Revenue Opportunities Research Articles

8469 Endocrinologists Underutilize Virtual Care Services Resulting in Suboptimal Clinical and Financial Outcomes

Abstract Disclosure: D. Terry: Employee; Self; Valendo Health. Less than 150,000 Medicare patients with diabetes (PWD) receive billable telehealth and remote monitoring services, even though over 12 million PWDs are eligible for these services. This is a missed quality opportunity, as studies show that PWDs who receive these services experience reductions in A1C levels and improvements in TIR. It is also a missed financial opportunity for Endocrinologists, who are among the lowest paid specialists in the US. The economics of Endocrinology are important, because inadequate compensation is leading to access constraints when the diabetes population is growing, and care complexity is increasing. We analyzed billed virtual health claims for every Medicare PWD in 2022. The types of services we examined included: Chronic Care Management (CCM & PCM), Continuous Glucose Monitoring (CGM & RPM), Medical Nutrition Therapy (MNT), and Diabetes Self-Management Training (DSMT). When we looked by Endocrinologist by virtual care service type, we found the following levels of service delivery for Endocrinologists at the median levels of utilization:4.8% of eligible PWDs received remote Continuous Glucose Monitoring support.4.2% received virtual Chronic Care Management services.6.2% received virtual Diabetes Self-Management Support.<1% received Medical Nutrition Therapy This is clearly a missed clinical quality opportunity as a study published in JAMA in October 2023, Comprehensive Telehealth Model to Support Diabetes Self-Management, reported the following improvements for PWDs who received virtual care for 6 months:Mean change in A1C levels: Type 1: -0.6%; Type 2: -1.0%Mean TIR Improvement: Type 1: 16%; Type 2: 18% It is also a missed financial opportunity for Endocrinology practices. Each patient with diabetes is potentially eligible for $100 or more of virtual care services per month. We’ve looked at every Endocrinology practice in the US and many are missing out on over a million dollars of annual revenue opportunity. This is important as Endocrinology organizations everywhere, independent and hospital based, are struggling to retain the doctors & staff necessary to provide adequate access to care - leading to months of wait time to see an Endocrinologist. The prevalence of diabetes is growing significantly, while Endocrinologist capacity is shrinking. Value added and billable virtual care services create new opportunities for Endocrinologist to generate the revenue necessary to increase clinical capacity and improve access by creating diverse clinical teams led by Endocrinologists and supported by Diabetes Educators, Dietitians, and others with expertise in diabetes who can care for many more PWDs. Creating virtual care capabilities is also an early step in moving Endocrinology into Value-Based Care arrangements that reward providers for improving care and reducing costs rather than for generating more visits. Presentation: 6/1/2024

Ecological implications of chromium-contaminated effluents from Indian tanneries and their phytoremediation: a sustainable approach.

Industrial activities are paramount to sustaining the economy in a rapidly developing nation and global powerhouse like India. Leather industries are important in the country's economic map due to the high revenue and employment generation opportunities. Several of these industries contribute largely to environmental pollution. The pollution of the environment is mainly caused by improper disposal of the tannery effluents that are highly rich in hexavalent chromium, a potent human carcinogen. Hexavalent chromium imparts toxic effects on the biotic components, which include plants, animals, and humans. The review portrays the current status of the Indian leather tanning sector and its impact on the Indian economy. The process of chromium tanning and its adverse effects on the environmental biotic components have been briefly discussed. Phytoremediation of these effluents using suitable hyperaccumulating plants has been suggested as an eco-friendly and cost-effective approach for the sustainable restoration of the polluted environment. The mechanism behind the remediation approach and the factors influencing it have been detailed. The manuscript briefly discusses some important advancements in the field of phytoremediation and emerging technologies and concludes by emphasizing further research for sustainable management of tannery wastes.

