Cost-effective utilization of a private facility to perform outpatient surgery in public hospital waiting list patients.

Background: Public hospitals' long waiting lists make outpatient surgery in private facilities very attractive provided a standardized protocol is applied. The aim of this study was to assess this kind of innovative collaboration in abdominal surgery from a clinical and economical perspective. Methods: All consecutive patients operated on in an outpatient basis in a private facility by a public hospital abdominal surgeon and an assistant over a 5-year period (2004-2009) were included. Clinical assessment was carried out from patients' charts and satisfaction questionnaire, and economic assessment from the comparison between the surgeons' charges paid by the private facility and the surgeons' hospital salaries during the days devoted to surgery at the private facility. Results: Over the 5 years, 602 operative procedures were carried out during 190 operative days. All patients could be discharged the same day and only 1% of minor complications occurred. The patients' satisfaction was 98%. The balance between the surgeons' charges paid by the private facility and their hospital salary costs was positive by 25.8% for the senior surgeon and 12.6% for the assistant or, on average, 21.9% for both. Conclusion: Collaboration between an overloaded university hospital surgery department and a private surgical facility was successful, effective, safe, and cost-effective. It could be extended to other surgical specialities. Copyright (C) 2011 S. Karger AG, Basel

Prospects for library cooperation in New York City: planning for more effective utilization of reference and research resources.

Mode of access: Internet.

Technical impediments to a more effective utilization of neutron transmutation doped silicon for high-power device fabrication /

"Issued May 1980."

Water circulations for effective bleaching of high-brightness mechanical pulps

The amount of water available is usually restricted, which leads to a situation where a complete understanding of the process, including water circulations and the influence of water components, is essential. The main aim of this thesis was to clarify the possibilities for the efficient use of residual peroxide by means of water circulation rearrangements. Rearranging water circulations and the reduction of water usage may cause new problems, such as metal induced peroxide decomposition that needs to be addressed. This thesis introduces theoretical methods of water circulations to combine two variables; effective utilization of residual peroxide and avoiding manganese in the alkaline peroxide bleaching stage. Results are mainly based on laboratory and mill site experiments concerning the utilization of residual peroxide. A simulation model (BALAS) was used to evaluate the manganese contents and residual peroxide doses. It was shown that with optimum recirculation of residual peroxide the brightness can be improved or chemical costs can be decreased. From the scientific perspective, it was also very important to discover that recycled peroxide was more effective pre-bleaching agent compared to fresh peroxide. This can be due to the organic acids i.e. per acetic acid in wash press filtrate that have been formed in alkaline bleaching stage. Even short retention time was adequate and the activation of residual peroxide using sodium hydroxide was not necessary. There are several possibilities for using residual peroxide in practice regarding bleaching. A typical modern mechanical pulping process line consist of defibering, screening, a disc filter, a bleach press, high consistency (HC) peroxide bleaching and a wash press. Furthermore there usually is not a particular medium consistency (MC) pre-bleaching stage that includes additional thickening equipment. The most advisable way to utilize residual peroxide in this kind of process is to recycle the wash press filtrate to the dilution of disc filter pulp (low MC pre-bleaching stage). An arrangement such as this would be beneficial in terms of the reduced convection of manganese to the alkaline bleaching stage. Manganese originates from wood material and will be removed to the water phase already in the early stages of the process. Recycling residual peroxide prior to the disc filter is not recommended because of low consistencies. Regarding water circulations, the novel point of view is that, it would be beneficial to divide water circulations into two sections and the critical location for the division is the disc filter. Both of these two sections have their own priority. Section one before the disc filter: manganese removal. Section two after the disc filter: brightening of pulp. This division can be carried out if the disc filter pulp is diluted only by wash press filtrate before the MC storage tower. The situation is even better if there is an additional press after the disc filter, which will improve the consistency of the pulp. This has a significant effect on the peroxide concentration in the MC pre-bleaching stage. In terms of manganese content, it is essential to avoid the use of disc filter filtrate in the bleach press and wash press showers. An additional cut-off press would also be beneficial for manganese removal. As a combination of higher initial brightness and lower manganese content, the typical brightness increase varies between approximately 0.5 and 1% ISO units after the alkaline peroxide bleaching stage. This improvement does not seem to be remarkable, but as it is generally known, the final brightness unit is the most expensive and difficult to achieve. The estimation of cost savings is not unambiguous. For example in GW/TMP mill case 0.6% ISO units higher final brightness gave 10% savings in the costs of bleaching chemicals. With an hypothetical 200 000 ton annual production, this means that the mill could save in the costs of bleaching chemicals more than 400 000 euros per year. In general, it can be said that there were no differences between the behavior of different types of processes (GW, PGW, TMP and BCTMP). The enhancement of recycling gave a similar response in all cases. However, we have to remember that the utilization of residual peroxide in older mills depends a great deal on the process equipment, the amount of water available and existing pipeline connections. In summary, it can be said that processes are individual and the same solutions cannot be applied to all cases.

