Three essays on hospital efficiency

This dissertation analyzes hospital efficiency using various econometric techniques. The first essay provides additional and recent evidence to the presence of contract management behavior in the U.S. hospital industry. Unlike previous studies, which focus on either an input-demand equation or the cost function of the firm, this paper estimates the two jointly using a system of nonlinear equations. Moreover, it addresses the longitudinal problem of institutions adopting contract management in different years, by creating a matched control group of non-adopters with the same longitudinal distribution as the group under study. The estimation procedure then finds that labor, and not capital, is the preferred input in U.S. hospitals regardless of managerial contract status. With institutions that adopt contract management benefiting from lower labor inefficiencies than the simulated non-contract adopters. These results suggest that while there is a propensity for expense preference behavior towards the labor input, contract managed firms are able to introduce efficiencies over conventional, owner controlled, firms. Using data for the years 1998 through 2007, the second essay investigates the production technology and cost efficiency faced by Florida hospitals. A stochastic frontier multiproduct cost function is estimated in order to test for economies of scale, economies of scope, and relative cost efficiencies. The results suggest that small-sized hospitals experience economies of scale, while large and medium sized institutions do not. The empirical findings show that Florida hospitals enjoy significant scope economies, regardless of size. Lastly, the evidence suggests that there is a link between hospital size and relative cost efficiency. The results of the study imply that state policy makers should be focused on increasing hospital scale for smaller institutions while facilitating the expansion of multiproduct production for larger hospitals. The third and final essay employs a two staged approach in analyzing the efficiency of hospitals in the state of Florida. In the first stage, the Banker, Charnes, and Cooper model of Data Envelopment Analysis is employed in order to derive overall technical efficiency scores for each non-specialty hospital in the state. Additionally, input slacks are calculated and reported in order to identify the factors of production that each hospital may be over utilizing. In the second stage, we employ a Tobit regression model in order to analyze the effects a number of structural, managerial, and environmental factors may have on a hospital’s efficiency. The results indicated that most non-specialty hospitals in the state are operating away from the efficient production frontier. The results also indicate that the structural make up, managerial choices, and level of competition Florida hospitals face have an impact on their overall technical efficiency.

Monitoramento por microcontrolador do cultivo de spirulina em fotobiorreator raceway

A oportunidade de produção de biomassa microalgal tem despertado interesse pelos diversos destinos que a mesma pode ter, seja na produção de bioenergia, como fonte de alimento ou servindo como produto da biofixação de dióxido de carbono. Em geral, a produção em larga escala de cianobactérias e microalgas é feita com acompanhamento através de análises físicoquímicas offline. Neste contexto, o objetivo deste trabalho foi monitorar a concentração celular em fotobiorreator raceway para produção de biomassa microalgal usando técnicas de aquisição digital de dados e controle de processos, pela aquisição de dados inline de iluminância, concentração de biomassa, temperatura e pH. Para tal fim foi necessário construir sensor baseado em software capaz de determinar a concentração de biomassa microalgal a partir de medidas ópticas de intensidade de radiação monocromática espalhada e desenvolver modelo matemático para a produção da biomassa microalgal no microcontrolador, utilizando algoritmo de computação natural no ajuste do modelo. Foi projetado, construído e testado durante cultivos de Spirulina sp. LEB 18, em escala piloto outdoor, um sistema autônomo de registro de informações advindas do cultivo. Foi testado um sensor de concentração de biomassa baseado na medição da radiação passante. Em uma segunda etapa foi concebido, construído e testado um sensor óptico de concentração de biomassa de Spirulina sp. LEB 18 baseado na medição da intensidade da radiação que sofre espalhamento pela suspensão da cianobactéria, em experimento no laboratório, sob condições controladas de luminosidade, temperatura e fluxo de suspensão de biomassa. A partir das medidas de espalhamento da radiação luminosa, foi construído um sistema de inferência neurofuzzy, que serve como um sensor por software da concentração de biomassa em cultivo. Por fim, a partir das concentrações de biomassa de cultivo, ao longo do tempo, foi prospectado o uso da plataforma Arduino na modelagem empírica da cinética de crescimento, usando a Equação de Verhulst. As medidas realizadas no sensor óptico baseado na medida da intensidade da radiação monocromática passante através da suspensão, usado em condições outdoor, apresentaram baixa correlação entre a concentração de biomassa e a radiação, mesmo para concentrações abaixo de 0,6 g/L. Quando da investigação do espalhamento óptico pela suspensão do cultivo, para os ângulos de 45º e 90º a radiação monocromática em 530 nm apresentou um comportamento linear crescente com a concentração, apresentando coeficiente de determinação, nos dois casos, 0,95. Foi possível construir um sensor de concentração de biomassa baseado em software, usando as informações combinadas de intensidade de radiação espalhada nos ângulos de 45º e 135º com coeficiente de determinação de 0,99. É factível realizar simultaneamente a determinação inline de variáveis do processo de cultivo de Spirulina e a modelagem cinética empírica do crescimento do micro-organismo através da equação de Verhulst, em microcontrolador Arduino.

