A way for reducing drug supply chain cost for a hospital district: A case study

Energy Technology Data Exchange (ETDEWEB)

Postacchini, L.; Ciarapica, F.E.; Bevilacqua, M.; Mazzuto, G.; Paciarotti, C.

2016-07-01

This work aims at providing insights to optimise healthcare logistic of the drug management, in order to deal with the healthcare expenditure cut. In this paper the effects of different drug supply chain configurations, on the resulting average stock, service level and Bullwhip effect, of the studied supply chain, is quantitatively assessed. A case study of an Italian district has been studied, taking into account three echelons: suppliers, central stock, and hospitals. A model of the various supply chain configurations has been created with the use of the simulation. Specifically, 24 supply chain configurations have been examined, stemming from the combination of several supply chain design parameters, namely: transshipment policies (Emergency Lateral Transshipment or Total Inventory Equalization); re-order and inventory management policies (Economic Order Quantity or Economic Order Interval); required service levels (90% or 95%); the number of available vans (one or two). For each configuration, hospital average stock, service level and a “Bullwhip effect” analysis are computed. To know which input variables are statistically significant, a DoE (Design of Experiments) analysis has been executed. The output of this paper provides useful insights and suggestions to optimize the healthcare logistic and drug supply chain. According to the developed DoE analysis, it can be stated that the introduction of transshipment policies provides important improvement in terms of service and stock levels. To reduce the Bullwhip effect, which results in a service level decreasing, and in a managing stock costs increasing, it is worth to adopt an EOQ re-order policy. This research gives practical recommendations to the studied system, in order to reduce costs and maintain a very satisfactory service level. This paper fulfils an identified need to study which combination of transshipment policies, re-order/inventory management policies and required service levels, can be the

A way for reducing drug supply chain cost for a hospital district: A case study

Directory of Open Access Journals (Sweden)

Leonardo Postacchini

2016-03-01

Full Text Available Purpose: This work aims at providing insights to optimise healthcare logistic of the drug management, in order to deal with the healthcare expenditure cut. In this paper the effects of different drug supply chain configurations, on the resulting average stock, service level and Bullwhip effect, of the studied supply chain, is quantitatively assessed. Design/methodology/approach: A case study of an Italian district has been studied, taking into account three echelons: suppliers, central stock, and hospitals. A model of the various supply chain configurations has been created with the use of the simulation. Specifically, 24 supply chain configurations have been examined, stemming from the combination of several supply chain design parameters, namely: transshipment policies (Emergency Lateral Transshipment or Total Inventory Equalization; re-order and inventory management policies (Economic Order Quantity or Economic Order Interval; required service levels (90% or 95%; the number of available vans (one or two. For each configuration, hospital average stock, service level and a “Bullwhip effect” analysis are computed. To know which input variables are statistically significant, a DoE (Design of Experiments analysis has been executed. Findings: The output of this paper provides useful insights and suggestions to optimize the healthcare logistic and drug supply chain. According to the developed DoE analysis, it can be stated that the introduction of transshipment policies provides important improvement in terms of service and stock levels. To reduce the Bullwhip effect, which results in a service level decreasing, and in a managing stock costs increasing, it is worth to adopt an EOQ re-order policy. Practical implications: This research gives practical recommendations to the studied system, in order to reduce costs and maintain a very satisfactory service level. Originality/value: This paper fulfils an identified need to study which combination of

[Impact of Increased Supply of Newly Licensed Nurses on Hospital Nurse Staffing and Policy Implications].

Science.gov (United States)

Kim, Yunmi; You, Sunju; Kim, Jinhyun

2017-12-01

This study aimed to analyze the impact of increasing the supply of newly licensed nurses on improving the hospital nurse staffing grades for the period of 2009~2014. Using public administrative data, we analyzed the effect of newly licensed nurses on staffing in 1,594 hospitals using Generalized Estimating Equation (GEE) ordered logistic regression, and of supply variation on improving staffing grades in 1,042 hospitals using GEE logistic regression. An increase of one newly licensed nurse per 100 beds in general units had significantly lower odds of improving staffing grades (grades 6~0 vs. 7) (odds ratio=0.95, p=.005). The supply of newly licensed nurses increased by 32% from 2009 to 2014, and proportion of hospitals whose staffing grade had improved, not changed, and worsened was 19.1%, 70.1%, and 10.8% respectively. Compared to 2009, the supply variation of newly licensed nurses in 2014 was not significantly related to the increased odds of improving staffing grades in the region (OR=1.02, p=.870). To achieve a balance in the regional supply and demand for hospital nurses, compliance with nurse staffing legislation and revisions in the nursing fee differentiation policy are needed. Rather than relying on increasing nurse supply, retention policies for new graduate nurses are required to build and sustain competent nurse workforce in the future. © 2017 Korean Society of Nursing Science

THE POTENTIAL AND SUPPLY CHAIN OF COCOA IN THE CENTRAL SULAWESI, INDONESIA

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Muslimin

2017-07-01

Full Text Available Cocoa is a reliance commodity of the plantation that plays a strategic role in national economy, especially as a provider of employment, source of income, and foreign exchange income. This research aims to identify the cocoa potential and the supply chain of cocoa in Central Sulawesi – Indonesia. Type of the research is descriptive research using survey method in the cocoa supply chain in 13 Regencies/Cities in Central Sulawesi. The result of the study shows that: (1 The largest contributor of the cocoa producer in Indonesia is Central Sulawesi with 23.14 percent of national cocoa and 188,600 hectares area. (2 The cocoa supply chain consists of farmers → collecting traders → wholesalers → industry. (3 The risks in the supply chain of cocoa are (1 Price: No access to a certain information about the price of cocoa resulting in the price determined by the trader unilaterally, (2 Pest Risk: cocoa rot disease; Stem cancer, (3 Seasonal Risk: the rainy season can also cause fungal disease in the stems and damage the cocoa fruit, (4 Human Resources Risk: Low awareness of the community on how to maintain cocoa well and how to turn it into the main livelihood.

An Exploration of Supply Chain Management Practices in the Central District Municipality

Science.gov (United States)

Ambe, I. M.

2009-01-01

The main objective of the paper is to explore supply chain management practices in the Central District Municipality, North West province of South Africa, using the grounded theory methodology. Supply chain management was introduced in the South African public sector to alleviate deficiencies related to governance, interpretation and…

Optimization models of the supply of power structures’ organizational units with centralized procurement

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Sysoiev Volodymyr

2013-01-01

Full Text Available Management of the state power structures’ organizational units for materiel and technical support requires the use of effective tools for supporting decisions, due to the complexity, interdependence, and dynamism of supply in the market economy. The corporate nature of power structures is of particular interest to centralized procurement management, as it provides significant advantages through coordination, eliminating duplication, and economy of scale. This article presents optimization models of the supply of state power structures’ organizational units with centralized procurement, for different levels of simulated materiel and technical support processes. The models allow us to find the most profitable options for state power structures’ organizational supply units in a centre-oriented logistics system in conditions of the changing needs, volume of allocated funds, and logistics costs that accompany the process of supply, by maximizing the provision level of organizational units with necessary material and technical resources for the entire planning period of supply by minimizing the total logistical costs, taking into account the diverse nature and the different priorities of organizational units and material and technical resources.

Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality

NARCIS (Netherlands)

de Wilde, R. F.; Besselink, M. G. H.; van der Tweel, I.; de Hingh, I. H. J. T.; van Eijck, C. H. J.; Dejong, C. H. C.; Porte, R. J.; Gouma, D. J.; Busch, O. R. C.; Molenaar, I. Q.

Background: The impact of nationwide centralization of pancreaticoduodenectomy (PD) on mortality is largely unknown. The aim of this study was to analyse changes in hospital volumes and in-hospital mortality after PD in the Netherlands between 2004 and 2009. Methods: Nationwide data on International

Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality

NARCIS (Netherlands)

de Wilde, R. F.; Besselink, M. G. H.; van der Tweel, I.; de Hingh, I. H. J. T.; van Eijck, C. H. J.; Dejong, C. H. C.; Porte, R. J.; Gouma, D. J.; Busch, O. R. C.; Molenaar, I. Q.

2012-01-01

Background: The impact of nationwide centralization of pancreaticoduodenectomy (PD) on mortality is largely unknown. The aim of this study was to analyse changes in hospital volumes and in-hospital mortality after PD in the Netherlands between 2004 and 2009. Methods: Nationwide data on International

Altruism, Rivalry and Crowding-Out in the Nonprofit Firm's Supply of Charity Services: The Case of Hospitals

OpenAIRE

Richard G. Frank; David S. Salkever

1988-01-01

This paper extends previous research on Individuals' supply of charitable donations to the behavior of nonprofit firms. Specifically, we study provision of charity care by private, nonprofit hospitals. We demonstrate that In the absence of large positive income effects on charity care supply, convex preferences for the nonprofit hospital imply crowding out by other private or government hospitals. Extending our model to include patient heterogeneity and impure altruism (rivalry) provides a po...

A Brief Discussion of Improving Quality Management and Prevention of Infection in Disinfection Supply Department of Local Hospital

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Hua-lin HU

2014-10-01

Full Text Available Objective: In order to improve the quality management of supply department in our hospital, develop the quality of our nursing work, control hospital infection. Methods: Make scientific and standard working procedures, pay attention to training of staff in supply department, make strict rules and regulations, attach importance to process management, improve the quality of nursing work, reinforce the protection of our staff. Results: We improved the method of management, developed the level of management. Conclusion: Supply Department up to standards, scientific and standardized level through a series of management measures, plays an important role in controlling Infection of hospital.

Supply chain management with cost-containment & financial-sustainability in a tertiary care hospital.

Science.gov (United States)

Chandra, Hem; Rinkoo, Arvind Vashishta; Verma, Jitendra Kumar; Verma, Shuchita; Kapoor, Rakesh; Sharma, R K

2013-01-01

Financial crunch in the present recession results in the non-availability of the right materials at the right time in large hospitals. However due to insufficient impetus towards systems development, situation remains dismal even when funds are galore. Cost incurred on materials account for approximately one-third of the total recurring expenditures in hospitals. Systems development for effective and efficient materials management is thus tantamount to cost-containment and sustainability. This scientific paper describes an innovative model, Hospital Revolving Fund (HRF), developed at a tertiary care research institute in Asia. The main idea behind inception of HRF was to ensure availability of all supplies in the hospital so that the quality of healthcare delivery was not affected. The model was conceptualized in the background of non-availability of consumables in the hospital leading to patient as well as staff dissatisfaction. Hospital supplies have been divided into two parts, approximately 3250 unit items and 1750 miscellaneous items. This division is based on cost, relative-utility and case-specific utilization. 0.1 Million USD, separated from non-planned budget, was initially used as seed money in 1998. HRF procures supplies from reputed firms on concessional rates (8-25%) and make them available to patients at much lesser rates vis-à-vis market rates, levying minimal maintenance charges. In 2009-10, total annual purchases of 14 Million USD were made. The balance sheet reflected 1.4 Million USD as fixed deposit investment. The minimal maintenance charges levied on the patients along with the interest income were sufficient to pay for all recurring expenses related to HRF. Even after these expenses, HRF boosted of 0.2 Million USD as cash-in-hand in financial year 2009-10. In-depth analysis of 'balance sheet' and 'Income and Expenditure' statement of the fund for last five financial years affirms that HRF is a self-sustainable and viable supply chain

Money Supply as the Target of the Central Bank

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Jędruchniewicz Andrzej

2014-06-01

Full Text Available The main purpose of the article is a critical analysis of the monetary policy strategy that is based on the adoption of money supply as an intermediate target. The analysis is conducted from the perspective of the theory of the Austrian school. The first part of the article presents an influence of the supply of money on changes of categories in economy according to mainstream theories of economics. The second part discusses the essence of the strategy of monetary policy using money supply as an intermediate target from the point of view of the main trend in economics. It is demonstrated that in order to use it, two elementary conditions must be met: the function of demand for money must be at least relatively stable and the central bank must practically shape changes in the money supply at the planned level. The third part is of key importance for the purpose of this article. It involves the criticism of Friedman’s principle, i.e. a constant increase in money supply as a monetary strategy. According to the Austrian theory, an increase in the quantity of money which is not financed by voluntary savings separates the time structure of production and consumption. Thus, after the period of prosperity there a collapse in production must take place. It is also pointed out that the crisis can be postponed only when the quantity of money increases at an ever faster rate.

Fornecimento de hortifrutigranjeiros para unidades de alimentação e nutrição hospitalares The supply of fruits and vegetables for food and nutrition hospitals units

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Aline Petter Schneider

2006-06-01

Full Text Available O fornecimento de hortifrutigranjeiros para o setor hospitalar é um importante segmento dentro da cadeia de suprimento agroalimentar. Este fornecimento demanda altos padrões de qualidade, incluindo o cumprimento de normas higiênico-sanitárias, padrão do tamanho, da forma, da procedência, da isenção de resíduos e agrotóxicos, entre outros. O objetivo deste estudo foi analisar o processo atual de fornecimento de hortifrutigranjeiros e identificar as necessidades e exigências das unidades hospitalares. A metodologia empregada foi a de estudo de múltiplos casos. Foram analisados os hospitais do município de Porto Alegre (Rio Grande do Sul, Brasil e a Central de Abastecimento e Distribuição de Hortifrutigranjeiros e seus distribuidores. Os resultados obtidos demonstram, por parte dos hospitais, grande preocupação quanto ao atual método de fornecimento, bem como a necessidade de um fornecimento especializado. No que se refere aos fornecedores, verificou-se o descumprimento de fatores considerados indispensáveis pelos hospitais, entre os quais o controle na utilização de agrotóxicos, as condições higiênico-sanitárias, a procedência e as condições de transporte. Como conclusão, verificou-se que o fornecimento atual não é eficiente e se dá de maneira inadequada, não atendendo a maioria dos requisitos hospitalares de fornecimento. Sugere-se a implementação da metodologia de Análise dos Perigos e Pontos Críticos de Controle, das Boas Práticas de Fabricação, do Gerenciamento da Cadeia de Suprimentos e do Cooperativismo, como propostas para a otimização do fornecimento.The food and vegetables supply to hospitals is an important part of food supply channel. This supply demands, among others, high patterns of quality, including size, shape, origin, low levels of residuals and pesticides, as well as the accomplishment of hygiene and sanitary rules. The aim of this study was to evaluate the current process of food and

Rule Based Expert System for Monitoring Real Time Drug Supply in Hospital Using Radio Frequency Identification Technology

Science.gov (United States)

Driandanu, Galih; Surarso, Bayu; Suryono

2018-02-01

A radio frequency identification (RFID) has obtained increasing attention with the emergence of various applications. This study aims to examine the implementation of rule based expert system supported by RFID technology into a monitoring information system of drug supply in a hospital. This research facilitates in monitoring the real time drug supply by using data sample from the hospital pharmacy. This system able to identify and count the number of drug and provide warning and report in real time. the conclusion is the rule based expert system and RFID technology can facilitate the performance in monitoring the drug supply quickly and precisely.

Comparative ecobalancing accounting of semi-central house heat supply from wood residues

International Nuclear Information System (INIS)

Biemann, Kirsten

2015-01-01

In 2008 almost 40 percent of the German final energy demand was used for room heating and hot water supply. To decrease environmental burdens and to save fossil resources a restructuring of the heating sector is needed. Therefore legislation enforces higher insulation standards of buildings and a more frequent use of renewable energies as well as heating networks. Wood as a renewable and storable energy source is an attractive fuel. However, it must be used as efficiently as possible because of limited wood supplies. Connecting buildings via a heating network is a good option since bigger heating plants can operate at higher efficiencies than small heaters. However, the higher insulation standards of the buildings often oppose the construction of a heating network, because heating networks work best with high energy demands and low network lengths. Therefore the environmental and economic feasibility of new heating networks needs to be checked beforehand. This thesis explores the environmental burdens of different semi- centralized heating networks using wood residues as fuel. A semi- centralized heating network is a network with no more than 500 customers and a heating plant with less than 5 MWth. While wood residues are used in the base load plant, peak load is covered by a gas heating plant. As a method to analyze the potential environmental burdens of the heat supply a life cycle assessment according to ISO 14040/44 is used. Opposed to former life cycle assessment studies, construction and operation of the network is included in the assessment. Even though the environmental impacts of the semi- centralized heating from wood residues are dominated by the heat supply, an observation of the impacts solely at the heating plant is not sufficient. By varying the boundary conditions of the heating network two main contributors to the environmental impacts are found. In addition to the heat production at the plant the type of the buildings in the settlement has a huge

Safety Stocks in Centralized and Decentralized Supply Chains under Different Types of Random Yields

OpenAIRE

Karl Inderfurth

2015-01-01

Safety stock planning with focus on risk protection to cope with demand uncertainties is a very well researched topic in the field of supply chain management, in central as well as in local decision making systems. In contrast, there is only few knowledge about safety stock management in situations where supply risks have to be covered that are caused by uncertainties with respect to production yields. In this study, a two-stage manufacturer-retailer supply chain is considered in a single-per...

The optimization of heat supply centralization on the basis of boiler-rooms

International Nuclear Information System (INIS)

Arshakian, D.

1992-01-01

In this article the problem of finding of the optimum of heat supply centralization of towns and insutrial districts on the basis of boiler-rooms, using organic and nuclear fuel in the natural-climatic conditions and town-building transitions of Armenia is considered. (orig.) [de

Some features of an economical central heating water supply

International Nuclear Information System (INIS)

Glaeser, G.

1990-01-01

This paper is concerned with the necessary savings of energy and fuel as well as reduction of pollutant emission in the field of central district heat supply. Results of studies on solving these problems are presented. To provide thermal power based on heating water essential features of the district heating system in the GDR are outlined and advantages, resources and limits of specific solutions quantified. Finally, selected systems are evaluated as to energy and cost expenses, and some conclusions are drawn for future concepts. (author)

Bootstrapping data envelopment analysis of efficiency and productivity of county public hospitals in Eastern, Central, and Western China after the public hospital reform.

Science.gov (United States)

Wang, Man-Li; Fang, Hai-Qing; Tao, Hong-Bing; Cheng, Zhao-Hui; Lin, Xiao-Jun; Cai, Miao; Xu, Chang; Jiang, Shuai

2017-10-01

China implemented the public hospital reform in 2012. This study utilized bootstrapping data envelopment analysis (DEA) to evaluate the technical efficiency (TE) and productivity of county public hospitals in Eastern, Central, and Western China after the 2012 public hospital reform. Data from 127 county public hospitals (39, 45, and 43 in Eastern, Central, and Western China, respectively) were collected during 2012-2015. Changes of TE and productivity over time were estimated by bootstrapping DEA and bootstrapping Malmquist. The disparities in TE and productivity among public hospitals in the three regions of China were compared by Kruskal-Wallis H test and Mann-Whitney U test. The average bias-corrected TE values for the four-year period were 0.6442, 0.5785, 0.6099, and 0.6094 in Eastern, Central, and Western China, and the entire country respectively, with average non-technical efficiency, low pure technical efficiency (PTE), and high scale efficiency found. Productivity increased by 8.12%, 0.25%, 12.11%, and 11.58% in China and its three regions during 2012-2015, and such increase in productivity resulted from progressive technological changes by 16.42%, 6.32%, 21.08%, and 21.42%, respectively. The TE and PTE of the county hospitals significantly differed among the three regions of China. Eastern and Western China showed significantly higher TE and PTE than Central China. More than 60% of county public hospitals in China and its three areas operated at decreasing return scales. There was a considerable space for TE improvement in county hospitals in China and its three regions. During 2012-2015, the hospitals experienced progressive productivity; however, the PTE changed adversely. Moreover, Central China continuously achieved a significantly lower efficiency score than Eastern and Western China. Decision makers and administrators in China should identify the causes of the observed inefficiencies and take appropriate measures to increase the efficiency of county

National conference on centralized heat supply from heat feeders in selected localities

International Nuclear Information System (INIS)

1990-05-01

The proceedings contain 8 contributions, out of which 5 have been inputted in INIS. These deal with centralized heat supply systems, hydraulic and thermal parameters of the hot water distribution systems, and the feasibility of including nuclear sources into the systems. Treated are both actual systems and calculation models. (B.S.)

江苏省36所二级医院消毒供应中心验收质量抽查探析%Research on spot check of acceptance quality of central sterile supply departments of 36 secondary hospitals in Jiangsu province

Institute of Scientific and Technical Information of China (English)

黄进; 霍孝蓉

2016-01-01

OBJECTIVE To understand the current status of hardware and software equipments of central sterile supply departments (CSSD) ,find out the problems ,and put forward rectification recommendations so as to im-prove the overall quality of CSSD .METHODS The CSSD panel of experts were divided into four groups ,each group consisted of the nursing administrators ,infection control department staff ,and CSSD experts .The 36 hospi-tals were randomly assigned to four expert groups for the onsite supervision ,the scoring was conducted based on the detailed rules and regulations of′criteria for construction and management of central sterile supply department′of Jiangsu province ,and the rectification measures were put forward according to the deduction item .RESULTS The comprehensive scoring was conducted based on the′criteria for construction and management of central sterile supply department′,with the full mark 1000 points ;among the 36 hospitals ,there were 10 hospitals with the score varying from 850 to 950 points ,6 hospitals with the score varying from 800 to 849 points ,16 hospitals with the score varying from 700 to 799 points ,and 4 hospitals with the score varying from 600 to 699 points .The major existing problems included the inadequate training of the CSSD ,imperfect inspection of cleaning quality ,and un-qualified storage of sterile supplies and staff allocation .CONCLUSION To deal with the exiting problems ,it is nec-essary to strengthen the communication between the CSSD and functional departments ,carry out detailed manage-ment ,improve the training of staff ,and further implement and promote the standardized management of the CSSD .The rectification period is 3 month ,and the members of expert group carry out the onsite supervision and inspection after the rectification and evaluate the rectification effect .%目的：了解目前医院消毒供应中心（CSSD �

The impact of forest thinning on the reliability of water supply in central Arizona.

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Silvio Simonit

Full Text Available Economic growth in Central Arizona, as in other semiarid systems characterized by low and variable rainfall, has historically depended on the effectiveness of strategies to manage water supply risks. Traditionally, the management of supply risks includes three elements: hard infrastructures, landscape management within the watershed, and a supporting set of institutions of which water markets are frequently the most important. In this paper we model the interactions between these elements. A forest restoration initiative in Central Arizona (the Four Forest Restoration Initiative, or 4FRI will result in thinning of ponderosa pine forests in the upper watershed, with potential implications for both sedimentation rates and water delivery to reservoirs. Specifically, we model the net effect of ponderosa pine forest thinning across the Salt and Verde River watersheds on the reliability and cost of water supply to the Phoenix metropolitan area. We conclude that the sediment impacts of forest thinning (up to 50% of canopy cover are unlikely to compromise the reliability of the reservoir system while thinning has the potential to increase annual water supply by 8%. This represents an estimated net present value of surface water storage of $104 million, considering both water consumption and hydropower generation.

The Impact of Forest Thinning on the Reliability of Water Supply in Central Arizona

Science.gov (United States)

Simonit, Silvio; Connors, John P.; Yoo, James; Kinzig, Ann; Perrings, Charles

2015-01-01

Economic growth in Central Arizona, as in other semiarid systems characterized by low and variable rainfall, has historically depended on the effectiveness of strategies to manage water supply risks. Traditionally, the management of supply risks includes three elements: hard infrastructures, landscape management within the watershed, and a supporting set of institutions of which water markets are frequently the most important. In this paper we model the interactions between these elements. A forest restoration initiative in Central Arizona (the Four Forest Restoration Initiative, or 4FRI) will result in thinning of ponderosa pine forests in the upper watershed, with potential implications for both sedimentation rates and water delivery to reservoirs. Specifically, we model the net effect of ponderosa pine forest thinning across the Salt and Verde River watersheds on the reliability and cost of water supply to the Phoenix metropolitan area. We conclude that the sediment impacts of forest thinning (up to 50% of canopy cover) are unlikely to compromise the reliability of the reservoir system while thinning has the potential to increase annual water supply by 8%. This represents an estimated net present value of surface water storage of $104 million, considering both water consumption and hydropower generation. PMID:25835003

Water supply facility damage and water resource operation at disaster base hospitals in miyagi prefecture in the wake of the Great East Japan Earthquake.

Science.gov (United States)

Matsumura, Takashi; Osaki, Shizuka; Kudo, Daisuke; Furukawa, Hajime; Nakagawa, Atsuhiro; Abe, Yoshiko; Yamanouchi, Satoshi; Egawa, Shinichi; Tominaga, Teiji; Kushimoto, Shigeki

2015-04-01

The aim of this study was to shed light on damage to water supply facilities and the state of water resource operation at disaster base hospitals in Miyagi Prefecture (Japan) in the wake of the Great East Japan Earthquake (2011), in order to identify issues concerning the operational continuity of hospitals in the event of a disaster. In addition to interview and written questionnaire surveys to 14 disaster base hospitals in Miyagi Prefecture, a number of key elements relating to the damage done to water supply facilities and the operation of water resources were identified from the chronological record of events following the Great East Japan Earthquake. Nine of the 14 hospitals experienced cuts to their water supplies, with a median value of three days (range=one to 20 days) for service recovery time. The hospitals that could utilize well water during the time that water supply was interrupted were able to obtain water in quantities similar to their normal volumes. Hospitals that could not use well water during the period of interruption, and hospitals whose water supply facilities were damaged, experienced significant disruption to dialysis, sterilization equipment, meal services, sanitation, and outpatient care services, though the extent of disruption varied considerably among hospitals. None of the hospitals had determined the amount of water used for different purposes during normal service or formulated a plan for allocation of limited water in the event of a disaster. The present survey showed that it is possible to minimize the disruption and reduction of hospital functions in the event of a disaster by proper maintenance of water supply facilities and by ensuring alternative water resources, such as well water. It is also clear that it is desirable to conclude water supply agreements and formulate strategic water allocation plans in preparation for the eventuality of a long-term interruption to water services.

Medication supply chain management through implementation of a hospital pharmacy computerized inventory program in Haiti

Directory of Open Access Journals (Sweden)

Michelle R. Holm

2015-01-01

Full Text Available Background: In the aftermath of the 2010 earthquake in Haiti, St. Luke Hospital was built to help manage the mass casualties and subsequent cholera epidemic. A major problem faced by the hospital system was the lack of an available and sustainable supply of medications. Long-term viability of the hospital system depended largely on developing an uninterrupted medication supply chain. Objective: We hypothesized that the implementation of a new Pharmacy Computerized Inventory Program (PCIP would optimize medication availability and decrease medication shortages. Design: We conducted the research by examining how medications were being utilized and distributed before and after the implementation of PCIP. We measured the number of documented medication transactions in both Phase 1 and Phase 2 as well as user logins to determine if a computerized inventory system would be beneficial in providing a sustainable, long-term solution to their medication management needs. Results: The PCIP incorporated drug ordering, filling the drug requests, distribution, and dispensing of the medications in multiple settings; inventory of currently shelved medications; and graphic reporting of ‘real-time’ medication usage. During the PCIP initiation and establishment periods, the number of medication transactions increased from 219.6 to 359.5 (p=0.055, respectively, and the mean logins per day increased from 24.3 to 31.5, p<0.0001, respectively. The PCIP allows the hospital staff to identify and order medications with a critically low supply as well as track usage for future medication needs. The pharmacy and nursing staff found the PCIP to be efficient and a significant improvement in their medication utilization. Conclusions: An efficient, customizable, and cost-sensitive PCIP can improve drug inventory management in a simplified and sustainable manner within a resource-constrained hospital.

The effects of pay and job satisfaction on the labour supply of hospital consultants.

Science.gov (United States)

Ikenwilo, Divine; Scott, Anthony

2007-12-01

There is little evidence about the responsiveness of doctors' labour supply to changes in pay. Given substantial increases in NHS expenditure, new national contracts for hospital doctors and general practitioners that involve increases in pay, and the gradual imposition of a ceiling on hours worked through the European Working Time Directive, knowledge of the size of labour supply elasticities is crucial in examining the effects of these major changes. This paper estimates a modified labour supply model for hospital consultants, using data from a survey of consultants in Scotland. Rigidities in wage setting within the NHS mean that the usual specification of the labour supply model is extended by the inclusion of job quality (job satisfaction) in the equation explaining the optimal number of hours worked. Generalised Method of Moments estimation is used to account for the endogeneity of both earnings and job quality. Our results confirm the importance of pay and non-pay factors on the supply of labour by consultants. The results are sensitive to the exclusion of job quality and show a slight underestimation of the uncompensated earnings elasticity (of 0.09) without controlling for the effect of job quality, and 0.12 when we controlled for job quality. Pay increases in the new contract for consultants will only result in small increases in hours worked. Small and non-significant elasticity estimates at higher quantiles in the distribution of hours suggest that any increases in hours worked are more likely for consultants who work part time. Those currently working above the median number of hours are much less responsive to changes in earnings. Copyright (c) 2007 John Wiley & Sons, Ltd.

European future natural gas demand and supply diversification: key issues for Central and Eastern Europe

International Nuclear Information System (INIS)

Mueller-Elschner, E.

1996-01-01

policy and the activities of the ECE as well as the promoters of the Energy Charter are fostering this process. (3) All European gas industries, in addition, are confronted with the following challenges: to meet the growing gas demand by securing additional gas supplies; to build new pipelines and storage facilities; to diversify gas supplies (eastern and central European countries); to optimize diversification of gas supplies (Western European countries); to interconnect pipeline grids and to strengthen security of supply, as the dominating goal of the whole European gas business

Endometrial pathology in a teaching hospital in North Central ...

African Journals Online (AJOL)

The study was a 5 year histopathological survey of endometrial biopsies seen at the University of Ilorin Teaching Hospital , Ilorin, North Central Nigeria from January 1st 1997 to December 31st 2001. It aimed at identifying the morphological patterns of endometrial disorders, prevalence of these disorders and the ...

Simulation modelling of central order processing system under resource sharing strategy in demand-driven garment supply chains

Science.gov (United States)

Ma, K.; Thomassey, S.; Zeng, X.

2017-10-01

In this paper we proposed a central order processing system under resource sharing strategy for demand-driven garment supply chains to increase supply chain performances. We examined this system by using simulation technology. Simulation results showed that significant improvement in various performance indicators was obtained in new collaborative model with proposed system.

Suburban Housing Development and Off-Grid Electric Power Supply Assessment for North-Central Nigeria

Directory of Open Access Journals (Sweden)

Ibikunle Olalekan Ogundari

2017-01-01

Full Text Available Energy infrastructures in North-Central Nigeria are inadequate and grid electricity is unable to meet suburban housing electricity demand. The alternative power-supply options proposed by government for the region require appropriation analysis for selection. Four public housing estates in suburban Abuja are selected for electricity demand analysis under conventional and energy-efficient lighting scenarios; then techno-economic parameters of two off-grid electric power supply systems (PV and Diesel-powered generation to meet these electricity demands are evaluated. An energy techno-economic assessment methodology is used. The study determines the energy-efficient lighting system is appropriate with 40% energy savings relative to the Conventional Lighting Systems. The diesel generator alternative power-supply option has Life Cycle Costs almost 4 times those of the PV option. The study established the PV-energy-efficient lighting system as the most feasible off-grid electric power supply alternative for implementation.

Hospital Impact After a Chemical Spill That Compromised the Potable Water Supply: West Virginia, January 2014.

Science.gov (United States)

Hsu, Joy; Del Rosario, Maria C; Thomasson, Erica; Bixler, Danae; Haddy, Loretta; Duncan, Mary Anne

2017-10-01

In January 2014, a chemical spill of 4-methylcyclohexanemethanol and propylene glycol phenyl ethers contaminated the potable water supply of approximately 300,000 West Virginia residents. To understand the spill's impact on hospital operations, we surveyed representatives from 10 hospitals in the affected area during January 2014. We found that the spill-related loss of potable water affected many aspects of hospital patient care (eg, surgery, endoscopy, hemodialysis, and infection control of Clostridium difficile). Hospital emergency preparedness planning could be enhanced by specifying alternative sources of potable water sufficient for hemodialysis, C. difficile infection control, and hospital processing and cleaning needs (in addition to drinking water). (Disaster Med Public Health Preparedness. 2017;11:621-624).

An integrated outsourcing solution at York Central Hospital.

Science.gov (United States)

Marr, Jo-Anne; Tam, Richard; Simms, Stephen; Bacchus, Feria

2011-01-01

Canadian hospitals struggle to balance the need to increase and improve operational services and quality with diminishing resources. Many realize that sustaining their organization depends on how well they focus their resources and talents on their core business, clinical care delivery. Outsourcing of non-core, non-clinical support services is a solution for many organizations. Most often, this is put into action one service provider at a time. In 2007, however, York Central Hospital (YCH) implemented Sodexo's integrated Comprehensive Service Solutions (CSS) for all its support service functions. In doing so, YCH achieved significant improvements in patient and staff satisfaction rates, substantial cost savings through improved operational efficiency from process improvements and leveraging technology investments, and increased retail food revenue.

Prevalence of Neonatal Jaundice on Central Hospital, Warri, Delta ...

African Journals Online (AJOL)

Methods: 272 babies (aged 1 – 30 days) the Neonatal Clinic of the Department of Child Health, Central Hospital, Warri, Delta State between June 2009 and June 2010 were examined daily for evidence of jaundice. Those with serum bilirubin ³15mg/100ml were subjected to additional clinical and laboratory investigations to ...

Water supply in the Central Namib Region: A socio-economic study

OpenAIRE

Moorsom, Richard

1997-01-01

This study provides an empirical report and analysis of the results of a June/July 1995 household sample survey of the four towns (Walvis Bay, Swakopmund, Arandis and Henties Bay) located in the central west coast region of Namibia. It also draws on other primary data sets, in particular 1991 census enumeration area returns and 1994/95 municipal account databases. Its aim is to establish the socioeconomic context of domestic and small business water supply for urban communities in a desert en...

Mobile technologies and supply chain management - lessons for the hospitality industry

OpenAIRE

Car, Tomislav; Pilepić, Ljubica; Šimunić, Mislav

2014-01-01

Purpose – The purpose of this paper is to define preconditions and integration capabilities of the mobile business in supply chain management (SCM) in the hospitality industry via mobile devices and mobile applications. The aims of this paper are to reflect on what mobile technology has to offer and to draw attention to the role of mobile applications and their use in the SCM. Although mobile technologies are present in almost all areas, they are not used to their full potential. Design – The...

Central radiological department of the Jahn Ferenc hospital and medical center

Energy Technology Data Exchange (ETDEWEB)

Erdelyi, M Jr [Jahn Ferenc Korhaz-Rendeloeintezet, Budapest (Hungary). Koezponti Radiologia

1982-01-01

The design, organisation and functioning of the central X-ray diagnostical unit of the new hospital, inaugurated in December 1980 are reviewed. The experiences of the shortcomings of the planning are summerized, too.

Comparative status and development trends of central electricity supply technologies in the Federal Republic of Germany

International Nuclear Information System (INIS)

Kolb, G.

1989-01-01

This paper describes the present situation in the public electricity sector of the FRG with its legal and political constraints, to identify the development trends of the supply technologies for central electricity in regard to their application potential during the forthcoming 10 to 20 years. Summarizing expectations and conclusions are drawn on the foreseeable contribution of the electricity supply sector to the aspired CO 2 -reductions in the FRG

[Improving a hospital's supply chain through lean management].

Science.gov (United States)

Aguilar-Escobar, V G; Garrido-Vega, P; Godino-Gallego, N

2013-01-01

Supply management is an area where hospitals have significant opportunities for improvement. The main objective of this paper has been to analyze how the application of Lean principles can improve logistics costs and user satisfaction. In connection with satisfaction, it also aimed to examine which aspects of the service define it and check for differences between different groups of users. The results of an experience to reorganize the hospital logistic system based on some Lean principles have been studied. This is therefore a case study, which combine different methods of data collection. The logistics cost calculation was carried out using the full costing method. To measure satisfaction of healthcare personnel, the internal logistics service users, an anonymous survey was conducted. Processing of the data obtained from the survey have included exploratory analysis, factor analysis and ANOVAs. The data have showed an improvement in logistics management after the implementation of Lean principles. Logistics costs were reduced and the satisfaction level of the internal users with the new logistics system was increased. Some differences in the degree of satisfaction by different groups of users were also detected, although they did not seem to distinguish between different aspects of logistic service. The analyzed experience shows the applicability and suitability of Lean principles to improve logistics operational costs and increase user satisfaction. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.

An unusual outbreak of nontuberculous mycobacteria in hospital respiratory wards: Association with nontuberculous mycobacterial colonization of hospital water supply network

Directory of Open Access Journals (Sweden)

Salvatore D′Antonio

2016-01-01

Full Text Available The incidence and prevalence of pulmonary nontuberculous mycobacterial (NTM infection is increasing worldwide arousing concerns that NTM infection may become a serious health challenge. We recently observed a significant increase of NTM-positive sputa samples from patients referred to respiratory disease wards of a large tertiary hospital in Rome. A survey to identify possible NTM contamination revealed a massive presence of NTM in the hospital water supply network. After decontamination procedures, NTM presence dropped both in water pipelines and sputa samples. We believe that this observation should encourage water network surveys for NTM contamination and prompt decontamination procedures should be considered to reduce this potential source of infection.

Regional supply of outreach service and length of stay in psychiatric hospital among patients with schizophrenia: National case mix data analysis in Japan.

Science.gov (United States)

Niimura, Junko; Nakanishi, Miharu; Yamasaki, Syudo; Nishida, Atsushi

2017-12-01

Several clinical trials have demonstrated that linkage to an outreach service can prevent prolonged length of stay of patients at psychiatric hospitals. However, there has been no investigation of the association between length of stay in psychiatric hospital and regional supply of outreach services using national case mix data. The aim of this study was to clarify the relationship between length of stay in psychiatric hospital and regional supply of outreach services. We used data from the National Patient Survey in Japan, a nationally representative cross-sectional survey of inpatient care conducted every three years from 1996 to 2014. Data from 42,268 patients with schizophrenia who had been admitted to psychiatric hospitals were analyzed. After controlling for patient and regional characteristics, patients in regions with fewer number of visits for psychiatric nursing care at home had significantly longer length of stay in psychiatric hospitals. This finding implies that enhancement of the regional supply of outreach services would prevent prolonged length of stay in psychiatric hospitals. Copyright © 2017 Elsevier B.V. All rights reserved.

Diabetic retinopathy at the Yaoundé Central Hospital in Cameroon ...

African Journals Online (AJOL)

We carried out a cross-sectional analytical survey using data from patients who had done Fluorescein Angiography at the Yaounde Central Hospital Diabetic Retinopathy Prevention and Management Project between October 2007 and January 2010 to identify the risk factors, incidence and severity of different types of ...

About opportunities of the sharing of city infrastructure centralized warmly - and water supply

Science.gov (United States)

Zamaleev, M. M.; Gubin, I. V.; Sharapov, V. I.

2017-11-01

It is shown that joint use of engineering infrastructure of centralized heat and water supply of consumers will be the cost-efficient decision for municipal services of the city. The new technology for regulated heating of drinking water in the condenser of steam turbines of combined heat and power plant is offered. Calculation of energy efficiency from application of new technology is executed.

Preliminary report on theNeurology workload ina central hospital in ...

African Journals Online (AJOL)

Introduction: Identification of the local pattern of neurological diseases is expected to help setting the priorities for good planning of management and public education. Objectives: To identify the pattern of neurological disorders in a second biggest central hospital in Sudan. Methodology: Review of the diagnosis of 170 ...

Inadequate ventilation for nosocomial tuberculosis prevention in public hospitals in Central Thailand.

Science.gov (United States)

Jiamjarasrangsi, W; Bualert, S; Chongthaleong, A; Chaindamporn, A; Udomsantisuk, N; Euasamarnjit, W

2009-04-01

Forty-two community and general hospitals in central Thailand. To examine the adequacy of indoor ventilation for nosocomial tuberculosis (TB) prevention in public hospitals in central Thailand. A cross-sectional survey was conducted among 323 patient care and ancillary areas in the target hospitals. Data on indoor ventilation rate were collected by the tracer gas method and reported as air changes per hour (ACH). The adequacy of the measured ventilation rates were then determined by comparison with the international recommended standard values. Indoor ventilation rates were inadequate in almost half of the studied areas (144/323, 44.6%). The inadequacy was particularly serious in the emergency rooms (ERs) and radiological areas, where 73.8% (31/42 each) of the rooms had ACH below the recommended standards. Detailed analysis showed that most of the rooms with natural ventilation had air exchange rates that exceeded the recommended standards, while the opposite was the case for rooms with air-conditioning, particularly the window or wall-mount type. Indoor ventilation in high-risk nosocomial TB areas in public hospitals in Thailand was inadequate due to the installation of air-conditioning systems in modern buildings.

Typology of the supply chains of non-wood forest products in central Serbia

Directory of Open Access Journals (Sweden)

Nonić Dragan

2013-01-01

Full Text Available Modern economies are characterized by a growing importance of cooperation and the creation of networks of enterprises, organizations and institutions, which are all part of a supply chain, in order to achieve competitive advantage in a market. The aim of this study was to determine the structure of the supply chains of non-wood forest products in selected forest areas of Central Serbia (Golijsko, Podrinjsko-kolubarsko, Posavsko-podunavsko, Rasinsko and Tarsko-zlatiborsko FAs. The comparative method was applied in this paper, along with the method of specialization (classification, the method of structural partial analysis (supply chain analysis and the statistical method (analysis of frequencies and two-step cluster. The data collection was conducted in 2011, by using the technique of door-to-door survey. The analysis of the basic types of the supply chains of non-wood forest products and their main stages (purchasing, processing and placement was conducted in the selected areas. A cluster analysis showed that there were six basic types of supply chains in the selected forest areas and one dominant type. [Projekat Ministarstva nauke Republike Srbije, br. 443007/16 –III: Istraživanja klimatskih promena i njihovog uticaja na životnu sredinu -praćenje uticaja, adaptacija i ublažavanje, podprojekat: Socio-ekonomski razvoj, ublažavanje i adaptacija na klimatske promene

Physicians’ engagement in dual practices and the effects on labor supply in public hospitals: results from a register-based study

Science.gov (United States)

2014-01-01

Background Physician dual practice, a combination of public and private practice, has attracted attention due to fear of reduced work supply and a lack of key personnel in the public system, increase in low priority treatments, and conflicts of interest for physicians who may be competing for their own patients when working for private suppliers. In this article, we analyze both choice of dual practice among hospital physicians and the dual practices’ effect on work supply in public hospitals. Methods The sample consisted of 12,399 Norwegian hospital physicians working in public hospitals between 2001 and 2009. We linked hospital registry data on salaries and hospital working hours with data from national income and other registries covering non-hospital income, including income from dual work, cohabiting status, childbirths and socioeconomic characteristics. Our dataset also included hospital variables describing i.e. workload. We estimated odds ratio for choosing dual practice and the effects of dual practice on public working hours using different versions of mixed models. Results The percentage of physicians engaged in dual practice fell from 35.1% for men and 17.6% for women in 2001 to 25.0% and 14.2%, respectively, in 2009. For both genders, financial debt and interest payments were positively correlated and having a newborn baby was negatively correlated with engaging in dual practice. Larger family size and being cohabitating increased the odds ratio of dual practice among men but reduced it for women. The most significant internal hospital factor for choosing dual practice was high wages for extended working hours, which significantly reduced the odds ratio for dual practice. The total working hours in public hospitals were similar for both those who did and did not engage in dual practice; however, dual practice reduced public working hours in some specialties. Conclusion Economic factors followed by family variables are significant elements influencing

Decentralization and centralization of healthcare resources: investigating the associations of hospital competition and number of cardiologists per hospital with mortality and resource utilization in Japan.

Science.gov (United States)

Park, Sungchul; Lee, Jason; Ikai, Hiroshi; Otsubo, Tetsuya; Imanaka, Yuichi

2013-11-01

To investigate the associations of hospital competition and number of cardiologists per hospital (indicating the decentralization and centralization of healthcare resources, respectively) with 30-day in-hospital mortality, healthcare spending, and length of stay (LOS) among patients with acute myocardial infarction (AMI) in Japan. We collected data from 23,197 AMI patients admitted to 172 hospitals between 2008 and 2011. Hospital competition and number of cardiologists per hospital were analyzed as exposure variables in multilevel regression models for in-hospital mortality, healthcare spending, and LOS. Other covariates included patient, hospital, and regional variables; as well as the use of percutaneous coronary intervention (PCI). Hospitals in competitive regions and hospitals with a higher number of cardiologists were both associated lower in-hospital mortality. Additionally, hospitals in competition regions were also associated with longer LOS durations, whereas hospitals with more cardiologists had higher spending. The use of PCI was also associated with reduced mortality, increased spending and increased LOS. Centralization of cardiologists at the hospital level and decentralization of acute hospitals at the regional level may be contributing factors for improving the quality of care in Japan. Policymakers need to strike a balance between these two approaches to improve healthcare provision and quality. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Medication supply chain management through implementation of a hospital pharmacy computerized inventory program in Haiti.

Science.gov (United States)

Holm, Michelle R; Rudis, Maria I; Wilson, John W

2015-01-01

In the aftermath of the 2010 earthquake in Haiti, St. Luke Hospital was built to help manage the mass casualties and subsequent cholera epidemic. A major problem faced by the hospital system was the lack of an available and sustainable supply of medications. Long-term viability of the hospital system depended largely on developing an uninterrupted medication supply chain. We hypothesized that the implementation of a new Pharmacy Computerized Inventory Program (PCIP) would optimize medication availability and decrease medication shortages. We conducted the research by examining how medications were being utilized and distributed before and after the implementation of PCIP. We measured the number of documented medication transactions in both Phase 1 and Phase 2 as well as user logins to determine if a computerized inventory system would be beneficial in providing a sustainable, long-term solution to their medication management needs. The PCIP incorporated drug ordering, filling the drug requests, distribution, and dispensing of the medications in multiple settings; inventory of currently shelved medications; and graphic reporting of 'real-time' medication usage. During the PCIP initiation and establishment periods, the number of medication transactions increased from 219.6 to 359.5 (p=0.055), respectively, and the mean logins per day increased from 24.3 to 31.5, psupply as well as track usage for future medication needs. The pharmacy and nursing staff found the PCIP to be efficient and a significant improvement in their medication utilization. An efficient, customizable, and cost-sensitive PCIP can improve drug inventory management in a simplified and sustainable manner within a resource-constrained hospital.

The Eastring gas pipeline in the context of the Central and Eastern European gas supply challenge

Science.gov (United States)

Mišík, Matúš; Nosko, Andrej

2017-11-01

Ever since the 2009 natural gas crisis, energy security has been a crucial priority for countries of Central and Eastern Europe. Escalating in 2014, the conflict between Ukraine and Russia further fuelled negative expectations about the future development of energy relations for the region predominantly supplied by Russia. As a response to the planned cessation of gas transit through the Brotherhood pipeline, which brings Russian gas to Europe via Ukraine and Slovakia, the Slovak transmission system operator Eustream proposed the Eastring pipeline. This Perspective analyses this proposal and argues that neither the perceived decrease in Slovak energy security nor the loss of economic rent from the international gas transit should be the main policy driver behind such a major infrastructure project. Although marketed as an answer to current Central and Eastern European gas supply security challenges, the Eastring pipeline is actually mainly focused on issues connected to the Slovak gas transit.

A 54 year analysis of articles from Mpilo Central Hospital, Bulawayo ...

African Journals Online (AJOL)

PubMed and Google Scholar were searched to obtain articles originating from Mpilo Central Hospital, Bulawayo, Zimbabwe - 1958 to August 2011 (54 years). 168 articles cited 999 times were retrieved giving about 6 citations per article. Analysis of publication trends over time as well as publication avenues is made.

Effects of changes in micro- and macro-environmental factors on the supply of hospitals services.

Science.gov (United States)

Kassaye, W W; Tseng, K C

1990-01-01

The failures, marketing difficulties and financial hardships hospitals have experienced raises a question as to whether they have been responsive to the changes in the micro and macro-environmental factors. To determine how responsive hospitals have been to these changes, we investigate the impact of a number of selected factors on the supply of hospital services during 1972 through 1978. The findings indicate that despite the fact that the economy went through recessionary periods, and the demographic distribution exhibited both a shift and a change in the aging and birth rates of the nation, the changes in hospitals' responsiveness have been less than satisfactory. It appears that hospitals readily respond to the changes in the micro-environment than to the changes in macro-environment. Their response to the changes in the macro-environment. Their response to the changes in the macro-environment may be characterized as an effort to create a higher level of production whose goal is to create a still higher level of needs and wants.

Cob biomass supply for combined heat and power and biofuel in the north central USA

International Nuclear Information System (INIS)

Schmer, Marty R.; Dose, Heather L.

2014-01-01

Corn (Zea mays L.) cobs are being evaluated as a potential bioenergy feedstock for combined heat and power generation (CHP) and conversion into a biofuel. The objective of this study was to determine corn cob availability in north central United States (Minnesota, North Dakota, and South Dakota) using existing corn grain ethanol plants as a proxy for possible future co-located cellulosic ethanol plants. Cob production estimates averaged 6.04 Tg and 8.87 Tg using a 40 km radius area and 80 km radius area, respectively, from existing corn grain ethanol plants. The use of CHP from cobs reduces overall GHG emissions by 60%–65% from existing dry mill ethanol plants. An integrated biorefinery further reduces corn grain ethanol GHG emissions with estimated ranges from 13.9 g CO 2  equiv MJ −1 to 17.4 g CO 2  equiv MJ −1 . Significant radius area overlap (53% overlap for 40 km radius and 86% overlap for 80 km radius) exists for cob availability between current corn grain ethanol plants in this region suggesting possible cob supply constraints for a mature biofuel industry. A multi-feedstock approach will likely be required to meet multiple end user renewable energy requirements for the north central United States. Economic and feedstock logistics models need to account for possible supply constraints under a mature biofuel industry. - Highlights: • Corn cob biomass was estimated for the north central United States region. • Cobs were evaluated for combined heat and power generation and bioethanol. • Co-located ethanol plants showed a reduction in greenhouse gas emissions. • Biomass supply constraints may occur under a mature cellulosic ethanol scenario

Evaluation of natural gas supply options for south east and central Europe. Part 1: Indicator definitions and single indicator analysis

International Nuclear Information System (INIS)

Afgan, Naim H.; Carvalho, Maria G.; Pilavachi, Petros A.; Martins, Nelson

2007-01-01

The need for diversification of energy sources is an immanent goal in long term energy strategy. In particular, this is of great importance for the natural gas supply. In this respect, evaluation and assessment of potential natural gas resources and their relation to consumers is of great importance. The natural gas supply in Europe is one of the main issues of European energy strategy to be followed in the future. In particular, the natural gas supply in the southeast countries is important. This paper provides a framework for understanding how much natural gas is available for use in south east and central Europe as well as the links to the recent supply of natural gas and its transport. The analysis is focused on evaluation of the potential routes for natural gas supply to the south east and central European countries. The potential options included in this analysis are the Yamal Route; Nabucco Route; West Balkan Route; LNG NEUM Route and Gas by Wire Route. In this analysis, attention is focused on the following indicators for assessment of potential options: environmental indicator; NG cost indicator; NG transport and royalty indicator; investment indicator; and NG demand indicator. The first part of this paper is devoted to the definition of the indicators and to single indicator analysis. (author)

Introducing DRG-based financing in Hungary : a study into the relationship between supply of hospital beds and use of these beds under changing institutional circumstances

NARCIS (Netherlands)

Kroneman, Madelon W.; Nagy, Júlia

2001-01-01

Most hospital reforms carried out in Europe over the past few decades concern the supply of hospital beds and hospital financing systems. In Hungary, financing was not tied to hospital input or output until a Diagnosis-Related-Group system was introduced. This change provided an opportunity to study

The relationship of centralization, organizational culture and performance indexes in teaching hospitals affiliated to Tehran University of Medical Sciences.

