Strategic Emergency department design: An approach to capacity planning in healthcare provision in overcrowded emergency rooms

Healthcare professionals and the public have increasing concerns about the ability of emergency departments to meet current demands. Increased demand for emergency services, mainly caused by a growing number of minor and moderate injuries has reached crisis proportions, especially in the United Kingdom. Numerous efforts have been made to explore the complex causes because it is becoming more and more important to provide adequate healthcare within tight budgets. Optimisation of patient pathways in the emergency department is therefore an important factor. This paper explores the possibilities offered by dynamic simulation tools to improve patient pathways using the emergency department of a busy university teaching hospital in Switzerland as an example.

Peri-implant bone loss of dental implants with platform-switching design after 5 years of loading: a cross-sectional study

OBJECTIVE The aim of this cross-sectional study was to estimate bone loss of implants with platform-switching design and analyze possible risk indicators after 5 years of loading in a multi-centered private practice network. METHOD AND MATERIALS Peri-implant bone loss was measured radiographically as the distance from the implant shoulder to the mesial and distal alveolar crest, respectively. Risk factor analysis for marginal bone loss included type of implant prosthetic treatment concept and dental status of the opposite arch. RESULTS A total of 316 implants in 98 study patients after 5 years of loading were examined. The overall mean value for radiographic bone loss was 1.02 mm (SD ± 1.25 mm, 95% CI 0.90- 1.14). Correlation analyses indicated a strong association of peri-implant bone loss > 2 mm for removable implant-retained prostheses with an odds ratio of 53.8. CONCLUSION The 5-year-results of the study show clinically acceptable values of mean bone loss after 5 years of loading. Implant-supported removable prostheses seem to be a strong co-factor for extensive bone level changes compared to fixed reconstructions. However, these results have to be considered for evaluation of the included special cohort under private dental office conditions.

A User Centered Design Approach for Patient Interfaces to a Diabetes IT Platform

Improving patient self-management can have a greater impact than improving any clinical treatment (WHO). We propose here a systematic and comprehensive user centered design approach for delivering a technological platform for diabetes disease management. The system was developed under the METABO research project framework, involving patients from 3 different clinical centers in Parma, Modena and Madrid.

Design of an Advanced Platform for Citizen Participation Committed to Ensuring Freedom of Speech

This paper presents a proposal for an advanced system of debate in an environment of digital democracy which overcomes the limitations of existing systems. We have been especially careful in applying security procedures in telematic systems, for they are to offer citizens the guarantees that society demands. New functional tools have been included to ensure user authentication and to permit anonymous participation where the system is unable to disclose or even to know the identity of system users. The platform prevents participation by non-entitled persons who do not belong to the authorized group from giving their opinion. Furthermore, this proposal allows for verifying the proper function of the system, free of tampering or fraud intended to alter the conclusions or outcomes of participation. All these tools guarantee important aspects of both a social and technical nature, most importantly: freedom of expression, equality and auditability.

Design and evaluation of an educational platform for implementing and testing bilateral control algorithms

This paper describes the design and evaluation of a new platform created in order to improve the learning experience of bilateral control algorithms in teleoperation. This experimental platform, developed at Universidad Politécnica de Madrid, is used by the students of the Master on Automation and Robotics in the practices of the subject called “Telerobotics and Teleoperation”. The main objective is to easily implement different control architectures in the developed platform and evaluate them under different conditions to better understand the main advantages and drawbacks of each control scheme. So, the student’s tasks are focused on adjusting the control parameters of the predefined controllers and designing new ones to analyze the changes in the behavior of the whole system. A description of the subject, main topics and the platform constructed are detailed in the paper. Furthermore, the methodology followed in the practices and the bilateral control algorithms are presented. Finally, the results obtained in the experiments with students are also shown.

