\r\n\t
\r\n\tSince its discovery in the mid-50’s, a wide range of applications from low to high voltage appeared, putting polyimide as a key material to design more performing and reliable electrical devices and systems. On another hand, polyimide appears also essential for the development of new electronic devices where further considerations such as high power density, integration, higher temperature, thermal conduction management, energy storage, reliability or flexibility are required in order to sustain the growing electrical energy consumption needs of the global society.
\r\n\tConsequently, polyimide materials have and will have to face new exciting fundamental, technological and environmental challenges among which:
\r\n\t• a better understanding of its intrinsic electrical properties to identify current limitations and propose new advanced device designs,
\r\n\t• the development of innovative composites and nanocomposites structuration to tailor its physical properties by involving classical and original nanoparticles such as graphene layer, carbon nanotubes, metal, silicates, nitrides, etc.,
\r\n\t• the development of polyimide composites for energy storage, thermal management, reinforced nanodielectrics and corona-resistant nanocomposites,
\r\n\t• the development of new low and ultra-low dielectric constant polyimide for microelectronics (fluorinated polyimides, nanoporous, mesoporous),
\r\n\t• the development of new higher temperature reliable polyimide (high glass transition, high degradation temperature),
\r\n\t• the emergence of solvent-free processes to fit with environmental purposes
\r\n\tMoreover, many challenges regarding the aging mechanisms understanding under single or multiple constraints and the realistic lifetime prediction using robust physical modelling is a ubiquitous questioning in most of the electronic industries.
\r\n\tThis book will target to review both the state-of-the-art and new researches on Polyimide for Electronic and Electrical Engineering Applications. It will present interdisciplinary chapters on the state of knowledge of each topic under consideration through a combination of overviews and original unpublished research. Chapter proposals related to one of the following topics and their keywords (but not only restricted to them) are very welcome to be submitted for this book publication project:
\r\n\t• General Considerations and Technological Processes of Polyimide for Electronics and Electrical Systems
\r\n\tProcessability, Photosensitive and non-photosensitive polyimide, Curing temperature,
\r\n\tSpin-coating, Dip-coating, Extruded enameled wires, Other casting methods
\r\n\t• Polyimide in Microelectronic Applications
\r\n\tDielectric properties, Intermetal layer, Ultra Large-Scale Integration (ULSI), Low-k dielectrics, Fluorinated polyimide, Nanoporous polyimide, Flexible substrates, Thin film transistors, LCD devices, sensors and actuators (gas, humidity, pressure, tactile…)
\r\n\t• Polyimide in Medium and High Voltage Applications
\r\n\tElectrical insulation properties (conduction, breakdown), Digital isolators, Power electronics and devices, Power modules, Power integration, Passivation, Packaging, High voltage power systems, Enameled wires for fed-inverter rotating machine
According to the definition made by the International Organization for Research on Aging (IASP), pain is a sensorial, emotional, unpleasant sensation about someone’s past experiences, whether they are connected to an organic gown or not, starting from anywhere in the body.
Acute pain: it is a type of pain that starts suddenly, has a nociceptive nature, has tissue damage, shows a close relationship with the cause of the lesion in terms of location, time, and intensity, and gradually disappears as the healing progresses [1, 2]. The most common types of acute pain are posttraumatic, postoperative, and obstetric pain [3].
Superficial (cutaneous) pain: it is type of a pain that occurs against nociceptive stimuli that occur in skin, subcutaneous tissue, and mucous membranes.
Deep somatic pain: it is a pain that is usually caused by muscle, tendon, joint receptors or bones, which is blunt and cannot be localized.
Visceral pain: it is a pain originated from the deterioration of functions of their tissue (parietal pleura, pericardium, and peritoneum).
Chronic pain: it is defined as acute pain that begins as acute pain and lasts for 1–6 months [4].
In order for a stimulus to be perceived as pain, it is necessary to go through four different physiological processes:
Transduction; at the end of the nerve is the stage where the stimulus is converted into electrical activity.
Transmission; it is the spread of electrical activity throughout the nervous system.
Modulation; changes in nociceptive transmission.
Perception; interaction with the individual’s psychology and subjective emotional experiences.
Postoperative pain is caused by neuronal damage that occurs during the surgical procedure and the stimulation of the nociceptors. In postoperative period, total knee arthroplasty (TKA) is painful and pain management is quite difficult. The main purpose of postoperative pain relief is to reduce the pain of the patient, to contribute to the healing process, to shorten the length of hospital stay, and to reduce hospital costs.
Techniques such as intravenous analgesia, epidural analgesia, and peripheral nerve blocks are used to prevent postoperative pain. In addition, oral and parenteral analgesics, patient-controlled analgesia, nerve blocks, and periarticular injection methods are used as multimodal analgesia method. Systemic opioids, nonsteroidal anti-inflammatory drugs, and local anesthetics are frequently used for postoperative analgesia.
Pain scales such as visual analogue scale (VAS), verbal descriptive scale (VDS), numerical rating scale (NRS) are used as standard methods in the evaluation of pain of patients.