Science.gov (United States)

Nasirpour, Amir Ashkan; Gohari, Mahmoud Reza; Moradi, Saied

2010-01-01

One of the main problems in the efficiency and efficacy of an organization is its structural issue. Organizational culture is also considered as an effective factor in the performance of many organizations. The main goal of the present study was to determine the relationship of Centralization and organizational culture and performance indexes in Teaching Hospitals affiliated to Tehran University of Medical Sciences. This correlation study was performed in the year 2007. The population studied consisted of 4408 personnel from 13 hospitals among whom 441 subjects were selected and studied via a class sampling method. Data was compiled using a check list concerning the evaluation status of Centralization and another form concerning performance indexes as well as Robbin's organizational culture questionnaire. Data were obtained from the subjects by self answering and analyzed by using descriptive statistical indexes, T- test and Fisher's exact tests. Among the organizational culture indexes of the hospitals studied, control and organizational identity was better as compared to others (mean=3.32 and 3.30). Concerning the extent of Centralization in the hospitals studied, 53.85 % and 46.15 % were reported to have upper and lower organizational Centralization, respectively. Mean ratio of surgical operations to inpatients was 40%, the mean rate of admissions per active bed was 60.83, mean bed occupancy coefficient was 70.79%, average length of stay was 6.96 days, and mean net death rate was 1.41%. No significant correlation was seen between Centralization degree, organizational culture and performance indexes in teaching hospitals Tehran university of medical sciences. (with 95% confidence interval). Due to the fact that first grade Teaching hospitals use board certified members, expert personnel, and advanced equipments and because of the limitation of patients choice and, the extent of Centralization and many organizational culture components have no significant

42 CFR 409.14 - Supplies, appliances, and equipment.

Science.gov (United States)

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Supplies, appliances, and equipment. 409.14 Section... Hospital Services § 409.14 Supplies, appliances, and equipment. (a) Except as specified in paragraph (b) of this section, Medicare pays for supplies, appliances, and equipment as inpatient hospital or inpatient...

Development of personnel radiation monitoring program for occupationally exposed workers in Malawian Hospitals : A case study of Kamuzu Central, Bwaila and Mtengo Wa Nthenga Hospitals

International Nuclear Information System (INIS)

Chinangwa, Getrude

2016-07-01

Malawi became an IAEA member state in 2006 and developed the Atomic Energy Act and Regulations in 2011 and 2012 respectively. However, regulatory authority and personnel monitoring services have not yet been established. As such, hospitals operating radiological services in Malawi do not have personnel monitoring programme. This study aimed at developing the personnel radiation monitoring program for three hospitals in Malawi namely; Kamuzu Central Hospital, Bwaila Hospital, and Mtengo wa Nthenga Hospital. A radiation protection questionnaire was administered to the X-ray Departments involved in the study to investigate radiation protection practices in the hospitals. Dose rate measurements in the facilities were taken using survey meters and doses to individuals were recorded using personal dosimeters. The results showed that the hospitals lack radiation protection program which covers the critical issues of quality assurance and control as well as the personnel dose monitoring. Average ambient dose rate values were 0.39 μSv/hr for Mtengo wa Nthenga Hospital, 5.03 μSv/hr for Bwaila Hospital and 4μSv/hr for Kamuzu Central Hospital. Average monthly dose for workers was 0.247 mSv. The study recommends the establishment of a regulatory authority, consistent dose assessment, quality control tests and structural shielding assessment in these and probably all the diagnostic facilities in Malawi. The personnel monitoring programme developed from this study is intended to guide diagnostic facilities and personnel monitoring service providers in Malawi in tracking and reporting exposure record for their occupationally exposed workers. (au)

SURVEY OF DEMAND AND SUPPLY BALANCE IN LOAN MARKETS: CENTRAL BANK'S EXPERIENCE

Directory of Open Access Journals (Sweden)

S. Naumenkova

2014-09-01

Full Text Available This article examines the existing Bank Lending Survey (BLS approaches to the assessment of the non-price lending conditions' impact on the credit market balance. BLS responses provided domestic central banks an early and reliable signal about the deterioration of financing conditions and the financial access. The monitoring pattern stipulate by using the core indicators: net percentage, diffusion index, Bank Lending Tightness (BLT. The priority tasks for National Bank of Ukraine for Bank Lending Survey were put forward by author. Senior Loan Officer Opinion Survey (SLOOS on Bank Lending Practices address changes in the supply of, and demand for, bank loans to businesses and households over the past months.

Depletion of blood supply and cost due to indeterminate donations at the Guillermo Almenara Irigoyen National Hospital

Directory of Open Access Journals (Sweden)

Jeel Moya-Salazar

2017-06-01

Full Text Available Objective: To evaluate the depletion of blood supply and the cost due to indeterminate donations at Hospital Nacional Guillermo Almenara Irigoyen during 2014. Materials and methods: A retrospective cross-sectional study and a cost-utility analysis were conducted in donations showing results in the gray zone (sample value/cutoff value between >0.85 and <1 after a serological screening of seven infectious markers (HIV, HBsAg, HBcAb, HCV, HTLV-1/2, syphilis and Chagas disease and the simultaneous determination of the HIV Ag/Ab combo by means of a fourth generation ELISA. Data was encoded and tabulated using the e-Delphyn® system. The cost-utility analysis was performed considering the current exchange rate. Results: Out of 9,560 donations, 20.7% (1977 donations showed results in the gray zone which caused a loss of 863.9 liters of blood and USD 92,640. The highest and lowest rate of seroprevalence were observed in HBcAb with 10.18% (973 indeterminate test results and anti-HIV with 0.39% (47 indeterminate test results, respectively (p<0.05. No significant differences were found between the anti-HIV y HIV Ag/Ab combo screening methods (p=0.776. Conclusions: It was demonstrated that more than 800 liters of discarded blood generated a more than USD 90,000 cost due to indeterminate donations causing economic damages to the hospital budget and a depletion of blood supply available for patients at Hospital Nacional Guillermo Almenara Irigoyen.

[Antiretroviral drug supply in Argentina: National Program to Combat Human Retroviruses, AIDS, and STDs].

Science.gov (United States)

Colautti, Marisel; Luppi, Irene; Salamano, Mercedes; Traverso, María Luz; Botta, Carina; Palchik, Valeria

2009-01-01

To evaluate the supply cycle of antiretroviral (ARV) drugs, overseen by the National Program to Combat Human Retroviruses, AIDS, and STDs, through its order fulfillment indicators, and to obtain input from supply chain stakeholders. A study was carried out from April-September 2005 in the pharmacies of two hospitals in Rosario, Argentina, involving both a quantitative analysis of indicators and secondary sources and a qualitative evaluation using semistructured interviews. The indicators reveal the impact that interruptions in ARV supply stream from the Program (central level) have and the overstocking that takes place at the pharmacies (local level) to manage the shortages. Changes in ARV treatment account for over 50% of the prescriptions. Fulfillments fall short of the reference value. The interviewees shared possible strategies for overcoming the communication gaps between levels, for building-up stock, for guaranteeing availability, and for shortening waiting times; reached informal agreements to deal with the lack of policies and the shortage of staff; acknowledged the challenges facing the jurisdictions (central, intermediate, and local/community); and recognized local efforts to improve management. These challenges could be the starting point for building teams to work on effectively decentralizing the entire supply chain and allowing the Program to fulfill its much-needed oversight role.

Prospects for development of heat supply systems in high-rise districts

Science.gov (United States)

Zhila, Viktor; Solovyeva, Elena

2018-03-01

The article analyzes the main advantages and disadvantages of centralized and decentralized heat supply systems in high-rise districts. The main schemes of centralized heat supply systems are considered. They include centralized heat supply from boiler houses, centralized heat supply from autonomous heat sources, heat supply from roof boiler houses and door-to-door heating supply. For each of these variant, the gas distribution systems are considered and analyzed. These systems vary depending on the heat source location. For each of these systems, technical and economic indicators are taken into account, the analysis of which allows choosing the best option for districts where high-rise buildings predominate.

Alignment of global supply networks based on strategic groups of supply chains

OpenAIRE

Nikos G. Moraitakis; Jiazhen Huo; Hans-Christian Pfohl

2017-01-01

Background: From a supply chain perspective, often big differences exist between global raw material suppliers’ approaches to supply their respective local markets. The progressing complexity of large centrally managed global supply networks and their often-unknown upstream ramifications increase the likelihood of undetected bottlenecks and inefficiencies. It is therefore necessary to develop an approach to strategically master the upstream complexity of such networks from a holistic su...

Role of water quality assessments in hospital infection control: Experience from a new oncology center in eastern India

Directory of Open Access Journals (Sweden)

Ramkrishna Bhalchandra

2014-01-01

Full Text Available Water quality assessment and timely intervention are essential for health. Microbiology, total dissolved solids (TDS and free residual chlorine were measured for water quality maintenance in an oncology center in India. Impact of these interventions over a period of 22 months has been demonstrated with four cardinal events. Pseudomonas in hospital water was controlled by adequate chlorination, whereas high TDS in the central sterile supply department water was corrected by the installation of electro-deionization plant. Contaminated bottled water was replaced using quality controlled hospital supply. Timely detection and correction of water-related issues, including reverse osmosis plant was possible through multi-faceted approach to water quality.

Comparative ecobalancing accounting of semi-central house heat supply from wood residues; Vergleichende Oekobilanzierung der semi-zentralen Hauswaermebereitstellung aus Holzreststoffen

Energy Technology Data Exchange (ETDEWEB)

Biemann, Kirsten

2015-07-01

In 2008 almost 40 percent of the German final energy demand was used for room heating and hot water supply. To decrease environmental burdens and to save fossil resources a restructuring of the heating sector is needed. Therefore legislation enforces higher insulation standards of buildings and a more frequent use of renewable energies as well as heating networks. Wood as a renewable and storable energy source is an attractive fuel. However, it must be used as efficiently as possible because of limited wood supplies. Connecting buildings via a heating network is a good option since bigger heating plants can operate at higher efficiencies than small heaters. However, the higher insulation standards of the buildings often oppose the construction of a heating network, because heating networks work best with high energy demands and low network lengths. Therefore the environmental and economic feasibility of new heating networks needs to be checked beforehand. This thesis explores the environmental burdens of different semi- centralized heating networks using wood residues as fuel. A semi- centralized heating network is a network with no more than 500 customers and a heating plant with less than 5 MWth. While wood residues are used in the base load plant, peak load is covered by a gas heating plant. As a method to analyze the potential environmental burdens of the heat supply a life cycle assessment according to ISO 14040/44 is used. Opposed to former life cycle assessment studies, construction and operation of the network is included in the assessment. Even though the environmental impacts of the semi- centralized heating from wood residues are dominated by the heat supply, an observation of the impacts solely at the heating plant is not sufficient. By varying the boundary conditions of the heating network two main contributors to the environmental impacts are found. In addition to the heat production at the plant the type of the buildings in the settlement has a huge

Clinical risk management in hospitals: strategy, central coordination and dialogue as key enablers.

Science.gov (United States)

Briner, Matthias; Manser, Tanja; Kessler, Oliver

2013-04-01

The study aims to identify key enablers fostering clinical risk management (CRM) in hospitals to guide health care in this vital area of patient safety. A cross-sectional survey was conducted at the national level in 324 Swiss hospitals in 2007-2008 to assess the relationship between key elements and systematic CRM. Therefore, a comprehensive monitoring instrument for CRM was used for the first time. Organizational factors (e.g. strategy, coordination, resources) and structural conditions (e.g. hospital size) were tested as key elements. CRM was assessed by evaluating its maturity (i.e. the level of CRM development) by 12 theoretically derived indices joining together essential aspects of CRM at the hospital level and the service level. Chi-square measures were used to analyse the relationships between organizational factors or structural conditions and maturity of CRM. Participation in this voluntary survey was good, with CRM experts of 138 out of 324 hospitals responding (response rate 43%). Three key enablers for CRM were identified: implementing a function for central CRM coordination, assuring dialogue with and between the different hospital services, and developing strategic CRM objectives. This study offers, for the first time, an assessment of the maturity of hospitals' CRM and identifies key enablers related to CRM. This is a feasible first step in guiding hospitals to shape their CRM and presents a basis for future studies, for example, linking CRM to outcome data. © 2012 Blackwell Publishing Ltd.

Specialized consultant in radiological safety to the north central hospital of high speciality, PEMEX. II. - August of 2001; Asesoria especializada en seguridad radiologica al hospital central norte de alta especialidad, PEMEX II.- Agosto de 2001

Energy Technology Data Exchange (ETDEWEB)

Angeles C, A.; Vizuet G, J.; Benitez S, J. A.; Rodriguez A, F.; Garcia A, J

2001-10-15

The north central hospital of high speciality, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Author)0.

Specialized consultant in radiological safety to the north central hospital of high speciality, PEMEX. I. - July of 2001; Asesoria especializada en seguridad radiologica al hospital central norte de alta especialidad, PEMEX I.- Julio de 2001

Energy Technology Data Exchange (ETDEWEB)

Angeles C, A.; Vizuet G, J.; Benitez S, J. A

2001-09-15

The north central hospital of high speciality, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Author)

Specialized consultant in radiological safety to the south central hospital of high speciality, PEMEX. I. - July of 2001; Asesoria especializada en seguridad radiologica al hospital central sur de alta especialidad, PEMEX I.- Julio de 2001

Energy Technology Data Exchange (ETDEWEB)

Angeles C, A.; Vizuet G, J

2001-09-15

The south central hospital of high speciality, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Author)

Specialized consultant in radiological safety to the south central hospital of high speciality, PEMEX. II.- August of 2001; Asesoria especializada en seguridad radiologica al hospital central sur de alta especialidad, PEMEX II.- Agosto de 2001

Energy Technology Data Exchange (ETDEWEB)

Angeles C, A.; Vizuet G, J.; Benitez S, J. A.; Rodriguez A, F.; Garcia A, J

2001-12-15

The south central hospital of high speciality, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Author)

Specialized consultant in radiological safety to the south central hospital of high speciality, PEMEX. III.- September of 2001; Asesoria especializada en seguridad radiologica al hospital central sur de alta especialidad, PEMEX III.- Septiembre de 2001

Energy Technology Data Exchange (ETDEWEB)

Angeles C, A.; Vizuet G, J.; Benitez S, J. A.; Rodriguez A, F.; Garcia A, J

2001-12-15

The south central hospital of high speciality, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Author)

Specialized consultant in radiological safety to the north central hospital of high speciality, PEMEX. III. - September of 2001; Asesoria especializada en seguridad radiologica al hospital central norte de alta especialidad, PEMEX III.- Septiembre de 2001

Energy Technology Data Exchange (ETDEWEB)

Angeles C, A; Vizuet G, J; Benitez S, J A; Rodriguez A, F; Garcia A, J

2001-12-15

The north central hospital of high speciality, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Author)

Specialized consultant in radiological safety to the south central hospital of high speciality, PEMEX. V. - November of 2001; Asesoria especializada en seguridad radiologica al hospital central sur de alta especialidad, PEMEX. V.- Noviembre de 2001

Energy Technology Data Exchange (ETDEWEB)

Angeles C, A; Vizuet G, J; Benitez S, J A; Garcia A, J; Rodriguez A, F

2002-01-15

The south central hospital of high speciality, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Autho000.

Two-tier charging in Maputo Central Hospital: costs, revenues and effects on equity of access to hospital services.

Science.gov (United States)

McPake, Barbara; Hongoro, Charles; Russo, Giuliano

2011-06-02

Special services within public hospitals are becoming increasingly common in low and middle income countries with the stated objective of providing higher comfort services to affluent customers and generating resources for under funded hospitals. In the present study expenditures, outputs and costs are analysed for the Maputo Central Hospital and its Special Clinic with the objective of identifying net resource flows between a system operating two-tier charging, and, ultimately, understanding whether public hospitals can somehow benefit from running Special Clinic operations. A combination of step-down and bottom-up costing strategies were used to calculate recurrent as well as capital expenses, apportion them to identified cost centres and link costs to selected output measures. The results show that cost differences between main hospital and clinic are marked and significant, with the Special Clinic's cost per patient and cost per outpatient visit respectively over four times and over thirteen times their equivalent in the main hospital. While the main hospital cost structure appeared in line with those from similar studies, salary expenditures were found to drive costs in the Special Clinic (73% of total), where capital and drug costs were surprisingly low (2 and 4% respectively). We attributed low capital and drug costs to underestimation by our study owing to difficulties in attributing the use of shared resources and to the Special Clinic's outsourcing policy. The large staff expenditure would be explained by higher physician time commitment, economic rents and subsidies to hospital staff. On the whole it was observed that: (a) the flow of capital and human resources was not fully captured by the financial systems in place and stayed largely unaccounted for; (b) because of the little consideration given to capital costs, the main hospital is more likely to be subsidising its Special Clinic operations, rather than the other way around. We conclude that the

Two-tier charging in Maputo Central Hospital: Costs, revenues and effects on equity of access to hospital services

Directory of Open Access Journals (Sweden)

Russo Giuliano

2011-06-01

Full Text Available Abstract Background Special services within public hospitals are becoming increasingly common in low and middle income countries with the stated objective of providing higher comfort services to affluent customers and generating resources for under funded hospitals. In the present study expenditures, outputs and costs are analysed for the Maputo Central Hospital and its Special Clinic with the objective of identifying net resource flows between a system operating two-tier charging, and, ultimately, understanding whether public hospitals can somehow benefit from running Special Clinic operations. Methods A combination of step-down and bottom-up costing strategies were used to calculate recurrent as well as capital expenses, apportion them to identified cost centres and link costs to selected output measures. Results The results show that cost differences between main hospital and clinic are marked and significant, with the Special Clinic's cost per patient and cost per outpatient visit respectively over four times and over thirteen times their equivalent in the main hospital. Discussion While the main hospital cost structure appeared in line with those from similar studies, salary expenditures were found to drive costs in the Special Clinic (73% of total, where capital and drug costs were surprisingly low (2 and 4% respectively. We attributed low capital and drug costs to underestimation by our study owing to difficulties in attributing the use of shared resources and to the Special Clinic's outsourcing policy. The large staff expenditure would be explained by higher physician time commitment, economic rents and subsidies to hospital staff. On the whole it was observed that: (a the flow of capital and human resources was not fully captured by the financial systems in place and stayed largely unaccounted for; (b because of the little consideration given to capital costs, the main hospital is more likely to be subsidising its Special Clinic

Prevalencia de displasia y cáncer cervicouterino y factores asociados en el Hospital Central de Chihuahua, México

OpenAIRE

Ivonne Salas-Urrutia; Eyra Alejandra Villalobos; Brenda Lizeth Ramírez-Vega

2006-01-01

Objetivos: Los objetivos del presente estudio fueron determinar la prevalencia y los factores de riesgo asociados a cáncer cervicouterino en; las mujeres que acuden al Hospital Central de Chihuahua en el 2004 ya que no se cuenta registros de esta entidad en la ciudad de Chihuahua.; Material y Métodos: Se realizó un estudio observacional, transversal, donde se incluyó a mujeres que demandaron realizarse la citología; cervical en el Hospital Central del Estado de Chihuahua, en el año 2...

Beyond the bundle: a survey of central line-associated bloodstream infection prevention practices used in US and Canadian pediatric hospitals.

Science.gov (United States)

Klieger, Sarah B; Potter-Bynoe, Gail; Quach, Caroline; Sandora, Thomas J; Coffin, Susan E

2013-11-01

We surveyed US and Canadian pediatric hospitals about their use of central line-associated bloodstream infection (CLABSI) prevention strategies beyond typical insertion and maintenance bundles. We found wide variation in supplemental strategies across hospitals and in their penetration within hospitals. Future studies should assess specific adjunctive prevention strategies and CLABSI rates.

Endogeneity of Money Supply: Evidence From Turkey

Directory of Open Access Journals (Sweden)

Oguzhan Cepni

2017-02-01

Full Text Available There is a long discussion among academics and central bankers about the theories of money supply. According to the exogenous view, central banks have the full control over money supply via policy actions including the adjustments of interest rates and reserve ratios, both of which alter commercial banks’ lending decisions. However, the theory of endogenous money supply emphasizes the role of demand for bank loans in money creation. More specifically, banks create money by meeting the demand of economic agents. In this study, we investigate which of the money supply theories holds in Turkish economy for the period 2006-2015 by employing cointegration and causality tests. Our findings show that the causality runs from bank loans to money supply both in the short and long terms, which supports the endogenous view in a sense that central bank and the banks fully meet the total demand for money in Turkish economy.

The spectrum of central nervous system infections in an adult referral hospital in hanoi, Vietnam

NARCIS (Netherlands)

Taylor, Walter R.; Nguyen, Kinh; Nguyen, Duc; Nguyen, Huyen; Horby, Peter; Nguyen, Ha L.; Lien, Trinh; Tran, Giang; Tran, Ninh; Nguyen, Ha M.; Nguyen, Thai; Nguyen, Ha H.; Nguyen, Thanh; Tran, Giap; Farrar, Jeremy; de Jong, Menno; Schultsz, Constance; Tran, Huong; Nguyen, Diep; Vu, Bich; Le, Hoa; Dao, Trinh; Nguyen, Trung; Wertheim, Heiman

2012-01-01

To determine prospectively the causative pathogens of central nervous system (CNS) infections in patients admitted to a tertiary referral hospital in Hanoi, Vietnam. From May 2007 to December 2008, cerebrospinal fluid (CSF) samples from 352 adults with suspected meningitis or encephalitis underwent

Endogeneity of Money Supply: Evidence From Turkey

OpenAIRE

Oguzhan Cepni; Ibrahim Ethem Guney

2017-01-01

There is a long discussion among academics and central bankers about the theories of money supply. According to the exogenous view, central banks have the full control over money supply via policy actions including the adjustments of interest rates and reserve ratios, both of which alter commercial banks’ lending decisions. However, the theory of endogenous money supply emphasizes the role of demand for bank loans in money creation. More specifically, banks create money by meeting the demand ...

[Research of regional medical consumables reagent logistics system in the modern hospital].

Science.gov (United States)

Wu, Jingjiong; Zhang, Yanwen; Luo, Xiaochen; Zhang, Qing; Zhu, Jianxin

2013-09-01

To explore the modern hospital and regional medical consumable reagents logistics system management. The characteristics of regional logistics, through cooperation between medical institutions within the region, and organize a wide range of special logistics activities, to make reasonable of the regional medical consumable reagents logistics. To set the regional management system, dynamic management systems, supply chain information management system, after-sales service system and assessment system. By the research of existing medical market and medical resources, to establish the regional medical supplies reagents directory and the initial data. The emphasis is centralized dispatch of medical supplies reagents, to introduce qualified logistics company for dispatching, to improve the modern hospital management efficiency, to costs down. Regional medical center and regional community health service centers constitute a regional logistics network, the introduction of medical consumable reagents logistics services, fully embodies integrity level, relevance, purpose, environmental adaptability of characteristics by the medical consumable reagents regional logistics distribution. Modern logistics distribution systems can increase the area of medical consumables reagent management efficiency and reduce costs.

Specialized consultant in radiological safety to the north central hospital of high speciality, PEMEX. I. - May-June of 2003; Asesoria especializada en seguridad radiologica al hospital central norte de alta especialidad, PEMEX I.- Mayo-Junio de 2003

Energy Technology Data Exchange (ETDEWEB)

Angeles C, A.; Camacho V, B.; Rodriguez A, F

2003-09-15

The north central hospital of high speciality, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Author)

A multi-criteria assessment of scenarios on thermal processing of infectious hospital wastes: A case study for Central Macedonia

International Nuclear Information System (INIS)

Karagiannidis, A.; Papageorgiou, A.; Perkoulidis, G.; Sanida, G.; Samaras, P.

2010-01-01

In Greece more than 14,000 tonnes of infectious hospital waste are produced yearly; a significant part of it is still mismanaged. Only one off-site licensed incineration facility for hospital wastes is in operation, with the remaining of the market covered by various hydroclave and autoclave units, whereas numerous problems are still generally encountered regarding waste segregation, collection, transportation and management, as well as often excessive entailed costs. Everyday practices still include dumping the majority of solid hospital waste into household disposal sites and landfills after sterilization, still largely without any preceding recycling and separation steps. Discussed in the present paper are the implemented and future treatment practices of infectious hospital wastes in Central Macedonia; produced quantities are reviewed, actual treatment costs are addressed critically, whereas the overall situation in Greece is discussed. Moreover, thermal treatment processes that could be applied for the treatment of infectious hospital wastes in the region are assessed via the multi-criteria decision method Analytic Hierarchy Process. Furthermore, a sensitivity analysis was performed and the analysis demonstrated that a centralized autoclave or hydroclave plant near Thessaloniki is the best performing option, depending however on the selection and weighing of criteria of the multi-criteria process. Moreover the study found that a common treatment option for the treatment of all infectious hospital wastes produced in the Region of Central Macedonia, could offer cost and environmental benefits. In general the multi-criteria decision method, as well as the conclusions and remarks of this study can be used as a basis for future planning and anticipation of the needs for investments in the area of medical waste management.

Influencing the central heating technologies installed in homes: The role of social capital in supply chain networks

International Nuclear Information System (INIS)

Wade, Faye; Shipworth, Michelle; Hitchings, Russell

2016-01-01

The likely installation of, and potential energy savings from, low carbon technologies in domestic buildings is not only dependent on those who fit them, but also the broader supply chains of which they are part. Despite this, the role of supply chain actors has been largely overlooked in strategies seeking to encourage the installation of more sustainable domestic heating technologies. With reference to central heating, this paper responds through an ethnographic analysis of how plumbers' merchants and sales representatives can influence the work of heating installers in the United Kingdom. It applies two dimensions of the concept of ‘social capital’: relational and structural. Relational social capital focuses on the trust, loyalty and reciprocity at play in relations, whilst structural social capital considers how the strength of tie can influence those to whom people turn for advice and support. Together, these ideas demonstrate how relationships amongst these groups can serve to influence product choice and facilitate information exchange. The paper concludes by discussing how these supply chains might be engaged with as a means of encouraging the installation of low carbon domestic technologies. - Highlights: •Ethnography is used to investigate the relationships in heating supply chains. •Social capital is seen to be an important part of these relationships. •These relationships could help in the promotion of low carbon technologies.

We are family? Spanish law and lesbian normalization in Hospital Central.

Science.gov (United States)

Calvo, Mónica; Escudero, Maite

2009-01-01

After four decades of a repressive dictatorial regime during which homosexuality was banned and punished with prison sentence and electroshock, Spain became a democratic country in 1978. The social, political, and legal debates previous to the passing of the law on same-sex marriage in June 2005 fueled lesbian visibility in the media. Considering that the emergence of lesbian representation has been linked to these social and political changes, our contribution centers on the ways in which the prime time TV series Hospital Central unravels as a vehicle for the normalization of lesbian relationships and families as addressed to a mostly heterosexual audience.

Prescribing Albumin in a Central Hospital. New Standards versus Old Habits

OpenAIRE

Pasini, J; Marcelino, P

2012-01-01

O presente estudo teve como objectivo aferir a adequação da prescrição de albumina humana num hospital central à evidência científica nesta área actualmente disponível. O estudo foi retrospectivo e analisou os pedidos de albumina aos serviços farmacêuticos entre Setembro de 2007 e Agosto de 2008. Analisadas 761 requisições de 619 doentes com idade média de 58,1 +/- 14,7 anos, 510 (77%) dos quais do sexo masculino. Foram avaliados parâmetros analíticos globais (proteínas totais, album...

ENDOGENEITY OF INDONESIAN MONEY SUPPLY

OpenAIRE

Rachma, Meutia Safrina

2011-01-01

There has been a long debate about the endogeneity of money supply. The main objective of this article is to identify whether money supply in Indonesia is an exogenous or an endogenous variable. Using a Vector Autoregressive model and monthly data 1997(5)-2010(6), the estimation result shows that money supply in Indonesia is an endogenous variable. The movement of broad money supply does influence the movement of base money and Consumer Price Index. Consequently, the central bank does not hav...

Endogeneity Of Indonesian Money Supply

OpenAIRE

Rachma, Meutia Safrina

2010-01-01

There has been a long debate about the endogeneity of money supply. The main objective of this article is to identify whether money supply in Indonesia is an exogenous or an endogenous variable. Using a Vector Autoregressive model and monthly data 1997(5)-2010(6), the estimation result shows that money supply in Indonesia is an endogenous variable. The movement of broad money supply does influence the movement of base money and Consumer Price Index. Consequently, the central bank does not hav...

Specialized consultant in radiological safety to the clinical north central hospital of high speciality, PEMEX. IV. - December of 2001; Asesoria especializada en seguridad radiologica a la clinica hospital central norte de alta especialidad, PEMEX. IV.- Diciembre de 2001

Energy Technology Data Exchange (ETDEWEB)

Angeles C, A.; Vizuet G, J.; Benitez S, J. A.; Garcia A, J.; Rodriguez A, F

2002-01-15

The clinical north central hospital of high speciality, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Author)

Specialized consultant in radiological safety to the south central hospital of high speciality, PEMEX. IV. - October of 2001; Asesoria especializada en seguridad radiologica a la clinica al hospital central sur de alta especialidad, PEMEX. IV.- Octubre de 2001

Energy Technology Data Exchange (ETDEWEB)

Angeles C, A.; Vizuet G, J.; Benitez S, J. A.; Garcia A, J.; Rodriguez A, F

2002-01-15

The south central hospital of high speciality, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Author)

Aetiologies of central nervous system infection in Viet Nam: a prospective provincial hospital-based descriptive surveillance study.

Directory of Open Access Journals (Sweden)

Nghia Ho Dang Trung

Full Text Available Infectious diseases of the central nervous system (CNS remain common and life-threatening, especially in developing countries. Knowledge of the aetiological agents responsible for these infections is essential to guide empiric therapy and develop a rational public health policy. To date most data has come from patients admitted to tertiary referral hospitals in Asia and there is limited aetiological data at the provincial hospital level where most patients are seen.We conducted a prospective Provincial Hospital-based descriptive surveillance study in adults and children at thirteen hospitals in central and southern Viet Nam between August 2007-April 2010. The pathogens of CNS infection were confirmed in CSF and blood samples by using classical microbiology, molecular diagnostics and serology.We recruited 1241 patients with clinically suspected infection of the CNS. An aetiological agent was identified in 640/1241 (52% of the patients. The most common pathogens were Streptococcus suis serotype 2 in patients older than 14 years of age (147/617, 24% and Japanese encephalitis virus in patients less than 14 years old (142/624, 23%. Mycobacterium tuberculosis was confirmed in 34/617 (6% adult patients and 11/624 (2% paediatric patients. The acute case fatality rate (CFR during hospital admission was 73/617 (12% in adults and to 42/624 (7% in children.Zoonotic bacterial and viral pathogens are the most common causes of CNS infection in adults and children in Viet Nam.

Depression in chronic respiratory disorders in a tertiary rural hospital of Central India

Institute of Scientific and Technical Information of China (English)

Sameer singhal; Pankaj Banode; Nitish Baisakhiya

2009-01-01

Objective: To determine prevalence of depression in chronic respiratory disorders in a tertiary rural hospital of Central India. Various studies done in past have shown that prevalence of depression in diabetes and hypertension is around 40%-57%. Few studies have been done to screen depression in chronic respiratory disorders. This study was conducted in a tertiary rural hospital of Central India to find out prevalence of depression in indoor patients suffering from chronic respiratory disorders. Methods: Total 68 patients were evaluated for depression. Patients suffering from chronic respiratory disorders (total duration of illness >3 months) were evaluated using Prime MD Questionnaire. Patients suffering from diabetes, heart diseases, stroke, having past history of psychiatric illness, drug abusers, having lack of social support and suffering from chronic upper respiratory tract infections were excluded from this study. Questionnaire was asked when treatment for acute phase of illness is over. Results: Out of 68 patients evaluated, 36 (53%) were found out to be suffering from depression. Female gender (80%) was more prone to depression, inspite of the fact that all alcoholics were male. 39% of all chronic obstructive pulmonary disease (COPD) patients were suffering from depression in comparison to 65% for pulmonary tuberculosis and 44% for other chronic respiratory illness. 54% of patients suffering from depression are 60 yrs of age, suggesting that age has no relation with depression. No association was seen between alcoholism and depression. Conclusion: Prevalence of depression in patients of chronic respiratory illness is very high, like in cases of diabetes and hypertension. Further community and hospital based studies are needed to find out exact prevalence of depression in chronic respiratory illnesses.

Characteristics and visual outcomes of patients hospitalized for ocular trauma in central China:2006-2011

Directory of Open Access Journals (Sweden)

Ying Qi

2015-05-01

Full Text Available AIM: To complete the data of ocular trauma in central China, as a well-known tertiary referral center for ocular trauma, we documented the epidemiological characteristics and visual outcomes of patients hospitalized for ocular trauma in this region. METHODS: A retrospective study of patients hospitalized for ocular trauma in central China from 2006 to 2011 was performed. RESULTS: This study included 5964 eyes of 5799 patients. The average age was 35.5±21.8y with a male-to-female ratio of 2.8:1. The most common age was 45-59y age group. Most patients were farmers and workers (51.9%. The most common injuries were firework related (24.5%, road traffic related (24.2%, and work related (15.0%. Among the most common causative agents were firecrackers (24.5%, followed by metal/knife/scissors (21.4%. Most injuries occurred in January (14.2%, February (27.0%, and August (10.0%. There were 8.5% patients with ocular injuries combined with other injuries. The incidence of open ocular injuries (4585 eyes, 76.9% was higher than closed ocular injuries (939 eyes, 15.7%. The incidences of chemical and thermal ocular injuries were 1.2% and 0.6%. Ocular trauma score (OTS predicted final visual acuity at non light perception (NLP, 20/200-20/50 and 20/40 with a sensitivity of 100%, and light perception (LP/hand motion (HM and 1/200-19/200 with a specificity of 100%. CONCLUSIONS: This study provides recent epidemiological data of patients hospitalized for ocular trauma in central China. Some factors influencing the visual outcome include time interval between injury and visit to the clinic, wound location, open or closed globe injury, initial visual acuity, and OTS.

Tying supply chain costs to patient care.

Science.gov (United States)

Parkinson, Rosalind C

2014-05-01

In September 2014, the FDA will establish a unique device identification (UDI) system to aid hospitals in better tracking and managing medical devices and analyzing their effectiveness. When these identifiers become part of patient medical records, the UDI system will provide a much-needed link between supply cost and patient outcomes. Hospitals should invest in technology and processes that can enable them to trace supply usage patterns directly to patients and analyze how these usage patterns affect cost and quality.

ENDOGENEITY OF INDONESIAN MONEY SUPPLY

Directory of Open Access Journals (Sweden)

Meutia Safrina Rachma

2011-09-01

Full Text Available There has been a long debate about the endogeneity of money supply. The main objective of this article is to identify whether money supply in Indonesia is an exogenous or an endogenous variable. Using a Vector Autoregressive model and monthly data 1997(5-2010(6, the estimation result shows that money supply in Indonesia is an endogenous variable. The movement of broad money supply does influence the movement of base money and Consumer Price Index. Consequently, the central bank does not have control power on money supply. The bank is only able to maintain the stability and control the movement of broad money supply. Keywords: Endogenous variable, money supply, vector autoregressionJEL classification numbers: E51, E52, E58

[Application of supply chain integration management of medical consumables].

Science.gov (United States)

Zhang, Jian

2013-07-01

This paper introduces the background, the content, the information management system of material supply chain integration management and the consumables management process. The system helps to expand the selection of hospital supplies varieties, to reduce consumables management costs, to improve the efficiency of supplies, to ensure supplies safety, reliability and traceability.

Effects of rainwater harvesting on centralized urban water supply systems

DEFF Research Database (Denmark)

Grandet, C.; Binning, Philip John; Mikkelsen, Peter Steen

2010-01-01

depths but very different temporal distributions. Supply reliability and the extent of reliance on the public distribution system are identified as suitable performance indicators for mains water infrastructure. A uniform temporal distribution of rainfall in an oceanic climate like that of Dinard......, Northern France, yielded supply reliabilities close to 100% for reasonable tank sizes (0.065 m3/m2 of roof area in Dinard compared with 0.262 m3/m2 in Nice with a RWSO of 30% for a detached house). However, the collection and use of rainfall results in a permanent decrease in mains water demand leading...... to an increase in water age in the distribution network. Investigations carried on a real network showed that water age is greatly affected when rainwater supplies more than 30% of the overall water demand. In urban water utilities planning, rainwater supply systems may however be profitable for the community...

Assessing the Vulnerability of Public-Supply Wells to Contamination: Central Valley Aquifer System near Modesto, California

Science.gov (United States)

Jagucki, Martha L.; Jurgens, Bryant C.; Burow, Karen R.; Eberts, Sandra M.

2009-01-01

This fact sheet highlights findings from the vulnerability study of a public-supply well in Modesto, California. The well selected for study pumps on average about 1,600 gallons per minute from the Central Valley aquifer system during peak summer demand. Water samples were collected at the public-supply well and at monitoring wells installed in the Modesto vicinity. Samples from the public-supply wellhead contained the undesirable constituents uranium, nitrate, arsenic, volatile organic compounds (VOCs), and pesticides, although none were present at concentrations exceeding drinking-water standards. Of these contaminants, uranium and nitrate pose the most significant water-quality risk to the public-supply well because human activities have caused concentrations in groundwater to increase over time. Overall, study findings point to four primary factors that affect the movement and (or) fate of contaminants and the vulnerability of the public-supply well in Modesto: (1) groundwater age (how long ago water entered, or recharged, the aquifer); (2) irrigation and agricultural and municipal pumping that drives contaminants downward into the primary production zone of the aquifer; (3) short-circuiting of contaminated water down the public-supply well during the low-pumping season; and (4) natural geochemical conditions of the aquifer. A local-scale computer model of groundwater flow and transport to the public-supply well was constructed to simulate long-term nitrate and uranium concentrations reaching the well. With regard to nitrate, two conflicting processes influence concentrations in the area contributing recharge to the well: (1) Beneath land that is being farmed or has recently been farmed (within the last 10 to 20 years), downward-moving irrigation waters contain elevated nitrate concentrations; yet (2) the proportion of agricultural land has decreased and the proportion of urban land has increased since 1960. Urban land use is associated with low nitrate

Squaring the circle of healthcare supplies.

Science.gov (United States)

Böhme, Tillmann; Williams, Sharon; Childerhouse, Paul; Deakins, Eric; Towill, Denis

2014-01-01

The purpose of this paper is to use a systems lens to assess the comparative performance of healthcare supply chains and provide guidance for their improvement. A well-established and rigorous multi-method audit methodology, based on the uncertainty circle model, yields an objective assessment of value stream performance in eight Australasian public sector hospitals. Cause-effect analysis identifies the major barriers to achieving smooth, seamless flows. Potentially high-leverage remedial actions identified using systems thinking are examined with the aid of an exemplar case. The majority of the healthcare value streams studied are underperforming compared with those in the European automotive industry. Every public hospital appears to be caught in the grip of vicious circles of system uncertainty, in large part being caused by problems of their own making. The single exception is making good progress towards seamless functional integration, which has been achieved by elevating supply chain management to a core competence; having a clearly articulated supply chain vision; adopting a systems approach; and, managing supplies with accurate information. The small number of cases limits the generalisability of the findings at this time. Hospital supply chain managers endeavouring to achieve smooth and seamless supply flows should attempt to elevate the status of supplies management within their organisation to that of a core competence, and should use accurate information to manage their value streams holistically as a set of interwoven processes. A four-level prism model is proposed as a useful framework for thus improving healthcare supply delivery systems. Material flow concepts originally developed to provide objective assessments of value stream performance in commercial settings are adapted for use in a healthcare setting. The ability to identify exemplar organisations via a context-free uncertainty measure, and to use systems thinking to identify high

Correspondence: risk factors of acute respiratory infection in under-fives in a rural hospital of Central India – Authors’ reply

Directory of Open Access Journals (Sweden)

Amar Taksande

2016-07-01

Full Text Available Dear Editor,We thank the authors for their interest and comments on our paper. They have raised some very valid points. This corrispondence refers to the following article:Taksande AM, Yeole M. Risk factors of Acute Respiratory Infection (ARI in under-fives in a rural hospital of Central India. J Pediatr Neonat Individual Med. 2016;5(1:e050105. doi: 10.7363/050105 br />Comments can be found in the following article:Mandal A, Sahi PK. Correspondence: risk factors of acute respiratory infection in under-fives in a rural hospital of Central India. J Pediatr Neonat Individual Med. 2016;5(2:e050207. doi: 10.7363/050207

The anti-hepatitis drug use effect and inventory management optimization from the perspective of hospital drug supply chain.

Science.gov (United States)

Liu, Zhanyu

2017-09-01

By analyzing the current hospital anti hepatitis drug use, dosage, indications and drug resistance, this article studied the drug inventory management and cost optimization. The author used drug utilization evaluation method, analyzed the amount and kind distribution of anti hepatitis drugs and made dynamic monitoring of inventory. At the same time, the author puts forward an effective scheme of drug classification management, uses the ABC classification method to classify the drugs according to the average daily dose of drugs, and implements the automatic replenishment plan. The design of pharmaceutical services supply chain includes drug procurement platform, warehouse management system and connect to the hospital system through data exchange. Through the statistical analysis of drug inventory, we put forward the countermeasures of drug logistics optimization. The results showed that drug replenishment plan can effectively improve drugs inventory efficiency.

Finding gold in the supply chain.

Science.gov (United States)

Caudle, Allen

2009-12-01

To optimize supply chain performance and achieve savings that enhance the bottom line, hospitals should: Generate purchase orders for every item purchased. Ensure the organization is protected from undue vendor influence. Keep track of where supply chain dollars are going. Review contracts regularly to ensure competitiveness. Have a contract for each product category. Buy only what the organization is sure to use. Get rid of excess inventory. Develop a strategic plan for continued supply chain savings.

Specialized consultant in radiological safety to the north central hospital of high speciality, PEMEX. III. - September of 2001

International Nuclear Information System (INIS)

Angeles C, A.; Vizuet G, J.; Benitez S, J. A.; Rodriguez A, F.; Garcia A, J.

2001-12-01

The north central hospital of high speciality, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Author)

Specialized consultant in radiological safety to the north central hospital of high speciality, PEMEX. II. - August of 2001

International Nuclear Information System (INIS)

Angeles C, A.; Vizuet G, J.; Benitez S, J. A.; Rodriguez A, F.; Garcia A, J.

2001-10-01

The north central hospital of high speciality, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Author)

Specialized consultant in radiological safety to the north central hospital of high speciality, PEMEX. I. - July of 2001

International Nuclear Information System (INIS)

Angeles C, A.; Vizuet G, J.; Benitez S, J. A.

2001-09-01

The north central hospital of high speciality, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Author)

Specialized consultant in radiological safety to the south central hospital of high speciality, PEMEX. II.- August of 2001

International Nuclear Information System (INIS)

Angeles C, A.; Vizuet G, J.; Benitez S, J. A.; Rodriguez A, F.; Garcia A, J.

2001-12-01

The south central hospital of high speciality, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Author)

Specialized consultant in radiological safety to the south central hospital of high speciality, PEMEX. III.- September of 2001

International Nuclear Information System (INIS)

Angeles C, A.; Vizuet G, J.; Benitez S, J. A.; Rodriguez A, F.; Garcia A, J.

2001-12-01

The south central hospital of high speciality, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Author)

Specialized consultant in radiological safety to the south central hospital of high speciality, PEMEX. IV. - October of 2001

International Nuclear Information System (INIS)

Angeles C, A.; Vizuet G, J.; Benitez S, J. A.; Garcia A, J.; Rodriguez A, F.

2002-01-01

The south central hospital of high speciality, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Author)

Specialized consultant in radiological safety to the south central hospital of high speciality, PEMEX. I. - July of 2001

International Nuclear Information System (INIS)

Angeles C, A.; Vizuet G, J.

2001-09-01

The south central hospital of high speciality, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Author)

Specialized consultant in radiological safety to the south central hospital of high speciality, PEMEX. V. - November of 2001

International Nuclear Information System (INIS)

Angeles C, A.; Vizuet G, J.; Benitez S, J. A.; Garcia A, J.; Rodriguez A, F.

2002-01-01

The south central hospital of high speciality, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Author)

Diagnostic, evaluation and handling of the tumors of soft tissues. Experience in the Central Military Hospital

International Nuclear Information System (INIS)

Pineda Acero, Gustavo Adolfo; Torres Quintero, Pio

2001-01-01

With the purpose of analyzing the experience of the orthopedics service and traumatology of the central military hospital in the treatment of the tumors of soft tissues, it carries out a descriptive observational study, type series of cases and retrospective. The incidence of the tumors of soft tissues compared with carcinomas and other neoplasia, constitutes less than 1% of all cancerous and the benign ones are more common than the wicked ones in a range of 100:1. The knowledge of the classification, stadification, evaluation strategies, previous biopsy, surgical treatment, radiotherapy y/o chemotherapy is vital for a good final result. 29 clinical histories were included of patient with tumoral lesions in the soft tissues, valued in the central military hospital between March of 1996 and March of 2001. The age average was of 39 years and the pursuit of 24 months. In most of the cases the anatomical commitment belonged to the inferior members (93%), 79% for benign tumors and 21% for wicked tumors. To avoid incorrect diagnoses and inappropriate treatments it is necessary the coordinated evaluation of all multidisciplinary team

The evolving role of supply chain management technology in healthcare.

Science.gov (United States)

Langabeer, Jim

2005-01-01

The healthcare supply chain is a vast, disintegrated network of products and players, loosely held together by manual and people-intensive processes. Managing the flow of information, supplies, equipment, and services from manufacturers to distributors to providers of care is especially difficult in clinical supply chains, compared with more technology-intense industries like consumer goods or industrial manufacturing. As supplies move downstream towards hospitals and clinics, the quality and robustness of accompanying management and information systems used to manage these products deteriorates significantly. Technology that provides advanced planning, synchronization, and collaboration upstream at the large supply manufacturers and distributors rarely is used at even the world's larger and more sophisticated hospitals. This article outlines the current state of healthcare supply chain management technologies, addresses potential reasons for the lack of adoption of technologies and provides a roadmap for the evolution of technology for the future. This piece is based on both quantitative and qualitative research assessments of the healthcare supply chain conducted during the last two years.

Editorial: Supply Chain Management

Directory of Open Access Journals (Sweden)

Dimitrios Aidonis

2017-05-01

Full Text Available This special issue has followed up the 3rd Olympus International Conference on Supply Chains held on Athens Metropolitan Expo, November 7 & 8 2015, Greece. The Conference was organized by the Department of Logistics Technological Educational Institute of Central Macedonia, in collaboration with the: a Laboratory of Quantitative Analysis, Logistics and Supply Chain Management of the Department of Mechanical Engineering, Aristotle University of Thessaloniki (AUTH, b Greek Association of Supply Chain Management (EEL of Northern Greece and the c Supply Chain & Logistics Journal. During the 2-Days Conference more than 60 research papers were presented covering the following thematic areas: (i Transportation, (ii Best Practices in Logistics, (iii Information and Communication Technologies in Supply Chain Management, (iv Food Logistics, (v New Trends in Business Logistics, and (vi Green Supply Chain Management. Three keynote invited speakers addressed interesting issues for the Operational Research, the Opportunities and Prospects of Greek Ports chaired Round Tables with other Greek and Foreign Scientists and Specialists.

[Primary lymphoma of the central nervous system: 20 years' experience in a referral hospital].

Science.gov (United States)

Calderón-Garcidueñas, A L; Pacheco-Calleros, J; Castelán-Maldonado, E; Nocedal-Rustrián, F C

Primary central nervous system lymphomas (PCNSL) are rare neoplasms. AIM. To study the clinical aspects and the immuno-phenotype of all cases of PCNSL in a 20 years lapse in a referral hospital in Northeastern Mexico. From January 1986 to December 2005 all PCNSL histologically confirmed were studied. The primary lymphomas were 1% of malignant central nervous system neoplasms. 21 cases were studied (ages from 9-70 years) with male predominance (2:1). 24% patients had immuno-suppression. The more frequent clinical data were: papilledema (71%), headache (62%), paresis (48%) and seizures (33%). 33% of patients died during the first six months after diagnosis. The T lymphomas were 19% of cases and corresponded to small cell type. PCNSL are still a diagnostic challenge. Multicenter studies are required in order to determine the best treatment protocol.

Water supply

International Nuclear Information System (INIS)

Peterson, F.L.

1986-01-01

Options and methodologies for the development of fresh water supplies on Bikini Atoll are much the same as those practiced in the rest of the Marshall Islands and for that matter, most atolls in the central Pacific Ocean Basin. That is, rainfall distribution on Bikini produces a distinct wet season, lasting from about May through November, with the remaining months being generally dry. As a result, fresh water from surface catchments tends to be plentiful during the wet season? but is usually scarce during the dry months, and alternative sources such as groundwater must be utilized during this time. On Bikini the problems of fresh water supply are somewhat more difficult than for most Marshall Island atolls because rainfall is only about half the Marshall Island's average. Tus water supply is a critical factor limiting the carrying capacity of Bikini Atoll. To address this problem BARC has undertaken a study of the Bikini Atoll water supply. Te primary objectives of this work are to determine: (1) alternatives available for fresh water supply, 2 the amounts, location and quality of available supplies and 3 optimal development methods. The study planned for one's year duration, has been underway only since the summer of 1985 and is thus not yet fully completed. However, work done to date, which is presented in this report of preliminary findings, provides a reasonably accurate picture of Bikini's fresh water supplies and the various options available for their development. The work remaining to be completed will mainly add refinements to the water supply picture presented in the sections to follow

10 CFR 600.135 - Supplies and other expendable property.

Science.gov (United States)

2010-01-01

... acquisition. If there is a residual inventory of unused supplies exceeding $5000 in total aggregate value upon... 10 Energy 4 2010-01-01 2010-01-01 false Supplies and other expendable property. 600.135 Section... Education, Hospitals, and Other Nonprofit Organizations Post-Award Requirements § 600.135 Supplies and other...

Present and Future Supply of Registered Nurses.

Science.gov (United States)

Altman, Stuart H.

During the 1960's, nursing education shifted dramatically away from hospital-operated diploma schools toward associate degree and baccalaureate programs. This report examines the nature of this shift in training and its anticipated impact on future supply. Other important factors affecting the future supply of nurses are analyzed, including the…

Supply chain solutions to improve the distribution of antiretroviral ...

African Journals Online (AJOL)

Mamolise Mokheseng

Received 8 September 2015. Accepted 4 ... the hospital; as well as poor inventory management and poor overall communication. ..... This ensure the smooth running of supply chain operations. ...... Supply chain logistics management (4th ed.).

Alignment of global supply networks based on strategic groups of supply chains

Directory of Open Access Journals (Sweden)

Nikos G. Moraitakis

2017-09-01

Full Text Available Background: From a supply chain perspective, often big differences exist between global raw material suppliers’ approaches to supply their respective local markets. The progressing complexity of large centrally managed global supply networks and their often-unknown upstream ramifications increase the likelihood of undetected bottlenecks and inefficiencies. It is therefore necessary to develop an approach to strategically master the upstream complexity of such networks from a holistic supply chain perspective in order to align regional competitive priorities and supply chain structures. The objective of this research is hence to develop an approach for the supply-chain-based alignment of complex global supply networks. Method: We review existing literature from the fields of supply chain and network management, strategic sourcing, and strategic management. Based on the literature review and theoretical and practical considerations we deduce a conceptual approach to consider upstream supply chain structures in supply network alignment initiatives. Results: On the basis of these considerations and current empirical literature we transfer strategic group theory to the supply network management context. The proposed approach introduces strategic groups of supply chains as a segmentation criterion for complex global supply networks which enables the network-wide alignment of competitive priorities. Conclusion: Supply-chain-based segmentation of global supply network structures can effectively reduce the complexity, firms face when aiming to strategically align their supply chains on a holistic level. The results of this research are applicable for certain types of global supply networks and can be used for network alignment and strategy development. The approach can furthermore generate insights useable for negotiation support with suppliers.

Lineamientos de un plan estratégico para el mejoramiento de la calidad del servicio brindado en el Hospital Militar Central de Lima

OpenAIRE

Cabrera Rioja, Luis Alberto

2007-01-01

El presente estudio, realizado en el Hospital Militar Central (HMC) de Lima, está dirigido al diseño de los lineamientos de un plan estratégico que permita formular la misión y visión del HMC, analizar el entorno e intorno organizacional y formular objetivos estratégicos orientados al mejoramiento continuo de la calidad del servicio. A fin de superar las dificultades económicas, logísticas y de personal que afronta actualmente el Hospital Militar Central, debido a los recortes presupuestales ...