Redefining General Public Segment In Kustomfest: A Research On Visitor Motives In Attending A Kustom Kulture Festival

The Indonesian creative economy has experienced significant growth, with creative tourism emerging as a prominent driver. This study centers on Kustomfest, the Indonesian Kustom Kulture Festival, recognized as one of the largest Kustom Kulture hubs in the country. Between 2019 and 2023, there was a notable shift in the festival's audience composition, with the general public now constituting the majority segment. The research aims to identify and analyze the key motives driving the general public to attend Kustomfest, segment the market based on these motives, and examine each segment's sociodemographic profiles and behavioral characteristics. Three distinct market segments were identified, each motivated by different factors. Insights from this study can assist organizers of similar Kustom Kulture-related events in expanding creative tourism in Indonesia. By understanding visitor motivations and behaviors, event organizers can tailor marketing strategies, enhance visitor experiences, and capitalize on revenue opportunities from the general public segment. Recommendations are provided to attract, retain, and expand each segment through business model innovation, thus contributing to the sustained growth of Indonesia's creative economy. The findings highlight the importance of understanding visitor motivations and behaviors to maximize the impact of cultural events on the broader creative economy. These insights enable event organizers to foster growth in Indonesia's creative sector, ensuring that cultural festivals like Kustomfest continue to evolve and appeal to a diverse audience.

(Invited) The U.S. Department of Energy’s Hydrogen Consortium for Advanced Water Splitting Materials

The goals of the Hydrogen and Fuel Cell Technologies Office (HFTO) support those of the Biden Administration to build a clean and equitable energy economy and address the climate crisis through development and deployment of hydrogen technologies to the benefit of all Americans. HFTO is dedicated to meeting the goals of DOE’s Hydrogen Shot,1 which targets affordable clean hydrogen production at $1/kg within the decade, and the H2@Scale Initiative,2 which aims to advance affordable hydrogen to enable decarbonization and revenue opportunities across multiple sectors.HFTO’s HydroGEN consortium (https://www.h2awsm.org) for advanced water splitting (AWS) materials, part of the DOE’s Energy Materials Network (EMN), focuses on multiple clean hydrogen production pathways, including several relevant to renewable fuels via artificial photosynthesis. Since the consortium’s establishment in 2016, HydroGEN researchers have made significant progress in the areas of low and high temperature electrolysis, as well as solar thermochemical (STCH), and most relevant here, photoelectrochemical (PEC) hydrogen production pathways. The HydroGEN consortium facilitates collaborations between national laboratories, academia, and industry, bringing together world-class technical expertise with state-of-the-art facilities made available to project partners. HydroGEN offers an extensive collection of materials research capabilities for addressing R&D challenges. Project participants can choose from over 40 unique capability nodes. Each capability node is comprised of a combination of a tool, technique, and expertise that is unique to the national laboratory system.HydroGEN has supported over 30 competitively selected R&D projects with industry and academic partners by providing streamlined access to national lab resources and expertise. The consortium is also involved in fostering cross-cutting activities to advance material performance and durability through community engagement and protocol development and initiating critical laboratory-led efforts to address specific R&D gaps in the AWS portfolio.A new cohort of solar fuels focused projects were recently selected through the Funding Opportunity Announcement (FOA) Number: DE-FOA-0002792 with additional funding in this area expected in the future. A total of 11 new projects were selected, six in PEC and five in STCH, to work with the HydroGEN consortium towards advancing solar fuels production technology. Projects from both technology pathways must define materials metrics and targets for meeting the interim hydrogen cost target of $2/kg-H2 with extrapolation to additional requirements for meeting $1/kg-H2.Selected PEC projects focused on the development of materials or material systems for efficient and durable PEC water-splitting with a focus on innovations in bandgap and bandgap alignment, functional interfaces, stable surface catalysis, and protective coatings. A successful PEC photoelectrode project will need to achieve 15% STH efficiency for the entirety of operation exceeding 1,000 hours, with proposed pathways for achieving efficiencies up to 25% and durability up to 10,000 hours. Further, PEC systems will be required to demonstrate hydrogen production at a rate of 0.1 g/h for diurnal operation over two weeks.Selected STCH projects focused on accelerating discovery, development, and demonstration of alternative redox materials for a two-step STCH process and addressing projected costs and materials challenges associated with the required operating temperatures. Successful STCH projects will need to include a demonstration of the STCH process using sunlight or simulated sunlight. STCH systems must demonstrate hydrogen production at a rate of 1 g/h for diurnal operation over two weeks.For the first time, in line with the Justice40 Initiative,3 applicants were required to submit DEIA (diversity equity, inclusion, and accessibility) plans. Objectives from these plans were incorporated into the project objectives with specific goals identified for each year.Despite the progress, there is still significant ground to be covered through water splitting materials R&D. With the support of HydroGEN, these selected projects will help to address remaining challenges and enable low-cost and large-scale hydrogen production. An overview of consortium and project goals and objectives will be discussed. Hydrogen Shot | Department of EnergyH2@Scale | Department of Energy,The Justice40 initiative, created by Executive Order 14008, establishes a goal that 40% of the overall benefits of certain federal investments flow to disadvantaged communities. Figure 1

