Operating room efficiency in a low resource setting: a pilot study from a large tertiary referral center in Ethiopia

Background The operating room (OR) is one of the most expensive areas of a hospital, requiring large capital and recurring investments, and necessitating efficient throughput to reduce costs per patient encounter. On top of increasing costs, inefficient utilization of operating rooms results in prolonged waiting lists, high rate of cancellation, frustration of OR personnel as well as increased anxiety that negatively impacts the health of patients. This problem is magnified in developing countries, where there is a high unmet surgical need. However, no system currently exists to assess operating room utilization in Ethiopia. Methodology A prospective study was conducted over a period of 3 months (May 1 to July 31, 2019) in a tertiary hospital. Surgical case start time, end time, room turnover time, cancellations and reason for cancellation were observed to evaluate the efficiency of eight operating rooms. Results A total of 933 elective procedures were observed during the study period. Of these, 246 were cancelled, yielding a cancellation rate of 35.8%. The most common reasons for cancellation were related to lack of OR time and patient preparation (8.7% and 7.7% respectively). Shortage of facilities (instrument, blood, ICU bed) were causes of cancelation in 7.7%. Start time was delayed in 93.4% (mean 8:56 am ± 52 min) of cases. Last case completion time was early in 47.9% and delayed in 20.6% (mean 2:54 pm ± 156 min). Turnover time was prolonged in 34.5% (mean 25 min ± 49 min). Total operating room utilization ranged from 10.5% to 174%. Operating rooms were underutilized in 42.7% while overutilization was found in 14.6%. Conclusion We found a high cancellation rate, most attributable to late start times leading to delays for the remainder of cases, and lack of preoperative patient preparation. In a setting with a high unmet burden of surgical disease, OR efficiency must be maximized with improved patient evaluation workflows, adequate OR staffing and commitment to punctual start times. We recommend future quality improvement projects focusing on these areas to increase OR efficiency.

Safety of Bottle-Feeding Under Nasal Respiratory Support in Preterm Lambs With and Without Tachypnoea

Aim: Convalescing preterm infants often require non-invasive respiratory support, such as nasal continuous positive airway pressure or high-flow nasal cannulas. One challenging milestone for preterm infants is achieving full oral feeding. Some teams fear nasal respiratory support might disrupt sucking–swallowing–breathing coordination and induce severe cardiorespiratory events. The main objective of this study was to assess the safety of oral feeding of preterm lambs on nasal respiratory support, with or without tachypnoea.Methods: Sucking, swallowing and breathing functions, as well as electrocardiogram, oxygen haemoglobin saturation, arterial blood gases and videofluoroscopic swallowing study were recorded in 15 preterm lambs during bottle-feeding. Four randomly ordered conditions were studied: control, nasal continuous positive airway pressure (6 cmH2O), high-flow nasal cannulas (7 L•min–1), and high-flow nasal cannulas at 7 L•min–1 at a tracheal pressure of 6 cmH2O. The recordings were repeated on days 7–8 and 13–14 to assess the effect of maturation.Results: None of the respiratory support impaired the safety or efficiency of oral feeding, even with tachypnoea. No respiratory support systematically impacted sucking–swallowing–breathing coordination, with or without tachypnoea. No effect of maturation was found.Conclusion: This translational physiology study, uniquely conducted in a relevant animal model of preterm infant with respiratory impairment, shows that nasal respiratory support does not impact the safety or efficiency of bottle-feeding or sucking–swallowing–breathing coordination. These results suggest that clinical studies on bottle-feeding in preterm infants under nasal continuous positive airway pressure and/or high-flow nasal cannulas can be safely undertaken.

IMPACT OF INNOVATIONS ON THE SAVING OF THE PRODUCTION COMPANY'S WORKING TIME FUND

The article deals with innovation management in the conditions of a manufacturing company whose aim is to reduce the working time fund that directly determines productivity or efficiency of the company in competitive market conditions. Based on explicit quantification of time frames based on an analytical – chronometric method applicable to production operations in the process. The results of observation, time measurement, research and evaluation of time consumption during the implementation of a repeated production operation, or its complex part within defined production site are presented. Based on explicitly performed quantitative analysis, introducing of innovative technology, innovative solutions in the field of production technology management that support sustainable development with an emphasis on the development of environmental quality are presented including an explicit quantification of working time fund savings through the implementation of innovative machinery and equipment in critical production operations of the analysed production process.