细节管理前移理念应用于中心供应室的效果评估%Effect evaluation of the concept of forward lead details management applied to central supply room

Institute of Scientific and Technical Information of China (English)

吴立新; 李君文

2013-01-01

目的 对细节管理前移理念在医院中心供应室中的作用进行研究.方法 采用自身对照设计.对照组为首都医科大学附属北京地坛医院2011年1月～2011年12月尚没有实施细节管理前移理念的中心供应室,以2012年1月～2012年12月已经实施了细节管理前移这一理念的中心供应室作为观察组.比较细节管理前移理念实施前后中心供应室的各项工作效率变化情况,并检查评分情况.结果 观察组管腔清洗的合格率(94.33％)、棉布包装的合格率(95.51％)、包装标示的合格率(94.71％)、器械附件丢失的合格率(44.25％)、攒包的合格率(9.54％),均高于对照组(59.21％、40.36％、44.25％、3.64％、3.24％),差异有统计学意义(P＜0.05)；观察组主要去污区得分为(96.22±1.18)分,包装检查灭菌区得分为(96.56±1.27)分,无菌物品存放区得分为(97.86±1.24)分,技能知识得分为(93.81±1.29)分,满意度得分为(92.26±1.23)分,均高于对照组[(82.38±2.75)、(89.21±1.26)、(81.62±3.48)、(87.52±1.39)、(86.22±2.51)分],差异有统计学意义(P＜0.05).结论 细节管理前移理论规范了中心供应室的相关管理.%Objective To study the effect of the concept of forward lead details management for hospital central supply room.Methods Taking self-control design,the central supply room that had not yet taken the concept of forward lead details management in Beijing Ditan Hospital Affiliated to Capital Medical University from January 2011 to December 2011 was selected as the control group,while the central supply room that had taken the idea from January 2012 to December 2012 was taken as the observation group.The changes of central supply room before and after the concept of forward lead details management was supplied were compared,and the scores were checked.Results The bureaucratic tone (94.33％),the cleaning pass rate (95.51％),the packaging pass rate (94.71％),the pass rate of equipment

Specialized consultant in radiological safety to the north central hospital of high speciality, PEMEX. I. - May-June of 2003

International Nuclear Information System (INIS)

Angeles C, A.; Camacho V, B.; Rodriguez A, F.

2003-09-01

The north central hospital of high speciality, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Author)

Specialized consultant in radiological safety to the clinical north central hospital of high speciality, PEMEX. IV. - December of 2001

International Nuclear Information System (INIS)

Angeles C, A.; Vizuet G, J.; Benitez S, J. A.; Garcia A, J.; Rodriguez A, F.

2002-01-01

The clinical north central hospital of high speciality, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Author)

Drug supply strategies, constraints and prospects in Nigeria.

Science.gov (United States)

Yusuff, K B; Tayo, F

2004-12-01

The study set out to identify the strategies for public drug supply in Nigeria, assess its functionality, and recommend appropriate means to ensure regular availability of safe, efficacious, good quality and affordable essential drugs at public health facilities. The investigation was carried out at the Directorate of Pharmaceutical services, Federal Ministry of Health (F.M.O.H) Abuja and Federal Medical Stores, Oshodi, Lagos. Semi-structured interview was conducted with key informants at the Department of Food & Drugs, Drug procurement unit and Central Medical store using structured questionnaires and direct informants answers. Our study shows that public drug supply in Nigeria is governed by a National Drug Policy (NDP) which was introduced in 1990 and it is yet to be reviewed after ten years. We also identified the Central Medical Store (CMS) system as the current public drug supply strategy in Nigeria. Public drug supply is mainly financed by governments and this is inadequate to ensure sustained availability of essential drugs. The major procurement methods in use are open tender and direct procurement. These methods as presently operated suffer from late order placement, delay in payment and poor supplier lead-time mainly attributable to lateness in payment for previous drug supplies. These have contributed to stock out of essential drugs at public health facilities. Major losses due to expiration and spoilage are recorded at both central and peripheral storage points despite adequacy of storage facilities and personnel. Road transportation was the major mode of drug distribution from central to peripheral storage points and shortage of vehicle was a key factor affecting drug distribution. There was an apparent lack of a functioning drug management information system to effectively coordinate public drug supply and there are no definite systems that monitor and evaluate staff performance. The CMS strategy currently used for public drug supply in Nigeria has

Protective and control relays as coal-mine power-supply ACS subsystem

Science.gov (United States)

Kostin, V. N.; Minakova, T. E.

2017-10-01

The paper presents instantaneous selective short-circuit protection for the cabling of the underground part of a coal mine and central control algorithms as a Coal-Mine Power-Supply ACS Subsystem. In order to improve the reliability of electricity supply and reduce the mining equipment down-time, a dual channel relay protection and central control system is proposed as a subsystem of the coal-mine power-supply automated control system (PS ACS).

Information technology, innovation and supply chain structure

NARCIS (Netherlands)

Stroeken, J.H.M.

2000-01-01

The link between IT, innovation and supply chain structure is central here. This article is divided into three parts. First, a theoretical analysis of the role of IT in innovation processes. Actually, it involves the total innovation of the supply chain, not merely logistic innovation. The

Variation of central corneal thickness in patients with diabetic retinopathy as detected by ultrasonic pachymetry in patients presenting to a tertiary care hospital

International Nuclear Information System (INIS)

Khan, S.A.

2017-01-01

To compare the central corneal thickness between patients with diabetic retinopathy and non diabetics. Study Design: A cross sectional study. Place and Duration of Study: Lahore General Hospital Lahore, from 1st Dec 2015 to 31st May 2016. Material and Methods: A cross-sectional study was conducted in the ophthalmology outpatient department of Lahore General Hospital. A total of one hundred and fifty subjects from different age groups were selected for the study. An ultrasound pachymeter was used to measure CCT. There were two groups for sample, 75 were patients with diabetic retinopathy and 75 of them were non-diabetic subjects. Results: The diabetic patients had average central corneal thickness of value 554.93 +- 33.73 microns. The average central corneal thickness found in non-diabetic patients was 520.41 +- 26.06 microns. The diabetic patients showed an increased central corneal thickness as compared to non-diabetics. The result of this study was statistically significant (p=0.001). Conclusion: The diabetic patients showed an increased central corneal thickness as compared to non-diabetic patients. (author)

Geothermal heat-pump systems of heat supply

International Nuclear Information System (INIS)

Vasil'ev, G.P.

2004-01-01

The data on the multilayer operation of the objects, located in the climatic conditions of the central area of Russia and equipped with the geothermal heat-pumping systems of the heat supply are presented. The results of the analytical studies on evaluating the geothermal heat-pumping systems of the heat supply integration efficiency into the structure of the energy supply system, prevailing in the country, are presented [ru

[A Survey of the Perception of Nurses Toward the Practice Environment at a Regional Teaching Hospital in Central Taiwan].

Science.gov (United States)

Hung, Jui-Tai; Lin, Ching-Wen; Wen, Wei-Chun; Lin, Esther Ching-Lan

2015-08-01

The nursing practice environment has been shown to wield significant influence on nursing retention and nursing quality of care. Because a large percentage of Taiwan nurses currently work at regional teaching hospitals, exploring the perception toward the practice environment of nurses working at this type of hospital is important. This study explored the perception of nurses working at a regional teaching hospital in central Taiwan toward their practice environment. A cross-sectional research design with a sample of 474 nurses from a regional hospital in central Taiwan was conducted. Instruments including the demographic data and the Chinese-version Practice Environment Scale-Nursing Work Index (CPES-NWI) were anonymously self-administered. Overall, participants were moderately satisfied with their practice environment, with the greatest dissatisfaction focused on staffing and resource adequacy. Work unit and nursing level, respectively, had significant impacts on perceptions regarding the practice environment. Furthermore, discriminant analysis identified two new compound variables: 1) adequate staffing resources and partnership in the workplace and 2) supportive administrative management environment. Participants who worked in medical and surgical units were significantly more dissatisfied with the adequacy of staffing resources and partnership in the workplace than participants who worked in acute/intensive and special units. Participants at the N2 level were significantly more dissatisfied with the supportive nature of the administrative management environment. These findings support that the nursing practice environment of regional hospitals may be improved using several measures, including: modifying the staffing and resource adequacy of nurses, fostering collaborative nurse-physician relationships, and further involving nurses in administrative management and decision-making.

Chapter 5. Essential equipment, pharmaceuticals and supplies. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster

NARCIS (Netherlands)

Sprung, Charles L.; Kesecioglu, Jozef; Christian, Michael D.; Camargo, Ruben; Ceraso, Daniel; Azoulay, Elie; Duguet, Alexandre; Guery, Benoit; Reinhart, Konrad; Adini, Bruria; Barlavie, Yaron; Benin-Goren, Odeda; Cohen, Robert; Klein, Motti; Leoniv, Yuval; Margalit, Gila; Rubinovitch, Bina; Sonnenblick, Moshe; Steinberg, Avraham; Weissman, Charles; Wolff, Donna; de Jong, Menno; Moreno, Rui; An, Youzhong; Du, Bin; Joynt, Gavin M.; Colvin, John; Loo, Shi; Richards, Guy; Artigas, Antonio; Pugin, Jerome; Amundson, Dennis; Devereaux, Asha; Beigel, John; Danis, Marion; Farmer, Chris; Hick, John L.; Maki, Dennis; Masur, Henry; Rubinson, Lewis; Sandrock, Christian; Talmor, Daniel; Truog, Robert; Zimmerman, Janice; Brett, Steve; Montgomery, Hugh; Rhodes, Andrew; Sanderson, Frances; Taylor, Bruce

2010-01-01

To provide recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza pandemic or mass disaster with a specific focus on essential equipment, pharmaceuticals and supplies. Based on a literature review and expert opinion, a Delphi process was

If I were a band-aid, where would I be? Researching the use and location of supplies on two patient units.

Science.gov (United States)

Bazuin, Doug; Martinez, Jessica; Harper, Kathy; Okland, Kathy; Bergquist, Patricia; Kumar, Shilpi

2015-01-01

The purpose of this study was to gain insight into the use and storage of supplies in the neonatal intensive care and women's health units of Parkland Hospital in Dallas, Texas. Construction of a new Parkland Hospital is underway, with completion of the 862-bed, 2.5-million square feet hospital in 2014. Leaders from the hospital and representatives from one of its major vendors collaborated on a research study to evaluate the hospital's current supply management system and develop criteria to create an improved system to be implemented at the new hospital. Approach includes qualitative and quantitative methods, that is, written survey, researcher observations, focus groups, and evaluation of hospital supply reports. Approaching the ideal location of supplies can be best approached by defining a nurse's activity at the point of care. Determining an optimal supply management system must be approached by understanding the "what" of caregivers' activities and then determining the "where" of the supplies that support those activities. An ideal supply management system locates supplies as close as possible to the point of use, is organized by activity, and is standardized within and across units. © The Author(s) 2015.

Mo-99 supply issues: Status report and lessons learned

International Nuclear Information System (INIS)

Ponsard, B.

2010-01-01

The worldwide supply of 99 Mo relies on a limited number of research reactors and processing facilities. Its production is essential for the nuclear medicine as 99m Tc, obtained from 99 Mo/ 99m Tc generators, is used in about 80% of the diagnostic nuclear imaging procedures. These applications represent yearly approximately 30 million examinations worldwide. The short half-life's of 99 Mo (66 hours) and its daughter 99m Tc (6 hours) require a regular supply of 99 Mo/ 99m Tc generators to hospitals or central radiopharmacies. Currently, there are only five nuclear reactors involved in the production of 99 Mo on industrial scale: NRU (Canada), HFR (Netherlands), BR2 (Belgium), OSIRIS (France) and SAFARI (South Africa). They irradiate highly enriched uranium targets for the production of about 95% of the available 99 Mo by four processing facilities: AECL/MDS NORDION (Canada), COVIDIEN (Netherlands), IRE (Belgium) and NTP (South Africa). However, these ageing reactors are subject to unscheduled shutdowns and longer maintenance periods making the 99 Mo supply chain vulnerable and unreliable. Several severe disruptions have been experienced since the fall 2005 due to the occurrence of problems at different stages of the supply chain: reactor outages, release of activity from processing facilities, recall of 99 Mo/ 99m Tc generators by the manufacturers, ... It is not expected that the situation will improve significantly in the near future. Therefore, several workshops have been organized in 2009 by the OECD Nuclear Energy Agency (NEA), the International Atomic Energy Agency (IAEA) and the Association of Imaging Producers and Equipment Suppliers (AIPES) to define measures that should be taken to secure the 99 Mo supply in the short, medium and long term. This paper summarizes the current status of the 99 Mo supply, discusses the ongoing plans for additional 99 Mo production capacity and outlines the issues for a reliable global supply chain. (author)

U.S. healthcare fix: leveraging the lessons from the food supply chain.

Science.gov (United States)

Kumar, Sameer; Blair, John T

2013-01-01

U.S. healthcare costs consistently outpace inflation, causing growing problems of affordability. This trend cannot be sustained indefinitely. The purpose of this study is to use supply-chain tools for macro-level examination of the U.S. healthcare as a business system and identify options and best use practices. We compare the important and successful U.S. food industry to the essential but problematic U.S. healthcare industry. Supply chain strategies leading to food business operations success are examined and healthcare applications suggested. We emphasize "total cost of ownership" which includes all costs incurred by all stakeholders of U.S. healthcare, including maintenance and cleanup, not just the initial purchase price. U.S. hospitals and clinics can use supply chain strategies in a total cost of ownership framework to reduce healthcare costs while maintaining patient care quality. Supply chain strategies of resource pooling, mass customization, centralized logistics, specialization, postponement and continuous improvement that have been successfully used in the U.S. food industry should be more widely applied to the U.S. healthcare industry. New and growing areas of telemedicine and medical tourism should be included in the supply chain analysis of U.S. healthcare. Valid statistical analysis of results in all areas of U.S. healthcare is an important part of the process. U.S. healthcare industry problems are systematic operational and supply chain problems rather than problems with workforce or technology. Examination of the U.S. healthcare industry through a supply chain framework should lead to significant operational improvement in both prevention and treatment of acute and chronic ailments. A rational and unemotional reorganization of the U.S. healthcare system operations, using supply chain strategies, should help reduce healthcare costs while maintaining quality and increasing accessibility.

Macroeconomic susceptibility, inflation, and aggregate supply

Science.gov (United States)

Hawkins, Raymond J.

2017-03-01

We unify aggregate-supply dynamics as a time-dependent susceptibility-mediated relationship between inflation and aggregate economic output. In addition to representing well various observations of inflation-output dynamics this parsimonious formalism provides a straightforward derivation of popular representations of aggregate-supply dynamics and a natural basis for economic-agent expectations as an element of inflation formation. Our formalism also illuminates questions of causality and time-correlation that challenge central banks for whom aggregate-supply dynamics is a key constraint in their goal of achieving macroeconomic stability.

[The Jewish Hospital in Budapest under the Nazi occupation (1944-1945)].

Science.gov (United States)

Weisskopf, Varda

2008-01-01

On March 19, 1944 the German army invaded and occupied Hungary. The Waffen-SS soldiers captured the buildings of the Jewish community in Budapest, including the famous and important Jewish hospital on Szabolcs Street, founded in 1802. The Jewish hospital moved into a school belonging to the Jewish community on 44 Wesselényi Street. The hospital personnel managed to smuggle out medical equipment, and operating rooms were transferred into this central, temporary medical location. Other hospitals were founded, some inside the ghetto, others outside. The Judenrat supplied these hospitals with medical equipment obtained through contributions from Jews. The temporary hospitals admitted sick patients and a great number of those injured as a result of the war in Budapest. These hospitals operated with poor equipment. Surgeries were sometimes performed on kitchen tables, and medical equipment was sterilized by burning the synagogue's benches and library books. As of December 1944, there was no electricity in the hospitals. Thus doctors were forced to operate by the light of candles and flashlights. Nevertheless, they managed to save numerous lives. In spite of the terrible conditions under which the medical staff worked, they were committed to their mission, and their courage deserves appreciation. Ghetto Budapest was liberated by the Red army on 18th January, 1945. Thousands of Jews were released from the temporary hospitals.

The Study for Optimizing of the Electricity Power Supply in Central Java Province

International Nuclear Information System (INIS)

Herdinie, Sc S; Sudi-Ariyanto; Edi-Sartono; Suprapto; Nuryanti

2004-01-01

Electricity planning includes identification of electricity generation potential and problem where solution are being planned through the annual program. Due to correlation between electricity growth and economic growth, the sensitivity study for Central Java province has been done using three scenarios of annual electricity growth, i.e.: 6.7 %, 8 % and 10 % within the study period of 2003-2020. The tool used in this sensitivity study is WASP IV. From result the calculation gives total installed capacity in the end of study period for each electricity growth scenario are 3960 MW, 5500 MW and 8620 MW respectively. Total produced energy in the end of study period for each electricity growth scenario are 32301 G Wh, 39619 G Wh and 54374 G Wh. For total fuel required. Coal still predominate in all scenarios, followed by HSD and Gas. According to this study, Nuclear power plant can be introduced in 2020 for scenario of 8 % growth and 2017 for that of 10 % growth. WASP is utilized for projecting electricity supply. (author)

Evaluation of hospital medication inventory policies.

Science.gov (United States)

Gebicki, Marek; Mooney, Ed; Chen, Shi-Jie Gary; Mazur, Lukasz M

2014-09-01

As supply chain costs constitute a large portion of hospitals' operating expenses and with $27.7 billion spent by the US hospitals on drugs alone in 2009, improving medication inventory management provides a great opportunity to decrease the cost of healthcare. This study investigates different management approaches for a system consisting of one central storage location, the main pharmacy, and multiple dispensing machines located in each department. Each medication has a specific unit cost, availability from suppliers, criticality level, and expiration date. Event-driven simulation is used to evaluate the performance of several inventory policies based on the total cost and patient safety (service level) under various arrangements of the system defined by the number of drugs and departments, and drugs' criticality, availability, and expiration levels. Our results show that policies that incorporate drug characteristics in ordering decisions can address the tradeoff between patient safety and cost. Indeed, this study shows that such policies can result in higher patient safety and lower overall cost when compared to traditional approaches. Additional insights from this study allow for better understanding of the medication inventory system's dynamics and suggest several directions for future research in this topic. Findings of this study can be applied to help hospital pharmacies with managing their inventory.

INVESTIGATION OF LEGIONELLA SPECIES IN TEHRAN’S HOSPITAL WATER SUPPLIES

Directory of Open Access Journals (Sweden)

MOHAMMAD RAFIEE

2015-03-01

Full Text Available The present work was performed to investigate the presence of Legionella spp. and its common species in hospital water supplies. Considering the drawback of culture method, polymerase chain reaction (PCR assays were developed to detect the gene 16S rRNA regardless of the bacterial serotype. Four well-established DNA extraction protocols (freeze & thaw and phenol-chloroform as two manual protocols and two commercial kits were examined and critiqued to release DNA from bacterial cells. A total of 45 samples were collected from seven distinct hospitals’ sites during a period of 10 months. The PCR assay was exploited to amplify a 654-bp fragment of the 16S rRNA gene. Legionella were detected in 13 samples (28.9% by all of the methods applied for DNA extraction. Considerable differences were noted in the yield of extracted nucleic acids. Legionella were not detected in any of the samples when DNA extraction by freeze & thaw was used. Omitting this method and comparing manual protocol with commercial kits, Kappa coefficient was calculated as 0.619 with p < 0.05. Although no meaningful differences were found between the kits, DNA extraction with Bioneer kit displayed a higher sensitivity than classical Qiagen. Showerheads and cold-water taps were the most and least contaminated sources with 55.5 and 9 percent positive samples, respectively. Moreover two positive samples were identified for species by DNA sequencing and submitted to the Gene Bank database with accession Nos. FJ480932 and FJ480933.

Etiologic Agents of Central Nervous System Infections among Febrile Hospitalized Patients in the Country of Georgia

OpenAIRE

Akhvlediani, Tamar; Bautista, Christian T.; Shakarishvili, Roman; Tsertsvadze, Tengiz; Imnadze, Paata; Tatishvili, Nana; Davitashvili, Tamar; Samkharadze, Tamar; Chlikadze, Rusudan; Dvali, Natia; Dzigua, Lela; Karchava, Mariam; Gatserelia, Lana; Macharashvili, Nino; Kvirkvelia, Nana

2014-01-01

OBJECTIVES: There is a large spectrum of viral, bacterial, fungal, and prion pathogens that cause central nervous system (CNS) infections. As such, identification of the etiological agent requires multiple laboratory tests and accurate diagnosis requires clinical and epidemiological information. This hospital-based study aimed to determine the main causes of acute meningitis and encephalitis and enhance laboratory capacity for CNS infection diagnosis. METHODS: Children and adults patients cli...

Analysis of uranium supply to 2050

International Nuclear Information System (INIS)

2001-05-01

The central theme of this report is to assess the adequacy of uranium resources to meet future requirements based on a range of opinions as to the future of nuclear power. The report discusses three demand cases that project uranium requirements from 2000 to 2050. The report also reviews the supply sources that are expected to be available to meet reactor uranium demand through to 2050. Supply is divided into two broad categories: secondary and primary supply. The report also assesses the adequacy of uranium resources to satisfy market based production requirements

Analysis of energy wood supply chain in thinning operations: a case study in a pine stand of Central Italy

Directory of Open Access Journals (Sweden)

Baldini S

2010-10-01

Full Text Available Thinning is an essential practice in Mediterranean pine forests management but is rarely applied because of the high harvesting costs. The new market of bioenergy products could give a profit to wood biomass harvesting activities, though the drawbacks of elevated supply chain costs, related to technical problems and lack of knowledge about the wood quality have to be overcome in advance. This study analyzed technical, economic, energy and environmental factors of a pine stand thinning in Central Italy, where collected biomass was directed to energy, in order to give a decisional support to reach economical profitability and environmental sustainability in thinning practices. The introduction of Full Tree System maximized the recovery of available biomass, full tree chipping produced material with Heating Value superior than single tree components. The use of a felling frame in motor-manual felling in comparison with the traditional chainsaw reduced operator effort, increasing the number of felled trees per hour, when the stump diameter remained under 15 cm. The energy wood supply chain is not sustainable from an economic point of view, the profitability could be reached only acting on suggested technical levers and particularly reducing costs of hauling operation. The estimation of output/input energy ratio in the supply chain underlined the feasibility of thinning practices for energy. The assessment of CO2 emissions confirmed the environmental sustainability of biomass supply chain in energy when compared to traditional fossil fuels. Study conclusions provide the guidelines for thinning treatment in Mediterranean pine stands, in order to reach environmental and economic sustainability of these practices.

Implementing health care reform: implications for performance of public hospitals in central Ethiopia.

Science.gov (United States)

Manyazewal, Tsegahun; Matlakala, Mokgadi C

2018-06-01

Understanding the way health care reforms have succeeded or failed thus far would help policy makers cater continued reform efforts in the future and provides insight into possible levels of improvement in the health care system. This work aims to assess and describe the implications of health care reform on the performance of public hospitals in central Ethiopia. A facility-based, cross-sectional study was carried out in five public hospitals with different operational characteristics that have been implementing health care reform in central Ethiopia. The reform documents were reviewed to assess the nature and targets of the reform for interpretive analysis. Adopting dimensions of health system performance as the theoretical framework, a self-administered questionnaire was developed. Consenting health care professionals who have been involved in the reform from inception to implementation filled the questionnaire. Cronbach's alpha was measured to ensure internal consistency of the instrument. Descriptive statistics, weighted median score, χ 2 , and Mann-Whitney U and Kruskal-Wallis tests were used for data analysis. s Despite implementation of the reform, the health care system in public hospitals was still fragmented as confirmed by 50% of respondents. Limited effects were reported in favour of quality (48%), access (50%), efficiency (51%), sustainability (53%), and equity (61%) of care, while poor effects were reported in patient-provider (41%) and provider-management (32%) interactions. Though there was substantial gain in infrastructure and workspace, stewardship of health care resources was less benefited. The predominant hindrances of the reform were the working environment (adjusted Odds Ratio (aOR) = 2.27, 95% confidence interval (CI): 1.15-4.47), financial resources (aOR = 3.54, 95%CI = 1.97-6.33), management (aOR = 2.27, 95% CI = 1.15-4.47), and information technology system (aOR = 3.15, 95% CI = 1.57-6.32). s The Ethiopian

Research Methodologies in Supply Chain Management

DEFF Research Database (Denmark)

Kotzab, Herbert

. Within the 36 chapters 70 authors bring together a rich selection of theoretical and practical examples of how research methodologies are applied in supply chain management. The book contains papers on theoretical implications as well as papers on a range of key methods, such as modelling, surveys, case...... studies or action research. It will be of great interest to researchers in the area of supply chain management and logistics, but also to neighbouring fields, such as network management or global operations.......While supply chain management has risen to great prominence in recent year, there are hardly related developments in research methodologies. Yet, as supply chains cover more than one company, one central issue is how to collect and analyse data along the whole or relevant part of the supply chain...

Smart Power Supply for Battery-Powered Systems

Science.gov (United States)

Krasowski, Michael J.; Greer, Lawrence; Prokop, Norman F.; Flatico, Joseph M.

2010-01-01

A power supply for battery-powered systems has been designed with an embedded controller that is capable of monitoring and maintaining batteries, charging hardware, while maintaining output power. The power supply is primarily designed for rovers and other remote science and engineering vehicles, but it can be used in any battery alone, or battery and charging source applications. The supply can function autonomously, or can be connected to a host processor through a serial communications link. It can be programmed a priori or on the fly to return current and voltage readings to a host. It has two output power busses: a constant 24-V direct current nominal bus, and a programmable bus for output from approximately 24 up to approximately 50 V. The programmable bus voltage level, and its output power limit, can be changed on the fly as well. The power supply also offers options to reduce the programmable bus to 24 V when the set power limit is reached, limiting output power in the case of a system fault detected in the system. The smart power supply is based on an embedded 8051-type single-chip microcontroller. This choice was made in that a credible progression to flight (radiation hard, high reliability) can be assumed as many 8051 processors or gate arrays capable of accepting 8051-type core presently exist and will continue to do so for some time. To solve the problem of centralized control, this innovation moves an embedded microcontroller to the power supply and assigns it the task of overseeing the operation and charging of the power supply assets. This embedded processor is connected to the application central processor via a serial data link such that the central processor can request updates of various parameters within the supply, such as battery current, bus voltage, remaining power in battery estimations, etc. This supply has a direct connection to the battery bus for common (quiescent) power application. Because components from multiple vendors may have

Centrally Banked Cryptocurrencies

OpenAIRE

Danezis, George; Meiklejohn, Sarah

2015-01-01

Current cryptocurrencies, starting with Bitcoin, build a decentralized blockchain-based transaction ledger, maintained through proofs-of-work that also generate a monetary supply. Such decentralization has benefits, such as independence from national political control, but also significant limitations in terms of scalability and computational cost. We introduce RSCoin, a cryptocurrency framework in which central banks maintain complete control over the monetary supply, but rely on a distribut...

Centrally Banked Cryptocurrencies

OpenAIRE

Danezis, G.; Meiklejohn, S.

2016-01-01

Current cryptocurrencies, starting with Bitcoin, build a decentralized blockchain-based transaction ledger, maintained through proofs-of-work that also serve to generate a monetary supply. Such decentralization has benefits, such as independence from national political control, but also significant limitations in terms of computational costs and scalability. We introduce RSCoin, a cryptocurrency framework in which central banks maintain complete control over the monetary supply, but rely on...

Stop the supply chain insanity. Retail as a model for hospitals.

Science.gov (United States)

Belkoski, David A

2008-04-01

The healthcare supply chain has yet to embrace any single industrywide source for synchronized product data. A synchronized product data system is a keystone in other multibillion-dollar markets. University Health Care System (UHCS), Augusta, Ga., developed a pilot program that demonstrates the benefits of data standardization and synchronization and enabled the system to recognize productivity gains in the supply chain.

Heterogeneity of farms entering export supply chains: the case of fruit growers from central-south Chile

Energy Technology Data Exchange (ETDEWEB)

Barrena, J.; Nahuelhual, L.; Engler, A.; Echeverria, R.; Cofre, G.

2013-06-01

The increasing stringency of world food markets requires farmers to adjust farm structure and commercial strategies to remain integrated in export supply chains. The goal of this study was to identify and characterize different types of fresh fruit farms with regard to farm structural and commercial strategies for a representative sample of fresh fruit growers from central-south Chile exporting to world markets. A typology of farms was constructed based on multivariate analysis, according to which five types of farms were differentiated from five distinct factors. Cluster I comprised the smallest and uncertified farms (14.3% of the sample). The remaining four clusters comprised certified farms, but with different farm structural and commercial characteristics. Cluster II (15.1%) was composed of farms located further from market connections. Cluster III (23.9%) comprised farms with the highest number of fruit species, and consequently, more diversified in fruit production. Cluster IV (8.8%) was the smallest group, and comprised the largest firms. Finally, Cluster V (37.8%) was composed of highly specialized fruit farms, with the highest proportion of hectares dedicated to the production of a single fruit species. The results show the heterogeneity among fresh fruit farms and support the need for differentiated incentives and technological transfer schemes from the public sector and fruit companies in order to successfully keep farmers within export supply chains. (Author) 40 refs.

Facilitators and Inhibitors of Supply Chain Innovation-prospects for Supply Chain Managment in the Irish Grocery Sector

OpenAIRE

Keegan, Joan; O'Callaghan, Edmund; Wilcox, Mary

2001-01-01

Supply chain management is one of the most significant strategic challenges currently facing the Irish grocery sector. The UK grocery market with its emphasis on composite deliveries via regional distribution centres is extremely sophisticated; the Irish grocery sector, however, is in the embryonic stage of implementing central distribution. The potential to develop innovative supply chain systems is mediated by both national logistic-related variables and company characteristics. In additio...

The Supply Chain Has No Clothes: Technology Adoption of Blockchain for Supply Chain Transparency

Directory of Open Access Journals (Sweden)

Kristoffer Francisco

2018-01-01

Full Text Available Blockchain technology, popularized by Bitcoin cryptocurrency, is characterized as an open-source, decentralized, distributed database for storing transaction information. Rather than relying on centralized intermediaries (e.g., banks this technology allows two parties to transact directly using duplicate, linked ledgers called blockchains. This makes transactions considerably more transparent than those provided by centralized systems. As a result, transactions are executed without relying on explicit trust [of a third party], but on the distributed trust based on the consensus of the network (i.e., other blockchain users. Applying this technology to improve supply chain transparency has many possibilities. Every product has a long and storied history. However, much of this history is presently obscured. Often, when negative practices are exposed, they quickly escalate to scandalous, and financially crippling proportions. There are many recent examples, such as the exposure of child labor upstream in the manufacturing process and the unethical use of rainforest resources. Blockchain may bring supply chain transparency to a new level, but presently academic and managerial adoption of blockchain technologies is limited by our understanding. To address this issue, this research uses the Unified Theory of Acceptance and Use of Technology (UTAUT and the concept of technology innovation adoption as a foundational framework for supply chain traceability. A conceptual model is developed and the research culminates with supply chain implications of blockchain that are inspired by theory and literature review.

Allogenic bone grafts used at Central Hospital during June 1995 to July 1998

International Nuclear Information System (INIS)

Yolchai Jongjirasiri; Yongyudh Vajaradul

1999-01-01

Producing and using allogenic bone graft in Thailand began ten years ago. There are approximately 1,000 cases a year on orthopaedic surgery at Central Hospital. For using allogenic bone graft from the Bangkok Biomaterial Center, 66 cases were operated since June 1995. This was generated by 30 in males, 36 in females and by ages between 12-81 years old. After the operation, 43 cases had bone gap from injuries and 19 cases, fusion of spondylolisthesis and scoliosis were done. Four cases had tumor surgery, and 59 out of 66 cases had good bone union that is 89%. Delayed union happened in 6 cases only. Immune response to allogenic bone graft has not been found yet

[Basic research on digital logistic management of hospital].

Science.gov (United States)

Cao, Hui

2010-05-01

This paper analyzes and explores the possibilities of digital information-based management realized by equipment department, general services department, supply room and other material flow departments in different hospitals in order to optimize the procedures of information-based asset management. There are various analytical methods of medical supplies business models, providing analytical data for correct decisions made by departments and leaders of hospital and the governing authorities.

Reconstruction of Low Pressure Gas Supply System

Directory of Open Access Journals (Sweden)

S. N. Osipov

2013-01-01

Full Text Available The current reconstruction of residential areas in large cities especially with the developed heat-supply systems from thermal power stations and reduction of heat consumption for heating due to higher thermal resistance of building enclosing structures requires new technical solutions in respect of gas-supply problems. While making reconstruction of a gas-supply system of the modernized or new buildings in the operating zone of one gas-distribution plant it is necessary to change hot water-supply systems from gas direct-flow water heaters to centralized heat-supply and free gas volumes are to be used for other needs or gas-supply of new buildings with the current external gas distribution network.Selection of additional gas-line sections and points of gas-supply systems pertaining to new and reconstructed buildings for their connection to the current distribution system of gas-supply is to be executed in accordance with the presented methodology.

Bedding, not boarding. Psychiatric patients boarded in hospital EDs create crisis for patient care and hospital finances.

Science.gov (United States)

Kutscher, Beth

2013-11-18

As the supply of psychiatric beds dwindles, hospitals are devising innovative ways handle psych patients who come through the emergency department. Some collaborate with other hospitals, use separate pysch EDs or refer patients to residential treatment centers.

Monitoring Changes of Ecosystem Services Supply and Demand Pattern in Central and Southern Liaoning Urban Agglomerations, China Using Landsat Images

Science.gov (United States)

Li, B.; Huang, F.; Chang, S.; Qi, H.; Zhai, H.

2018-04-01

Indentifying the spatio-temporal patterns of ecosystem services supply and demand and the driving forces is of great significance to the regional ecological security and sustainable socio-economic development. Due to long term and high-intensity development, the ecological environment in central and southern Liaoning urban agglomerations has been greatly destroyed thereafter has restricted sustainable development in this region. Based on Landsat ETM and OLI images, land use of this urban agglomeration in 2005, 2010 and 2015 was extracted. The integrative index of multiple-ecosystem services (IMES) was used to quantify the supply (IMESs), demand (IMESd) and balance (IMESb) of multiple-ecosystem services, The spatial patterns of ecosystem services and its dynamics for the period of 2005-2015 were revealed. The multiple regression and stepwise regression analysis were used to explore relationships between ecosystem services and socioeconomic factors. The results showed that the IMESs of the region increased by 2.93 %, whereas IMESd dropped 38 %. The undersupplied area was reduced to 2. The IMESs and IMESb were mainly negatively correlated with gross domestic product (GDP), population density, foreign investment and industrial output, while GDP per capita and the number of teachers had significant positive impacts on ecosystem services supply. The positive correlation between IMESd and GDP, population density and foreign investment were found. The ecosystem services models were established. Supply and balance of multiple-ecosystem services were positively correlated with population density, but the demand was the opposite. The results can provide some reference value for the coordinately economic and ecological development in the study area.

Centralized, Decentralized, and Hybrid Purchasing Organizations

DEFF Research Database (Denmark)

Bals, Lydia; Turkulainen, Virpi

This paper addresses one of the focal issues in purchasing and supply management – global sourcing – from an organizational design perspective. In particular, we elaborate the traditional classification of global sourcing organization designs into centralized, decentralized, and hybrid models. We...... organization we can identify organization designs beyond the classical centralization-decentralization continuum. We also provide explanations for the observed organization design at GCC. The study contributes to research on purchasing and supply management as well as research on organization design....

Out for blood. The newly overhauled American Red Cross is thirsty for a bigger share of the $2 billion business of supplying blood to hospitals.

Science.gov (United States)

Hensley, S

1998-06-22

The newly overhauled American Red Cross, led by President Elizabeth Dole (left), has launched an ambitious campaign to increase its piece of the more than $2 billion business of supplying blood to hospitals. Its quest for market share has sparked what some call a "blood war" with its main competitors: independent, community-governed blood banks affiliated with America's Blood Centers.

Medical Supplies Shortages and Burnout among Greek Health Care Workers during Economic Crisis: a Pilot Study

Science.gov (United States)

Rachiotis, George; Kourousis, Christos; Kamilaraki, Maria; Symvoulakis, Emmanouil K.; Dounias, George; Hadjichristodoulou, Christos

2014-01-01

Greece has been seriously affected by the economic crisis. In 2011 there were reports of 40% reduction to public hospital budgets. Occasional shortages of medical supplies have been reported in mass media. We attempted to pivotally investigate the frequency of medical supplies shortages in two Greek hospital units of the National Health System and to also assess their possible impact on burnout risk of health care workers. We conducted a cross-sectional study (n=303) of health care workers in two Greek hospitals who were present at the workplace during a casually selected working day (morning shift work). The Maslach Burnout Inventory (MBI) was used as the measure of burnout. An additional questionnaire was used about demographics, and working conditions (duration of employment, cumulative night shifts, type of hospital including medical supplies shortages and their impact on quality of healthcare. The prevalence of emotional exhaustion, depersonalization and low personal accomplishment was 44.5%, 43.2% and 51.5%, respectively. Medical supply shortages were significantly associated with emotional exhaustion and depersonalization. This finding provides preliminary evidence that austerity has affected health care in Greece. Moreover, the medical supply shortages in Greek hospitals may reflect the unfolding humanitarian crisis of the country. PMID:24688306

A Proposed Solution for Managing Doctor's Smart Cards in Hospitals Using a Single Sign-On Central Architecture

OpenAIRE

Mauro, Christian;Sunyaev, Ali;Leimeister, Jan Marco;Schweiger, Andreas;Krcmar, Helmut

2014-01-01

This paper describes a single sign-on solution for the central management of health care provider?s smart cards in hospitals. The proposed approach which is expected to be an improvement over current methods is made possible through the introduction of a national healthcare telematics infrastructure in Germany where every physician and every patient will automatically be given an electronic health smart card (for patients) and a corresponding health professional card (for health care provider...

Adherence to hand hygiene protocol by clinicians and medical students at Queen Elizabeth Central Hospital, Blantyre-Malawi.

Science.gov (United States)

Kalata, N L; Kamange, L; Muula, A S

2013-06-01

While communicable diseases are the leading causes of morbidity and mortality in Malawi, the contribution of nosocomial or hospital-acquired infections (HAIs) is unknown but could be substantial. The single most important method of preventing nosocomial infections is hand hygiene. We report a study which was conducted in 2011 to investigate adherence to hand hygiene protocols by clinicians and medical students working at Queen Elizabeth Central Hospital in Blantyre, Malawi. There were two parts to the study: a single blinded arm in which participants were observed without their knowledge by trained nurses; and a second arm which included self-completion of questionnaire after participant consent was obtained. The 2009 World Health Organization hand hygiene technique and recommendations which were adopted by Queen Elizabeth Central Hospital were used to define an opportunity for hand washing and effectiveness of hand washing. Hand hygiene effectiveness was defined as adherence to at least 6 out of 7 steps (80%) of the hand hygiene technique when using alcohol-based formulation or at least 8 out of 10 steps (80%) of the hand hygiene technique when using water and soap formulation before and after having direct contact with patients or their immediate surroundings. Clinicians were found to have disinfected their hands more than medical students (phand sanitizer and hand hygiene practice (p=0.3). Adherence to hand hygiene was found to be 23%. Most of the participants mentioned infection transmission prevention as a reason for disinfecting their hands. Other reasons mentioned included: a routine personal hand hygiene behaviour and discomfort if not washing hands. The top three reasons why they did not disinfect hands were forgetfulness, unavailability of sanitizers and negligence. Adherence to hand hygiene practice was found to be low, with forgetfulness and negligence being the major contributing factors. A hospital-wide multifaceted program aiming at clinicians and

Future Availability of Water Supply from Karstic Springs under Probable Climate Change. The case of Aravissos, Central Macedonia, Greece.

Science.gov (United States)

Vafeiadis, M.; Spachos, Th.; Zampetoglou, K.; Soupilas, Th.

2012-04-01

The test site of Aravissos is located at 70 Km to the West (W-NW) of Thessaloniki at the south banks of mount Païko, in the north part of Central Macedonia The karstic Aravissos springs supply 40% of total volume needed for the water supply of Thessaloniki, Greece. As the water is of excellent quality, it is feed directly in the distribution network without any previous treatment. The availability of this source is therefore of high importance for the sustainable water supply of this area with almost 1000000 inhabitants. The water system of Aravissos is developed in a karstic limestone with an age of about Late Cretaceous that covers almost the entire western part of the big-anticline of Païko Mountain. The climate in this area and the water consumption area, Thessaloniki, is a typical Mediterranean climate with mild and humid winters and hot and dry summers. The total annual number of rainy days is around 110. The production of the Aravissos springs depends mostly from the annual precipitations. As the feeding catchement and the karst aquifer are not well defined, a practical empirical balance model, that contains only well known relevant terms, is applied for the simulation of the operation of the springs under normal water extraction for water supply in present time. The estimation of future weather conditions are based on GCM and RCM simulation data and the extension of trend lines of the actual data. The future evolution of the availability of adequate water quantities from the springs is finally estimated from the balance model and the simulated future climatic data. This study has been realised within the project CC-WaterS, funded by the SEE program of the European Regional Development Fund (http://www.ccwaters.eu/).

Identification of rice supply chain risk to DKI Jakarta through Cipinang primary rice market

Science.gov (United States)

Sugiarto, D.; Ariwibowo, A.; Mardianto, I.; Surjasa, D.

2018-01-01

This paper identifies several sources of risks in DKI Jakarta rice supply chain that through Cipinang Primary Rice Market (CPRM). Secondary data from several sources were collected and analysed using pareto chart and time series analysis. Based on the pareto analysis, it was known that there was a change in the order of suppliers whereas in 2011, 80% of the supply came only from Cirebon, Karawang and Bandung (West Java Province). While in 2015 the main source of supply changed to Cirebon, Central Java and Karawang. Linear trend equation using decomposition model for Cirebon and Karawang showed trend of decreasing monthly supply while Central Java had a positive trend. Harvest area of wetland paddy in Cirebon and Karawang showed a negative trend in the last 6 years. The data also showed that West Java Province was the province with the largest rice crop area affected by plant organism attack and drought disaster in 2015. DKI Jakarta had several potential supply chain risks from rice supply, drought risk and pests risk where the province of West Java, which previously could become a major supplier began to require supply assistance from other provinces, especially Central Java.

Centralization and decentralization in energy systems and associated risks

International Nuclear Information System (INIS)

Rehm, W.; Schinner, F.; Kromp, W.

1998-01-01

Full text of publication follows: the concept of centralization/decentralization is - considering its widespread use - surprisingly ill-defined. Within the SERF-program (Socio Economic Research on Fusion) an attempt is made to clarify the complex issue of centralization/decentralization and to analyze its expected interaction with electricity production system in the case of nuclear fusion. Fusion research at the time is a multinational, highly centralized undertaking. As a result of this, and due to the expected large energy production units, it is generally expected that fusion will be embedded in a highly centralized, international energy supply system. The degree of centralization of an energy supply system, however, is believed to have for reaching consequences on the stability of the system, and beyond that, on decision making processes in energy policy, as well as democratic structures on the national or even international level. Internationalization might require control instruments that do not exist so far. Amongst other reservations, it is the possibly unwanted consequences of such a highly centralized, international energy supply system that limit acceptance of the fusion technology in the public. Therefore, centralization and decentralization trends of energy supply systems over the years are being looked at, to study their influence on the political and social systems (and vice-versa). In a first step, an attempt is made to classify centralization. Careful analyses and evaluation of available literature revealed a broad spectrum of different forms and degrees of centralization. Various parameters describing energy production and distribution are used. A differentiation of centralization on a technical and on an organizational level seems necessary, although they are not fully independent of each other. Beyond this, the choice of parameters must depend on the questions to be addressed. A new approach defining different levels and degrees of

Centralization and decentralization in energy systems and associated risks

Energy Technology Data Exchange (ETDEWEB)

Rehm, W.; Schinner, F.; Kromp, W. [Vienna Univ., Institute of Risk Research, IRR (Austria)

1998-07-01

Full text of publication follows: the concept of centralization/decentralization is - considering its widespread use - surprisingly ill-defined. Within the SERF-program (Socio Economic Research on Fusion) an attempt is made to clarify the complex issue of centralization/decentralization and to analyze its expected interaction with electricity production system in the case of nuclear fusion. Fusion research at the time is a multinational, highly centralized undertaking. As a result of this, and due to the expected large energy production units, it is generally expected that fusion will be embedded in a highly centralized, international energy supply system. The degree of centralization of an energy supply system, however, is believed to have for reaching consequences on the stability of the system, and beyond that, on decision making processes in energy policy, as well as democratic structures on the national or even international level. Internationalization might require control instruments that do not exist so far. Amongst other reservations, it is the possibly unwanted consequences of such a highly centralized, international energy supply system that limit acceptance of the fusion technology in the public. Therefore, centralization and decentralization trends of energy supply systems over the years are being looked at, to study their influence on the political and social systems (and vice-versa). In a first step, an attempt is made to classify centralization. Careful analyses and evaluation of available literature revealed a broad spectrum of different forms and degrees of centralization. Various parameters describing energy production and distribution are used. A differentiation of centralization on a technical and on an organizational level seems necessary, although they are not fully independent of each other. Beyond this, the choice of parameters must depend on the questions to be addressed. A new approach defining different levels and degrees of

Legitimacy of hospital reconfiguration: the controversial downsizing of Kidderminster hospital.

Science.gov (United States)

Oborn, Eivor

2008-04-01

This paper examines the contested organizational legitimacy of hospital reconfiguration, which continues to be a central issue in health care management. A qualitative study which focuses on the controversial downsizing of Kidderminster Hospital, a highly publicized landmark case of district general hospital closure. Rhetorical strategies are analysed to examine how legitimacy was constructed by stakeholder groups and how these strategies were used to support or resist change. Stakeholders promoting change legitimized re-organization pragmatically and morally arguing the need for centralization as a rational necessity. Stakeholders resisting change argued for cognitive and moral legitimacy in current service arrangements, contrasting local versus regionalized aspects of safety and provision. Groups managed to talk past each other, failing to establish a dialogue, which led to significant conflict and political upheaval. Stakeholders value hospitals in different ways and argue for diverse accounts of legitimacy. Broader discourses of medical science and democratic participation were drawn into rhetorical texts concerning regionalization to render them more powerful.

Rifampicin resistance in mycobacterium tuberculosis patients using GeneXpert at Livingstone Central Hospital for the year 2015: a cross sectional explorative study.

Science.gov (United States)

Masenga, Sepiso K; Mubila, Harrison; Hamooya, Benson M

2017-09-22

Since the recent introduction of GeneXepert for the detection of Tuberculosis (TB) drug resistance mutations in both primary resistance and acquired resistance in Zambia, little has been documented in literature on the issue of rifampicin resistance especially in the face of a high National TB burden. The study aimed to determine the prevalence of rifampicin resistance in tuberculosis patients at Livingstone Central Hospital for the year 2015. This was a cross sectional study conducted at Livingstone Central Hospital where we reviewed 152 records (from January 1, 2015 to 31st December, 2015) involving patients who presented with clinically suspected TB or documented TB, whose samples were sent to the laboratory for GeneXpert Mycobacterium tuberculosis/rifampicin testing. Statistical evaluations used a one-sample test of proportion and Fisher's exact test. The age of participants ranged from 8 months to 73 years old (median = 34). Of the participants with complete data on gender, 99 (66%) and 52 (34%) were males and females respectively. The TB co-infection with HIV prevalence was 98.3% (p < 0.001). Prevalence of rifampicin resistance was 5.9% and there was no statistical significant difference between being male or female (p = 0.721). We were able to show from our study, evidence of rifampicin resistance at Livingstone Central Hospital. Hence, there was need for further in-depth research and appropriate interventions (i.e close follow-up and patient care for drug resistance positive patients).

Water Related Health Problems in Central Asia—A Review

Directory of Open Access Journals (Sweden)

Zakir Bekturganov

2016-05-01

Full Text Available The present paper provides an extensive literature review on water related health issues in Central Asia. Even though the per capita amount of available freshwater is substantial in all Central Asian states the uneven distribution in time and space creates problems for water availability. Due to this, the Central Asian economies are developing under increasing water deficiency. The degradation of water supply systems and sewage treatment plants is often severe leading to potentially high water loss rates and inadequate accessibility to safe water supply. In this context, rural areas are the most affected. Low tariffs in combination with absent metering and low collection rates for water fees mean that operation and maintenance costs for basic services of water supply and sanitation are not covered. Unsafe water supply contains both microbiological and non-microbiological contaminants. Helminthiasis and intestinal protozoa infections are of considerable public health importance in Central Asia. Agricultural and industrial pollution is especially affecting downstream areas of Amu Darya and Syr Darya rivers. In large areas copper, zinc, and chromium concentrations in water exceed maximum permissible concentration. Thus, there is an urgent need to strengthen the environmental monitoring system. Small-scale water supply and sanitation systems need to be developed in line with more efficient public spending on these.

Time-based analysis of the apheresis platelet supply chain in England.

Science.gov (United States)

Wilding, R; Cotton, S; Dobbin, J; Chapman, J; Yates, N

2011-10-01

During 2009/2010 loss of platelets within NHS Blood and Transplant (NHSBT) due to time expiry was 9.3%. Hospitals remain reluctant to hold stocks of platelets due to the poor shelf life at issue. The purpose of this study was to identify areas for time compression in the apheresis platelet supply chain to extend the shelf life available for hospitals and reduce wastage in NHSBT. This was done within the context of NHSBT reconfiguring their supply chain and moving towards a consolidated and centralised approach. Time based process mapping was applied to identify value and non-value adding time in two manufacturing models. A large amount of the non-value adding time in the apheresis platelet supply chain is due to transportation and waiting for the next process in the manufacturing process to take place. Time based process mapping provides an effective 'lens' for supply chain professionals to identify opportunities for improvement in the platelet supply chain. © 2011 The Author(s). Vox Sanguinis © 2011 International Society of Blood Transfusion.

Money supply growth and inflation – the monetary policy strategy of the European Central Bank

Directory of Open Access Journals (Sweden)

Svatopluk Kapounek

2007-01-01

Full Text Available The main aim of this article is to find out whether there is a significant relationship between money supply growth and inflation in the Eurozone. For this reason, the monetary policy strategy of the European Central Bank (ECB has been evaluated. Since the establishment of the ECB in January 1999 to May 2003 the ECB‘s monetary policy strategy consisted of three main elements: a quantitative definition of price stability, a prominent role for money in the assessment of risks to price stability (aggregate M3 as a reference value, and a broadly based assessment of the outlook for price developments. Nevertheless, since May 2003 M3 or any other monetary aggregate has lost its prominent role in the ECB‘s strategy. Therefore the nowadays ECB‘s monetary policy strategy consists of a quantitative definition of the primary objective of price stability and an analytical framework based on two pillars – economic analysis and monetary analysis. These two pillars are used by the ECB‘s Governing Council in the overall assessment of risks to price stability and in monetary policy decisions.The empirical part of this article is based on time series correlation between money supply growth and inflation in selected member countries of the Economic and Monetary Union (EMU - Eurozone during the period 1995–2005. The time series are divided into two parts. The first part covers data for selected member countries of the European Union from 1995 till 1998, i.e. before the establishment of the EMU. Whereas the second part includes data for the whole Eurozone since its official start in 1999 to 2005. The time series are adjusted by SARIMA models.

The Economics of Timber Supply: An Analytical Synthesis of Modeling Approaches

Science.gov (United States)

David N. Wear; Peter J. Parks

1994-01-01

The joint supply of timber and other services from forest environments plays a central role in most forest land debates. This paper defines a general conceptual model of timber supply that provides the context for discussing both individual harvest choice and aggregate supply models. While the structure and breadth of these models has developed considerably over the...

Trend of Legionella colonization in hospital water supply.

