scholarly journals In a high volume orthopaedic unit, managing natural variability and utilising the theory of constraints improves surgical throughput.

2020 ◽  
Author(s):  
Thomas Wainwright ◽  
Robert Middleton
Keyword(s):  
High Volume ◽  
Individual Case ◽  
Theory Of Constraints ◽  
Delivery Of Care ◽  
Joint Replacements ◽  
Knee Replacements ◽  
Operating Theatres ◽  
One Step ◽  
System Constraint ◽  
Time Required

Introduction This project involved hip and knee replacement patients at the Royal Bournemouth Hospital. Throughput of surgical cases is determined by the number of operations you can perform each day and the number of beds available for patients following surgery. Modelling using length of stay data indicated that we had enough beds and so we used the Theory of Constraints (TOC) to optimise surgical throughput. The TOC process is outlined below. Intervention Put simply, the system was required to complete 1350 joint replacements per year through 2 operating theatres. Having established this, we identified the system constraint using TOC methodology. The constraint is the element of the system that prevented additional throughput from occurring. Our analysis revealed that the constraint in our setting was the surgeon. We then designed an operating template that subordinated everything to the constraint. A staggered operating model in which the surgeon moved between two operating theatres to perform 6 hip and knee replacements in succession each day was introduced. Results The model has been used in over 2000 patients, and 28 different surgeons and 48 anaesthetists have worked within the model. We found that for all surgeons this has improved their productivity, as well as reducing the variability in the time required to complete each individual case. The staggered model and predictable nature of the model has also had benefits to the nursing and rehabilitation staff on the ward. Admissions to theatre and returns from theatre are now equally staggered throughout the day. This smoothing of flow is a central principle of lean and has made the delivery of care much easier on the ward and requires less staff. Key message The TOC is a useful model for analysing complex systems where one step determines the rate of the process. Within our context the constraint was the surgeon. By subordinating all processes to utilise the surgeons time maximally we optimised surgical throughput.

A modified fractionation procedure for avian erythrocyte histones

1969 ◽  
Vol 47 (12) ◽  
pp. 1121-1123 ◽  
Author(s):  
G. H. M. Adams ◽  
J. M. Neelin
Keyword(s):  
Cation Exchange ◽  
Exchange Chromatography ◽  
Cation Exchange Chromatography ◽  
Fractionation Procedure ◽  
Exclusion Chromatography ◽  
One Step ◽  
Avian Erythrocyte ◽  
Fractionation Method ◽  
Time Required

The fractionation method of Vidali and Neelin for avian erythrocyte histones was modified to reduce the time required to obtain clean fractions of serine-rich and arginine-rich histones. Histones were extracted from washed nuclei in one step with 0.20 M HCl. The lysine-rich and the moderately lysine-rich histones were fractionated by cation-exchange chromatography but the serine-rich and arginine-rich histones were eluted together. These histones were separated by subsequent exclusion chromatography.

scholarly journals Response to COVID-19 in South Korea and implications for lifting stringent interventions

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Amy Dighe ◽  
Lorenzo Cattarino ◽  
Gina Cuomo-Dannenburg ◽  
Janetta Skarp ◽  
Natsuko Imai ◽  
...  
Keyword(s):  
South Korea ◽  
High Volume ◽  
Individual Case ◽  
Metropolitan Region ◽  
Contact Tracing ◽  
Social Distancing ◽  
Early Adoption ◽  
The Usa ◽  
Sharp Growth ◽  
Seoul Metropolitan Region

Abstract Background After experiencing a sharp growth in COVID-19 cases early in the pandemic, South Korea rapidly controlled transmission while implementing less stringent national social distancing measures than countries in Europe and the USA. This has led to substantial interest in their “test, trace, isolate” strategy. However, it is important to understand the epidemiological peculiarities of South Korea’s outbreak and characterise their response before attempting to emulate these measures elsewhere. Methods We systematically extracted numbers of suspected cases tested, PCR-confirmed cases, deaths, isolated confirmed cases, and numbers of confirmed cases with an identified epidemiological link from publicly available data. We estimated the time-varying reproduction number, Rt, using an established Bayesian framework, and reviewed the package of interventions implemented by South Korea using our extracted data, plus published literature and government sources. Results We estimated that after the initial rapid growth in cases, Rt dropped below one in early April before increasing to a maximum of 1.94 (95%CrI, 1.64–2.27) in May following outbreaks in Seoul Metropolitan Region. By mid-June, Rt was back below one where it remained until the end of our study (July 13th). Despite less stringent “lockdown” measures, strong social distancing measures were implemented in high-incidence areas and studies measured a considerable national decrease in movement in late February. Testing the capacity was swiftly increased, and protocols were in place to isolate suspected and confirmed cases quickly; however, we could not estimate the delay to isolation using our data. Accounting for just 10% of cases, individual case-based contact tracing picked up a relatively minor proportion of total cases, with cluster investigations accounting for 66%. Conclusions Whilst early adoption of testing and contact tracing is likely to be important for South Korea’s successful outbreak control, other factors including regional implementation of strong social distancing measures likely also contributed. The high volume of testing and the low number of deaths suggest that South Korea experienced a small epidemic relative to other countries. Caution is needed in attempting to replicate the South Korean response in populations with larger more geographically widespread epidemics where finding, testing, and isolating cases that are linked to clusters may be more difficult.