To Assess the Activities of Self-Regulatory Organizations of Auditors

In the article, from the standpoint of economic theory, the construction of partial and integral assessments of the activity of the SROA is considered through the assessment of the quality of this activity (and not its effectiveness or efficiency). The expediency of using the method of point estimates and its specific application in the construction of these estimates is shown - both from the standpoint of the national economic approach and from the standpoint of the SROA itself. A table of 18 main activities of the SROA is compiled, based mainly on legislative acts. A number of organizational aspects of the evaluation of the SROA activity are analyzed.

Universal coordinates and methods of reformatting an ambiguous humanitarian paradigm

In the conditions of market uncertainty, the coronavirus pandemic, the absence of an officially articulated national idea, national interests and ideology in Kazakhstan, the problem of the lack of logically justified and coordinated coordinates of systemic thinking, an unambiguous paradigm of humanitarian thinking (analytical, pedagogical, managerial, economic, etc.) is becoming more and more clearly realized as the most important conditions for personal, civil and professional self-determination. The purpose is to substantiate the general logical coordinates and methods of reformatting the ambiguous humanitarian paradigm used in the activity. The study used various methods: the ontological principle of genetically meaningful logic, the method of transformation of concrete images of objects based on their abstract essence, the method of ascent from the abstract to the concrete, the speculative language of schematic images of thought and the language of methodological theory of activity. Logically justified universal abstract-concrete coordinates of universal motion are given. In relation to life and the world of activity, they can be concretized by coordinates: "standard of living – efficiency of activity", or "efficiency of activity – time", or "results – costs", or "quality – quantity", etc. The use of motion vectors in the logic of descent from the concrete to the abstract (NCA), ascent from the abstract to the concrete (AAC), as well as in their combination – logic CAC gives certainty to thinking. As an example, the scheme of the qualitative difference between educational (pre-professional) activities from professional ones using these methods and paired dialectical categories is given. The scheme and description of the functional model of the system object, considered as a rubicon of the transformation of educational activity into professional activity, are given. To reformat the indefinite, ambiguous paradigms of the humanities used in the activity into functional-logical, visible, constructive and unambiguous, it is recommended to use abstract-concrete coordinates, the methods given, the language of schematic images and the paradigm of the methodological theory of activity. As an example, the concept of a typical unit of activity development is given. A visible unambiguous paradigm is a necessary, but not sufficient prerequisite for adequate personal, civil and professional self-determination of a person in situations of high uncertainty. A sufficient prerequisite is the acquisition by subjects of appropriate reflexive-thinking abilities for self-determination, self-organization, self-regulation, etc.

Comparative Study of the Identification Methods of the Management System of the Day-Ahead Market of Polish Energy Market S.A.

Nowadays, identification and neural methods are used more and more often in modeling IT forecasting systems in addition to analytical methods. Six characteristic models used to forecast the Day-Ahead Market system functioning as a transaction management system at the Polish Power Exchange (POLPX) and the Nord Pool Spot market have been selected for comparative analysis. The research was preceded by a detailed discussion of modern criteria used to assess the quality of model fitting to the system, namely: effectiveness, efficiency, and robustness. In the literature, there are two main groups of system modeling methods, namely time series modeling methods and identification modeling methods, including neural modeling methods. Modeling usually results in such models as parametric models and artificial neural networks learned neural models of the Day-Ahead Market, as well as time series models, among others. In the comparative analysis, special attention was paid to the accuracy of the obtained models concerning the system. It has been pointed out that the studied solutions used to measure the accuracy of modeling criteria such as accuracy of fit or efficiency, and did not use the modeling efficiency, which is very important in IT forecasting systems for such large markets as the Day-Ahead Market of POLPX. The search for the best market models, including identification models of the Day-Ahead Market operation that can be used in electricity price forecasting is a very important issue both from the point of view of algorithmic solutions and economical solutions.