Total knee arthroplasty (TKA) is known to be a very painful orthopedic procedure [5]. For this reason, effective pain control is important to optimize the rehabilitation process in order to ensure patient satisfaction, hospital stay, and cost reduction [6]. However, the difficulty of postoperative pain management after TKA is to maintain adequate motor function with adequate analgesia. The patient is informed about the surgery to be performed before the operation, and a training program and the physical preparation are recommended. Patients undergoing preoperative exercise and training showed significant improvements in function, quadriceps strength, and duration of stay. After the surgical intervention is performed, the patient can continue the rehabilitation program to speed up the healing process in the home under the supervision of a physiotherapist. Rehabilitation therapy depends on many factors such as patient characteristics, prosthesis characteristics, and postoperative complications.
More than 1.1 million joint arthroplasty (TJA) are performed annually in the USA, and more than 700,000 of them are primary TKA [7, 8].
Acute postoperative pain that is poorly treated is associated with both physiological and psychological functions in the body [2, 9, 10, 11], which are as follows:
Cardiovascular system: coronary ischemia, myocardial infarction
Pulmonary system: hypoventilation, decreased vital capacity, pulmonary infection
Gastrointestinal system: reduced motility, ileus, nausea, vomiting
Renal system: increases in urinary retention and sphincter tone, oliguria
There are negative effects on the muscular system, on the coagulation system, on the wound healing, and on the immune system. Finally, poorly controlled pain after surgery may impair sleep and have negative psychological effects, such as demoralization and anxiety.
Regional analgesia techniques and multimodal analgesia
Drug therapy
Nonpharmacological techniques
Preemptive analgesia
Patient education
Despite improvements in pain management, approximately half of TKA (total knee arthroplasty) patients develop severe pain in the early postoperative period. Excessive tissue damage and complex innervation in TKA make pain control difficult. Femoral nerve, sciatic nerve, and obturator nerve are involved in the innervation of the knee joint. In major surgeries, such as TKA, changes occur in the endocrine system and central, peripheral, and sympathetic nervous systems. If postoperative analgesia is not achieved adequately, systemic responses induced by the surgery increase and serious risks may occur to the patients.
Conventional methods such as parenteral opioids, epidural analgesia, and femur blocks have been widely used to remove the pain associated with TKA [12]. In addition, the fascia iliaca block has recently been used more frequently to reduce the pain associated with TKA [13]. Comparing general anesthesia with neuraxial anesthesia in the patients with TKA, the risk of perioperative complications was significantly reduced in patients undergoing neuraxial anesthesia [14]. In another study, the risk of short-term complications in patients with TKA was higher in patients receiving general anesthesia than in patients receiving neuraxial anesthesia [15]. Neuraxial anesthesia was associated with the reduction of major complications. A recent meta-analysis has shown that there is a significant decrease in the incidence of postoperative surgical site infection in neuraxial anesthesia when compared to general anesthesia and neuraxial anesthesia in the patients with TKA and total hip arthroplasty (THA) [16]. The use of peripheral nerve block (PNB) also reduced the need for postsurgical critical care services [17].
Multimodal analgesia techniques are often used in the “fast-track” recovery protocols to improve pain relief. Mixture of local anesthetics and anti-inflammatory and opioid analgesics for periarticular infiltration has been used in the multimodal protocols. It can improve the pain score, reduce the total perioperative opioid consumption, enhance the early mobilization, and increase the patient satisfaction [18]. Several multimodal analgesics have been developed in clinical practice [19, 20] and paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, ketamine [21], alpha-2 adrenergic agonists [22], and corticosteroids have been used [23].
Periarticular drug injection is an attempt to apply a low-concentration, high-volume local anesthetic solution to the joint capsule and periarticular surrounding tissues to provide postoperative analgesia [24]. When used as a part of a multimodal analgesic protocol in patients undergoing TKA, femoral nerve blockade has been shown to reduce narcotic consumption and improve postoperative pain scores [25]. However, periarticular infiltration is usually insufficient to provide adequate analgesia in the anterior direction of the knee [26]. Periarticular infiltration analgesic protocols that infiltrate anterior, posterior, and medial compartments of the knee are reported to only last between 6 and 12 h [27]. Prolonged motor blockade, quadriceps muscle weakness, difficulty ambulating, and postoperative falls limit the utility of femoral nerve block (FNB) in the “fast track” rehabilitation protocols [28, 29]. In a study, Fascia iliaca block effectively reduced the amount of morphine used after TKA in the first 24 h. This study shows that the fascia iliaca block provides the same level of analgesia with the use of less morphine compared with the periarticular injection [30]. However, the fascia iliaca block requires as much as 40–50 mL of volume to achieve an effective result [31]. In another study, the analgesic efficacy of the fascia iliaca block was compared to the femur nerve block in the guideline of ultrasonography and no difference was found in VAS scores and opioid consumption [32]. The sciatic nerve block (SNB) is used in addition to FNB for complete analgesia after TKA. In a systematic review, SNB administered as a supplement to FNB has shown that it does not provide adequate analgesic activity [33]. Studies with larger patient groups showed a significant reduction in postoperative opioid consumption, less opioid-induced adverse effects, and significantly lower resting and dynamic pain scores [34, 35, 36, 37, 38]. Adductor channel block was also studied. In the meta-analysis study performed, there was no significant difference in pain control and morphine consumption between the adductor canal bloc (ACB) and the femoral nerve block (FNB) group. However, it was observed that ACB provided faster postoperative mobilization ability without reduction of analgesia in patients undergoing TKA [39]. Another study conducted after TKA to compare the efficacy of single-shot adductor canal block (SACB) and postoperative continuous adductor canal block (CACB) placement and showed that CACB was superior to SACB for analgesia control but ambulation ability, success rate, early functional recovery, and treatment-related side effects were similar [40]. Different studies have shown that ACB and FNB have similar motor function recovery, strength ratings, and quadriceps muscle strength at postoperative 24 and 48 h in TKA patients [41, 42].
