Continuous monitoring, continuous auditing and continuous assurance are three methods that utilize a high degree of business intelligence and analytics. The increased interest in the three methods has led to multiple studies that analyze each method or a combination of methods from a micro-level. However, limited studies have focused on the perceived usage scenarios of the three methods from a macro level through the eyes of the end-user. In this study, we bridge the gap by identifying the different usage scenarios for each of the methods according to the end-users, the accountants. Data has been collected through a survey, which is analyzed by applying a nominal analysis and a process mining algorithm. Results show that respondents indicated 13 unique usage scenarios, while not one of the three methods is included in all of the 13 scenarios, which illustrates the diversity of opinions in accountancy practice in the Netherlands.
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In this post I give an overview of the theory, tools, frameworks and best practices I have found until now around the testing (and debugging) of machine learning applications. I will start by giving an overview of the specificities of testing machine learning applications.
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Background: In 2009, the Steering Committee for Pregnancy and Childbirth in the Netherlands recommended the implementation of continuous care during labor in order to improve perinatal outcomes. However, in current care, routine maternity caregivers are unable to provide this type of care, resulting in an implementation rate of less than 30%. Maternity care assistants (MCAs), who already play a nursing role in low risk births in the second stage of labor and in homecare during the postnatal period, might be able to fill this gap. In this study, we aim to explore the (cost) effectiveness of adding MCAs to routine first- and second-line maternity care, with the idea that these MCAs would offer continuous care to women during labor. Methods: A randomized controlled trial (RCT) will be performed comparing continuous care (CC) with care-as-usual (CAU). All women intending to have a vaginal birth, who have an understanding of the Dutch language and are > 18 years of age, will be eligible for inclusion. The intervention consists of the provision of continuous care by a trained MCA from the moment the supervising maternity caregiver establishes that labor has started. The primary outcome will be use of epidural analgesia (EA). Our secondary outcomes will be referrals from primary care to secondary care, caesarean delivery, instrumental delivery, adverse outcomes associated with epidural (fever, augmentation of labor, prolonged labor, postpartum hemorrhage, duration of postpartum stay in hospital for mother and/or newborn), women’s satisfaction with the birth experience, cost-effectiveness, and a budget impact analysis. Cost effectiveness will be calculated by QALY per prevented EA based on the utility index from the EQ-5D and the usage of healthcare services. A standardized sensitivity analysis will be carried out to quantify the outcome in addition to a budget impact analysis. In order to show a reduction from 25 to 17% in the primary outcome (alpha 0.05 and bèta 0.20), taking into account an extra 10% sample size for multi-level analysis and an attrition rate of 10%, 2 × 496 women will be needed (n = 992). Discussion: We expect that adding MCAs to the routine maternity care team will result in a decrease in the use of epidural analgesia and subsequent costs without a reduction in patient satisfaction. It will therefore be a costeffective intervention. Trial registration: Trial Registration: Netherlands Trial Register, NL8065. Registered 3 October 2019 - Retrospectively registered.
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Due to the changing technological possibilities of services, the demands that society places on the level of service provided by the Dutch Central Government (DCG) are changing rapidly. To accommodate this, the Dutch government is improving its processes in such a way that they become more agile and are continuously improved. However, the DCG struggles with the implementation of improvement tools that can support this. The research described in this paper aims to deliver key factors that influence the adoption of tools that improve the agile way of working and continuous improvement at the DCG. Therefore, a literature review has been conducted, from which 24 factors have been derived. Subsequently, 9 semi structured interviews have been conducted to emphasize the perspective of employees at the DCG. In total, 7 key factors have been derived from the interviews. The interviewees consisted of both employees from departments who already worked with tools to improve agile working and continuous improvement as well as employees from departments who haven’t used such tools yet. An important insight based on this research is that the aims, way of working and scope of the improvement tools must be clear for all the involved co-workers
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Purpose – purpose of this article is to report about the progress of the development of a method that makes sense of knowledge productivity, in order to be able to give direction to knowledge management initiatives. Methodology/approach – the development and testing of the method is based on the paradigm of the Design Sciences. In order to increase the objectivity of the research findings, and in order to test the transferability of the method, this article suggests a methodology for beta testing. Findings – based on the experiences within this research, the concept of beta testing seems to fit Design Science Research very well. Moreover, applying this concept within this research resulted in valuable findings for further development of the method. Research implications – this is the first article that explicitly applies the concept of beta testing to the process of developing solution concepts. Originality/value – this article contributes to the further operationalization of the relatively new concept of knowledge productivity. From a methodological point of view, this article aims to contribute to the paradigm of the Design Sciences in general, and the concept of beta testing in particular.
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While the original definition of replacement focuses on the replacement of the use of animals in science, a more contemporary definition focuses on accelerating the development and use of predictive and robust models, based on the latest science and technologies, to address scientific questions without the use of animals. The transition to animal free innovation is on the political agenda in and outside the European Union. The Beyond Animal Testing Index (BATI) is a benchmarking instrument designed to provide insight into the activities and contributions of research institutes to the transition to animal free innovation. The BATI allows participating organizations to learn from each other and stimulates continuous improvement. The BATI was modelled after the Access to Medicine Index, which benchmarks pharmaceutical companies on their efforts to make medicines widely available in developing countries. A prototype of the BATI was field-tested with three Dutch academic medical centers and two universities in 2020-2021. The field test demonstrated the usability and effectiveness of the BATI as a benchmarking tool. Analyses were performed across five different domains. The participating institutes concluded that the BATI served as an internal as well as an external stimulus to share, learn, and improve institutional strategies towards the transition to animal free innovation. The BATI also identified gaps in the development and implementation of 3R technologies. Hence, the BATI might be a suitable instrument for monitoring the effectiveness of policies. BATI version 1.0 is ready to be used for benchmarking at a larger scale.