(Invited) Hydrogen Detection Strategies to Support H2@Scale--the NREL Sensor Laboratory

Hydrogen represents a major pathway to decarbonize and stabilize the national and international energy industry and select manufacturing markets. To facilitate the development of hydrogen markets, the US Department of Energy initiated H2@Scale to bring together stakeholders to advance affordable hydrogen production, transport, storage, and utilization to increase revenue opportunities in multiple energy sectors. One major impediment to hydrogen implementation is cost. To expedite the use of hydrogen in energy and other markets, the United States announced in 2021 the Hydrogen Shot, which seeks to reduce the cost of clean hydrogen by 80% to $1 per 1 kilogram in 1 decade ("1 1 1"). As the cost of hydrogen drops, new applications will emerge that will require unique configurations of existing equipment and infrastructure, and eventually lead to advances in the generation and utilization of hydrogen. As the hydrogen economy expands, sensors and detection methods will need to adapt to changing infrastructure demands to address the primary targets of health & safety, emissions monitoring, and process control. The NREL Sensor Laboratory is playing a pivotal role in advancing the use of hydrogen sensors and detection methodologies in each of these categories to support DOE’s mission for safe and efficient utilization in emerging markets. Health & safety monitors are required to ensure that operators and facilities can react to unintended hydrogen releases, either as GH2, LH2, or as a constituent of blends (e.g., natural gas or ammonia). Current detection methodologies focus on safety applications to detect near its lower flammable limit (4 vol %), and typically include point sensors in applications such as fixed or mobile detectors (e.g., personal gas monitors). Methodologies amenable for area detection include acoustic, emerging optical imaging methods, and flame detectors.Comparable detection strategies can be utilized for emissions monitoring and quantization, however few methods can simultaneously cover both low (emissions) and high (health & safety) levels. Deployment of emission level detectors will be required to 1) reduce product loss through small but potentially significant leaks from an environmental or cost perspective, 2) reduce downtime of high demand systems by early identification of eminent system failures (leaks through pump or compressor seals indicative of impending failure), and 3) address potential emission monitoring requirements that may be set by regulating bodies. The first two points should be adopted by industry to reduce the cost-of-goods-sold.The third main category for hydrogen detection relates to process control and may be advantageous for many existing applications. Two main applications are emerging. For example, the purity requirements for hydrogen that is dispensed from refueling systems for hydrogen fuel cell electric vehicles (FCEV) is rigorously regulated by the Standard SAE J2719, which prescribes maximum allowable levels of multiple impurities in the hydrogen fuel and must be verified by a regulatory body. Hydrogen contaminant detectors (HCD) integrated to the fueling station can assure this compliance. HCDs must be able operate in 100% H2 backgrounds and be able to distinguish between multiple contaminants at low ppm to low ppb levels.Secondly, as a strategy to decarbonize the natural gas grid, there are proposals to blend hydrogen with natural gas. This blending will affect transport applications (pipeline infrastructure), stationary combustion systems (turbines), and consumer and commercial appliances. In the short-term, hydrogen levels up to 20% are proposed. Variations in the hydrogen level can have dramatic impact on the combustion process and on the potential response of safety sensors. These mixtures may be regulated so that the concentration at a delivery point must be monitored with high precision. However, routine maintenance may introduce background gases such as ambient air (with water) or maintenance gases (introduced with welding processes or adhesive outgassing.) Therefore, the detection methodology must be robust enough to recover or respond to various contaminants.Several reviews can be found in literature addressing sensing and detection technologies, including their limitations and applications. However, for most applications, limitations can be alleviated by combining various detection techniques either through system integration or implementation of machine learning methods (artificial intelligence). Many detection methods already implement some sort of senor fusion, i.e., integrated temperature and humidity sensors allow for compensation methods of point sensors to increase the accuracy and precision of detectors through a wide range of environmental conditions. Similarly, sensing arrays (electronic noses) may implement intelligent algorithms to quantify multiple gasses present in a sample, or simply to identify a single gas in a mixture.In this presentation, we will discuss several applications, highlight their current approach for hydrogen detection, and suggest detection strategies to supplement their limitations.