TKA operation is one of the most painful orthopedic procedures [43]. For this reason, it is difficult to provide adequate analgesia with a single drug or method. Multimodal analgesia methods will be more appropriate to reduce side effects and provide pain control. Multimodal analgesia is defined as providing more effective pain control by the combined use of various analgesic drugs and techniques that may have additive or synergistic effects targeting different pain mechanisms in the peripheral and/or central nervous system [44].
In multimodal pain management, patient education, preemptive oral medications, regional anesthesia methods, peripheral nerve blocks, local infiltrations, and postoperative rehabilitation are included. Most of the side effects seen in analgesia treatment are due to the parenteral opioid. One of the main goals of multimodal analgesia is to reduce the need for opioids.
Tissue inflammation in TKA surgery triggers the production of PGs that play a role in acute postoperative pain. NSAIDs reduce central sensitization by inhibiting central and peripheral prostaglandin synthesis. It may be effective for 2 weeks when inflammation continues in the postoperative period. Ketorolac is a nonselective COX inhibitor and has oral, parenteral, ophthalmic, and nasal forms. It is used in moderate and severe postoperative pain management after major surgeries [45]. It reduces opioid consumption when used as a part of multimodal pain management [46]. The use of NSAIDs can cause gastritis or peptic ulcer formation and impair platelet aggregation, renal function, and wound healing. For this reason, there are concerns about their use in the perioperative period. Preemptive use of selective COX-2 (cyclooxygenase) inhibitors (celecoxib and rofecoxib) has been shown to reduce postoperative pain scores in the knee surgeries [47]. The use of selective COX2 inhibitors in TKA surgeries has been shown to reduce opioid consumption, provide early onset of physical rehabilitation, and reduce nausea and vomiting [48]. Similarly, diclofenac or ketorolac administered in a single dose in joint arthroplasty patients reduced morphine consumption by 29% compared to placebo [49].
It is nonopioidand and non-NSAID analgesic. It inhibits prostaglandin synthesis in the CNS and plays a role in preventing central sensitization. There is a minimal effect on peripheral PG synthesis. Unlike NSAIDs, the anti-inflammatory effect is poor, and there are no negative effects on platelet function and gastric mucosa. It has been shown that 1 g intravenous paracetamol provides rapid and effective analgesia in major orthopedic surgeons [50]. Paracetamol can be administered 1 g/day four times. When combined with paracetamol and NSAIDs, better analgesia is achieved when both drugs are used alone [51].
Glucocorticoids have strong anti-inflammatory effects. Corticosteroids are thought to be an important component because of their local anti-inflammatory effects and their ability to reduce the local stress response in the operation [52]. There have been many studies on corticosteroids, and conflicting evidence has been obtained about their benefits [53, 54, 55, 56, 57, 58]. Some studies have shown that postoperative pain is improved with corticosteroids [53, 54, 55, 56] but other studies do not benefit [57, 58]. In another study, postoperative pain level was lower in the corticosteroid group than that in the noncorticosteroid group in first 24 h [59]. In a meta-analysis, dexamethasone, a long-acting glucocorticoid, has been shown to reduce postoperative pain and opioid consumption [60]. In one study, it was shown that preoperative single dose iv 40 mg dexamethasone reduced dynamic pain scores [61]. Another study showed that dexamethasone administered as a part of multimodal analgesia in 269 patients undergoing TKA reduced postoperative pain and bulimia and did not increase wound complications [62]. In contrast to these studies, patients with a periarticular injection with high- and low-dose corticosteroids were compared and found no improvement in postoperative pain level [58]. Surgical techniques such as the surgical approach and the use of pneumatic turniken may be effective on early postoperative pain [63, 64]. One of the most commonly used corticosteroids for periarticular injection is methylprednisolone [52, 57, 65, 66, 67].
Opioids have been used to provide analgesia and relieve anxiety for centuries. Opioid receptors are found in many regions of the CNS. These receptors are located in the central nervous system, cerebral cortex, hypothalamus, thalamus, midbrain extrapyramidal area, substantia gelatinosa, and sympathetic preganglionic nerves. Places with the highest concentration of these receptors are structures and pathways associated with pain [68].