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This systematic review aims to get insight into the feasibility of cardiopulmonary exercise testing (CPET) in patients with cancer prior to a physical exercise programme. We will focus on quality (defined as the adherence to international guidelines for methods of CPET) and safety of CPET. Furthermore, we compare the peak oxygen uptake (V̇O2peak) values of patients with cancer with reference values for healthy persons to put these values into a clinical perspective. A computer aided search with ‘cardiopulmonary exercise testing’ and ‘cancer’ using MEDLINE, EMBASE, Pedro, CINAHL® and SPORTDiscus™ was carried out. We included studies in which CPET with continuous gas exchange analysis has been performed prior to a physical exercise programme in adults with cancer. Twenty studies describing 1158 patients were eligible. Reported adherence to international recommendations for CPET varied per item. In most studies, the methods of CPET were not reported in detail. Adverse events occurred in 1% of patients. The percentage V̇O2peak of reference values for healthy persons varied between 65% and 89% for tests before treatment, between 74% and 96% for tests during treatment and between 52% and 117% for tests after treatment. Our results suggest that CPET is feasible and seems to be safe for patients with cancer prior to a physical exercise programme. We recommend that standard reporting and quality guidelines should be followed for CPET methods. The decreased V̇O2peak values of patients with cancer indicate that physical exercise should be implemented in their standard care.
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To improve retention rate of factual knowledge for health students we set out to design a game which challenges students to continue testing themselves during their studies. Since we intend for them to play this game for at least two years, we had two major challenges to overcome. Firstly, how can students feel motivated to continue playing for two years on end, and secondly, how can enough content be generated for a two-year game play. The first challenge was solved by tapping into a core motivation of health students: many intend to start their own practice and for that, they want to be involved with other practitioners. We, therefore, proposed a sim-type game in which students cannot just practice on virtual patients but also on practitioners logged in as a patient. The second challenge was tackled by building a flexible framework for case collection, and including the production of those cases in the curricula of the involved programmes.
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Implementation of reliable methodologies allowing Reduction, Refinement, and Replacement (3Rs) of animal testing is a process that takes several decades and is still not complete. Reliable methods are essential for regulatory hazard assessment of chemicals where differences in test protocol can influence the test outcomes and thus affect the confidence in the predictive value of the organisms used as an alternative for mammals. Although test guidelines are common for mammalian studies, they are scarce for non-vertebrate organisms that would allow for the 3Rs of animal testing. Here, we present a set of 30 reporting criteria as the basis for such a guideline for Developmental and Reproductive Toxicology (DART) testing in the nematode Caenorhabditis elegans. Small organisms like C. elegans are upcoming in new approach methodologies for hazard assessment; thus, reliable and robust test protocols are urgently needed. A literature assessment of the fulfilment of the reporting criteria demonstrates that although studies describe methodological details, essential information such as compound purity and lot/batch number or type of container is often not reported. The formulated set of reporting criteria for C. elegans testing can be used by (i) researchers to describe essential experimental details (ii) data scientists that aggregate information to assess data quality and include data in aggregated databases (iii) regulators to assess study data for inclusion in regulatory hazard assessment of chemicals.
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A bioaugmentation approach was used to enhance the performance of anaerobic digestion (AD) using cow manure (CM) as the substrate in a continuous system. To obtain the desirable microbial culture for bioaugmentation, a biochemical methane potential test (BMP) was used to evaluate three commonly used inocula namely (1) municipal solid waste (MSW), (2) wastewater treatment plant (WWTP), and (3) cow manure digester (CMMD) for their hydrolytic capacity. The highest lignocellulose removal (56% for cellulose and 50% for hemicellulose) and the most profusion of cellulolytic bacteria were obtained when CM was inoculated with CMMD. CMMD was thus used as the seed inoculum in a continuously operated reactor (Ra) with the fiber fraction of CM as the substrate to further enrich cellulolytic microbes. After 100 days (HRT: 30 days), the Bacteria fraction mainly contained Ruminofilibacter, norank_o_SBR1031, Treponema, Acetivibrio. Surprisingly, the Archaea fraction contained 97% ‘cellulolytic archaea’ norank_c_Bathyarchaeia (Phylum Bathyarchaeota). This enriched consortium was used in the bioaugmentation experiment. A positive effect of bioaugmentation was verified, with a substantial daily methane yield (DMY) enhancement (24.3%) obtained in the bioaugmented reactor (Rb) (179 mL CH4/gVS/d) than that of the control reactor (Rc) (144 mL CH4/gVS/d) (P < 0.05). Meanwhile, the effluent of Rb enjoyed an improved cellulose reduction (14.7%) than that of Rc, whereas the amount of hemicellulose remained similar in both reactors' effluent. When bioaugmentation stopped, its influence on the hydrolysis and methanogenesis sustained, reflected by an improved DMY (160 mL CH4/gVS/d) and lower cellulose content (53 mg/g TS) in Rb than those in Rc (DMY 144 mL/CH4/gVS/d and cellulose content 63 mg/g TS, respectively). The increased DMY of the continuous reactor seeded with a specifically enriched consortium able to degrade the fiber fraction in CM shows the feasibility of applying bioaugmentation in AD of CM.
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