Determination of coalescence kernels for high-shear granulation using DEM simulations

Discrete element method (DEM) modeling is used in parallel with a model for coalescence of deformable surface wet granules. This produces a method capable of predicting both collision rates and coalescence efficiencies for use in derivation of an overall coalescence kernel. These coalescence kernels can then be used in computationally efficient meso-scale models such as population balance equation (PBE) models. A soft-sphere DEM model using periodic boundary conditions and a unique boxing scheme was utilized to simulate particle flow inside a high-shear mixer. Analysis of the simulation results provided collision frequency, aggregation frequency, kinetic energy, coalescence efficiency and compaction rates for the granulation process. This information can be used to bridge the gap in multi-scale modeling of granulation processes between the micro-scale DEM/coalescence modeling approach and a meso-scale PBE modeling approach.

Efficiency Measures in the Agricultural Sector: With Applications

Copyright 2013 Springer Netherlands.

The strategic deployment of quality-improvement innovations

Journal of Business, Vol. 78 Issue 3, p1049-1072

Influence of the crushing process of recycled aggregates on concrete properties

This work intends to evaluate the (mechanical and durability) performance of concrete made with coarse recycled concrete aggregates (CRCA) obtained using two crushing processes: primary crushing (PC) and primary plus secondary crushing (PSC). This analysis intends to select the most efficient production process of recycled aggregates (RA). The RA used here resulted from precast products (P), with strength classes of 20 MPa, 45 MPa and 65 MPa, and from laboratory-made concrete (L) with the same compressive strengths. The evaluation of concrete was made with the following tests: compressive strength; splitting tensile strength; modulus of elasticity; carbona-tion resistance; chloride penetration resistance; capillary water absorption; and water absorption by immersion. These findings contribute to a solid and innovative basis that allows the precasting industry to use without restrictions the waste it generates. © (2015) Trans Tech Publications, Switzerland.

Melhoria do planeamento e abastecimento à montagem

Para conseguir responder às exigências atuais dos mercados, as indústrias necessitam de ser flexíveis, ou seja, é necessário terem a capacidade de adaptar o seu funcionamento e os seus produtos às alterações que se sucedem. Como forma de responder a este facto, o funcionamento da empresa assenta numa produção flexível para conseguir que os seus produtos que abranjam diferente o maior número possível de clientes. No entanto esta metodologia tem apresentado alguns problemas na sua implementação, por isso com o objetivo de obter uma produção mais eficaz e eficiente, a empresa tem canalizado esforços para a melhoria contínua das linhas de montagem. O trabalho desenvolvido na FUTE está enquadrado com a melhoria contínua e visa o processo de abastecimento dos diversos materiais necessários para a produção, característica fundamental para que as linhas possam produzir de forma contínua. Este estudo iniciou-se por analisar o método de abastecimento e identificar os seus problemas e causas, para que posteriormente com o auxílio dos conhecimentos adq uiridos, fosse possível conceber soluções. Os resultados apresentados neste trabalho demonstram que as melhorias implementadas a nível de organização de armazéns, métodos de trabalho e meios de transporte de materiais permitem diminuir o tempo e os recursos necessários durante o processo de abastecimento, além de melhorar condições de trabalho dos operários.

Optimal design and operation of compact simulated moving bed processes for enantioseparations