The first opioid receptors were found in 1973. Later, endogenous opioids were found. There are four types of receptors. These include mu (μ), kappa (k), sigma (s), and delta (d) receptors. Opioids show their effect by linking their receptors.
Mu (μ) receptors: specific morphine agonist. It is stimulated by morphine and is responsible for supraspinal analgesia.
Kappa (k) receptors: they are responsible for spinal analgesia and sedation.
Sigma (s) receptors: responsible for dysphoria and hallucinations.
Delta (d) receptors: beta-endorphin and encephalin are specific agonists. It is influential on motor integration and urine function.
Classification of opioids:
Natural opioids: phenanthrene derivatives: codeine, morphine, and thebaine. Benzylisoquinoline derivatives: papaverine.
Synthetic opioids: phenylpiperidine derivatives (fentanyl, sufentanil, and meperidine), benzomorphan derivatives (pentazocine and phenazocine), diphenylpropyl or methadone derivatives (methadone and d-propoxyphene), and morphinan derivatives (levorphanol).
Semisynthetic opioids: dihydromorphone/morphinone, heroin, and thebaine derivatives (etorphine).
Morphine contains the basic properties of the majority of the structures of the opioids. The effects of morphine in the central nervous system, analgesia, euphoria and sedation. The most important effect of morphine on the central nervous system therapeutically is analgesia.
Analgesia provided by systemic opioids often accompanies side effects such as sedation, nausea, pruritus, urinary retention, and constipation. However, they continue to be an important part of severe postoperative pain management [69]. They can be used intramuscularly, intravenously, orally, rectally, sublingually, subcutaneously, epidurally, or intrathecally. If patients are able to use the oral route, oral administration is recommended. Side effects of oral opioids are less frequent and are mostly related to the gastrointestinal system. Intravenous patient-controlled analgesia (PCA) should be preferred if the parenteral route is used. Intravenous opioid PCA is recommended for bolus application with appropriate lock interval without basal infusion. In the postoperative period, it is usually administered via intravenous PCA for the first 24–48 h and then is used as oral agents [44]. Oral opioids have immediate release and controlled release forms [70]. Rapid-release patients are effective in the treatment of moderate and severe postoperative pain, but are impractical because they need to be reapplied every 4 h. Since postoperative pain is continuous at the beginning, analgesics should be used regularly especially in the first 24 h. Long-acting oxymorphone and oxycodone have been shown to be effective in postoperative analgesia in TKAs [71, 72]. Especially morphine and fentanyl are frequently used for postoperative analgesia in ТKА cases. The application of intrathecal morphine and fentanyl is very effective in postoperative pain control. In a study conducted, 0.2 mg and 0.3 mg intrathecal morphine administration was shown to be effective for postoperative analgesia [73]. Other studies have been done to support this study. The use of 0.5 mg intrathecal morphine has been shown to be more reliable and more effective than injections of 0.2 mg [74]. Intrathecal morphine is less hydrophobic than other opioids, has a longer duration in the cerebrospinal fluid, and provides very good postoperative analgesia [75]. On the other hand, another study reported that morphine should not be used even in small doses due to these side effects [76]. Opioids are known to produce more effective and long-lasting anesthesia when used with local anesthetics. Opioids are known to produce more effective and long-lasting anesthesia when used with local anesthetics [77, 78]. In a study of TKA cases, we compared the use of intrathecal morphine and fentanyl for postoperative analgesia and found that fentanyl provided more effective postoperative analgesia [79]. Long-acting opioids (LAO) are often used for malignant, nonmalignant, and different pain treatments. A lot of work about LAO (oxycodone, morphine) has been done in this regard. In a study on LAO, there was a decrease in pain while there was an increase in vomiting and sedation [80]. After the use of LAO (oxycodone), the rehabilitation of patients was found to be better in TKA cases [81]. In the studies performed, intravenous PCA and oxycodone were compared and there was no difference in pain [82], and no difference in pain after LAO (oxycodone) used after total joint arthroplasty [83].
Gabapentin has been shown to be effective in the treatment of herpetic neuralgia, neuropathic pain [84], and diabetic neuropathy [85]. These anticonvulsant drugs, which have been used for a long time in the management of chronic pain, have started to be used in acute postoperative analgesia in recent years. They may cause side effects such as sedation and dizziness. It has been shown that administration of pregabalin (300 mg preoperatively and 150–50 mg twice daily for the first 14 days postoperatively) reduces the incidence of opioid consumption and neuropathic pain development after TKA [86]. We also have studies showing that postoperative analgesia is reduced after the application of preoperative gabapentin and pregabalin in lower extremity surgeons [87, 88]. Another study has shown that gabapentin effectively reduces postoperative narcotics consumption and pruritus incidence [89]. In another meta-analysis trial, the use of pregabalin shows that it could improve pain control at 24 and 48 h with rest, reduce morphine consumption, and improve knee flexion level, as well as reduce nausea, vomiting, and pruritic event rate. However, pregabalin increased the incident rate of dizziness after total knee arthroplasty (TKA) and total hip arthroplasty (THA) but could not improve the pain control at 72 h with rest [90].