Operational Flexibility: A Model for Effective Project Management

The aim of this study is to investigate the role of operational flexibility for effective project management in the construction industry. The specific objectives are to: a) Identify the determinants of operational flexibility potential in construction project management b) Investigate the contribution of each of the determinants to operational flexibility potential in the construction industry c) Investigate on the moderating factors of operational flexibility potential in a construction project environment d) Investigate whether moderated operational flexibility potential mediates the path between predictors and effective construction project management e) Develop and test a conceptual model of achieving operational flexibility for effective project management The purpose of this study is to findout ways to utilize flexibility inorder to manage uncertain project environment and ultimately achieve effective project management. In what configuration these operational flexibility determinants are demanded by construction project environment in order to achieve project success. This research was conducted in three phases, namely: (i) exploratory phase (ii) questionnaire development phase; and (iii) data collection and analysis phase. The study needs firm level analysis and therefore real estate developers who are members of CREDAI, Kerala Chapter were considered. This study provides a framework on the functioning of operational flexibility, offering guidance to researchers and practitioners for discovering means to gain operational flexibility in construction firms. The findings provide an empirical understanding on kinds of resources and capabilities a construction firm must accumulate to respond flexibly to the changing project environment offering practitioners insights into practices that build firms operational flexibility potential. Firms are dealing with complex, continuous changing and uncertain environments due trends of globalization, technical changes and innovations and changes in the customers’ needs and expectations. To cope with the increasingly uncertain and quickly changing environment firms strive for flexibility. To achieve the level of flexibility that adds value to the customers, firms should look to flexibility from a day to day operational perspective. Each dimension of operational flexibility is derived from competences and capabilities. In this thesis only the influence on customer satisfaction and learning exploitation of flexibility dimensions which directly add value in the customers eyes are studied to answer the followingresearch questions: “What is the impact of operational flexibility on customer satisfaction?.” What are the predictors of operational flexibility in construction industry? .These questions can only be answered after answering the questions like “Why do firms need operational flexibility?” and “how can firms achieve operational flexibility?” in the context of the construction industry. The need for construction firms to be flexible, via the effective utilization of organizational resources and capabilities for improved responsiveness, is important because of the increasing rate of changes in the business environment within which they operate. Achieving operational flexibility is also important because it has a significant correlation with a project effectiveness and hence a firm’s turnover. It is essential for academics and practitioners to recognize that the attainment of operational flexibility involves different types namely: (i) Modification (ii) new product development and (iii) demand management requires different configurations of predictors (i.e., resources, capabilities and strategies). Construction firms should consider these relationships and implement appropriate management practices for developing and configuring the right kind of resources, capabilities and strategies towards achieving different operational flexibility types.

Predicting the revolving door phenomenon among patients with schizophrenic, affective disorders and non-organic psychoses

OBJECTIVE: The aim of the study was to identify the variables that predict the revolving door phenomenon in psychiatric hospital at the moment of a second admission. METHODS: The sample consisted of 3,093 patients who have been followed during 5 to 24 years after their first hospital admission due to schizophrenia, and affective or psychotic disorders. Those who had had four or more admissions during the study period were considered as revolving door patients. Logistic regression analyses were used to assess the impact of gender, age, marital status, urban conditions, diagnosis, mean period of stay on the first admission, interval between the first and second admissions on the patterns of hospitalization. RESULTS: The variables with the highest predictive power for readmission were the interval between first and second admissions, and the length of stay in the first admission. CONCLUSIONS: These data may help public health planners in providing optimal care to a small group of patients with more effective utilization of the available services.

Kannattavuusraportoinnin laadun arviointi data warehouse ratkaisussa Case: Paperiteollisuuden myynnin ja asiakaspalvelun tietojärjestelmä