Simulated moving bed (SMB) chromatography is attracting more and more attention since it is a powerful technique for complex separation tasks. Nowadays, more than 60% of preparative SMB units are installed in the pharmaceutical and in the food in- dustry [SDI, Preparative and Process Liquid Chromatography: The Future of Process Separations, International Strategic Directions, Los Angeles, USA, 2002. http://www. strategicdirections.com]. Chromatography is the method of choice in these ¯elds, be- cause often pharmaceuticals and ¯ne-chemicals have physico-chemical properties which di®er little from those of the by-products, and they may be thermally instable. In these cases, standard separation techniques as distillation and extraction are not applicable. The noteworthiness of preparative chromatography, particulary SMB process, as a sep- aration and puri¯cation process in the above mentioned industries has been increasing, due to its °exibility, energy e±ciency and higher product purity performance. Consequently, a new SMB paradigm is requested by the large number of potential small- scale applications of the SMB technology, which exploits the °exibility and versatility of the technology. In this new SMB paradigm, a number of possibilities for improving SMB performance through variation of parameters during a switching interval, are pushing the trend toward the use of units with smaller number of columns because less stationary phase is used and the setup is more economical. This is especially important for the phar- maceutical industry, where SMBs are seen as multipurpose units that can be applied to di®erent separations in all stages of the drug-development cycle. In order to reduce the experimental e®ort and accordingly the coast associated with the development of separation processes, simulation models are intensively used. One impor- tant aspect in this context refers to the determination of the adsorption isotherms in SMB chromatography, where separations are usually carried out under strongly nonlinear conditions in order to achieve higher productivities. The accurate determination of the competitive adsorption equilibrium of the enantiomeric species is thus of fundamental importance to allow computer-assisted optimization or process scale-up. Two major SMB operating problems are apparent at production scale: the assessment of product quality and the maintenance of long-term stable and controlled operation. Constraints regarding product purity, dictated by pharmaceutical and food regulatory organizations, have drastically increased the demand for product quality control. The strict imposed regulations are increasing the need for developing optically pure drugs.(...)

Optimization of low-cost nutritional supplementation for lignocellulosic ethanol fermentation

[Excerpt] Bioethanol from lignocellulosic materials (LCM), also called second generation bioethanol, is considered a promising alternative to first generation bioethanol. An efficient production process of lignocellulosic bioethanol involves an effective pretreatment of LCM to improve the accessibility of cellulose and thus enhance the enzymatic saccharification. One interesting approach is to use the whole slurry from treatment, since allows economical and industrial benefits: washing steps are avoided, water consumption is lower and the sugars from liquid phase can be used, increasing ethanol concentration [1]. However, during the pretreatment step some compounds (such as furans, phenolic compounds and weak acids) are produced. These compounds have an inhibitory effect on the microorganisms used for hydrolysate fermentation [2]. To overcome this, the use of a robust industrial strain together with agro-industrial by-products as nutritional supplementation was proposed to increase the ethanol productivities and yields. (...)

RNA-driven cyclin-dependent kinase regulation: when CDK9/cyclin T subunits of P-TEFb meet their ribonucleoprotein partners.

The positive transcription elongation factor (P-TEFb) consists of CDK9, a cyclin-dependent kinase and its cyclin T partner. It is required for transcription of most class II genes. Its activity is regulated by non-coding RNAs. The 7SK cellular RNA turns the HEXIM cellular protein into a P-TEFb inhibitor that binds its cyclin T subunit. Thus, P-TEFb activity responds to variations in global cellular transcriptional activity and to physiological conditions linked to cell differentiation, proliferation or cardiac hypertrophy. In contrast, the Tat activation region RNA plays an activating role. This feature at the 5' end of the human immunodeficiency (HIV) viral transcript associates with the viral protein Tat that in turn binds cyclin T1 and recruits active P-TEFb to the HIV promoter. This results in enhanced P-TEFb activity, which is critical for an efficient production of viral transcripts. Although discovered recently, the regulation of P-TEFb becomes a paradigm for non-coding RNAs that regulate transcription factors. It is also a unique example of RNA-driven regulation of a cyclindependent kinase.

Hepatitis B and C virus coinfection: a novel model system reveals the absence of direct viral interference.

Coinfection with hepatitis B virus (HBV) and hepatitis C virus (HCV) has been associated with severe liver disease and frequent progression to cirrhosis and hepatocellular carcinoma. Clinical evidence suggests reciprocal replicative suppression of the two viruses, or viral interference. However, interactions between HBV and HCV have been difficult to study due to the lack of appropriate model systems. We have established a novel model system to investigate interactions between HBV and HCV. Stable Huh-7 cell lines inducibly replicating HBV were transfected with selectable HCV replicons or infected with cell culture-derived HCV. In this system, both viruses were found to replicate in the same cell without overt interference. Specific inhibition of one virus did not affect the replication and gene expression of the other. Furthermore, cells harboring replicating HBV could be infected with cell culture-derived HCV, arguing against superinfection exclusion. Finally, cells harboring replicating HBV supported efficient production of infectious HCV. Conclusion: HBV and HCV can replicate in the same cell without evidence for direct interference in vitro. Therefore, the viral interference observed in coinfected patients is probably due to indirect mechanisms mediated by innate and/or adaptive host immune responses. These findings provide new insights into the pathogenesis of HBV-HCV coinfection and may contribute to its clinical management in the future.

