Innovation through Design Strategy: Case Study of SMEs in Bandung

The rise of business in the city of Bandung has caused the intensity of competition to be very high. Small-scale businesses are very difficult to survive especially facing companies that have larger economies of scale. Innovation can be one way for SMEs to compete. Previous research stated that implementing a design strategy can trigger opportunities to create innovation in the company. This study examines how design is used by Soca companies to produce innovation as a strategy to survive in competition. Soca is an SME in Bandung that produces glasses with wood materials. As a startup, Soca is considered successful in penetrating the market amid intense competition. This study uses a qualitative method with a descriptive case study approach. Primary data is obtained through document review, in-depth interviews and observations. The results of this study are expected to be a reference for how design strategies are used by SMEs to generate innovation Keywords Innovations, SMEs, Design Strateg

Eligibility for bariatric surgery among adults in England: analysis of a national cross-sectional survey.

This study aimed to determine the number eligible for bariatric surgery and their sociodemographic characteristics.We used Health Survey for England 2006 data, representative of the non-institutionalized English population.The number of people eligible for bariatric surgery in England based on national guidance is unknown. The UK National Institute for Health and Clinical Excellence criteria for eligibility are those with body mass index (BMI) 35-40 kg/m(2) with at least one comorbidity potentially improved by losing weight or a BMI > 40 kg/m(2).Of 13,742 adult respondents (≥18 years), we excluded participants with invalid BMI (n = 2103), comorbidities (n = 2187) or sociodemographic variables (n = 27) data, for a final study sample of 9425 participants.The comorbidities examined were hypertension, type 2 diabetes, stroke, coronary heart disease and osteoarthritis. Sociodemographic variables assessed included age, sex, employment status, highest educational qualification, social class and smoking status.5.4% (95% CI 5.0-5.9) of the non-institutionalized adult population in England could meet criteria for having bariatric surgery after accounting for survey weights. Those eligible were more likely than the general population to be women (60.1% vs. 39.9%, p<0.01), retired (22.4% vs. 12.8% p<0.01), and have no formal educational qualifications (35.7% vs. 21.3%, p<0.01).The number of adults potentially eligible for bariatric surgery in England (2,147,683 people based on these results and 2006 population estimates) far exceeds previous estimates of eligibility. In view of the sociodemographic characteristics of this group, careful resource allocation is required to ensure equitable access on the basis of need

Vertical spinal electronic device with large room temperature magnetoresistance

We report experimental transport measurements of a vertical hybrid ferromagnetic (FM)/III-V semiconductor (SC)/ferromagnetic(FM) type structure, i.e., Cr(20ML)/Co(15ML)/GaAs(50 nm, n-type)/Al/sub 0.3/Ga/sub 0.7/As(200 nm, n-type)/FeNi(30 nm). The current-voltage (I-V) characteristics reveal Schottky/tunneling type behavior in the direction of FeNi/Semiconductor/Co and observed to be dependent on external magnetic field. The magnetoresistance (MR) behavior shows a strong dependence on the measured current and field. At low fields no significant change in MR has been observed with increasing current. However, at high fields the MR initially increases with increasing current and becomes stable beyond a critical current of 10 /spl mu/A. A maximum of 12% change in the MR has been observed at room temperature, which is far larger than that of the conventional AMR effect. This property of the device could be utilized as field sensors or magnetic logic devices

Strengthening strategic management approaches to address antimicrobial resistance in global human health: a scoping review