Science.gov (United States)

D'Alessandro, D; Fabiani, M; Cerquetani, F; Orsi, G B

2015-01-01

In many nosocomial Legionella outbreaks water distribution systems are the most frequent source of infection. Considering the hospital waterline old age, an investigation on colonization by Legionella spp was carried out in order to evaluate the pipeline system weaknesses and to implement environmental preventive measures. From 2004 to 2010, overall 97 samples from the water line were collected. The samples were analyzed according to the italian Legionella spp standard methods; water temperature, pH and residual free chlorine were determined at the time of collection. X2 test, exact-test and t-test were used to compare proportions and means. Overall 28 samples (23.7%) were positive for Legionella spp, and five of them (17.9%) exceeded the threshold level >104 cfu/L. The number of positive samples varied along the years, showing a significant increasing trend (X2 for trend = 11.5; pLegionella spp by comparison to negative ones showed a lower free chlorine concentration (0.08 mg/L vs 0.15 mg/L) and a higher water temperature (46.1° vs 42.7°). Actually the percentage of positive samples decreased significantly with the increasing in free chlorine in the water (X2 for trend = 8.53; pLegionella. All hospital buildings were colonized by Legionella spp, although 80% of samples >104 cfu/L occurred in the C-building. No cases of nosocomial legionellosis were reported during the study period. Hospital water system showed a diffuse colonization by Legionella spp, although the degree of contamination reached the threshold level (>104 cfu/L) only in a small percentage of samples, showing a substantial effectiveness of the control measures applied.

Arthroplasty of hip resection, handling with external fixation - Experience in the central military hospital

International Nuclear Information System (INIS)

Satizabal Azuero, Carlos E; Calderon Uribe, Oscar; Naquira Escobar, Luis F

2006-01-01

This is an observational retrospective study series of cases carried out between January 1998 and July 2004 in the central military hospital, 13 patients were treated with Girdlestone arthroplasty with external fixation, with a pursuit average of 53 months. Function, return to the daily activities and associate complications was evaluated. They were as complication; pain in the fixator site, osteitis, and fixator broke. All patients report at the end of the treatment no pain in the hip. Shortening in the patient without lenghting was 3,5 cm and in the group with lenghting was 1.5 cm. the obtained results demonstrate that Girdlestone arthroplasty with external fixation, is option, to improve the patient's pain and function of the hip

Supply chain performance within agri-food sector

Directory of Open Access Journals (Sweden)

Dinu Daniela Magdalena

2016-01-01

Full Text Available By setting the goals of this scientific paper has been outlined the research methodology. Thus were developed conclusion, and by using the methods, procedures, techniques, rules and tools and know-how has been demonstrated the central hypothesis: 'Inside the agri-food supply chain is created value through operations and logistics activities.' The value created leads to competitive advantages in order to identify companies within market, gaining loyal consumers. The article presents the components of agri-food supply chain, the main Key Performance Indicators measuring its performance, the difference between a traditional supply chain and sustainable supply chain by analyzing the waste management component. In order to get professional expertise referring to Key Performance Indicators a quantitative research has been organized. In closing the article present the development strategies of agri-food supply chain.

Propuesta de mejora para el Complejo Hospitalario de Navarra, Hospital D: manual de procedimientos para la Central de Esterilización

OpenAIRE

Garde Sesma, Idoia

2014-01-01

La esterilización es una ciencia en la que se emplean tecnologías muy variadas con el fin de lograr la destrucción de todos los microorganismos. Una vez que se ha esterilizado todo el material, debe mantenerse esa condición hasta el momento de “uso” de los equipos. La central de esterilización (en adelante CE o Central), es una unidad de vital importancia dentro de la estructura de un hospital. Recibe una enorme cantidad y variedad de instrumental quirúrgico que debe ser recogido, limpiad...

Supply Chain Simulation using Business Process Modeling in Service Oriented Architecture

OpenAIRE

Taejong Yoo

2015-01-01

For supply chain optimization, as a key determinant of strategic resources mobility along the value-added chain, simulation is widely used to test the impact on supply chain performance for the strategic level decisions, such as the number of plants, the modes of transport, or the relocation of warehouses. Traditionally, a single centralized model that encompasses multiple participants in the supply chain is built when optimization of the supply chain through simulation is required. However, ...

An investigation on research and development cost reduction and channel strategies in competing supply chains

Directory of Open Access Journals (Sweden)

Qinqin Li

2014-06-01

Full Text Available With the intensification of market competition, the competition form of firms is evolving from the competition among firms to the competition among supply chains. This paper considers a market with two competing supply chains consisting of one supplier and one manufacturer. The two supply chains compete on products’ quantities and research and development (R&D level when the two manufacturers conduct technological innovation. This paper analyses the supply chain competition in three scenarios: two decentralized supply chains (DD, one decentralized supply chain and one centralized supply chain (DC and two centralized supply chains (CC. The results indicate that the production quantity, the R&D level and the total profit of the integrated supply chain in DC scenario are the largest, CC scenario comes second, those of the DD scenario come third and those of the decentralized supply chain in DC scenario are the smallest. CC strategy is the supply chain system’s Nash equilibrium, which is good for the both supply chains, and there is no prisoner's dilemma.

Microsurgical anatomy of the central lobe.

Science.gov (United States)

Frigeri, Thomas; Paglioli, Eliseu; de Oliveira, Evandro; Rhoton, Albert L

2015-03-01

The central lobe consists of the pre- and postcentral gyri on the lateral surface and the paracentral lobule on the medial surface and corresponds to the sensorimotor cortex. The objective of the present study was to define the neural features, craniometric relationships, arterial supply, and venous drainage of the central lobe. Cadaveric hemispheres dissected using microsurgical techniques provided the material for this study. The coronal suture is closer to the precentral gyrus and central sulcus at its lower rather than at its upper end, but they are closest at a point near where the superior temporal line crosses the coronal suture. The arterial supply of the lower two-thirds of the lateral surface of the central lobe was from the central, precentral, and anterior parietal branches that arose predominantly from the superior trunk of the middle cerebral artery. The medial surface and the superior third of the lateral surface were supplied by the posterior interior frontal, paracentral, and superior parietal branches of the pericallosal and callosomarginal arteries. The venous drainage of the superior two-thirds of the lateral surface and the central lobe on the medial surface was predominantly through the superior sagittal sinus, and the inferior third of the lateral surface was predominantly through the superficial sylvian veins to the sphenoparietal sinus or the vein of Labbé to the transverse sinus. The pre- and postcentral gyri and paracentral lobule have a morphological and functional anatomy that differentiates them from the remainder of their respective lobes and are considered by many as a single lobe. An understanding of the anatomical relationships of the central lobe can be useful in preoperative planning and in establishing reliable intraoperative landmarks.

Fuel supply security

International Nuclear Information System (INIS)

Wakabayashi, Hiroaki

1987-01-01

Stable fuel supply is a prerequisite for any nuclear power program including ISER-PIUS. It encompasses procurement of uranium ore, enriched uranium and fuel elements. Uranium is different from oil in that it can be stockpiled for more than a decade besides the fact that the core residence time is as long as six years, for example in the case of ISER-PIUS. These basic fuel characteristics are favoring nuclear fuel over others in terms of supply security. The central concern will be a gradual increase in prices of uranium and enrichment. Under the present glut situation with the worldwide prevalence of LWRs, fuel supply security seems ensured for the time being till the middle of 21st century. It is estimated that by the turn of the century, the free world will have roughly 450 GWe capacity of nuclear power. If 10 % is supplied for ISER-PIUS, more than 200 modules of 200 MWe ISER-PIUS may be deployed all over the world probably starting around 2000. As part of the fuel supply security consideration, heavy water reactor (HWR) may seem interesting to such a country as Indonesia where there is uranium resources but no enrichment capability. But it needs heavy water instead and the operation is not so easy as of LWR, because of the positive void coefficient as was seen at the Chernobyl-4. Safeguarding of the fuel is also difficult, because it lends itself to on line refueling. The current and future situation of the fuel supply security for LWR seem well founded and established long into the future. (Nogami, K.)

[Introduction of the psychoprophylactic method and its influence on the prenatal care program for institutional parturition in Japan: the practice in the Central Hospital of Maternity of the Japanese Red Cross Society and Oomori Red Cross Hospital, 1953-1964].

Science.gov (United States)

Fujihara, Satoko; Tsukisawa, Miyoko

2014-03-01

The psychoprophylactic method is one of the methods for providing 'painless childbirth without drugs' and was invented by applying I. Pavlov's theory of higher nervous activity. In 1951, it was adopted as a national policy in the Union of Soviet Socialist Republics. This method was then introduced in the People's Republic of China in 1952. In 1953, it was brought to Japan by Masatomo SUGAI, an obstetrician, and was introduced into the Central Hospital of Maternity of the Japanese Red Cross Society with the support of the director, Naotarou KUJI. The practice of this method by the research team, which consisted of the obstetricians and midwives of the Central Hospital of Maternity of the Japanese Red Cross Society and Oomori Red Cross Hospital, resulted in the initiation and characterization of the prenatal care program to encourage the autonomy of the pregnant women for normal parturition in the institutions of Japan.

Research on Coordination of Fresh Produce Supply Chain in Big Market Sales Environment

Science.gov (United States)

Su, Juning; Liu, Chenguang

2014-01-01

In this paper, we propose two decision models for decentralized and centralized fresh produce supply chains with stochastic supply and demand and controllable transportation time. The optimal order quantity and the optimal transportation time in these two supply chain systems are derived. To improve profits in a decentralized supply chain, based on analyzing the risk taken by each participant in the supply chain, we design a set of contracts which can coordinate this type of fresh produce supply chain with stochastic supply and stochastic demand, and controllable transportation time as well. We also obtain a value range of contract parameters that can increase profits of all participants in the decentralized supply chain. The expected profits of the decentralized setting and the centralized setting are compared with respect to given numerical examples. Furthermore, the sensitivity analyses of the deterioration rate factor and the freshness factor are performed. The results of numerical examples show that the transportation time is shorter, the order quantity is smaller, the total profit of whole supply chain is less, and the possibility of cooperation between supplier and retailer is higher for the fresh produce which is more perishable and its quality decays more quickly. PMID:24764770

Research on coordination of fresh produce supply chain in big market sales environment.

Science.gov (United States)

Su, Juning; Wu, Jiebing; Liu, Chenguang

2014-01-01

In this paper, we propose two decision models for decentralized and centralized fresh produce supply chains with stochastic supply and demand and controllable transportation time. The optimal order quantity and the optimal transportation time in these two supply chain systems are derived. To improve profits in a decentralized supply chain, based on analyzing the risk taken by each participant in the supply chain, we design a set of contracts which can coordinate this type of fresh produce supply chain with stochastic supply and stochastic demand, and controllable transportation time as well. We also obtain a value range of contract parameters that can increase profits of all participants in the decentralized supply chain. The expected profits of the decentralized setting and the centralized setting are compared with respect to given numerical examples. Furthermore, the sensitivity analyses of the deterioration rate factor and the freshness factor are performed. The results of numerical examples show that the transportation time is shorter, the order quantity is smaller, the total profit of whole supply chain is less, and the possibility of cooperation between supplier and retailer is higher for the fresh produce which is more perishable and its quality decays more quickly.

Does autonomy for public hospitals in developing countries increase performance? Evidence-based case studies.

Science.gov (United States)

De Geyndt, Willy

2017-04-01

Governments in middle and low income countries have sought ways for the past decades to make their public hospitals more performing. The objectives of this assessment are to: (a) synthesize the experience of eleven countries at granting autonomy to their public hospitals and the obstacles encountered; (b) deduce which autonomy policies have or have not been effective documenting successes and failures; and (c) propose evidence-based recommendations to policy makers. Data for five countries are derived from the author's participation in the autonomy process augmented by current updates provided by national colleagues. Data for the other six countries are derived from publications available in the literature. Policies granting autonomy to public hospitals have had limited success. In all cases Boards of Directors have been created. Governance of autonomized hospitals by Boards however is obstructed by the resistance of central level entities to have their authority diminished. The Ministry of Finance tends to maintain control over revenues and expenditures. The Public Service Commission resists abdicating its role to hire, promote, transfer and dismiss government employees. The Ministry of Health attempts to keep its authority to appoint hospital staff, procure medical supplies and equipment; it may do so directly or indirectly by selecting and appointing Board members. Management information systems continue to collect activity measures to be aggregated at the national level for statistical purposes and do not provide financial and clinical data useful for decision making by the Boards and by senior management. Decentralizing decision making to the operational level has had limited success. Stakeholders at the central level devise strategies to maintain their power. Two main obstacles are delegating authority over human resources and finances that are sine qua non conditions for governing and increasing the performance of public hospitals. Copyright © 2017 Elsevier

Impact of lightning strikes on hospital functions.

Science.gov (United States)

Mortelmans, Luc J M; Van Springel, Gert L J; Van Boxstael, Sam; Herrijgers, Jan; Hoflacks, Stefaan

2009-01-01

Two regional hospitals were struck by lightning during a one-month period. The first hospital, which had 236 beds, suffered a direct strike to the building. This resulted in a direct spread of the power peak and temporary failure of the standard power supply. The principle problems, after restoring standard power supply, were with the fire alarm system and peripheral network connections in the digital radiology systems. No direct impact on the hardware could be found. Restarting the servers resolved all problems. The second hospital, which had 436 beds, had a lightning strike on the premises and mainly experienced problems due to induction. All affected installations had a cable connection from outside in one way or another. The power supplies never were endangered. The main problem was the failure of different communication systems (telephone, radio, intercom, fire alarm system). Also, the electronic entrance control went out. During the days after the lightening strike, multiple software problems became apparent, as well as failures of the network connections controlling the technical support systems. There are very few ways to prepare for induction problems. The use of fiber-optic networks can limit damage. To the knowledge of the authors, these are the first cases of lightning striking hospitals in medical literature.

Antiretroviral drug supply challenges in the era of scaling up ART in Malawi.

Science.gov (United States)

Schouten, Erik J; Jahn, Andreas; Ben-Smith, Anne; Makombe, Simon D; Harries, Anthony D; Aboagye-Nyame, Francis; Chimbwandira, Frank

2011-07-06

The number of people receiving antiretroviral treatment (ART) has increased considerably in recent years and is expected to continue to grow in the coming years. A major challenge is to maintain uninterrupted supplies of antiretroviral (ARV) drugs and prevent stock outs. This article discusses issues around the management of ARVs and prevention of stock outs in Malawi, a low-income country with a high HIV/AIDS burden, and a weak procurement and supply chain management system. This system for ARVs, paid for by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and bypassing the government Central Medical Stores, is in place, using the United Nations Children's Fund's (UNICEF's) procurement services. The system, managed by a handful of people who spend limited time on supply management, is characterized by a centrally coordinated quantification based on verified data from all national ART clinics, parallel procurement through UNICEF, and direct distribution to ART clinics. The model worked well in the first years of the ART programme with a single first-line ARV regimen, but with more regimens becoming available (e.g., alternative first-line, second-line and paediatric regimens), it has become more difficult to administer. Managing supplies through a parallel system has the advantage that weaknesses in the national system have limited influence on the ARV procurement and supply chain management system. However, as the current system operates without a central warehouse and national buffer stock capacity, it diminishes the ability to prevent ARV stock outs. The process of ordering ARVs, from the time that estimates are made to the arrival of supplies in health facilities, takes approximately one year. Addressing the challenges involved in maintaining ARVs through an efficient procurement and supply chain management system that prevents ARV stock outs through the establishment of a dedicated procurement team, a central warehouse and/or national buffer stock is a

Stepwise introduction of the 'Best Care Always' central-line-associated bloodstream infection prevention bundle in a network of South African hospitals.

Science.gov (United States)

Richards, G A; Brink, A J; Messina, A P; Feldman, C; Swart, K; van den Bergh, D

2017-09-01

Healthcare-associated infection (HCAI) remains a major international problem. The 'Best Care Always!' (BCA) campaign was launched in South Africa to reduce preventable HCAI, including central-line-associated bloodstream infection (CLABSI). The intervention took place in 43 Netcare Private Hospitals, increasing later to 49 with 958 intensive care units (ICUs) and 439 high-care (HC) beds and 1207 ICUs and 493 HC beds, respectively. Phase 1, April 2010 to March 2011, ICU infection prevention and control (IPC) nurse-driven change: commitment from management and doctors and training of IPC nurses. Bundle compliance and infections per 1000 central-line-days were incorporated as standard IPC measures and captured monthly. Phase 2, April 2011 to March 2012, breakthrough collaborative method: multiple regional learning sessions for nursing leaders, IPC nurses and unit managers. Phase 3, April 2012 to May 2016: sustained goal-setting, benchmarks, ongoing audits. A total of 1,119,558 central-line-days were recorded. Bundle compliance improved significantly from a mean of 73.1% [standard deviation (SD): 11.2; range: 40.6-81.7%] in Phase 1 to a mean of 90.5% (SD: 4.7; range: 76.5-97.2%) in Phase 3 (P = 0.0004). The CLABSI rate declined significantly from a mean of 3.55 (SD: 0.82; range: 2.54-5.78) per 1000 central-line-days in Phase 1 to a mean of 0.13 (SD: 0.09; range: 0-0.33) (P hospitals resulted in significant decreases in CLABSI. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

The dynamic simulation model of soybean in Central Java to support food self sufficiency: A supply chain perspective

Science.gov (United States)

Oktyajati, Nancy; Hisjam, Muh.; Sutopo, Wahyudi

2018-02-01

Consider food become one of the basic human needs in order to survive so food sufficiency become very important. Food sufficiency of soybean commodity in Central Java still depends on imported soybean. Insufficiency of soybean because of there is much gap between local soybean productions and its demand. In the year 2016 the shortage of supply soybean commodity as much 68.79%. Soybean is an important and strategic commodity after rice and corn. The increasing consumption of soybean is related to increasing population, increasing incomes, changing of healthy life style. The aims of this study are to determine the soybean dynamic model based on supply chain perspective, define the proper price of local soybean to trigger increasing of local production, and to define the alternative solution to support food self sufficiency. This study will capture the real condition into dynamics model, then simulate a series of scenario into a computer program to obtain the best results. This study will be conducted the following first scenario with government intervention policy and second without government intervention policy. The best solution of the alternative can be used as government consideration for governmental policy. The results of the propose scenarios showed that self sufficiency on soybean can be achieved after the next 20 years by increasing planting area 4% and land productivity 1% per year.

Extrinsic and intrinsic blood supply to the optic chiasm.

Science.gov (United States)

Salaud, Céline; Ploteau, Stéphane; Blery, Pauline; Pilet, Paul; Armstrong, Olivier; Hamel, Antoine

2018-04-01

Although there have been many studies of the arterial cerebral blood supply, only seven have described the optic chiasm (OC) blood supply and their results are contradictory. The aim of this study was to analyze the extrinsic and intrinsic OC blood supply on cadaveric specimens using dissections and microcomputer tomography (Micro-CT). Thirteen human specimens were dissected and the internal or common carotid arteries were injected with red latex, China Ink with gelatin or barium sulfate. Three Micro-CTs were obtained to reveal the intrinsic blood supply to the OC. The superior hypophyseal arteries (SupHypA) (13/13) and posterior communicating artery (PCoA) (12/13) supplied the pial network on the inferior side of the OC. The first segment of the anterior cerebral artery (ACA) (10/10), SupHypA (7/10), the anterior communicating artery (ACoA) (9/10), and PComA (1/10) supplied the pial network of its superior side. The intrinsic OC blood supply was divided into three networks (two lateral and one central). Capillaries entering the OC originated principally from the inferior pial network. The lateral network capillaries had the same orientation as the visual lateral pathways, but the central network was not correlated with the nasal fibers crossing into the OC. There was no anastomosis in the pial or intrinsic networks. Only SupHypA, PCoA, ACoA, and ACA were involved in the OC blood supply. Because there was no extrinsic or intrinsic anastomosis, all arteries should be preserved. Tumor compression of the inferior intrinsic arterial network could contribute to visual defects. Clin. Anat. 31:432-440, 2018. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Removing the regional level from the Niger vaccine supply chain.

Science.gov (United States)

Assi, Tina-Marie; Brown, Shawn T; Kone, Souleymane; Norman, Bryan A; Djibo, Ali; Connor, Diana L; Wateska, Angela R; Rajgopal, Jayant; Slayton, Rachel B; Lee, Bruce Y

2013-06-10

Since many of the world's vaccine supply chains contain multiple levels, the question remains of whether removing a level could bring efficiencies. We utilized HERMES to generate a detailed discrete-event simulation model of Niger's vaccine supply chain and compared the current four-tier (central, regional, district, and integrated health center levels) with a modified three-tier structure (removing the regional level). Different scenarios explored various accompanying shipping policies and frequencies. Removing the regional level and implementing a collection-based shipping policy from the district stores increases vaccine availability from a mean of 70-100% when districts could collect vaccines at least weekly. Alternatively, implementing a delivery-based shipping policy from the central store monthly in three-route and eight-route scenarios only increases vaccine availability to 87%. Restricting central-to district vaccine shipments to a quarterly schedule for three-route and eight-route scenarios reduces vaccine availability to 49%. The collection-based shipping policy from district stores reduces supply chain logistics cost per dose administered from US$0.14 at baseline to US$0.13 after removing the regional level. Removing the regional level from Niger's vaccine supply chain can substantially improve vaccine availability as long as certain concomitant adjustments to shipping policies and frequencies are implemented. Copyright © 2013 Elsevier Ltd. All rights reserved.

Transfusion practice in Helsinki University Central Hospital: an analysis of diagnosis-related groups (DRG).

Science.gov (United States)

Syrjälä, M T; Kytöniemi, I; Mikkolainen, K; Ranimo, J; Lauharanta, J

2001-12-01

Transfusion data combined with data automatically recorded in hospital databases provides an outstanding tool for blood utilization reporting. When the reporting is performed with an online analytical processing (OLAP) tool, real time reporting can be provided to blood subscribers. When this data is combined with a common patient classification system, Diagnosis-Related Groups (DRG), it is possible to produce statistical results, that are similar in different institutions and may provide a means for international transfusion bench-marking and cost comparison. We use a DRG classification to describe the transfusion practice in Helsinki University Central Hospital. The key indicators include the percentage of transfused patients, the number of transfused units and costs in different DRG groups, as well as transfusion rates per DRG weighted treatment episodes. Ninety-three per cent of all transfusions could be classified into different DRGs. The largest blood-using DRG group was acute adult leukaemia (DRG 473), which accounted for 10.4% of all transfusion costs. The 13 largest blood consuming DRGs accounted for half the total costs in 1998. Currently, there is a lack of an internationally accepted standardized way to report institutional or national transfusion practices. DRG-based transfusion reporting might serve as a means for transfusion benchmarking and thus aid studies of variations in transfusion practice.

Leukaemia at Queen Elizabeth Central Hospital in Blantyre, Malawi.

Science.gov (United States)

Mukiibi, J M; Nyirenda, C M; Adewuyi, J O; Mzula, E L; Magombo, E D; Mbvundula, E M

2001-07-01

To determine the patterns of leukaemias seen in Malawians at Queen Elizabeth Central Hospital (QECH) and to compare the findings with those from elsewhere. An overview of the problems encountered in the management of leukaemia in developing countries especially those in sub-Saharan Africa are highlighted. Retrospective descriptive analysis of consecutive leukaemia cases seen from January 1994 through December 1998. Of the 95 leukaemia patients diagnosed during the study period, childhood (0-15 years) leukaemia occurred in 27 (28.4%) patients while adulthood (above 15 years) leukaemia accounted for 68 (71.6%) patients. The main leukaemia types were: acute lymphoblastic leukaemia (ALL) 14 (14.7%), acute myeloblastic leukaemia (AML) 25 (26.3%), chronic myeloid (granulocytic) leukaemia (CML) 32 (33.7%), chronic lymphocytic (lymphatic) leukaemia (CLL) 22 (23.2%) and hairy cell leukaemia (HCL) two (2.1%) patients. Most of the acute leukaemia (AL) cases occurred in the six to 15 year age bracket with a male preponderance. In ALL, lymphadenopathy was the commonest presenting feature followed by pallor (92.9%) while in the AML group, pallor occurred in 80% of cases. Abdominal swelling (87.5%) due to splenomegaly (81.3%) were the main clinical features in the CML group whereas lymphadenopathy (63.6%) followed by splenomegaly (59.1%) were the dominant presenting features in CLL. Haematologically, although leucocytosis characterised both acute and chronic leukaemias, most cases of acute leukaemia presented with more severe anaemia (Hb charitable organisations.

Infecciones del sistema nervioso central por enterovirus en niños atendidos en un hospital de Lima, Perú Enteroviral central nervous system infections in children treated at a hospital in Lima, Peru

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Iván O Espinoza

2011-12-01

Full Text Available Objetivos. Determinar la frecuencia y las características clínicas de las infecciones del sistema nervioso central por enterovirus en niños atendidos en el Hospital Nacional Cayetano Heredia de Lima, Perú. Materiales y métodos. Se realizó un estudio prospectivo y descriptivo desde abril 2008 hasta marzo 2010. Se enrolaron pacientes de un mes a 14 años con diagnóstico clínico de encefalitis o meningitis asépticas. Se investigó la presencia de enterovirus, virus herpes simple 1 (VHS-1, virus herpes simple 2 (VHS-2 y virus varicela-zoster (VZV mediante reacción en cadena de polimerasa (PCR. Resultados. Se enrolaron 97 pacientes de los cuales 69 % presentaron encefalitis aguda y 31 % meningitis aguda. Se identificó enterovirus en 52,6 % del total de infecciones agudas no bacterianas del sistema nervioso central; encontrándose en 83,3 % de las meningitis y en 38,8 % de las encefalitis. No hubo casos de infección por VHS-1, VHS-2 ni VZV. Las infecciones por enterovirus alcanzaron el 82,9 % en los meses cálidos de noviembre a enero y el 28,6 % en los meses fríos de mayo a julio. Conclusiones. Los enterovirus fueron los principales agentes etiológicos en las encefalitis y meningitis asépticas agudas en pacientes pediátricos de Lima, Perú. Los enterovirus tienen un comportamiento epidemiológico estacional con un claro aumento del número de casos en los meses de verano. Resulta útil tener disponible un método de diagnóstico rápido, como una ayuda para el manejo de las infecciones agudas del sistema nervioso.Objectives. To determine the frequency and clinical features of central nervous system infections caused by enterovirus in children treated at the Hospital Nacional Cayetano Heredia in Lima, Peru. Materials and methods. A prospective, descriptive study was performed from April 2008 to March 2010. Patients aged 1 month - 14 years with clinical diagnosis of encephalitis or aseptic meningitis were included. We investigated the

The Law of Supply and Demand: Here It Is Finally

OpenAIRE

Kakarot-Handtke, Egmont

2014-01-01

There is no such thing as a law of human or social behavior. The conceptual consequence of the present paper is therefore to discard the subjectivebehavioral axioms and to take objective-structural axioms as new formal foundations. The central piece of economic theory is the interaction of demand and supply which determines prices and quantities. Demand and supply in turn are determined by subjective factors. In the structural axiomatic paradigm the Law of Supply and Demand follows from objec...

ARTRODESIS TIBIOTALOCALCANEA CON PLACA PHILOS: EXPERIENCIA EN EL HOSPITAL MILITAR CENTRAL. ENERO 2007 A DICIEMBRE DE 2009

OpenAIRE

MUÑOZ FALLA, GERARDO ALEXI; DELGADO NEIRA, ALEJANDRO; ENRIQUE GAMBA, CESAR; HERNÁNDEZ PERDOMO, EDGAR

2011-01-01

Estudio descriptivo observacional, retrospectivo tipo serie de casos, realizado entre enero de 2007 y diciembre de 2009 en el Hospital Militar Central. Fueron tratados 21 pacientes con artrosis de la articulación tibio talar y subtalar de etiología diversa, con seguimiento mínimo de 6 meses. Se evaluó; la función pre operatoria y post operatoria por medio de la escala AOFAS, el dolor mediante la escala visual análoga, el tiempo de consolidación con controles radiográficos, el tipo de injerto ...

Research on Coordination of Fresh Produce Supply Chain in Big Market Sales Environment

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Juning Su

2014-01-01

Full Text Available In this paper, we propose two decision models for decentralized and centralized fresh produce supply chains with stochastic supply and demand and controllable transportation time. The optimal order quantity and the optimal transportation time in these two supply chain systems are derived. To improve profits in a decentralized supply chain, based on analyzing the risk taken by each participant in the supply chain, we design a set of contracts which can coordinate this type of fresh produce supply chain with stochastic supply and stochastic demand, and controllable transportation time as well. We also obtain a value range of contract parameters that can increase profits of all participants in the decentralized supply chain. The expected profits of the decentralized setting and the centralized setting are compared with respect to given numerical examples. Furthermore, the sensitivity analyses of the deterioration rate factor and the freshness factor are performed. The results of numerical examples show that the transportation time is shorter, the order quantity is smaller, the total profit of whole supply chain is less, and the possibility of cooperation between supplier and retailer is higher for the fresh produce which is more perishable and its quality decays more quickly.

Neurocognitive sequelae of cerebral malaria in adults: a pilot study in Benguela Central Hospital, Angola.

Science.gov (United States)

Peixoto, Bruno; Kalei, Isabel

2013-07-01

To characterize the neurocognitive sequelae of cerebral malaria (CM) in an adult sample of the city of Benguela, Angola. A neuropsychological assessment was carried out in 22 subjects with prior history of CM ranging from 6 to 12 months after the infection. The obtained results were compared to a control group with no previous history of cerebral malaria. The study was conducted in Benguela Central Hospital, Angola in 2011. CM group obtained lower results on the two last trials of a verbal learning task and on an abstract reasoning test. CM is associated to a slower verbal learning rate and to difficulties in the ability to discriminate and perceive relations between new elements.

Modeling nitrate at domestic and public-supply well depths in the Central Valley, California

Science.gov (United States)

Nolan, Bernard T.; Gronberg, JoAnn M.; Faunt, Claudia C.; Eberts, Sandra M.; Belitz, Ken

2014-01-01

Aquifer vulnerability models were developed to map groundwater nitrate concentration at domestic and public-supply well depths in the Central Valley, California. We compared three modeling methods for ability to predict nitrate concentration >4 mg/L: logistic regression (LR), random forest classification (RFC), and random forest regression (RFR). All three models indicated processes of nitrogen fertilizer input at the land surface, transmission through coarse-textured, well-drained soils, and transport in the aquifer to the well screen. The total percent correct predictions were similar among the three models (69–82%), but RFR had greater sensitivity (84% for shallow wells and 51% for deep wells). The results suggest that RFR can better identify areas with high nitrate concentration but that LR and RFC may better describe bulk conditions in the aquifer. A unique aspect of the modeling approach was inclusion of outputs from previous, physically based hydrologic and textural models as predictor variables, which were important to the models. Vertical water fluxes in the aquifer and percent coarse material above the well screen were ranked moderately high-to-high in the RFR models, and the average vertical water flux during the irrigation season was highly significant (p < 0.0001) in logistic regression.

Modeling nitrate at domestic and public-supply well depths in the Central Valley, California

Science.gov (United States)

Nolan, Bernard T.; Gronberg, JoAnn M.; Faunt, Claudia C.; Eberts, Sandra M.; Belitz, Ken

2014-01-01

Aquifer vulnerability models were developed to map groundwater nitrate concentration at domestic and public-supply well depths in the Central Valley, California. We compared three modeling methods for ability to predict nitrate concentration >4 mg/L: logistic regression (LR), random forest classification (RFC), and random forest regression (RFR). All three models indicated processes of nitrogen fertilizer input at the land surface, transmission through coarse-textured, well-drained soils, and transport in the aquifer to the well screen. The total percent correct predictions were similar among the three models (69–82%), but RFR had greater sensitivity (84% for shallow wells and 51% for deep wells). The results suggest that RFR can better identify areas with high nitrate concentration but that LR and RFC may better describe bulk conditions in the aquifer. A unique aspect of the modeling approach was inclusion of outputs from previous, physically based hydrologic and textural models as predictor variables, which were important to the models. Vertical water fluxes in the aquifer and percent coarse material above the well screen were ranked moderately high-to-high in the RFR models, and the average vertical water flux during the irrigation season was highly significant (p in logistic regression.

the biomedical waste management in selected hospitals of chittoor

African Journals Online (AJOL)

management in Government and Private Hospitals. Materials and .... supply of the color coded bags has many deficiencies in both types of .... Journal of Academy of Hospital Administration ... Resource Centre, National Rural Health. Mission: ...

Dizziness in a community hospital: central neurological causes, clinical predictors, and diagnostic yield and cost of neuroimaging studies.

Science.gov (United States)

Ammar, Hussam; Govindu, Rukma; Fouda, Ragai; Zohdy, Wael; Supsupin, Emilio

2017-03-01

Objectives : Neuroimaging is contributing to the rising costs of dizziness evaluation. This study examined the rate of central neurological causes of dizziness, relevant clinical predictors, and the costs and diagnostic yields of neuroimaging in dizziness assessment. Methods : We retrospectively reviewed the records of 521 adult patients who visited the hospital during a 12-month period with dizziness as the chief complaint. Clinical findings were analyzed using Fisher's exact test to determine how they correlated with central neurological causes of dizziness identified by neuroimaging. Costs and diagnostic yields of neuroimaging were calculated. Results : Of the 521 patients, 1.5% had dizziness produced by central neurological causes. Gait abnormalities, limb ataxia, diabetes mellitus, and the existence of multiple neurological findings predicted central causes. Cases were associated with gait abnormalities, limb ataxia, diabetes mellitus, and the existence of multiple neurological findings . Brain computed tomography (CT) and magnetic resonance imaging (MRI) were performed in 42% and 9.5% of the examined cases, respectively, with diagnostic yields of 3.6% and 12%, respectively. Nine cases of dizziness were diagnosed from 269 brain scans, costing $607 914. Conclusion : Clinical evaluation can predict the presence of central neurological causes of dizziness, whereas neuroimaging is a costly and low-yield approach. Guidelines are needed for physicians, regarding the appropriateness of ordering neuroimaging studies. Abbreviations : OR: odds ratio; CI: confidence interval; ED: emergency department; CT: computed tomography; MRI: magnetic resonance imaging; HINTS: Head impulse, Nystagmus, Test of skew.

An Overview of Hybrid Water Supply Systems in the Context of Urban Water Management: Challenges and Opportunities

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Mukta Sapkota

2014-12-01

Full Text Available This paper presents a critical review of the physical impacts of decentralized water supply systems on existing centralized water infrastructures. This paper highlights the combination of centralized and decentralized systems, which is referred to as hybrid water supply systems. The system is hypothesized to generate more sustainable and resilient urban water systems. The basic concept is to use decentralized water supply options such as rainwater tanks, storm water harvesting and localized wastewater treatment and reuse in combination with centralized systems. Currently the impact of hybrid water supply technologies on the operational performance of the downstream infrastructure and existing treatment processes is yet to be known. The paper identifies a number of significant research gaps related to interactions between centralized and decentralized urban water services. It indicates that an improved understanding of the interaction between these systems is expected to provide a better integration of hybrid systems by improved sewerage and drainage design, as well as facilitate operation and maintenance planning. The paper also highlights the need for a framework to better understand the interaction between different components of hybrid water supply systems.

Central Diabetes Insipidus, Central Hypothyroidism, Renal Tubular ...

African Journals Online (AJOL)

readmitted to the hospital because of jaundice and failure to thrive, for which he was investigated and diagnosed to have central congenital hypothyroidism. Shortly thereafter, he was admitted to our institute with a history of vomiting, decreased oral intake, polyuria, and dehydration having lasted 5 days. He was investigated ...

Supplier’s Joint Investments in Cost Reduction and Quality Improvement in a Decentralized Supply Chain

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Hengyun Zhang

2017-01-01

Full Text Available We consider a decentralized supply chain with a downstream manufacturer and an upstream supplier. The upstream supplier sells a product to the manufacturer, who faces a quality and price sensitive demand. The supplier has a chance to invest in both cost reduction and quality improvement of its product. We derive the optimal investment and pricing decisions for the supply chain members. We do so in both the centralized and the decentralized supply chains. We show that the optimal investment and pricing decisions in the decentralized supply chain may deviate from that in the centralized supply chain. We develop a mechanism to coordinate the decentralized supply chain. The developed mechanism contains four policies: wholesale price, sharing of revenue, sharing of cost reduction investment cost, and sharing of quality improvement investment cost. We also show that the developed coordination mechanism can lead to Pareto improvement.

Evaluation of natural gas supply options for Southeast and Central Europe: Part 2. Multi-criteria assessment

International Nuclear Information System (INIS)

Afgan, Naim H.; Carvalho, Maria G.; Pilavachi, Petros A.; Martins, Nelson

2008-01-01

Decision making methods are used as a tool for the selection of alternatives to be evaluated on the basis of several criteria. Evaluation of the potential routes for natural gas supply to the Southeast and Central European countries is studied using single and multi-criteria evaluation. The potential options included in this analysis are the: Yamal Route; Nabucco Route; West Balkan Route; LNG Neum Route; and Gas by Wire Route. In part 1, the paper was devoted to the definition of the indicators and to single indicator analysis. In part 2, the analysis is based on multi-criteria evaluation, which comprises the possibility to assess the options under predefined constraints amongst indicators. The paper also describes different methods used for multi-criteria evaluation. This analysis focuses on cases with different priorities defined among individual weighting coefficients with the others having the same value. It was shown that all options under specific constraints can be qualified as promising in the decision making process. It is also concluded that favourite indicator constraints may exaggerate some options

Central European projects could alter oil movement patterns

International Nuclear Information System (INIS)

Deffarges, E.H.; Howard, D.J.; Treat, J.E.

1991-01-01

This paper reports that several oil transportation projects are set to transform the flows of oil in Central Europe, with potentially important implications for crude oil and product prices in the region. These projects are spurred by the desires of the newly opened economies of Central Europe to diversify their sources of oil supplies away from the U.S.S.R. and by expectations of economic growth in this region. Today, Central European countries (Poland, Czechoslovakia, Hungary, Yugoslavia, Romania, and Bulgaria) rely heavily on Soviet crude supplies. Of the 1.7 million b/d of crude oil consumed by these six countries, about 55% is imported from the U.S.S.R. This is down significantly from the more than 75% import dependence in the mid-1980s. This dependency on U.S.S.R. crude - for countries that either have a history of indigenous production (Romania) or access to Middle East or North African supplies (Yugoslavia) - testifies to more than 40 years of centrally planned economics in which Moscow provided the energy and raw materials and Central European countries delivered finished goods. Since the end of World War II, the pipeline flow of crude oil and products from Western to Central Europe has been almost nonexistent. In fact, the Western European crude and product pipeline network itself is a rather poorly integrated system, with only limited interconnections between northern and southern networks and no real competition across the major flow routes

Effects of dietary pattern and education on glycemic control in patients with type 2 diabetes mellitus at Dr. Sardjito Central General Hospital, Yogyakarta.

Science.gov (United States)

Sinorita, Hemi; Saádah; Jazakillah, Setyowati

2008-04-01

to recognize the effect of education and diet on glycemic control in patients with type 2 diabetes mellitus at Dr. Sardjito Central General Hospital, Jogjakarta. a cross-sectional study was conducted in 88 patients with type 2 DM who had routine visit to the outpatient clinic in Endocrinology Division of Dr. Sardjito Central General Hospital, Jogjakarta. As inclusion criteria, patients who had routine visit in 3 month continuously with fasting plasma glucose (GDN) 126 mg/dl as poor glycemic control group. Data were recorded which included age, sex, period of DM, daily diet pattern, and education received. we found that glycemic control was not affected by sex (p=0.52) and age (p=0.38), but it was affected by period of DM (p=0.02). Glycemic control in the present study was affected by dietary pattern (p=0.01), but not by education (p=1.00). the present study has found significant correlation between regulation of dietary pattern and glycemic control (p=0.01).

Two-echelon logistics service supply chain decision game considering quality supervision

Science.gov (United States)

Shi, Jiaying

2017-10-01

Due to the increasing importance of supply chain logistics service, we established the Stackelberg game model between single integrator and single subcontractors under decentralized and centralized circumstances, and found that logistics services integrators as a leader prefer centralized decision-making but logistics service subcontractors tend to the decentralized decision-making. Then, we further analyzed why subcontractor chose to deceive and rebuilt a principal-agent game model to monitor the logistics services quality of them. Mixed Strategy Nash equilibrium and related parameters were discussed. The results show that strengthening the supervision and coordination can improve the quality level of logistics service supply chain.

APPROACH TO ASSESSING THE PREPAREDNESS OF HOSPITALS TO POWER OUTAGES

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Lenka BREHOVSKÁ

2017-06-01

Full Text Available Within the secondary impacts of electricity blackouts, it is necessary to pay attention to facilities providing medical care for the population, namely the hospitals. Hospitals represent a key position in the provision of health care also in times of crisis. These facilities must provide constant care; it is therefore essential that the preparedness of such facilities is kept at a high level. The basic aim of this article is to analyse the preparedness of hospitals to power outages (power failures, blackouts within a pilot study. On that basis, a SWOT analysis is used to determine strengths and weaknesses of the system of preparedness of hospitals to power outages and solutions for better security of hospitals are defined. The sample investigated consists of four hospitals founded by the Regional Authority (hospitals Nos. 1-4 and one hospital founded by the Ministry of Health of the Czech Republic (hospital No. 5. The results of the study shows that most weaknesses of the preparedness of hospitals are represented by inadequately addressed reserves of fuel for the main backup power supply, poor knowledge of employees who are insufficiently retrained, and old backup power supplies (even 35 years in some cases.

Dynamic joint investments in supply chains under information asymmetry

OpenAIRE

Agrell, Per Joakim; Kasperzec, Roman

2010-01-01

Supply chain management involves the selection, coordination and motivation of independently operated suppliers. However the central planner's perspective in operations management translates poorly to vertically separated chains, where suppliers may have rational myopic reasons to object to full in- formation sharing and centralized decision rights. Particular problems occur when a downstream coordinator demands relation-specific investments (equipment, cost improvements in processes, adaptat...

Retail Services and Pricing Decisions in a Closed-Loop Supply Chain with Remanufacturing

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Zhen-Zheng Zhang

2015-02-01

Full Text Available Environmental and social responsibilities have led many manufacturers to used products recovery. Meanwhile, many manufacturers nowadays sell products via indirect retailer channels and direct Internet channels. This paper models a dual-channel closed-loop supply chain to improve the sustainability of products. We apply the two-stage optimization technique and the Nash game to examine the impacts of the retail services and the degree of customer loyalty to the retail channel on the pricing of players in a centralized and a decentralized dual-channel supply chain. Our results show that the retail services have a great impact on the manufacturer and the retailer’s pricing strategies. We also compare the differences of pricing strategies between a centralized and a decentralized dual-channel supply chain and suggest the optimal retail services and pricing decisions for the players in the supply chain.

Assessing the costs of disposable and reusable supplies wasted during surgeries.

Science.gov (United States)

Chasseigne, V; Leguelinel-Blache, G; Nguyen, T L; de Tayrac, R; Prudhomme, M; Kinowski, J M; Costa, P

2018-05-01

The management of disposable and reusable supplies might have an impact on the cost efficiency of the Operating Room (OR). This study aimed to evaluate the cost and reasons for wasted supplies in the OR during surgical procedures. We conducted an observational and prospective study in a French university hospital. We assessed the cost of wasted supplies in the OR (defined by opened unused devices), the reasons for the wastage, and the circulator retrievals. At the end, we assessed the perception of surgeons and nurses relative to the supply wastage. Fifty routine procedures and five non-scheduled procedures were observed in digestive (n = 20), urologic (n = 20) and gynecologic surgery (n = 15). The median cost [IQR] of open unused devices was €4.1 [0.5; 10.5] per procedure. Wasted supplies represented up to 20.1% of the total cost allocated to surgical supplies. Considering the 8000 surgical procedures performed in these three surgery departments, the potential annual cost savings were 100 000€. The most common reason of wastage was an anticipation of the surgeon's needs. The circulating nurse spent up to 26.3% of operative time outside of the OR, mainly attending to an additional demand from the surgeon (30%). Most of the survey respondents (68%) agreed that knowing supply prices would change their behavior. This study showed the OR is a major source of wasted hospital expenditure and an area wherein an intervention would have a significant impact. Reducing wasted supplies could improve the cost efficiency of the OR and also decrease its ecological impact. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Clinical and endoscopic profile of the patients with upper gastrointestinal bleeding in central rural India: A hospital-based cross-sectional study

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Jyoti Jain

2018-01-01

Full Text Available Introduction: Acute Upper Gastrointestinal bleeding (UGIB is one of the common causes with which the patients present to emergency. The upper gastrointestinal (UGI endoscopy remains a crucial tool in identification of UGIB. The aim of the present study was to determine the endoscopic profile of UGIB in adult population of rural central India admitted with history of UGIB (hemetemesis and/or malena. Methods: This prospective, cross sectional study was conducted in rural hospital in central India and we enrolled all consecutive patients aged 18 years and above who were admitted in the hospital ward with the history of UGIB. After obtaining the demographic data, all patients underwent clinical examination, laboratory investigations and video-endoscopy. We used Student's t test to compare means, Chi-square test to compare proportions and Mann-Whitney test to compare medians. P value <0.05 will be considered significant. Results: The mean age of our study population (N = 118 was 46.2 years. Among 118 patients who underwent endoscopy, 47.4% had esophageal varices, 27.1% had portal hypertensive gastropathy, 14.4% had gastric erosions, 5.9% each had duodenal ulcers and esophagitis, 5% had gastric ulcer disease, 4.2% each had Mallory-Weiss tear and had gastric malignancy, 1.7% had esophageal malignancy and 16.1% had normal endoscopic findings. Conclusion: Esophageal varices were the most common cause of UGIB in the adult population of rural central India presenting with UGIB, when diagnosed by video-endoscopy.

Comparision between bed side testing of blood glucose by glucometer vs centralized testing in a tertiary care hospital.

Science.gov (United States)

Baig, Ayaz; Siddiqui, Imran; Jabbar, Abdul; Azam, Syed Iqbal; Sabir, Salman; Alam, Shahryar; Ghani, Farooq

2007-01-01

To determine the accuracy, turnaround time and cost effectiveness of bedside monitoring of blood glucose levels by non-laboratory health care workers and centralized testing of blood glucose by automated analyzer in a tertiary care hospital. The study was conducted in Section of Chemical Pathology, Department of Pathology and Microbiology and Section of Endocrinology Department of Medicine, Aga Khan University and Hospital Karachi, from April 2005 to March 2006. One hundred and ten patients were included in the study. The blood glucose levels were analyzed on glucometer (Precision Abbott) by finger stick, using Biosensor Technology. At the same time venous blood was obtained to analyze glucose in clinical laboratory on automated analyzer (SYNCHRON CX7) by glucose oxidase method. We observed good correlation between bed side glucometer and laboratory automated analyzer for glucose values between 3.3 mmol/L (60 mg/dl) and 16.7 (300 mg/dl). A significant difference was observed for glucose values less than 3.3 mmol/L (p = 0.002) and glucose values more than 16.67 mmol/l (p = 0.049). Mean Turnaround time for glucometer and automated analyzer were 0.08 hours and 2.49 hours respectively. The cost of glucose testing with glucometer was 48.8% lower than centralized lab based testing. Bedside glucometer testing, though less expensive does not have good accuracy in acutely ill patient with either very high or very low blood glucose levels.

Distribution of variable vs fixed costs of hospital care.

Science.gov (United States)

Roberts, R R; Frutos, P W; Ciavarella, G G; Gussow, L M; Mensah, E K; Kampe, L M; Straus, H E; Joseph, G; Rydman, R J

1999-02-17

Most strategies proposed to control the rising cost of health care are aimed at reducing medical resource consumption rates. These approaches may be limited in effectiveness because of the relatively low variable cost of medical care. Variable costs (for medication and supplies) are saved if a facility does not provide a service while fixed costs (for salaried labor, buildings, and equipment) are not saved over the short term when a health care facility reduces service. To determine the relative variable and fixed costs of inpatient and outpatient care for a large urban public teaching hospital. Cost analysis. A large urban public teaching hospital. All expenditures for the institution during 1993 and for each service were categorized as either variable or fixed. Fixed costs included capital expenditures, employee salaries and benefits, building maintenance, and utilities. Variable costs included health care worker supplies, patient care supplies, diagnostic and therapeutic supplies, and medications. In 1993, the hospital had nearly 114000 emergency department visits, 40000 hospital admissions, 240000 inpatient days, and more than 500000 outpatient clinic visits. The total budget for 1993 was $429.2 million, of which $360.3 million (84%) was fixed and $68.8 million (16%) was variable. Overall, 31.5% of total costs were for support expenses such as utilities, employee benefits, and housekeeping salaries, and 52.4% included direct costs of salary for service center personnel who provide services to individual patients. The majority of cost in providing hospital service is related to buildings, equipment, salaried labor, and overhead, which are fixed over the short term. The high fixed costs emphasize the importance of adjusting fixed costs to patient consumption to maintain efficiency.

Security of supply and regulation of energy networks

International Nuclear Information System (INIS)

Jamasb, Tooraj; Pollitt, Michael

2008-01-01

In recent years, the security of energy supplies has re-emerged as a central issue in the energy policy arena in the UK and elsewhere. This re-emergence takes place against a backdrop of increased liberalisation of the energy markets, so that security of supply needs to be revisited within this context. Security of supply is multifaceted, but is often discussed in terms of physical availability of energy sources and their commodity price risk. This paper discusses the relationship between security of supply and network regulation - that is, how the energy networks, and appropriate regulation of them, can contribute to security of supply in liberalised energy sectors. Energy networks are predominantly natural monopolies and as a result are generally subject to regulatory oversight. We discuss a range of issues and trends that pose challenges and opportunities to network regulation and which call for new and innovative measures. The paper identifies a number of areas where network regulation can play a significant role in increasing the security of supply of future energy systems. (author)

Towards a smoke-free hospital: how the smoking status of health professionals influences their knowledge, attitude and clinical activity. Results from a hospital in central Italy.

Science.gov (United States)

Giorgi, E; Marani, A; Salvati, O; Mangiaracina, G; Prestigiacomo, C; Osborn, J F; Cattaruzza, M S

2015-01-01

In Italy, the prevalence of smoking among health professionals is higher than in the general population and this might hamper their role in the promotion of health. This study aimed to investigate how the smoking status of healthcare professionals might influence knowledge, attitudes and clinical practice in a hospital in central Italy in order to enforce effective tobacco control measures. Physicians and professionals of the hospital were asked to complete an anonymous questionnaire which yielded epidemiological and environmental information on knowledge, attitude, clinical practice and quality of the hospital environments, in relation to smoking. Overall, among the employees of the hospital, the smoking prevalence was 47%, (42% among physicians and 43% among nurses); 30% admitted smoking in the hospital and three quarters of the smokers would like to quit. Some knowledge, opinions and attitudes differ statistically among the smoking categories. For example, only 35% of the smokers admitted that smoking is more dangerous to health than atmospheric and car pollution compared with 60% of the ex or never smokers (p=0.04). Fewer smokers realize that their behavior is seen as a role model by patients. A greater percentage of smokers state that patients (34%) and visitors (43%) often smoke in hospital and these percentages are significantly higher than those reported by ex or never smokers (p≤0.05). All smokers claim that they never smoke in patient rooms, infirmaries and clinics, whereas over 20% of ex or never smokers report that smoking sometimes occurs in these places (p=0.015). The mean concentration of PM 2.5 in the 25 rooms was 2.4 μg/m3 with a range from 1 to 7 μg/m3. This study implies that the prevalence of smoking among health professionals may be very high, and might be twice the rate observed in the general population. Generally, smokers report less knowledge compared with ex and never-smokers and it seems that they systematically underestimate the

Quantifying Supply Risk at a Cellulosic Biorefinery

Energy Technology Data Exchange (ETDEWEB)

Hansen, Jason K [Idaho National Laboratory; Jacobson, Jacob Jordan [Idaho National Laboratory; Cafferty, Kara Grace [Idaho National Laboratory; Lamers, Patrick [Idaho National Laboratory; Roni, MD S [Idaho National Laboratory

2015-03-01

In order to increase the sustainability and security of the nation’s energy supply, the U.S. Department of Energy through its Bioenergy Technology Office has set a vision for one billion tons of biomass to be processed for renewable energy and bioproducts annually by the year 2030. The Renewable Fuels Standard limits the amount of corn grain that can be used in ethanol conversion sold in the U.S, which is already at its maximum. Therefore making the DOE’s vision a reality requires significant growth in the advanced biofuels industry where currently three cellulosic biorefineries convert cellulosic biomass to ethanol. Risk mitigation is central to growing the industry beyond its infancy to a level necessary to achieve the DOE vision. This paper focuses on reducing the supply risk that faces a firm that owns a cellulosic biorefinery. It uses risk theory and simulation modeling to build a risk assessment model based on causal relationships of underlying, uncertain, supply driving variables. Using the model the paper quantifies supply risk reduction achieved by converting the supply chain from a conventional supply system (bales and trucks) to an advanced supply system (depots, pellets, and trains). Results imply that the advanced supply system reduces supply system risk, defined as the probability of a unit cost overrun, from 83% in the conventional system to 4% in the advanced system. Reducing cost risk in this nascent industry improves the odds of realizing desired growth.

