Impact of parenteral nutrition standardization on costs and quality in adult patients

Background: Parenteral nutrition (PN) is a costly therapy that can also be associated with serious complications. Therefore, efforts are focusing on reducing rate of complications, and costs related to PN. Objective: The aim was to analyze the effect of the implementation of PN standardization on costs and quality criteria. Secondary aim was to assess the use of individualized PN based on patient's clinical condition. Methods: We compare the use of PN before and after the implementation of PN standardization. Demographic, clinical and PN characteristics were collected. Costs analysis was performed to study the costs associated to the two different periods. Quality criteria included were: 1) PN administration; 2) nutrition assessment (energy intake between 20-35 kcal/kg/day; protein contribution according to nitrogen balance); 3) safety and complications (hyperglycemia, hypertriglyceridemia, hepatic complications, catheter-related infection); 4) global efficacy (as serum albumin increase). Chi-square test was used to compare percentages; logistic regression analysis was performed to evaluate the use of customized PN. Results: 296 patients were included with a total of 3,167 PN compounded. During the first period standardized PN use was 47.5% vs 85.7% within the second period (p < 0.05). No differences were found in the quality criteria tested. Use of individualized PN was related to critical care patients, hypertriglyceridemia, renal damage, and long-term PN. Mean costs of the PN decreased a 19.5%. Annual costs savings would be € 86,700. Conclusions: The use of customized or standard PN has shown to be efficient and flexible to specific demands; however customized PN was significantly more expensive.

Geothermal district heating networks: modelling novel operational strategies incorporating heat storage

The value of integrating a heat storage into a geothermal district heating system has been investigated. The behaviour of the system under a novel operational strategy has been simulated focusing on the energetic, economic and environmental effects of the new strategy of incorporation of the heat storage within the system. A typical geothermal district heating system consists of several production wells, a system of pipelines for the transportation of the hot water to end-users, one or more re-injection wells and peak-up devices (usually fossil-fuel boilers). Traditionally in these systems, the production wells change their production rate throughout the day according to heat demand, and if their maximum capacity is exceeded the peak-up devices are used to meet the balance of the heat demand. In this study, it is proposed to maintain a constant geothermal production and add heat storage into the network. Subsequently, hot water will be stored when heat demand is lower than the production and the stored hot water will be released into the system to cover the peak demands (or part of these). It is not intended to totally phase-out the peak-up devices, but to decrease their use, as these will often be installed anyway for back-up purposes. Both the integration of a heat storage in such a system as well as the novel operational strategy are the main novelties of this thesis. A robust algorithm for the sizing of these systems has been developed. The main inputs are the geothermal production data, the heat demand data throughout one year or more and the topology of the installation. The outputs are the sizing of the whole system, including the necessary number of production wells, the size of the heat storage and the dimensions of the pipelines amongst others. The results provide several useful insights into the initial design considerations for these systems, emphasizing particularly the importance of heat losses. Simulations are carried out for three different cases of sizing of the installation (small, medium and large) to examine the influence of system scale. In the second phase of work, two algorithms are developed which study in detail the operation of the installation throughout a random day and a whole year, respectively. The first algorithm can be a potentially powerful tool for the operators of the installation, who can know a priori how to operate the installation on a random day given the heat demand. The second algorithm is used to obtain the amount of electricity used by the pumps as well as the amount of fuel used by the peak-up boilers over a whole year. These comprise the main operational costs of the installation and are among the main inputs of the third part of the study. In the third part of the study, an integrated energetic, economic and environmental analysis of the studied installation is carried out together with a comparison with the traditional case. The results show that by implementing heat storage under the novel operational strategy, heat is generated more cheaply as all the financial indices improve, more geothermal energy is utilised and less fuel is used in the peak-up boilers, with subsequent environmental benefits, when compared to the traditional case. Furthermore, it is shown that the most attractive case of sizing is the large one, although the addition of the heat storage most greatly impacts the medium case of sizing. In other words, the geothermal component of the installation should be sized as large as possible. This analysis indicates that the proposed solution is beneficial from energetic, economic, and environmental perspectives. Therefore, it can be stated that the aim of this study is achieved in its full potential. Furthermore, the new models for the sizing, operation and economic/energetic/environmental analyses of these kind of systems can be used with few adaptations for real cases, making the practical applicability of this study evident. Having this study as a starting point, further work could include the integration of these systems with end-user demands, further analysis of component parts of the installation (such as the heat exchangers) and the integration of a heat pump to maximise utilisation of geothermal energy.

