve continual improvement.Originality/valueThe ESS process model is a novel approach to integrate ES features in stadiums, through enhancing collaboration among stakeholders and overcoming challenges in choosing, implementing and maintaining ES features.

"Pixel Wars": Digital Collectibles Trading on the Internet

With the rise of Non-Fungible Tokens (NFT) internationally, digital collection trading in China has also emerged. In the trading practices of the digital collectibles market, consumers find themselves caught in the vortex of fraud, illegal fundraising, and pyramid schemes. Legal professionals are striving to assist consumers in protecting their rights, but they face significant challenges. An analysis of the crimes and misdemeanors in China's digital collectibles trading market reveals inadequate market regulation, ineffective regulatory enforcement, and numerous other persistent issues and challenges. In response to these issues, this paper will analyze the legal challenges encountered in digital collectibles trading and propose corresponding solutions: defining the scope of regulation, clarifying the flow of funds, and drawing on regulatory frameworks from NFT markets in other regions, among other approaches. It will also analyze the criminal elements under similar circumstances, clarify the distinction between criminal and non-criminal acts, and identify the subjects of regulation within digital collectibles trading. As digital collectible trading continues to evolve, laws and regulations will require ongoing improvement to keep pace with these developments.

Fetal Cardiovascular Magnetic Resonance: History, Current Status, and Future Directions.

Fetal cardiovascular magnetic resonance imaging (MRI) has emerged as a complementary modality for prenatal imaging in suspected congenital heart disease. Ongoing technical improvements extend the potential clinical value of fetal cardiovascular MRI. Ascertaining equivocal prenatal diagnostics obtained with ultrasonography allows for appropriate parental counseling and planning of postnatal surgery. This work summarizes current acquisition techniques and clinical applications of fetal cardiovascular MRI in the prenatal diagnosis and follow-up of fetuses with congenital heart disease. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 3.

Enhancing ride comfort and driving safety in urban autonomous buses: A data-driven hierarchical longitudinal motion planning using approximate and stochastic MPCs

This paper presents an advanced hierarchical longitudinal motion planning strategy for autonomous buses (ABs), specifically designed to enhance ride comfort and ensure driving safety – key challenges in contemporary autonomous vehicle technologies. ABs typically face limitations due to a narrower perception range and heterogeneous motion profiles compared to human drivers. To tackle these issues, our study employs a dual-phase motion planning framework utilizing both approximate and stochastic Model Predictive Controls (MPCs). In the long time-horizon planning phase, we aim to enhance ride comfort by optimizing a reference motion profile that covers the full perception range of the ABs. This optimization is facilitated by leveraging deep neural networks to approximate the MPC policy, ensuring efficient real-time computational performance. The short time-horizon planning phase focuses on driving safety by determining optimal control inputs, considering vehicle dynamics, and integrating safety-related chance constraints with stochastic MPC. Additionally, this phase fine-tunes the weights in the MPC’s objective function based on risk indices derived from human driving data, balancing the priorities of safety in hazardous situations and maintaining ride comfort. Our hierarchical motion planning strategy ensures both consistent ride comfort and safety in critical scenarios. Through comprehensive evaluations using computer simulations and vehicle tests in actual urban bus-only lanes, the proposed method has proven to significantly enhance ride comfort while maintaining driving safety. This approach contributes to the ongoing improvement of the operational quality of ABs, supporting public transportation goals and meeting passenger expectations effectively.

"Evolution of a combined baccalaureate/medical degree program as a pipeline to primary care: retention strategies and lessons learned".

The University of New Mexico School of Medicine established the combined baccalaureate/medical degree (BA/MD) program in response to critical physician shortages in New Mexico (NM). This 8-year program aims to improve health care in NM by expanding access to medical education for local students, particularly from rural and underserved communities and/or racial/ethnically underrepresented in medicine (URiM) in NM. To describe the BA/MD program's initial design, the impact of improvements on retention, and the outcomes in terms of physicians in practice, particularly in primary care specialties. The study reviews the BA/MD program's progress from 2006 to 2023, focusing on curriculum and support enhancements. Retention rates and choice of primary care specialties were analyzed by geographic origin and racial/ethnic background. From 2006 to 2023, the program graduated 81 physicians, with 53 practicing in 10 of NM's 33 counties. Approximately two-thirds specialize in primary care, and a similar proportion are URiM. Students from 31 of NM's 33 counties were admitted, with two-thirds coming from outside the state's metropolitan area. Overall retention and retention across demographic groups improved significantly in the baccalaureate phase of the program due to changes in curriculum and support services. The program has effectively addressed physician shortages in NM, particularly in rural and underserved areas. Its success in training and retaining physicians from diverse backgrounds, with a focus on primary care, is crucial for improving health care access in the state. Ongoing improvements in the program are essential to sustaining and enhancing these outcomes.