Quantifying Supply Risk at a Cellulosic Biorefinery

Energy Technology Data Exchange (ETDEWEB)

Hansen, Jason K.; Jacobson, Jacob J.; Cafferty, Kara G.; Lamers, Patrick; Roni, Mohammad S.

2015-07-01

In order to increase the sustainability and security of the nation’s energy supply, the U.S. Department of Energy through its Bioenergy Technology Office has set a vision for one billion tons of biomass to be processed for renewable energy and bioproducts annually by the year 2030. The Renewable Fuels Standard limits the amount of corn grain that can be used in ethanol conversion sold in the U.S, which is already at its maximum. Therefore making the DOE’s vision a reality requires significant growth in the advanced biofuels industry where currently three cellulosic biorefineries convert cellulosic biomass to ethanol. Risk mitigation is central to growing the industry beyond its infancy to a level necessary to achieve the DOE vision. This paper focuses on reducing the supply risk that faces a firm that owns a cellulosic biorefinery. It uses risk theory and simulation modeling to build a risk assessment model based on causal relationships of underlying, uncertain, supply driving variables. Using the model the paper quantifies supply risk reduction achieved by converting the supply chain from a conventional supply system (bales and trucks) to an advanced supply system (depots, pellets, and trains). Results imply that the advanced supply system reduces supply system risk, defined as the probability of a unit cost overrun, from 83% in the conventional system to 4% in the advanced system. Reducing cost risk in this nascent industry improves the odds of realizing desired growth.

Teleconnected food supply shocks

Science.gov (United States)

Bren d'Amour, Christopher; Wenz, Leonie; Kalkuhl, Matthias; Steckel, Jan Christoph; Creutzig, Felix

2016-03-01

The 2008-2010 food crisis might have been a harbinger of fundamental climate-induced food crises with geopolitical implications. Heat-wave-induced yield losses in Russia and resulting export restrictions led to increases in market prices for wheat across the Middle East, likely contributing to the Arab Spring. With ongoing climate change, temperatures and temperature variability will rise, leading to higher uncertainty in yields for major nutritional crops. Here we investigate which countries are most vulnerable to teleconnected supply-shocks, i.e. where diets strongly rely on the import of wheat, maize, or rice, and where a large share of the population is living in poverty. We find that the Middle East is most sensitive to teleconnected supply shocks in wheat, Central America to supply shocks in maize, and Western Africa to supply shocks in rice. Weighing with poverty levels, Sub-Saharan Africa is most affected. Altogether, a simultaneous 10% reduction in exports of wheat, rice, and maize would reduce caloric intake of 55 million people living in poverty by about 5%. Export bans in major producing regions would put up to 200 million people below the poverty line at risk, 90% of which live in Sub-Saharan Africa. Our results suggest that a region-specific combination of national increases in agricultural productivity and diversification of trade partners and diets can effectively decrease future food security risks.

Peripherally Inserted Central Catheters (PICCs) and Potential Cost Savings and Shortened Bed Stays In an Acute Hospital Setting.

LENUS (Irish Health Repository)

O’Brien, C

2018-01-01

Peripheral inserted central catheters (PICCs) have increasingly become the mainstay of patients requiring prolonged treatment with antibiotics, transfusions, oncologic IV therapy and total parental nutrition. They may also be used in delivering a number of other medications to patients. In recent years, bed occupancy rates have become hugely pressurized in many hospitals and any potential solutions to free up beds is welcome. Recent introductions of doctor or nurse led intravenous (IV) outpatient based treatment teams has been having a direct effect on early discharge of patients and in some cases avoiding admission completely. The ability to deliver outpatient intravenous treatment is facilitated by the placement of PICCs allowing safe and targeted treatment of patients over a prolonged period of time. We carried out a retrospective study of 2,404 patients referred for PICCs from 2009 to 2015 in a university teaching hospital. There was an exponential increase in the number of PICCs requested from 2011 to 2015 with a 64% increase from 2012 to 2013. The clear increase in demand for PICCs in our institution is directly linked to the advent of outpatient intravenous antibiotic services. In this paper, we assess the impact that the use of PICCs combined with intravenous outpatient treatment may have on cost and hospital bed demand. We advocate that a more widespread implementation of this service throughout Ireland may result in significant cost savings as well as decreasing the number of patients on hospital trollies.

Study of factors affecting demand and supply of sugar in Indonesia ...

African Journals Online (AJOL)

This study is aimed at determining: (a) the factors influencing the demand of national sugar, and the price elasticity of demand (ep) and; (b) the factors influencing the supply of national sugar, and the price elasticity of supply (es). The data comprised a time series of 1990-2006, taken from the Central Statistics Bureau, The ...

Regional variation in hospital admission rates in the Netherlands, Belgium, Northern France and Nordrhein-Westfalen.

NARCIS (Netherlands)

Noordt, M. van; Zee, J. van der; Groenewegen, P.P.

1992-01-01

For the analysis of regional variations in hospital admission rates a model was set up, including both supply and demand indicators. Data were gathered for regions in four health care systems (the Dutch, Belgian, French and German), for 1982, 1979, 1974 (France 1982 only). Hospital bed supply proved

Performance evaluation of nonhomogeneous hospitals: the case of Hong Kong hospitals.

Science.gov (United States)

Li, Yongjun; Lei, Xiyang; Morton, Alec

2018-02-14

Throughout the world, hospitals are under increasing pressure to become more efficient. Efficiency analysis tools can play a role in giving policymakers insight into which units are less efficient and why. Many researchers have studied efficiencies of hospitals using data envelopment analysis (DEA) as an efficiency analysis tool. However, in the existing literature on DEA-based performance evaluation, a standard assumption of the constant returns to scale (CRS) or the variable returns to scale (VRS) DEA models is that decision-making units (DMUs) use a similar mix of inputs to produce a similar set of outputs. In fact, hospitals with different primary goals supply different services and provide different outputs. That is, hospitals are nonhomogeneous and the standard assumption of the DEA model is not applicable to the performance evaluation of nonhomogeneous hospitals. This paper considers the nonhomogeneity among hospitals in the performance evaluation and takes hospitals in Hong Kong as a case study. An extension of Cook et al. (2013) [1] based on the VRS assumption is developed to evaluated nonhomogeneous hospitals' efficiencies since inputs of hospitals vary greatly. Following the philosophy of Cook et al. (2013) [1], hospitals are divided into homogeneous groups and the product process of each hospital is divided into subunits. The performance of hospitals is measured on the basis of subunits. The proposed approach can be applied to measure the performance of other nonhomogeneous entities that exhibit variable return to scale.

The MeSH model for hospital-physician joint ventures.

Science.gov (United States)

Anderson, J G

1985-01-01

The MeSH (Medical Staff-Hospital Joint Venture Company) concept has arisen to meet the perceived need for hospital-physician cooperation in a modern age of prospective payment systems, increased supply of health-care providers, cost conscious consumers, corporate health care organizations, and a general trend toward industrialization of health care. Supply and demand economics have created a situation which threatens the autonomy and financial integrity of both hospitals ans physicians, forcing cooperation or mutual destruction. MeSH seeks to preserve the autonomy and financial integrity of both parties through the creation of a free-standing business entity jointly owned by a hospital and those members of its medical staff who choose to participate. This article presents reasons for the need for cooperation, the objectives of MeSH, a description of its structure and operation, and a list of potential projects the program could include.

ENERGY-EFFICIENT REGIMES FOR HEATING-SUPPLY OF THE RESIDENTIAL BUILDINGS

Directory of Open Access Journals (Sweden)

S. N. Osipov

2015-01-01

Full Text Available Rise in comfort and inhabitation safety is one of the main requirements of the general maintenance, reconstruction of the old and construction of the new residential houses. One of the essential factors of it is substitution in the household hot-water preparing sources: from the individual domestic gas  water-heaters to  the common  entire-building hot-water supply at the expense of the centralized heat supply. Extremely erratic hot-water daily consumption by tenants leads to the necessity of sharp increase in central heat-supply level during a few hours of the day, which requires a significant increase of the source heat-power. On that score, the authors propose to direct a significant part (up to 50 % of the centralized heating and ventilation heat power-consumption to the hot water preparation during the period of short-term hot water consumption peak.Substitution  of  the  individual  domestic  gas  water-heaters  with  the  common  entirebuilding hot-water supply releases a huge amount of natural gas which can be utilized not only for production of the necessary heat power but as well for electric power producing. This substitution is especially advantageous if heat-power is delivered to the residential area from a НРС where significant part of heat especially in a relatively warm season of the year is thrown out into the air. The content of the article is based on several patents received earlier.

Replacement power supply with micro-hydropower. Case micro central - Pipinta

International Nuclear Information System (INIS)

Gomez, Jorge I; Hincapie, Luis A; Woodcock, Edgar; Arregoces Alvaro

2006-01-01

This paper describes the Micro-Hydro Electric Pipinta through its main components and their parameters. An evaluation of the actual power plant costs and a proposed redesign are also given with prices referenced to year 2004. A comparison between the electricity price supplied by the grid and the cost for the electricity in this Micro-Hydro Power Plant let conclude that projects of this type are available in rural areas of Colombia reached by the grid.

Berlin Brandenburg International (BER: planning and implementation of a concrete supply chain for the airport construction site

Directory of Open Access Journals (Sweden)

Guido Riedel

2012-12-01

Full Text Available Background: With the decision to extend the airport Berlin-Schönefeld to the new airport Berlin Brandenburg International (BER in 2006, a construction of superlatives has emerged. One of the biggest challenges was the supply of around 2.5 million cubic meters of high quality concrete that had to be produced for the construction of the airport. Due to the scale of this enterprise as well as its environment, the logistic solution of raw material supply has to be found.       Method: The planning of the concrete supply chain for the airport construction site BER had to be carried out with two major goals: the stability of the supply chain to assure that the demands of the construction site are met and delays are prevented, as well as assurance of the high quality standards of the concrete production and to avoid an alkali silica reaction and the resulting unavoidable disaggregation of the concrete. External effects, such as the carbon dioxide emission and the effect of the supply chain on adjoining residents were key factors that had to be integrated in a holistic supply chain concept.  The principle underlying method is an analysis of limiting conditions for two approaches: a centralized supply chain with on-site concrete factory and upstream transport of raw materials versus a decentralized supply chain with off-site factories and downstream transport of ready-mixed concrete. Results: The analysis of constraints and the effects on key requirements of the concrete supply chain for the BER airport construction site lead to the installation of the most modern concrete plant in Europe. The benefits of a centralized supply chain are significant. On one hand, the high quality standards can be met with the on-site mixture of the concrete and centralized quality assurance, on the other hand, the majority of the supply traffic for the construction site was moved from the road to train-bound logistics, meeting the emission requirements of the

Pricing Strategies in Information Goods in Data Supply Chain

OpenAIRE

Xinming Li; Huaqing Wang

2018-01-01

By focusing on new features of data products and, based on game theoretical models, we study three pricing mechanisms’ performance and their effects on the participants in the data industry from the data supply chain perspective. A win-win pricing strategy for the players in the data supply chain is proposed. We obtain analytical solutions in each pricing mechanism, including the decentralized and centralized pricing, Nash Bargaining pricing, and revenue sharing mechanism. Our findings show t...

Regional power supply with decentral and renewable energy sources; Regionale Energieversorgung mit dezentralen und erneuerbaren Energien

Energy Technology Data Exchange (ETDEWEB)

Bonow, Martin [Genossenschaftsverband, Neu-Isenburg/Zeppelinheim-Ost (Germany); George, Wolfgang [GenoPortal, Neu-Isenburg (Germany); Klement, Martin [Kassel Univ. (Germany). Fachbereich 6 - Architektur, Stadtplanung, Landschaftsplanung

2009-04-15

The contribution starts by assuming a region as a business organisation; on this basis, the authors develop the idea of a regional value-adding chain with regard to regional power supply. After presenting the central actors and their manner of integration, the contribution discusses concepts for sustainable power supply as well as the central parameters of such a development in terms of quality of life, attractivity of the region, future success of technologies, and criteria of value-adding. Finally, the implementation of regional power supply with the aid of a so-called 'balanced scorecard' is explained, which involves balancing of the various perspectives of the process up to the establishment of the final regional power supply concept. Finally, the contribution briefly discusses co-operative models for the establishment of a regional power supply concept. (orig.)

Ranking agility factors affecting hospitals in Iran

Directory of Open Access Journals (Sweden)

M. Abdi Talarposht

2017-04-01

Full Text Available Background: Agility is an effective response to the changing and unpredictable environment and using these changes as opportunities for organizational improvement. Objective: The aim of the present study was to rank the factors affecting agile supply chain of hospitals of Iran. Methods: This applied study was conducted by cross sectional-descriptive method at some point of 2015 for one year. The research population included managers, administrators, faculty members and experts were selected hospitals. A total of 260 people were selected as sample from the health centers. The construct validity of the questionnaire was approved by confirmatory factor analysis test and its reliability was approved by Cronbach's alpha (α=0.97. All data were analyzed by Kolmogorov-Smirnov, Chi-square and Friedman tests. Findings: The development of staff skills, the use of information technology, the integration of processes, appropriate planning, and customer satisfaction and product quality had a significant impact on the agility of public hospitals of Iran (P<0.001. New product introductions had earned the highest ranking and the development of staff skills earned the lowest ranking. Conclusion: The new product introduction, market responsiveness and sensitivity, reduce costs, and the integration of organizational processes, ratings better to have acquired agility hospitals in Iran. Therefore, planners and officials of hospitals have to, through the promotion quality and variety of services customer-oriented, providing a basis for investing in the hospital and etc to apply for agility supply chain public hospitals of Iran.

ARSENIC IN DRINKING WATER SUPPLY WELLS: A MULTI ...

Science.gov (United States)

Studies have indicated that arsenic concentrations greater than the new U.S. Environmental Protection Agency (EPA) maximum contaminant level (MCL) concentration of 10 micrograms per liter (µg/L) occur in numerous aquifers around the United States. One such aquifer is the Central Oklahoma aquifer, which supplies drinking water to numerous communities in central Oklahoma. Concentrations as high as 230 µg/L have been reported in some drinking water supply wells from this aquifer. The city of Norman, like most other affected cities, is actively seeking a cost-effective solution to the arsenic problem. Only six of the city’s 32 wells exceeded the old MCL of 50 µg/L. With implementation of the new MCL this year, 18 of the 32 wells exceed the allowable concentration of arsenic. Arsenic-bearing shaly sandstones appear to be the source of the arsenic. It may be possible to isolate these arsenic-bearing zones from water supply wells, enabling production of water that complies with drinking water standards. It is hypothesized that geologic mapping together with detailed hydrogeochemical investigations will yield correlations which predict high arsenic occurrence for the siting of new drinking water production wells. More data and methods to assess the specific distribution, speciation, and mode of transport of arsenic in aquifers are needed to improve our predictions for arsenic occurrence in water supply wells. Research is also needed to assess whether we can ret

Coordinating a Supply Chain When Manufacturer Makes Cost Reduction Investment in Supplier

Directory of Open Access Journals (Sweden)

Shilei Huang

2016-01-01

Full Text Available We consider a supply chain consisting of an upstream supplier and a downstream manufacturer, in which the supplier provides a component to the manufacturer, facing a price-sensitive and uncertain demand. The manufacturer makes cost reduction investment in the supplier to improve the supplier’s production efficiency, which benefits the entire supply chain. We derive the optimal investment and operating decisions. Both the centralized and decentralized supply chains are studied. We show that the optimal investment and operating decisions in the decentralized setting may deviate from that in the centralized setting. To avoid the profit loss caused by such a deviation, we develop a coordination mechanism by introducing a combined policy of revenue-sharing policy and investment cost-sharing policy. We also show that the developed coordination mechanism can achieve Pareto improvement for the two players.

Specialized consulting in radiological safety to the North Central Hospital of high specialty, PEMEX. V. November of 2001; Asesoria especializada en seguridad radiologica al Hospital Central Norte de alta especialidad, PEMEX. V. Noviembre de 2001

Energy Technology Data Exchange (ETDEWEB)

Angeles C, A.; Vizuet G, J.; Benitez S, J. A.; Garcia A, J.; Rodriguez A, F. [ININ, 52045 Ocoyoacac, Estado de Mexico (Mexico)

2002-01-15

It is a report of a specialized consulting in radiological safety that to be carried the ININ to PEMEX for the North Central Hospital of High Specialty, to maintain the sanitary license for the use of X ray equipment of medical diagnostic, and guarantee these services with a program of quality assurance. To give fulfilment to that requests it is programmed a technical assistance monthly, with reports of results during the development of the service. In this document it is carried a report of the advances and results in the month of November of the 2001, where the following documents are analyzed: Manual of radiological safety, program of quality assurance, operation procedures, procedure of maintenance team, procedure of medical radiological control of the specialized personnel; also are annotate the obtained results and their observations. (Author)

Specialized consulting in radiological safety to the south central hospital of high specialty, PEMEX. VI. December of 2001; Asesoria especializada en seguridad radiologica al hospital central sur de alta especialidad. PEMEX. VI. Diciembre de 2001

Energy Technology Data Exchange (ETDEWEB)

Angeles C, A.; Vizuet G, J.; Benitez S, J.A.; Garcia A, J.; Rodriguez A, F. [ININ, 52045 Ocoyoacac, Estado de Mexico (Mexico)

2002-01-15

It is a report of a specialized consulting in radiological safety that to be carried the ININ to PEMEX for the South Central Hospital of High Specialty, to maintain the sanitary license for the use of X-ray equipment of medical diagnostic, and guarantee these services with a program of quality assurance. To give fulfilment to that requests it is programmed a technical assistance monthly, with reports of results during the development of the service. In this document it is carried a report of the advances and results in the month of december of the 2001, where the following documents are analyzed: Manual of radiological safety, program of quality assurance, operation procedures, procedure of maintenance team, procedure of medical radiological control of the specialized personnel; also are annotate the obtained results and their observations. (Author)

SPD-based Logistics Management Model of Medical Consumables in Hospitals

Science.gov (United States)

LIU, Tongzhu; SHEN, Aizong; HU, Xiaojian; TONG, Guixian; GU, Wei; YANG, Shanlin

2016-01-01

Background: With the rapid development of health services, the progress of medical science and technology, and the improvement of materials research, the consumption of medical consumables (MCs) in medical activities has increased in recent years. However, owing to the lack of effective management methods and the complexity of MCs, there are several management problems including MC waste, low management efficiency, high management difficulty, and frequent medical accidents. Therefore, there is urgent need for an effective logistics management model to handle these problems and challenges in hospitals. Methods: We reviewed books and scientific literature (by searching the articles published from 2010 to 2015 in Engineering Village database) to understand supply chain related theories and methods and performed field investigations in hospitals across many cities to determine the actual state of MC logistics management of hospitals in China. Results: We describe the definition, physical model, construction, and logistics operation processes of the supply, processing, and distribution (SPD) of MC logistics because of the traditional SPD model. With the establishment of a supply-procurement platform and a logistics lean management system, we applied the model to the MC logistics management of Anhui Provincial Hospital with good effects. Conclusion: The SPD model plays a critical role in optimizing the logistics procedures of MCs, improving the management efficiency of logistics, and reducing the costs of logistics of hospitals in China. PMID:27957435

SPD-based Logistics Management Model of Medical Consumables in Hospitals.

Science.gov (United States)

Liu, Tongzhu; Shen, Aizong; Hu, Xiaojian; Tong, Guixian; Gu, Wei; Yang, Shanlin

2016-10-01

With the rapid development of health services, the progress of medical science and technology, and the improvement of materials research, the consumption of medical consumables (MCs) in medical activities has increased in recent years. However, owing to the lack of effective management methods and the complexity of MCs, there are several management problems including MC waste, low management efficiency, high management difficulty, and frequent medical accidents. Therefore, there is urgent need for an effective logistics management model to handle these problems and challenges in hospitals. We reviewed books and scientific literature (by searching the articles published from 2010 to 2015 in Engineering Village database) to understand supply chain related theories and methods and performed field investigations in hospitals across many cities to determine the actual state of MC logistics management of hospitals in China. We describe the definition, physical model, construction, and logistics operation processes of the supply, processing, and distribution (SPD) of MC logistics because of the traditional SPD model. With the establishment of a supply-procurement platform and a logistics lean management system, we applied the model to the MC logistics management of Anhui Provincial Hospital with good effects. The SPD model plays a critical role in optimizing the logistics procedures of MCs, improving the management efficiency of logistics, and reducing the costs of logistics of hospitals in China.

Variations in hospitalization rates among nursing home residents: the role of discretionary hospitalizations.

Science.gov (United States)

Carter, Mary W

2003-08-01

To examine variations in hospitalization rates among nursing home residents associated with discretionary hospitalization practices. Quarterly Medicaid case-mix reimbursement data from the state of Massachusetts served as the core data source for this study, which was linked with data from the Medicare Provider Analysis and Review file (MEDPAR) to specify hospitalization status, nursing facility attribute data from the state of Massachusetts to specify facility-level organizational and structural attributes, and data from the Area Resource File (ARF) to specify area market-level attributes. Data spans three years (1991-1993) to produce a longitudinal analytical file containing 72,319 person-quarter-level observations. Two-step, multivariate logistic regression models were estimated for highly discretionary hospitalizations versus those containing less discretion, and low discretionary hospitalizations versus those containing greater amounts of physician discretion. Findings indicate that facility case-mix levels and area hospital bed supply levels contribute to variations in hospitalization rates among nursing home residents. Highly discretionary hospitalizations appear to be most sensitive to patient diagnoses best described as chronic, ambulatory care sensitive conditions. Findings suggest that defining hospitalizations simply in terms of whether an event occurs versus otherwise may obscure valuable information regarding the contribution of various risk factors to highly discretionary versus low discretionary hospitalization rates.

The More Supply Chain Control Power, the Better? A Comparison among Four Kinds of Cooperation Models

Directory of Open Access Journals (Sweden)

Weihua Liu

2015-01-01

Full Text Available This paper introduces the parameter of supply chain control power into existing supply chain coordination models and explores the impacts of control power on the profits of manufacturer, retailer, and the overall supply chain under four modes of decision-making, including the decentralized decision-making dominated by manufacturer, the decentralized decision-making dominated by retailer, centralized decision-making, and Nash negotiation decision-making. Some significant conclusions are obtained. Firstly, supply chain control power does have great impact on the supply chain profits. The profit of the whole supply chain with centralized decision-making is higher than those of the other three modes, while the overall profit of supply chain with decentralized decision-making is superior to the profit when retailer and manufacturer dominate the supply chain together. Secondly, with decentralized decision-making, for manufacturer and retailer, it is beneficial to gain the control powers of the supply chain; however, control power has an optimal value, not the bigger, the better. Thirdly, under certain circumstances, order quantity will increase and the wholesale price will decrease when control power is transferred from manufacturer to retailer. In this case, the total profit of supply chain dominated by retailer will be greater than that dominated by manufacturer.

Benefiting from networks by occupying central positions: an empirical study of the Taiwan health care industry.

Science.gov (United States)

Peng, Tzu-Ju Ann; Lo, Fang-Yi; Lin, Chin-Shien; Yu, Chwo-Ming Joseph

2006-01-01

At issue is whether network resources imply some resources available to all members in networks or available only to those occupying structurally central positions in networks. In this article, two conceptual models, the additive and interaction models of the firm, are empirically tested regarding the impact of hospital resources, network resources, and centrality on hospital performance in the Taiwan health care industry. The results demonstrate that: (1) in the additive model, hospital resources and centrality independently affect performance, whereas network resources do not; and (2) no evidence supports the interaction effect of centrality and resources on performance. Based on our findings in Taiwanese practices, the extent to which the resources are acquired externally from networks, we suggest that while adopting interorganizational strategies, hospitals should clearly identify those important resources that reside in-house and those transferred from network partners. How hospitals access resources from central positions is more important than what network resources can hospitals acquire from networks. Hospitals should improve performance by exploiting its in-house resources rather than obtaining network resources externally. In addition, hospitals should not only invest in hospital resources for better performance but should also move to central positions in networks to benefit from collaborations.

Central control system for the EAST tokamak

International Nuclear Information System (INIS)

Sun Xiaoyang; Ji Zhenshan; Wu Yicun; Luo Jiarong

2008-01-01

The architecture, the main function and the design scheme of the central control system and the collaboration system of EAST tokamak are described. The main functions of the central control system are to supply a union control interface for all the control, diagnoses, and data acquisition (DAQ) subsystem and it is also designed to synchronize all those subsystem. (authors)

Comparability of Point-of-Care versus Central Laboratory Hemoglobin Determination in Emergency Patients at a Supra-Maximal Care Hospital.

Science.gov (United States)

Dolscheid-Pommerich, Ramona C; Dolscheid, Sarah; Grigutsch, Daniel; Stoffel-Wagner, Birgit; Graeff, Ingo

2016-01-01

Fulfilling the requirements of point-of-care testing (POCT) training regarding proper execution of measurements and compliance with internal and external quality control specifications is a great challenge. Our aim was to compare the values of the highly critical parameter hemoglobin (Hb) determined with POCT devices and central laboratory analyzer in the highly vulnerable setting of an emergency department in a supra maximal care hospital to assess the quality of POCT performance. In 2548 patients, Hb measurements using POCT devices (POCT-Hb) were compared with Hb measurements performed at the central laboratory (Hb-ZL). Additionally, sub collectives (WHO anemia classification, patients with Hb 85y.) were analyzed. Overall, the correlation between POCT-Hb and Hb-ZL was highly significant (r = 0.96, p2.5g/dl occurred. McNemar´s test revealed significant differences regarding anemia diagnosis according to WHO definition for male, female and total patients (♂ phemoglobin concentration measurement methods, i.e. POCT devices and at the central laboratory. The results confirm the successful implementation of the presented POCT concept. Nevertheless some limitations could be identified in anemic patients stressing the importance of carefully examining clinically implausible results.

Optimisation of energy supply at off-grid healthcare facilities using Monte Carlo simulation

International Nuclear Information System (INIS)

Dufo-López, Rodolfo; Pérez-Cebollada, Eduardo; Bernal-Agustín, José L.; Martínez-Ruiz, Ignacio

2016-01-01

Highlights: • We study the application of renewable energies in a hospital located in Kalonge. • A stochastic approach is developed by means of Monte Carlo simulation. • We propose adding PV panels to improve the supply of electrical energy. • The results show that optimal design could achieve 28% reduction in the LCE. • Furthermore, we discuss possible improvements to the telecommunications of the hospital. - Abstract: In this paper, we present a methodology for the optimisation of off-grid hybrid systems (photovoltaic–diesel–battery systems). A stochastic approach is developed by means of Monte Carlo simulation to consider the uncertainties of irradiation and load. The optimisation is economic; that is, we look for a system with a lower net present cost including installation, replacement of the components, operation and maintenance, etc. The most important variable that must be estimated is the batteries lifespan, which depends on the operating conditions (charge/discharge cycles, corrosion, state of charge, etc.). Previous works used classical methods for the estimation of batteries lifespan, which can be too optimistic in many cases, obtaining a net present cost of the system much lower than in reality. In this work, we include an advanced weighted Ah-throughput model for the lead-acid batteries, which is much more realistic. The optimisation methodology presented in this paper is applied in the optimisation of the electrical supply for an off-grid hospital located in Kalonge (Democratic Republic of the Congo). At the moment, the power supply relies on a diesel generator; batteries are used in order to ensure the basic supply of energy when the generator is unavailable (night hours). The optimisation includes the possibility of adding solar photovoltaic (PV) panels to improve the supply of electrical energy. The results show that optimal design could achieve a 28% reduction in the levelised cost of energy and a 54% reduction in the diesel fuel

Anti-Candida activity assessment of Pelargonium graveolens oil free and nanoemulsion in biofilm formation in hospital medical supplies.

Science.gov (United States)

Giongo, Janice Luehring; de Almeida Vaucher, Rodrigo; Fausto, Viviane Pedroso; Quatrin, Priscilla Maciel; Lopes, Leonardo Quintana Soares; Santos, Roberto Christ Vianna; Gündel, André; Gomes, Patrícia; Steppe, Martin

2016-11-01

Infections due to microbial biofilm formation on the surface of catheters and other medical devices are constantly reported as a major cause of morbidity and mortality in patients admitted to hospitals. Furthermore, sessile cells are more resistant to phagocytosis and most antimicrobial, which complicates the treatment of such infections. Researches aimed at new antimicrobial originating mainly from plants have increased in recent years and the development of new strategies for their release is critical in combating the formation of biofilms. Geranium oil (GO) has proven antimicrobial activity. Because of this, the aim of this study was to develop nanoemulsions containing this oil (NEG) and evaluate its activity after the biofilm formation of Candida albicans, Candida tropicalis, Candida glabrata, and Candida krusei in hospital medical supplies. For quantification of the biofilm, crystal violet, total protein, and ATP-bioluminescence assays were used. The results revealed that GO and NEG showed lower MIC for C. albicans and C. tropicalis. The biofilms formed by different species of Candida on the surfaces of polyethylene and polyurethane were quantified. GO and NEG significantly inhibited the formation of biofilms in all species tested on the surfaces of polyethylene. However, NEG antibiofilm has had better activity than GO for C. albicans, C. tropicalis and C. glabrata, according to the surface potential analysis by atomic force microscopy (AFM). The analysis of the biofilm formation on the polyethylene surface by ATP-bioluminescence and CFU showed similar results. In both methods the formation of biofilm in the catheter occurred in greater quantity for C. albicans and C. tropicalis. GO did not significantly inhibit the formation of biofilms only in C. krusei, although NEG significantly increased this activity GO in all species tested when compared to the control training biofilm. The following study shows that the development of NEG may become an effective

36 CFR 1210.35 - Supplies and other expendable property.

Science.gov (United States)

2010-07-01

... HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Property... exceeding $5,000 in total aggregate value upon termination or completion of the project or program and the... equipment. (b) The recipient shall not use supplies acquired with NHPRC funds to provide services to non...

Heat supply of the town of Trnava from EBO nuclear plant

International Nuclear Information System (INIS)

Kovarik, Z.

4 variants of central heat supply from the V-2 Bohunice nuclear power plant were considered. Three included the supply of hot water while the fourth envisaged the supply of steam. The variants of hot water supply differed in the proportion of heat supply during load peak, the range being from 75% to 88% to 100%. The system suggested considers hot water with a maximum overpressure of 2.5 MPa and temperature of 150/70 degC, with possible temporary decrease to 130/70 degC. The estimated power of heat exchange stations is 240 MW at a temperature gradient of 150/70 degC and 180 MW at a temperature gradient 130/70 degC. The location, design and control of the heat supply system and the specifications of heat generation facilities are given. (J.P.)

Dual Competing Photovoltaic Supply Chains: A Social Welfare Maximization Perspective

Science.gov (United States)

Su, Shong-Iee Ivan

2017-01-01

In the past decades, the inappropriate subsidy policies in many nations have caused problems such as serious oversupply, fierce competition and subpar social welfare in the photovoltaic (PV) industry in many nations. There is a clear shortage in the PV industry literature regarding how dual supply chains compete and the key decision issues regarding the competition between dual PV supply chains. It is critical to develop effective subsidy policies for the competing PV supply chains to achieve social welfare maximization. This study has explored the dual PV supply chain competition under the Bertrand competition assumption by three game-theoretical modeling scenarios (or supply chain strategies) considering either the public subsidy or no subsidy from a social welfare maximization perspective. A numerical analysis complemented by two sensitivity analyses provides a better understanding of the pricing and quantity decision dynamics in the dual supply chains under three different supply chain strategies and the corresponding outcomes regarding the total supply chain profits, the social welfare and the required total subsidies. The key findings disclose that if there are public subsidies, the dual PV supply chains have the strongest intention to pursue the decentralized strategy to achieve their maximal returns rather than the centralized strategy that would achieve the maximal social welfare; however, the government would need to pay for the maximal subsidy budget. Thus, the best option for the government would be to encourage the dual PV supply chains to adopt a centralized strategy since this will not only maximize the social welfare but also, at the same time, minimize the public subsidy. With a smart subsidy policy, the PV industry can make the best use of the subsidy budget and grow in a sustainable way to support the highly demanded solar power generation in many countries trying very hard to increase the proportion of their clean energy to combat the global

Dual Competing Photovoltaic Supply Chains: A Social Welfare Maximization Perspective

Directory of Open Access Journals (Sweden)

Zhisong Chen

2017-11-01

Full Text Available In the past decades, the inappropriate subsidy policies in many nations have caused problems such as serious oversupply, fierce competition and subpar social welfare in the photovoltaic (PV industry in many nations. There is a clear shortage in the PV industry literature regarding how dual supply chains compete and the key decision issues regarding the competition between dual PV supply chains. It is critical to develop effective subsidy policies for the competing PV supply chains to achieve social welfare maximization. This study has explored the dual PV supply chain competition under the Bertrand competition assumption by three game-theoretical modeling scenarios (or supply chain strategies considering either the public subsidy or no subsidy from a social welfare maximization perspective. A numerical analysis complemented by two sensitivity analyses provides a better understanding of the pricing and quantity decision dynamics in the dual supply chains under three different supply chain strategies and the corresponding outcomes regarding the total supply chain profits, the social welfare and the required total subsidies. The key findings disclose that if there are public subsidies, the dual PV supply chains have the strongest intention to pursue the decentralized strategy to achieve their maximal returns rather than the centralized strategy that would achieve the maximal social welfare; however, the government would need to pay for the maximal subsidy budget. Thus, the best option for the government would be to encourage the dual PV supply chains to adopt a centralized strategy since this will not only maximize the social welfare but also, at the same time, minimize the public subsidy. With a smart subsidy policy, the PV industry can make the best use of the subsidy budget and grow in a sustainable way to support the highly demanded solar power generation in many countries trying very hard to increase the proportion of their clean energy to

Dual Competing Photovoltaic Supply Chains: A Social Welfare Maximization Perspective.

Science.gov (United States)

Chen, Zhisong; Su, Shong-Iee Ivan

2017-11-20

In the past decades, the inappropriate subsidy policies in many nations have caused problems such as serious oversupply, fierce competition and subpar social welfare in the photovoltaic (PV) industry in many nations. There is a clear shortage in the PV industry literature regarding how dual supply chains compete and the key decision issues regarding the competition between dual PV supply chains. It is critical to develop effective subsidy policies for the competing PV supply chains to achieve social welfare maximization. This study has explored the dual PV supply chain competition under the Bertrand competition assumption by three game-theoretical modeling scenarios (or supply chain strategies) considering either the public subsidy or no subsidy from a social welfare maximization perspective. A numerical analysis complemented by two sensitivity analyses provides a better understanding of the pricing and quantity decision dynamics in the dual supply chains under three different supply chain strategies and the corresponding outcomes regarding the total supply chain profits, the social welfare and the required total subsidies. The key findings disclose that if there are public subsidies, the dual PV supply chains have the strongest intention to pursue the decentralized strategy to achieve their maximal returns rather than the centralized strategy that would achieve the maximal social welfare; however, the government would need to pay for the maximal subsidy budget. Thus, the best option for the government would be to encourage the dual PV supply chains to adopt a centralized strategy since this will not only maximize the social welfare but also, at the same time, minimize the public subsidy. With a smart subsidy policy, the PV industry can make the best use of the subsidy budget and grow in a sustainable way to support the highly demanded solar power generation in many countries trying very hard to increase the proportion of their clean energy to combat the global

Implementation of Monetary Policy: How Do Central Banks Set Interest Rates?

OpenAIRE

Benjamin M. Friedman; Kenneth N. Kuttner

2010-01-01

Central banks no longer set the short-term interest rates that they use for monetary policy purposes by manipulating the supply of banking system reserves, as in conventional economics textbooks; today this process involves little or no variation in the supply of central bank liabilities. In effect, the announcement effect has displaced the liquidity effect as the fulcrum of monetary policy implementation. The chapter begins with an exposition of the traditional view of the implementation of ...

Tuberculosis patients hospitalized in the Albert Schweitzer Hospital, Lambaréné, Gabon-a retrospective observational study

NARCIS (Netherlands)

Stolp, S. M.; Huson, M. A. M.; Janssen, S.; Beyeme, J. O.; Grobusch, M. P.

2013-01-01

Epidemiological data on tuberculosis in Central Africa are limited. We performed a retrospective observational study on clinical characteristics of 719 hospitalized tuberculosis patients in Lambaréné, Gabon. Human immunodeficiency virus (HIV) co-infection rate was high (34%) and in-hospital

LEAN HEALTHCARE SUPPLY CHAIN MANAGEMENT: MINIMIZING WASTE AND COSTS

Directory of Open Access Journals (Sweden)

Catia M L Machado

2014-12-01

Full Text Available The purpose of this research is to investigate the management models applied in the supply chain providing services in healthcare organizations, considering the lenses of lean. The aim of this is to develop a model of supply chain management focusing on the identification and minimization of waste, assisting in decision making and contributing to the quality of services and as a consequence the reduction of the costs involved in healthcare supply chain. The philosophies of continuous improvement and lean techniques have a role to play in helping healthcare to provide quality service and support to reduce costs in the current budget constraints. In the supply chain of hospitals the financial costs can be around 40% of its budget (MASOUMI et al. 2012; SOUZA et al., 2013. This article sheds light on the improvement in decision making and the effect of reducing costs in the healthcare supply chain. In this sense, the research intend to expand knowledge related to supply chain management in the area of ​​provision of healthcare services through the use of the philosophy of continuous improvement and lean principles, helping healthcare to provide quality service within their current budget constraints.

Supply chain solutions to improve the distribution of antiretroviral drugs (ARVs to clinics in rural areas: A case study of the QwaQwa district

Directory of Open Access Journals (Sweden)

Mamolise Mokheseng

2017-10-01

Full Text Available This article serves as a case study based on research that was performed in the QwaQwa district in the Free State Province where the distribution of ARVs to the regional Manapo hospital, as well as between the hospital and its peripheral clinics, was interrupted and inconsistent due to problems in the supply chain. An unreliable and interrupted ARV supply chain creates the risk of virus reactivation and eventual patient mortality. The objectives of the study were to explore the problems experienced with the ARV distribution practices at the Manapo hospital, and to recommend ways in which the distribution of ARVs can be improved so that patients can receive an uninterrupted supply. The nature of the topic researched dictated the use of mainly the quantitative research method. The main problems identified include: Wrong and no uniform practice of ordering stock by the hospital and the clinics; lack of reliable, structured transportation from the depot to the hospital; as well as poor inventory management and poor overall communication. Recommendations to address the problems include: Implementing a supply chain planning and design process; improving inventory management and warehousing practices; implementing more effective and reliable distribution and transportation processes; as well as improving supply chain coordination and overall communication.

PFI redux? Assessing a new model for financing hospitals.

Science.gov (United States)

Hellowell, Mark

2013-11-01

There is a growing need for investments in hospital facilities to improve the efficiency and quality of health services. In recent years, publicly financed hospital organisations in many countries have utilised private finance arrangements, variously called private finance initiatives (PFIs), public-private partnerships (PPPs) or P3s, to address their capital requirements. However, such projects have become more difficult to implement since the onset of the global financial crisis, which has led to a reduction in the supply of debt capital and an increase in its price. In December 2012, the government of the United Kingdom outlined a comprehensive set of reforms to the private finance model in order to revive this important source of capital for hospital investments. This article provides a critical assessment of the 'Private Finance 2' reforms, focusing on their likely impact on the supply and cost of capital. It concludes that constraints in supply are likely to continue, in part due to regulatory constraints facing both commercial banks and institutional investors, while the cost of capital is likely to increase, at least in the short term. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Decentralization or centralization: striking a balance.

Science.gov (United States)

Dirschel, K M

1994-09-01

An Executive Vice President for Nursing can provide the necessary link to meet diverse clinical demands when encountering centralization--decentralization decisions. Centralized communication links hospital departments giving nurses a unified voice. Decentralization acknowledges the need for diversity and achieves the right balance of uniformity through a responsive communications network.

Perceptions of the hospital ethical environment among hospital social workers in the United States.

Science.gov (United States)

Pugh, Greg L

2015-01-01

Hospital social workers are in a unique context of practice, and one where the ethical environment has a profound influence on the ethical behavior. This study determined the ratings of ethical environment by hospital social workers in large nationwide sample. Correlates suggest by and compared to studies of ethical environment with nurses are explored. Positive ratings of the ethical environment are primarily associated with job satisfaction, as well as working in a centralized social work department and for a non-profit hospital. Religiosity and MSW education were not predictive. Implications and suggestions for managing the hospital ethical environment are provided.

Way for reducing drug supply chain cost for a hospital district: a case study

OpenAIRE

Postacchini, Leonardo; Ciarapica, Filippo Emanuele; Bevilacqua, Maurizio; Mazzuto, Giovanni; Paciarotti, Claudia

2016-01-01

Purpose: This work aims at providing insights to optimise healthcare logistic of the drug management, in order to deal with the healthcare expenditure cut. In this paper the effects of different drug supply chain configurations, on the resulting average stock, service level and Bullwhip effect, of the studied supply chain, is quantitatively assessed. Design/methodology/approach: A case study of an Italian district has been studied, taking into account three echelons: suppliers,...

The application of hospitality elements in hospitals.

Science.gov (United States)

Wu, Ziqi; Robson, Stephani; Hollis, Brooke

2013-01-01

In the last decade, many hospital designs have taken inspiration from hotels, spurred by factors such as increased patient and family expectations and regulatory or financial incentives. Increasingly, research evidence suggests the value of enhancing the physical environment to foster healing and drive consumer decisions and perceptions of service quality. Although interest is increasing in the broader applicability of numerous hospitality concepts to the healthcare field, the focus of this article is design innovations, and the services that such innovations support, from the hospitality industry. To identify physical hotel design elements and associated operational features that have been used in the healthcare arena, a series of interviews with hospital and hotel design experts were conducted. Current examples and suggestions for future hospitality elements were also sought from the experts, academic journals, and news articles. Hospitality elements applied in existing hospitals that are addressed in this article include hotel-like rooms and decor; actual hotels incorporated into medical centers; hotel-quality food, room service, and dining facilities for families; welcoming lobbies and common spaces; hospitality-oriented customer service training; enhanced service offerings, including concierges; spas or therapy centers; hotel-style signage and way-finding tools; and entertainment features. Selected elements that have potential for future incorporation include executive lounges and/or communal lobbies with complimentary wireless Internet and refreshments, centralized controls for patients, and flexible furniture. Although the findings from this study underscore the need for more hospitality-like environments in hospitals, the investment decisions made by healthcare executives must be balanced with cost-effectiveness and the assurance that clinical excellence remains the top priority.

Dynamic Pricing and Supply Coordination with Reimbursement Contract under Random Yield and Demand

Directory of Open Access Journals (Sweden)

Guo Li

2013-01-01

Full Text Available This paper investigates the dynamic pricing and supply chain coordination in a decentralized system that consists of one supplier and one manufacturer, in which both the market demand and production yield are stochastic. We show that the centralized expected profit is jointly concave in the production quantity and order quantity when the price is ex-ante selected. We also derive the equilibrium strategies in the decentralized system and prove that the entire profit of supply chain is inevitably lower than that under centralized system. Based on this, we propose a reimbursement contract to coordinate the decentralized supply chain so as to achieve the maximized profit. It is worth mentioning that, under reimbursement contract, the equilibrium production and order quantities are irrelevant to the manufacturer's risk sharing coefficient but are only determined by the supplier’s risk sharing coefficient.

Intraclass reliability for assessing how well Taiwan constrained hospital-provided medical services using statistical process control chart techniques.

Science.gov (United States)

Chien, Tsair-Wei; Chou, Ming-Ting; Wang, Wen-Chung; Tsai, Li-Shu; Lin, Weir-Sen

2012-05-15

Few studies discuss the indicators used to assess the effect on cost containment in healthcare across hospitals in a single-payer national healthcare system with constrained medical resources. We present the intraclass correlation coefficient (ICC) to assess how well Taiwan constrained hospital-provided medical services in such a system. A custom Excel-VBA routine to record the distances of standard deviations (SDs) from the central line (the mean over the previous 12 months) of a control chart was used to construct and scale annual medical expenditures sequentially from 2000 to 2009 for 421 hospitals in Taiwan to generate the ICC. The ICC was then used to evaluate Taiwan's year-based convergent power to remain unchanged in hospital-provided constrained medical services. A bubble chart of SDs for a specific month was generated to present the effects of using control charts in a national healthcare system. ICCs were generated for Taiwan's year-based convergent power to constrain its medical services from 2000 to 2009. All hospital groups showed a gradually well-controlled supply of services that decreased from 0.772 to 0.415. The bubble chart identified outlier hospitals that required investigation of possible excessive reimbursements in a specific time period. We recommend using the ICC to annually assess a nation's year-based convergent power to constrain medical services across hospitals. Using sequential control charts to regularly monitor hospital reimbursements is required to achieve financial control in a single-payer nationwide healthcare system.

Designing the Reverse Supply Chain

DEFF Research Database (Denmark)

Gobbi, Chiara

2011-01-01

Purpose – The purpose of this paper is to explore the impact of the product residual value (PRV) and the loss of value over time of returned products in the reverse supply chain configuration. It also examines whether or not the distinction of Fisher's functional and innovative products holds...... that allows for recapturing most of the PRV. These notions have then been tested by analyzing two reverse supply chains with a case study research methodology. Findings – The findings show that low PRV is associated with second-class recovery options (recycling and energy recovery) and that high PRV...... is associated with first-class recovery options (reconditioning and remarketing). When the recovery option is recycling, time is not relevant, the primary objective is cost reduction (efficiency), the chain is centralized, and actors and phases of the reverse chain are determined by the specificity...

Supply chain optimization at an academic medical center.

Science.gov (United States)

Labuhn, Jonathan; Almeter, Philip; McLaughlin, Christopher; Fields, Philip; Turner, Benjamin

2017-08-01

A successful supply chain optimization project that leveraged technology, engineering principles, and a technician workflow redesign in the setting of a growing health system is described. With continued rises in medication costs, medication inventory management is increasingly important. Proper management of central pharmacy inventory and floor-stock inventory in automated dispensing cabinets (ADCs) can be challenging. In an effort to improve control of inventory costs in the central pharmacy of a large academic medical center, the pharmacy department implemented a supply chain optimization project in collaboration with the medical center's inhouse team of experts on process improvement and industrial engineering. The project had 2 main components: (1) upgrading and reconfiguring carousel technology within an expanded central pharmacy footprint to generate accurate floor-stock inventory replenishment reports, which resulted in efficiencies within the medication-use system, and (2) implementing a technician workflow redesign and algorithm to right-size the ADC inventory, which decreased inventory stockouts (i.e., incidents of depletion of medication stock) and improved ADC user satisfaction. Through a multifaceted approach to inventory management, the number of stockouts per month was decreased and ADC inventory was optimized, resulting in a one-time inventory cost savings of $220,500. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Sustainable supply chain design: a configurational approach.

Science.gov (United States)

Masoumik, S Maryam; Abdul-Rashid, Salwa Hanim; Olugu, Ezutah Udoncy; Raja Ghazilla, Raja Ariffin

2014-01-01

Designing the right supply chain that meets the requirements of sustainable development is a significant challenge. Although there are a considerable number of studies on issues relating to sustainable supply chain design (SSCD) in terms of designing the practices, processes, and structures, they have rarely demonstrated how these components can be aligned to form an effective sustainable supply chain (SSC). Considering this gap in the literature, this study adopts the configurational approach to develop a conceptual framework that could configure the components of a SSC. In this respect, a process-oriented approach is utilized to classify and harmonize the design components. A natural-resource-based view (NRBV) is adopted to determine the central theme to align the design components around. The proposed framework presents three types of SSC, namely, efficient SSC, innovative SSC, and reputed SSC. The study culminates with recommendations concerning the direction for future research.

Sustainable Supply Chain Design: A Configurational Approach

Science.gov (United States)

Masoumik, S. Maryam; Raja Ghazilla, Raja Ariffin

2014-01-01

Designing the right supply chain that meets the requirements of sustainable development is a significant challenge. Although there are a considerable number of studies on issues relating to sustainable supply chain design (SSCD) in terms of designing the practices, processes, and structures, they have rarely demonstrated how these components can be aligned to form an effective sustainable supply chain (SSC). Considering this gap in the literature, this study adopts the configurational approach to develop a conceptual framework that could configure the components of a SSC. In this respect, a process-oriented approach is utilized to classify and harmonize the design components. A natural-resource-based view (NRBV) is adopted to determine the central theme to align the design components around. The proposed framework presents three types of SSC, namely, efficient SSC, innovative SSC, and reputed SSC. The study culminates with recommendations concerning the direction for future research. PMID:24523652

Energy consumption in the food supply system

DEFF Research Database (Denmark)

Kamp, Andreas; Østergård, Hanne; Hauggaard-Nielsen, Henrik

2016-01-01

Historically, productivity gains have been possible by the application of energy intensive technologies. In the future, new technologies and practices based on energy from renewable resources are central for the development of our food supply system and they will contribute in two different ways....... As the energy sector increasingly bases energy supply on renewable sources, the energy requirements of the food sector will automatically substitute renewable energy for non-renewable energy in all stages of food supply. In principle, the food sector does not need to change if renewable energy is sufficient...... and available as the energy carriers that we are used to today. We may think of this as passive adaptation. A passive adaptation strategy may support a development towards the image ‘high input – high output’. The food sector, however, may also actively adapt to a future without fossil fuels and change...

Improvements in electric power supply in coal mines

Energy Technology Data Exchange (ETDEWEB)

Minovskii, Yu.P.; Nabokov, Eh.P.; Savel' ev, G.P.

1985-01-01

Reviews measures taken by major coal producing countries to increase output levels. Discusses research carried out into advance design of equipment in FRG, UK, USA and France and proposes establishment of central automatic control of electric power supply system in Soviet mines, improvement in underground power supply equipment, increase in reliability, stabilization of standby capacity in low voltage circuits, maintenance-free electrical equipment, and efficient spare part storage in underground workings. States that introduction of the proposed system (details are given) will ensure that Soviet mines will eventually reach the development level of foreign mines. 2 refs.

American Hospital Association

Science.gov (United States)

... Central Office-Coding Resources AHA Team Training Health Career Center Health Forum Connect More Regulatory Relief The regulatory burden faced by hospitals is substantial and unsustainable. Read the report . More AHA Opioid Toolkit Stem the Tide: Addressing the Opioid Epidemic More ...

Antecedents for the Adoption and Execution of Supply Chain Management

DEFF Research Database (Denmark)

Kotzab, Herbert; Teller, Christoph; Grant, David B.

2011-01-01

through a survey of 174 senior supply chain managers representing the biggest organisations within a central European country. Findings – Using structural equation modelling the hypothesised hierarchical order of three proposed antecedents is verified: “internal SCM conditions”, that affect “joint......Purpose – The purpose of this paper is to develop a conceptual model that includes drivers of supply chain management (SCM) adoption and execution identified in the literature, provide a set of measurement scales that operationalise constructs within this model, empirically verify a hierarchical......-specific supply chain setting. Practical implications – The findings provide a hierarchical focus for financial, personnel and management initiatives to increase integration within a supply chain and improve competitiveness. Originality/value – The major contribution of this paper is that it provides empirical...

Canadian gas supply: going up? or down?

International Nuclear Information System (INIS)

Woronuk, R. H.