Tutkielman tavoitteena oli selvittää, onko tutkielman tilaajan toteuttaman kannattavuusraportoinnin laatu käyttäjien mielestä riittävä. Kannattavuusraportointi on toteutettu data warehouse tekniikalla. Tutkielman tavoitteina oli myös määrittää, mitä ohjelmiston laatu tarkoittaa ja miten sitä voidaan arvioida. Tutkimuksessa käytettiin kvalitatiivista tutkimusmenetelmää. Laadun arviointiin käytetty aineisto kerättiin haastattelemalla seitsemäätoista kannattavuusraportoinnin aktiivikäyttäjää. Tutkielmassa ohjelmiston laatu tarkoittaa sen kykyä täyttää tai ylittää käyttäjiensä kohtuulliset toiveet ja odotukset. Laatua arvioitiin standardin ISO/IEC 9126 määrittelemällä kuudella laatuominaisuudella, jotka kuvaavat minimaalisella päällekkäisyydellä ohjelmiston laadun. Lisäksi arvioinnissa hyödynnettiin varsinaiseen standardiin kuulumatonta informatiivista liitettä, joka tarkentaa ISO/IEC 9126 standardissa esitettyjä laadun ominaispiirteitä. Tutkimuksen tuloksena voidaan todeta, että käyttäjien mukaan kannattavuusraportointi on tarpeeksi laadukas, sillä se pystyy tarjoamaan helppokäyttöisiä, oikeanmuotoisia raportteja riittävän hyvällä vasteajalla käyttäjien tarpeisiin. Tehokkaasta hyödyntämisestä voidaan päätellä data warehousen rakentamisen onnistuneen. Tutkimuksessa nousi esiin myös runsaasti kehittämis- ja parannusideoita, jotka toimivat yhtenä kehitystyön apuvälineenä tulevaisuudessa.

Business intelligence –järjestelmä integraation tukena kansainvälisessä yrityksessä

Business intelligencellä tarkoitetaan liiketoimintatiedon hallintaan liittyviä prosesseja ja tekniikoita. Se pitää sisällään tiedon keräämiseen, tallentamiseen, analysointiin ja jakamiseen käytettyt tuotteet, tekniikat ja prosessit, joiden tavoitteena on auttaa yrityksen työntekijöitä liiketoimintaan liittyvässä päätöksenteossa. Tutkimuksen tavoitteena on tutkia uuden yritysryhmän laajuisen BI-tietojärjestelmän suunnitteluun ja käyttöönotoon liittyviä seikkoja ja luoda valmiudet BI-tietojärjestelmän kehitys- ja käyttöönottoprojektin kohdeyrityksessä, jonka toimiala on kansainvälinen terveydenhoitoalan tukkuliiketoiminta. Uuden BI-järjestelmän halutaan tukeva yritysryhmän yritysten välistä integraatiota ja tehostavan tiedonhakuun ja analysointiin liittyviä prosesseja. Tutkimus toteutettiin konstruktiivisena tutkimuksena, joka kattaa kohdeyrityksen IT-arkkitehtuurin, tietosisällön, prosessit ja organisaation raportoinnin kannalta. Lisäksi työssä suoritettiin ohjelmistovertailu kahden markkinoilla toimivan merkittävän ohjelmistotalon BI-tuotteiden välillä. Työssä havaittiin, että BI-projekti on laaja-alainen ja suuri hanke, joka ulottuu läpi koko organisaation. BI-ohjelmiston tehokas hyödyntäminen asettaa vaatimuksia erityisesti taustajärjestelmien tiedon huolelliseen mallintamiseen liittyen. Työssä saatiin pilotoinnin kautta käytännön kokemuksia uudesta järjestelmästä ja sen tarjoamista mahdollisuuksista kohdeyrityksessä.

Vapastii ohjelmoitavan automaatioyksikön suunnitteluprosessi

Rakennusautomaatiossa tulee esiin sovelluksia, joissa järjestelmän ohjaus-, säätö- tai valvontaratkaisun toteuttaminen ohjelmoitavilla logiikoilla ei ole riittävän edullista. Tällöin vaihtoehtona on oman laitteen suunnittelu. Työn tavoitteena oli suunnitella ja toteuttaa kustannustehokas CAN-väylään liitettävä vapaasti ohjelmoitava automaatioyksikkö. Suunnittelua ohjasivat asiakkaan laatimat vaatimusmäärittelyt. Niistä laitteen konfigurointimahdollisuudet ja piirilevyn tavoitekoko asettivat suurimmat haasteet laitteen suunnittelulle. Työn tuloksena toteutettiin asiakkaan tarpeisiin soveltuva automaatioyksikkö. Tavoitteisiin päästiin komponenttivalinnoilla ja hyödyntämällä tehokkaasti mikro-ohjaimen integroituja ominaisuuksia. Näiden avulla pystyttiin karsimaan monia yksiköitä, joita tavanomaisesti toteutetaan erilliskomponenteilla. Työssä perehdyttiin sulautetun järjestelmän elektroniikan tuotekehitysprosessiin ideasta prototyyppiin. Samalla on kuvailtu valittuja ratkaisuja sekä suunnittelussa tapahtuneita virheitä ja miten ne on ratkaistu.