Sustainable Fashion: Exploring the Concept of Greenwashing and New Trends in the Fashion Industry

The fashion industry, characterized by rapid cycles of production and consumption, has emerged as a global economic powerhouse, generating significant revenue and employment opportunities worldwide. However, this growth has come at a substantial environmental and social cost, marked by extensive resource consumption, greenhouse gas emissions, and labor exploitation. This paper critically examines the environmental and social impacts of the fashion industry, focusing on issues such as textile waste, water pollution, and unethical labor practices. It explores the transition towards sustainable fashion practices, highlighting initiatives like circular fashion and consumer behavior shifts towards eco-friendly choices. The study employs a comprehensive review of current literature and case studies to analyze the challenges and opportunities for achieving sustainability within the fashion sector. By synthesizing diverse perspectives and research findings, this paper proposes strategies to combat greenwashing, enhance transparency, and foster a circular economy in fashion. Ultimately, it aims to provide a framework for stakeholders to navigate towards a more ethical and environmentally responsible future for the fashion industry.

Trade-offs in biomethane production by substrate mixture optimization under German market conditions

BackgroundNew regulations and market conditions in Germany affect the profitability of biomethane upgrading as a repowering option for existing biogas plants following on-site CHP utilization. These conditions present trade-off challenges between higher sustainability requirements, maintaining production capacity and new revenue opportunities. Optimization methods, such as linear programming (LP), are essential for determining the ideal substrate mixture and profitable solutions amidst multiple market conditions, plant-specific process constraints, and substrate properties.MethodsWe updated a substrate mixture optimization model within an assessment framework for the repowering of existing biogas plants (BGPs), which focuses on the operator’s perspective. By integrating multiple German biomethane markets for various BGPs, we assessed changes in the substrate mixture, GHG emissions, contribution margins, and constraint parameters to derive conclusions for operators and future framework design.ResultsIntegrating market revenues and constraints can increase contribution margins by 12–55%. Additional gains can be achieved by considering multiple markets simultaneously but limited to a few BGPs. The plant-specific LP solution space and used benchmark market are decisive. The former limits the potential of high substrate-specific contribution margins, which has a significantly higher impact than the relation between plant-specific characteristics and process constraints. The advanced fuel market is currently the lead market for biomethane, incentivizing GHG-emission extensive substrates, decreasing gas production and GHG emissions but increasing levelized cost of energy (LCOE) and partially CO2 abatement costs.ConclusionsThe key to improve profitability and to supply an increasing biomethane demand while fulfilling new requirements is a large LP solution space. Increasing market options, substrate availability, and digestion system capacity achieve this on the operator’s side. Policy makers could reduce normative requirements such as the maize cap or double counting of advanced fuels and favor high but uniform GHG requirements. Operators can prepare robustly for the future substrate mixture by adding digester volume and pre-treatment tech, ensuring long-term and diverse substrate availability, and contracts with flexible components. Although current market conditions can improve specific GHG emissions, they do not necessarily increase manure usage when other options, such as straw, are viable. Other regulatory support systems will be required to do so.