Ketamine is used by anesthetists for sedation and general anesthesia. With the detection of the N-methyl-
There have been many studies on surgical techniques and equipment, but most have had no or limited effect on postoperative analgesia. These studies focused on drains, surgical approaches, tourniquet use, prosthetic types, and reshaping of the patellar surface. A comparison of cooling and compression techniques with the control group showed that postoperative pain and morphine consumption were reduced [92]. The efficacy of TENS administration in postoperative analgesia after TDP was not demonstrated [93]. The results of cryotherapy are contradictory. The potential benefits of cryotherapy in a meta-analysis are not clinically significant [94]. Routine use is therefore not recommended.
Analgesics are administered before painful stimulation to prevent peripheral and central sensitization. Preemptive analgesia inhibits peripheral sensitization and central sensitization. It should also prevent inflammatory and neuropathic pain types [95]. Local anesthetic infiltration, regional anesthesia methods, and drugs (NMDA receptor antagonists, opioids, COX-2 inhibitors, nonsteroidal anti-inflammatory drugs (NSAID), and local anesthetics) can be used for preemptive analgesia. According to a study, preemptive analgesia is statistically significant, although not clinically significant [96]. When preemptive analgesia is administered, it should be considered as a method of pathological pain as well as physiological conventional perioperative analgesia [97]. Preemptive analgesia is an effective method in clinical practice for the approach to postoperative pain involving incisional and inflammatory injury [98].
Drugs used in preemptive analgesia:
Local anesthetics
Nonsteroidal anti-inflammatory drugs (NSAIDs)
COX-2 inhibitors
Opioids
NMDA receptor antagonists
There are two major components of pain perception: the sensory discriminative component and the motivational affective component [99]. Emotional component is targeted with patient education. Patients and their relatives are informed, and their anxiety is reduced by eliminating their fears about the unknown; the realistic goals are identified, and a relationship is established with patients and their relatives; the patient satisfaction increases, and the pain scores decrease [100].
In TKA, many methods are proposed and used for postoperative pain management. There are many factors that affect postoperative pain management. The age of the patient, the experience of the surgeon, the technical conditions, and the method used are some of these. Taking all these factors and literature into consideration, the use of multimodal analgesia techniques is recommended.
Systemic medications for postoperative analgesia after TKA:
Paracetamol
NSAIDs
Celecoxib
Ibuprofen
Naproxen
Ketorolac
Ketamine
Gabapentinoids
Gabapentin
Pregabalin
Glucocorticoids
Opioids
Morphine
Fentanyl
Hydromorphone
Hydrocodone
Tramadol
Extended-release oxycodone
Extended-release morphine
Bone-bond stability is a prerequisite for optimal knee function recovery [101, 102].
Postsurgery rehabilitation program should be started early.
During the rehabilitation program, unbalanced and full weight should not be allowed until a normal range of motion and walking pattern is achieved.
The development of reflex inhibition in the extensor or flexor mechanisms should be recognized early and must be struggled in the appropriate modalities.
The operated and unoperated extremities should be strengthened together.
For the success of the rehabilitation program, orthopedic surgeon, physical medicine and rehabilitation specialist, physiotherapist, occupational therapist, nurse, and the social team of service specialists need to communicate well.
The modern global economy is on the brink of a new industrial revolution, as evidenced by many actual trends, following the provisions of modern economic theory (economic cycle theory, crisis theory, innovation theory). Overcome the global crisis, a new wave of innovation has needed where Industry 4.0 will become a new global industrial landmark and standard of development in the real economic sector of the entire global economic system [1]. In line with the goals of society 5.0, Industry 4.0 revolutionizes the production industry by increasing operational efficiency, new business models, services, and products. Society 5.0 focuses on using technology developed by Industry 4.0 to benefit humankind by utilizing advanced technology to solve problems and the economy. This study identifies that disruption of innovation through environmental turbulence offers opportunities to drive business development. Society 5.0 focuses on people and changes from innovation to technological transformation through industrial automation 4.0 [2, 3]. In this study, environmental turbulence refers to exogenous factors that give rise to uncertain and volatile situations that impact business performance [4, 5].
\nWhile some companies view environmental instability as a risk that threatens performance, it has understood as a threat and an opportunity for more entrepreneurial firms. It opens opportunities for the growth of various new businesses accompanied by increasingly fierce competition [6]. The desire to find ways to overcome turbulence and create growth and success from turbulence drives companies to think and act. Rapid technological advances have led to significant business developments and changes [7]. Likewise, as reported by The Global Competitiveness Report 2017–2018, the interruption and disruption of technological change create extraordinary possibilities and challenges which strengthen by using the convergence of digital, physical and organic technology that has characterized the rise of the Fourth Industrial Revolution [8].
