The study also revealed that the indirect effect is stronger when employees hold a higher employee environmental commitment. The theoretical and practical implications for environmental sustainability in respect of organizations as well as future research directions are discussed.The world is looking toward organizations for social responsibility to contribute to a sustainable environment. Employees’ organizational citizenship behavior for the environment (OCBE) is a voluntary environmental-oriented behavior that is important for organizations’ environmental performance. Based on social learning theory, this study examined the effects of responsible leadership in connection with OCBE by using a sample of 520 employees in the manufacturing and service sectors in China including engine manufacturing, petroleum plants, banking, and insurance sector organizations. Further, the roles of psychological ownership and employee environmental commitment were used as mediators and moderators simultaneously. The direct, mediation, and moderation model results exposed a positive relationship between responsible leadership and OCBE  Global climate change and biodiversity reduction have increased in recent years, which has raised positive ecological expectations of the corporate sector . Common Being critical stakeholders of organizations, organizations’ environmental protection behavior is highly dependent upon behaviors and interpersonal interaction of employees of any enterprise . It is wThe substantial impact of employee environmental protective behavior and outcomes has driven attention toward the factors that encourage OCBE. These factors include the self-responsibility of employees for environmental protection , and corThis paper significantly contributes to the existing literature on responsible leadership and organizational citizenship behavior for the environment in several ways. First, the rarely investigated relationship of responsible leadership and OCBE is investigated and extended. Responsible leadership undertakes the interest of stakeholders, including employees and their concerns about the environment and their psychological ownership for organizations. In this way, it further enriches the antecedents of OCBE. Second, this study also sheds light on existing models of responsible leadership and OCBE in connection with employees’ psychological ownership and analyzes its mediating effects on the primary relationship of OCBE and responsible leadership. Previously, the leadership role was highlighted regarding OCBE in the mediation of psychological ownership , but theResponsible leadership originated from social relations and ethical theories and a leadership style that took place in the social interaction process . CurrentEmployees in organizations that practice paper-saving behavior, lower energy consumption, enhanced environmental protection, giving assistance to others in practicing green behavior, and recommending enhanced environmental protection are typical examples of OCBE . ResponsDaily introduced the concept of Organizational Citizenship Behavior for the Environment (OCBE) in 2009; since then, it has been popular among management scholars. OCBE is a persons’ voluntary behavior toward the environment in the organization which is not covered by any formal incentive system . The volEmployees’ initiatives for improvements in organizational environmental performances are widely studied and incorporated in green literature . EmployeHypothesis 1:Responsible Leadership is positively associated with OCBE.Psychological ownership is based upon psychological ownership theory and is defined by Hypothesis 2:Responsible Leadership is significantly associated with psychological ownership.Hypothesis 3:Psychological ownership is significantly correlated with OCBE.The responsible leadership style emphasizes upon stakeholder-leader approach. The responsible leader considers all the needs and demands of the stakeholders. All the social, psychological, financial, and environmental needs of various stakeholders are prioritized along with safeguarding shareholders and employees’ interests. This care and sense of protection ignite positivity and a sense of importance among employees. They consider themselves an essential part of an organization and, in return, establish a sense of psychological ownership for the organization. They consider themselves responsible for organizational success and sustainability and voluntarily invest extra time and energy to discharge the responsibility of psychological ownership . The empHypothesis 4:Psychological ownership mediates the relationship between responsible Leadership and OCBE.Environmentally committed employees respond positively to signals from their organization regarding the environment and green practices . The rolThe attitude theory of Hypothesis 5:Employee environmental commitment moderates the relationship between responsible leadership and psychological ownership such that the relationship will be stronger for those high in Employee environmental commitment.Commitments have gained exceptional attention of management researchers as these are the gear of specific behavior to facilitate employees in the attainment of goals , and a gEmployee environmental commitment is employee attachment and responsibility towards the environment at work . Daily aHypothesis 6:Employee environmental commitment moderates the relationship between responsible leadership and OCBE such that the relationship will be stronger for those high in Employee environmental commitment.The above mentioned relationships are portrayed in The sample of the study includes 520 employees of six manufacturing and service organizations: an engine manufacturing plant, an insurance company, two petroleum manufacturing plants, and two banking offices located in Beijing, Sichuan, and Shaanxi provinces of China, considered as industrial provinces. Data was collected by convenient sampling technique. Recently, the Chinese government has paid great attention to green initiatives and developing a role for environmental protections. We considered these organizations for examining their organizational citizenship behavior for the environment and their work on green initiatives. These organizations are taking green initiatives and details are provided on their websites. For inclusion and exclusion purposes, we first ensured that organizations must be listed on stock exchanges, then organizations must have hundred or more employees, and the organizations had to be taking environmental problems seriously and providing details of green initiatives on their websites. As the target population was Chinese, for this purpose, the English version of the survey was translated into the Chinese language by two Chinese professors with fluency in English and Chinese languages. For the accuracy of the Chinese version of the survey, it was again translated back into English by similar Chinese professors .The firms’ human resource departments were contacted by emails, using some references, and through telephonic contact. Data for the study was collected using an online survey on two points of time divided by the gap of 1 month to lessen the potential common method biases . All theThe measure of the study is divided into three parts. In the first part, the overview of the study is given and the importance of the role of responses is discussed. The purpose of the study is clarified to the respondents and it is further informed that the research was purely for academic purposes. In the second part, demographics are asked i.e., gender, age, education, and work experience of the respondents. In the third and main part of the questioner, items related to variables of the study were asked. The respondents answered the questionnaire on a five-point Likert scale from 1 (strongly agree) to 5 (strongly disagree). The Questionnaire was translated into the Chinese language to facilitate respondents.Responsible leadership measurement was assessed by using a five-item scale developed by We used the 10 item scale of OCBE developed by We assessed psychological ownership by the scale developed by We used the eight-item scale of employee environmental commitment was developed by P-values, and t-statistics were calculated.In this study, data were examined using SPSS 25 and AMOS. The bootstrapping technique in SPSS 25 was also used in this study. Following In six organizations approximately 750 employees were randomly selected, so a total of 750 survey links were distributed out of which 520 (69.33%) were received back completed in all senses and were used for data analysis. Out of these 520 respondents, 232 respondents (44.6%) were female, and 288 (55.4%) were male respondents. The age-wise distribution includes five age brackets. The first age bracket consists of age 20–25 and 71 respondents fall in this bracket. The second age bracket is 25–30 and a total 132 respondents fall in this age category. A total of 240 respondents, making up 46%, fall in the third age group of 30–35. Similarly, the fourth age group has an age limit 35–40, and a total 55 respondents fall in this age group, which is 10.6% of total respondents. The lowest number, i.e., 22 respondents, falls in the highest age group of above 40. The sample employees having work experience between 1 and 5 years are 30.2%, the largest group of employees, 45.4%, had work experience between 5 and 10 years, and the remaining 24.4% had work experience above 10 years. In employees’ education level distribution, 65.4% of respondents had a bachelor’s degree while 23.8% of respondents had a master’s degree. Supplementary information of the