Interna revizija u javnim bolnicama: slučaj Grčke

Internal control is of utmost importance for effective corporate governance, particularly in public hospitals aiming for modernization in the Greek framework. Internal audit functions enhance transparency, enforce accountability, and ensure compliance with societal values, bolstering public trust. This study delves into the implementation of internal control in Greek public hospitals, considering factors like size, structure, and operational intricacies. We explore the regulatory framework, procedures, scope, and objectives, while interviewing auditing experts for insights into challenges and opportunities. Findings reveal procedural dominance in current implementation of the Law. Focus on accounting neglects crucial functional departments. The audit committee\u27s role and composition raise independence concerns. Understaffing further hampers operations. A significant weakness appears in the independence of the audit. Internal auditors report to the hospital administrator and participate in the audit committee. The appointment and remuneration of auditors is not based on the auditor\u27s competence and suitability, but on a cost basis. The question therefore arises as to whether the auditor performs the duties objectively and impartially in accordance with the International Institute of Internal Auditors\u27 standards. Furthermore, regarding the research question on the role of the internal auditor and the treatment by auditees, there has been a significant improvement as evident by the respondents’ answers.Unutarnja kontrola od iznimne je važnosti za učinkovito korporativno upravljanje, posebno u javnim bolnicama koje teže modernizaciji u grčkom okviru. Funkcije interne revizije povećavaju transparentnost, provode odgovornost i osiguravaju usklađenost s društvenim vrijednostima, jačajući povjerenje javnosti. Ova rad bavi se provedbom interne kontrole u grčkim javnim bolnicama, uzimajući u obzir čimbenike poput veličine, strukture i složenosti rada. Istražujemo regulatorni okvir, postupke, opseg i ciljeve, te intervjuiramo revizorske stručnjake radi uvida u izazove i prilike. Nalazi otkrivaju proceduralnu dominaciju u trenutnoj provedbi Zakona. Usredotočenost na računovodstvo zanemaruje ključne funkcionalne odjele. Uloga i sastav odbora za reviziju izaziva zabrinutost glede neovisnosti. Nedostatak osoblja dodatno otežava rad. Značajna slabost javlja se u neovisnosti revizije. Unutarnji revizori odgovaraju upravitelju bolnice i sudjeluju u revizijskom odboru. Imenovanje i nagrađivanje revizora ne temelji se na stručnosti i podobnosti revizora, već na osnovi troškova. Stoga se postavlja pitanje obavlja li revizor svoju dužnost objektivno i nepristrano u skladu sa standardima Međunarodnog instituta internih revizora. Nadalje, kada je riječ o istraživačkom pitanju o ulozi internog revizora i pristupu reviziji, došlo je do značajnog poboljšanja što je vidljivo iz odgovora ispitanika

What climate sensitivity index is most useful for projections?

Transient climate response (TCR), transient response at 140 years (T140) and equilibrium climate sensitivity (ECS) indices are intended as benchmarks for comparing the magnitude of climate response projected by climate models. It is generally assumed that TCR or T140 would explain more variability between models than ECS for temperature change over the 21st Century, since this timescale is the realm of transient climate change. Here we find that TCR explains more variability across CMIP5 than ECS for global temperature change since pre-industrial, for 50- or 100-year global trends up to the present, and for projected change under representative concentration pathways in regions of delayed warming such as the Southern Ocean. However, unexpectedly we find that ECS correlates higher than TCR for projected change from the present in the global mean and in most regions. This higher correlation doesn’t relate to aerosol forcing, and the physical cause requires further investigation

Ultrasound-Guided Greater Auricular Nerve Block as Sole Anesthetic for Ear Surgery

A greater auricular nerve (GAN) block was used as the sole anesthetic for facial surgery in an 80-year-old male patient with multiple comorbidities which would have made general anesthesia challenging. The GAN provides sensation to the ear, mastoid process, parotid gland, and angle of the mandible. In addition to anesthesia for operating room surgery, the GAN block can be used for outpatient or emergency department procedures without the need for a separate anesthesia team. Although this nerve block has been performed using landmark-based techniques, the ultrasound-guided version offers several potential advantages. These advantages include increased reliability of the nerve block, as well as prevention of inadvertent vascular puncture or blockade of the phrenic nerve, brachial plexus, or deep cervical plexus. The increasing access to ultrasound technology for medical care providers outside the operating room makes this ultrasound guided block an increasingly viable alternative