Puupolttoaineen varastonhallinta- ja hankintamalli

Työssä luodaan energiapuun varastonhallintamalli ja hankintamalli energiantuotantolaitoksen näkökulmasta sekä kuvataan kustannustehokkaita ja toimitusvarmoja vaihtoehtoja puupolttoaineen varastoinnille ja haketukselle. Varastonhallintamallissa keskitytään varastotason hallintamenetelmiin toimintaympäristössään. Hankintamalli määrittää oman varaston ja suoran laitostoimituksen suhteen sekä auttaa pohtimaan strategisen hankinnan merkitystä hankinnan toteuttamiseen ja hankintakanavien valintaan. Työ antaa vastauksia koko hankintatoiminnan toteutukseen ja hallitsemiseen. Varastonhallintamallin skenaariotarkastelussa selvisi, että yrityksen oma varasto vaatii 18 – 37 % varmuusvaraston suhteessa käyttövarastoon. Hankintamallin mukaan oman varaston kannattavimman puupolttoainejakeen hankintaetäisyys voisi olla keskimäärin korkeintaan 96 km. Tarpeen, saatavuuden, jakeiden kustannustasojen ja toimintaympäristön mahdollisuuksien ollessa selvillä, on mahdollista tehdä päätöksiä hankintakanavista ja varmuusvarastoista kustannustehokkuuden perusteella. Yrityksen polttoainemäärien ohjauksen toteutukseen vaaditaan kehittämistoimia. Oman toimintaympäristön vakiointi ja toimintamallien dokumentointi on tärkeää tiedonjaon, toimitussopimusten mitoittamisen ja toiminnan kehittämisen kannalta. Toiminnan pullonkaulojen vähentäminen ja puupolttoaineen ohjaaminen kustannustehokkaimpien haketusketjujen kautta mahdollisimman tehokkaasti synnyttävät kustannussäästöjä toimitusketjussa.

Wind turbine indirect ice detection and operational analysis

Wind energy is one of the most promising and fast growing sector of energy production. Wind is ecologically friendly and relatively cheap energy resource available for development in practically all corners of the world (where only the wind blows). Today wind power gained broad development in the Scandinavian countries. Three important challenges concerning sustainable development, i.e. energy security, climate change and energy access make a compelling case for large-scale utilization of wind energy. In Finland, according to the climate and energy strategy, accepted in 2008, the total consumption of electricity generated by means of wind farms by 2020, should reach 6 - 7% of total consumption in the country [1]. The main challenges associated with wind energy production are harsh operational conditions that often accompany the turbine operation in the climatic conditions of the north and poor accessibility for maintenance and service. One of the major problems that require a solution is the icing of turbine structures. Icing reduces the performance of wind turbines, which in the conditions of a long cold period, can significantly affect the reliability of power supply. In order to predict and control power performance, the process of ice accretion has to be carefully tracked. There are two ways to detect icing – directly or indirectly. The first way applies to the special ice detection instruments. The second one is using indirect characteristics of turbine performance. One of such indirect methods for ice detection and power loss estimation has been proposed and used in this paper. The results were compared to the results directly gained from the ice sensors. The data used was measured in Muukko wind farm, southeast Finland during a project 'Wind power in cold climate and complex terrain'. The project was carried out in 9/2013 - 8/2015 with the partners Lappeenranta university of technology, Alstom renovables España S.L., TuuliMuukko, and TuuliSaimaa.

How to optimize operational shipping processes of non-production materials? The Volkswagen Autoeuropa case study

Field lab: Entrepreneurial and innovative ventures

Forming the link between strategic performance and operational success: The development of a balanced scorecard at Lisbon Consulting Group

Directed internship

MEDAR/MEDATLAS 2002: A Mediterranean and Black Sea database for operational oceanography Elsevier Oceanography Series

A comprehensive database of temperature, salinity and bio-chemical parameters in the Mediterranean and Black Sea has been constructed through comprehensive co-operation between the bordering countries. Statistical climatologies have been computed with all assembled and quality controlled data. The database, designed to initiate and validate prediction models, also represents a system to quality-check new incoming data produced by ocean observing systems.