respondents is shown in below First of all, screening of data was carried out to find out the missing values, any abnormal response of outliers, the test of differences, and the technique of common method variance. The Harman single factor test for common method bias was carried out to undertake the factor analysis (exploratory) by using SPSS 25. We consider all the variables  for factor analysis. The highest covariance value was 36.40% (below 50%) indicated that the common method bias problem does not exist.2, CFI, TLI, and RMSEA following  these results highlight responsible leadership and psychological ownership, and employees environmental commitment and responsible leadership are indicated . Employees’ environmental commitment and psychological ownership show a correlation . The OCBE shows positive correlations with all other constructs.p < 0.001), which provides support for our hypothesis H1. The table also shows that there is a significant and positive relationship exist between responsible leadership and psychological ownership  which also supports our hypothesis H2. Furthermore, it has been indicated that psychological ownership has a significant positive influence on OCBE and the results show that  psychological ownership changes organizational citizenship behavior to this extent. Therefore, these hypotheses H1 and H2, and also H3 are accepted in this study empirically, intensifying the significant relationship between responsible leadership, psychological ownership, and OCBE. There is also a significant mediating effect of psychological ownership on the association of responsible leadership and OCBE, as the table indicates , which provides support for mediating relationship and acceptance of H4. Furthermore, previously in the literature, we anticipated that employees environmental commitment would moderate the relationship between responsible leadership and psychological ownership. Besides supporting the moderation analysis, and the strength of indirect value (mediation), it is likely to rely on the value of moderation  which is known as a conditional indirect effect or moderated mediation (ediation . The oveAccording to This study adds psychological ownership to differentiate these two mechanisms with employees’ environmental commitment as a control moderator. The result showed that psychological ownership mediates the relationship between responsible leadership and OCBE. In practice, the results indicated some new suggestions on how to encourage employees to actively engage in OCBE within the organization. Furthermore, this study indicated a partial mediation in the table of mediation, and the results showed a significant linkage of psychological ownership playing a mediator role between responsible leadership and OCBE. These findings are in line with previous studies , which aAccording to In this research, we endeavor to investigate the association between responsible leadership and OCBE in the mechanism of psychological ownership and employee environmental commitment. The sample used for data analysis of this study consist of 520 employees from Chinese organizations. For data analysis the SPSS 25 and AMOS used and drew the following conclusions; responsible leadership positively and significantly affects the OCBE. Psychological ownership performed a mediating role in the relationship of responsible leadership and OCBE, employee environmental commitment plays a moderating role between responsible leadership and psychological ownership, and OCBE.This study contributed theoretically to social learning and social exchange theories. The social learning theory strives for the compound behavior of people which is primarily acquired through direct and indirect observation and imitation of the behavior of activists or objects . In the This study contributed to the existing literature of responsible leadership, organizational citizenship behavior, psychological ownership, and employee environmental commitment. Data for the study were collected from three provinces of China. This study contributed to the existing body of knowledge of responsible leadership and organizational citizenship behavior based upon social learning theory. The study proves that to nurture organizational citizenship behavior for the environment, the importance of responsible leadership is undeniable. In the emerging environmental issues, particularly in developing countries like China, leaders having the traits of responsible leaders can motivate employees for socially responsible behavior that is beneficial not only for themselves, but also for the organization and for the environment at a large. Furthermore, this study also sheds new light on the existing model of responsible leadership and OCBE in the connection of employees’ psychological ownership. Additionally, based upon social exchange theory, this study analyzes mediating effects of psychological ownership on the primary relationship of OCBE and responsible leadership. This study underwrote the efforts in the Chinese context and expanded the context of social exchange theory. This paper investigated the role of responsible leadership for organizational citizenship behavior for the environment in the Chinese context with the mediation and moderation of psychological ownership and employee environmental commitment. Based upon the findings of the current study, we draw the following practical implications for management and policymakers. First, the role of responsible leadership for nurturing the organizational citizenship behavior for the environment in the organization should be highlighted. In an organizational setting, the managers’ sense of CSR and environmental-related ethics affect the employees’ practices and attitudes. So, the level of traits of responsible leadership in managers should be improved. Managers should be hired who possess the characters of responsible leadership, or managers should undergo training programs that produce and polish such characteristics. The manager’s collaboration with employees should be encouraged, to stimulate employee workplace environmental protection attitudes and practices and their efforts for organizational sustainable development. Second, organizations should hire such leaders and develop leadership training programs that demonstrate the ethics and characteristics of responsible leadership. These ethics and values should be embedded in training and leadership development programs to support responsible leadership behavior. Furthermore, organizations should encourage the employee’s pro-environmental behavior by endorsing environmental-friendly attitudes and practices like reducing carbon emissions, saving energy, and reusing resources.Third, employee psychological ownership affects employees’ motivation to involve in environmental protection behavior. To increase the level of OCBE in the organization, it is essential to stimulate their sense of psychological ownership for the organization. In return, the employee will exhibit environmental protection behavior. Psychological ownership gives employees a sense of ownership in the organization, so they feel more attached to the organization, strive for its sustainable development, and in this way show environmental protection behavior. Therefore, training programs should be implemented to enhance the employees’ sense of psychological ownership for the organization and increase their skills to participate in environmental protection activities.There are a few limitations associated with this study to be deliberated. First of all, the instrument used to measure responsible leadership is derivative from scales developed for the western perspective. Scales have good validity and reliability, but the theoretical association of responsible leadership and its endorsement for diverse cultures, particularly the eastern perspective, including China, needs further exploration. Second, although the use of the time-lagged data reduces the chances of common method bias, it prevents any causative inferences. It is recommended for upcoming research to use longitudinal study designs to generate casual relationships. Third, in this study, psychological ownership was used as a mediator and employee environmental commitment was used as a moderation agent between responsible leadership and OCBE. The role of HR in developing green culture and climate as suggested by The datasets generated for this study are available on request to the corresponding author.AA contributed to the data curation, formal analysis, conceptualization, and original draft and revision of the manuscript. YC contributed to the supervision and guidelines. Bilal contributed to the revision of the manuscript. SZ contributed to the review. SM contributed to formatting, review and editing of the manuscript. IU contributed to the, formal analysis, and revision of the manuscript. YHM contributed to the reviewed and edited of the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Background: At times, electronic medical records (EMRs) have proven to be less than optimal, causing longer hours behind computers, shorter time with patients, suboptimal patient safety, provider dissatisfaction, and physician burnout. These concerning healthcare issues can be positively affected by optimizing EMR usability, which in turn would lead to substantial benefits to healthcare professionals such as increased healthcare professional productivity, efficiency, quality, and accuracy. Documentation issues, such as non-standardization of physician note templates and tedious, time-consuming notes in our mother-baby unit (MBU), were discussed during meetings with stakeholders in the