Bidding zero? An analysis of solar power plants’ price bids in the electricity day-ahead market

Typically, solar power is offered for price bids at the level of their near zero marginal costs to electricity markets. While aggregate effects of this behaviour on prices (merit-order effect) and profits (cannibalisation effect) have been studied extensively, potential deviations from this strategy still lack an understanding. We observe a group of firms to offer solar power for prices larger than zero to the Iberian electricity day-ahead market. Based on a literature review and analysing incentives set for solar power by the Spanish electricity market design, we suggest these price bids to result from revenue opportunities in sequential markets. Results of our regression analyses confirm that the observed group of firms is more likely to conduct arbitrage. This motive also allows for explaining the level of a case-study firm’s price bids.

Modernize the academic medical center through innovation career pathways

An academic medical center (AMC) is a hospital system that is organizationally and administratively integrated with an academic institution to achieve a tripartite mission: train the healthcare workforce, conduct clinical research, and deliver high‐quality patient care. The mission and value of AMCs has made them a core element of the healthcare system in the United States, and has afforded AMCs relative stability against industry turbulence over the years. However, a new era of care transformation characterized by increased demand for accessibility, convenience, and affordability is challenging that stability. Evolving patient needs and preferences are creating a new value equation in the U.S. healthcare system, which may shrink the viable market for AMCs that fail to modernize all aspects of their tripartite mission. New market entrants and existing competitors that embrace innovation will soon out‐pace AMCs that lack the innovation infrastructure to create new clinical capabilities, enhance patient experiences, optimize cost structures, and seize on emerging revenue opportunities.

APPLICATION OF MODERATED REMOTE USABILITY TESTING METHOD ON AGROVEST WEBSITE

This article is intended to improve the user experience on the Agrovest website, with the aim that users continue to use the site and website developers do not miss out on revenue opportunities from existing sources. Agrovest is a platform that provides information about agriculture, from plant types to fertilization. The site comes with various features, such as information about crops and fertilizers, fertilizer calculators, as well as chat rooms. The method used in this study is moderated remote usability testing which is one method of usability testing. The results of the research study revealed that (1) there were 16 findings, consisting of two positive findings, eight neutral findings and six negative findings on Agrovest features (2) the need to improve the Agrovest website to improve user experience. This study also provides recommendations for improving the Agrovest website based on the results of moderated remote usability testing conducted on five participants.© 2023 Educational Technology UPI

Technographic segmentation of smartphone usage at the Rainforest World Music Festival

PurposeThis is amongst the first works to develop a technographic segmentation of smartphone users attending music festivals based on attitudes, motivations and usage patterns. We also aim to describe festivalgoers’ characteristics.Design/methodology/approachThe data were collected from 522 festivalgoers who attended the Rainforest World Music Festival (RWMF) in Malaysia. A two-stage cluster analysis of Ward’s method and k-means was applied to develop technographic segmentation during the festival. Using discriminant analysis, we confirmed that each festivalgoer’s characteristics differ amongst groups.FindingsFour technographic segments were developed: alarm hitters, technological tickers, plug pullers and fuse blowers. The results confirmed that festivalgoers had distinct characteristics and preferences based on smartphone use.Research limitations/implicationsWe extend previous research on the technographic segmentation of smartphones and festivalgoers. We highlighted the limitations of cluster analysis in terms of stability to produce a suitable number of segments and to include other festivals. The generalisability of the results may be constrained by the time gap between data collection and publication.Practical implicationsOur results can help marketing managers understand the needs of segments by selecting appropriate advertisements and promotional tools that appeal directly to the desired target segments.Social implicationsThis study will help local communities increase their revenue and job opportunities. The culture of music festivals for the next generation can be sustained and promoted by local and international festival lovers.Originality/valueThis study is the first to present festivalgoers' use of the technographic segmentation term in music festivals.