Performance of downscaled regional climate simulations using a variable-resolution regional climate model : Tasmania as a test case

In this study we develop methods for dynamically downscaling output from six general circulation models (GCMs) for two emissions scenarios using a variable-resolution atmospheric climate model. The use of multiple GCMs and emissions scenarios gives an estimate of model range in projected changes to the mean climate across the region. By modeling the atmosphere at a very fine scale, the simulations capture processes that are important to regional weather and climate at length scales that are subgrid scale for the host GCM. We find that with a multistaged process of increased resolution and the application of bias adjustment methods, the ability of the simulation to reproduce observed conditions improves, with greater than 95% of the spatial variance explained for temperature and about 90% for rainfall. Furthermore, downscaling leads to a significant improvement for the temporal distribution of variables commonly used in applied analyses, reproducing seasonal variability in line with observations. This seasonal signal is not evident in the GCMs. This multistaged approach allows progressive improvement in the skill of the simulations in order to resolve key processes over the region with quantifiable improvements in the correlations with observations

742-4 Radial Artery Graft: Angiographic Follow-up

Interest in the use of the radial artery (RA) as a coronary bypass graft has increased. Attention to harvesting and use of perioperative calcium channel inhibitors have ameliorated problems with spasm noted in earlier studies. Since 1993, 72 patients (pts) underwent grafting using a free RA from the non-dominant forearm. Re-angiography was performed in 24 pts to date and is the subject of this study. Pts ranged from 39–79 years (mean 55.5); all had 2 or 3 vessel disease and an average of 3 grafts/pt were constructed (range 2–4). Left internal thoracic artery (L1TA) was used in all cases except 1. The RA was a single graft in 19 including 2 to the LAD system, 12 to the circumflex system and 5 to the RCA. The RA-was sequential in 5 cases. Of the 24 pts catheterized an average of 9 weeks post-op 24/24 RA's were patent: 1 (sequential) RA had a mid-graft stenosis. There was no spasm seen in any RA. RA distal diameters (2.6mm) were well matched to the recipient vessel (RV) (2.2mm). The ratio RV/graft diameter was 0.83 for the radial artery similar to the ratio for the L1TA (0.90).ConclusionThe RA is a viable coronary conduit, easily harvested and has excellent early patency rates

The method of producing climate change datasets impacts the resulting policy guidance and chance of mal-adaptation

AbstractImpact, adaptation and vulnerability (IAV) research underpin strategies for adaptation to climate change and help to conceptualise what life may look like in decades to come. Research draws on information from global climate models (GCMs) though typically post-processed into a secondary product with finer resolution through methods of downscaling. Here we consider the production process as a chain of processes leading to an application-ready data set, where each step may have a significant impact on the climate change signal. Through worked examples set in an Australian context we assess the influence of GCM sub-setting, geographic area sub-setting and downscaling method on the regional change signal. Examples demonstrate that choices impact on the final results differently depending on various factors such as application needs, range of uncertainty of the projected variable, amplitude of natural variability, and size of study region. For heat extremes, the choice of emissions scenario is of prime importance, but for a given scenario the method of preparing data can affect the magnitude of the projection by a factor of two or more, strongly affecting the indicated adaptation decision. For our catchment level runoff projections, the choice of emission scenario is less dominant. Rather the method of selecting and producing application-ready datasets is crucial as demonstrated by results with opposing sign of change, raising the real possibility of mal-adaptive decisions. This work illustrates the potential pitfalls when using unwise GCM sub-sampling or the use of a single downscaled product when conducting IAV research

Fibroblast growth factor receptors 1 and 2 in keratinocytes control the epidermal barrier and cutaneous homeostasis

Loss of FGFRs results in skin abnormalities due to activation of keratinocytes and epidermal T cells