MBU and our hospital's EMR analysts.Objective: The objective of this study was to assess physician note optimization on saving time for patient care and improving provider satisfaction.Methods: This quality improvement pilot investigation was conducted in our MBU where four note templates were optimized: History and Physical (H and P), Progress Note (PN), Discharge Summary (DCS), and Hand-Off List (HOL). Free text elements documented elsewhere in the EMR  were identified and replaced with dynamic links that automatically populate the note with these data. Discrete data pick lists replaced necessary elements that were previously free texts. The new note templates were given new names for ease of accessibility. Ten randomly chosen pediatric residents completed both the old and new note templates for the same control newborn encounter during a period of one year. Time spent and number of actions taken  to complete these notes were recorded. Surveys were sent to MBU providers regarding overall satisfaction with the new note templates.Results: The ten residents' average time saved was 23 min per infant. Reflecting this saved time on the number of infants admitted to our MBU between January 2016 and September, 2019 which was 9373 infants; resulted in 2.6 hours saved per day, knowing that every infant averages two days length of stay. The new note templates required 69 fewer actions taken than the old ones . The provider surveys were consistent with improved provider satisfaction.Conclusion: Optimizing physician notes saved time for patient care and improved physician satisfaction. Our hospital, like many others in the nation, adopted the Epic Systems software  for electronic medical record (EMR) documentation in 2012. The Notes in our Mother Baby Unit (MBU) were minimally updated from the initial system loaded templates. Each of our pediatric residents had his/her own template, which generates numerous note arrangements. This lack of standardization led to confusion and dissatisfaction from the staff and community pediatricians who follow our newborns after they were discharged from our hospital.The introduction of EMR changed the format of health records and improved healthcare . It is eThe majority of the newborn medical record documentation is derived from the maternal medical condition reflected and is usually pulled from the mother's obstetrical prenatal and delivery documentation . The invThe objective of this study was to assess physician note optimization on saving time for patient care and improving provider satisfaction.This project took place in the MBU at a regional perinatal center and a major academic university hospital, which is the largest in the Northern Florida and Southern Georgia region of the United States. Average infant deliveries are 2,800–3,200 per year.via artifact analysis and observations that the majority of physician note data in the MBU was entered manually, such as maternal labs (at least seven required lab tests)  , number b tests) , hearingb tests) . After tThe planned project was approved as Quality Improvement Pilot Project, and it was registered in the Quality Improvement Project Registry (QIPR) of our institution.The first step in the note optimization process was to identify all free text elements documented elsewhere in the medical records  , 2. ThesPrior to optimization, during the second half of 2014, ten pediatric residents evenly divided in their first and second years of training  were ranPost optimization, from October to December 2015, the same ten residents who completed the notes prior to optimization were again asked to complete notes, but this time with the newly optimized note templates . Again, None of the ten pediatric residents who completed the timed pre- and post-optimization notes was a stakeholder for this project.The average length of stay (LOS) in the MBU is 2 days. During the entire LOS, every infant requires a minimum of three notes in total: H and P, PN, and DCS and daily updated HOL. However, to make the calculation simpler regarding HOL, we opted to record the time and count the actions taken required to complete the HOL only on the first day when the infant was born and admitted.An anonymous survey form with three “yes/no” questions was sent to the MBU providers, which included pediatric residents, nurse practitioners, and pediatric faculty members, regarding accuracy, efficiency, and overall satisfaction of the new notes in comparison to the old notes. The survey link was sent to 46 providers' work emails, and they were given a week to complete it. The survey questions were:Is the information generated from the new note templates more accurate than the information generated from the old note templates?Were the new notes easier to complete than the old notes?Are you, overall, satisfied with the new note templates as compared to the old templates?To assess the efficiency of the new note templates and to check how much provider time was saved, we calculated the number of residents' minutes saved per month based on the average number of infants born in a given month. In order to do so, a report of the number of infants admitted to the MBU for the period of January 2016 to September 2019 (45 months) was requested from our data solution center. The generated report indicated that 9373 infants had been admitted to the MBU during the requested period.p-value of 0.002 was obtained for each measure of the notes, indicating statistically significant pre-post optimization comparison. The Bonferroni adjustment for multiple testing also showed statistical significance.Together, the actions taken saved when completing the new notes in comparison with the old notes were defined as follows: H and P: 11, PN: 8, DCS: 18, and HOL: 32. These numbers were exactly similar among all the ten residents . An exacTime spent to complete the pre-optimization and post-optimization notes for the ten residents was recorded in s and converted to min .The number of residents completed the pre and post-optimization notes and the amount of training in MBU is seen in Completing the four new note templates took an average of 1,386 s less time when compared to completing the old ones for one infant. This was converted to min and it indicated that 23 min per infant was saved during the entire LOS, assuming, as mentioned earlier, that each infant required four notes, including an HOL, during the average two days LOS .From January 2016 to September 2019 (45 months), there were 9,373 infants born in, averaging 208 infants per month. Reflecting the 23 min time saved per infant on the average 208 infants born per month during the study period, we estimated that 4,791 min were saved per month. Therefore, 80 h were saved per month, which is equal to 2.6 h saved per day.Twenty-eight MBU providers completed the satisfaction survey, averaging 61% completion. Those who completed the survey showed an overwhelming 100% satisfaction with the new note templates .This study aimed to improve the efficiency and quality of documentation, and provider satisfaction simply by reforming the note templates in our MBU.Optimizing the physician note templates to automatically extract relevant data and using pick lists reduced by 69 the number of clicks required to care for an infant in the MBU, which resulted in an estimated average of 4,791 min saved per month. This was achieved by simple improvement and optimization of the note templates. The providers were also substantially satisfied with the new templates.A hospital system in Saudi Arabia conducted a study on their EMR and found that it offered substantial benefits to healthcare professionals, as it improved access to information and increased healthcare professional productivity, efficiency, quality, and accuracy . In AustBased on previous examples, we can confidently state that EMR is an important tool in healthcare around the world. It should ideally improve patient care, communication, provider efficiency, and productivity. The goal and benefits of EMRs are the same worldwide and across all departments in both inpatient and ambulatory settings. In 2010, the University of Washington in Seattle found that the main barrier in transitioning patient medical records from paper to electronic physician inpatient notes was the time required to enter the notes that contained data-rich templates . The samOur project successfully made simple adjustments to the existing EMR and improved physician note usability and documentation. It also succeeded in estimating the amount of hours saved on a daily basis. The significance of this accomplishment in the healthcare system, specifically in an academic setting, is resident involvement, their patient care, and education while also complying with their duty hours . In 2016The literature is clear that EMR implementation is necessary to improve healthcare in general, as stated above. However, not enough literature on how we can improve the usability of EMR and optimize it to reach high levels of patient safety and provider satisfaction exists. Michael Kavuma defined usability as the effectiveness, efficiency, and satisfaction with which specific users can achieve a specific set of tasks in a particular environment . MaximizIn this project, we worked on the usability of our EMR, optimized the physician notes, and improved the workflow in the MBU. We were able to save time on a daily basis, enabling us to spend more time in direct patient care. We also demonstrated an optimal and efficient EMR documentation and improvement in provider satisfaction.Our study limitations: (1) the resident sample size of ten was small and arbitrarily chosen; (2) there is