1999-01-01

With regard to Canada's gas reserves there are clear indications that the gas market is moving from a supply/demand balance controlled by demand to one that is controlled by supply. There is evidence of a recognition that the Western Canadian Sedimentary Basin (WCSB) , the source of most of Canada's gas supply is a mature basin, with over half of its reserves already discovered, that consumption has exceeded reserve additions for all but one of the last sixteen years, and that under these conditions consumption cannot grow, or even be maintained indefinitely. The central argument advanced in this paper is that the era of ever increasing production from the WCSB is nearing its end and that a more aggressive approach to exploration and development in the WCSB, especially in the deeper and more environmentally sensitive areas, together with the exploitation of conventional gas in frontier areas and unconventional resources will be necessary to prevent projected declines in supply. Identification of new geological plays, exploration for and connection of reserves from frontier regions and the development of technologies for enhanced recoveries will involve increasingly long lead times, therefore, initiatives to address forthcoming supply issues must begin immediately. 4 refs., 17 figs

Availability and Expiry of Essential Medicines and Supplies During the

African Journals Online (AJOL)

Erah

Pharmacotherapy Group,. Faculty of Pharmacy, University of Benin,. Benin City, 300001 Nigeria. All rights reserved. Available online at http://www.tjpr.org. Research Article. Availability and Expiry of Essential Medicines and. Supplies During the 'Pull' and 'Push' Drug Acquisition. Systems in a Rural Ugandan Hospital.

Hydro, wind and solar power as a base for a 100% renewable energy supply for South and Central America.

Directory of Open Access Journals (Sweden)

Larissa de Souza Noel Simas Barbosa

Full Text Available Power systems for South and Central America based on 100% renewable energy (RE in the year 2030 were calculated for the first time using an hourly resolved energy model. The region was subdivided into 15 sub-regions. Four different scenarios were considered: three according to different high voltage direct current (HVDC transmission grid development levels (region, country, area-wide and one integrated scenario that considers water desalination and industrial gas demand supplied by synthetic natural gas via power-to-gas (PtG. RE is not only able to cover 1813 TWh of estimated electricity demand of the area in 2030 but also able to generate the electricity needed to fulfil 3.9 billion m3 of water desalination and 640 TWhLHV of synthetic natural gas demand. Existing hydro dams can be used as virtual batteries for solar and wind electricity storage, diminishing the role of storage technologies. The results for total levelized cost of electricity (LCOE are decreased from 62 €/MWh for a highly decentralized to 56 €/MWh for a highly centralized grid scenario (currency value of the year 2015. For the integrated scenario, the levelized cost of gas (LCOG and the levelized cost of water (LCOW are 95 €/MWhLHV and 0.91 €/m3, respectively. A reduction of 8% in total cost and 5% in electricity generation was achieved when integrating desalination and power-to-gas into the system.

Hydro, wind and solar power as a base for a 100% renewable energy supply for South and Central America.

Science.gov (United States)

Barbosa, Larissa de Souza Noel Simas; Bogdanov, Dmitrii; Vainikka, Pasi; Breyer, Christian

2017-01-01

Power systems for South and Central America based on 100% renewable energy (RE) in the year 2030 were calculated for the first time using an hourly resolved energy model. The region was subdivided into 15 sub-regions. Four different scenarios were considered: three according to different high voltage direct current (HVDC) transmission grid development levels (region, country, area-wide) and one integrated scenario that considers water desalination and industrial gas demand supplied by synthetic natural gas via power-to-gas (PtG). RE is not only able to cover 1813 TWh of estimated electricity demand of the area in 2030 but also able to generate the electricity needed to fulfil 3.9 billion m3 of water desalination and 640 TWhLHV of synthetic natural gas demand. Existing hydro dams can be used as virtual batteries for solar and wind electricity storage, diminishing the role of storage technologies. The results for total levelized cost of electricity (LCOE) are decreased from 62 €/MWh for a highly decentralized to 56 €/MWh for a highly centralized grid scenario (currency value of the year 2015). For the integrated scenario, the levelized cost of gas (LCOG) and the levelized cost of water (LCOW) are 95 €/MWhLHV and 0.91 €/m3, respectively. A reduction of 8% in total cost and 5% in electricity generation was achieved when integrating desalination and power-to-gas into the system.

A robust optimization model for blood supply chain in emergency situations

Directory of Open Access Journals (Sweden)

Meysam Fereiduni

2016-09-01

Full Text Available In this paper, a multi-period model for blood supply chain in emergency situation is presented to optimize decisions related to locate blood facilities and distribute blood products after natural disasters. In disastrous situations, uncertainty is an inseparable part of humanitarian logistics and blood supply chain as well. This paper proposes a robust network to capture the uncertain nature of blood supply chain during and after disasters. This study considers donor points, blood facilities, processing and testing labs, and hospitals as the components of blood supply chain. In addition, this paper makes location and allocation decisions for multiple post disaster periods through real data. The study compares the performances of “p-robust optimization” approach and “robust optimization” approach and the results are discussed.

TFTR CAMAC power supplies reliability

International Nuclear Information System (INIS)

Camp, R.A.; Bergin, W.

1989-01-01

Since the expected life of the Tokamak Fusion Test Reactor (TFTR) has been extended into the early 1990's, the issues of equipment wear-out, when to refurbish/replace, and the costs associated with these decisions, must be faced. The management of the maintenance of the TFTR Central Instrumentation, Control and Data Acquisition System (CICADA) power supplies within the CAMAC network is a case study of a set of systems to monitor repairable systems reliability, costs, and results of action. The CAMAC network is composed of approximately 500 racks, each with its own power supply. By using a simple reliability estimator on a coarse time interval, in conjunction with determining the root cause of individual failures, a cost effective repair and maintenance program has been realized. This paper describes the estimator, some of the specific causes for recurring failures and their correction, and the subsequent effects on the reliability estimator. By extension of this program the authors can assess the continued viability of CAMAC power supplies into the future, predicting wear-out and developing cost effective refurbishment/replacement policies. 4 refs., 3 figs., 1 tab

Evaluación de las causas de los eventos adversos o incidentes que afectan la seguridad del paciente, en el hospital central de la policía de enero 2012 a diciembre 2013

OpenAIRE

Alarcon Ruiz, Diego Jesus; Gil Vargas, Luis Fabio

2016-01-01

TITULO DEL TRABAJO: Evaluación de las causas de los eventos adversos o incidentes que afectan la seguridad del paciente, en el hospital central de la policía de enero 2012 a diciembre 2013. OBJETIVO: Determinar y analizar la causa raíz de los principales factores de riesgo que afectan la seguridad del paciente que puedan ocasionar eventos adversos en la atención de los pacientes, con el uso de la teoría de restricciones TOC en el Hospital Central de la Policía HOCEN. MATERIALES Y METODO: Se r...

Compliance with the guidelines of prescription writing in a central hospital in the West Bank.

Science.gov (United States)

Tayem, Y I; Ibrahim, M A; Qubaja, M M; Shraim, R K; Taha, O B; Abu Shkhedem, E

2013-09-01

This retrospective, cross-sectional study was carried out to evaluate the quality of 2208 outpatient prescriptions in a central hospital in the West Bank, Palestine. The physicians' handwriting was poorly readable or illegible in one-third of the prescriptions. The prescriber's name and signature and patient's name were mentioned in almost all orders whereas the patient's age was stated in 54.9%. The vast majority of physicians (95.5%) prescribed drugs using their trade (brand) names. Drug strength, quantity and dose/frequency were stated in 61.1%, 76% and 73.8% of prescriptions respectively. Only 33 prescriptions (1.5%) contained full directions for use for all drugs. Correlation analysis revealed that the presence of certain prescription elements was statistically significantly associated with the clinic of origin and the number of drugs prescribed. The overall poor legibility and incompleteness of the prescriptions is of concern.

Distribution Free Approach for Coordination of a Supply Chain with Consumer Return

Science.gov (United States)

Hu, Jinsong; Xu, Yuanji

Consumer return is considered in a coordination of a supply chain consisting of one manufacturer and one retailer. A distribution free approach is employed to deal with a centralized decision model and a decentralized model which are constructed under the situation with only knowing the demand function's mean and variance, respectively. A markdown money contract is designed to coordinate the supply chain, and it is also proved that the contract can make the supply chain perfectly coordinated. Several numerical examples are given at the end of this paper.

Creation of reactor's reliable system of emergency energy supply

International Nuclear Information System (INIS)

Batyrbekov, G.A.; Brovkin, A.Yu.; Petukhov, V.K.; Chekushin, A.I.; Chernyaev, V.P.; Yagotinets, N.A.

1998-01-01

System of reliable power supply of the WWR-K reactor complex is described, which completely provides safety operation of reactor equipment in the case of total voltage loss from external power transmission lines as well as under destruction of accumulation batteries by earthquake more than 6 balls. Switching on in operation of diesel-generators and system of constant current supply from accumulator batteries is occurred automatically under cessation of voltage supply from centralized power system. Reliable reactor dampening in case it work on capacity has been ensured. Reactor cooling under its emergency shutdown during both the partial or the total loss of coolant in first counter has been carried out. Under full coolant loss the system of emergency reactor cooling has been switched on in operation

Modelling Hospital Materials Management Processes

Directory of Open Access Journals (Sweden)

Raffaele Iannone

2013-06-01

integrated and detailed analysis and description model for hospital materials management data and tasks, which is able to tackle information from patient requirements to usage, from replenishment requests to supplying and handling activities. The model takes account of medical risk reduction, traceability and streamlined processes perspectives. Second, the paper translates this information into a business process model and mathematical formalization.The study provides a useful guide to the various relevant technology‐related, management and business issues, laying the foundations of an efficient reengineering of the supply chain to reduce healthcare costs and improve the quality of care.

Marketing alternatives for hospitals to the nursing crisis.

Science.gov (United States)

Goldman, R L; Bates, D P; Bradbury, M; Breaux, D K; Caron, M; Gerardo, C; Copoulos, S; Hansen, L L; Oien, S M; Semones, C

1990-01-01

The current nursing shortage problem as defined in this article, is the result of a supply and demand imbalance. The demand for nurses is growing at a faster rate than the supply. If strategies are not implemented to correct this imbalance the demand for nurses will continue to surpass the supply, negatively affecting access to and delivery of quality patient care. Factors contributing to the increased demand for nurses and the dwindling supply must be examined if solutions to the problem are to be found and implemented. Factors contributing to the growing demand for nurses include the decreasing use of ancillary personnel by hospitals in an effort to tighten their budgets; the impact of Medicare's prospective payment system on hospital lengths of stay; the increase in patient acuity with advances in medical technology; and alternative health care opportunities pulling nurses away from the hospital setting. The supply of RNs is shrinking in relation to demand because of low retention rates; declining nursing school enrollment; non-competitive wages; poor working conditions; alternative career opportunities for women; and the lack of power and support within the nursing profession. An active marketing approach that relies on this assessment of contributing factors has been formulated in an attempt to resolve the problem and meet the increasing demand. Recommendations have been made and ranked in the order of their priority and pros and cons established for each. The strategies developed have been divided into four basic marketing categories of product, price, place, and promotion. If the problem is to be resolved these strategies must be marketed to hospitals, their administrators, nurses, other allied health professionals, third party payors, educators, and the general public. The nursing profession itself must find the unity and strength within its own group of professionals to build political and economic powers to enhance their product. Nursing is at a crossroad

Hospital costs of central line-associated bloodstream infections and cost-effectiveness of closed vs. open infusion containers. The case of Intensive Care Units in Italy

Directory of Open Access Journals (Sweden)

Torbica Aleksandra

2010-05-01

Full Text Available Abstract Objectives The aim was to evaluate direct health care costs of central line-associated bloodstream infections (CLABSI and to calculate the cost-effectiveness ratio of closed fully collapsible plastic intravenous infusion containers vs. open (glass infusion containers. Methods A two-year, prospective case-control study was undertaken in four intensive care units in an Italian teaching hospital. Patients with CLABSI (cases and patients without CLABSI (controls were matched for admission departments, gender, age, and average severity of illness score. Costs were estimated according to micro-costing approach. In the cost effectiveness analysis, the cost component was assessed as the difference between production costs while effectiveness was measured by CLABSI rate (number of CLABSI per 1000 central line days associated with the two infusion containers. Results A total of 43 cases of CLABSI were compared with 97 matched controls. The mean age of cases and controls was 62.1 and 66.6 years, respectively (p = 0.143; 56% of the cases and 57% of the controls were females (p = 0.922. The mean length of stay of cases and controls was 17.41 and 8.55 days, respectively (p Conclusions CLABSI results in considerable and significant increase in utilization of hospital resources. Use of innovative technologies such as closed infusion containers can significantly reduce the incidence of healthcare acquired infection without posing additional burden on hospital budgets.

Analysis of trends in the development of cities' heat supply systems

Science.gov (United States)

Stennikov, V. A.; Mednikova, E. E.

2016-09-01

New challenges—including the modern urban development policy, formation of the market of energy efficient technologies and different types of equipment of a broad power capacity range, tightening requirements to reliability, quality, and economic accessibility of heat supply—enhance the competitiveness of decentralized heat supply. In addition, its spontaneous growth and not always reasonable implementation lead to unjustified expenses, low efficiency, and ecological inconsistency. This proves the relevance of solving the problems of dividing an urban territory into zones of centralized heating (CH) and decentralized heating (DCH) along with their planning and justification, as well as determining a reasonable level of heat supply centralization and concentration of heat sources' power capacity. Solving these problems using the suggested method will allow optimizing the application areas for various types of heat supply and heat sources, justifying the degree of heat power capacity concentration and the extent of the systems as early as at the phase of a detailed urban planning project and then refining them during the design of urban heat supply systems. This will dramatically improve the reasonability of the decisions made and will simplify the procedure of their implementation. For criteria of limiting the extent (radius) of heat supply systems and defining their type, we suggest using standard values—the density of heat load per unit length of the pipeline and per unit area of urban territory. Standard values must be differentiated across the territory of Russia taking into account regional climatic and economic conditions and unique characteristics of heat supply development in cities and towns. The present article continues and develops the statements made in the previous articles created within the framework of the Theory of Hydraulic Circuits and takes into account the current situation and emerging trends in heat supply.

Mechanical ventilators in US acute care hospitals.

Science.gov (United States)

Rubinson, Lewis; Vaughn, Frances; Nelson, Steve; Giordano, Sam; Kallstrom, Tom; Buckley, Tim; Burney, Tabinda; Hupert, Nathaniel; Mutter, Ryan; Handrigan, Michael; Yeskey, Kevin; Lurie, Nicole; Branson, Richard

2010-10-01

The supply and distribution of mechanical ventilation capacity is of profound importance for planning for severe public health emergencies. However, the capability of US health systems to provide mechanical ventilation for children and adults remains poorly quantified. The objective of this study was to determine the quantity of adult and pediatric mechanical ventilators at US acute care hospitals. A total of 5,752 US acute care hospitals included in the 2007 American Hospital Association database were surveyed. We measured the quantities of mechanical ventilators and their features. Responding to the survey were 4305 (74.8%) hospitals, which accounted for 83.8% of US intensive care unit beds. Of the 52,118 full-feature mechanical ventilators owned by respondent hospitals, 24,204 (46.4%) are pediatric/neonatal capable. Accounting for nonrespondents, we estimate that there are 62,188 full-feature mechanical ventilators owned by US acute care hospitals. The median number of full-feature mechanical ventilators per 100,000 population for individual states is 19.7 (interquartile ratio 17.2-23.1), ranging from 11.9 to 77.6. The median number of pediatric-capable device full-feature mechanical ventilators per 100,000 population younger than 14 years old is 52.3 (interquartile ratio 43.1-63.9) and the range across states is 22.1 to 206.2. In addition, respondent hospitals reported owning 82,755 ventilators other than full-feature mechanical ventilators; we estimate that there are 98,738 devices other than full-feature ventilators at all of the US acute care hospitals. The number of mechanical ventilators per US population exceeds those reported by other developed countries, but there is wide variation across states in the population-adjusted supply. There are considerably more pediatric-capable ventilators than there are for adults only on a population-adjusted basis.

Supplier–customer relationships: Weaknesses in south african automotive supply chains

Directory of Open Access Journals (Sweden)

M. J. Naude

2012-11-01

Full Text Available The South African automotive industry, which is an important sector in the South African economy, needs to function efficiently if it is to compete internationally. However, South African automotive components manufacturers (ACMs are not internationally competitive and automotive assemblers, also known as original equipment manufacturers (OEMs, often import cheaper components from abroad. All parties in the South African automotive supply chains need each other to ensure optimal efficiency and competitiveness. Furthermore, it is vital that good relationships exist between customers and suppliers in the automotive supply chains in South Africa. ACMs are central to automotive supply chains. A survey was conducted among ACMs to determine the nature of relationships that exist between buyers and suppliers in South Africa’s automotive supply chains. The results showed that collaborative relationships do indeed exist between members of the supply chain but that communication, understanding of the parties’ situations and cooperation can improve this relationship and so create total alliance between OEMs and ACMs.

A global water supply reservoir yield model with uncertainty analysis

International Nuclear Information System (INIS)

Kuria, Faith W; Vogel, Richard M

2014-01-01

Understanding the reliability and uncertainty associated with water supply yields derived from surface water reservoirs is central for planning purposes. Using a global dataset of monthly river discharge, we introduce a generalized model for estimating the mean and variance of water supply yield, Y, expected from a reservoir for a prespecified reliability, R, and storage capacity, S assuming a flow record of length n. The generalized storage–reliability–yield (SRY) relationships reported here have numerous water resource applications ranging from preliminary water supply investigations, to economic and climate change impact assessments. An example indicates how our generalized SRY relationship can be combined with a hydroclimatic model to determine the impact of climate change on surface reservoir water supply yields. We also document that the variability of estimates of water supply yield are invariant to characteristics of the reservoir system, including its storage capacity and reliability. Standardized metrics of the variability of water supply yields are shown to depend only on the sample size of the inflows and the statistical characteristics of the inflow series. (paper)

Service differentiation in spare parts supply through dedicated stocks

NARCIS (Netherlands)

Alvarez, Elisa; van der Heijden, Matthijs C.; Zijm, Willem H.M.

2012-01-01

We investigate keeping dedicated stocks at customer sites in addition to stock kept at some central location as a tool for applying service differentiation in spare parts supply. We study the resulting two-echelon system in a multi-item setting, both under backordering and under emergency shipments

A social network model of supply chain management in formal and informal inter-firm engagement

Directory of Open Access Journals (Sweden)

Lokhman Hakim Osman

2015-12-01

Full Text Available Background: This research looks into the different effects of firms' network structural positions in an upstream supply network upon the firms' level of relational capital outcomes.  Previous research has largely focus on the context of decentralized network structure.  However, the supply network is a centralized network because of the existence of the focal firm.  The existence of the focal firm may influence the impact of relational capital outcomes.  Methods: The objective of this research is to determine the type of network structural positions required to obtain reasonable relational capital outcome in upstream supply network.  Results and conclusions: This study found that, network structural positions i.e. betweeness centrality contributed to firms' level of relational capital influence. In conclusion, firms, embedded in upstream supply network benefits differently in terms of relational capital through different degree of embeddedness.  Firms' resources should be re-aligned to match the benefits with the different network structural positions.

Isolation of Legionella pneumophila from hospital cooling towers in Johor, Malaysia.

Science.gov (United States)

Abdul Samad, B H; Suhaili, M R; Baba, N; Rajasekaran, G

2004-08-01

Water-based cooling towers and their water supply at two hospitals in Johor were surveyed for the presence Legionella pneumophila. L. pneumophila were grown from 19 (76%) out of 25 collected water samples. One hospital cooling tower was contaminated with L. pneumophila serogroup 1.

An RFID middleware for supply chain management

Directory of Open Access Journals (Sweden)

Artur Pinto Carneiro

2011-12-01

Full Text Available RFID (Radio Frequency Identification systems for identification and tracking of products and equipments have been progressively adopted as an essential tool for supply chain management, a production environment where the members usually share with each other their own logistic and management systems. Therefore, the development of supply chain RFID systems can be strongly simplified through the inclusion of an intermediate software layer – the middleware – responsible for the creation of interfaces to integrate all the heterogeneous software components. In this article we present a case study developed at IPT (Instituto de Pesquisas Tecnológicas do Estado de São Paulo which gave rise to a middleware prototype able to implement the required software integration on the supply chain of an electric power distribution company. The developed middleware is used to manage the interactions with a heterogeneous group of mobile devices  cell phones, handhelds and data colectors,  operated by different supply chain agents that grab data associated to various processes executed by a given electric power distribution equipment during its life cycle and transfer those data to a central database in order to share them with all the logistic and management corporation systems.

The theory of money supply: a case study

OpenAIRE

Taylor, Leon

2014-01-01

The theory of money supply is less developed than that of money demand, largely because 19th-century economists believed that money was unimportant and because they viewed the central bank as either an appendage to the economy or as a welfare-maximizing black box. The paper reviews each of these beliefs in turn.

Decision on risk-averse dual-channel supply chain under demand disruption

Science.gov (United States)

Yan, Bo; Jin, Zijie; Liu, Yanping; Yang, Jianbo

2018-02-01

We studied dual-channel supply chains using centralized and decentralized decision-making models. We also conducted a comparative analysis of the decisions before and after demand disruption. The study shows that the amount of change in decision-making is a linear function of the amount of demand disruption, and it is independent of the risk-averse coefficient. The optimal sales volume decision of the disturbing supply chain is related to market share and demand disruption in the decentralized decision-making model. The optimal decision is only influenced by demand disruption in the centralized decision-making model. The stability of the sales volume of the two models is related to market share and demand disruption. The optimal system production of the two models shows robustness, but their stable internals are different.

Extraction of business relationships in supply networks using statistical learning theory.

Science.gov (United States)

Zuo, Yi; Kajikawa, Yuya; Mori, Junichiro

2016-06-01

Supply chain management represents one of the most important scientific streams of operations research. The supply of energy, materials, products, and services involves millions of transactions conducted among national and local business enterprises. To deliver efficient and effective support for supply chain design and management, structural analyses and predictive models of customer-supplier relationships are expected to clarify current enterprise business conditions and to help enterprises identify innovative business partners for future success. This article presents the outcomes of a recent structural investigation concerning a supply network in the central area of Japan. We investigated the effectiveness of statistical learning theory to express the individual differences of a supply chain of enterprises within a certain business community using social network analysis. In the experiments, we employ support vector machine to train a customer-supplier relationship model on one of the main communities extracted from a supply network in the central area of Japan. The prediction results reveal an F-value of approximately 70% when the model is built by using network-based features, and an F-value of approximately 77% when the model is built by using attribute-based features. When we build the model based on both, F-values are improved to approximately 82%. The results of this research can help to dispel the implicit design space concerning customer-supplier relationships, which can be explored and refined from detailed topological information provided by network structures rather than from traditional and attribute-related enterprise profiles. We also investigate and discuss differences in the predictive accuracy of the model for different sizes of enterprises and types of business communities.

Projecting demand and supply of forest biomass for heating in Norway

International Nuclear Information System (INIS)

Tromborg, Erik; Havskjold, Monica; Lislebo, Ole; Rorstad, Per Kristian

2011-01-01

This paper assesses the increase in demand and supply for forest biomass for heating in Norway in 2020. By then there is a political aim to double the national production of bioenergy from the level in 2008. The competitiveness of woody biomass in central and district heating is analyzed in a model selecting the least-cost heating technology and scale in municipalities given a set of constraints and under different fuels price scenarios. The supply of forest biomass from roundwood is estimated based on data of forest inventories combined with elasticities regarding price and standing volumes. The supply of biomass from harvesting residues is estimated in an engineering approach based on data from the national forest inventories and roundwood harvest. The results show how the production of bioenergy is affected by changes in energy prices and support schemes for bioenergy. One conclusion from the analyses is that the government target of 14 TWh more bioenergy by 2020 is not likely to be met by current technologies and policy incentives. The contribution of the analysis is the detailed presentation of the heat market potentials and technology choices combined with supply functions for both roundwood and harvesting residues. - Highlights: → This paper accesses the demand and supply for forest biomass for heating in Norway in 2020. → Market share for wood in central and new district heating is analyzed in a cost-minimizing model. → The supply of forest biomass includes wood chips from import, roundwood and harvesting residues. → The production of bioenergy is affected by changes in energy prices and support schemes. → The government target for bioenergy is not met by current technologies and policy incentives.

Extraction of business relationships in supply networks using statistical learning theory

Directory of Open Access Journals (Sweden)

Yi Zuo

2016-06-01

Full Text Available Supply chain management represents one of the most important scientific streams of operations research. The supply of energy, materials, products, and services involves millions of transactions conducted among national and local business enterprises. To deliver efficient and effective support for supply chain design and management, structural analyses and predictive models of customer–supplier relationships are expected to clarify current enterprise business conditions and to help enterprises identify innovative business partners for future success. This article presents the outcomes of a recent structural investigation concerning a supply network in the central area of Japan. We investigated the effectiveness of statistical learning theory to express the individual differences of a supply chain of enterprises within a certain business community using social network analysis. In the experiments, we employ support vector machine to train a customer–supplier relationship model on one of the main communities extracted from a supply network in the central area of Japan. The prediction results reveal an F-value of approximately 70% when the model is built by using network-based features, and an F-value of approximately 77% when the model is built by using attribute-based features. When we build the model based on both, F-values are improved to approximately 82%. The results of this research can help to dispel the implicit design space concerning customer–supplier relationships, which can be explored and refined from detailed topological information provided by network structures rather than from traditional and attribute-related enterprise profiles. We also investigate and discuss differences in the predictive accuracy of the model for different sizes of enterprises and types of business communities.

Non-structural Components influencing Hospital Disaster Preparedness in Malaysia

Science.gov (United States)

Samsuddin, N. M.; Takim, R.; Nawawi, A. H.; Rosman, M. R.; SyedAlwee, S. N. A.

2018-04-01

Hospital disaster preparedness refers to measures taken by the hospital’s stakeholders to prepare, reduce the effects of disaster and ensure effective coordination during incident response. Among the measures, non-structural components (i.e., medical laboratory equipment & supplies; architectural; critical lifeline; external; updated building document; and equipment & furnishing) are critical towards hospital disaster preparedness. Nevertheless, over the past few years these components are badly affected due to various types of disasters. Hence, the objective of this paper is to investigate the non-structural components influencing hospital’s disaster preparedness. Cross-sectional survey was conducted among thirty-one (31) Malaysian hospital’s employees. A total of 6 main constructs with 107 non-structural components were analysed and ranked by using SPSS and Relative Importance Index (RII). The results revealed that 6 main constructs (i.e. medical laboratory equipment & supplies; architectural; critical lifeline; external; updated building document; and equipment & furnishing) are rated as ‘very critical’ by the respondents. Among others, availability of medical laboratory equipment and supplies for diagnostic and equipment was ranked first. The results could serve as indicators for the public hospitals to improve its disaster preparedness in terms of planning, organising, knowledge training, equipment, exercising, evaluating and corrective actions through non-structural components.

FPGA based control system for -100 kV, 25 A Crowbarless DC power supply

International Nuclear Information System (INIS)

Upadhyay, R.; Tripathi, A.; Badapanda, M.K.; Lad, M.

2015-01-01

FPGA based digital control system has been developed for -100 kV, 25 A solid state modular crowbarless DC klystron bias power supply of 1 MW, 352.2 MHz RF test stand. The control system has capability to operate this power supply either in CW or pulse mode. Central controller, PSM controller and graphical user interface are key parts of this control system. Central controller monitors the status of various subsystems of this power supply like 11 kV step start unit, four numbers of main transformers each having 44 numbers of secondary windings and 176 numbers of switch power modules for deciding the number of power modules to be put ON and their duty cycles depending on the set output voltage and current. PSM controller sends appropriate control signal to the switch power modules through fibre optic lines and communicates it to the central controller. Linux based graphical user interface has been developed which enables the user to set the operating parameters along with their trip limits and displays the information of critical parameters of this power supply on a local touch screen panel. Provision for remote control and supervision is also provided through a separate PC connected to the main control system via Ethernet. The control system has capability to trip the power supply within 5 μsec in case any parameter exceeds its set limit. Suitable data logging feature is incorporated for offline fault analysis. The control system architecture along with its software protection interlocks are presented in this paper. The performance of the control system has been verified during operation of -100 kV, 25 A DC power supply with 1 MW, 352.2 MHz klystron amplifier. (author)

A Computerized Hospital Patient Information Management System

Science.gov (United States)

Wig, Eldon D.

1982-01-01

The information processing needs of a hospital are many, with varying degrees of complexity. The prime concern in providing an integrated hospital information management system lies in the ability to process the data relating to the single entity for which every hospital functions - the patient. This paper examines the PRIMIS computer system developed to accommodate hospital needs with respect to a central patient registry, inpatients (i.e., Admission/Transfer/Discharge), and out-patients. Finally, the potential for expansion to permit the incorporation of more hospital functions within PRIMIS is examined.

The functions of hospital-based home care for people with severe mental illness in Taiwan.

Science.gov (United States)

Huang, Xuan-Yi; Lin, Mei-Jue; Yang, Tuz-Ching; Hsu, Yuan-Shan

2010-02-01

The purposes of this study were to understand the functions of hospital-based home care for people with severe mental illness in Taiwan, and the factors that affect functions of professionals who provide hospital-based home care. Hospital-based home care is a service which provides those people with serious mental illnesses who are in crisis and who are candidates for admission to hospital. Home care has been shown to have several advantages over inpatient treatment. However, there is a lack of knowledge about the functions of hospital-based home care for people with severe mental illness in Taiwan. This qualitative study was based on the grounded theory method of Strauss and Corbin. The study was conducted in six different hospital areas in central Taiwan in 2007-2008. Data were collected using semi-structured face-to-face interviews. Constant comparative analysis continued during the open, axial and selective coding processes until data saturation occurred. Participants were selected by theoretical sampling. When theoretical saturation was achieved, 21 clients with mental illness, 19 carers and 25 professionals were interviewed. Several functions were found when these professionals provided hospital-based home care services for people with severe mental illness in Taiwan, including stabilising the clients illness, supplying emergency care services, improving life-coping abilities, employment and welfare assistance, emotional support for both clients and carers, assistance with future and long-term arrangements and assistance with communication between carers and clients. Hospital-based home care provides several important services for helping clients and their families to live in the community. The recommendations based on the findings of this study can be used as a guide to improve the delivery of hospital-based home care services to community-dwelling clients with severe mental illness and their carers.

How Much Control Dose Central Bank of Iran over Money Supply?

OpenAIRE

Jafar HAGHIGHAT

2011-01-01

In discussions about the efficacy of monetary policy instruments, attention is often focused on analyzing the money supply process. Monetarists, in general, argue that the monetary authorities can exercise effective control over the stock of money; others, especially those who share the new view of monetary theory argue that the determination of the stock of money is part of the economy. In this view, the stock of money is the outgrowth of the behavior of the public, the financial sector (ban...

SELECTION OF HEAT SUPPLY SOURCE FOR MOBILE BUILDING STRUCTURE

Directory of Open Access Journals (Sweden)

T. I. Dolgikh

2014-01-01

Full Text Available The paper proposes a vortex heat generator with energy transformation of the highest  state  of matter motion  into  the  lowest  one  as  a  heat  supply  source  for a mobile object. Energy transformation coefficient indices close or equal to 1 have been obtained as a result of experiments on efficiency of the vortex heat generator. Such results can be explained with the help of the 2nd Bohr quantum postulate. Standard series of certified VTG heat generators has been proposed for heat supply of the mobile object (field hospital.

The effects of hospital reforms on the management of public hospitals in Tanzania: Challenges and lessons learnt.

Science.gov (United States)

Shwekerela, Byera

2014-01-01

Although hospital reforms are being advocated internationally as part of a solution to hospital management problems in developing countries, studies have shown that they do give rise to some challenges. A study was undertaken that used in-depth interviews, focus group discussion and document review to examine hospital reforms. The article examines the effects of reforms on the management of Level II public hospitals in Tanzania and documents the related challenges and lessons Learnt. It is shown that hospital reforms have mixed effects in resource-strained hospitals, and that hospital reform actions may have replaced the bureaucratic inefficiencies associated with hospitals being managed from the central level (MoHSW) with the equally bureaucratic inefficiencies that characterize the management of these hospitals from a supposedly local level, the office of the Regional Administrative Secretary (RAS). Managing hospitals from this level seems to cause many hospital management problems to be left unattended.

Radiation hygienic assessment of centralized heat and hot water supply of Bilibino village from Bilibin central nuclear heating- and power plant

International Nuclear Information System (INIS)

Eremin, V.A.; Marej, A.N.; Nechiporenko, N.I.; Rasskazov, A.P.; Sayapin, N.P.; Soldatov, G.E.; Shcherbinin, A.S.

1983-01-01

The experience in using an atomic power plant for heat and hot water supply of the village of Bilibino is outlined. Particular attention is given to the population radiation safety. It has been demonstrated that radiation safety of the system is ensured by maintaining fixed pressure levels in the heating media and by the hermetic state of heat exchanges. Water in the heat and hot water supply network meets the requirements for drinking water. Radioactive corrosion products were not detected in the test water. Gamma-radiation dose rate from the surface of heating devices and pipe-lines in the test premises did not exceed the natural background, that is, U.U1-0.025 mrad

Association between medication supplies and healthcare costs in older adults from an urban healthcare system.

Science.gov (United States)

Stroupe, K T; Murray, M D; Stump, T E; Callahan, C M

2000-07-01

The amount of medication dispensed to older adults for the treatment of chronic disease must be balanced carefully. Insufficient medication supplies lead to inadequate treatment of chronic disease, whereas excessive supplies represent wasted resources and the potential for toxicity. We used an electronic medical record system to determine the distribution of medications supplied to older urban adults and to examine the correlations of these distributions with healthcare costs and use. A cross-sectional study using data acquired over 3 years (1994-1996). A tax-supported urban public healthcare system consisting of a 300-bed hospital, an emergency department, and a network of community-based ambulatory care centers. Patients were >60 years of age and had at least one prescription refill and at least two ambulatory visits or one hospitalization during the 3-year period. Focusing on 12 major categories of drugs used to treat chronic diseases, we determined the amounts and direct costs of these medications dispensed to older adult patients. Amounts of medications that were needed by patients to medicate themselves adequately were compared with the medication supply actually dispensed considering all sources of care (primary, emergency, and inpatient). We calculated the excess drug costs attributable to oversupply of medication (>120% of the amount needed) and the drug cost reduction caused by undersupply of medication (120% of the supply needed. The total direct cost of targeted medications for 3 years was $1.96 million or, on average, $654,000 annually. During the 3-year period, patients receiving >120% of their needed medications had excess direct medication costs of $279,084 or $144 per patient, whereas patients receiving <80% of drugs needed had reduced medication costs of $423,438 or $634 per patient. Multivariable analyses revealed that both under- and over-supplies of medication were associated with a greater likelihood of emergency department visits and hospital

Supply chain collaboration in industrial symbiosis networks

DEFF Research Database (Denmark)

Herczeg, Gabor; Akkerman, Renzo; Hauschild, Michael Zwicky

2018-01-01

A strategy supporting the development towards a circular economy is industrial symbiosis (IS). It is a form of collaborative supply chain management aiming to make industry more sustainable and achieve collective benefits based on utilization of waste, by-products, and excess utilities between...... economically independent industries. Based on an extensive analysis of published studies on existing IS collaborations and interviews with central stakeholders of a comprehensive IS, this paper investigates IS from a supply chain collaboration perspective. A theoretical framework is built and used to discuss...... how industrial symbiosis pursues sustainability and to identify the main collaboration aspects and performance impacts. This framework is then used in the analysis of selected published cases. Based on this, we derive propositions on the organizational and operational requirements for collaboration...

Mass casualty drill in a local hospital | Ardill | Nigerian Journal of ...

African Journals Online (AJOL)

The stated goals of the mass casualty drill were as follows: evaluate the performance of the hospital staff at every cadre, the communication systems, the adequacy of hospital supplies and equipment and provide immediate feedback to the staff for their educational benefit and improved future performance. The Consultant ...

Incidence of thrombosis in children with tunneled central venous access devices versus peripherally inserted central catheters (PICCs).

Science.gov (United States)

Kanin, Maralee; Young, Guy

2013-11-01

The recent proliferation of deep vein thrombosis in children has been attributed to the increased use of central venous catheters, specifically tunneled lines and peripherally inserted central catheters. A formal comparison of the incidence rate for deep vein thrombosis between tunneled lines and peripherally inserted central catheters has not been undertaken. Children inclusion. Data were extracted from the hospital discharge database which includes data on all procedures and up to 20 diagnoses per admission. Diagnoses and procedures were identified by International Classification of Disease, Ninth Revision coding. Patients were excluded if they received more than one central line. Data collected included type of central line, deep vein thrombosis event, and underlying medical illnesses classified according to chronic complex conditions. Over the seven year study period there was an overall rate of 73 deep vein thromboses per 10,000 hospital discharges. Of the 6915 eligible subjects, 181 had a deep vein thrombosis for an overall incidence rate of 2.6%. There were 152 thrombi (2.6%) in subjects with peripherally inserted central catheters and 29 thrombi (3.1%) in subjects with tunneled lines [OR=.83 (0.55, 1.29), p=0.38]. Despite the relative ease and simplicity of use of peripherally inserted central catheters leading to a substantial rise in their use, this study demonstrates that such lines pose a substantial risk for venous thrombosis and no difference in incidence was detected between such lines and tunneled lines. © 2013.

A GIS-based methodology for highlighting fuelwood supply/demand imbalances at the local level: A case study for Central Mexico

International Nuclear Information System (INIS)

Ghilardi, Adrian; Guerrero, Gabriela; Masera, Omar

2009-01-01

When fuelwood is harvested at a rate exceeding natural growth and inefficient conversion technologies are used, negative environmental and socio-economic impacts, such as fuelwood shortages, natural forests degradation and net GHG emissions arise. In this study, we argue that analyzing fuelwood supply/demand spatial patterns require multi-scale approaches to effectively bridge the gap between national results with local situations. The proposed methodology is expected to help 1) focusing resources and actions on local critical situations, starting from national wide analyses and 2) estimating, within statistically robust confidence bounds, the proportion of non-renewable harvested fuelwood. Starting from a previous work, we selected a county-based fuelwood hot spot in the Central Highlands of Mexico, identified from a national wide assessment, and developed a grid-based model in order to identify single localities that face concomitant conditions of high fuelwood consumption and insufficient fuelwood resources. By means of a multi-criteria analysis (MCA), twenty localities, out of a total of 90, were identified as critical in terms of six indicators related to fuelwood use and availability of fuelwood resources. Fuelwood supply/demand balances varied among localities from -16.2 ± 2.5 Gg y -1 to 4.4 ± 2.6 Gg y -1 , while fractions of non-renewable fuelwood varied from 0 to 96%. These results support the idea that balances and non-renewable fuelwood fractions (mandatory inputs for Clean Development Mechanism (CDM) cookstoves projects) must be calculated on a locality by locality basis if gross under or over-estimations want to be avoided in the final carbon accounting. (author)

A way for reducing drug supply chain cost for a hospital district: A case study

OpenAIRE

Leonardo Postacchini; Filippo Emanuele Ciarapica; Maurizio Bevilacqua; Giovanni Mazzuto; Claudia Paciarotti

2016-01-01

Purpose: This work aims at providing insights to optimise healthcare logistic of the drug management, in order to deal with the healthcare expenditure cut. In this paper the effects of different drug supply chain configurations, on the resulting average stock, service level and Bullwhip effect, of the studied supply chain, is quantitatively assessed. Design/methodology/approach: A case study of an Italian district has been studied, taking into account three echelons: suppliers, centra...

Moderate glucose supply reduces hemolysis during systemic inflammation

Directory of Open Access Journals (Sweden)

Jägers J

2018-03-01

Full Text Available Johannes Jägers,1 Stephan Brauckmann,2 Michael Kirsch,1 Katharina Effenberger-Neidnicht1,3 1Institute of Physiological Chemistry, University Hospital Essen, Essen, Germany; 2Clinic for Anesthesiology and Intensive Care, University Hospital Essen, Essen, Germany; 3Institute of Physiological Chemistry, University Hospital Essen, Essen, Germany Background: Systemic inflammation alters energy metabolism. A sufficient glucose level, however, is most important for erythrocytes, since erythrocytes rely on glucose as sole source of energy. Damage to erythrocytes leads to hemolysis. Both disorders of glucose metabolism and hemolysis are associated with an increased risk of death. The objective of the study was to investigate the impact of intravenous glucose on hemolysis during systemic inflammation.Materials and methods: Systemic inflammation was accomplished in male Wistar rats by continuous lipopolysaccharide (LPS infusion (1 mg LPS/kg and h, 300 min. Sham control group rats received Ringer’s solution. Glucose was supplied moderately (70 mg glucose/kg and h or excessively (210 mg glucose/kg and h during systemic inflammation. Vital parameters (eg, systemic blood pressure as well as blood and plasma parameters (eg, concentrations of glucose, lactate and cell-free hemoglobin, and activity of lactate dehydrogenase were measured hourly. Clot formation was analyzed by thromboelastometry.Results: Continuous infusion of LPS led to a so-called post-aggression syndrome with disturbed electrolyte homeostasis (hypocalcemia, hyperkalemia, and hypernatremia, changes in hemodynamics (tachycardia and hypertension, and a catabolic metabolism (early hyperglycemia, late hypoglycemia, and lactate formation. It induced severe tissue injury (significant increases in plasma concentrations of transaminases and lactate dehydrogenase, alterations in blood coagulation (disturbed clot formation, and massive hemolysis. Both moderate and excessive glucose supply reduced LPS

Misplaced Inventory and Lead-Time in the Supply Chain: Analysis of Decision-Making on RFID Investment with Service Level

Directory of Open Access Journals (Sweden)

Li-Hao Zhang

2014-01-01

Full Text Available Radio-frequency identification (RFID, as the key technology of Internet of Things (IoT, has been hailed as a major innovation to solve misplaced inventory and reduce lead-time. Many retailers have been pushing their suppliers to invest this technology. However, its associated costs seem to prohibit its widespread application. This paper analyzes the situation of service level in a retail supply chain, which has resulted from misplaced inventory and lead-time. By newsvendor model, we analyze the difference between with- and without-RFID technologies in service level of centralized and decentralized supply chains, respectively. Then with different service levels, we determine the tag cost thresholds at which RFID technology investment becomes profitable in centralized and decentralized supply chains, respectively. Furthermore, we apply a linear transfer payment coefficient strategy to coordinate with the decentralized supply chain. It is found that whether the adoption of RFID technology improves the service level depends on the cost of RFID tag in the centralized system, but it improves the service level in the decentralized system when only the supplier bears the cost of RFID tag. Moreover, the same cost thresholds of RFID tag with different service levels exist in both the centralized and the decentralized cases.

Granuloma central de células gigantes Giant cells central granuloma

Directory of Open Access Journals (Sweden)

Ayelén María Portelles Massó

2011-03-01

Full Text Available El granuloma reparativo central de células gigantes es una lesión proliferativa no neoplásica de etiología desconocida. Se presenta un paciente masculino de 40 años de edad, portador de prótesis parcial superior. Fue remitido al Servicio de Cirugía Maxilofacial del Hospital "V. I. Lenin" por presentar aumento de volumen en reborde alveolar superior, de color rojo grisáceo y que provocaba expansión de corticales óseas. Una vez analizados los exámenes clínicos, radiográficos e histopatológicos se diagnosticó un granuloma reparativo central de células gigantes Se realizó exéresis quirúrgica de la lesión y extracción de dientes adyacentes con una evolución satisfactoria sin señales de recidivas luego de tres años del tratamiento. El granuloma reparativo central de células gigantes se presentó como respuesta a un trauma. La correcta interpretación de los datos clínicos, radiográficos e histopatológicos nos permitió llegar al correcto diagnóstico y plan de tratamiento.Giant-cell central reparative granuloma is non neoplastic proliferative lesion of unknown etiology. We report a 40 years old male patient who was admitted at the Maxillofacial Service of the "V. I. Lenin" Hospital. The patient had partial upper prosthesis and was complaining of red-grey volume increase lesion in upper alveolar ridge which led to the expansion of cortical bone. Having analyzed clinical, radiographic and histopathological findings the case was concluded as a giant-cell central reparative granuloma. Surgical exeresis and adjunct tooth extraction were done. After three years of treatment, satisfactory follow up without recurrence is reported.

Turn-key supply for the power supplies of the control coils of wendelstein 7-X experiment

International Nuclear Information System (INIS)

Jauregi, E.; Ganuza, D.; Garcia, I.; Rio, J.M. del; Rummel, T.; Fuellenbach, F.

2003-01-01

In the Max-Planck Institute for Plasma Physics, IPP, in Greifswald, a new stellerator is being built for fusion research experiments, the so called Wendelstein 7-X Experiment. JEMA Company has designed, manufacture and supply the turnkey system which energises the ten control coils in the stellerator. The system comprises ten independent Switch-mode power supplies, and the central distribution stations for power, cooling and control facilities. Each power supply must provide a controlled current compounded of direct current and 0-20 Hz bandwidth ac current in a range of almost 3 kA at low voltage, 30 V, in four quadrants. Positive and negative voltage and sinusoidal current with low harmonic distortion is required by load. The selected design is based on Switch-mode-power supply technology (SMPS) providing the system with a very high regulation response (very low current and voltage ripple) and excellent input power factor, keeping the grid total harmonic distortion (THD) under minimum values. The sources can be operated locally as independent systems or they can be co-ordinated from a main control keeping current synchronisation requirements. The system in its entirety requires a high efficiency due to thermal considerations and reduced space. The system presented here introduces a decisive solution for the future power supplies to superconducting or regular coils, where the regulation, precision and ripple are the basic requirements for the design. During year 2000 the design stage was covered and in 2001 a first prototype for the power supplies was manufactured and successfully tested at factory. The entire system has been installed over this year after the series fabrication and it is currently working at IPP facilities, waiting for the acceptance tests scheduled before end of the year. This paper aims to explain the different stages the company went through in order to get validation of the power supply system and make it running at its last location

Global public health impact of recovered supplies from operating rooms: a critical analysis with national implications.

Science.gov (United States)

Wan, Eric L; Xie, Li; Barrett, Miceile; Baltodano, Pablo A; Rivadeneira, Andres F; Noboa, Jonathan; Silver, Maya; Zhou, Richard; Cho, Suzy; Tam, Tammie; Yurter, Alp; Gentry, Carol; Palacios, Jorge; Rosson, Gedge D; Redett, Richard J

2015-01-01

In modern operating rooms, clean and unused medical supplies are routinely discarded and can be effectively recovered and redistributed abroad to alleviate the environmental burden of donor hospitals and to generate substantial health benefits at resource-poor recipient institutions. We established a recovery and donation program to collect clean and unused supplies for healthcare institutions in developing nations. We analyzed items donated over a 3-year period (September 2010-November 2013) by quantity and weight, and estimated the projected value of the program under potential nationwide participation. To capture the health benefits attributable to the donated supplies at recipient institutions, we partnered with two tertiary-care centers in Guayaquil, Ecuador and conducted a pilot study on the utility of the donated supplies at the recipient institutions (October 2013). We determined the disability-adjusted life years (DALY) averted for all patients undergoing procedures involving donated items and estimated the annual attributable DALY as well as the cost per DALY averted both by supply and by procedure. Approximately, 2 million lbs (907,185 kg) per year of medical supplies are recoverable from large non-rural US academic medical centers. Of these supplies, 19 common categories represent a potential for donation worth US $15 million per year, at a cost-utility of US $2.14 per DALY averted. Hospital operating rooms continue to represent a large source of recoverable surgical supplies that have demonstrable health benefits in the recipient communities. Cost-effective recovery and need-based donation programs can significantly alleviate the global burden of surgical diseases.

Stage implementation of RFID in hospitals.

Science.gov (United States)

Kumar, Sameer; Livermont, Gregory; McKewan, Gregory

2010-01-01

The use of radio frequency identification device (RFID) technology within the healthcare industry was researched and specific instances of implementation of this technology in the hospital environment were examined. The study primarily makes use of ideas from operations and supply chain management, such as work flow diagrams, value stream mapping, and poka-yokes (mistake proofing measures) for investigations of processes, failures, and solutions. This study presents a step-by-step approach of how to implement the use of RFID tracking systems within the entire hospital. A number of poka-yokes were also devised for improving the safety of the patient and cost effectiveness of the hospital to insure the success of the hospital health care delivery system. Many players in the hospital environment may be impacted. This includes patients, doctors, nurses, technicians, administrators, and other hospital personnel. Insurance and government agencies may be impacted as well. Different levels of training of hospital personnel will be required based on the degree of interaction with the RFID system. References to costs, Return On Investment, change management, ethical and legal considerations are also made to help the reader understand the benefits and implications of the technology in the hospital environment.

Japanese hospitals--culture and competition: a study of ten hospitals.

Science.gov (United States)

Anbäcken, O

1994-01-01

Japanese health care is characterized by a pluralistic system with a high degree of private producers. Central government regulates the prices and the financing system. All citizens are covered by a mandatory employment-based health insurance operating on a non-profit basis. The consumer has a free choice of physician and hospital. A comparison between Japan, Sweden and some other countries shows significant dissimilarities in the length of stay, number of treatments per hospital bed and year and the staffing of hospitals. About 80 per cent of the hospitals and 94 per cent of the clinics are privately owned. The typical private hospital owned by a physician has less than 100 beds. In this paper, data collected (1992/93) in an empirical study of Japanese hospitals and their leadership is presented. Also discussed are the hospitals' style of management, tools and strategies for competition and competences--personal and formal skills required of the leadership in the hospital. There follows a study of ten hospitals, among which hospital directors and chief physicians were interviewed. Interviews are also made with key persons in the Ministry of Health and Welfare and other organizations in the health care field. The result is also analysed from a cultural perspective--'what kind of impact does the Japanese culture have on the health care organization?' and/or 'what kind of sub-culture is developed in the Japanese hospitals'. Some comparisons are made with Sweden, USA, Canada and Germany. The different roles of the professions in the hospital are included in the study as well as the incentives for different kinds of strategies--specialization, growing in size, investments in new equipment, different kind of ownership and hospitals. Another issue discussed is the attempt to uncover whether there is an implicit distribution of specialties--silent agreements between hospitals, etc.

HIV/AIDS related commodities supply chain management in public health facilities of Addis Ababa, Ethiopia: a cross-sectional survey.

Science.gov (United States)

Berhanemeskel, Eyerusalem; Beedemariam, Gebremedhin; Fenta, Teferi Gedif

2016-01-01

A wide range of pharmaceutical products are needed for diagnosis, treatment, and prevention of HIV/AIDS. However, interrupted supplies and stock-outs are the major challenges in the supply chain of ARV medicines and related commodities. The aim of this study was to assess the supply chain management of HIV/AIDS related commodities in public health facilities of Addis Ababa, Ethiopia. A descriptive cross-sectional survey complemented by qualitative method was conducted in 24 public health facilities (4 hospitals and 20 health centers). A semi-structured questionnaire and observation check list were used to collect data on HIV/AIDS related service, reporting and ordering; receiving, transportation and storage condition of ARV medicines and test kits; and supportive supervision and logistics management information system. In addition, in-depth interview with flexible probing techniques was used to complement the quantitative data with emphasis to the storage condition of ARV medicines and test kits. Quantitative data was analyzed using SPSS version-20. Analysis of qualitative data involved rigorous reading of transcripts in order to identify key themes and data was analyzed using thematic approach. The study revealed that 16 health centers and one hospital had recorded and reported patient medication record. Six months prior to the study, 14 health centers and 2 hospitals had stopped VCT services for one time or more. Three hospitals and 18 health centers claimed to have been able to submit the requisition and report concerning ARV medicines to Pharmaceutical Fund and Supply Agency according to the specific reporting period. More than three-fourth of the health centers had one or more emergency order of ARV medicines on the day of visit, while all of hospitals had emergency order more than 3 times within 6 months prior to the study. All of the hospitals and nearly half of the health centers had an emergency order of test kits more than 3 times in the past 6�

75 FR 75681 - Peripheral and Central Nervous System Drugs Advisory Committee; Notice of Meeting

Science.gov (United States)

2010-12-06

...] Peripheral and Central Nervous System Drugs Advisory Committee; Notice of Meeting AGENCY: Food and Drug...: Peripheral and Central Nervous System Drugs Advisory Committee. General Function of the Committee: To provide...) and/or abnormal vascularity (abnormal blood supply and circulation) of the central nervous system. The...

Unintended inhalation of nitric oxide by contamination of compressed air: physiologic effects and interference with intended nitric oxide inhalation in acute lung injury.