Efficient thrust enhancement by modified pitching motion

Thrust and/or efficiency of a pitching foil (mimicking a tail of swimming fish) can be enhanced by tweaking the pitching waveform. The literature, however, show that non-sinusoidal pitching waveforms can enhance either thrust or efficiency but not both simultaneously. With the knowledge and inspiration from nature, we devised and implemented a novel asymmetrical sinusoidal pitching motion that is a combination of two sinusoidal motions having periods T1 and T2 for the forward and retract strokes, respectively. The motion is represented by period ratio $\mathrm{\mathbb{T}} = {T_1}/T$ , where T = (T1 + T2)/2, with $\mathrm{\mathbb{T}} > 1.00$ giving the forward strokes (from equilibrium to extreme position) slower than the retract strokes (from extreme to equilibrium position) and vice versa. The novel pitching motion enhances both thrust and efficiency for $\mathrm{\mathbb{T}} > 1.00$ . The enhancement results from the resonance between the shear-layer roll up and the increased speed of the foil. Four swimming regimes, namely normal swimming, undesirable, floating and ideal are discussed, based on instantaneous thrust and power. The results from the novel pitching motion display similarities with those from fish locomotion (e.g. fast start, steady swimming and braking). The $\mathrm{\mathbb{T}} > 1.00$ motion in the faster stroke has the same characteristics and results as the fast start of prey to escape from a predator while $\mathrm{\mathbb{T}} < 1.00$ imitates braking locomotion. While $\mathrm{\mathbb{T}} < 1.00$ enhances the wake deflection at high amplitude-based Strouhal numbers (StA = fA/U∞, where f and A are the frequency and peak-to-peak amplitude of the pitching, respectively, and U∞ is the freestream velocity), $\mathrm{\mathbb{T}} > 1.00$ improves the wake symmetry, suppressing the wake deflection. The wake characteristics including wake width, jet velocity and vortex structures are presented and connected with $S{t_d}( = fd/{U_\infty })$ , ${A^{\ast}}( = A/d)$ and $\mathrm{\mathbb{T}}$ , where d is the maximum thickness of the foil.

Surrogate Models Applied to Optimized Organic Rankine Cycles

Global optimization of industrial plant configurations using organic Rankine cycles (ORC) to recover heat is becoming attractive nowadays. This kind of optimization requires structural and parametric decisions to be made; the number of variables is usually high, and some of them generate disruptive responses. Surrogate models can be developed to replace the main components of the complex models reducing the computational requirements. This paper aims to create, evaluate, and compare surrogates built to replace a complex thermodynamic-economic code used to indicate the specific cost (US$/kWe) and efficiency of optimized ORCs. The ORCs are optimized under different heat sources conditions in respect to their operational state, configuration, working fluid and thermal fluid, aiming at a minimal specific cost. The costs of 1449.05, 1045.24, and 638.80 US$/kWe and energy efficiencies of 11.1%, 10.9%, and 10.4% were found for 100, 1000, and 50,000 kWt of heat transfer rate at average temperature of 345 °C. The R-square varied from 0.96 to 0.99 while the number of results with error lower than 5% varied from 88% to 75% depending on the surrogate model (random forest or polynomial regression) and output (specific cost or efficiency). The computational time was reduced in more than 99.9% for all surrogates indicated.

Adaptations in metabolism and protein translation give rise to the Crabtree effect in yeast

Aerobic fermentation, also referred to as the Crabtree effect in yeast, is a well-studied phenomenon that allows many eukaryal cells to attain higher growth rates at high glucose availability. Not all yeasts exhibit the Crabtree effect, and it is not known why Crabtree-negative yeasts can grow at rates comparable to Crabtree-positive yeasts. Here, we quantitatively compared two Crabtree-positive yeasts, Saccharomyces cerevisiae and Schizosaccharomyces pombe, and two Crabtree-negative yeasts, Kluyveromyces marxianus and Scheffersomyces stipitis, cultivated under glucose excess conditions. Combining physiological and proteome quantification with genome-scale metabolic modeling, we found that the two groups differ in energy metabolism and translation efficiency. In Crabtree-positive yeasts, the central carbon metabolism flux and proteome allocation favor a glucose utilization strategy minimizing proteome cost as proteins translation parameters, including ribosomal content and/or efficiency, are lower. Crabtree-negative yeasts, however, use a strategy of maximizing ATP yield, accompanied by higher protein translation parameters. Our analyses provide insight into the underlying reasons for the Crabtree effect, demonstrating a coupling to adaptations in both metabolism and protein translation.