a slight possibility of bias in time measurements due to repetition; (3) 25% of the residents who completed the pre-optimization notes had slightly less training in the MBU than the rest of the residents; (4) the MBU provider survey was limited to three “yes/no,” leading questions with no option for comments by providers; (5) this project was conducted in a single center with standardized MBU workflow; therefore, there is a possibility that our approach might not apply to other units and elsewhere in the EMR.This study concluded that optimizing physician note templates saved an average of 2.6 h per day and improved provider satisfaction.Workflow in MBUs can be made more efficient by integrating obstetric and pediatric charts with elements of standardized data to reduce duplication of documentation. A similar approach may help in other multidisciplinary care settings. More projects on EMR usability should be taken across healthcare to serve as positive tools for patient care and provider satisfaction.The original contributions presented in the study are included in the article/The studies involving human participants were reviewed and approved by University of Florida. Written informed consent from the participants' legal guardian/next of kin was not required to participate in this study in accordance with the national legislation and the institutional requirements.RA is a stakeholder and attended the meetings with EMR analytics, formulated the hypothesis, structured the study design, registered it in QIPR and the data solution center, supervised note implementation and production process, organized and conducted the time tables, The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Managing the care of older adults with heart failure (HF) largely centers on medication management. Because of frequent medication or dosing changes, an app that supports these older adults in keeping an up-to-date list of medications could be advantageous. During the COVID-19 pandemic, HF outpatient consultations are taking place virtually or by telephone. An app with the capability to share a patient’s medication list with health care professionals before consultation could support clinical efficiency, for example, by reducing consultation time. However, the influence of apps on maintaining an up-to-date medication history for older adults with HF in Ireland remains largely unexplored.The aims of this review are twofold: to review apps with a medication list functionality and to assess the quality of the apps included in the review using the Mobile App Rating Scale (MARS) and the IMS Institute for Healthcare Informatics functionality scale.A systematic search of apps was conducted in June 2019 using the Google Play Store and iTunes App Store. The MARS was used independently by 4 researchers to assess the quality of the apps using an Android phone and an iPad. Apps were also evaluated using the IMS Institute for Healthcare Informatics functionality score.Google Play and iTunes App store searches identified 483 potential apps (292 from Google Play and 191 from iTunes App stores). A total of 6 apps (3 across both stores) met the inclusion criteria. Of the 6 apps, 4 achieved an acceptable MARS score (3/5). The Medisafe app had the highest overall MARS score (4/5), and the Medication List & Medical Records app had the lowest overall score (2.5/5). On average, the apps had 8 functions based on the IMS functionality criteria (range 5-11). A total of 2 apps achieved the maximum score for number of features (11 features) according to the IMS Institute for Healthcare Informatics functionality score, and 2 scored the lowest (5 features). Peer-reviewed publications were identified for 3 of the apps.The quality of current apps with medication list functionality varies according to their technical aspects. Most of the apps reviewed have an acceptable MARS objective quality . However, subjective quality  was poor. Only 3 apps are based on scientific evidence and have been tested previously. A total of 2 apps featured all the IMS Institute for Healthcare Informatics functionalities, and half did not provide clear instructions on how to enter medication data, did not display vital parameter data in an easy-to-understand format, and did not guide users on how or when to take their medication. Managing the care of older adults with heart failure (HF) largely centers on symptom and medication management . MedicatGiven the complexity of HF self-care, assisting older adults in managing their own care at home is critical to the success of HF management. Emerging evidence suggests that mobile health , particularly mobile technologies, can serve as a form of support for patients with HF and may enhance patient-provider collaboration for self-management ,10. By tFor older adults, social isolation and loneliness increase the risk of anxiety, depression symptoms, heart disease, reduction of activities of daily living, morbidity, and mortality ,13. GoveAttend Anywhere, endorsed by the Health Service Executive, is now widely available for HCPs to conduct web-based consultations [Across many countries, emerging evidence confirms the important role that mHealth can play in community care, especially during COVID-19. In the United States, there have been 10-fold web-based consultations in a few weeks , “...as ltations . Howeverltations , except The process of medication review over the phone is difficult and time-consuming . HCPs haEmerging evidence suggests that apps can support patients by checking drug interactions, tracking medication intake, and facilitating an up-to-date list of medications. However, although some app interventions have explored HF self-management ,24, app The objectives of this review are two-fold: to review apps with a medication list functionality and to evaluate the quality of the apps included in the review with a validated scale. To assess the quality and functionality of the apps, 2 tools were used: the MARS tool and the IMS Institute for Healthcare Informatics functionality score. For the purpose of this paper, an app with a medication list functionality is an app that generates a comprehensive medication history, allowing the patient to email or share the list in real time with HCPs.medication list was used to identify apps with a medication list functionality. The term medication app was excluded from the search as it identified apps with a different primary purpose . After the initial identification of apps containing a medical list function, the apps were tabulated. If the same app was available on different platforms (iOS or Android), both versions were retained for analysis as apps behave differently depending on the platform, as seen in previous work by Nicholas et al [A systematic search of apps accessible in Ireland was conducted in June 2019 using the Google Play and iTunes App stores. The purpose of this search was to identify apps with a medication list functionality. The search term as et al . InclusiApps that met the inclusion criteria were downloaded and evaluated by a team of 4 researchers. The MARS was used to assess the quality of the apps using an Android phone and an iPad. Apps were also evaluated using the IMS Institute for Healthcare Informatics functionality scores.A Google Scholar search of the apps was conducted to identify apps included in this review that have been evaluated and published in peer-reviewed journals.Apps were included if they had a medication list function; if they were updated in the last 2 years; were free of charge, reflecting popular trends in app downloads ; were avApps were excluded from evaluation if they were a game app, were not available in Ireland, focused solely on a particular medical condition , were a mobile clinical decision support system, were designed primarily for self-care management of a condition , were not available for patients to use at home, and had a barcode scanner that did not recognize medication used in Ireland.The following information for each app with a medication list function was downloaded: developer, number of downloads of the app, last update, and description of the app in the app store. The apps were downloaded from the app store, and scientific support was evaluated by investigating their content. Scientific support provides information on the app’s evidence of validity, as apps that are not supported by evidence are associated with decrements in quality and safety . For exaAll apps were subjected to in-depth analysis and evaluation using the MARS. To the best of our knowledge, there are no published studies using the MARS to assess the quality of apps with a medication list functionality. The MARS was developed by a team of researchers at the University of Queensland, Australia, to provide a systematic means of assessing, classifying, and rating the quality of mHealth apps .Within this framework, apps are rated according to 4 objective measures  and one subjective measure . More spThe apps were independently reviewed by 4 reviewers using a five-point scale , as shown in The reviewers carefully read the MARS instructions, independently reviewed the apps, and provided a rationale for their ratings. Subsequently, they compared the results and reached a consensus on each of the ratings for each of the MARS subscales . Before To complement the MARS quality assessment, another tool was used to independently evaluate app functionalities . This evUnlike MARS, this tool only assesses objective quality and has been used previously to evaluate app capabilities ,33. The Google Play and iTunes App stores searches identified 483 potential apps (292 Google Play stores and 191 iTunes