Conceptual design of offshore platform supply vessel based on hybrid diesel generator-fuel cell power plant

Nowadays increasing fuel prices and upcoming pollutant emission regulations are becoming a growing concern for the shipping industry worldwide. While fuel prices will keep rising in future years, the new International Convention for the Prevention of Pollution from Ships (MARPOL) and Sulphur Emissions Control Areas (SECA) regulations will forbid ships to use heavy fuel oils at certain situations. To fulfil with these regulations, the next step in the marine shipping business will comprise the use of cleaner fuels on board as well as developing new propulsion concept. In this work a new conceptual marine propulsion system is developed, based on the integration of diesel generators with fuel cells in a 2850 metric tonne of deadweight platform supply vessel. The efficiency of the two 250 kW methanol-fed Solid Oxide Fuel Cell (SOFC) system installed on board combined with the hydro dynamically optimized design of the hull of the ship will allow the ship to successfully operate at certain modes of operation while notably reduce the pollutant emissions to the atmosphere. Besides the cogeneration heat obtained from the fuel cell system will be used to answer different heating needs on board the vessel

Structure of the HIV-1 integrase catalytic domain complexed with an inhibitor: A platform for antiviral drug design

HIV integrase, the enzyme that inserts the viral DNA into the host chromosome, has no mammalian counterpart, making it an attractive target for antiviral drug design. As one of the three enzymes produced by HIV, it can be expected that inhibitors of this enzyme will complement the therapeutic use of HIV protease and reverse transcriptase inhibitors. We have determined the structure of a complex of the HIV-1 integrase core domain with a novel inhibitor, 5ClTEP, 1-(5-chloroindol-3-yl)-3-hydroxy-3-(2H-tetrazol-5-yl)-propenone, to 2.1-Å resolution. The inhibitor binds centrally in the active site of the integrase and makes a number of close contacts with the protein. Only minor changes in the protein accompany inhibitor binding. This inhibitor complex will provide a platform for structure-based design of an additional class of inhibitors for antiviral therapy.

A configuration framework of manufacturing strategy paradigm in state owned enterprises within China's petrochemical industry:building context-embedded configurations for the paradigm of strategic manufacturing management from exploratory case studies