Plastic Air Content versus Hardened Air Content by High Pressure Air Meter, MLR-99-03, 2001

Plastic air content is typically tested by the pressure method, ASTM C138. Loss of air content through the paver has been shown to exceed 2 percent at times. Research has shown that early deterioration of pavements in Iowa may be directly or indirectly related to low or inadequate air content. Hardened air content is typically checked using the linear traverse method, ASTM C457. The linear traverse method is very time consuming and could not be used on a production scale. A quick and effective method of testing in place air content is needed. Research has shown a high degree of correlation with the high-pressure method of determining air content of hardened concrete versus plastic air content in laboratory conditions. This research indicated that air contents are more variable when comparing core results to plastic air content, although the overall average for the air content was comparable. Perhaps, the location of the plastic air content test, obtained from construction records, versus location of the cores was not as accurate as needed.

Konfiguroituvan tuotteen tuoterakennesystematiikan kehittäminen

Ponsse Oyj:n kaltainen konfiguroituvaa, monimutkaista tuotetta valmistava yhtiö tarvitsee ehdottomasti nykyaikaisen modulaarisuuteen perustuvan tuoterakennesystematiikan. Käyttämällä osioita eri modulaarisuusmalleista ja soveltamalla niitä Ponssen näkökulmasta kaikkein edullisimmalla tavalla, on kehitetty ensimmäinen case - tapaus ja sen myötä mahdollisimman yksinkertainen toimintamalli. Mallissa on otettu huomioon myös useat tuoterakenteen kanssa vuorovaikutuksessa olevat tekijät. Myyntitilanteen valinnat ovat listattu konfigurointimatriisiin ja ne voivat olla itsenäisiä tai sulkea pois joitakin toisia valintoja. Kun sopiva koneyksilö on muodostettu, saadaan matriisista samantien tulostettua valintojen mukainen tuoteyksilö. Tuoteyksilön moduulirakenne toimii kyseisen, yksittäisen koneen työmääräimenä sekä koneenvalmistuksen dokumenttina, sillä luettelon yksi moduuli on yhden valmistettavantyövaiheen moduulipiirustus alimoduuleineen ja osineen. Moduulipiirustusten on siis otettava huomioon tuotannon, oston, suunnittelun ja dokumentoinnin näkökulmat. Piirustuksen laatijan on tiedettävä kyseisen moduulin valmistus eli koottavan komponenttikokoelman laajuus sekä tuotantolinjan että osto-osaston intressien mukaisesti. Piirustuksen on nivouduttava sitä kutsuvaan matriisiin ja kyseisen moduulin valinnan kytköksiin muihin moduuleihin nähden. Kaiken lisäksi piirustuksen on toimittava kokoonpano-ohjeena sekä jälkimarkkinoinnin työkaluna. Tässä työssä muodostettiin metsätraktorin ohjaamosta esimerkkitapaus. Case tapauksessa käytettiin työssä esitettyä uutta tuoterakennesystematiikkaa uuden modulaarisuussäännöstön käytöstä, laskettu sen aiheuttamat muutokset ja sen tuotantoon otosta on kerätty ensimmäiset kommentit. Esimerkillä pyrittiin saavuttamaan modulaarisen tuoterakenteen mahdollistamat edut ja projektia on jatkettu Ponsse Oyj:llä käsittämään muitakin tuotekokonaisuuksia.