scholarly journals Using Statistical Modeling for Enhanced and Flexible Pharmacovigilance Audit Risk Assessment and Planning

2020 ◽  
Vol 55 (1) ◽  
pp. 190-196 ◽  
Author(s):  
Min Zou ◽  
Yves Barmaz ◽  
Melissa Preovolos ◽  
Leszek Popko ◽  
Timothé Ménard
Keyword(s):  
Risk Assessment ◽  
Quality Assurance ◽  
High Volume ◽  
Individual Case ◽  
Risk Indicators ◽  
Impact Factors ◽  
European Medicines Agency ◽  
Pv System ◽  
Data Set ◽  
Sliding Windows

Abstract Background The European Medicines Agency Good Pharmacovigilance Practices (GVP) guidelines provide a framework for pharmacovigilance (PV) audits, including limited guidance on risk assessment methods. Quality assurance (QA) teams of large and medium sized pharmaceutical companies generally conduct annual risk assessments of the PV system, based on retrospective review of data and pre-defined impact factors to plan for PV audits which require a high volume of manual work and resources. In addition, for companies of this size, auditing the entire “universe” of individual entities on an annual basis is generally prohibitive due to sheer volume. A risk assessment approach that enables efficient, temporal, and targeted PV audits is not currently available. Methods In this project, we developed a statistical model to enable holistic and efficient risk assessment of certain aspects of the PV system. We used findings from a curated data set from Roche operational and quality assurance PV data, covering a span of over 8 years (2011–2019) and we modeled the risk with a logistic regression on quality PV risk indicators defined as data stream statistics over sliding windows. Results We produced a model for each PV impact factor (e.g. 'Compliance to Individual Case Safety Report') for which we had enough features. For PV impact factors where modeling was not feasible, we used descriptive statistics. All the outputs were consolidated and displayed in a QA dashboard built on Spotfire®. Conclusion The model has been deployed as a quality decisioning tool available to Roche Quality professionals. It is used, for example, to inform the decision on which affiliates (i.e. pharmaceutical company commercial entities) undergo audit for PV activities. The model will be continuously monitored and fine-tuned to ensure its reliability.

Scramble and Crosswalk Signal Timing

1998 ◽  
Vol 1636 (1) ◽  
pp. 83-87 ◽  
Author(s):  
Mark R. Virkler
Keyword(s):  
Field Study ◽  
High Volume ◽  
Signalized Intersections ◽  
Signal Timing ◽  
Pedestrian Flow ◽  
Crossing Time ◽  
Time Required ◽  
Pedestrian Crossing

A variety of methods have been developed for determining appropriate pedestrian crossing times at signalized intersections. Although many of these methods have useful applications, all have significant shortcomings when estimating the crossing time required under high-volume conditions and with two-way flow within a crosswalk. Existing methods are described. A field study conducted to address these shortcomings is then described. The results of the study are used to develop relationships to describe pedestrian flow at signalized crossings. Recommendations are then made to improve the signal timing parameters used for higher-volume pedestrian flows.

scholarly journals Thrombin-Accelerated Quick Clotting Serum Tubes: An Evaluation with 22 Common Biochemical Analytes

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Wai-Yoong Ng ◽  
Chin-Pin Yeo
Keyword(s):  
Test Performance ◽  
High Volume ◽  
Blood Collection ◽  
Test Accuracy ◽  
Significant Deterioration ◽  
Whole Process ◽  
Clinical Laboratories ◽  
And Performance ◽  
Serum Storage ◽  
Time Required