Introduction The development and implementation of national strategic plans is a critical component towards successfully addressing antimicrobial resistance (AMR). This study aimed to review the scope and analytical depth of situation analyses conducted to address AMR in human health to inform the development and implementation of national strategic plans. Methods A systematic search of the literature was conducted to identify all studies since 2000, that have employed a situation analysis to address AMR. The included studies are analysed against frameworks for strategic analysis, primarily the PESTELI (Political, Economic, Sociological, Technological, Ecological, Legislative, Industry) framework, to understand the depth, scope and utility of current published approaches. Results 10 studies were included in the final review ranging from single country (6) to regional-level multicountry studies (4). 8 studies carried out documentary review, and 3 of these also included stakeholder interviews. 2 studies were based on expert opinion with no data collection. No study employed the PESTELI framework. Most studies (9) included analysis of the political domain and 1 study included 6 domains of the framework. Technological and industry analyses is a notable gap. Facilitators and inhibitors within the political and legislative domains were the most frequently reported. No facilitators were reported in the economic or industry domains but featured inhibiting factors including: lack of ring-fenced funding for surveillance, perverse financial incentives, cost-shifting to patients; joint-stock drug company ownership complicating regulations. Conclusion The PESTELI framework provides further opportunities to combat AMR using a systematic, strategic management approach, rather than a retrospective view. Future analysis of existing quantitative data with interviews of key strategic and operational stakeholders is needed to provide critical insights about where implementation efforts should be focussed, and also how to build contingency at the strategic level for agile responses to macro-level environmental influences

Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework: a multilevel qualitative analysis

Objective:(1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice. Design A national and local-level analysis of the 27 indicators was conducted. At the national level, documentary review of regulations/policies/guidelines was conducted. At the local level data collection comprised: (a) review of documentary sources from 14 hospitals, to determine the capacity to report performance against these indicators; (b) qualitative interviews with 3 senior managers from 5 hospitals and direct observation of hospital wards to find out if these indicators are used to improve IPC management and practice. Setting 2 acute English National Health Service (NHS) trusts and 1 NHS foundation trust (14 hospitals). Participants 3 senior managers from 5 hospitals for qualitative interviews. Primary and secondary outcome measures As primary outcome measures, a ‘Red-Amber-Green’ (RAG) rating was developed reflecting how well the indicators were included in national documents or their availability at the local organisational level. The current use of the indicators to inform IPC management and practice was also assessed. The main secondary outcome measure is any inconsistency between national and local RAG rating results. Results National regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management. Conclusions For effective patient safety and infection prevention in English hospitals, routine and proactive approaches need to be developed. Our approach to evaluation can be extended to other country settings

The Differences in Antibiotic Decision-making Between Acute Surgical and Acute Medical Teams: An Ethnographic Study of Culture and Team Dynamics

Background Cultural and social determinants influence antibiotic decision-making in hospitals. We investigated and compared cultural determinants of antibiotic decision-making in acute medical and surgical specialties. Methods An ethnographic observational study of antibiotic decision-making in acute medical and surgical teams at a London teaching hospital was conducted (August 2015–May 2017). Data collection included 500 hours of direct observations, and face-to-face interviews with 23 key informants. A grounded theory approach, aided by Nvivo 11 software, analyzed the emerging themes. An iterative and recursive process of analysis ensured saturation of the themes. The multiple modes of enquiry enabled cross-validation and triangulation of the findings. Results In medicine, accepted norms of the decision-making process are characterized as collectivist (input from pharmacists, infectious disease, and medical microbiology teams), rationalized, and policy-informed, with emphasis on de-escalation of therapy. The gaps in antibiotic decision-making in acute medicine occur chiefly in the transition between the emergency department and inpatient teams, where ownership of the antibiotic prescription is lost. In surgery, team priorities are split between 3 settings: operating room, outpatient clinic, and ward. Senior surgeons are often absent from the ward, leaving junior staff to make complex medical decisions. This results in defensive antibiotic decision-making, leading to prolonged and inappropriate antibiotic use. Conclusions In medicine, the legacy of infection diagnosis made in the emergency department determines antibiotic decision-making. In surgery, antibiotic decision-making is perceived as a nonsurgical intervention that can be delegated to junior staff or other specialties. Different, bespoke approaches to optimize antibiotic prescribing are therefore needed to address these specific challenges

Pembuatan Silika High Grade dari Fly Ash Sawit dengan Proses Ekstraksi dan Cation Exchange