App stores), the app selection process for both app stores can be seen in On average, the apps had 8 functions based on the IMS criteria (range 5-11). Two apps achieved the highest IMS functionality criteria score (11 functions), whereas 2 apps achieved the lowest score (5 functions). All functions (n=11) are listed in Four out of the six apps achieved acceptable quality, suggesting that most apps are of acceptable quality. None of the apps presented any major technical issues during the review, and all were updated in the last 2 years. Features included in most apps reviewed were medication reminders, medication history logs with the ability to share a medication report with others, vital parameter tracking, and syncing the account to other devices.Only one app (Medisafe) achieved the highest objective and subjective overall MARS scores. One of the distinctive features of this app was the ability to educate users on how and when to take their medication, drug-drug interaction information, and medication side effects. This information was presented in videos using a clear and concise language and text format. In addition, there is evidence of effectiveness, as the Medisafe app has been previously tested in 2 randomized controlled trials ,35, as aThe overall subjective quality dimension was significantly lower (2.8/5) than the overall objective mean of all apps (3.4/5). Only one app  achieved a lower objective overall score (2.5/5) than the subjective overall score. The subjective quality represented the opinion of the user on the level of satisfaction with the app, willingness to pay for it, and the extent to which the user will recommend it to others. It appears that the apps reviewed, to a certain extent, are well designed, as most apps achieved an acceptable objective quality. However, the subjective quality was poor, as the reviewers provided lower scores on continuity of use and willingness to recommend the apps to others.The functionality dimension mean score achieved the highest score (3.7), indicating a trend toward higher responses in a timely manner, intuitiveness and ease of use, and navigation across all apps. However, the mean score for the information and engagement dimensions was the lowest (3.2). The information dimension represents the quality and quantity of information present in the app and the way this information is provided, for example, through the use of different formats, such as videos, text, or graphs. The quality of the information on the apps reviewed varied, as some provided good quality medication information; in others, there was a very poor level of information or none present at all.None of the apps included in the review performed very well in the engagement dimension (if the app was fun or interesting to the user). Medication apps as a rule are not fun and entertaining; however, most apps allow interactivity (ability to input information and prompting) and customization (sending notifications and setting up medication reminders). Another category in engagement, the target group, evaluated if the app content  was appropriate for the user. Most patients diagnosed with HF are older adults. The apps reviewed were not specifically designed for use by older adults and did not have an age-friendly interface. An example of an age-friendly interface is when an app facilitates older adults to enlarge the font size of the screen if required. Avoiding information overload and providing detailed instructions on how to use the app are also age-friendly interface examples . Three oOnly 2 apps (Medisafe and MyTherapy) communicated effectively to users, offering an educational component about medication and the medical condition associated with each medication. In addition, both apps informed users about the medication they are taking and possible drug-to-drug interactions. Due to frequent medication or dosing changes in patients with HF, this is a critical function. Medication adherence and continuous education on the condition and symptom management are vital to reduce rehospitalization, illness progression, and exacerbation of symptoms in patients with HF .Some of the apps reviewed  were not intuitive and did not provide clear instructions on how to enter medication strength, time of the day, route, and setting up medication reminders. In other studies, the level of detailed instructions varied. Providing clear instructions on the use of an app is vital for older adults with HF. Patients with HF are predominantly patients aged ≥ 65 years , and oldAll apps allowed users to record their medication and a history of use. Most apps also had the capability to record vital parameters. For patients with HF, blood pressure and weight measurements are useful for monitoring the progress of their illness and identifying when symptoms exacerbate. One of the main goals of HF care is to avoid rehospitalization and major adverse cardiac events . In partFour apps  allowed data entered into the app to be analyzed and evaluated by the user, a relative, or an HCP. This functionality allows for information to be shared easily and in a timely manner for HCPs to evaluate it and act accordingly. For example, relatives and clinicians can evaluate whether a person is adhering to medication.Five out of the six apps  had the capability to recommend the user, a relative, or a medical practitioner to intervene based on the data collected. Building from the example provided in “evaluate data,” once the health information is evaluated, an intervention can be put in place. Examples of interventions for patients with HF could be to reduce or increase the medication dose, reduce fluid intake, and attend the clinic or emergency department on the day. Other examples are the ability of the app to communicate effectively to provide a positive intervention, that is, reminders to refill their medication or a suggestion to engage in physical activity to achieve their daily activity goal.Apps with a cluttered or bland display do not engage users and are less likely to offer a positive user experience. In 3 of the apps reviewed , the data were displayed in a clear and colorful graphical representation format. This function could potentially be effective for patients with HF as they can easily understand health reports, that is, medication, weight, and blood pressure . ConsequHalf of the apps  did not provide comprehensive guidance or training about the correct administration of medication or advice on the time of day that the medication should be administered, for example, before or after a meal. HF medication management is complex, and continuous education and advice on regular medication use is vital for HF self-management .All apps issued an alert to remind users to take their medication and most allowed the users to tick off their medication once they take it or record it as a missed dose. Most apps also had the capability of reminding users of upcoming medical appointments. Apps with a reminder function improved medication adherence and enhanced complex medication management in patients with HF . One of This function offers the option to communicate with HCPs or with an online support group in real time. The Medisafe app offers users the possibility to communicate with unlimited Medfriends supporters . Another app, MyTherapy, provides HCPs with an overview of patients’ data to plan for their treatment between visits through the web dashboard function.A search was conducted to identify the apps included in this review that have been evaluated and published in peer-reviewed journals. Out of all the apps reviewed, 3 apps were identified in the search: (1) Dosecast, (2) MyTherapy, and (3) Medisafe app.To our knowledge, this is the first study to assess the quality of apps with a medication list functionality using the MARS and the IMS Institute for Healthcare Informatics functionality scale available to Irish consumers. The most common functionalities found in the apps reviewed were medication reminders, medication history logs, and the ability to share medication reports with others, vital parameter tracking, and syncing the account to other devices. However, half did not provide clear instructions on how to enter medication data, did not display vital parameter data in an easy-to-understand format, and did not guide users on how or when to take their medication.App users prefer apps that are effective, useful, and easy to use . From thThe quality and efficacy of health apps is another important factor to be considered by users, as they provide positive user experiences and a higher uptake . Most ofThe use of mHealth apps is growing at an exponential rate, but there are questions about their efficacy. One of the methods to check the evidence of efficacy is to conduct a search for peer-reviewed academic evidence. For the purpose of this study, a search was conducted for each app in Google Scholar to identify any published peer-reviewed articles. Three of the reviewed apps were identified in the search. The Medisafe app has been previously tested in 2 randomized controlled trials: (1) a medication adherence study  and (2) The mHealth research community has been actively searching for self-management solutions to support older adults shielding at home during the COVID-19 pandemic. One of their focus areas is to support self-management and medication adherence . Apps wiFinally, this paper identified a small number of apps that could be suitable for patients with HF sharing their medication list with HCPs before consultation. Owing to the sensitive nature of health care data and in an era where General Data Protection Regulation (GDPR) legislation