Assessing research culture and capacity amongst faculty at a North American chiropractic institution: an explanatory mixed methods study

BackgroundResearch enables a profession to establish its cultural authority, validate its professional roles and ensure ongoing improvement in the quality of its academic programming. Despite the clear importance of research, a mature research culture has eluded the chiropractic profession. A fostering institutional culture that enables, values, and supports research activity is essential to building research capacity. Our study aimed to collect information about the existing research capacity and culture at the Canadian Memorial Chiropractic College (CMCC) and explore the views, attitudes and experiences of faculty members regarding research.MethodsWe conducted a sequential explanatory mixed methods study with quantitative priority between April and July, 2023. Quantitative data were collected using the Research Capacity and Culture (RCC) tool. Survey results guided the qualitative data collected from four faculty focus groups with varying levels of research experience. Quantitative data were analyzed using descriptive statistics by domain and stratified by research education and workload. The qualitative data were thematically analyzed and then integrated with the quantitative results to provide deeper meaning to the results.ResultsThe faculty survey response rate was 42% (59/144). Attributes at the organization or department level were consistently rated as either moderate or high; however, research skills at an individual level were more variable and influenced by factors such as research workload and highest research-related academic qualification. Qualitative focus group data were categorized under four themes: institutional factors, resource allocation, career pathways and personal factors. Lower scores for survey items related to mentorship, research planning and ensuring faculty research career pathways, as well as the identified workload and time-related barriers (e.g., other work roles and desire for work/life balance) for engaging in research were supported by each of the four themes. Research motivators included keeping the brain stimulated, developing skills and increasing job satisfaction.ConclusionThe quantitative and qualitative information in this study provides a baseline evaluation for RCC and identifies key factors impacting RCC at the CMCC. This information is critical for planning, developing, implementing, and evaluating future interventions to enhance research capacity. Ultimately, these efforts are aimed at maturing the research culture of the chiropractic profession.

Will Food Safety Incidents Stimulate the Public's Desire for Food Safety Governance?

This paper, grounded in the Stimulus-Organism-Response (SOR) model and event system theory, examines the mechanisms through which public recognition-specifically novel, disruptive, and critical recognition-of the intensity of food safety incidents influences willingness to engage in food safety governance. Risk perception is identified as a mediating variable, while risk communication serves as a moderating variable. Based on survey data, the study found that various forms of public recognition significantly impact governance willingness. Furthermore, risk perception plays a crucial mediating role, and risk communication has a notable moderating effect on the relationship between risk perception and food safety governance willingness. These findings illuminate the intrinsic connection between public recognition of food safety incidents and governance willingness, offering robust theoretical support and practical guidance for enhancing food safety governance. This research contributes to the ongoing improvement and optimization of food safety governance systems.

Navigating the Landscape of Organizational Process Mining Setups

AbstractProcess mining (PM) technology evolves around the analysis, design, implementation, and ongoing improvement of business processes. While it has experienced a lot of attention and significant technological advancements, contributions to the field have mostly revolved around technical matters, neglecting managerial and organizational aspects. Thus, researchers have called for a more holistic view of the application and adoption of PM in enterprises. To address this gap, this paper presents a taxonomy for organizational PM setups. Its applicability and usefulness are shown in three exemplary cases. This study extends the descriptive knowledge at the intersection of PM and business process management governance, highlighting the unique governance requirements associated with PM that cannot be effectively addressed through traditional governance approaches. The taxonomy provides practitioners with orientation when developing an effective PM setup and helps to characterize existing setups.

Safety of inpatient care in surgical settings: cohort study

ObjectivesTo estimate the frequency, severity, and preventability of adverse events associated with perioperative care, and to describe the setting and professions concerned.DesignMulticenter retrospective cohort study.Setting11 US hospitals.Participants1009 patients from a...