STANDARDIZATION OF CASSAVA MAHEWU FERMENTATION AND ASSESSMENT OF THE EFFECTS OF IRON SOURCES USED FOR FORTIFICATION

Cassava root is the main staple for 70% of the population in Mozambique, particularly in inaccessible rural areas, but is known to be low in iron. Anaemia is a public health problem in mothers and preschool children in Mozambique and up to 40% of these cases are probably due to dietary iron deficiency. The World Health Organization (WHO) and Food and Agriculture Organization of the United Nations (FAO) recognize the fortification of foodstuff as an effective method to remedy dietary deficiencies of micronutrients, including iron. Cassava mahewu, a non-alcoholic fermented beverage is prepared at subsistence level from cassava roots using indigenous procedures. The aim of the study was to standardize mahewu fermentation and investigate if the type of cassava fermented, or the iron compound used for fortification affected the final product. Roots of sweet and bitter varieties of cassava from four districts (Rapale, Meconta, Alto Molocue and Zavala) in Mozambique, were peeled, dried and pounded to prepare flour. Cassava flour was cooked and fermented under controlled conditions (45°C for 24 h). The fermentation period and temperature were set, based on the findings of a pilot study which showed that an end-point pH of about 4.5 was regularly reached after 24 h at 45°C. Cassava mahewu was fortified with ferrous sulfate (FeSO4.7H2O) or ferrous fumarate (C4H2FeO4) at the beginning (time zero) and at the end of fermentation (24 h). The amount of iron added to the mahewu was based on the average of the approved range of iron used for the fortification of maize meal. The mean pH at the endpoint was 4.5, with 0.29% titratable acidity. The pH and acidity were different to those reported in previous studies on maize mahewu, whereas the solid extract of 9.65% was found to be similar. Lactic acid bacteria (LAB) and yeast growth were not significantly different in mahewu fortified with either of the iron compounds. There was no significant difference between cassava mahewu made from bitter or sweet varieties. A standard method for preparation and iron fortification of cassava mahewu was developed. It is recommended that fortification occurs at the end of fermentation when done at household level.

IQuOD 4th workshop in Tokyo: Copernicus Marine in situ TAC, a service for operational oceanography

Copernicus is a European system for monitoring the Earth. COPERNICUS-CMEMS products and services are meant to serve all marine applications: Marine resources, Maritime safety, Coastal and Marine Environment, Seasonal Forecast & Climate. The service is ambitious as the ocean is complex and many processes are involved, from physical oceanography, biology, geology, ocean-atmosphere fluxes, solar radiations, moon induced tides, anthropic activity. A multi-platform approach is essential, taking into account sea-level stations, coastal buoys, HF radars, river flows, drifting buoys, sea-mammal or fishes fitted with sensors, vessels, gliders, floats.

Developing European operational oceanography for Blue Growth, climate change adaptation and mitigation, and ecosystem-based management

Operational approaches have been more and more widely developed and used for providing marine data and information services for different socio-economic sectors of the Blue Growth and to advance knowledge about the marine environment. The objective of operational oceanographic research is to develop and improve the efficiency, timeliness, robustness and product quality of this approach. This white paper aims to address key scientific challenges and research priorities for the development of operational oceanography in Europe for the next 5-10 years. Knowledge gaps and deficiencies are identified in relation to common scientific challenges in four EuroGOOS knowledge areas: European Ocean Observations, Modelling and Forecasting Technology, Coastal Operational Oceanography and Operational Ecology. The areas "European Ocean Observations" and "Modelling and Forecasting Technology" focus on the further advancement of the basic instruments and capacities for European operational oceanography, while "Coastal Operational Oceanography" and "Operational Ecology" aim at developing new operational approaches for the corresponding knowledge areas.

Os processos de normalização e desenvolvimento da doutrina militar combinada nas Forças Armadas Portuguesas