considerations are increasingly important, a strict data policy was a criterion for selection. For example, one of the most frequent concerns app users have is how their health data are processed. Under GDPR legislation, app users are encouraged to ask and obtain information in relation to data security and data processing . HoweverThe quality of current apps with a medication list functionality varies according to their technical aspects. Most of the reviewed apps have acceptable MARS objective quality. However, the subjective quality or satisfaction with the apps was poor. The objective quality assesses whether an app is interesting, easy to navigate, and overall visual appeal, among other characteristics. Subjective quality reflects user satisfaction, app endorsement, and continuity of use. Only 3 apps are based on scientific evidence and have been tested previously. Two apps featured all the IMS Institute for Healthcare Informatics functionalities and half did not provide clear instructions on how to enter medication data, did not display vital parameter data in an easy-to-understand format, and did not guide users on how or when to take their medication.To our knowledge, this is the first study to use the MARS to assess the quality of apps with a medication list functionality available in the Irish app stores. The need for an app to support older adults with HF to maintain an accurate medication list is warranted. We recommend that app developers display either in the app or on the website, a transparent and easy-to-understand privacy policy to increase patients’ and HCPs’ trust and use.One of the limitations of this review is the limited number of apps, as only those with a strict privacy policy written on their website or app store were included. Furthermore, due to the fast pace of app development, it is possible that by the time this paper is published, there may be new apps with a medication list functionality available to Irish consumers.


The demand for global software development is growing. The nonavailability of software experts at one place or a country is the reason for the increase in the scope of global software development. Software developers who are located in different parts of the world with diversified skills necessary for a successful completion of a project play a critical role in the field of software development. Using the skills and expertise of software developers around the world, one could get any component developed or any IT-related issue resolved. The best software skills and tools are dispersed across the globe, but to integrate these skills and tools together and make them work for solving real world problems is a challenging task. The discipline of risk management gives the alternative strategies to manage risks that the software experts are facing in today's world of competitiveness. This research is an effort to predict risks related to time, cost, and resources those are faced by distributed teams in global software development environment. To examine the relative effect of these factors, in this research, neural network approaches like Levenberg–Marquardt, Bayesian Regularization, and Scaled Conjugate Gradient have been implemented to predict the responses of risks related to project time, cost, and resources involved in global software development. Comparative analysis of these three algorithms is also performed to determine the highest accuracy algorithms. The findings of this study proved that Bayesian Regularization performed very well in terms of the MSE  criterion as compared with the Levenberg–Marquardt and Scaled Conjugate Gradient approaches. The last two decades have changed the world . LookingDue to the technological advancement, the field of software development is growing at a very fast pace both locally and globally and it has been now referred as global software development (GSD), offshore software development, or development by outsourcing. Software outsourcing is a corporate level strategy that has been adopted for the past two decades and is gaining maturity . The sofGSD is a model of the modern age. Software team members are dispersed as they operate across different geographical locations, at different time zones and organizational boundaries, communicate concurrently using tools, and exchange information irrespective of time difference and physical boundaries . Among tGSD projects can be divided as offshore and onshore. Offshore projects are not considered much successful. This is because of the physical time constraints, knowledge level, and cultural differences. Lack of communication also hampers the process of knowledge and data sharing between the two teams working at offshore and onshore locations . This reRisk can also be defined as the possibility of an event occurring that may end up having either a negative or a positive bearing on the overall objective . One of In project management, risk management plays a vital role in preventing and mitigating risks that have the potential to adversely affect the desired outcomes. In small- and medium-sized enterprises (SMEs), preventive measures are incorporated to minimize risks such as insurance and creation of reserves as part of the risk management process . All SMEBesides the benefits and risks, the threats are also involved while managing the GSD projects. As the team is located in several countries or designated in different regions, there may be obstacles like geographical risk, language barrier, political concerns, and weather issues that are to be considered while working on a global software development project. .In this research, the techniques of artificial neural network (ANN)-based training algorithms, Levenberg–Marquardt (LM), Bayesian Regularization (BR), and Scaled Conjugate Gradient (SCG) have been implemented to predict the risks involved in GSD environment. Results are presented using performance plot, training state plot, error histogram, and regression plot. To identify the best performance, comparative analysis of three implemented algorithms has also been performed.Most of the software organization faces risks in GSD environment. They mitigate the risk using traditional risk management tools. In addition, they realize that the traditional approaches of risk management lack the ability to address crucial characteristics of GSD in any significant detail. This is why the utilization of machine learning (ML) techniques to manage risk is helpful due to the self-learning and self-healing nature of ML algorithms. It becomes handy because such ML algorithms can deal with unstructured information. This research shows that ML provides effective techniques that help to predict the risks associated with GSD. It has a great contribution to optimize the process of GSD to make it competitive and efficient in terms of fulfilling the needs of the firms that depends upon IT infrastructure. Such tools can assist project managers in decision making in such a way that they can predict future risks with respect to project time, cost, and resource needed in the completion of the project.This paper comprises of five (5) sections. The first section covers the introduction of this research study. Related work with respect to research has been explained in In , authorsThe degree of requirement complexity was utilized as a predictor of software complexity by the authors in . The datFuzzy logic (FL) and neural Nnetwork (NN) methods were used by researchers in  to forecFor defect prediction in software, three cost sensitive enhanced algorithms have been studied by researchers in  to enhanThe chronic kidney disease (CKD) is one such disease for which in  researchResearchers in  used theThe cryptocurrency and digital currencies are growing fast as an alternative to the fiat currency. Authors in  used theDue to improvement in communication, the world has become a global village resulting in much of the software development taking place between groups situated in different countries. The measuring of software complexity is important because a code which is considered at a level of “good-complexity” is easier to understand, faster to debug, comfortable to maintain, and contains less errors. What is a “good-complexity” level? To answer this question, different metrics of software complexity are in use which include line of code metric, Halstead metric, and maintainability index to mention a few. The researchers in  proved tThe researchers in  used neuSoftware experts in global software development environment are facing many challenges. Moreover, risk is a big challenge as compared with other challenges. In GSD, where team members work in different geographical locations and different time zones, the risks related to project time, cost, and resources should be taken into account so that project managers can take better decisions to reduce these risks. This research article is an effort to focus on the implementation of neural network approaches  to predict overall project risks according to time, cost, and resources which will help decision makers to assess time, budget, and resources needed to conduct a project.Artificial neural networks (ANNs) are models inspired by the biological networks, especially the neural network in the human or animal brain. It tries to imitate functions of the human brain like speech recognition, pattern recognition, and face recognition which are just a few of the neurological processes that the human brain performs . The netThe three approaches pertinent to the artificial neural network algorithm named as Levenberg–Marquardt, Bayesian Regularization, and Scaled Conjugate Gradient training algorithms had been