Integrating Use of Customer Information Throughout Multiple Sales Channels to Create Customer Competence

Customer knowledge management (CKM) practices enable organizations to create customer competence with systematic use of customer information that is integrated throughout the organization. Nonetheless, organizations are not able to fully exploit the vast amount of data available. Previous research on use of customer information is limited especially in a multichannel environment. The aim of this study was to identify the main obstacles for utilizing customer information efficiently across multiple sales channels. The study was conducted as a single case study in order to gain deeper understanding of the research problem. The empirical findings indicate that lack of CKM practices and a common goal are major challenges obstructing effective utilization of customer information. Furthermore, decentralized organizational structure and insufficient analytical skills create obstacles for information sharing and capabilities to process information and create new knowledge. The implications of the study suggest that in order to create customer competence organizations should shift their focus from technology to the organizational factors affecting use of information and implement CKM practices throughout the organization.

Influence of Processing Variables on Protein Quality and Frozen Storage Stability of Two Commercially Important Species of Squid (Loligo duvaucelii and Doryteuthis sibogae )

Cephalopods are utilized as an important food item in various countries because of its delicacy as raw consumed food. Mainly sepia and loligo are consumed raw by Japanese and Russians. The freshness of the products is very important when the product is consumed raw. The major species that dominate our squid catch are Loligo duvaucelii and Doryteuthis sibogae. There is a noticeable difference in the quality of both the species. The needle squid (Doryteuthis sibogae ) contributes about 35% of the total squid landing. Due to the fast deterioration , a major portion of the needle squid, which is caught during the first few hauls, is thrown back to sea. The catch in the last hauls only are taken to the landing centers. At present the needle squid is processed as blanched rings and the desired quality is not obtained if it is processed as whole, whole cleaned or as tubes. In this study an attempt is made to investigate the biochemical characteristics in both the species of squid in relation to their quality and, the process control measures to be adopted. The effect of various treatments on their quality and the changes in proteolytic and lysosomal enzymes under various processing conditions are also studied in detail.Thus this study can provide the seafood industry with relevant suggestions and solutions for effective utilization of both the species of squid with emphasis on needle squid.

Studies on the technological aspects and economic efficiency of trawl gear operating along the Cochin coast

Trawling, despite being heavily energy expensive, still continues to be the most energy expensive fishing method particularly so in View of the export oriented nature of the Indian seafood industry. This study therefore aims at analyzing the efficiency of trawls operation from Cochin, an important fishing center along the southwest coast of India. The analysis is made along two perspectives - economic and technological. Even though technological efficiency complement economic efficiency, in the fishing parlance, parameters like the size composition of the catch, selectivity factors, etc., will have a direct bearing on the technological qualities of the trawl, and which parameters will have a significant impact on the effective exploitation of a fishery stock. Whereas the technological analysis aims at improving the efficiency with regard to the effective utilization of fuel and fishery stocks, economic analysis ascertains the present status of the trawling operations from the commercial angle.

Studies on the digestive enzymes of the Indian white prawn Penaeus indicus H. Milne Edwards

The efficiency of a diet not only depends on its nutrient composition and nutrient balance but also on the effective utilization by the animal. In the utilization of dietary nutrients, the digestive enzymes play the crucial role of catalysing the hydrolytic reactions, splitting the macromolecules into simple absorbable molecules. The activity of these biocatalysts is regulated by alterations in pH, temperature, substrate type and concentrations, and also by the presence of activators and inhibitors. Thus any shift from the optimum conditions necessary for these enzymes may affect their activity, thereby correspondingly modify the digestibility of the nutrients supplied to the animals. Thus, investigations on the important digestive enzymes and their preferential conditions of activity are essential, so that the results obtained could be used in rationally adjusting the quality and quantity of feed supplied to the different stages of prawns In India, directed research on nutritional physiology and biochemical approaches to digestion in commercially important prawns is taken up_ only recently, and the field is still in an infant stage. In view of its emerging importance it is identified as an area of priority and the present investigation has been carried out on the Indian white prawn Penaeus indicus

Rainfall Climatology over Middle East Region and its Variability

A better understanding of the rainfall climatology of the Middle East region identifying the mechanisms responsible for the rain producing systems is essential for effective utilization of the water resources over the arid region. A comprehensive analysis on the rainfall climatology of the Middle East region is carried out to bring out the spatial and temporal variation of rainfall and mechanisms responsible for the rain events. The study was carried out utilizing rainfall, OLR, wind and humidity data sets procured from TRMM, NOAA and NCEP-NCAR. Climatology of annual rainfall brings out two areas of alarmingly low rainfall in the Middle East region: one in Egypt, Jordan and adjoining areas and the other in the southern part of Saudi Arabia. Daily rainfall analysis indicates that northern region gets rainfall mainly during winter and spring associated with the passage of Mediterranean low pressure systems whereas rain over the southern region is caused mainly by the monsoon organized convection, cross equatorial flow and remnants of low pressure systems associated with the monsoon during the summer season. Thermodynamic structure of the atmosphere reveals that the region does not have frequent local convection due to insufficient moisture content. The sinking motion associated with the sub tropic high pressure system and subsidence associated with the Walker circulation are responsible for maintaining warm and dry air over the region.