A STUDY ON IMPROVING SUPPLY CHAIN USING BUSINESS INTELLIGENCE CONCERNING DHARA LOGISTICS

Business intelligence (BI) is software that ingests business data and presents it in user-friendly views such as reports, dashboards, charts and graphs. BI tools enable business users to access different types of data — historical and current, third-party and in-house, as well as semi-structured data and unstructured data like social media. Users can analyze this information to gain insights into how the business is performing. According to CIO magazine: “Although business intelligence does not tell business users what to do or what will happen if they take a certain course, neither is BI only about generating reports. Rather, BI offers a way for people to examine data to understand trends and derive insights.” Organizations can use the insights gained from business intelligence and data analysis to improve business decisions, identify problems or issues, spot market trends, and find new revenue or business opportunities. BI platforms traditionally rely on data warehouses for their baseline information. A data warehouse aggregates data from multiple data sources into one central system to support business analytics and reporting. Business intelligence software queries the warehouse and presents the results to the user in the form of reports, charts and maps. Data warehouses can include an online analytical processing (OLAP) engine to support multidimensional queries. “OLAP provides powerful technology for data discovery, facilitating business intelligence, complex analytic calculations and predictive analytics,” says IBM offering manager Doug Dailey in his data warehousing blog. “One of the main benefits of OLAP is the consistency of information and calculations it uses to drive data to improve product quality, customer interactions and process improvements.” Some newer business intelligence solutions can extract and ingest raw data directly using technology such as Hadoop, but data warehouses are still the data source of choice in many cases.

Resource use Efficiency in Carnation Production under Polyhouse Conditions in Himachal Pradesh, India

Floral expressions often capture the depth of emotions and sentiments that surpass the capabilities of verbal communication. The practice of flower farming within polyhouse conditions has emerged as a burgeoning segment within the agricultural domain, offering substantial revenue opportunities. This is particularly relevant in terrains characterized by hilly topographies, such as Himachal Pradesh, where agricultural land is scarce, with an average of 0.12 hectares of cultivable land and 0.02 hectares of irrigated land per capita. Such limitations necessitate an agricultural paradigm focused on maximizing returns per unit of area, labor, and capital investment. The research undertook an analytical journey in the Bilaspur district of Himachal Pradesh to scrutinize the efficiency of resource utilization in the cultivation of carnations under polyhouse conditions. Engaging a cohort of 60 polyhouse-utilizing farmers, selected through proportional allocation across two blocks of the district, the study unveiled that the utilization efficiencies, as measured by the marginal value product (MVP) to price ratios, were highest for manure (5.78), followed by pesticides (3.55), and labor (2.04), each exceeding the unity threshold. This indicates that augmenting the input of these resources could potentially amplify returns.

Smart parking: Multi-agent approach, architecture, and workflow

<p>Inefficient parking management systems in urban areas lead to limited parking capacity, congestion, and environmental contamination, resulting in time and fuel waste, increased carbon emissions, and economic inefficiency. Smart parking is a technological system that leverages the capabilities of the Internet of Things (IoT) to address urban congestion and parking management issues. It uses IoT sensors to collect real-time data on parking availability, which is then analyzed to optimize usage, improve traffic flow, and simplify the driver experience. Smart parking can be integrated into urban infrastructure, contributing to more efficient and environmentally-friendly urban mobility. Benefits include reduced time spent searching for parking, reduced traffic congestion, reduced greenhouse gas emissions, and new revenue opportunities for parking lot operators. Overall, IoT-enabled smart parking creates sustainable and user-friendly urban environments. This paper presents a multi-agent smart parking approach, providing a comprehensive architectural framework and workflow for various smart parking scenarios. The proposed methodology and structure encompass several aspects of intelligent parking management, incorporating the use of Internet of Things (IoT) technologies. It involves a multi-agent system for monitoring parking spaces, managing traffic, and providing user services. This system enhances efficiency and reduces the need for manual parking, thereby enhancing the overall efficiency of urban parking.</p>

How does CEO–TMT exchange quality incongruence affect business model innovation? The moderating role of environmental dynamism