implemented in various research papers to examine to relative efficiency of these three approaches in terms of predictive ability.It is an algorithm that trains ANN relatively quicker than the backpropagation algorithm. In this approach, the minimum of a function is expressed as a sum of squares of a nonlinear function. . The LevThe Scaled Conjugate Gradient algorithm belongs to the group of Conjugate Gradient methods . It starThis algorithm was built on conjugate directions and not on a line-search. The stopping criteria are either a maximum number of epochs or the maximum amount of time exceeds or the performance reaches below to minimum gradient , 47.As compared with the standard backpropagation method, Bayesian Regularization is relatively more robust which eliminates the need for cross-validation . It provIt belongs to the group of probabilistic graphical simulations based on a set of random variables and directed acyclic graphs to exhibit the probable dependence between variables .Several researchers have used these three ANN techniques with a variety of applications. In , authorsUnder umbrella of the artificial neural network algorithm, Levenberg–Marquardt, Bayesian Regularization, and Scaled Conjugate Gradient training algorithms have been implemented for risk prediction in global software development projects.This study utilized both experimental and simulation-based research designs. Using convenient sampling, a total of 274 medium- and large-sized software organizations in Pakistan, Australia, and the United States have been identified from where data can be collected. However, first, a thorough study of the available literature has been carried out to identify risks associated with project time, cost, and resources.A total of 54 risks related to project time, cost, and resource were identified from literature review that would have been sufficient to compromise the effectiveness and viability of a software project in software development. List of 54 identified risk factors was sent to industry connoisseurs; the industry experts decreased the 54 risk factors to 26 see  that couThere are mainly three types of risk factors that are cumulatively linked to an overall risk in a project related to GSD, i.e., time risk, cost risk, and resource risk. However, the extent of the risk posed by each risk factor may differ in weightage or effect on an overall risk. Therefore, a thorough examination of the three risks is needed to find the extent to which each risk contributes to an overall risk in the project. To address this, three neural network approaches named as Levenberg–Marquardt (LM), Bayesian Regularization (BR), and Scaled Conjugate Gradient (SCG) have been implemented to predict these risks in GSD.Finally, results have been achieved, and comparative analysis of LM, BR, and SCG has been performed with respect to project time, cost, and resource-related risks see .The people who replied to the questionnaire were the project managers, team leaders, and system and business analysts from medium- to large-sized software development organizations, located in Pakistan, Australia, and the United States. They are the people who have to face different types of risk in GSD environment. A total of 107, 103, and 64 responses were received from the American, Australian, and Pakistani software organizations.The risks concerning the challenges of global software development were investigated using the questionnaire survey method. The questionnaire contained 33 questions related to time, cost, and resource risks. Out of these 33 questions, Q13, Q14, Q15, Q17, Q19, Q20, Q26, Q27, and Q28 covered the risk related to time; Q8, Q13, Q14, Q15, Q18, Q26, Q27, and Q28 encompass risk pertinent to cost whereas Q8, Q10, Q11, Q15, Q16, Q21, Q22, Q23, Q24, and Q25 to risk caused pertinent to resource (for ouestionnaire see Appendix).The respondents were given the options as follows: 0 (Very Unlikely), 1 (Unlikely), 2 , 3 (Likely), and 4 (Very Likely).The questionnaire was sent to 760 medium- and large-sized software development organizations located in Pakistan, Australia, and the United States. A total of 390 responses were received; out of which, 116 responses were rejected considered as invalid. The sample data of 274 respondents are given in Tables R values, processing time, performance and gradient are calculated , regression LM, BR, and SCG-based neural networks are trained in which 1 input layer, 1 hidden layer, and 1 output layer are used see .R as compared with the results for the same indicators of the other two models. Also, performance has the highest value in case of the Levenberg–Marquardt method. Epoch is computed with the least number of iterations in case of Levenberg–Marquardt as compared with the number of iterations associated to the other two approaches.To predict the effect of time-related risk on the overall risk pertinent to global software development, three approaches of neural networks have been used. The results summarized see  reveal tThe performance plot of time-related risk in which 5 Epoch values are plotted versus mean squared error using Levenberg–Marquardt approach is shown in The error histogram which shows the distribution of errors for training, validation, and test is shown in R for training, validation, and test and overall taking the target on the horizontal axis and different functional structures on the vertical axis for all four specifications. The values of R measure in all four regression plots are not significantly different.The regression plot of time-related risks see  gives a The performance plot of time-related risk in which 19 Epoch values are plotted versus mean squared error using Scaled Conjugate approach is shown in The error histogram see  shows thR for training, validation, and test and overall taking the target on the horizontal axis and different functional structures on the vertical axis for all four specifications. The values of R measure in case of test are significantly greater as compared with those of the other three regression plots.The regression plot of time-related risks see  gives a L-shaped distribution starting from 0 and follows the horizontal line trend for all values above 6.The performance plot of time-related risk in which 150 Epoch values are plotted versus mean squared error based on Bayesian approach is shown in The error histogram see  shows thR for training, validation, and test and overall taking the target on the horizontal axis and different functional structures on the vertical axis for all four specifications. The values of R measure in case of test are relatively greater as compared with those of the other two regression plots.The regression plot of time-related risks see  gives a R as compared with the results for the same indicators of the other two approaches and performance has the highest value in case of the Levenberg–Marquardt method. Epoch is computed with the least number of iterations in case of Levenberg–Marquardt as compared with the number of iterations associated to the other two approaches.The results are summarized in The performance plot of cost-related risk in which 6 Epoch values are plotted versus mean squared error based on Levenberg–Marquardt approach is shown in R for training, validation, and test and overall taking the target on the horizontal axis and different functional structures on the vertical axis for all four specifications. The value of R measure of validation is relatively greater as compared with that of the other four regression plots.The regression plot of cost-related risks see  gives a The performance plot of cost-related risk in which 49 Epoch values are plotted versus mean squared error using Scaled Conjugate approach is shown in The error histogram see  shows thR for training, validation, and test and overall taking the target on the horizontal axis and different functional structures on the vertical axis for all four specifications. The values of R measure in case of test and validation are nearly same.The regression plot of cost-related risks see  gives a L-shaped distribution starting from 0 and follows the horizontal line trend for all values above 0. It also indicates the best training performance at Epoch 6.The performance plot of cost-related risk in which 238 Epoch values are plotted versus mean squared error based on Bayesian approach is shown in The error histogram see  shows thR for training and test and overall taking the target on the horizontal axis and different functional structures on the vertical axis for all three specifications. It can be observed that the value of R measure in case of training is significantly greater as compared with that of test.The regression plot of cost-related risks see  gives a R as compared with the results for the same indicators of the other two approaches whereas performance has the highest value in case of the Levenberg–Marquardt method. Epoch is computed with the least number of iterations in case of Levenberg–Marquardt as compared with the number of iterations associated to the other two approaches.The results of the three neural network approaches used to determine the effect of resource-related risks on the overall risk linked with global software development are presented see . The resThe performance plot of resource-related risk in which 6 Epoch values are plotted versus mean squared error based on LM approach is shown in The error histogram see  shows thR for training, validation, and test and overall taking the target on the horizontal axis and different functional structures on the vertical axis for all four specifications. The values of R measure for all three