Mortality in the Burn Intensive Care Unit (2017-2023) at Mohammed VI University Hospital, Department of Reconstructive and Aesthetic Surgery, Marrakech

This internal audit aims to evaluate the management of burn patients in the intensive care unit (ICU) of Mohammed VI University Hospital in Marrakech, a specialized burn treatment center in Morocco. The retrospective study spans from 2017 to 2023, analyzing the deaths of 27 patients admitted to the ICU, with an average age of 62. The primary causes of death identified were septic shock (54%) and acute respiratory distress syndrome (18%). Key challenges emerged, including nursing staff shortages, inadequate stock management of dressing materials, and the absence of care assistants, all of which impacted the quality of care provided. The study also underscores the importance of improved care organization, drawing from international best practices. The report proposes several solutions, such as increasing nursing staff, optimizing workflows, and improving sanitary infrastructure to minimize infection risks. A crucial recommendation involves reassessing admission criteria to ensure that critically ill patients are redirected to appropriate units, particularly by strengthening the presence of full-time intensivists in the burn ICU. Furthermore, the report highlights the need for continuous training of medical personnel and interdisciplinary collaboration to enhance the quality of care. The introduction of assistive technologies and companion programs for isolated patients would also improve their nutritional and psychological support. These initiatives could alleviate the burden on medical staff and improve patient outcomes. By implementing these recommendations, the burn ICU could be transformed into a model of excellence, providing optimal, safe, and respectful care tailored to the individual needs of burn patients. This audit serves as a foundation for ongoing improvement, emphasizing patient safety and well-being as the core priorities in burn patient management.

Abstract 4138268: The Use of Mavacamten for Management of Post TAVR Obstruction: A Novel Approach to Treatment

Background: Treatment of left ventricular outflow tract (LVOT) obstruction involves a combination of negative inotropic agents. However, these therapies have limitations which may result in insufficient control of symptoms, leading to more invasive options such as surgical septal myectomy or septal alcohol ablation. Mavacamten, a cardiac myosin inhibitor, is currently approved for the treatment of patients with symptomatic obstructive hypertrophic cardiomyopathy (HCM). We present a case of a patient treated with mavacamten in addition to β-blockers (BB) for management of post-TAVR LVOT obstruction. Case: A 76 year old female with a past medical history of hypertension, severe aortic stenosis, and coronary artery disease underwent a Medtronic Evolut TAVR in March 2022. Her TTE post TAVR showed LVOT peak gradient greater than 100 mm Hg, LVEF 75% and severe eccentric mitral regurgitation secondary to systolic anterior motion (SAM) of the mitral valve (MV). After multidisciplinary discussion, the patient was discharged on maximally tolerated BB therapy. Follow up TTE showed persistent obstruction and gradients, so diltiazem was added to her regimen. Her subsequent TTE showed a peak LVOT > 100 mmHg at rest, and severe MR. Given persistent findings, she was started on mavacamten, continued on metoprolol, and tapered off of diltiazem. Her TTE two months after initiation of mavacamten revealed resolution of LVOT gradients, reduction of MR to mild and normal LV and TAVR function. She tolerated the therapy well and endorsed ongoing symptomatic improvement on subsequent follow up. Discussion: With the increasing use of TAVR therapy, there has been a corresponding rise in cases of post-TAVR obstruction that must be managed. As demonstrated by this case, management with BB therapy alone may be suboptimal. Although mavacamten is currently approved in patients with HCM, the obstruction in post-TAVR patients is functionally similar. Thus, this medication was trialed as a supplemental treatment in this patient and yielded positive results. This case highlights the potential benefit of extending use of mavacamten alongside β-blocker therapy for this patient population and suggests the need for future studies.

THE KEY DIRECTIONS FOR IMPROVING THE FINANCIAL MANAGEMENT OF THE TAX SYSTEM IN THE REPUBLIC OF ARMENIA

The transition to market relations involves addressing numerous challenges, and resolving these challenges is essential for creating the necessary preconditions for the further development of the market economy in the Republic of Armenia (RA). This includes the implementation of radical transformations in the country's financial, monetary, banking, fiscal, social, structural, and other systems. During the reforms of the financial system in the Republic of Armenia, special attention has been given to the creation and ongoing improvement of an effective tax system. In this regard, the RA State Revenue Committee, as the tax authority, has served as a state government body responsible for tax administration for more than 30 years. Over this period, it has accumulated significant experience and, in line with contemporary developments, has implemented various infrastructures and information systems. According to the author, the financial management of the RA tax system falls within the general theory of management, and the functions of financial management, such as financial planning, analysis, forecasting, and control, are adequately reflected in this context. The article emphasizes the conceptual foundations of program budgeting and accounting, which ensure a practical, close connection between the financial management of the RA tax system and accounting, budgeting, and the financial flows of the tax system and their related transactions. This connection leads to the effective management of the assets and liabilities of the RA tax system.