Clot activator serum tubes have significantly improved turnaround times for result reporting compared to plain tubes. With increasing workload and service performance expectations confronting clinical laboratories with high-volume testing and with particular emphasis on critical analytes, attention has focussed on preanalytical variables that can be improved. We carried out a field study on the test performance of BD vacutainer rapid serum tubes (RSTs) compared to current institutional issued BD vacutainer serum separator tubes (SSTs) in its test result comparability, clotting time, and stability on serum storage. Data from the study population (n=160) of patients attending outpatient clinics and healthy subjects showed that results for renal, liver, lipids, cardiac, thyroid, and prostate biochemical markers were comparable between RSTs and SSTs. Clotting times of the RSTs were verified to be quick with a median time of 2.05 min. Analyte stability on serum storage at 4°C showed no statistically significant deterioration except for bicarbonate, electrolytes, and albumin over a period of 4 days. In conclusion, RSTs offered savings in the time required for the clotting process of serum specimens. This should translate to further trimming of the whole process from blood collection to result reporting without too much sacrifice on test accuracy and performance compared to the current widely used SSTs in most clinical laboratories.

scholarly journals The Effect of Stepped Austempering on Phase Composition and Mechanical Properties of Nanostructured X37CrMoV5-1 Steel

2015 ◽  
Vol 60 (1) ◽  
pp. 517-521
Author(s):  
S. Marciniak ◽  
E. Skołek ◽  
W. Świątnicki
Keyword(s):  
Mechanical Properties ◽  
Retained Austenite ◽  
Isothermal Annealing ◽  
Volume Fraction ◽  
Bainitic Ferrite ◽  
High Volume ◽  
Thin Layers ◽  
Strength Parameters ◽  
One Step ◽  
Step Heat Treatment

AbstractThis paper presents the results of studies of X37CrMoV5-1 steel subjected to quenching processes with a one-step and a two-step isothermal annealing. The TEM observation revealed that steel after one-step treatment led is composed of carbide-free bainite with nanometric thickness of ferrite plates and of high volume fraction of retained austenite in form of thin layers or large blocks. In order to improve the strength parameters an attempt was made to reduce the austenite content by use of quenching with the two-step isothermal annealing. The temperature and time of each step were designed on the basis of dilatometric measurements. It was shown, that the two-step heat treatment led to increase of the bainitic ferrite content and resulted in improvement of steel's strength with no loss of steel ductility.

GAZI and the Shock Absorber Market in Thailand

2013 ◽  
Vol 17 (02) ◽  
pp. 243-266
Author(s):  
Rawiporn Koojaroenpaisan ◽  
Paul Patterson
Keyword(s):  
Shock Absorber ◽  
High Volume ◽  
Medium Size ◽  
Barriers To Entry ◽  
Gen Y ◽  
Used Oil ◽  
Shock Absorbers ◽  
First Mover Advantage ◽  
One Step ◽  
Rapid Pace

Siam Suspension Innovation Co. Ltd. (SSI) in 2004 manufactured the first local brand of shock absorber for motor cycles (GAZI brand) in Thailand. This case documents how several entrepreneurs with a passion for motorcycles grasped an opportunity to invent, manufacture and successfully brand a decorative shock absorber for the ubiquitous motorcycle riders of Thailand. Prior to the development of the GAZI brand, shock absorbers were simply just another OEM (original equipment manufacturer) component on a motor bike that was typically only replaced when it was worn out. Shock absorbers were differentiated on their performance characteristics of smoothness of ride. Siam Suspension Company (SSI) changed all that with their decorative GAZI brand that had a mass appeal to consumers under 25 years who possessed a 125–150cc motorcycle (by far the largest segment) who simply wanted their motorcycles to look attractive. Rather than compete in the high volume, low margin standard shock absorber segment, SSI positioned GAZI as a decorative shock absorber. However, because GAZI used a new innovative gas filled technology (all other brands used oil filled cylinders) it also gave a much smoother ride on the rough roads of Thailand. GAZI's management initially created a “first-mover” advantage by targeting Gen Y consumers and convincing them to use shock absorbers to decorate their motorcycles. Hence a replacement market was born for decorative shock absorbers, with many riders replacing the OEM shocks as soon as they purchased a new motorcycle. Sales grew at a rapid pace until other manufacturers of standard shocks saw the success of GAZI. At this time the barriers to entry were quite low. As a SME (small to medium size enterprise) with limited capital, the challenge for SSI in 2012 is how to regroup and stay one step ahead of the competition and protect its market share from further erosion.