O emprego das Forças Armadas Portuguesas em Operações Conjuntas e Combinadas faz-se no âmbito do quadro de alianças de que Portugal faz parte, das quais destacamos a Organização do Tratado do Atlântico Norte. No sentido de melhorar a eficácia operacional, a normalização assume um papel fundamental para que se possa atingir a interoperabilidade entre as forças da Aliança. Assim, este trabalho teve como objetivo principal, analisar e sintetizar os processos de normalização e desenvolvimento de doutrina Militar Conjunta e Combinada nas Forças Armadas Portuguesas. Tem ainda como finalidade, identificar lacunas nos processos nacionais, de forma a contribuir para uma melhor integração e harmonização da doutrina da Aliança, tendo em consideração a doutrina nacional e os interesses nacionais. A nossa investigação baseou-se num raciocínio hipotético-dedutivo, apoiado por uma estratégia qualitativa. O modelo de análise desenvolvido teve por hipóteses, que foram deduzidas de questões derivadas da questão central. Neste processo analítico, identificámos indicadores que permitiram a validação das hipóteses, para este efeito, recorremos a dois estudos de caso e uma análise SWOT. O desenvolvimento de um plano de ação que permita a integração dos processos analisados constitui o principal contributo desta investigação. A necessidade de criar uma Estrutura Coordenadora de Normalização, primordial para agilizar os procedimentos de normalização entre o Ministério da Defesa Nacional, o Estado-Maior General das Forças Armadas e os Ramos, juntamente, com a criação de um Conselho Superior de Doutrina nas Forças Armadas, que defina as prioridades e orientações gerais para o desenvolvimento de doutrina, constituem os principais resultados desta investigação. Abstract: The use of the Portuguese Armed Forces in Combined and Joint Operations is made within the framework of alliances that Portugal is a member, of which we highlight the North Atlantic Treaty Organization. In order to improve the operational efficiency, standardization plays a key role in achieving the interoperability between the forces of the Alliance. The aim of this study is to analyse and synthesize the standardization and development processes of Combined and Joint Military Doctrine in the Portuguese Armed Forces. Identify gaps in national processes, in order to contribute to a better integration and harmonization of the Alliance Doctrine, taking into account the national doctrine and national interests. Our research was based on a hypothetical-deductive argument, supported by a qualitative strategy. The analysis model developed based on assumptions, deducted from derivatives questions of the central question. In this analytical process, we identify indicators that allowed the validation of hypotheses, to achieve this purpose we used two case studies and resort to a SWOT analysis. The development of an action plan that allows the integration of the analysed processes is the main contribution of this research. The need to create a Standardization Coordination Structure it´s crucial to streamline the procedures of normalization between the Ministry of Defence, the Armed Forces General Joint Staff and the Services, along with the establishment of a Doctrine Supreme Council in the Armed Forces, which set the priorities and guidelines for the development of doctrine. This are the main outputs of this research.

Tiro de Artilharia vs. Tiro de Morteiro : Procedimentos

A presente investigação tem como objetivo identificar as diferenças existentes entre os procedimentos técnicos relativos ao tiro de Artilharia de Campanha e ao tiro de Morteiro. Tem por finalidade estudar a possibilidade de uniformização dos procedimentos, no que respeita aos procedimentos de Pontaria, cálculo dos Elementos de Tiro, Pedido e Regulação de Tiro e à Segurança, utilizados pelas unidades de tiro de Artilharia de Campanha e de Morteiro. O trabalho estuda cada tipo de procedimento, começando por enunciá-los e explicar os seus métodos, finalidade e determinação, tanto para o tiro de Artilharia de Campanha como para o tiro de Morteiro. Os procedimentos são comparados através de tabelas e sínteses, com o objetivo de analisar o porquê de serem executados da maneira prevista na doutrina, remetendo dessa forma para o estudo da sua possível padronização. Como método de recolha de dados foram submetidos inquéritos livres a oficiais subalternos de diversas unidades de formação e operacionais relacionadas com a instrução e execução do tiro de Artilharia de Campanha e de Morteiro, de forma a recolher a sua opinião sobre a viabilidade de adoção dos procedimentos e esclarecimento de dúvidas. Foram depois realizadas análises comparativas para verificar quais os procedimentos que apresentam possibilidade de uniformização. No final os procedimentos padronizáveis foram identificados e comparados com os procedimentos executados pelo Grupo de Artilharia de Campanha da Brigada de Reação Rápida, à qual pertence uma Bateria integrada na NATO Response Force 16. Sendo a única unidade orgânica a nível nacional que opera com meios de tiro de Artilharia de Campanha e de Morteiro, a sua análise foi crucial para a investigação. Dado que a finalidade do trabalho é estudar a possibilidade de adoção de procedimentos comuns, as conclusões tiveram a sua origem na análise comparativa com os procedimentos desta unidade. Verificou-se assim que os procedimentos são padronizáveis, mas que são necessárias algumas condições para que possam ser aplicados, devido às diferenças na orgânica e tática entre as unidades de tiro de Artilharia de Campanha e de Morteiro, à diferença técnica das armas e dos meios auxiliares de cálculo dos Elementos de Tiro e técnica dos dois tipos de tiro.