One alternative raw materials manufacture of high grade silica is using palm oil mill fly ash. This research aimed to study the effect of temperatureprocess, time and the ratio mass of zeolite and obtain optimum conditions cation exchange process (Fe) in a solution of sodium silicate with raw material palm oil mill fly ash. Palm oil mill fly ash is heated using oven at 105° C for 24 hours. Then fly ash reacted with 1,4N NaOH solution at 105° C for 50 minutes. Then obtained sodium silicate solution is reacted with Na-zeolite. The results of the optimization then precipitated using 10% H2SO4 and derived solidsilica. XRF analysis results showed solid silica has a purity of 96.129%

Risk perception of antimicrobial resistance by infection control specialists in Europe: a case-vignette study

Background Using case-vignettes, we assessed the perception of European infection control (IC) specialists regarding the individual and collective risk associated with antimicrobial resistance (AMR) among inpatients. Methods In this study, sixteen case-vignettes were developed to simulate hospitalised patient scenarios in the field of AMR and IC. A total of 245 IC specialists working in different hospitals from 15 European countries were contacted, among which 149 agreed to participate in the study. Using an online database, each participant scored five randomly-assigned case-vignettes, regarding the perceived risk associated with six different multidrug resistant organisms (MDRO). The intra-class correlation coefficient (ICC), varying from 0 (poor) to 1 (perfect), was used to assess the agreement for the risk on a 7-point Likert scale. High risk and low/neutral risk scorers were compared regarding their national, organisational and individual characteristics. Results Between January and May 2017, 149 participants scored 655 case-vignettes. The perceptions of the individual (clinical outcome) and collective (spread) risks were consistently lower than other MDRO for extended spectrum beta-lactamase producing Enterobacteriaceae cases and higher for carbapenemase producing Enterobacteriaceae (CPE) cases. Regarding CPE cases, answers were influenced more by the resistance pattern (93%) than for other MDRO. The risk associated with vancomycin resistant Enterococci cases was considered higher for the collective impact than for the individual outcome (63% vs 40%). The intra-country agreement regarding the individual risk was globally poor varying from 0.00 (ICC: 0–0.25) to 0.51 (0.18–0.85). The overall agreement across countries was poor at 0.20 (0.07–0.33). IC specialists working in hospitals preserved from MDROs perceived a higher individual (local, p = 0.01; national, p < 0.01) and collective risk (local and national p < 0.01) than those frequently exposed to bacteraemia. Conversely, IC specialists working in hospitals with a high MDRO clinical burden had a decreased risk perception. Conclusions The perception of the risk associated with AMR varied greatly across IC specialists and countries, relying on contextual factors including the epidemiology. IC specialists working in high prevalence areas may underestimate both the individual and collective risks, and might further negatively promote the MDRO spread. These finding highlight the need to shape local and national control strategies according to risk perceptions and contextual factors

Modeling anisotropic and rate-dependent plasticity in short-fiber reinforced thermoplastics

In this study, an anisotropic viscoelastic-viscoplastic macro-mechanical model is presented for short-fiber reinforced thermoplastics (SFRT). In injection molding of SFRT, the fiber orientation is influenced by the flow velocity profile which varies throughout the mold. The flow-induced orientation in the microstructure leads to anisotropy in the mechanical response. In addition to the mechanical anisotropy, SFRTs show time dependent behavior because of the thermoplastic matrix. The developed model captures the effects of both material orientation and loading rate on the yield behavior. In this study, uniaxial tests are performed at different strain rates and material orientations with samplescutfrominjectionmoldedplaques. Theexperimentalresultsshowthattheeffects of loading rate and material orientation on the yield are decoupled. The presented model takes advantage of this observation to simplify material characterization. An implicit integration scheme is used for the numerical implementation of the model as a UMAT in ABAQUS. Multiple relaxation times are used in order to capture the nonlinear pre-yield regime. An efficient method for obtaining the model parameters for different modes is proposed. Experimental results are used for validation of the model and a good agreement is observed for the prediction of viscoelastic and viscoplastic behavior