Decarbonization of Distribution Transformers Based on Current Reduction: Economic and Environmental Impacts

Well-known industrial practice efficiency improvement techniques, such as reactive compensation, load balancing, and harmonic filtering, are used in this paper to reduce energy losses in distribution transformers, and therefore, to decrease carbon dioxide emissions and economic costs in the operation of these transformers. Load balancing is carried out by monitoring the values of the angles of the active and reactive components of the vector unbalanced power. Likewise, the application of Order 3/2020 of the Spanish National Markets and Competition Commission is described, in detail, for the calculation of the economic costs derived from the transformer energy losses caused by the load currents and the penalties due to transformer energy deliveries with capacitive power factors. Finally, all these improvement techniques are applied to determine savings in carbon dioxide emissions and costs on the electricity bill of an actual 1000 kVA distribution transformer that supplies a commercial and night-entertainment area. The results of this application case reveal that cost reductions due to energy loss savings are modest, but the reduction in carbon dioxide emissions and the savings in penalties for capacitive reactive supplies are significant.

Virtual Care: A Quality Improvement Project on the Experience of Paediatricians During the COVID-19 Pandemic (Preprint)

BACKGROUND Prior to the COVID-19 pandemic, in-clinic visits were the standard of care for paediatricians at our centre. At the pandemic onset, virtual care (VC) was adopted at an unprecedented scale and pace. OBJECTIVE This quality improvement (QI) initiative explored the VC experience of paediatricians during the pandemic by determining factors that supported and challenged VC adoption. METHODS The Donabedian model was used to evaluate VC experience via online survey. All department-affiliated paediatricians (including generalists and subspecialists in surgery and medicine) were invited to participate via email. Results were collated and descriptive statistics were applied. RESULTS Of 195 paediatric physicians, 63 responded (response rate 32.3%, mostly subspecialists at academic centres (84.1%)). Pre-pandemic, only 30.1% used VC and saw <10% of patients virtually. During March-May 2020, 93.8% transitioned to VC; with >50% seeing over 75% of patients virtually. Telephone and OTN were the platforms most used (77.4% and 64.2% respectively). VC experience was considered positive (73.6%), and only 18.8% found VC difficult to use despite 41.5% reporting technical difficulties. Challenges included lack of physical exam, lower patient volumes, and poor patient VC etiquette. Regardless of demographics, 96.4% would continue VC, ideally for patients who live far away (90.2%) and for follow-ups/established diagnoses (73.1%). CONCLUSIONS Transition to VC during COVID-19 was associated with challenges but also positive experiences. Willingness among paediatricians to continue VC was high. Paediatricians’ VC experiences at our centre could be improved with patient education and targeting select populations. Future research is needed to improve practice efficiency, and to inform regulatory guidelines for VC. CLINICALTRIAL Research ethics exemption was granted by The Office of Human Research Ethics (OHRE) on behalf of Western University's REB.

149 Virtual Care: A Quality Improvement Project on the Experience of Paediatricians during the COVID-19 Pandemic

Primary Subject area Practice/Office Management Background Prior to the COVID-19 pandemic, in-person visits were the standard of care for paediatricians at our centre. With the pandemic onset, virtual care (VC) was adopted at an unprecedented scale and pace. Studies have reported positive patient VC experience; however, few have explored physician experience. This quality improvement (QI) initiative sought to qualify the VC experience of local paediatricians during the pandemic, with the intention of implementing VC clinical practice changes at the department level. Objectives To determine key factors that have supported and challenged the adoption of, and that will support integration of, VC in the future. Design/Methods The Donabedian model for healthcare QI was used to evaluate VC experience through an online survey with a focus on structure, process, and outcome measures. All physicians affiliated with the Department of Paediatrics (generalists and subspecialists in medicine and surgery) were invited to participate via email. Three reminder emails were sent at 2-week intervals. Descriptive statistics were reported. Results The response rate was 32.3% (63 of 195 physicians). The majority of respondents were subspecialists (84.1%), and at academic centres (87.5%) (Table 1). Pre-pandemic, only 30.1% used VC and saw &lt;10% of patients virtually. During March-May 2020, 93.8% transitioned to VC, with &gt; 50% seeing over 75% of patients virtually. By summer 2020, VC use declined, but remained higher than pre-pandemic (53.6% seeing &lt; 25% of patients). OTN and telephone were platforms most used (32.8% and 28.6%, respectively). Most conducted visits from their work location (55.2%) versus home (44.8%). VC experience was considered positive by most physicians (73.6%), and only 18.8% found VC difficult to use despite technical difficulties reported by 41.5% (Figure 1). Physicians with ≤ 5 years in practice were most likely to find VC convenient (93.8%). Challenges with VC included lack of physical exam, diagnostic uncertainty, lower patient volumes, and poor patient VC etiquette. Regardless of practice location, specialty, years in practice, and prior experience, 96% would continue VC to 25% of patients, ideally for patients who live far away (26.4%) and for follow-ups of patients with established diagnoses (21.4%). Conclusion A rapid transition to VC during the COVID-19 pandemic was associated with challenges but also positive experiences. Willingness to continue VC was high. VC experience could be improved with greater patient education and focus on select patient populations. Future research is needed to improve practice efficiency and to inform regulatory guidelines for VC at a local level.