plots of training, test, and validation are significantly different which is least in case of training and highest in case of test.The regression plot of resource-related risks see  gives a The performance plot of resource-related risk in which 31 Epoch values are plotted versus mean squared error using Scaled Conjugate approach is shown in The error histogram see  exhibitsR for training, validation, and test which are significantly different in which test has the least value of R and validation has the highest value.The regression plot of resource-related risks see  gives a L-shaped distribution starting from 0 and follows the horizontal line trend for all values above 0.The performance plot of resource-related risk in which Epoch values plotted versus mean squared error based on Bayesian approach indicate the best training performance at Epoch 8 is shown in The error histogram see  shows thR for training and test and overall taking the target on the horizontal axis. It can be observed that the value of R measure in case of training is significantly greater as compared with that of test.The regression plot of resource-related risks see  gives a R values, processing time, performance, and gradient have been calculated. Comparative analysis of the implemented algorithms has also been performed. The results revealed that the MSE  of Bayesian Regularization in time-related, cost-related, and resource-related risks has the least value as compared with the other two alternative approaches used in this study. Hence, the results proved that Bayesian Regularization gave better results as compared with the other two approaches. This finding is similar to [The GSD is a complex software development environment in which teams are dispersed and located in different geographical locations and perform their duties in different time zones. Therefore, the risk management pertinent to the software development environment seems difficult. Consequently, there is a need to design and implement proper risk management practices to minimize the impact of risk associated with GSD environment. In this research, neural network training algorithms like Levenberg–Marquardt, Bayesian Regularization, and Scaled Conjugate Gradient have been implemented to predict the responses of risks related to project time, cost, and resource involved in global software development. The data set has been trained using these neural network algorithms, and mean squared rrror (MSE), regression milar to , 50 but milar to .GSD faces heterogeneous work environments that results in multiple challenges which have been highlighted in this research study. This paper points out the importance of time, cost, and resource risks within GSD. This paper further provides a useful insights of various risk factors within GSD and provided a scalable and generalizable solution to manage them using effective risk prediction. To the best of our knowledge, this is the first study concerned with the risk prediction in the context of GSD using artificial neural network. Three ANN methods are used  to compare predictive abilities of these methods. The results of this study show that Levenberg is not as efficient as Bayesian regularization and Scaled Conjugate are. After dataset training, the Bayesian Regularization method gave less error in prediction as compared with Levenberg–Marquardt and Scaled Conjugate. Bayesian Regularization provides a robust model in quantitative studies.Overall findings of this research indicate that all three risks, namely, time, cost, and resource related to the GSD are found significant and critically important for the overall risk associated with GSD. The research findings imply that these factors that are affecting the overall risk must be given due importance and should be minimized to optimize the benefits of GSD. To increase the validity of the findings, this research could also be revisited by including greater span of countries where the operations related to GSD are closely linked. This will help to study the effects of any changes in the nature and intensity in the factors with the greater degree of certainty so that it gives a more reliable framework to optimize the performance of GSD.It is recommended to use artificial neural network methods, namely, Levenberg–Marquardt, Scaled Conjugate, and Bayesian Regularization for prediction purpose specially on nonlinear data because several researchers have used these three methods with a variety of applications –34. ANN In this research, the data have been collected from Pakistan, Australia, and the USA. Future study will include other countries to broaden the scope of research. It will be of great help to identify the similarities and dissimilarities regarding the trends related to global software development in different countries of the world. Furthermore, the data are collected on the basis of convenience sampling that prevents the researchers to generalize the results. The use of random sampling will overcome this problem, and the result and findings of the study could be generalized.The activities related to global software development are the sole responsibility of the team leaders or project managers involved in the survey. Therefore, we receive only one response as only representation from an organization and that is from the project managers' perspective, and consequently it limits the diversity of opinions and perceptions regarding risks related to global software development within an organization.To identify the risks associated with the global software development, deep learning algorithms may also be used as an alternative to get a greater insight into the subject area as deep learning outperforms machine learning techniques for larger sample sizes. Therefore, the study may be replicated with greater sample size to increase the validity of results.


In vitro systems using primary immune cells or immune cells lines have been established from a wide array of fish species and basically from all immune tissues, and in principal these assays should be able to detect chemical impacts on diverse immune functions. In fact, in vitro assays were found to be a valuable tool in investigating the mechanisms and modes of action through which environmental agents interfere with immune cell functions. However, at the current state of knowledge the usefulness of these assays for immunotoxicity screening in the context of chemical hazard assessment appears questionable. This is mainly due to a lack of assay standardization, and an insufficient knowledge of assay performance with respect to false positive or false negative signals for the different toxicant groups and different immune functions. Also the predictivity of the in vitro immunotoxicity assays for the in vivo immunotoxic response of fishes is uncertain. In conclusion, the currently available database is too limited to support the routine application of piscine in vitro assays as screening tool for assessing immunotoxic potentials of environmental chemicals to fish.There is growing awareness that a range of environmental chemicals target the immune system of fish and may compromise the resistance towards infectious pathogens. Existing concepts to assess chemical hazards to fish, however, do not consider immunotoxicity. Over recent years, the application of  In assessing the risk of environmental contaminants for fish, for a long time most consideration has been given to apical effects such as changes of survival, growth and reproduction , 2. ThisTo make sublethal effects assessment a valuable addition in evaluating the risks of environmental contaminants to fish populations, it is critical to not get lost in measuring an increasingly broad range of subtle parameters, but to focus on processes and traits that have potential toxicological and ecological inferences, and/or influence the vulnerability of species and populations towards chemical impacts , 12, 13.Fish immunotoxicology aims to understand the impact of environmental contaminants on the health of fish and to assess the consequences for fish populations –30. Therin vitro assays can play an important role. In fact, over recent years, in vitro assays have been increasingly applied for screening purposes in (eco)toxicological hazard assessment . Th. Thin vity . M. Min vitty , toxic a et al.  who showin vitro assays as rapid, non-animal and cost-effective tools, as exemplified by the US EPA ToxCast Program for monosubstancess [e.g., -binding PCBs, which are well known immunotoxicants impacting the health and disease status of wild fish populations [cf. . However, the two non-immunotoxic chemicals, displaying a narcotic mode of action – butanol and ethylene glycol – also induced an immune response. This false positive result may be explained by an overlap of the cellular immune response with the cellular stress response. The two cellular responses share a number of receptors and signalling pathways  in vivo and in the isolated head kidney leukocytes in vitro, a conclusive answer was not possible because the number of studies was too low.The discussion on false positives and negative results leads to the question how  predictive the vivo cf. . In contukocytes –275 is nactivity , 278. Reactivity  performes et al.  who compin vivo tests, although the use of in vitro approaches for the prediction of direct immunosuppressive effect is increasingly discussed , as it has been applied for skin sensitisation safety assessment  Post Doc Mobility Fellowship number P400PB_183824. BJ was supported by the National Natural Science Foundation of China under the number 4197721.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.