Empirical investigation regarding ethical decision making: a stakeholder cross-impact analysis (SCIA)

Purpose The purpose of this research was to study senior and middle-level executive perspectives on ethical decision-making exploring stakeholder cross-impact analysis (SCIA). Given the complexities of business today, stakeholder identification, prioritisation and complexities of reciprocal stakeholder influences have become very important. Various philosophical approaches raised questions than responses to these problems. There was a clear need to find ways through which the worldview of agents could be assimilated and understood. Design/methodology/approach This study used the original hypothetical short case and brought in middle and senior executive reflections of Indian fast-moving consumer goods (FMCG) managers. Reflections of ten senior and 178 middle-level Indian FMCG managers were presented, exploring ethical dilemmas using short hypothetical case. These reflections have been analysed using the SCIA framework. The paired t-test was performed to compare the reflections of senior and middle-level executives. Findings The study results indicated that differences emerged regarding stakeholder identification, prioritisation and reciprocal stakeholder influences between Indian middle and senior FMCG executives. Hence, this study paved a reflective space for SCIA. The findings were in line with the tenets of agents’ dilemmas depicted in agency theory. Research limitations/implications This study made contribution to theory by integrating the perspective of ethical dilemma confronted by organisational decision-making units (DMUs) with respect to stakeholder influence and prioritisation. Specifically, theoretical contribution was made towards SCIA. Practical implications This study would help middle and senior executives to better understand the needs and complexities of stakeholder identification, prioritisation and complexities of reciprocal stakeholder influences. Originality/value To the best of the authors’ knowledge, this was one of the first studies from an emerging market context country like India that applied SCIA in the FMCG sector. Organisational DMUs while facing ethical dilemma undertook stakeholder influence vis-a-vis stakeholder prioritisation.

Sensor-based human activity recognition using fuzzified deep CNN architecture with λmax method

Purpose This work aims to develop a novel fuzzy associator rule-based fuzzified deep convolutional neural network (FDCNN) architecture for the classification of smartphone sensor-based human activity recognition. This work mainly focuses on fusing the λmax method for weight initialization, as a data normalization technique, to achieve high accuracy of classification. Design/methodology/approach The major contributions of this work are modeled as FDCNN architecture, which is initially fused with a fuzzy logic based data aggregator. This work significantly focuses on normalizing the University of California, Irvine data set’s statistical parameters before feeding that to convolutional neural network layers. This FDCNN model with λmax method is instrumental in ensuring the faster convergence with improved performance accuracy in sensor based human activity recognition. Impact analysis is carried out to validate the appropriateness of the results with hyper-parameter tuning on the proposed FDCNN model with λmax method. Findings The effectiveness of the proposed FDCNN model with λmax method was outperformed than state-of-the-art models and attained with overall accuracy of 97.89% with overall F1 score as 0.9795. Practical implications The proposed fuzzy associate rule layer (FAL) layer is responsible for feature association based on fuzzy rules and regulates the uncertainty in the sensor data because of signal inferences and noises. Also, the normalized data is subjectively grouped based on the FAL kernel structure weights assigned with the λmax method. Social implications Contributed a novel FDCNN architecture that can support those who are keen in advancing human activity recognition (HAR) recognition. Originality/value A novel FDCNN architecture is implemented with appropriate FAL kernel structures.

A budget impact analysis of substituting sitagliptin with liraglutide in type 2 diabetes from a private health insurance perspective in Egypt

Introduction Type 2 diabetes mellitus causes a sizable burden globally from both health and economic points of view. This study aimed to assess the budget impact of substituting sitagliptin with liraglutide versus other glucose-lowering drugs from the private health insurance perspective in Egypt over a 3-year time horizon. Methods Two budget impact models were compared with the standard of care (metformin, pioglitazone, gliclazide, insulin glargine, repaglinide, and empagliflozin) administered in addition to liraglutide or sitagliptin versus the standard of care with placebo. A gradual market introduction of liraglutide or sitagliptin was assumed, and the existing market shares for the other glucose-lowering drugs were provided and validated by the Expert Panel. The event rates were extracted from the LEADER and TECOS trials. Direct and mortality costs were measured. Sensitivity analyses were performed. Results The estimated target population of 120,574 type 2 diabetic adult patients was associated with cardio vascular risk. The budget impact per patient per month for liraglutide is EGP29 ($6.7), EGP39 ($9), and EGP49 ($11.3) in the 1st, 2nd, and 3rd years, respectively. The budget impact per patient per month for sitagliptin is EGP11 ($2.5), EGP14 ($3.2), and EGP18 ($4.1) in the 1st, 2nd, and 3rd years, respectively. Furthermore, adoption of liraglutide resulted in 203 fewer deaths and 550 avoided hospitalizations, while sitagliptin resulted in 43 increased deaths and 14 avoided hospitalizations. The treatment costs of liraglutide use are mostly offset by substantial savings due to fewer cardiovascular-related events, avoided mortality and avoided hospitalizations over 3 years. Conclusion Adding liraglutide resulted in a modest budget impact, suggesting that the upfront drug costs were offset by budget savings due to fewer cardiovascular-related complications and deaths avoided compared to the standard of care. Sitagliptin resulted in a small budget impact but was associated with increased deaths and fewer hospitalizations avoided.

Impact of a high-risk multimorbidity integrated care implemented at the public health system in Chile

During recent years, multimorbidity has taken relevance because of the impact of causes in the system, people, and their families, which has been a priority in the health care plan. Interventions strategies and their implementation are still an emerging topic. In this context, Centro de Innovación en Salud ANCORA UC, together with Servicio de Salud Metropolitano Sur Oriente, implemented as a pilot study High-Risk Multimorbidity Integrated Care strategy. This study aimed to evaluate the impact of this strategy in terms of health services utilization and mortality. A cohort study was conducted with high-risk patients with multimorbidity, stratified by ACG®, intervened between April 2017 and December 2019. The studied population was 3,933 patients who belonged to similar size and location primary care centers. The impact analysis was performed used generalized linear models. Results showed that intervened patients had a significantly lower incidence in mortality (OR 0.56; 95% CI 0.40–0.77), hospital admissions, length of stay, and the number of hospital emergency consultancies. With the proper barriers and facilitators of a real context intervention, the implementation process allowed the systematization and consolidation of the intervention provided in this study. The training for new roles and the constant implementation support from the Centro de Innovación en Salud ANCORA UC team were essential in the progress and success of the intervention. A complete description of the high-risk intervention strategy is provided to contribute to this emerging topic and facilitate its scale-up. We can conclude that this complex intervention was feasible to be implemented in a real context. The Ministry of Health has taken the systematization and consolidation of the conditions for the national scale-up.