AbstractIn today's dynamic business environment, business model innovation (BMI) has become a strategic lever that businesses can harness to unlock new revenue opportunities and fortify their long‐term competitive edge. BMI often hinges on the exchange relationships between chief executive officers (CEOs) and their top management team (TMT) members. However, in practice, CEOs and TMT members often have incongruent perceptions of these relationships, which may impede them from making joint efforts to achieve BMI. When such incongruence arises, relying solely on either the CEO's or the TMT members' perceptions of exchange quality might provide an incomplete understanding of the effect of CEO–TMT exchange quality on BMI. In this study, we investigate how CEO–TMT exchange quality incongruence influences BMI under various levels of environmental dynamism. Using archival industry data and matched survey data from 618 CEOs and 1854 TMT members in China, the polynomial regression and response surface analyses indicate that CEO–TMT exchange quality incongruence negatively affects BMI. This finding suggests that while high perceptions of exchange quality by both CEOs and TMTs independently contribute to BMI, an incongruent perception of exchange quality between CEOs and TMT members can undermine the success of BMI. Moreover, high levels of environmental dynamism aggravate the negative effect of CEO–TMT exchange quality incongruence on BMI. These findings enable us to offer new theoretical insights regarding the influence of the CEO–TMT exchange quality on BMI, thus complementing existing studies on antecedents of BMI and enriching literature on the outcomes of the CEO–TMT interface. Additionally, this study offers practical guidance for enhancing BMI through effective management of incongruent perceptions of CEO–TMT exchanges.

Resident dictation of operative notes: a reimbursement comparison and mixed-methods analysis

PurposeSurgical documentation is crucial to ensure quality patient care and accurate coding and billing. Operative dictation also serves as a valuable educational opportunity for surgical trainees. However, resident dictations may not fully capture procedural details and complexities, resulting in missed revenue opportunities. On July 1, 2021, our university-based surgery department implemented a policy requiring attendings to dictate all operative reports. The purpose of this mixed-method study was to investigate the financial impact of this policy and explore differences in resident and attending dictations.MethodsCore general surgery operations performed by the Department of Surgery between July 1, 2020 and June 30, 2022 were identified from billing data. The surgeon, current procedural terminology (CPT) and modifier codes, and relative value units (RVUs) for each case were acquired. Surgeons not present for the entire study period or cases requiring multiple surgeons were excluded. Descriptive statistics and Kolmogorov–Smirnov (KS) non-parametric tests compared pre- and post-policy RVU distributions on overall charges and 18 key general surgery operations. Targeted thematic analysis was performed on operative reports pre- and post-policy to explore resident and attending differences.ResultsA total of 42 attendings performed 16,233 cases, billing 28,560 CPT codes (50.3% pre- vs. 49.7% post-policy). There was a small but statistically significant increase in RVU distribution post-policy, mean 20.2 pre- vs. 20.3 RVUs post-, $4372 pre- vs. $4418 per case post-, KS = 0.02 (p = 0.009). Specifically, higher RVU distributions were seen among attending-dictated cases for melanoma (p = 0.009), minimally invasive ventral hernia repair (VHR, p = 0.008), parathyroidectomy (p < 0.001), anorectal incision and drainage (p = 0.003) and anorectal exam under anesthesia (p = 0.029). Higher RVU distributions were noted among resident-dictated, attending-edited cases for partial colectomy (p = 0.043), and open VHR (p = 0.004). No differences were noted among the remaining operations (p > 0.05). Three major themes were noted from focused sampling of 112 operative reports: billable items, clinical/surgical reasoning, and technical details. Differences in billable items and clinical and surgical reasoning were the most influential on modifying clinical implications of operative notes. Themes and differences were consistent regardless of surgeon or specialty.ConclusionAdopting an attending-only operative dictation policy yielded a small increase in billable RVUs, predominantly from select operations. Gaps in coding-directed language and depth of clinical reasoning were noted in resident dictations. These findings reveal an educational opportunity that concomitantly optimizes patient care, resident education, and procedural revenue.