Playing With BEARS: Balancing Effort, Accuracy, and Response Speed in a Semantic Feature Verification Anomia Treatment Game

Purpose The purpose of this study was to develop and pilot a novel treatment framework called BEARS (Balancing Effort, Accuracy, and Response Speed). People with aphasia (PWA) have been shown to maladaptively balance speed and accuracy during language tasks. BEARS is designed to train PWA to balance speed–accuracy trade-offs and improve system calibration (i.e., to adaptively match system use with its current capability), which was hypothesized to improve treatment outcomes by maximizing retrieval practice and minimizing error learning. In this study, BEARS was applied in the context of a semantically oriented anomia treatment based on semantic feature verification (SFV). Method Nine PWA received 25 hr of treatment in a multiple-baseline single-case series design. BEARS + SFV combined computer-based SFV with clinician-provided BEARS metacognitive training. Naming probe accuracy, efficiency, and proportion of “pass” responses on inaccurate trials were analyzed using Bayesian generalized linear mixed-effects models. Generalization to discourse and correlations between practice efficiency and treatment outcomes were also assessed. Results Participants improved on naming probe accuracy and efficiency of treated and untreated items, although untreated item gains could not be distinguished from the effects of repeated exposure. There were no improvements on discourse performance, but participants demonstrated improved system calibration based on their performance on inaccurate treatment trials, with an increasing proportion of “pass” responses compared to paraphasia or timeout nonresponses. In addition, levels of practice efficiency during treatment were positively correlated with treatment outcomes, suggesting that improved practice efficiency promoted greater treatment generalization and improved naming efficiency. Conclusions BEARS is a promising, theoretically motivated treatment framework for addressing the interplay between effort, accuracy, and processing speed in aphasia. This study establishes the feasibility of BEARS + SFV and provides preliminary evidence for its efficacy. This study highlights the importance of considering processing efficiency in anomia treatment, in addition to performance accuracy. Supplemental Material https://doi.org/10.23641/asha.14935812

Operations Management in Ambulatory Care in Switzerland

Practice efficiency is influenced by its operations management. We aim at studying implementation of operations management in Swiss medical practices and we develop a dashboard that allows controlling and managing resources. To study operations management and relevant indicators in ambulant care, we distributed questionnaires by e-mail and conducted 6 interviews. In collaboration with a group practice, we collected requirements regarding a dashboard for operations management, developed a mockup and finally a prototype. This prototype was deployed and implemented in daily routine. From the assessments we learned that practice information systems (PIS) are not sufficiently supporting production planning and control. Relevant indicators include processing time per patient or waiting time for quantifying efficiency and identify potential improvements in production. Within 5 weeks of implementation of our dashboard in a group practice, we learned that calculating indicators and support of operations management by means of a dashboard is well appreciated by practice employees. Indicators are considered extremely useful for operations management.

Analiza uporabe metod in tehnik izboljševanja poslovnih procesov

Over 50 approaches, methods, and techniques have been developed in recent decades to achieve more efficient business systems operations. Due to the increasingly rapid changes in the business and social environment, the question of which method or technique will have the most significant impact on increasing its competitive advantage is becoming increasingly important. In the presented research, due to the scope of the issue, we focused on an overview of the most often used methods and techniques and their similarity. For this purpose, we prepared an overview of the frequency of particular methods and techniques in the sources collected in multidisciplinary databases. We were also interested in which phases of business process improvement a particular method or technique is used. Based on the knowledge gained in this way, we designed a set of appropriate methods and techniques for improving business processes. The performed research can serve as a starting point for solving this problem. It would be necessary for its integrity to check other properties of methods and techniques and their practice efficiency.