Science.gov (United States)

Benzing, A; Loop, T; Mols, G; Geiger, K

1999-10-01

Compressed air from a hospital's central gas supply may contain nitric oxide as a result of air pollution. Inhaled nitric oxide may increase arterial oxygen tension and decrease pulmonary vascular resistance in patients with acute lung injury and acute respiratory distress syndrome. Therefore, the authors wanted to determine whether unintentional nitric oxide inhalation by contamination of compressed air influences arterial oxygen tension and pulmonary vascular resistance and interferes with the therapeutic use of nitric oxide. Nitric oxide concentrations in the compressed air of a university hospital were measured continuously by chemiluminescence during two periods (4 and 2 weeks). The effects of unintended nitric oxide inhalation on arterial oxygen tension (n = 15) and on pulmonary vascular resistance (n = 9) were measured in patients with acute lung injury and acute respiratory distress syndrome by changing the source of compressed air of the ventilator from the hospital's central gas supply to a nitric oxide-free gas tank containing compressed air. In five of these patients, the effects of an additional inhalation of 5 ppm nitric oxide were evaluated. During working days, compressed air of the hospital's central gas supply contained clinically effective nitric oxide concentrations (> 80 parts per billion) during 40% of the time. Change to gas tank-supplied nitric oxide-free compressed air decreased the arterial oxygen tension by 10% and increased pulmonary vascular resistance by 13%. The addition of 5 ppm nitric oxide had a minimal effect on arterial oxygen tension and pulmonary vascular resistance when added to hospital-supplied compressed air but improved both when added to tank-supplied compressed air. Unintended inhalation of nitric oxide increases arterial oxygen tension and decreases pulmonary vascular resistance in patients with acute lung injury and acute respiratory distress syndrome. The unintended nitric oxide inhalation interferes with the

out-patient prescribing practices at mbagathi district hospital-nairobi

African Journals Online (AJOL)

2013-12-01

Dec 1, 2013 ... Objective: To assess medicine use practices by using WHO prescribing and patient care indicators in .... from the hospital administration and ethics approval ..... additional funds to purchase medicines and medical supplies.

Supply chain design under uncertainty for advanced biofuel production based on bio-oil gasification

International Nuclear Information System (INIS)

Li, Qi; Hu, Guiping

2014-01-01

An advanced biofuels supply chain is proposed to reduce biomass transportation costs and take advantage of the economics of scale for a gasification facility. In this supply chain, biomass is converted to bio-oil at widely distributed small-scale fast pyrolysis plants, and after bio-oil gasification, the syngas is upgraded to transportation fuels at a centralized biorefinery. A two-stage stochastic programming is formulated to maximize biofuel producers' annual profit considering uncertainties in the supply chain for this pathway. The first stage makes the capital investment decisions including the locations and capacities of the decentralized fast pyrolysis plants as well as the centralized biorefinery, while the second stage determines the biomass and biofuels flows. A case study based on Iowa in the U.S. illustrates that it is economically feasible to meet desired demand using corn stover as the biomass feedstock. The results show that the locations of fast pyrolysis plants are sensitive to uncertainties while the capacity levels are insensitive. The stochastic model outperforms the deterministic model in the stochastic environment, especially when there is insufficient biomass. Also, farmers' participation can have a significant impact on the profitability and robustness of this supply chain. - Highlights: • Decentralized supply chain design for advanced biofuel production is considered. • A two-stage stochastic programming is formulated to consider uncertainties. • Farmers' participation has a significant impact on the biofuel supply chain design

Small Farmers and Big Retail: trade-offs of supplying supermarkets in Nicaragua

OpenAIRE

Michelson, Hope; Reardon, Thomas; Perez, Francisco Jose

2010-01-01

In Nicaragua and elsewhere in Central America, small-scale farmers are weighing the risks of entering into contracts with supermarket chains. We use unique data on negotiated prices from Nicaraguan farm cooperatives supplying supermarkets to study the impact of supply agreements on producers’ mean output prices and price stability. We find that prices paid by the domestic retail chain approximate the traditional market in mean and variance. In contrast, we find that mean prices paid by Wal-ma...

Development and utilization of spring water in small scale supply ...

African Journals Online (AJOL)

Development and utilization of spring water in small scale supply scheme for the Kogi State Polytechnic, Lokoja, central Nigeria. Joseph Omada. Abstract. No Abstract. Journal of Mining and Geology 2005, Vol. 41(1): 131-135. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL ...

[Supply prescription filling and out-of-pocket expenditures on medicines in public hospitals in Mexico in 2009].

Science.gov (United States)

Sesma-Vázquez, Sergio; Gómez-Dantés, Octavio; Wirtz, Veronika J; Castro-Tinoco, Manuel

2011-01-01

To analyze the availability of drugs in public hospitals, the prescription-filling patterns for in-patients when they are discharged and their out-of-pocket expenditure during their hospitalization. Using the National Satisfaction and Responsiveness Survey (ENSATA) 2009, which includes a representative sample of public hospitals in Mexico in 2009, the availability of 83 essential medicines in the hospital pharmacies at the day of visit, the proportion of prescriptions completely filled for patients when they are discharged and their out-of-pocket expenditure during their hospitalization were analyzed. A total of 26 271 patients in 160 public hospitals were interviewed. The mean availability of drugs was 82% for all hospitals, with the lowest availability for the Ministry of Health (SESA) hospitals (77%, with a range of 30 to 96%). Patients discharged at social security hospitals received in 97% of cases a complete prescription filling, while in SESA hospitals the average was only 56.2%, with a large variance among states (13 to 94%). The median inpatient spending was 150 pesos in national currency (1% spent over 10 000 pesos). The lack of medicines in public hospitals may increase in-patient morbidity and mortality and has an economic impact on household spending, particularly in those with scarce resources.

Assessing reliability in energy supply systems

International Nuclear Information System (INIS)

McCarthy, Ryan W.; Ogden, Joan M.; Sperling, Daniel

2007-01-01

Reliability has always been a concern in the energy sector, but concerns are escalating as energy demand increases and the political stability of many energy supply regions becomes more questionable. But how does one define and measure reliability? We introduce a method to assess reliability in energy supply systems in terms of adequacy and security. It derives from reliability assessment frameworks developed for the electricity sector, which are extended to include qualitative considerations and to be applicable to new energy systems by incorporating decision-making processes based on expert opinion and multi-attribute utility theory. The method presented here is flexible and can be applied to any energy system. To illustrate its use, we apply the method to two hydrogen pathways: (1) centralized steam reforming of imported liquefied natural gas with pipeline distribution of hydrogen, and (2) on-site electrolysis of water using renewable electricity produced independently from the electricity grid

Teleradiology and PACS - strategy of the Innsbruck University Hospital

International Nuclear Information System (INIS)

Vogl, R.

2005-01-01

Systems for management of digital imaging data are very important and widespread at the Innsbruck University Hospital and constitute a central component of the IT strategies followed by the hospital operating company TILAK (Tyrolean public hospitals). The particular goal is to integrate all imaging data into the electronic medical records and make these available online to each of the approx. 2500 clinic workstations and ensure electronic data exchange with other healthcare services. Teleradiology connections have been established at the University Clinic for Radiology since 1995; these have been continually expanded and linked to the central PACS. An eHealth web portal was recently established to facilitate transfer of images and findings from TILAK hospitals to other healthcare organizations. Registered users can be cleared for a limited time to access all radiological imaging data via this web portal. (orig.) [de

Hospital network performance: a survey of hospital stakeholders' perspectives.

Science.gov (United States)

Bravi, F; Gibertoni, D; Marcon, A; Sicotte, C; Minvielle, E; Rucci, P; Angelastro, A; Carradori, T; Fantini, M P

2013-02-01

Hospital networks are an emerging organizational form designed to face the new challenges of public health systems. Although the benefits introduced by network models in terms of rationalization of resources are known, evidence about stakeholders' perspectives on hospital network performance from the literature is scanty. Using the Competing Values Framework of organizational effectiveness and its subsequent adaptation by Minvielle et al., we conducted in 2009 a survey in five hospitals of an Italian network for oncological care to examine and compare the views on hospital network performance of internal stakeholders (physicians, nurses and the administrative staff). 329 questionnaires exploring stakeholders' perspectives were completed, with a response rate of 65.8%. Using exploratory factor analysis of the 66 items of the questionnaire, we identified 4 factors, i.e. Centrality of relationships, Quality of care, Attractiveness/Reputation and Staff empowerment and Protection of workers' rights. 42 items were retained in the analysis. Factor scores proved to be high (mean score>8 on a 10-item scale), except for Attractiveness/Reputation (mean score 6.79), indicating that stakeholders attach a higher importance to relational and health care aspects. Comparison of factor scores among stakeholders did not reveal significant differences, suggesting a broadly shared view on hospital network performance. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Non-steroidal anti-inflammatory drugs and antibiotics prescription trends at a central west bank hospital.

Science.gov (United States)

Tayem, Yasin I; Qubaja, Marwan M; Shraim, Riyad K; Taha, Omar B; Abu Shkheidem, Imadeddin A; Ibrahim, Murad A

2013-11-01

We aimed to reliably describe the pattern of outpatient prescription of non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics (ATBs) at a central hospital in the West Bank, Palestine. This was a retrospective, cross-sectional study investigating a cohort of 2,208 prescriptions ordered by outpatient clinics and the emergency room over one year in Beit Jala Hospital in Bethlehem, West Bank. The orders were analysed for the rate and types of NSAIDs and ATBs utilised, and the appropriateness of these drugs to the diagnosis. Of the total prescriptions, 410 contained NSAIDs (18.6%), including diclofenac (40.2%), low dose aspirin (23.9%), ibuprofen (17.8%) and indomethacin (15.1%). A minority of these prescriptions contained a combination of these agents (2.5%). Only one prescription contained cyclooxyeganse-2 inhibitors (0.2%). The appropriateness of NSAID use to the diagnosis was as follows: appropriate (58.3%), inappropriate (14.4%) and difficult to tell (27.3%). The rate of ATB use was 30.3% (669 prescriptions). The ATBs prescribed were amoxicillin (23.3%), augmentin (14.3%), quinolones (12.7%), first and second generation cephalosporins (9.4% and 12.7%, respectively) and macrolides (7.2%). ATB combinations were identified in 9.4%, with the most common being second-generation cephalopsorins and metronidazole (4.3%). Regarding the appropriateness of prescribing ATBs according to the diagnosis, it was appropriate in 44.8%, inappropriate in 20.6% and difficult to tell in 34.6% of the prescriptions. These findings revealed a relatively large number and inappropriate utilisation of ATBs and NSAIDs. An interventional programme needs to be adopted to reinforce physicians' knowledge of the rational prescription of these agents.

Loan Supply Shocks in Macedonia: A Bayesian SVAR Approach with Sign Restrictions

Directory of Open Access Journals (Sweden)

Rilind Kabashi

2016-06-01

Full Text Available This paper analyzes the effects of loan supply, as well as aggregate demand,aggregate supply and monetary policy shocks between 1998 and 2014 in Macedonia using a structural vector autoregression model with sign restrictions and Bayesian estimation. The main results indicate that loan supply shocks have no significant effect on loan volumes and lending rates, or on economic activity and prices. The effects of monetary policy on lending activity are fairly limited, although there is some evidence that it affects lending rates more than loan volumes. Monetary policy shocks have strong effects on inflation, while the central bank reacts strongly to adverse shocks hitting the economy. Baseline results are confirmed by several robustness checks. According to historical decomposition, the lending activity was supporting economic growth before and during the crisis, but its contribution became negative during the recovery and it was a drag on growth until the end of the period. Pre-crisis GDP growth is mostly explained by supportive monetary policy. However, the restrictive monetary policy during the crisis contributed to the fall of GDP, before becoming supportive again during the early stages of the recovery. Policy rates in recent years mostly reflect subdued lending activity and aggregate supply factors, which the central bank tries to counteract with a more accommodative policy.

Implementation of the WHO multimodal Hand Hygiene Improvement Strategy in a University Hospital in Central Ethiopia.

Science.gov (United States)

Pfäfflin, Frieder; Tufa, Tafese Beyene; Getachew, Million; Nigussie, Tsehaynesh; Schönfeld, Andreas; Häussinger, Dieter; Feldt, Torsten; Schmidt, Nicole

2017-01-01

The burden of health-care associated infections in low-income countries is high. Adequate hand hygiene is considered the most effective measure to reduce the transmission of nosocomial pathogens. We aimed to assess compliance with hand hygiene and perception and knowledge about hand hygiene before and after the implementation of a multimodal hand hygiene campaign designed by the World Health Organization. The study was carried out at Asella Teaching Hospital, a university hospital and referral centre for a population of about 3.5 million in Arsi Zone, Central Ethiopia. Compliance with hand hygiene during routine patient care was measured by direct observation before and starting from six weeks after the intervention, which consisted of a four day workshop accompanied by training sessions and the provision of locally produced alcohol-based handrub and posters emphasizing the importance of hand hygiene. A second follow up was conducted three months after handing over project responsibility to the Ethiopian partners. Health-care workers' perception and knowledge about hand hygiene were assessed before and after the intervention. At baseline, first, and second follow up we observed a total of 2888, 2865, and 2244 hand hygiene opportunities, respectively. Compliance with hand hygiene was 1.4% at baseline and increased to 11.7% and 13.1% in the first and second follow up, respectively (p hand hygiene was consistent across professional categories and all participating wards and was independently associated with the intervention (adjusted odds ratio, 9.18; 95% confidence interval 6.61-12.76; p hand hygiene actions. The median hand hygiene knowledge score overall was 13 (interquartile range 11-15) at baseline and increased to 17 (15-18) after training (p hand hygiene is feasible and sustainable in a resource-constrained setting using a multimodal improvement strategy. However, absolute compliance remained low. Strong and long-term commitment by hospital management and

Role of the tunisian central pharmacy in the import of radio-pharmaceutical products

International Nuclear Information System (INIS)

Souissi Jaziri, Camelia; Moulahi, L.

2013-01-01

In Tunisia the centralized organization of the medicine sector has a strategic and economic importance. It presents particular characteristics concerning the importation and the control of drugs. Tcp has a monopoly on the importation of drugs for the country, which enters in the state policy for the control of drug purchasing costs, their availability in different region of the country and their guarantee and quality. The Tcp has a crucial role in the availability of drugs and in the holding safety stock and strategic reserve of the imported pharmaceutical products, either for the public or private sector. The Tcp has to stock up medicaments, chemical and pharmaceutical products, objects of bandages, instruments, accessory tools and other supplies necessary for the human and veterinary medicine. The Tcp packages any specialized or not medicament and all other products or supplies. The Tcp provides medicaments and products entering within the framework of its task to different health groups and hospitals. The Tcp provides distributors, laboratories and pharmacies over the country. In Tunisia the import of radioisotopes used in the medical domain is attributed to the Tcp. The objective is to centralize purchases and to guarantee: the security, the availability as well as the traceability. The Tcp supply radiopharmaceutical products for diagnostic and therapy purposes according to an authorization delivered annually by the National Center of Radiation Protection (NCRP). An authorization of removal used at the customs allows the clearance of products at the level of the air freights by the transit service of the Tcp. Regarding the evolution of purchases of radio-pharmaceutical products, their importation remained stable during the last three years. Indeed, it is approximately around 1MDT annually (954 121 DT in 2010, 939 956 in 2011 and 1047 967 in 2012). Sources of supply are divided between 4 suppliers: International IBA-CISBIO (49.9 pour cent), COVIDIEN EX (TYCO

Using Lean Six Sigma Methodology to Improve Quality of the Anesthesia Supply Chain in a Pediatric Hospital.

Science.gov (United States)

Roberts, Renée J; Wilson, Ashley E; Quezado, Zenaide

2017-03-01

Six Sigma and Lean methodologies are effective quality improvement tools in many health care settings. We applied the DMAIC methodology (define, measure, analyze, improve, control) to address deficiencies in our pediatric anesthesia supply chain. We defined supply chain problems by mapping existing processes and soliciting comments from those involved. We used daily distance walked by anesthesia technicians and number of callouts for missing supplies as measurements that we analyzed before and after implementing improvements (anesthesia cart redesign). We showed improvement in the metrics after those interventions were implemented, and those improvements were sustained and thus controlled 1 year after implementation.

Operation of SST-1 TF power supply during SST-1 campaigns

International Nuclear Information System (INIS)

Sharma, Dinesh Kumar; Vora, Murtuza M.; Ojha, Amit; Singh, Akhilesh Kumar; Bhavsar, Chirag

2015-01-01

Highlights: • SST-1 TF power supply is 12 pulse SCR converter circuit. • TF power supply protection, measurement and control scheme are explained. • Quench, emergency and normal shot process is explained and results of SST-1 campaigns are shown. • Dynamic control of TF current. • The paper shows the results of last ten SST-1 campaigns. - Abstract: SST-1 TF power supply provides the direct current for the required magnetic field of TF coil. TF power supply includes transformer, 12-pulse converter, bus bar, water-cooled cable, protection and measuring equipments, and isolator, VME DAC system and GUI software. TF power supply is operated through GUI software built in TCL/Tk. VME DAC system monitors the parameters, provides On/Off commands, voltage and current references and initiates predefined reference to emergency shutdown. The emergency shutdown is hardwired to TF power supply from central control. During quench power supply converter opens DCCB and dump resistor is connected in the circuit and VME DAC system acquires bus bar voltage, dump voltage and dump current. Operation of TF power supply also requires monitoring of SCR and transformer temperature and water flow rate of water-cooled cable during high current long pulse shot. Before start up of TF power supply a quench simulation is performed to check the readiness of protection. This paper describes pre startup operation, normal shot operation, emergency and quench process, dynamic control and complete shutdown operation of TF power supply.

Operation of SST-1 TF power supply during SST-1 campaigns

Energy Technology Data Exchange (ETDEWEB)

Sharma, Dinesh Kumar, E-mail: dinesh@ipr.res.in; Vora, Murtuza M.; Ojha, Amit; Singh, Akhilesh Kumar; Bhavsar, Chirag

2015-10-15

Highlights: • SST-1 TF power supply is 12 pulse SCR converter circuit. • TF power supply protection, measurement and control scheme are explained. • Quench, emergency and normal shot process is explained and results of SST-1 campaigns are shown. • Dynamic control of TF current. • The paper shows the results of last ten SST-1 campaigns. - Abstract: SST-1 TF power supply provides the direct current for the required magnetic field of TF coil. TF power supply includes transformer, 12-pulse converter, bus bar, water-cooled cable, protection and measuring equipments, and isolator, VME DAC system and GUI software. TF power supply is operated through GUI software built in TCL/Tk. VME DAC system monitors the parameters, provides On/Off commands, voltage and current references and initiates predefined reference to emergency shutdown. The emergency shutdown is hardwired to TF power supply from central control. During quench power supply converter opens DCCB and dump resistor is connected in the circuit and VME DAC system acquires bus bar voltage, dump voltage and dump current. Operation of TF power supply also requires monitoring of SCR and transformer temperature and water flow rate of water-cooled cable during high current long pulse shot. Before start up of TF power supply a quench simulation is performed to check the readiness of protection. This paper describes pre startup operation, normal shot operation, emergency and quench process, dynamic control and complete shutdown operation of TF power supply.

Evaluación del espesor corneal central y su influencia en la presión intraocular en pacientes del Hospital "Dr. Miguel Enríquez" Evaluation of the central corneal thickness and its impact on the intraocular pressure of patients in "Dr. Miguel Enriquez" hospital

Directory of Open Access Journals (Sweden)

María Teresa Arrronte Alarcón

2012-01-01

Full Text Available Objetivo: evaluar el espesor corneal central en sujetos sanos, hipertensos oculares, sospechosos de glaucoma y glaucomatosos, y su influencia en la presión intraocular. Métodos: se realizó un estudio descriptivo y transversal que incluyó 708 ojos de 356 sujetos que acudieron al servicio de oftalmología del Hospital Universitario "Dr. Miguel Enríquez" entre enero y diciembre de 2010. A los pacientes se les midió el espesor corneal central con paquimetría ultrasónica (paquímetro US 4000. El resto de la información se obtuvo a partir de las historias clínicas de los pacientes. Resultados: Los hipertensos oculares presentaron córneas gruesas (p=0,07; el mayor número de casos que tenían diagnóstico de sospecha de glaucoma y de glaucoma primario de ángulo abierto presentaron un grosor corneal delgado (p=0,62 y p=0,08 respectivamente. Si no se hubiese tenido en cuenta el factor de corrección para evaluar la presión intraocular se encontraría 48,1 % de los glaucomatosos y 31,5 % de los hipertensos oculares con diagnóstico inadecuado (pObjective: to evaluate the central corneal thickness in healthy individuals, in persons with ocular hypertension, and in suspected glaucoma and glaucomatous people, and its influence in intraocular pressure. Methods: a cross-sectional and descriptive study was performed in 708 eyes from 356 people who had been seen at ophthalmology service of “Dr. Miguel Enríquez”, university hospital from January to December, 2010. Their central corneal thickness was measured with ultrasonic pachymetry (pachymeter US 4000. The rest of the information came from the clinical histories of the patients. Results: Most of the ocular hypertensives presented thick corneas (p=0,07; a high number of cases that had diagnosis of glaucoma suspicion and primary open-angle glaucoma showed thin corneas (p=0,62 and (p=0,08 respectively. If the correction factor to evaluate the IOP had not been considered, then 48,1 % of the

Calidad del servicio de atención en la Unidad de Laboratorio de Emergencia y Laboratorio Central, Hospital Público de Lima, 2016

OpenAIRE

Castillo Acuña, Marissa Gladys

2016-01-01

La Calidad en el Servicio de Atención de acuerdo a Camarasa (2004) “La Calidad de los servicios de atención constituyen el conjunto de prestaciones y atenciones que el cliente espera recibir de la organización que los presta”. (p.13) Objetivo: Comparar el nivel de calidad del servicio de atención en la unidad de Laboratorio de Emergencia con respecto a la unidad de Laboratorio Central en un Hospital Público de Lima 2016. Metodología: Estudio de Nivel descriptivo comparativo, tr...

Blood inventory management: hospital best practice.

Science.gov (United States)

Stanger, Sebastian H W; Yates, Nicola; Wilding, Richard; Cotton, Sue

2012-04-01

Blood is a perishable product, and hence good management of inventories is crucial. Blood inventory management is a trade-off between shortage and wastage. The challenge is to keep enough stock to ensure a 100% supply of blood while keeping time expiry losses at a minimum. This article focuses on inventory management of red blood cells in hospital transfusion laboratories to derive principles of best practice and makes recommendations that will ensure losses due to time expiry are kept to a minimum. The literature was reviewed to identify available models for perishable inventory management. Historical data from the UK blood supply chain was analyzed to identify hospitals with good inventory management practice and low wastage levels. Transfusion laboratory managers in the selected hospitals were interviewed in 7 case studies with the aim of identifying drivers for low wastage and good inventory management practice. The findings from the case studies were compared with the literature. The extant literature asserts that the drivers for good inventory performance are the use of complex inventory models and algorithms. This study has found this not to be the case. Instead, good performance is driven by the quality of transfusion laboratory staff, who must be skilled, regularly trained, and experienced. Electronic crossmatching, transparency of the inventory, and simple management procedures also facilitate good performance. Copyright © 2012 Elsevier Inc. All rights reserved.

Value of Lost Load: An Efficient Economic Indicator for Power Supply Security? A Literature Review

Energy Technology Data Exchange (ETDEWEB)

Schröder, Thomas, E-mail: t.schroeder@fz-juelich.de; Kuckshinrichs, Wilhelm [Institute of Energy and Climate Research – Systems Analysis and Technology Evaluation (IEK-STE), Forschungszentrum Jülich GmbH, Jülich (Germany)

2015-12-24

Security of electricity supply has become a fundamental requirement for well-functioning modern societies. Because of its central position in all sections of society, the present paper considers the economic consequences of a power supply interruption. The value of lost load (VoLL) is a monetary indicator expressing the costs associated with an interruption of electricity supply. This paper reviews different methods for calculating VoLL, provides an overview of recently published studies, and presents suggestions to increase the explanatory power and international comparability of VoLL.

Integration of decentralised renewable power supply plants in the grid - security of supply in the residential sector; Integration dezentraler regenerativer Energieversorgungsanlagen in den Netzbetrieb - Versorgungssicherheit im Wohnbereich

Energy Technology Data Exchange (ETDEWEB)

Bendel, C.; Nestle, D. [Kassel Univ. (DE). Inst. fuer Solare Energietechnik e.V. (ISET)

2007-06-15

By supplementing the existing technical and legal interface between the public network and the customer with intelligent components and applying the principle of local decision-making on the basis of central and local information BEMI (bidirectional energy management interface) creates a platform through which both suppliers and consumers can contribute substantially to the integration of naturally supply-dependent energy resources in the low-voltage supply network. This article describes a laboratory-scale system which demonstrates the performance capability of BEMI, which is being further improved through test runs.

Specialized consulting in radiological safety to the North Central Hospital of high specialty, PEMEX. V. November of 2001

International Nuclear Information System (INIS)

Angeles C, A.; Vizuet G, J.; Benitez S, J. A.; Garcia A, J.; Rodriguez A, F.

2002-01-01

It is a report of a specialized consulting in radiological safety that to be carried the ININ to PEMEX for the North Central Hospital of High Specialty, to maintain the sanitary license for the use of X ray equipment of medical diagnostic, and guarantee these services with a program of quality assurance. To give fulfilment to that requests it is programmed a technical assistance monthly, with reports of results during the development of the service. In this document it is carried a report of the advances and results in the month of November of the 2001, where the following documents are analyzed: Manual of radiological safety, program of quality assurance, operation procedures, procedure of maintenance team, procedure of medical radiological control of the specialized personnel; also are annotate the obtained results and their observations. (Author)

Specialized consulting in radiological safety to the south central hospital of high specialty, PEMEX. VI. December of 2001

International Nuclear Information System (INIS)

Angeles C, A.; Vizuet G, J.; Benitez S, J.A.; Garcia A, J.; Rodriguez A, F.

2002-01-01

It is a report of a specialized consulting in radiological safety that to be carried the ININ to PEMEX for the South Central Hospital of High Specialty, to maintain the sanitary license for the use of X-ray equipment of medical diagnostic, and guarantee these services with a program of quality assurance. To give fulfilment to that requests it is programmed a technical assistance monthly, with reports of results during the development of the service. In this document it is carried a report of the advances and results in the month of december of the 2001, where the following documents are analyzed: Manual of radiological safety, program of quality assurance, operation procedures, procedure of maintenance team, procedure of medical radiological control of the specialized personnel; also are annotate the obtained results and their observations. (Author)

Rolling out Productive Ward foundation modules across a hospital trust.

Science.gov (United States)

Foster, Sam; Gordon, Pete; McSherry, Wilfred

The Shrewsbury and Telford Hospitals NHS Trust has spent the last 12 months rolling out the Productive Ward foundation modules across the whole organisation. This has resulted in measurable increases in time spent on direct care, and reduced infection rates and ward non-pay (non-staffing) expenditure. This article discusses the initiative and looks at how problems with the hospital supply chain are being addressed.

Managing a two-echelon supply chain with price, warranty and quality dependent demand

Directory of Open Access Journals (Sweden)

Nikunja Mohan Modak

2015-12-01

Full Text Available This paper deals with a two-layer supply chain composed of one manufacturer and one retailer for single-type product. The demand function of the end customers depends on quality, warranty, and sales price of the product. The profit functions of the manufacturer and the retailers are maximized under centralized and decentralized approaches. Our study suggests that the joint profit in centralized system is always more than the decentralized system. Finally, the surplus profit in centralized system is shared according to their profits in decentralized system.

Gastric cancers at Kibogora Hospital | Ntakiyiruta | East and Central ...

African Journals Online (AJOL)

East and Central African Journal of Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 14, No 1 (2009) >. Log in or Register to get access to full text downloads.

The supply of general practitioners across local areas: accounting for spatial heterogeneity.

Science.gov (United States)

McIsaac, Michelle; Scott, Anthony; Kalb, Guyonne

2015-10-03

The geographic distribution of general practitioners (GPs) remains persistently unequal in many countries despite notable increases in overall supply. This paper explores how the factors associated with the supply of general practitioners (GPs) are aligned with the arbitrary geographic boundaries imposed by the use of spatially referenced GP supply data. Data on GP supply in postcodes within Australia are matched to data on the population characteristics and levels of amenities in postcodes. Tobit regression models are used that examine the associations between GP supply and postcode characteristics, whilst accounting for spatial heterogeneity. The results demonstrate that GPs do not consider space in a one-dimensional sense. Location choice is related to both neighbourhood-specific factors, such as hospitals, and broader area factors, such as area income and proximity to private schools. Although the proportion of females and elderly were related to GPs supply, mortality rate was not. This paper represents the first attempt to map the factors influencing GP supply to the appropriate geographic level at which GPs may be considering that factor. We suggest that both neighbourhood and broader regional characteristics can influence GPs' locational choices. This finding is highly relevant to the design and evaluation of relocation incentive programmes.

Impact of pharmacists assisting with prescribing and undertaking medication review on oxycodone prescribing and supply for patients discharged from surgical wards.

Science.gov (United States)

Tran, T; Taylor, S E; Hardidge, A; Findakly, D; Aminian, P; Elliott, R A

2017-10-01

Overprescribing of oxycodone is a contributor to the epidemic of prescription opioid misuse and deaths. Practice models to optimize oxycodone prescribing and supply need to be evaluated. We explored the impact of pharmacist-assisted discharge prescribing and medication review on oxycodone prescribing and supply for patients discharged from surgical wards. A retrospective audit was conducted on two surgical inpatient wards following a 16-week prospective pre- and post-intervention study. During the pre-intervention period, discharge prescriptions were prepared by hospital doctors and then reviewed by a ward pharmacist (WP) before being dispensed. Post-intervention, prescriptions were prepared by a project pharmacist in consultation with hospital doctors and then reviewed by a WP and dispensed. Proportion of patients who were prescribed, and proportion supplied, oxycodone on discharge; Median amount (milligrams) of oxycodone prescribed and supplied, for patients who were prescribed and supplied at least one oxycodone-containing preparation, respectively. A total of 320 and 341 patients were evaluated pre- and post-intervention, respectively. Pre-intervention, 75.6% of patients were prescribed oxycodone; after WP review, 60.3% were supplied oxycodone (Psupplied was 100 milligrams/patient. Post-intervention, 68.6% of patients were prescribed oxycodone; after WP review, 57.8% were supplied oxycodone (Psupplied was 50 milligrams/patient (difference in amount prescribed and supplied: 50 milligrams, Psupplied oxycodone but not the amount supplied/patient. Having a pharmacist assist with prescribing reduced the amount of oxycodone supplied. © 2017 John Wiley & Sons Ltd.

Coordination in the Decentralized Assembly System with Dual Supply Modes

Directory of Open Access Journals (Sweden)

Xu Guan

2013-01-01

Full Text Available This paper investigates a decentralized assembly system that consists of one assembler and two independent suppliers; wherein one supplier is perfectly reliable for the production, while the other generates yield uncertainty. Facing the random market demand, the assembler has to order the components from one supplier in advance and meanwhile requires the other supplier to deliver the components under VMI mode. We construct a Nash game between the supplier and the assembler so as to derive their equilibrium procurement/production strategies. The results show that the channel’s performance is highly undermined by the decentralization between players and also the combination of two supply modes. Compared to the centralized system, we propose an advance payment contract to perfectly coordinate the supply chain performance. The numerical examples indicate some management implications on the supply mode comparison and sensitivity analysis.

Radio frequency identification applications in hospital environments.

Science.gov (United States)

Wicks, Angela M; Visich, John K; Li, Suhong

2006-01-01

Radio frequency identification (RFID) technology has recently begun to receive increased interest from practitioners and academicians. This interest is driven by mandates from major retailers such as Wal-Mart, Target and Metro Group, and the United States Department of Defense, in order to increase the efficiency and visibility of material and information flows in the supply chain. However, supply chain managers do not have a monopoly on the deployment of RFID. In this article, the authors discuss the potential benefits, the areas of applications, the implementation challenges, and the corresponding strategies of RFID in hospital environments.

Introducing DRG-based financing in Hungary: a study into the relationship between supply of hopsital beds and use of these beds under changing instituonal circumstances.

NARCIS (Netherlands)

Kroneman, M.; Nagy, J.

2001-01-01

Most hospital reforms carried out in Europe over the past few decades concern the supply of hospital beds and hospital financing systems. In Hungary, financing was not tied to hospital input or output until a Diagnosis-Related-Group system was introduced. This change provided an opportunity to study

Hospital costs of central line-associated bloodstream infections and cost-effectiveness of closed vs. open infusion containers. The case of Intensive Care Units in Italy.

Science.gov (United States)

Tarricone, Rosanna; Torbica, Aleksandra; Franzetti, Fabio; Rosenthal, Victor D

2010-05-10

The aim was to evaluate direct health care costs of central line-associated bloodstream infections (CLABSI) and to calculate the cost-effectiveness ratio of closed fully collapsible plastic intravenous infusion containers vs. open (glass) infusion containers. A two-year, prospective case-control study was undertaken in four intensive care units in an Italian teaching hospital. Patients with CLABSI (cases) and patients without CLABSI (controls) were matched for admission departments, gender, age, and average severity of illness score. Costs were estimated according to micro-costing approach. In the cost effectiveness analysis, the cost component was assessed as the difference between production costs while effectiveness was measured by CLABSI rate (number of CLABSI per 1000 central line days) associated with the two infusion containers. A total of 43 cases of CLABSI were compared with 97 matched controls. The mean age of cases and controls was 62.1 and 66.6 years, respectively (p = 0.143); 56% of the cases and 57% of the controls were females (p = 0.922). The mean length of stay of cases and controls was 17.41 and 8.55 days, respectively (p Use of innovative technologies such as closed infusion containers can significantly reduce the incidence of healthcare acquired infection without posing additional burden on hospital budgets.

Optimizing Diamond Structured Automobile Supply Chain Network Towards a Robust Business Continuity Management

Directory of Open Access Journals (Sweden)

Abednico Montshiwa

2016-02-01

Full Text Available This paper presents an optimized diamond structured automobile supply chain network towards a robust Business Continuity Management model. The model is necessitated by the nature of the automobile supply chain. Companies in tier two are centralized and numerically limited and have to supply multiple tier one companies with goods and services. The challenge with this supply chain structure is the inherent risks in the supply chain. Once supply chain disruption takes place at tier 2 level, the whole supply chain network suffers huge loses. To address this challenge, the paper replaces Risk Analysis with Risk Ranking and it introduces Supply Chain Cooperation (SCC to the traditional Business Continuity Plan (BCP concept. The paper employed three statistical analysis techniques (correlation analysis, regression analysis and Smart PLS 3.0 calculations. In this study, correlation and regression analysis results on risk rankings, SCC and Business Impact Analysis were significant, ascertaining the value of the model. The multivariate data analysis calculations demonstrated that SCC has a positive total significant effect on risk rankings and BCM while BIA has strongest positive effects on all BCP factors. Finally, sensitivity analysis demonstrated that company size plays a role in BCM.

Evaluation of disaster preparedness for mass casualty incidents in private hospitals in Central Saudi Arabia

Directory of Open Access Journals (Sweden)

Abdullah A. Bin Shalhoub

2017-03-01

Full Text Available Objectives: To identify and describe the hospital disaster preparedness (HDP in major private hospitals in Riyadh, Saudi Arabia. Methods: This is an observational cross-sectional survey study performed in Riyadh city, Saudi Arabia between December 2015 and April 2016. Thirteen major private hospitals in Riyadh with more than 100 beds capacity were included in this investigation. Results: The 13 hospitals had HDP plan and reported to have an HDP committee. In 12 (92.3% hospitals, the HDP covered both internal and external disasters and HDP was available in every department of the hospital. There were agreements with other hospitals to accept patients during disasters in 9 facilities (69.2% while 4 (30.8% did not have such agreement. None of the hospitals conducted any unannounced exercises in previous year. Conclusion: Most of the weaknesses were apparent particularly in the education, training and monitoring of the hospital staff to the preparedness for disaster emergency occasion. Few hospitals had conducted an exercise with casualties, few had drilled evacuation of staff and patients in the last 12 months, and none had any unannounced exercise in the last year.

Factors associated with financial distress of nonprofit hospitals.

Science.gov (United States)

Kim, Tae Hyun

2010-01-01

Financial distress can have a detrimental influence on the performance of hospitals. Hospital management needs to monitor potential financial distress effectively and know how it will respond depending on the severity of the circumstances. This study examined the multiple factors that may explain the financial distress of nonprofit hospitals during 1998 to 2001 and discussed their importance. To obtain more robust results, financial distress was assessed in 2 ways: first, financial strength index was used to incorporate 4 financial dimensions including profitability, liquidity, leverage, and physical facilities; second, cash flow (CF) was used to address the issues of accrual-based accounting in hospitals. This study finds that decrease in occupancy rate and increase in Medicaid payer mix, health maintenance organization penetration, market competition, physician supply, and percentage of the elderly are associated with increased likelihood of financial distress of urban hospitals. Increases in both Medicare and Medicaid payer mix, however, are related to higher likelihood of financial distress of rural hospitals.

The Cost of Supplying Segmented Consumers From a Central Facility

DEFF Research Database (Denmark)

Turkensteen, Marcel; Klose, Andreas

consider three measures of dispersion of demand points: the average distance between demand points, the maximum distance and the surface size.In our distribution model, all demand points are restocked from a central facility. The observed logistics costs are determined using the tour length estimations...... described in Daganzo (2004). Normal, continuous travel distance estimates require that demand locations are uniformly distributed across the plane, but we also consider scenarios with non-uniformly distributed demand locations. The resulting travel distances are highly correlated with our surface size...

Competition or coordination in hospital markets with unionised labour.

Science.gov (United States)

Brekke, Kurt R

2004-03-01

This paper study labour market responses to hospital mergers. The market consists of two hospitals providing horizontally and vertically differentiated services. Hospitals compete either in price and quality or just in quality (non-price competition). To provide medical care, hospitals employ health care workers (e.g., physicians, nurses). The workers collectively bargain wages either at a central level, firm level or plant level. Anticipating wage responses, hospitals decide whether or not to merge. The main finding is that the bargaining structure, the nature of competition and the patient copayment rate have a crucial impact on the profitability of hospital mergers.

Do More Hospital Beds Lead to Higher Hospitalization Rates? A Spatial Examination of Roemer’s Law

Science.gov (United States)

Delamater, Paul L.; Messina, Joseph P.; Grady, Sue C.; WinklerPrins, Vince; Shortridge, Ashton M.

2013-01-01

continued regulation of hospital bed supply to assist in controlling hospital utilization is justified. PMID:23418432

[Blood supply and demand at the Fifth District Health Centre in Bamako (Mali)].

Science.gov (United States)

Traore, Mamadou; Dumont, Alexandre; Kaya, Amadou Balobo; Traore, Soumana Oumar; Traore, Oumar Moussokoro; Dolo, Amadou

2011-01-01

An adequate uncontaminated blood supply is an essential element of an effective health care system. A regional blood transfusion policy was defined in 2004 by the Direction of Health in Bamako, Mali. The objective of this study is to analyse the coverage of transfusion needs at the Fifth District health Center in Bamako after the implementation of this policy. This prospective study, conducted from December 2006 through May 2007, included 134 patients for whom transfusion orders were recorded in the laboratory. The coverage rate of transfusion needs was estimated by dividing the number of units transfused by the number of units that health professionals requested. The blood supply was regular (46 units per month, on average) and consistent with demand (59 units per month on average). Overall, 75% of the transfusions were required for obstetric complications. All patients received at least one 450-mL unit of whole blood. The coverage of transfusion needs has reached 65% of the total number of units required (95% CI = 60-70%). The implementation of a functioning system of blood transfusion is complex. In Bamako, a system based on a centralized transfusion center met a high proportion of the needs in a reference hospital where demand was high while ensuring a high level of patient safety. Further studies are needed to guide the implementation of feasible and sustainable strategies for providing sufficient quantities of safe blood in other contexts and to assess the impact of these different strategies on global health, and on maternal health in particular.

The diffusion of Magnet hospital recognition.

Science.gov (United States)

Abraham, Jean; Jerome-D'Emilia, Bonnie; Begun, James W

2011-01-01

Magnet recognition is promoted by many in the practice community as the gold standard of nursing care quality. The Magnet hospital population has exploded in recent years, with about 8% of U.S. general hospitals now recognized. The purpose of this study was to identify the characteristics that distinguish Magnet-recognized hospitals from other hospitals within the framework of diffusion theory. We conceptualize Magnet recognition as an organizational innovation and Magnet-recognized hospitals as adopters of the innovation. We hypothesize that adoption is associated with selected characteristics of hospitals and their markets. The study population consists of the 3,657 general hospitals in the United States in 2008 located in metropolitan or micropolitan areas. We used logistic regression analysis to estimate the association of Magnet recognition with organizational and market characteristics. Empirical results support hypotheses that adoption is positively associated with hospital complexity and specialization, as measured by teaching affiliation, and with hospital size, slack resources, and not-for-profit or public ownership (vs. for-profit). Adopters also are more likely to be located in markets that are experiencing population growth and are more likely to have competitor hospitals within the market that also have adopted Magnet status. A positive association of adoption with baccalaureate nursing school supply is contrary to the hypothesized relationship. Because of its rapid recent growth, consideration of Magnet program recognition should be on the strategic planning agenda of hospitals and hospital systems. Hospital administrators, particularly in smaller, for-profit hospitals, may expect more of their larger not-for-profit competitors, particularly teaching hospitals, to adopt Magnet recognition, increasing competition for baccalaureate-prepared registered nurses in the labor market.

Integral evaluation of energy supply systems at mountain refuges

Energy Technology Data Exchange (ETDEWEB)

Aschauer, C. [Univ. of Natural Resources and Applied Life Sciences, Vienna (Austria). Inst. for Chemical and Energy Engineering; Steinbacher, G. [Steinbacher and Steinbacher Civil Engineering Inc. (Austria); Weber, P. [DAV-Deutscher Alpenverein e.V. (Germany). Bundesgeschaeftsstelle; Deubler, Hubert

2010-07-01

Most of the mountain refuges scattered over the Alps (more than 1500) are not connected to public infrastructure, requiring decentralized supply and disposal and are therefore called island systems. The increasing number of guests goes along with a higher demand for comport and thus puts pressure on available resources. There are numerous challenges like remoteness, transport, low temperatures, seasonal operation and climate change to be faced. Furthermore, the supply and disposal system of an alpine hut has to merge different interests of the alpine associations, refuge operators, legal authorities and the alpine tourists. Therefore the respective infracstructure has to be managed as an overall-self-contained system. Energy supply is the central issue showing complex interaction with water supply, wastewater treatment and waste disposal. Many problems according to planning, decision-making, construction and operation concerning alpine infrastructure are reported. However detailed information on experiences made in these fields is missing at an international level so far. To correct this lack of data, the German Alpine Association (DAV) initiated the project ''Integral Evaluation of Supply and Disposal Systems of Mountain Refuges, IEVEBS'' in 2006, inviting all stakeholders (Alpine Associations, Legal Authorities, Planners, and Researchers) to participate. Additionally to the final project report which contains a detailed description and evaluation of the supply systems, guidelines will be elaborated in 2010 for planning, implementation and operation, all applicable at an international level. (orig.)

Patient satisfaction regarding eye care services at tertiary hospital of central India

Directory of Open Access Journals (Sweden)

Anand Sudhan

2011-01-01

Study Design : Descriptive study. Materials and Methods : This study was conducted between September 2005 and June 2006. Patients attending the eye clinic of Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India, and admitted as in-patients in this hospital were our study population. Randomly selected patients were interviewed by trained staff. Close-ended questionnaire was used to conduct these structured interviews. Their responses were grouped into one of five categories and evaluated to determine satisfaction for different components of eye care services. Results : Three hundred and twenty persons were interviewed. The satisfaction was of excellent grade among 77 (48.1% patients attending clinic and 156 (97.5% patients who were admitted in the hospital. The participants expressed dissatisfaction for the long waiting period in clinics, poor cleanliness, and insufficient toilet facilities. Those admitted in the hospital felt that food facilities were less than the expected quality. Child-friendly facilities received high satisfaction scores. Conclusion : Although eye care services both in clinics and in the wards were satisfactory according to the end-users, there are scopes for improvement. Patient satisfaction surveys should be encouraged in hospitals for better accountability and also for strengthening the quality of eye care services.

Awareness and Knowledge of Glaucoma in Central India: A Hospital-Based Study.

Science.gov (United States)

Maharana, Prafulla K; Rai, Vaishali G; Pattebahadur, Rajesh; Singhi, Shipra; Chauhan, Ashish K

2017-01-01

To assess the awareness and knowledge of glaucoma among people attending the ophthalmology outpatient department at a tertiary care hospital in central India. A prospective observational study. A questionnaire-based study was conducted, involving persons aged 18 and above attending the ophthalmology outpatient department from October 2014 to September 2015. Data on awareness and knowledge of glaucoma was collected through a face-to-face interview. Fourteen hundred people participated in the study. The mean age of participants was 43 ± 15 years (range, 18-85). The study participants included 53% men and 47% women. Only 27% (n = 380/1400) of the participants were aware of glaucoma. Age, sex, and presence or type of refractive error had no impact on glaucoma awareness. Awareness level was greater in individuals with higher education levels and those belonging to an upper socioeconomic class (SEC). Multiple logistic regression analysis revealed significantly higher levels of glaucoma awareness among participants belonging to the upper 2 SECs (P = 0.05) and those educated above the high school level (P = 0.001). The most common source of awareness was close acquaintance with relatives, famly members, and friends of glaucoma patients. Awareness of glaucoma in India is low. Lack of education and lower socioeconomic status are the major risk factors for late preentation of glaucoma. Continuous presence of a low level of awareness and the same factors accounting for it warrants the need for an aggressive and refined approach to increase awareness of glaucoma to prevent glaucoma-related blindness. Copyright 2017 Asia-Pacific Academy of Ophthalmology.

Reengineering knowledge for e-tourism and hospitality curricula

Directory of Open Access Journals (Sweden)

Jing Fu

2016-12-01

Full Text Available E-tourism and hospitality represents the development of tourism and hospitality to integrate ICT tools and has significantly changed the industry over the last decade. In order to meet the new needs, knowledge service suppliers (i.e. the university must meet the requirements and social developments of the tourism industry. The quality of e-tourism and hospitality curriculum depends largely on the education quality and its subsequent implementation. The research reveals that higher education is not currently meeting the needs of the industry, especially in the Greater Mekong Sub-region countries. This article focuses on two major problems, which represent a disparity between the knowledge needs of the tourism and hospitality industry and the knowledge provided by curricula in higher education. The authors leverage a knowledge engineering perspective so as to bridge the gap between knowledge demand and supply as related to e-tourism and hospitality curriculum design.

Molecular epidemiology of Acinetobacter baumannii in central intensive care unit in Kosova teaching hospital

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Lul Raka

Full Text Available Infections caused by bacteria of genus Acinetobacter pose a significant health care challenge worldwide. Information on molecular epidemiological investigation of outbreaks caused by Acinetobacter species in Kosova is lacking. The present investigation was carried out to enlight molecular epidemiology of Acinetobacterbaumannii in the Central Intensive Care Unit (CICU of a University hospital in Kosova using pulse field gel electrophoresis (PFGE. During March - July 2006, A. baumannii was isolated from 30 patients, of whom 22 were infected and 8 were colonised. Twenty patients had ventilator-associated pneumonia, one patient had meningitis, and two had coinfection with bloodstream infection and surgical site infection. The most common diagnoses upon admission to the ICU were politrauma and cerebral hemorrhage. Bacterial isolates were most frequently recovered from endotracheal aspirate (86.7%. First isolation occurred, on average, on day 8 following admission (range 1-26 days. Genotype analysis of A. baumannii isolates identified nine distinct PFGE patterns, with predominance of PFGE clone E represented by isolates from 9 patients. Eight strains were resistant to carbapenems. The genetic relatedness of Acinetobacter baumannii was high, indicating cross-transmission within the ICU setting. These results emphasize the need for measures to prevent nosocomial transmission of A. baumannii in ICU.

Price and Service Competition of Dual-Channel Supply Chain with Consumer Returns

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Lili Ren

2014-01-01

Full Text Available Products returned by consumers are common in the retail industry and result in additional costs to both the manufacturer and the retailer. This paper proposes dual-channel supply chain models involving consumer returns policies. Also, the price and service competition between retail channel and direct channel is considered in the models. According to the models, we analyze the optimal decisions in both centralized and decentralized scenarios. Then we design a new contract, coordinate the dual-channel supply chain, and enable both the retailer and the manufacturer to be a win-win.

ON REASONABLE ESTIMATE OF ENERGY PERFORMANCE OF THE RESIDENTIAL BUILDINGS SUSTENANCE WITH CENTRALIZED HEAT-SUPPLY SYSTEM

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S. N. Osipov

2016-01-01

Full Text Available As consisted with Directive No 3 of President of the Republic of Belarus of June, 14th 2007 ‘Economy and Husbandry – the Major Factors of Economic Security of the Republic of Belarus’, saving fuel-and-energy resources over the republic in 2010–2015 should amount to 7,1–8,9 MIO tons of fuel equivalent including 1,00–1,25 MIO tons of fuel equivalent at the expense of heat-supply optimization and 0,25–0,40 MIO tons of fuel equivalent at the expense of increasing enclosing structures heat resistance of the buildings, facilities and housing stock. It means, where it is expected to obtain around 18 % of general thermal resources economy in the process of heat-supply optimization, then by means of enhancing the cladding structure heat resistance of the buildings and constructions of various applications – only about 3–5 % and even a bit less so of the housing stock. Till 1994, in residential sector of the Republic of Belarus, the annual heat consumption of the heating and ventilation averaged more than 130 kW×h/(m2×year (~56 %, of the hot-water supply – around 100 kW×h/(m2×year (~44 %. In residential houses, built from 1994 to 2009, heat consumption of the heating and ventilation is already 90 kW×h/(m2×year, of the hot-water supply – around 70 kW×h/(m2×year. In buildings of modern mainstream construction, they expend 60 kW×h/(m2×year (~46 % on heating and ventilation and 70 kW×h/(m2×year (~54 % on hot-water supply. In some modern residential buildings with the exhausted warm air secondary energy resource utilization, the heating and ventilation takes around 30–40 kW×h/(m2×year of heat. Raising energy performance of the residential buildings by means of reducing heat expenses on the heating and ventilation is the last segment in the system of energy resources saving. The first segments in the energy performance process are producing heat and transporting it over the main lines and outside distribution networks. In

The Blood Stocks Management Scheme, a partnership venture between the National Blood Service of England and North Wales and participating hospitals for maximizing blood supply chain management.

Science.gov (United States)

Chapman, J F; Cook, R

2002-10-01

The Blood Stocks Management Scheme (BSMS) has been established as a joint venture between the National Blood Service (NBS) in England and North Wales and participating hospitals to monitor the blood supply chain. Stock and wastage data are submitted to a web-based data-management system, facilitating continuous and complete red cell data collection and 'real time' data extraction. The data-management system enables peer review of performance in respect of stock holding levels and red cell wastage. The BSMS has developed an innovative web-based data-management system that enables data collection and benchmarking of practice, which should drive changes in stock management practice, therefore optimizing the use of donated blood.

Upgrade of DC power supply system in ITER CS model coil test facility

International Nuclear Information System (INIS)

Shimono, Mitsugu; Uno, Yasuhiro; Yamazaki, Keita; Kawano, Katsumi; Isono, Takaaki

2014-03-01

Objective of the ITER CS Model Coil Test Facility is to evaluate a large scale superconducting conductor for fusion using the Central Solenoid (CS) Model Coil, which can generate a 13T magnetic field in the inner bore with a 1.5 m diameter. The facility is composed of a helium refrigerator / liquefier system, a DC power supply system, a vacuum system and a data acquisition system. The DC power supply system supplies currents to two superconducting coils, the CS Model Coil and an insert coil. A 50-kA DC power supply is installed for the CS Model Coil and two 30 kA DC power supplies are installed for an insert coil. In order to evaluate superconducting performance of a conductor used for ITER Toroidal Field (TF) coils whose operating current is 68 kA, the line for an insert coil is upgraded. A 10 kA DC power supply was added, DC circuit breakers were upgraded, bus bars and current measuring instrument were replaced. In accordance to the upgrade, operation manual was revised. (author)

[Importance of material logistics in the interface management of operation departments: is the supply of sterile equipment a new business area of operation room organization?].