Derivation of Solution Bundles in Hybrid Portfolios of Industrial Solution Providers in Machinery Engineering

Companies in the machinery engineering sector are identifying increased demand from their customers for integrated solutions that consist of product, service and software elements tailored to the customers’ specific needs. The companies must therefore transform themselves from classic product providers into industrial solution providers. In addition to the opportunity to differentiate themselves from other competitors, the transformation of the business model to the distribution of customer-specific value propositions provides new revenue opportunities. Progressive digitization and the increasing integration of service and software elements in the value chain are considered to be key enablers of the transformation into an industrial solution provider. In order to realize the transformation successfully, it is necessary to plan the portfolio holistically on the basis of systematized customer requirements and the existing elements in the portfolio. This paper therefore presents a methodology for deriving suitable solution bundles to realize the value propositions. For this purpose, an integrated architecture of the solutions is created, a comparison of the solution elements with the customer requirements is performed, and finally, a staggering of the solutions in the portfolio is conducted.

A Review of the Macadamia Nut Sector in Zimbabwe

The scope of macadamia nut (macadamia spp) as an alternative export crop in Zimbabwe has not been extensively explored. This study is a review of related literature from published and unpublished materials, press documents, websites, informal interviews with key informants along the macadamia value chain to explore the historical and current trends in macadamia nut production in Zimbabwe, policy framework, smallholder farmer’ contribution and the constraints that they are facing for informed policy making. Macadamia is an important lucrative crop in Zimbabwe, mainly used for income generation especially among smallholder producers and for the country’s export generation. It was established that Macadamia is a fully established crop whose production in Zimbabwe is not yet commensurate to the opportunities that exists in the global market. Smallholder macadamia farmers are constrained by high production costs, weak marketing systems, lack of access to export markets, poor research and development and limited support from government. Zimbabwe exports raw macadamia nut in shells resulting in short supply chain and a disparity which underscores a missed opportunity for higher revenue and value addition within the country. Research recommends targeted training, capitation of extension staff and establishments of a macadamia research station. Government is also recommended to ensure and enabling environment to facilitate private sector investment in macadamia value addition.

Socio-Ecological Resilience and Social System in Candirejo Village, Magelang

One of the serious problems faced by the Magelang District in developing villages that have been transformed into rural tourism as an effort to alleviate poverty, is the socio-ecological crisis that threatens the goal of sustainable development. The dilemma of complex rural ecosystems is due to changes in the socio-ecological dimensions resulting from the interaction of material and energy exchanges between humans and their environment. Exploitation of nature in the name of tourism has become one of the short-term solutions for farming communities. As a result, problems such as natural damage to social conflicts occur in the village. This research aims to analyze the causes of the socio-ecological crisis and explore the Social system in Candirejo Village. Magelang Regency. The Social System seen from the perspective of constructivism will be measured and analyzed using three aspects of cybernetic reflection (Luhmann). The method used is case study qualitative research and data is collected through in-depth interviews, FGDs, and observations. The results show that socio-ecological improvements also impact agents of change, extend the tourism season, increase community participation, align the visitor experience with Borobudur's image, and increase equitable access to tourism revenue opportunities, all of which strengthen the socio-ecological field.

Navigating the Digital Horizon: Unlocking Innovative Frontiers in Remote Banking Services

The rapid development of technology allows every industry including banking to adapt to integrate the banking business with technology. This research discusses the importance of digital transformation in the banking world, especially along with the COVID-19 pandemic. Digital transformation is the main key in increasing bank competitiveness, opening greater revenue opportunities, and increasing net profit efficiency. The utilization of digital channels during and after the pandemic has been an integral part of this change. The factors underlying digital transformation involve the increasingly high demands of technological trends. this study uses an analytical analysis approach from secondary data regarding digital banking. Methods of data comparison, data grouping and expert evaluation were conducted to ensure the analysis becomes more accurate. Research and analyses show that the operating costs of digital banks tend to be 40% lower compared to traditional banks. This cost reduction is largely due to increased efficiency, especially in terms of a 50% reduction in headcount. The future of banking cannot rely on the current cost structure, so digital transformation is a must. The importance of adapting to these changes is not only to survive during the crisis, but also to achieve long-term competitive advantage. Banks need to understand that successful digital transformation will open new opportunities and have a positive impact on financial well-being. Thus, this research underlines that digital transformation is not just a necessity, but a strategic investment that will shape the face of banking in the future.