IMPLEMENTATION OF STATE OWN GOODS MANAGEMENT IN COORDINATOR MINISTRY OF HUMAN DEVELOPMENT AND CULTURE

Commitment and consistency in managing state property effectively are crucial for ensuring accountability. However, the management of state property across various government institutions is often not treated as a priority. This journal seeks to evaluate how well state property management policies are implemented within the Coordinating Ministry for Human Development and Culture of the Republic of Indonesia. Using a qualitative research method, data were collected through in-depth interviews, observation, documentation, and literature review. Effective management of state property depends on the proper execution of policies, which, in turn, ensures accountability. The findings reveal that the implementation of state property management policies within the ministry has been consistent, particularly in the areas of needs planning, procurement, and administration. Nevertheless, there is a need for a stronger commitment to addressing certain technical aspects of management to further enhance policy effectiveness. Overall, while progress has been made, ongoing improvements are necessary to optimize state property management.

The Role of Forensic Medicine in Modern Criminal Justice: A Review of Current Practices and Innovations

Forensic medicine plays a pivotal role in modern criminal justice by providing scientific insights that aid in solving crimes, identifying victims, and ensuring the accurate administration of justice. This review examines the current practices in forensic medicine, including autopsies, toxicology, DNA analysis, and forensic anthropology, highlighting their applications in various criminal cases. Technological innovations, such as advanced DNA technologies, digital forensics, and forensic imaging, have significantly enhanced the field, improving accuracy and efficiency in investigations. The review also addresses challenges faced by forensic medicine, including issues of accuracy, resource constraints, and ethical considerations surrounding privacy and consent. The integration of artificial intelligence and portable forensic devices is explored as part of the ongoing evolution within the field. By analyzing the impact of these advancements on case resolutions, exonerations, and crime prevention, this article underscores the critical role of forensic medicine in the justice system and discusses future directions for research and practice. The insights presented aim to inform ongoing improvements in forensic methodologies and to foster a justice system that is both scientifically rigorous and ethically responsible.

Meeting the accreditation standard through implementation of a multiprogram residency advisory committee and ongoing quality improvement.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. To describe the process utilized by a large multiprogram residency site to expand preceptor engagement and establish ongoing quality improvement efforts in order to meet the program's needs in response to evolving ASHP accreditation standards. A multiprogram residency advisory committee (RAC) primarily composed of residency program leadership was formed to focus on aspects of program management and accreditation compliance that were not being addressed at the monthly all-preceptor meeting. The ASHP standard and a recent residency accreditation survey guided the RAC agenda, which led to the creation of a combined manual for the institution's 5 residency programs and a preceptor manual. Preceptor engagement was improved through the establishment of local preceptor requirements, inclusion of preceptor representatives on the RAC, expansion of subcommittee opportunities, addition of a preceptor midpoint retreat, and optimization of the end-of-year preceptor retreat. Communication with residents and identification of continual improvement opportunities were improved through roundtables with residents, residency program directors, and the RAC chair; a monthly meeting with the rotating chief resident and RAC chair; and face-to-face exit interviews with the department's chief of pharmacy. The RAC chair has been a key figure in coordinating program change to meet the ASHP standard as well as leading planning for subsequent ASHP surveys. Through the establishment of a multiprogram RAC and a RAC chair, our program has been able to engage a large preceptor group that is dedicated to continual improvement and provides the ability to dynamically respond to ASHP's progressing guidance for pharmacy residency programs.

IDENTIFEYE: Sketch-Based Facial Analysis in Forensics

Traditional forensic methods, like hand-drawn sketches, often fall short in quickly identifying suspects, making the process both slow and resource-intensive. This paper introduces an innovative application designed to streamline this task. Through a simple drag-and-drop interface, users can upload sketches and match them with entries in police databases, significantly boosting the speed and accuracy of suspect recognition. By integrating deep learning and cloud technology, this tool builds on existing algorithms to deliver higher precision and ease of use. Earlier methods have had trouble aligning sketches with photographs, especially when orientations differ. Our application overcomes these issues, merging the art of sketching with modern technology to enhance forensic work. Testing reveals promising accuracy, though ongoing improvements are needed to fully meet the demands of law enforcement. This research aims to offer a real-world solution, tackling past limitations and making suspect identification faster and more efficient for investigators. Keywords: Forensic identification, Suspect sketching, Deep learning, Recognition software, Law enforcement tools, Cloud technology.

Re-excision rates after breast-conserving surgery for invasive breast cancer: an Albertan perspective.