Ammoniakin talteenottoprosessin kehitys

Diplomityössä kehitettiin ioninvaihtoon perustuva ammoniakin talteenottoprosessi NSSC (Neutral Sulphite Semi Chemical) -prosessin haihduttamon lauhteille. Tarkoituksena oli saada aallotuskartonkitehtaan kemi-kaalikiertoa suljettua ja sitä kautta ammoniakkipäästöjä vähennettyä. Ammoniakki tuli ottaa hyötymuodossa (ammoniakkihöyry tai ammoniumsulfiitti) talteen. Ammoniumsulfiittiliuosta käytetään NSSC-prosessissa keittonesteenä. Kirjallisuusosassa selvitetään strippaukseen perustuvia ammoniakin talteenottomahdollisuuksia. Tutkitaan ioninvaihdon teoriaa ja ammoniumin talteenottoon sopivien ioninvaihtomateriaalien ominaisuuksia ioninvaihtajina. Lisäksi esitetään ioninvaihtoprosesseihin liittyviä laitteistoratkaisuja ja prosessiolosuhteita. Työn kokeellisessa osassa on yleiskuvaus Powerflute Oy Savon Sellun prosesseista ja selvitetään ammoniakin merkitystä tehtaalle. Laboratoriokokein tutkittiin orgaanisten kationihartsien sekä epäorgaanisen luonnon zeoliitin soveltuvuutta ammoniumionien vaihtoon esihaihduttamon lauhteesta. Ammoniakin talteenottoprosessin toimivuutta teollisessa mittakaavassa selvitettiin rakennetulla pilotlaitteistolla suoritettujen kokeiden avulla. Lopuksi tehtiin ammoniakin talteenottoprosessin scale-up: laskettiin prosessin talteenottokapasiteetti, arvioitiin kustannuksia sekä annettiin lausunto prosessin toteutettavuudesta. Laboratoriokokeiden perusteella luonnon zeoliitti ja heikosti hapan ioninvaihtohartsi eivät sovellu ammoniumionien vaihtoon NSSC haihduttamon lauhteista. Vahvasti hapan kationihartsi toimi ammoniumin talteenotossa parhaiten, joten se valittiin pilotkokeiden ioninvaihtomateriaaliksi. Pilotkokeissa ioninvaihtomateriaaliin saatiin sidottua ammoniumia noin 30 g NH4+ / dm3 hartsia, kun materiaalin teoreettinen ioninvaihtokapasiteetti oli 32 g NH4+ / dm3 hartsia. Ammoniumin läpäisykäyrien muotoon vaikutti suuresti syöttölauhteen virtausnopeus ja ammoniumpitoisuus. Ioninvaihtomateriaalipedin syvyydellä ei ollut niinkään merkitystä. Pilotkokeiden regenerointitavoista tehokkaimmaksi osoittautui höyrystrippaus, jossa saavutettiin noin 90 %:n talteenottotehokkuus. Rikkihapokekäsittelyllä talteenottotehokkuus jäi 50 %:iin. Teollisen mittakaavan laitoksella voidaan vuosittain regenerointitavasta riippuen ottaa talteen esihaihdut-tamon lauhteesta noin 100-150 tonnia ammoniakkia. Prosessin käyttökustannukset ovat talteenotetusta ammoniakista saataviin säästöihin verrattuna suuret ja niihin vaikuttaa merkittävästi ioninvaihtohartsin käyttöikä sekä regenerointikemikaalien kulutus. Osittaisella kemikaalikierron sulkemisella saavutetaan NSSC-prosessissa sekundäärietuja, joiden vaikutuksen merkittävyys pitäisi tarkentaa lisätutkimuksilla.

Laminaatin toiminnallisten ominaisuuksien hallinta

Lattialaminaatti on kerrosrakenteinen levymateriaali. Tässä työssä tutkittiin laminaatin epäsymmetrisen kerrosrakenteen aiheuttamaa taipumusta käyristymiseen. Työn tavoitteena oli kehittää lattialaminaatin käyristymän hallintaan käytettävää taustapaperia niin, että käyristymää ei tapahtuisi tai käyristymä olisi lievästi alapintaa kohden heti puristuksen jälkeen ja säilyisi samanlaisena varastoinnissa. Kehityksessä huomioitiin taustan ulkonäkö. Taustapapereita valmistettiin sekä pilot- että tuotantomittakaavassa. Lisäksi työssä tutkittiin laminointiolosuhteiden vaikutusta lattialaminaatin käyristymään. Työn kirjallisuusosassa käsitellään lattialaminaatin valmistusta huomioiden ulkonäköön vaikuttavat tekijät sekä lattialaminaatin käyristymiseen vaikuttavia tekijöitä.Lattialaminaatin käyristymään vaikuttavat laminointiolosuhteet. Puulevyä vasten puristettavat kalvot kutistuvat laminoinnissa, erityisesti puristuslämpötilan kasvaessa. Laminaatin puristuksen jälkeinen käyristymä määräytyy lähinnä ylä- ja alapinnan kalvojen kutistuman erolla.Lattialaminaatin käyristymään varastoinnissa vaikuttaa ylä- ja alapinnan kalvojen dimensiostabiliteettikerroin. Yläpinnan kalvon dimensiostabiliteetti on huonompi kuin alapinnan, jolloin yläpinnan kalvo kutistuu enemmän kuivissa olosuhteissa käyristäen samalla laminaattia positiiviseen suuntaan.Taustapaperin ominaisuuksista merkittävimmin laminaatin käyristymään vaikuttaa kuituraaka-aine. Lattialaminaatin ulkonäköön vaikuttavat pinnassa olevat kuopat. Laminaatin taustan ulkonäköä voidaan parantaa lisäämällä taustapaperiin pehmitintä. Vääräntyyppisellä pehmittimellä menetetään taustan vastavetovoimaa.