\nEnvironmental turbulence can occur in several factors: technology turbulence, competition intensity, market turbulence, and regulation. The biggest factor is due largely to rapid technological changes and the high intensity of competition marked by customer composition changes, behavior, and preferences. In Indonesia, over the top service (OTT) penetration was long before Covid-19 eroded revenue providers [9, 10]. Even though the operator is experiencing growth, the Telco industry requires a large investment, but the income is low. Although growing, digital services have not replaced declining operator revenues [11, 12]. When environmental turbulence occurs, it causes a direct disruption to company performance. Thus, the company’s initial response must be fast to reduce accumulated losses. In the firm’s predetermined response model, management reactions are initiated without delay on the rational trigger point, as illustrated in Figure 1 [13]. Due to the environment’s turbulent characteristics, both the base model and the Determinant model of responses are triggered after the event has occurred.
\nDecisive model of firm response to a crisis event.
In this study, the methodology used is a qualitative systematic literature review on various aspects of the topics discussed, including strategy, distinctive capability, environmental turbulence, and business model strategies. The basic ideas on carrying out such a systematic review had borrowed from leading scholars in the field [14]. Both integrative and interpretive techniques had used to uncover new insights into strategy. Various studies on dynamic strategies and volatile business environments have collected it from various primary qualitative studies conducted using this methodology. Several in-depth studies of the subject matter have carried it out so that conclusions have drawn it. Thus, the literature review’s qualitative synthesis has used it as the basis for the arguments discussed in this chapter.
\nThis study is also measured by asking respondents’ perceptions through explanatory studies and preliminary surveys on market predictability, innovation, and customer preferences. Disruptive innovation through environmental turbulence is a major creative driver for reengineering businesses. It is not just innovation but agile innovation that can take advantage of economic downturns by developing new creative business models by making new paradigm shifts [15, 16]. As globalization and digitization evolve, organizations must respond quickly to changing market demands. According to Milan Krstic, 2018 agile innovation is a collaborative process that connects innovation, people, technology, projects, and outputs that impact paradigm shifts driven by competition in the market and rapid technological advances [16]. Agile innovation emphasizes creative and adaptable teamwork in solving complex problems; Lean development focuses on eliminating all losses continuously so that the innovation process is significantly faster [15]. Thus, the company can be fast responding to Changes in Environmental Turbulence to encourage business growth in the face of deteriorating company performance.
\nExploratory case studies and literature reviews are using to test environmental turbulence’s antecedents, Distinctive Innovation Capabilities, through business model innovation strategies to firm performance [17, 18].
\nThis study fills the gap from the previous study. Since 2000, most business models have focused on organizations’ mediating role to mediate technology capabilities and firm performance. Only a handful of research publications so far have examined how organizations innovating should have structured collaborations and interact fluidly [19, 20]. There are no studies that elaborate on how organizations exploit internal resources and structures and how to access, configure, and utilize external resources embedded in business model strategies to produce the ability to manage business turbulence in the industrial evolution of the 4.0 era through Distinctive Innovation Capabilities [21, 22]. This research’s authenticity lies in how management produces a practically oriented framework of how organizations shape to be innovative and competitive by building a common business model. However, this study has limitations due to its qualitative nature and conceptual framework, which needs further investigation through large-scale surveys by quantitative research. The conceptualization and investigation of the independent and combined effects of business model innovation, environmental turbulence, and Distinctive Innovation Capabilities structures on organizational agility highlight the importance of complementarity between antecedents and add to the cumulative pool of knowledge in this research area.
\nFrom a managerial perspective, this study provides a comprehensive view of environmental turbulence impact, how to develop a Distinctive Innovation Capability strategy for developing an organization’s business model, how to achieve it, what variables contribute, and how to relate it to performance. Institutional cooperation requires collaboration in an innovation environment where consumers, companies, universities, and public authorities work together to produce innovation (Quadruple Helix). It means that the resulting research can apply to national development, and higher education is responsive to industrial, customer and social needs [23, 24].
\nCompanies are operating in a more dynamic environment that affects environmental turbulence that occurs influence business model transformation and business performance. Many studies confirm that several conditions in the Study of Environmental Turbulence and Model Transformation & Business Models affect company performance [25, 26, 27, 28]. The more turbulent an environment, companies must rely on innovation to neutralize the outdated threats of products and technology and take advantage of new technological opportunities to create new business models that can support company performance [29, 30]. However, according to [31] pragmatically, some problems will be missed and become strategic surprises even at the most sophisticated environmental scanning method. The recent economic downturn and current pressures on the market have increased the need for leaders to have a strategic business model plan [32]. Organizations whose historical business models have based on organic growth must now strategically position themselves taking into account the new ‘rules of the game’ and develop a posture that increases strategic, managerial aggressiveness [33].
\nThe process of forming a volatile environment is inseparable from the influence of technology, the emergence of a new economic order, changing values and lifestyles, and the availability of an exchange of information flows, goods and services with a decreasing price trend accompanied by the high speed of the flow of goods/services and the dissemination of information. The emergence of an economic model of sharing transportation and accommodation has disrupted business establishment. Several studies have confirmed the relationship between environmental turbulence and business strategy models and then show that it successfully competitive advantage. Besides, it mediates the role of business model innovation to show that there is a relationship, and the results of several studies suggest that business model innovation has a positive effect on company performance [34, 35].