The Seven Focusing Steps of the Theory of Constraints (DRAFT)

2018 ◽  
Author(s):  
Boaz Ronen ◽  
Joseph S Pliskin ◽  
Shimeon Pass
Keyword(s):  
Performance Measures ◽  
Operating Rooms ◽  
Theory Of Constraints ◽  
Full System ◽  
System View ◽  
Global Performance ◽  
System Constraint ◽  
Cost Utilization ◽  
The Cost ◽  
Measures Of Performance

The theory of constraints has the potential to increase throughput significantly, using existing resources. It consists of seven focusing steps that, when applied, can create extra capacity in operating rooms, emergency departments, imaging services, labs, and so on. The seven steps are simple, intuitive, and easy to implement. This chapter discusses the first three steps of the theory of constraints: determining the system’s goal, establishing global performance measures, and identifying the system constraint. Tools are provided for identifying bottlenecks and determining measures of performance for the system. It also introduces the cost-utilization diagram that provides managers with a full-system view.

The Way to High Volume Fabrication of Lab-on-a-Chip Devices—A Technological Approach for Polymer Based Microfluidic Systems with Integrated Active Valves and Pumps

2009 ◽  
Vol 6 (4) ◽  
pp. 198-204 ◽  
Author(s):  
Jochen Rupp ◽  
Manuela Schmidt ◽  
Bettina Günther ◽  
Michael Stumber ◽  
Sven Zinober ◽  
...  
Keyword(s):  
Mechanical Stability ◽  
Thermoplastic Elastomer ◽  
High Volume ◽  
Active Components ◽  
Passive Components ◽  
Process Step ◽  
Technological Approach ◽  
Pump Rate ◽  
One Step ◽  
Cost Efficient

We present a technology platform suitable for the mass production of laboratory-on-a-chip devices made of polymers with integrated active and passive components. The presented microfluidic platform with integrated valves and pumps for active flow management is realized with three layers consisting of two polymer parts separated by a thin elastic TPE (thermoplastic elastomer) membrane welded together in one step. The elastic TPE membrane acts as an integrated deflectable membrane layer between the two outer polymer layers, each made of a weldable thermoplastic polymer (polycarbonate). Valving is realized by applying pressure in a displacement chamber above a hydraulic channel causing the membrane to deform and to seal the channel. A pump is fabricated using a displacement chamber with a valve on the inlet and outlet. The presented components, namely valve and pump, show excellent behavior regarding response time, sealing quality, and pump rate needing only a low actuation pressure. The three-layer-stack is joined in a single process step by using laser welding, creating devices with high mechanical stability. This production technology fulfills the requirements of a high volume fabrication at high quality and has the potential to manufacture cost-efficient and reliable laboratory-on-a-chip systems. The used materials show a high chemical resistance against a broad range of commonly used liquids and good optical characteristics for the use in μTAS. This consistent technological approach represents a flexible platform for microfluidics with active components to be used in complex applications.

scholarly journals Overview of Optical Digital Measuring Challenges and Technologies in Laser Welded Components in EV Battery Module Design and Manufacturing

Batteries ◽  
2020 ◽  
Vol 6 (3) ◽  
pp. 47
Author(s):  
Heikki Saariluoma ◽  
Aki Piiroinen ◽  
Anna Unt ◽  
Jukka Hakanen ◽  
Tuomo Rautava ◽  
...  
Keyword(s):  
Contact Process ◽  
Dissimilar Materials ◽  
High Volume ◽  
Module Design ◽  
Battery Design ◽  
Design And Manufacturing ◽  
Battery Packs ◽  
Main Production ◽  
Component Assembly ◽  
Time Required

Ensuring the precision and repeatability of component assembly in the production of electric vehicle (EV) battery modules requires fast and accurate measuring methods. The durability of EV battery packs depends on the quality of welded connections, therefore exact positioning of the module components is critical for ensuring safety in exploitation. Laser welding is a non-contact process capable of welding dissimilar materials with high precision, for that reason it has become the preferred joining method in battery production. In high volume manufacturing, one of the main production challenges is reducing the time required for assessment of dimensional and geometrical accuracy prior to joining. This paper reviews the challenges of EV battery design and manufacturing and discusses commercially available scanner-based measurement systems suitable for fabrication of battery pack components. Versatility of novel metrological systems creates new opportunities for increasing the production speed, quality and safety of EV battery modules.

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