The role of the production system as a key determinant of competitive performance of business operations- has long been the subject of industrial organization research, even predating the .explicit conceptua1isation of manufacturing, strategy in the literature. Particular emergent production issues such as the globalisation of production, global supply chain management, management of integrated manufacturing and a growing e~busjness environment are expected to critically influence the overall competitive performance and therefore the strategic success of the organization. More than ever, there is a critical need to configure and improve production system and operations competence in a strategic way so as to contribute to the long-term competitiveness of the organization. In order to operate competitively and profitably, manufacturing companies, no matter how well managed, all need a long-term 'strategic direction' for the development of operations competence in order to consistently produce more market value with less cost towards a leadership position. As to the long-term competitiveness, it is more important to establish a dynamic 'strategic perspective' for continuous operational improvements in pursuit of this direction, as well as ongoing reviews of the direction in relation to the overall operating context. However, it also clear that the 'existing paradigm of manufacturing strategy development' is incapable of adequately responding to the increasing complexities and variations of contemporary business operations. This has been factually reflected as many manufacturing companies are finding that methodologies advocated in the existing paradigm for developing manufacturing strategy have very limited scale and scope for contextual contingency in empirical application. More importantly, there has also emerged a deficiency in the multidimensional and integrative profile from a theoretical perspective when operationalising the underlying concept of strategic manufacturing management established in the literature. The point of departure for this study was a recognition of such contextual and unitary limitations in the existing paradigm of manufacturing strategy development when applied to contemporary industrial organizations in general, and Chinese State Owned Enterprises (SOEs) in particular. As China gradually becomes integrated into the world economy, the relevance of Western management theory and its paradigm becomes a practical matter as much as a theoretical issue. Since China markedly differs from Western countries in terms of culture, society, and political and economic systems, it presents promising grounds to test and refine existing management theories and paradigms with greater contextual contingency and wider theoretical perspective. Under China's ongoing programmes of SOE reform, there has been an increased recognition that strategy development is the very essence of the management task for managers of manufacturing companies in the same way as it is for their counterparts in Western economies. However, the Western paradigm often displays a rather naive and unitary perspective of the nature of strategic management decision-making, one which largely overlooks context-embedded factors and social/political influences on the development of manufacturing strategy. This thesis studies the successful experiences of developing manufacturing strategy from five high-performing large-scale SOEs within China’s petrochemical industry. China’s petrochemical industry constitutes a basic heavy industrial sector, which has always been a strategic focus for reform and development by the Chinese government. Using a confirmation approach, the study has focused on exploring and conceptualising the empirical paradigm of manufacturing strategy development practiced by management. That is examining the ‘empirical specifics’ and surfacing the ‘managerial perceptions’ of content configuration, context of consideration, and process organization for developing a manufacturing strategy during the practice. The research investigation adopts a qualitative exploratory case study methodology with a semi-structural front-end research design. Data collection follows a longitudinal and multiple-case design and triangulates case evidence from sources including qualitative interviews, direct observation, and a search of documentations and archival records. Data analysis follows an investigative progression from a within-case preliminary interpretation of facts to a cross-case search for patterns through theoretical comparison and analytical generalization. The underlying conceptions in both the literature of manufacturing strategy and related studies in business strategy were used to develop theoretical framework and analytical templates applied during data collection and analysis. The thesis makes both empirical and theoretical contributions to our understanding of 'contemporary management paradigm of manufacturing strategy development'. First, it provides a valuable contextual contingency of the 'subject' using the business setting of China's SOEs in petrochemical industry. This has been unpacked into empirical configurations developed for its context of consideration, its content and process respectively. Of special note, a lean paradigm of business operations and production management discovered at case companies has significant implications as an emerging alternative for high-volume capital intensive state manufacturing in China. Second, it provides a multidimensional and integrative theoretical profile of the 'subject' based upon managerial perspectives conceptualised at case companies when operationalising manufacturing strategy. This has been unpacked into conceptual frameworks developed for its context of consideration, its content constructs, and its process patterns respectively. Notably, a synergies perspective towards the operating context, competitive priorities and competence development of business operations and production management has significant implications for implementing a lean manufacturing paradigm. As a whole, in so doing, the thesis established a theoretical platform for future refinement and development of context-specific methodologies for developing manufacturing strategy.

Towards the strategic adoption of Lean in aviation Maintenance Repair and Overhaul (MRO) industry:an empirical study into the industry's Lean status

Purpose - Despite many Maintenance Repair and Overhaul (MRO) organisations alluding their positive business performances to the adoption Lean initiatives, there is a paucity of direct literature that validates this assertion. Thus, the purpose of this paper is to study empirically via the use of an industry-wide survey to establish and extent of Lean adoption and to verify its suitability in mitigating prevalent MRO challenges. Design/methodology/approach - The empirical study contained in this paper is facilitated by an industry-wide survey to collect data from several firms across the MRO spectrum. The analysed responses from industry leaders, professionals and executives synthesised with existing literature was used in ascertaining the extent of Lean adoption within the operational framework of the industry. Findings - The empirical study helped in validating the suitability of Lean in MRO context. However, it was also observed that the focus of its application was skewed towards its production-orientated functions more than its service-orientated functions. Nonetheless, this paper presents results of the positive influence of Lean in MRO context. Research limitations/implications - This empirical study presented in this paper was carried out within a framework of key characteristics of operation. Although this approach is sufficient in assessing the industry's Lean status, further assessment can also be achieved within the context of relevant performance metrics which was not included in this paper. Practical implications - By exploring the industry's Lean status within the context of operational characteristics of operation, this study provides MRO practitioners with more awareness into some of the critical factors required for successful holistic Lean realisation. Social implications - The state-of-the-art of Lean within the aviation MRO context established through this research also contributes to the wider product-centric service environment by providing a platform that facilitates strategy development which ensures Lean success within this environment. Originality/value - Apart from validating the suitability of Lean in MRO contexts, by establishing the extent of Lean adoption within the context of the operational framework, this paper provides a clearer insight as to how successful Lean implementation can be achieved via a holistic implementation strategy balanced between the product-centric and service-centric aspects of the industry.