\nThe description above means the higher the organization’s ability to provide the right solutions with a good business model innovation strategy that can provide added value to the organization. Then the innovative business model will perform better in facing competitive advantages in the telecommunications industry. Therefore, it had assumed that environmental turbulence influences business innovation. According to [36], human resources and capabilities are important components of a company’s competitive advantage in a resource-based view. The concept of turbulence was initially introduced in 1965 by Emery and Trist. The business environment has been influencing by several components (competition, customers, suppliers, shareholders, public markets, regulatory bodies, legislative bodies, technology, economics, and society) [37]. Environmental turbulence influences the external environment or changes in the future [38, 39]. Based on the contingency theory [40, 41], organizations react to environmental changes, and organizational strategies are determined based on environmental conditions that occur. Figure 2 shows that many studies on environmental turbulence strategies with a link and difference focus have described it as pedigrees for the theoretical foundation of environmental turbulence from the market and organization perspective.
\nTheoretical foundation of environmental turbulence. Source: Various publication
This study ends with the definition of environmental turbulence for the Telecommunication Industry. Organizational ability to project business planning creatively, flexibly, and adaptively to anticipate potential disruptors, new regulations, technology changes, competition, social patterns, and consumer lifestyles. The dimension of environmental turbulence in this study is; Dynamics - the extent to which the company’s environmental components’ elements remain the same over time or a continuous flux [42]. The degree of dynamism (instability) has influenced it by changing environmental change and change intensity. Complexity - Increasing number of elements and their interdependence [43], homogeneity/heterogeneity [44] contribute to environmental complexity. Predictability - uncertainty, or ignorance, is a dimension related to the extent of causation and the availability of information about change contributing to the level of uncertainty [39, 45].
\nThe literature on strategic management shows different capabilities or competencies as an important part of an organization’s resources and competitive advantage. Mintzberg and Quinn [46] argue that Distinctive Innovation capability, as a competitive advantage source, provides the basis for a sustainable competitive advantage [43]. Meanwhile, Drucker [47] and Cavusgil et al. [48] discussed the importance of the ability of innovation for organizations to survive in an unstable environment [46, 47]. Innovation capability had proposed as a high-level integration capability, namely, forming and managing various capabilities [48]. Organizations with this innovation capability can integrate their company’s core capabilities and resources to stimulate innovation successfully [49, 50].
\nAccording to Amabile [51] and quoted by Zhao et al. [52] states that innovation capability is the application of knowledge relevant to the achievement of value in an organization. Teece and Pisano [53] and Teece et al. [54] suggested that the winners in the global market are companies that demonstrate timely responsiveness and innovation that is fast and flexible [55, 56], together with management’s ability to coordinate effectively and re-apply internal and external competencies [57]. However, Miranda and Figueiredo [58] distinguish routine and innovative companies based on technological innovation capabilities with the factors that shape vision and strategy capabilities [51, 52], utilization of competency bases, organizational intelligence, creativity and idea management, organizational structures and systems, culture and climate and technology management [53]. Saunila defines innovation capabilities by influencing an organization’s ability to manage innovation [53]. These aspects include participatory leadership culture, ideation, organizational structure, climate, worker welfare, knowledge development, regeneration, external knowledge [54], and individual activity [59].
\nThis study concludes that Distinctive Innovation capability is the company’s ability to develop and manage fast and flexible innovation by leveraging technology management’s creative capabilities, knowledge development, integrating capabilities, and core company resources to stimulate innovation and provide added value for companies to gain competitive advantage.
\nAny organization interested in competing in a dynamic market must create unique benefits that enable it to gain a competitive advantage over competitors. However, [60] argues that business has become a global and global market, which increasingly encourages an Innovation Business Model because companies must overcome global challenges. The way to outperform competitors is through innovation. Innovation as a strategy involves creating new ideas, processes, and methods to improve current goods and services or bring them into new products and services [37]. Innovation is needed to maintain the existing competitive position and the competitive advantage that has obtained it. Most studies conclude that business model innovation increases competitive advantage and contributes significantly [58, 61]. Previous studies examined cloud and digital computing as disruptive innovations. Building on this reflection, to better understand business model innovation resulting from accepting a cloud benefit model [36, 62].
\nTechnology has changed organizations must realize that a classic business model, such as buying and selling at a premium price, will no longer work [63]. Technological changes provide the necessary context for understanding the transformation of new digital technologies [64, 65, 66]. This article will help understand why this new business model’s strategy innovation is important and why everyone should understand the most successful business models. Looking at the business model is essential to understanding how to position a company and generate additional revenue [58, 60, 67]. New business models can also help companies become more resilient to market dynamics and diversify business strategy [68, 69]. Successful disruptive business models are often customer focused. Based on the description above, the higher the organization’s ability to provide the right solutions with a good business model innovation strategy that can provide sustainable Business Models, Added value to the organization, the high-level innovation will perform better in the face of competitive advantage [69, 70]. Therefore, a business model paradigm’s concept logic can help understand specific innovation to transformation challenges that companies will face when introducing new business models, a simplified schematic overview strategy Sustainability Business Model, reconceptualized from Figure 3 [71].