Re-operation after breast-conserving surgery for invasive breast cancer is variable among centres and individual surgeons. In this study, we aimed to characterize the current landscape of practice regarding re-operation for invasive breast cancer in the province of Alberta. This study was a retrospective review of the Synoptec database for patients undergoing primary breast-conserving surgery for invasive breast cancer or reoperation in the province of Alberta in the year 2020. We extracted data on demographic and tumour characteristics, use of intraoperative margin-assessment strategies, and surgical facility. We conducted univariate and multivariate logistic model analyses. We included 1391 breast surgeries in the study. A total of 158 patients underwent re-operation during the study period. The median time to first reoperation was 34 days. The overall re-operation rate was 11.4% (range 5.4%-18.5%) among surgical facilities. The completion mastectomy rate was 5.2%, and 1.5% of patients underwent multiple revisional surgeries. Tumour multifocality was associated with increased revisional surgery rates on multivariate analysis (odds ratio 2.80). The results of this study are consistent with the published literature. We have identified heterogeneity among sites in Alberta for revisional surgery after breast-conserving surgery for invasive breast cancer. This highlights an opportunity for ongoing education and quality improvement in breast cancer care in the province of Alberta.

Visual cognition-based optimised design of primary flight displays in cockpits

Abstract The objective of this study was to investigate the effects of different cockpit primary flight display (PFD) interface designs on pilot cognitive efficiency and cognitive load. This study designed five optimised PFD interfaces and conducted interface cognition experiments to assess cognitive responses across six different PFD interface designs, including the original design. It compared various subjective and objective metrics across different interface designs and evaluated the impact of each design factor on cognitive task performance. The experimental results show that the PFD interface in the original interface design performs better under different flight symbol designs, and the interface with 50% increase in font size performs better among interface designs with different font sizes with relatively lower cognitive load. This study provides experimental support and optimization suggestions for the optimal design of cockpit PFD interface, which can help improve pilots’ perception and operational capabilities, and thus enhance task performance efficiency and flight safety. Future research can investigate the effects of various design factors on the cognitive effects of the interface to enhance the ongoing improvement and optimisation of interface design.

Impact of Organisational Innovation on Sustainable Competitive Advantage of Manufacturing Firms in Lagos State, Nigeria

The increased level of competition in the current business climate required the implementation of processes and systems to guarantee a sustainable organisational competitive advantage for the benefit of stakeholders. This research evaluates the association between product innovation and manufacturing firms’ sustainable competitive advantage, determine the effect of process innovation on manufacturing firms’ sustainable competitive advantage, examine the influence of administrative innovation on manufacturing firms’ sustainable competitive advantage and ascertain the joint relationship between product, process, and administrative innovation on manufacturing firms’ sustainable competitive advantage. Descriptive research design was adopted and a sample size of 131 manufacturing firms was used for the analysis. Data were collected using a questionnaire and analysed using regression analysis with the aid of SPSS Version 25. The findings showed that product innovation (β = .524, p < .005) process innovation (β = .417, p < .005) and administrative innovation (β = .488, p < .005) significantly influenced firm sustainable competitive advantage, individually and jointly. The research concludes that manufacturing organisations should prioritise innovation in their strategic plans. This study suggests ongoing product improvement through process and administrative adjustments and a culture of innovation and experimentation to find new sources of competitive advantage and create sustainable value.

Enhancing Real-Time Emotion Recognition in Classroom Environments Using Convolutional Neural Networks: A Step Towards Optical Neural Networks for Advanced Data Processing

In contemporary academic settings, end-of-semester student feedback on a lecturer’s teaching abilities often fails to provide a comprehensive, real-time evaluation of their proficiency, and becomes less relevant with each new cohort of students. To address these limitations, an innovative feedback method has been proposed, utilizing image processing algorithms to dynamically assess the emotional states of students during lectures by analyzing their facial expressions. This real-time approach enables lecturers to promptly adapt and enhance their teaching techniques. Recognizing and engaging with emotionally positive students has been shown to foster better learning outcomes, as their enthusiasm actively stimulates cognitive engagement and information analysis. The purpose of this work is to identify emotions based on facial expressions using a deep learning model based on a convolutional neural network (CNN), where facial recognition is performed using the Viola–Jones algorithm on a group of students in a learning environment. The algorithm encompasses four key steps: image acquisition, preprocessing, emotion detection, and emotion recognition. The technological advancement of this research lies in the proposal to implement photonic hardware and create an optical neural network which offers unparalleled speed and efficiency in data processing. This approach demonstrates significant advancements over traditional electronic systems in handling computational tasks. An experimental validation was conducted in a classroom with 45 students, demonstrating that the level of understanding in the class as predicted was 43–62.94%, and the proposed CNN algorithm (facial expressions detection) achieved an impressive 83% accuracy in understanding students’ emotional states. The correlation between the CNN deep learning model and the students’ feedback was 91.7%. This novel approach opens avenues for the real-time assessment of students’ engagement levels and the effectiveness of the learning environment, providing valuable insights for ongoing improvements in teaching practices.