Design and analysis of a compliant parallel pan-tilt platform

In combination of the advantages of both parallel mechanisms and compliant mechanisms, a compliant parallel mechanism with two rotational DOFs (degrees of freedom) is designed to meet the requirement of a lightweight and compact pan-tilt platform. Firstly, two commonly-used design methods i.e. direct substitution and FACT (Freedom and Constraint Topology) are applied to design the configuration of the pan-tilt system, and similarities and differences of the two design alternatives are compared. Then inverse kinematic analysis of the candidate mechanism is implemented by using the pseudo-rigid-body model (PRBM), and the Jacobian related to its differential kinematics is further derived to help designer realize dynamic analysis of the 8R compliant mechanism. In addition, the mechanism’s maximum stress existing within its workspace is tested by finite element analysis. Finally, a method to determine joint damping of the flexure hinge is presented, which aims at exploring the effect of joint damping on actuator selection and real-time control. To the authors’ knowledge, almost no existing literature concerns with this issue.

The strategic role of design in supporting knowledge exchange

Within the last decade design has had a strategic role in tackling escalating environmental, social and economic problems. Through design thinking, creative methods have been applied to problem solving in a process of collaboration and designers working in new territories and knowledge domains. As the designer has moved further afield the method of Knowledge Exchange (KE) has become more recognised as a democratic approach to collaboration with the ethos that everyone has something creative and productive to offer. This paper provides reflections on early stage findings from a strategic design innovation process in which collaborative partnerships between academics, SMEs and designers emerged through KE and suggests that there is value to be had from using design strategically for not only those from a business or academic background but also for those from the design community and points to a need for more training for designers from all disciplines in how to use design strategically

Design and validation of a novel generic platform for the production of tetravalent IgG1-like bispecific antibodies

International audience

Development of a novel platform for high-throughput gene design and artificial gene synthesis to produce large libraries of recombinant venom peptides for drug discovery

Tese de Doutoramento em Ciências Veterinárias na Especialidade de Ciências Biológicas e Biomédicas

Strategic Optimization Techniques For FRTU Deployment and Chip Physical Design

Combinatorial optimization is a complex engineering subject. Although formulation often depends on the nature of problems that differs from their setup, design, constraints, and implications, establishing a unifying framework is essential. This dissertation investigates the unique features of three important optimization problems that can span from small-scale design automation to large-scale power system planning: (1) Feeder remote terminal unit (FRTU) planning strategy by considering the cybersecurity of secondary distribution network in electrical distribution grid, (2) physical-level synthesis for microfluidic lab-on-a-chip, and (3) discrete gate sizing in very-large-scale integration (VLSI) circuit. First, an optimization technique by cross entropy is proposed to handle FRTU deployment in primary network considering cybersecurity of secondary distribution network. While it is constrained by monetary budget on the number of deployed FRTUs, the proposed algorithm identi?es pivotal locations of a distribution feeder to install the FRTUs in different time horizons. Then, multi-scale optimization techniques are proposed for digital micro?uidic lab-on-a-chip physical level synthesis. The proposed techniques handle the variation-aware lab-on-a-chip placement and routing co-design while satisfying all constraints, and considering contamination and defect. Last, the first fully polynomial time approximation scheme (FPTAS) is proposed for the delay driven discrete gate sizing problem, which explores the theoretical view since the existing works are heuristics with no performance guarantee. The intellectual contribution of the proposed methods establishes a novel paradigm bridging the gaps between professional communities.