\nSustainability business model transformation.
An extensive literature review guided the choice of variables for the conceptual framework. Identify the dominant antecedents considered to form the business model innovation strategy and firm performance by developing it through exploratory case studies. Thus, in line with this study, the objectives are to examine the effect of Environmental Turbulence (ET), Distinctive Innovation Ability, and business model innovation influence firm performance (FP). The literature review of the concepts above will answer the questions in this study by explaining how the relationship between Environmental Turbulence (ET), Distinctive Innovation capabilities, and business model innovation affects company performance (FP)?
\nTherefore, based on the study literature and explanatory case study, this study defined several hypotheses. The following hypotheses have been compiled by modeling the relationships between the variables examined in detail in this section, and a conceptual research model developed, as shown in Figure 4.
Business model innovation has a positive effect on company performance.
Environmental Turbulence (ET) has a positive effect on company performance (FP) directly and indirectly through a business model innovation strategy.
Typical Innovation Capabilities have a positive influence on company performance (FP) directly or indirectly through a business model innovation strategy.
Conceptual model.
The explanation above and based on the previous literature means that the higher the organization’s ability to provide the right solution with a good environmental turbulence strategy that can add value to firm performance, either directly or through an innovation model business strategy. Meanwhile, based on a previous study, the higher its ability to carry out business model innovation and a good distinctive innovation capability, the higher its performance. Therefore, it should have assumed that based on the hypothesis in Figure 4, there is an influence between environmental turbulence, business innovation strategy, and distinctive innovation capability on company performance in the telecommunications industry.
\nExploratory case studies and systematic literature reviews prove that business strategy innovation and firm performance are essential for business success when faced with intense environmental turbulence. Typical Innovation Capabilities and Firm Performance are determined by appropriate revenue in the ongoing market and the expansion of technology and innovation in products for new information for decision-making capabilities [70]. Therefore, innovative portfolio business models are at the center of strategic decision-making capabilities, especially when the complexity of innovation and dynamics increases. This study conceptually develops a framework that connects environmental turbulence, distinctive innovation capabilities, business model innovation, and tests its effect on company performance. This study uses information processing theory to propose and test the antecedents and consequences of a business model innovation strategy.
\nInnovative business model capabilities are a continuous change from new business strategies to keep pace with market developments, competitive advantage, and performance. Therefore, innovation capabilities are not simply the ability to successfully run a new business or manage mainstream capabilities. However, innovation capability is about synthesizing three paradigms, enabling innovative companies to produce new products and services that are quality-focused, efficient, and responsive.
\nThis study proposes the idea of a Typical Innovation capability. We have used the innovation management literature and several case studies as examples of Cisco Systems to demonstrate how innovation capabilities synthesize new and mainstream flows to achieve effective innovation performance. The next section identifies the elements of makeup innovation capability. Therefore, the innovation capability model aims to build a theoretical framework that highlights the actions managers can take to influence innovation success. However, several attempts have made it use a dynamic capabilities approach to produce a holistic innovation capability model. Organizations focus on innovation and innovation output as a competitive strategy.
\nBesides, this study has been able to fill the gaps and enhance previous studies on business model innovation strategies. It has explained that the distinctive Innovation capabilities by utilizing the external organizational structure’s capabilities and flexibility can face business turbulence. It allows organizations to achieve an increase in business strategy innovation capabilities, high-quality company performance in the face of economic decline, and at the same time, add to this cumulative knowledge study. Investigations of a set of antecedents of distinctive Innovation capabilities, business model innovation strategies, and environmental turbulence on company performance have highlighted the importance of complementarity as critical factors developed in future research.
\nThis research has limitations in telecommunications information, communication, and technology in Indonesia. As an antecedent of the Service Innovation has identified it, and its relationship has presented, large-scale quantitative surveys will test the conceptual framework and further explore each variable’s role. Furthermore, future research expands to consider the international implications of research and the broader scope.
\nFrom a managerial perspective, this research gives organization management a comprehensive view of enhancing innovation business model strategy and consecutively providing a solution to customers and influencing it and their relationships. This study will benefit the telecommunications companies that want to move to digital transformation, which is still an expensive and lengthy process, by using strengthening integrative capability to perfecting internal monetization, but especially overcoming external monetization from the opportunity of environmental turbulence to leap forward. Portfolio managers have suggested it intensify the information system’s use as it positively impacts an organization’s innovation business performance by intensifying information exchange with internal and external stakeholders.
\nFrom the social impact perspective, with the sustainable growth of technology-based companies, through innovative business models, Distinctive Innovation capability and environmental turbulence capabilities, companies can provide general benefits from the microeconomic side to customers and at a macro level to the performance of the company and industry in general. Thus, it can be a driving force for the advancement of digitalized technology knowledge and adopted by the community to prepare development towards society 5.0.
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