Science.gov (United States)

Schmeck, J; Schmeck, S B; Kohnen, W; Werner, C; Schäfer, M; Gervais, H

2008-08-01

The implementation of diagnosis-related groups (DRGs) sharply increased economic pressure on hospitals. Hence, process optimization was focussed on cost-intensive areas, namely the operation room (OR) departments. Work-flow in the OR is characterized by a mandatory interlocking of the job functions of many different occupational groups and the availability of a variety of different materials. Alternatives for staff assignment optimization have been published in numerous publications dealing with the importance of OR management. In this connection the issue of material logistics in the context of OR management has not been frequently addressed. In order to perform a surgical procedure according to plan, one depends on personnel and on timely availability of the materials needed. Supply of sterilized materials is of utmost importance, because in most hospitals sterilized surgical devices constitute a critical resource. In order to coordinate the OR process with the production flow of sterilized materials, an organizational connection to the OR management makes sense. Hence, in a German university hospital the Department of Hospital Sterile Supplies was integrated into the OR management of the Department of Anesthesiology. This led to a close coordination of work-flow processes, and concomitantly a significant reduction of production costs of sterile supplies could be achieved by direct interaction with the OR. Thus, hospital sterile supplies can reasonably be integrated into an OR management representing a new interesting business area for OR organization.

Risk of central nervous system defects in offspring of women with and without mental illness.

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Ayoub, Aimina; Fraser, William D; Low, Nancy; Arbour, Laura; Healy-Profitós, Jessica; Auger, Nathalie

2018-02-22

We sought to determine the relationship between maternal mental illness and the risk of having an infant with a central nervous system defect. We analyzed a cohort of 654,882 women aged less than 20 years between 1989 and 2013 who later delivered a live born infant in any hospital in Quebec, Canada. The primary exposure was mental illness during pregnancy or hospitalization for mental illness before pregnancy. The outcomes were neural and non-neural tube defects of the central nervous system in any offspring. We computed risk ratios (RR) and 95% confidence intervals (CI) for the association between mental disorders and risk of central nervous system defects in log-binomial regression models adjusted for age at delivery, total parity, comorbidity, socioeconomic deprivation, place of residence, and time period. Maternal mental illness was associated with an increased risk of nervous system defects in offspring (RR 1.76, 95% CI 1.64-1.89). Hospitalization for any mental disorder was more strongly associated with non-neural tube (RR 1.84, 95% CI 1.71-1.99) than neural tube defects (RR 1.31, 95% CI 1.08-1.59). Women at greater risk of nervous system defects in offspring tended to be diagnosed with multiple mental disorders, have more than one hospitalization for mental disease, or be 17 or older at first hospitalization. A history of mental illness is associated with central nervous system defects in offspring. Women hospitalized for mental illness may merit counseling at first symptoms to prevent central nervous system defects at pregnancy.

Implementation of the WHO multimodal Hand Hygiene Improvement Strategy in a University Hospital in Central Ethiopia

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Frieder Pfäfflin

2017-01-01

Full Text Available Abstract Background The burden of health-care associated infections in low-income countries is high. Adequate hand hygiene is considered the most effective measure to reduce the transmission of nosocomial pathogens. We aimed to assess compliance with hand hygiene and perception and knowledge about hand hygiene before and after the implementation of a multimodal hand hygiene campaign designed by the World Health Organization. Methods The study was carried out at Asella Teaching Hospital, a university hospital and referral centre for a population of about 3.5 million in Arsi Zone, Central Ethiopia. Compliance with hand hygiene during routine patient care was measured by direct observation before and starting from six weeks after the intervention, which consisted of a four day workshop accompanied by training sessions and the provision of locally produced alcohol-based handrub and posters emphasizing the importance of hand hygiene. A second follow up was conducted three months after handing over project responsibility to the Ethiopian partners. Health-care workers’ perception and knowledge about hand hygiene were assessed before and after the intervention. Results At baseline, first, and second follow up we observed a total of 2888, 2865, and 2244 hand hygiene opportunities, respectively. Compliance with hand hygiene was 1.4% at baseline and increased to 11.7% and 13.1% in the first and second follow up, respectively (p < 0.001. The increase in compliance with hand hygiene was consistent across professional categories and all participating wards and was independently associated with the intervention (adjusted odds ratio, 9.18; 95% confidence interval 6.61-12.76; p < 0.001. After the training, locally produced alcohol-based handrub was used in 98.4% of all hand hygiene actions. The median hand hygiene knowledge score overall was 13 (interquartile range 11–15 at baseline and increased to 17 (15–18 after training (p < 0.001. Health

Managing Food Quality Risk in Global Supply Chain: A Risk Management Framework

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Pablo Jose Arevalo Chavez

2012-04-01

Full Text Available Today, the food sector is one of the sectors most vulnerable to intentional contamination by debilitating agents [1]. Some cases of contaminated food have indicated that product quality risk is one of the vulnerabilities in the global supply chain. A series of company scandals, affecting reputation and causing the recall of products and increasing costs have hit the food industry. The obvious problem is that even a minor incident in one part of the chain can have disastrous effects on other parts of the supply chain. Thus, risks are transmitted through the chain. Even though the dangers from members in the supply chain are small, the cumulative effect becomes significant. The aim of this study is to propose an integrated supply chain risk management framework for practitioners that can provide directions for how to evaluate food quality risk in the global supply chain. For validating the proposed model in‐depth, a case study is conducted on a food SME distributor in Central America. The case study investigates how product quality risks are handled according to the proposed framework.

77 FR 27869 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Science.gov (United States)

2012-05-11

... Considered HAC Candidate: Iatrogenic Pneumothorax With Venous Catheterization 3. Present on Admission (POA.... History of Measures Adopted for the Hospital IQR Program b. Maintenance of Technical Specifications for...-Associated Infection (HAI) Measures (A) Proposed Central Line Associated Blood Stream Infections ((CLABSI...

Efficiency and productivity of hospitals in Vietnam.

Science.gov (United States)

Pham, Thuy Linh

2011-01-01

The purpose of this paper is to examine the relative efficiency and productivity of hospitals during the health reform process. Data envelopment analyses method (DEA) with the input-oriented variable-returns-to-scale model was used to calculate efficiency scores. Malmquist total factor productivity index approach was then employed to calculate productivity of hospitals. Data of 101 hospitals was extracted from databases of the Ministry of Health, Vietnam from the years 1998 to 2006. There was evidence of improvement in overall technical efficiency from 65 per cent in 1998 to 76 per cent in 2006. Hospitals' productivity progressed around 1.4 per cent per year, which was mainly due to the technical efficiency improvement. Furthermore, provincial hospitals were more technically efficient than their central counterparts and hospitals located in different regions performed differently. The paper provides an insight in the performance of Vietnamese public hospitals that has been rarely examined before and contributes to the existing literature of hospital performance in developing countries

Supply prospects and network integration in the European natural gas sector

International Nuclear Information System (INIS)

Bergmann, B.

1998-01-01

At least for the next 10-15 years, natural gas will be the fastest growing energy form in Europe, with a higher rate of growth in consumption (from a lower base) in central Europe than in western Europe. Although most of the prospective demand until 2010 is covered by signed import contracts and indigenous production, important additional gas supply capacity still has to be developed out of a plenitude of reserves within and (in the long run primarily) outside western and central Europe. The real problem is how to mobilise the reserves economically and direct them towards the European market, in competition with other markets. Europe has a sophisticated transmission system whose development has gone hand-in-hand with long-term import agreements. Among the missing links is the Interconnector, which, at the end of 1998, is due to integrate the UK and Ireland into mainland Europe. This is expected to enhance security of supply in both areas, to balance prices and maybe also to foster ideas of liberalisation. Overall, the European gas industry is in an excellent position to develop the supply of gas in an environmentally benign way. The future belongs all the more to natural gas, the fewer the mistakes that are made when it comes to matters of legal frameworks and taxation

Costing the supply chain for delivery of ACT and RDTs in the public sector in Benin and Kenya.

Science.gov (United States)

Shretta, Rima; Johnson, Brittany; Smith, Lisa; Doumbia, Seydou; de Savigny, Don; Anupindi, Ravi; Yadav, Prashant

2015-02-05

Studies have shown that supply chain costs are a significant proportion of total programme costs. Nevertheless, the costs of delivering specific products are poorly understood and ballpark estimates are often used to inadequately plan for the budgetary implications of supply chain expenses. The purpose of this research was to estimate the country level costs of the public sector supply chain for artemisinin-based combination therapy (ACT) and rapid diagnostic tests (RDTs) from the central to the peripheral levels in Benin and Kenya. A micro-costing approach was used and primary data on the various cost components of the supply chain was collected at the central, intermediate, and facility levels between September and November 2013. Information sources included central warehouse databases, health facility records, transport schedules, and expenditure reports. Data from document reviews and semi-structured interviews were used to identify cost inputs and estimate actual costs. Sampling was purposive to isolate key variables of interest. Survey guides were developed and administered electronically. Data were extracted into Microsoft Excel, and the supply chain cost per unit of ACT and RDT distributed by function and level of system was calculated. In Benin, supply chain costs added USD 0.2011 to the initial acquisition cost of ACT and USD 0.3375 to RDTs (normalized to USD 1). In Kenya, they added USD 0.2443 to the acquisition cost of ACT and USD 0.1895 to RDTs (normalized to USD 1). Total supply chain costs accounted for more than 30% of the initial acquisition cost of the products in some cases and these costs were highly sensitive to product volumes. The major cost drivers were found to be labour, transport, and utilities with health facilities carrying the majority of the cost per unit of product. Accurate cost estimates are needed to ensure adequate resources are available for supply chain activities. Product volumes should be considered when costing supply chain

Private patients in NHS hospitals: comparison of two sources of information.

Science.gov (United States)

Williams, B T; Pearson, J

1999-03-01

The use of National Health Service (NHS) hospitals to treat private patients is debatable on the grounds of equity of access. Hospital Episodes Statistics (HES) annual reports are the only routine source of information on the scale of this activity. The accuracy of the information is doubted. This enquiry tested the completeness of HES data against information obtained directly from private patient unit managers. Managers of the 71 pay bed units in NHS hospitals in England were asked to supply from local registers and accounts the numbers of in-patients and day cases admitted in 1995-1996. Their reports were matched with the numbers of first consultant episodes for private in-patients and day cases shown for those hospitals in the HES data file for that year. Of the 71 units 62 responded; 53 of these gave usable data. The 53 included, and 18 excluded from the comparison, matched on median and range of bed numbers. Managers identified 16 per cent more total admissions than did HES, 62,572 against 54,131; 13 per cent more in-patient admissions, 39,776 against 35,319; and 21 per cent more day cases, 22,796 against 18,812. More total admissions were reported by managers of 38 pay bed units than were recorded in HES, fewer by 12, and equal numbers by three. Similar sized discrepancies were noted for in-patient admissions and day cases. Reasons for the under-reporting of private patients in HES included the use of separate patient administration systems for private patients with a failure to feed data to HES, and the omission of some provider units altogether by a minority of trusts from the returns made to the Department of Health. Overall, HES underestimates the amount of private patient activity reported directly by NHS hospitals. No method of validating private patient data is currently available. An amendment to an existing statistical return would provide a check on numbers. Central guidance on the inclusion of private patient activity in data transmitted by

Decision-Making for Supply Chain Integration Supply Chain Integration

CERN Document Server

Lettice, Fiona; Durowoju, Olatunde

2012-01-01

Effective supply chain integration, and the tight co-ordination it creates, is an essential pre-requisite for successful supply chain management.  Decision-Making for Supply Chain Integration is a practical reference on recent research in the area of supply chain integration focusing on distributed decision-making problems. Recent applications of various decision-making tools for integrating supply chains are covered including chapters focusing on: •Supplier selection, pricing strategy and inventory decisions in multi-level supply chains, •RFID-enabled distributed decision-making, •Operational risk issues and time-critical decision-making for sensitive logistics nodes, Modelling end to end processes to improve supply chain integration, and •Integrated systems to improve service delivery and optimize resource use. Decision-Making for Supply Chain Integration provides an insight into the tools and methodologies of this field with support from real-life case studies demonstrating successful application ...

Central corneal thickness among glaucoma patients attending ...

African Journals Online (AJOL)

AAU_CHS

ocular pressure measurement and is different among different ethnic population and subtypes of glaucoma. The central corneal thickness of different subtypes of glaucoma at Menelik II Hospital ... Intraocular pressure is a key element in the.

Psychometric properties of the Hospital Survey on Patient Safety Culture for hospital management (HSOPS_M

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Pfeiffer Yvonne

2011-07-01

Full Text Available Abstract Background From a management perspective, it is necessary to examine how a hospital's top management assess the patient safety culture in their organisation. This study examines whether the Hospital Survey on Patient Safety Culture for hospital management (HSOPS_M has the same psychometric properties as the HSOPS for hospital employees does. Methods In 2008, a questionnaire survey including the HSOPS_M was conducted with 1,224 medical directors from German hospitals. When assessing the psychometric properties, we performed a confirmatory factor analysis (CFA. Additionally, we proved construct validity and internal consistency. Results A total of 551 medical directors returned the questionnaire. The results of the CFA suggested a satisfactory global data fit. The indices of local fit indicated a good, but not satisfactory convergent validity. Analyses of construct validity indicated that not all safety culture dimensions were readily distinguishable. However, Cronbach's alpha indicated that the dimensions had an acceptable level of reliability. Conclusion The analyses of the psychometric properties of the HSOPS_M resulted in reasonably good levels of property values. Although the set of dimensions within the HSOPS_M needs further scale refinement, the questionnaire covers a broad range of sub-dimensions and supplies important information on safety culture. The HSOPS_M, therefore, is eligible to measure safety culture from the hospital management's points of view and could be used in nationwide hospital surveys to make inter-organisational comparisons.

[Study on medical service supply public-private partnership mode: based on the view of public economics].

Science.gov (United States)

Dai, Yue; Sun, Hong; Zhou, Li

2015-02-01

Due to the quasi-public attributes of medical service, the supply mode and system could influence equity and fairness of general people's health. Based on the view of public economics, the purpose of this paper was to explain the economic nature of medical service supply. By analyzing the practice of public-private partnership (PPP) mode in medical care supply and the related public economic issues, we summarized the feasibility and risks of PPP model in Chinese medical care supply market. Finally, we discussed the innovative medical service system provided by government, public hospitals, and social capitals together. Therefore, to guarantee further development of this new medical service supply--PPP mode, we should pay attention to some practical problems, such as the share of cooperation cost and the balance between the benefit and risk among all partners.

Open loop control of filament heating power supply for large volume plasma device

Energy Technology Data Exchange (ETDEWEB)

Sugandhi, R., E-mail: ritesh@ipr.res.in [Institute for Plasma Research, Gandhinagar, Gujarat 382428 (India); Homi Bhabha National Institute, Mumbai 400094 (India); Srivastava, P.K.; Sanyasi, A.K. [Homi Bhabha National Institute, Mumbai 400094 (India); Srivastav, Prabhakar [Institute for Plasma Research, Gandhinagar, Gujarat 382428 (India); Homi Bhabha National Institute, Mumbai 400094 (India); Awasthi, L.M., E-mail: kushagra.lalit@gmail.com [Institute for Plasma Research, Gandhinagar, Gujarat 382428 (India); Homi Bhabha National Institute, Mumbai 400094 (India); Mattoo, S.K. [Homi Bhabha National Institute, Mumbai 400094 (India)

2017-02-15

A power supply (20 V, 10 kA) for powering the filamentary cathode has been procured, interfaced and integrated with the centralized control system of Large Volume Plasma Device (LVPD). Software interface has been developed on the standard Modbus RTU communication protocol. It facilitates the dashboard for configuration, on line status monitoring, alarm management, data acquisition, synchronization and controls. It has been tested for stable operation of the power supply for the operational capabilities. The paper highlights the motivation, interface description, implementation and results obtained.

Open loop control of filament heating power supply for large volume plasma device

International Nuclear Information System (INIS)

Sugandhi, R.; Srivastava, P.K.; Sanyasi, A.K.; Srivastav, Prabhakar; Awasthi, L.M.; Mattoo, S.K.

2017-01-01

A power supply (20 V, 10 kA) for powering the filamentary cathode has been procured, interfaced and integrated with the centralized control system of Large Volume Plasma Device (LVPD). Software interface has been developed on the standard Modbus RTU communication protocol. It facilitates the dashboard for configuration, on line status monitoring, alarm management, data acquisition, synchronization and controls. It has been tested for stable operation of the power supply for the operational capabilities. The paper highlights the motivation, interface description, implementation and results obtained.

Recycling Pricing and Coordination of WEEE Dual-Channel Closed-Loop Supply Chain Considering Consumers' Bargaining.

Science.gov (United States)

Zhu, Xiaodong; Wang, Jing; Tang, Juan

2017-12-15

Environmentally friendly handling and efficient recycling of waste electrical on Waste Electrical and Electronic Equipment (WEEE) have grown to be a global social problem. As holders of WEEE, consumers have a significant effect on the recycling process. A consideration of and attention to the influence of consumer behavior in the recycling process can help achieve more effective recycling of WEEE. In this paper, we built a dual-channel closed-loop supply chain model composed of manufacturers, retailers, and network recycling platforms. Based on the influence of customer bargaining behavior, we studied several different scenarios of centralized decision-making, decentralized decision-making, and contract coordination, using the Stackelberg game theory. The results show that retailers and network recycling platforms will reduce the direct recovery prices to maintain their own profit when considering the impact of consumer bargaining behavior, while remanufacturers will improve the transfer payment price for surrendering part of the profit under revenue and the expense sharing contract. Using this contract, we can achieve supply chain coordination and eliminate the effect of consumer bargaining behavior on supply chain performance. It can be viewed from the parameter sensitivity analysis that when we select the appropriate sharing coefficient, the closed-loop supply chain can achieve the same system performance under a centralized decision.

Recycling Pricing and Coordination of WEEE Dual-Channel Closed-Loop Supply Chain Considering Consumers’ Bargaining

Directory of Open Access Journals (Sweden)

Xiaodong Zhu

2017-12-01

Full Text Available Environmentally friendly handling and efficient recycling of waste electrical on Waste Electrical and Electronic Equipment (WEEE have grown to be a global social problem. As holders of WEEE, consumers have a significant effect on the recycling process. A consideration of and attention to the influence of consumer behavior in the recycling process can help achieve more effective recycling of WEEE. In this paper, we built a dual-channel closed-loop supply chain model composed of manufacturers, retailers, and network recycling platforms. Based on the influence of customer bargaining behavior, we studied several different scenarios of centralized decision-making, decentralized decision-making, and contract coordination, using the Stackelberg game theory. The results show that retailers and network recycling platforms will reduce the direct recovery prices to maintain their own profit when considering the impact of consumer bargaining behavior, while remanufacturers will improve the transfer payment price for surrendering part of the profit under revenue and the expense sharing contract. Using this contract, we can achieve supply chain coordination and eliminate the effect of consumer bargaining behavior on supply chain performance. It can be viewed from the parameter sensitivity analysis that when we select the appropriate sharing coefficient, the closed-loop supply chain can achieve the same system performance under a centralized decision.

Recycling Pricing and Coordination of WEEE Dual-Channel Closed-Loop Supply Chain Considering Consumers’ Bargaining

Science.gov (United States)

Zhu, Xiaodong; Wang, Jing; Tang, Juan

2017-01-01

Environmentally friendly handling and efficient recycling of waste electrical on Waste Electrical and Electronic Equipment (WEEE) have grown to be a global social problem. As holders of WEEE, consumers have a significant effect on the recycling process. A consideration of and attention to the influence of consumer behavior in the recycling process can help achieve more effective recycling of WEEE. In this paper, we built a dual-channel closed-loop supply chain model composed of manufacturers, retailers, and network recycling platforms. Based on the influence of customer bargaining behavior, we studied several different scenarios of centralized decision-making, decentralized decision-making, and contract coordination, using the Stackelberg game theory. The results show that retailers and network recycling platforms will reduce the direct recovery prices to maintain their own profit when considering the impact of consumer bargaining behavior, while remanufacturers will improve the transfer payment price for surrendering part of the profit under revenue and the expense sharing contract. Using this contract, we can achieve supply chain coordination and eliminate the effect of consumer bargaining behavior on supply chain performance. It can be viewed from the parameter sensitivity analysis that when we select the appropriate sharing coefficient, the closed-loop supply chain can achieve the same system performance under a centralized decision. PMID:29244778

The energy situation in five Central American countries

Energy Technology Data Exchange (ETDEWEB)

Trocki, L.; Booth, S.R.; Umana Q, A.

1987-06-01

This study describes the energy resources and the changes that have taken place in energy supply and demand in five Central American countries between 1970 and 1984. Economic changes are also reviewed because they influence and are affected by changes in the energy sector. The work was performed under the auspices of the US Agency for International Development. The Central American countries of Costa Rica, El Salvador, Guatemala, Honduras, and Panama are highly dependent on fuel wood as a source of energy, particularly in the residential sector. They also rely upon imported oil products to supply a growing modern sector. Most countries have significant hydroelectric and geothermal resources, and most countries produce a large portion of their electricity from hydroelectric projects. Demand for electricity has grown rapidly. Relative shares of primary versus secondary energy in the five countries vary significantly and strongly correlate with average per capita income. Consumption of secondary energy has declined during the recent economic recession suffered by the region.

Modular organization and hospital performance.

Science.gov (United States)

Kuntz, Ludwig; Vera, Antonio

2007-02-01

The concept of modularization represents a modern form of organization, which contains the vertical disaggregation of the firm and the use of market mechanisms within hierarchies. The objective of this paper is to examine whether the use of modular structures has a positive effect on hospital performance. The empirical section makes use of multiple regression analyses and leads to the main result that modularization does not have a positive effect on hospital performance. However, the analysis also finds out positive efficiency effects of two central ideas of modularization, namely process orientation and internal market mechanisms.

International overview of hospital procurement.

Science.gov (United States)

Ferrier, Maud; Lariviere, David; Laurent, Claire; Roque, Eric

2011-01-01

This article was written by four French hospital director students at the Ecole des Hautes Etudes en Santé Publique (EHESP-School of Public Health) from a study conducted jointly with students at the Grenoble School of Management to present an international overview of hospital procurement methods in ten countries. An analysis of these methods showed that there was a general trend towards group purchasing, with some common aims in terms of costs and performance and some differences in legislation (competition), size of the public sector and centralization or decentralization.

Reducing replacement donors in Sub-Saharan Africa: challenges and affordability.

Science.gov (United States)

Bates, I; Manyasi, G; Medina Lara, A

2007-12-01

In 1975, the World Health Assembly recommended that blood for transfusion should come from voluntary, non-remunerated donors; yet, in Africa, 75-80% of blood for transfusion still comes from hospital-based replacement donors. Although comprehensive economic data are scarce, evidence indicates that blood from voluntary donors recruited and screened at centralized transfusion centres, costs four to eight times as much as blood from a hospital-based, replacement donor system. Donor recruitment, quality assurance systems and distribution mechanisms in the centralized system are major reasons for the cost difference. There are concerns about the sustainability of centralized voluntary donor systems and their compatibility with the levels of health care that exist in many poor countries yet burdening patients' families with the responsibility of finding replacement blood donors will exacerbate poverty and reduce the safety of the blood supply. There are measures that can be introduced into hospital-based systems to improve safe blood supply in Africa but their effectiveness in different contexts needs to be evaluated.

The Perceptual Differences among Stakeholders in the Tourism Supply of Xi’an City, China

Directory of Open Access Journals (Sweden)

Junsheng Liu

2017-02-01

Full Text Available The stakeholders’ perceptual evaluations of the supply structure of destination tourism play an important role in promoting the sustainable development of regional tourism. However, the research on the structural perceptions of destination tourism supply is relatively insufficient in current research on the perceptions of tourism stakeholders. This paper analyzes the perceptual differences among inbound tourists, community residents and tourism practitioners from the core and auxiliary tourism supply dimensions. After having applied the structural equation model in this paper, the advantages and disadvantages of the tourism supply of Xi’an, a famous tourist city in China, were identified. In addition, the findings of this paper are: the inbound tourists have high perceptual sensitivity over the factors of the urban core tourism supply; the community residents have high perceptual sensitivity over the auxiliary tourist supply factors; the tourism practitioners have similar perceptual sensitivity over the factors of urban core and auxiliary tourism supply. The advantageous factors involve tourist attractions, tourist shopping, tourist entertainment, hospitality environment and tourist information. Furthermore, the moderately stable supply factors of Xi’an include tourist transportation, tourist catering, tourist accommodation, marketing as well as safety and security, while the natural environment is the limiting factor. The results support sustainable development and the coordination of different stakeholders in the destinations.

Enterprise resource planning for hospitals

NARCIS (Netherlands)

van Merode, Godefridus G.; Groothuis, Siebren; Hasman, Arie

2004-01-01

Integrated hospitals need a central planning and control system to plan patients' processes and the required capacity. Given the changes in healthcare one can ask the question what type of information systems can best support these healthcare delivery organizations. We focus in this review on the

Enterprise resource planning for hospitals

NARCIS (Netherlands)

Merode, van G.G.; Groothuis, S.; Hasman, A.

2004-01-01

Integrated hospitals need a central planning and control system to plan patients’ processes and the required capacity. Given the changes in healthcare one can ask the question what type of information systems can best support these healthcare delivery organizations. We focus in this review on the

Supply chain solutions to improve the distribution of antiretroviral drugs (ARVs) to clinics in rural areas: A case study of the QwaQwa district

OpenAIRE

Mokheseng, Mamolise; Horn, Gideon S.; Klopper, Aileen G.

2017-01-01

This article serves as a case study based on research that was performed in the QwaQwa district in the Free State Province where the distribution of ARVs to the regional Manapo hospital, as well as between the hospital and its peripheral clinics, was interrupted and inconsistent due to problems in the supply chain. An unreliable and interrupted ARV supply chain creates the risk of virus reactivation and eventual patient mortality. The objectives of the study were to explore the problems e...

The architecture of enterprise hospital information system.

Science.gov (United States)

Lu, Xudong; Duan, Huilong; Li, Haomin; Zhao, Chenhui; An, Jiye

2005-01-01

Because of the complexity of the hospital environment, there exist a lot of medical information systems from different vendors with incompatible structures. In order to establish an enterprise hospital information system, the integration among these heterogeneous systems must be considered. Complete integration should cover three aspects: data integration, function integration and workflow integration. However most of the previous design of architecture did not accomplish such a complete integration. This article offers an architecture design of the enterprise hospital information system based on the concept of digital neural network system in hospital. It covers all three aspects of integration, and eventually achieves the target of one virtual data center with Enterprise Viewer for users of different roles. The initial implementation of the architecture in the 5-year Digital Hospital Project in Huzhou Central hospital of Zhejiang Province is also described.

Central line associated sepsis in children receiving parenteral nutrition in Oman.

Science.gov (United States)

Al Lawati, Tawfiq T; Al Jamie, Adawaiya; Al Mufarraji, Nasra

Parenteral Nutrition (PN) is used when gut fails to provide complete nutrition. Central line Associate Blood Stream Infection (CLABSI) a major complication of this therapy. The objective of the study was to report the incidence of CLABSI and associated mortality in children receiving PN in the Royal Hospital and study the indication and duration of PN use. All children from the age of 0-48 months who received TPN outside NICU from the period between 1/1/2011 till 31/12/2014 were included. Data were retrieved from the hospital electronic data base. There were 42 children 27 males and 15 females who used PN through a central line for a total duration of 569 days. The incidence of CLABSI was 14 days per 1000 days catheter and mortality of 556 per 10000. The average duration of TPN was 14.5 days. Most of the patient had CLABSI in the PICU and cardiac related illness or surgery was the most common indication of PN use. The average duration of use was 14 days. Inspite of that short duration use of PN, there is a very high incidence of CLABSI and its related mortality. Bundle policy for central line care is not used in the Royal Hospital and this study calls for urgent implementation of central line care bundle policy in the Royal Hospital. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Energy sector developments in Central America and the Caribbean

International Nuclear Information System (INIS)

Perez, J.

1997-01-01

Energy sector developments in Central America and the Caribbean were discussed. Central America is composed of six small countries whose total population is 32 million. The Caribbean population is 20.5 million. Central America is generally poor in hydrocarbon reserves but the geological prospects in several of the countries are encouraging. The oil and petroleum products supply and demand picture, the main characteristics of the hydrocarbon market, structure of the oil industry, hydrocarbon market reforms, pricing issues and recent trend towards reforms in the electric power industry in Central America were discussed. An overview of the Inter-American Development Bank's (IDB) effort to provide technical assistance and loans to strengthen the energy sector development in Central America and the Caribbean was also given. 17 refs., 2 tabs., 23 figs

Metagenomic Analysis of Showerhead Biofilms from a Hospital in Ohio

Science.gov (United States)

Background: The National Institute of Health estimated that 80% of human microbial infections are associated with biofilms. Although water supplies and hospital equipments are constantly treated with disinfectants, the presence of biofilms in these areas has been frequently obser...

Projected Impacts of Climate, Urbanization, Water Management, and Wetland Restoration on Waterbird Habitat in California's Central Valley.

Directory of Open Access Journals (Sweden)

Elliott L Matchett

Full Text Available The Central Valley of California is one of the most important regions for wintering waterbirds in North America despite extensive anthropogenic landscape modification and decline of historical wetlands there. Like many other mediterranean-climate ecosystems across the globe, the Central Valley has been subject to a burgeoning human population and expansion and intensification of agricultural and urban development that have impacted wildlife habitats. Future effects of urban development, changes in water supply management, and precipitation and air temperature related to global climate change on area of waterbird habitat in the Central Valley are uncertain, yet potentially substantial. Therefore, we modeled area of waterbird habitats for 17 climate, urbanization, water supply management, and wetland restoration scenarios for years 2006-2099 using a water resources and scenario modeling framework. Planned wetland restoration largely compensated for adverse effects of climate, urbanization, and water supply management changes on habitat areas through 2065, but fell short thereafter for all except one scenario. Projected habitat reductions due to climate models were more frequent and greater than under the recent historical climate and their magnitude increased through time. After 2065, area of waterbird habitat in all scenarios that included severe warmer, drier climate was projected to be >15% less than in the "existing" landscape most years. The greatest reduction in waterbird habitat occurred in scenarios that combined warmer, drier climate and plausible water supply management options affecting priority and delivery of water available for waterbird habitats. This scenario modeling addresses the complexity and uncertainties in the Central Valley landscape, use and management of related water supplies, and climate to inform waterbird habitat conservation and other resource management planning. Results indicate that increased wetland restoration

Projected Impacts of Climate, Urbanization, Water Management, and Wetland Restoration on Waterbird Habitat in California's Central Valley.

Science.gov (United States)

Matchett, Elliott L; Fleskes, Joseph P

2017-01-01

The Central Valley of California is one of the most important regions for wintering waterbirds in North America despite extensive anthropogenic landscape modification and decline of historical wetlands there. Like many other mediterranean-climate ecosystems across the globe, the Central Valley has been subject to a burgeoning human population and expansion and intensification of agricultural and urban development that have impacted wildlife habitats. Future effects of urban development, changes in water supply management, and precipitation and air temperature related to global climate change on area of waterbird habitat in the Central Valley are uncertain, yet potentially substantial. Therefore, we modeled area of waterbird habitats for 17 climate, urbanization, water supply management, and wetland restoration scenarios for years 2006-2099 using a water resources and scenario modeling framework. Planned wetland restoration largely compensated for adverse effects of climate, urbanization, and water supply management changes on habitat areas through 2065, but fell short thereafter for all except one scenario. Projected habitat reductions due to climate models were more frequent and greater than under the recent historical climate and their magnitude increased through time. After 2065, area of waterbird habitat in all scenarios that included severe warmer, drier climate was projected to be >15% less than in the "existing" landscape most years. The greatest reduction in waterbird habitat occurred in scenarios that combined warmer, drier climate and plausible water supply management options affecting priority and delivery of water available for waterbird habitats. This scenario modeling addresses the complexity and uncertainties in the Central Valley landscape, use and management of related water supplies, and climate to inform waterbird habitat conservation and other resource management planning. Results indicate that increased wetland restoration and additional

Public-private partnerships in the Canadian environment: options for hospital pharmacies.

Science.gov (United States)

Uddin, Z; Bear, R A

1997-01-01

This brief report explores the direction being pursued by hospitals interested in outsourcing non-core activities within the pharmacy department. Private sector logistics companies are looking to position themselves in the drug product supply chain to facilitate seamless transfers of drug products, ordering information and payments between drug manufacturers and hospitals. Opportunities for implementing consolidated purchasing, unit dosing, just-in-time inventory and electronic commerce systems are discussed.

Port supply chain integration : analyzing biofuel supply chains

NARCIS (Netherlands)

Stevens, Leonie C. E.; Vis, Iris F. A.

2016-01-01

This paper focuses on port supply chain integration to strengthen operational and business performance. We provide a structured and comprehensive method to enable port supply chain integration and demonstrate its applicability to the biofuel supply chain. We define the value proposition, role,

Modeling of the interest rate policy of the central bank of Russia

Science.gov (United States)

Shelomentsev, A. G.; Berg, D. B.; Detkov, A. A.; Rylova, A. P.

2017-11-01

This paper investigates interactions among money supply, exchange rates, inflation, and nominal interest rates, which are regulating parameters of the Central bank policy. The study is based on the data received from Russian source in 2002-2016. The major findings are 1) the interest rate demonstrates almost no relation with inflation; 2) ties of money supply and the nominal interest rate are strong; 3) money supply and inflation show meaningful relations only in comparison to their growth rates. We have developed a dynamic model, which can be used in forecasting of macroeconomic processes.

Decision Analysis of Advertising and Price for Bilateral Competing Supply Chain

Directory of Open Access Journals (Sweden)

Cheng-Tang Zhang

2013-01-01

Full Text Available The outcome of centralized equilibrium, prisoner's dilemma equilibrium, and decentralized equilibrium under different decision models has been provided with regards to bilateral competing supply chain system, either side of which is composed of one manufacturer and one retailer. Theoretical analysis indicates a positive correlation between price and one's own advertising investment level and a negative correlation between price and the opponent's advertising investment level. Through analysis of numerical examples, the results reveal a first mover advantage that leads to prisoner's dilemma in the system as well as the impact that price and advertising competition intensity has on the supply chain's choice of decision model.

[Munchausen syndrome: need for centralized administrative health-care management].

Science.gov (United States)

Altmark, D; Sigal, M; Gelkopf, M

1991-03-01

The clinical picture of Munchausen syndrome is that of feigned or self-induced illness with the aim of being hospitalized and/or receiving unnecessary medical interventions, peregrination from 1 hospital to another, and disruptive behavior when hospitalized. These patients are a danger to themselves and heavily burden inpatient facilities that care for them. We present a case that illustrates the problems of diagnosing and managing such patients. We stress the need for adequate centralization and distribution of the relevant information concerning these patients.

The Market for Hospital Medicine in Denmark

DEFF Research Database (Denmark)

Hostenkamp, Gisela

2012-01-01

Pharmaceutical expenditure growth has outpaced GDP and healthcare expenditure growth rates in Denmark as in most OECD countries for the last decade. A major part of this increase was due to high growth rates in specialist areas that are typically located in hospital settings. Yet the market...... for hospital medicines and their procurement are still poorly understood. The present paper characterises the market for hospital medicines in Denmark in terms of its organisation and developments between 2005 and 2009. In Denmark hospital medicines are publicly financed and procurement is centrally organised....... 98% of all medicines administered at Danish public hospitals are purchased through a public procurement agency by means of public tenders. Using data on actual contract prices we decompose pharmaceutical expenditure growth into the contributions from newly introduced medicines, price and volume...

Work-Related Accidents and Sharp Injuries in Paramedics-Illustrated with an Example of a Multi-Specialist Hospital, Located in Central Poland.

Science.gov (United States)

Garus-Pakowska, Anna; Szatko, Franciszek; Ulrichs, Magdalena

2017-08-10

(1) Background: An analysis of work-related accidents in paramedics in Poland by presenting the model and trend of accidents, accident rates and by identifying causes and results of accidents; (2) Methods: A retrospective analysis of medical documentation regarding work-related accidents in a multi-specialist hospital, located in central Poland, in the period 2005-2015. The study group included paramedics who had an accident while being on duty; (3) Results: According to hospital records, 88 paramedics were involved in 390 accidents and 265 injuries caused by sharp instruments. The annual accident rate was 5.34/100 employed paramedics. Most of the accidents occurred at night. The most common reason for the accident was careless behaviour of the paramedic, which resulted in joint sprains and dislocations. Injuries accounted for a huge portion of the total number of events. As many as 45% of injuries were not officially recorded; (4) Conclusion: High rates of work-related accidents and injuries caused by sharp instruments in paramedics are a serious public health problem. Further studies should be conducted in order to identify risk factors of accidents, particularly injuries, and to implement preventative programmes, aiming to minimise rates of occupational hazards for paramedics.

Expiry of medicines in supply outlets in Uganda.

Science.gov (United States)

Nakyanzi, Josephine Katabaazi; Kitutu, Freddy Eric; Oria, Hussein; Kamba, Pakoyo Fadhiru

2010-02-01

The expiry of medicines in the supply chain is a serious threat to the already constrained access to medicines in developing countries. We investigated the extent of, and the main contributing factors to, expiry of medicines in medicine supply outlets in Kampala and Entebbe, Uganda. A cross-sectional survey of six public and 32 private medicine outlets was done using semi-structured questionnaires. The study area has 19 public medicine outlets (three non-profit wholesalers, 16 hospital stores/pharmacies), 123 private wholesale pharmacies and 173 retail pharmacies, equivalent to about 70% of the country's pharmaceutical businesses. Our findings indicate that medicines prone to expiry include those used for vertical programmes, donated medicines and those with a slow turnover. Awareness about the threat of expiry of medicines to the delivery of health services has increased. We have adapted training modules to emphasize management of medicine expiry for pharmacy students, pharmacists and other persons handling medicines. Our work has also generated more research interest on medicine expiry in Uganda. Even essential medicines expire in the supply chain in Uganda. Sound coordination is needed between public medicine wholesalers and their clients to harmonize procurement and consumption as well as with vertical programmes to prevent duplicate procurement. Additionally, national medicine regulatory authorities should enforce existing international guidelines to prevent dumping of donated medicine. Medicine selection and quantification should be matched with consumer tastes and prescribing habits. Lean supply and stock rotation should be considered.

Economic and Water Supply Effects of Ending Groundwater Overdraft in California's Central Valley

Directory of Open Access Journals (Sweden)

Timothy Nelson

2016-03-01

Full Text Available doi: http://dx.doi.org/10.15447/sfews.2016v14iss1art7Surface water and groundwater management are often tightly linked, even when linkage is not intended or expected. This link is especially common in semi-arid regions, such as California. This paper summarizes a modeling study on the effects of ending long-term overdraft in California’s Central Valley, the state’s largest aquifer system. The study focuses on economic and operational aspects, such as surface water pumping and diversions, groundwater recharge, water scarcity, and the associated operating and water scarcity costs. This analysis uses CALVIN, a hydro-economic optimization model for California’s water resource system that suggests operational changes to minimize net system costs for a given set of conditions, such as ending long-term overdraft. Based on model results, ending overdraft might induce some major statewide operational changes, including large increases to Delta exports, more intensive conjunctive-use operations with increasing artificial and in-lieu recharge, and greater water scarcity for Central Valley agriculture. The statewide costs of ending roughly 1.2 maf yr-1 of groundwater overdraft are at least $50 million per year from additional direct water shortage and additional operating costs. At its worst, the costs of ending Central Valley overdraft could be much higher, perhaps comparable to the recent economic effects of drought. Driven by recent state legislation to improve groundwater sustainability, ending groundwater overdraft has important implications statewide for water use and management, particularly in the Sacramento–San Joaquin Delta. Ending Central Valley overdraft will amplify economic pressure to increase Delta water exports rather than reduce them, tying together two of California’s largest water management problems.

Social shaping of food intervention initiatives at worksites: Canteen takeaway schemes at two Danish hospitals

DEFF Research Database (Denmark)

Poulsen, Signe; Jørgensen, Michael Søgaard

2011-01-01

to improve the food supply for the evening shift and the work–life balance. The shaping of the schemes at the two hospitals became rather different change processes due to the local organizational processes shaped by previously developed norms and values. At one hospital the change process challenged norms...

Matching the demand for and supply of IT professionals : towards a learning organization

NARCIS (Netherlands)

Stam, Mark; Molleman, E

1999-01-01

This article presents a study among information technology (TT) companies and young IT professionals, which demonstrates the central role of career development and strategic training policies in improving the match between demand for and supply of IT professionals. These policies seem to be able to

Sustainable supply chain management: Review and research opportunities

Directory of Open Access Journals (Sweden)

Sudheer Gupta

2011-12-01

Full Text Available Anthropogenic emissions likely pose serious threat to the stability of our environment; immediate actions are required to change the way the earth’s resources are consumed. Among the many approaches to mitigation of environmental deterioration being considered, the processes for designing, sourcing, producing and distributing products in global markets play a central role. Considerable research effort is being devoted to understanding how organisational initiatives and government policies can be structured to facilitate incorporation of sustainability into design and management of entire supply chain. In this paper, we review the current state of academic research in sustainable supply chain management, and provide a discussion of future direction and research opportunities in this field. We develop an integrative framework summarising the existing literature under four broad categories: (i strategic considerations; (ii decisions at functional interfaces; (iii regulation and government policies; and (iv integrative models and decision support tools. We aim to provide managers and industry practitioners with a nuanced understanding of issues and trade-offs involved in making decisions related to sustainable supply chain management. We conclude the paper by discussing environmental initiatives in India and the relevance of sustainability discussions in the context of the Indian economy.

Testing the control of mineral supply rates on chemical erosion in the Klamath Mountains

Science.gov (United States)

West, N.; Ferrier, K.

2017-12-01

The relationship between rates of chemical erosion and mineral supply is central to many problems in Earth science, including the role of tectonics in the global carbon cycle, nutrient supply to soils and streams via soil production, and lithologic controls on landscape evolution. We aim to test the relationship between mineral supply rates and chemical erosion in the forested uplands of the Klamath mountains, along a latitudinal transect of granodioritic plutons that spans an expected gradient in mineral supply rates associated with the geodynamic response to the migration of the Mendocino Triple Junction. We present 10Be-derived erosion rates and Zr-derived chemical depletion factors, as well as bulk soil and rock geochemistry on 10 ridgetops along the transect to test hypotheses about supply-limited and kinetically-limited chemical erosion. Previous studies in this area, comparing basin-averaged erosion rates and modeled uplift rates, suggest this region may be adjusted to an approximate steady state. Our preliminary results suggest that chemical erosion at these sites is influenced by both mineral supply rates and dissolution kinetics.

Clogging of water supply wells in alluvial aquifers by mineral incrustations, central Serbia

Directory of Open Access Journals (Sweden)

Majkić-Dursun Brankica

2015-01-01

Full Text Available The formation of incrustations on public water supply well screens reduces their performance considerably. The incrustations increase hydraulic losses, reduce the capacity of the well and screen, affect the quality of the pumped water and increase maintenance costs. In alluvial environments, the most common deposits are iron and manganese hydroxides. However, the rates of formation, compositions and levels of crystallization vary, depending on the geochemical characteristics of the alluvial environment, the microbiological characteristics of the groundwater and the abstraction method. Samples of 15 incrustations were collected from wells that tap shallow alluvial aquifers and were found to be dominated by iron. XRD analyses detected low-crystalline ferrihydrite and manganese hydroxide in the samples collected from the water supply source at Trnovče (Velika Morava alluvial. The incrustations from the Belgrade Groundwater Source revealed the presence of ferrihydrite and a substantial amount of goethite α-FeOOH. Apart from goethite, greigite (Fe3S4 was detected in three samples, while one sample additionally contained bernalite Fe(OH3 and monoclinic sulfur S8. Among carbonates, only siderite was detected. Iron oxidizing bacteria generally catalyze deposition processes in wells, while sulfate reducing bacteria (SRB play a role in the biogenic formation of greigite. Determining the nature of the deposited material allows better selection of rehabilitation chemicals and procedure. [Projekat Ministarstva nauke Republike Srbije, br. TR37014

Comparing recent uranium supply scenarios

International Nuclear Information System (INIS)

Arnold, N.; Gufler, K.

2014-01-01

For more than one decade – even after the Fukushima accidents - an increase in global nuclear energy generation capacity is widely expected. At the same time a variety of uranium supply scenarios were published by industry, academics or international organizations, drawing different pictures of future uranium supply. They were created with the background of a uranium market facing several challenges. First an excursion in the uranium market price, in 2007, then reduced nuclear growth expectations after 2011, at least in non-Asian countries, also implying considerable changes to the supply side. For this publication a meta-study was carried out identifying, evaluating and comparing different recent scenarios on the availability of uranium. While there are some differences in the frame conditions (e.g. the expected uranium demand, the time fame, the considered mining projects,..), there are also notable similarities in these scenarios. This concerns long lead times for mine openings as well as the dependence on large mining projects (e.g. Olympic Dam, Cigar Lake). Generally, a decline in production in about 10 years is assumed, and thus the necessity of the timely development of mining projects is pointed out. In addition the omission of uranium from Russian nuclear weapons and the chances of keeping the changes in secondary supplies in balance with primary production have been widely discussed. Here, the production growth in Kazakhstan but also the role of the current market situation are central aspects. As another aspect the possible contribution from unconventional resources is of interest, particularly against the background of rising production costs for conventional resources. Finally, it shall be reflected how well older scenarios were able to map the reality and which trends could or could not be anticipated. It is relevant to identify which aspects in the development of mining capacities are essential for security of supply, and can therefore be regarded

Potential effects of drought on carrying capacity for wintering waterfowl in the Central Valley of California

Science.gov (United States)

Petrie, Mark J.; Fleskes, Joseph P.; Wolder, Mike A.; Isola, Craig R.; Yarris, Gregory S.; Skalos, Daniel A.

2016-01-01

We used the bioenergetics model TRUEMET to evaluate potential effects of California's recent drought on food supplies for waterfowl wintering in the Central Valley under a range of habitat and waterfowl population scenarios. In nondrought years in the current Central Valley landscape, food supplies are projected to be adequate for waterfowl from fall through early spring (except late March) even if waterfowl populations reach North American Waterfowl Management Plan goals. However, in all drought scenarios that we evaluated, food supplies were projected to be exhausted for ducks by mid- to late winter and by late winter or early spring for geese. For ducks, these results were strongly related to projected declines in winter-flooded rice fields that provide 45% of all the food energy available to ducks in the Central Valley in nondrought water years. Delayed flooding of some managed wetlands may help alleviate food shortages by providing wetland food resources better timed with waterfowl migration and abundance patterns in the Central Valley, as well as reducing the amount of water needed to manage these habitats. However, future research is needed to evaluate the impacts of delayed flooding on waterfowl hunting, and whether California's existing water delivery system would make delayed flooding feasible. Securing adequate water supplies for waterfowl and other wetland-dependent birds is among the greatest challenges facing resource managers in coming years, especially in the increasingly arid western United States.

First-order effects of a nuclear moratorium in Central Europe

International Nuclear Information System (INIS)

Messner, S.; Strubegger, M.

1986-12-01

An energy supply model developed at IIASA previously is used to investigate the consequences of a hypothetical nuclear power phaseout in Central Europe. It is assumed that no new nuclear power plants will be built in Central Europe after 1990 but the existing ones will be used for a planned lifetime of 25 years. Energy-specific consequences, import dependence, emissions, energy prices and investments from the energy sector are considered. (G.Q.)

Efficiency from Pharmacy Inventory Technology: A Means to Improving Quality in Non-Profit Hospitals

Science.gov (United States)

McKelvey, Florence Ann

2013-01-01

Hospitals, like all organizations, have both a mission and a finite supply of resources with which to accomplish that mission. Because the inventory of therapeutic drugs is among the more expensive resources needed by a hospital to achieve its mission, a conceptual model of structure plus process equals outcome posits that adequate emphasis should…

Modern Solutions for Automation of Electrical Traction Power Supply Systems

Directory of Open Access Journals (Sweden)

Ana Mihaela Andreica

2011-09-01

Full Text Available This paper presents modern solutions for the automation of the electrical traction power supply system used in urban public transport (trams, trolleybuses and subway trains. The monitoring and control of this process uses SCADA distributed architectures, grouped around a central point (dispatcher who controls all field sensors, transmitters and actuators using programmable logical controllers. The presented applications refer to the Bucharest electrical transport infrastructure.

Assessment of Future Skills Requirements in the Hospitality Sector in Ireland, 2015-2020

OpenAIRE

2015-01-01

The hospitality sector is one of the most important employment services sectors in the Irish economy, and there is significant potential for future expansion. The objective of this study is to assess the skills demand needs arising within the Hospitality sector in Ireland – hotels, restaurants, bars, canteens and catering – over the period to 2020. The aim is to ensure that there will be the right supply of skills to help drive domestic hospitality sector business and employment growth.

Projected impacts of climate, urbanization, water management, and wetland restoration on waterbird habitat in California’s Central Valley

Science.gov (United States)

Matchett, Elliott L.; Fleskes, Joseph

2017-01-01

The Central Valley of California is one of the most important regions for wintering waterbirds in North America despite extensive anthropogenic landscape modification and decline of historical wetlands there. Like many other mediterranean-climate ecosystems across the globe, the Central Valley has been subject to a burgeoning human population and expansion and intensification of agricultural and urban development that have impacted wildlife habitats. Future effects of urban development, changes in water supply management, and precipitation and air temperature related to global climate change on area of waterbird habitat in the Central Valley are uncertain, yet potentially substantial. Therefore, we modeled area of waterbird habitats for 17 climate, urbanization, water supply management, and wetland restoration scenarios for years 2006–2099 using a water resources and scenario modeling framework. Planned wetland restoration largely compensated for adverse effects of climate, urbanization, and water supply management changes on habitat areas through 2065, but fell short thereafter for all except one scenario. Projected habitat reductions due to climate models were more frequent and greater than under the recent historical climate and their magnitude increased through time. After 2065, area of waterbird habitat in all scenarios that included severe warmer, drier climate was projected to be >15% less than in the “existing” landscape most years. The greatest reduction in waterbird habitat occurred in scenarios that combined warmer, drier climate and plausible water supply management options affecting priority and delivery of water available for waterbird habitats. This scenario modeling addresses the complexity and uncertainties in the Central Valley landscape, use and management of related water supplies, and climate to inform waterbird habitat conservation and other resource management planning. Results indicate that increased wetland restoration and additional

Perspectives on long-term Eurasian energy supply: the role of the energy charter

International Nuclear Information System (INIS)

Kemper, R.

2004-01-01

This paper examines Croatian energy outlook in the broader 'Eurasian' context, taking into consideration the prospect of increasing energy import dependency in Western and Central Europe, and assesses the contribution that multilateral instruments, such as the Energy Charter Treaty, can make in promoting security of supply.(author)

Dynamics-based centrality for directed networks.

Science.gov (United States)

Masuda, Naoki; Kori, Hiroshi

2010-11-01

Determining the relative importance of nodes in directed networks is important in, for example, ranking websites, publications, and sports teams, and for understanding signal flows in systems biology. A prevailing centrality measure in this respect is the PageRank. In this work, we focus on another class of centrality derived from the Laplacian of the network. We extend the Laplacian-based centrality, which has mainly been applied to strongly connected networks, to the case of general directed networks such that we can quantitatively compare arbitrary nodes. Toward this end, we adopt the idea used in the PageRank to introduce global connectivity between all the pairs of nodes with a certain strength. Numerical simulations are carried out on some networks. We also offer interpretations of the Laplacian-based centrality for general directed networks in terms of various dynamical and structural properties of networks. Importantly, the Laplacian-based centrality defined as the stationary density of the continuous-time random walk with random jumps is shown to be equivalent to the absorption probability of the random walk with sinks at each node but without random jumps. Similarly, the proposed centrality represents the importance of nodes in dynamics on the original network supplied with sinks but not with random jumps.