Excessive Expenditure Research Articles

ПРАВОВІ МЕХАНІЗМИ МІНІМІЗАЦІЇ ПРОЕКТНИХ РИЗИКІВ, ЩО ВИНИКАЮТЬ В РАМКАХ МІЖНАРОДНОГО ПРОЕКТНОГО ФІНАНСУВАННЯ

This article examines, classifies and categorizes various types of project risks inherent to international project finance and discusses legal techniques employed by the key participants of project finance to mitigate each of these risks based on thorough examination of project documentation typically elaborated for this purpose. It covers both commercial (internal and external) and non-commercial risks, in particular, completion risk, risk of excess expenditure, operational risk, environmental risk, risk of insufficient revenues, supply risk, currency risk, inflation risk, interest rate risk and others. The author argues that non-commercial risks, including political or country risks, present even greater peril for an international project and offers a complex of protective legal measures which could be used for diminishing such risks in the long run. The conclusions formulated at the end of the article present the author’s personal attitude towards legal solution of the problem of minimization of the project risks arising within international project finance. Key words: project finance, project company, commercial risks, non-commercial risks, contractual remedies.

Energy-Aware Routing Hole Detection Algorithm in the Hierarchical Wireless Sensor Network

To minimize the communication overhead with the help of optimal path selection in Wireless Sensor Network (WSN) routing protocols is the challenging issue. Hierarchical routing optimizes energy utilization by distributing the workload among different clusters. But many-to-one multi-hop hierarchical routing will result in the excessive expenditure of energy near the sink and leads to early energy exhaustion of the nodes. Due to this the routing hole problem can be caused around the base station. Data routed along the hole boundary nodes will lead to premature exhaustion of energy. This will maximize the size of the hole in the network. Detection of holes saves the additional energy consumption around the hole and minimize the hole size. In this paper a novel energy efficient routing hole detection (EEHD) algorithm is presented, on the detection of routing hole, the periodic re-clustering is performed to avoid the long detour path. Extensive simulations are done in MATLAB, the results reveal that EEHD has better performance than other conventional routing hole detection techniques, such as BCP and BDCIS.

Management of Innovative Costs of Public Administration Institutions

The growth of costs for innovation, as well as the growing role of public administration institutions, makes us take a fresh look at the cost management system. The article discusses the key point of the innovation cost management system at different levels of administration. Public administration institutions contribute to the implementation of innovation in the framework of both its own economic strategy and taking into account the strategy of higher governing bodies. The interaction and cooperation of various management structures within the framework of the implementation of a single innovative project can create an excessive expenditure of financial resources, which is why the issue of competent management of innovative costs becomes so significant. On a specific innovation project, possible problems in the interaction of various public administration institutions are considered, when planning and implementing a joint innovation project.

Грошова застава як умова реалізації пасивного виборчого права громадян у контексті правових позицій Європейського суду з прав людини та Конституційного суду України

У статті досліджено правову природу поняття «грошова (виборча) застава» та проаналізовано висновки провідних національних і міжнародних установ щодо доцільності законодавчого встановлення грошової застави в аспекті забезпечення рівних виборчих прав громадян. Особливу увагу приділено правовим оцінкам грошової застави як інституту виборчого права в рішеннях Європейського суду з прав людини та Конституційного Суду України. За результатами дослідження дійдено висновку про основні умови, що мають бути враховані законодавцем для того, щоб грошова застава виступала індикатором, а не перешкодою належної реалізації пасивного виборчого права громадянами.

Bridging performance of new eco-friendly lost circulation materials

Abstract Lost circulation is one of the most important concerns of the drilling industry, causing excessive expenditure and increasing the non-productive drilling time. In this study, various lost circulation materials (LCMs) were used to control the lost circulation of two types of drilling fluids, bentonite mud and a new eco-friendly mud, named RIA-X, which has a remarkable effect on decreasing the amount of lost circulation in fractured and highly permeable reservoirs. The Bridging Material Test (BMT) apparatus was used to investigate the effectiveness of various LCMs in fractures of various sizes and to select the LCM and combination with the best performance. The use of three-dimensional fractures is one of the most notable points of this work, which makes the experimental conditions similar to those of real wells. The lost control performance of the new eco-friendly LCMs in RIA-X mud was tested in field. The outcomes show that the designed LCMs are able to control severe lost circulation that regular processes such as cementing or drilling with foam cannot deal with.

Two-Tier Energy Compensation Framework Based on Mobile Vehicular Electric Storage

Plug-in electric vehicle (PEV) commercialization propels an extensive charging station deployment in a power distribution system to satisfy fast growing PEV charging demands. Considering the power distribution, some stations deployed at limited capacity feeders may undergo power overload at peak hours due to time-varying traffic and PEV demands. The potential power overload could lead to severe transformer degradation or even black-out on the aged power infrastructure. To avoid power overload without excessive expenditure on the infrastructure upgrade, proper energy compensation at limited capacity station is highly effective. In this paper, we investigate an energy compensation problem based on utility-owned mobile vehicular electric storage (MVES), aiming to mitigate the overload issues among a group of charging stations (GCS). First, a Markov Chain based energy capacity model is developed to estimate the energy statuses among GCS and a graph theory based GCS transportation model is developed to facilitate on-road MVES allocation. Then, a two-tier energy compensation framework is introduced to efficiently schedule MVESs to minimize the scheduling cost. Simulations are conducted based on real traffic data on California highway collected by California department of transportation, and the results validate the effectiveness of the introduced framework.

Comparative Study between Effect of Sleeve Gastrectomy and Mini-Gastric Bypass on Type 2 Diabetes Mellitus

AbstractBackground: Severe obesity (most often defined as a BMI ³35kg/m2 with comorbid health conditions or a BMI ³40 kg/m2 without such conditions) is a highly prevalent chronic disease, which leads to substantial morbidity, premature mortality, impaired quality of life and excess healthcare expenditures. Bariatric surgery leads to greater weight loss and higher remission rates of type II diabetes and greater reductions in use of anti-diabetic drugs compared with non-surgical treatment for obesity.Aim of Study: The aim of this study is to compare between the effect of sleeve gastrectomy and mini-gastric bypass on patients with type 2 DM and BMI ³35kg/m2.Patients and Methods: A prospective comparative study which included 40 obese patients with type 2 DM (20 patients were operated for Laparoscopic Sleeve Gastrectomy (LSG) and 20 patients for Laparoscopic Mini-Gastric Bypass (LM-GB), with mean age at LSG group 42.95±7.63 with range of 31-59 years, at LMGB group was 42.9±6.17 with range of 34-58 years.Results: In SG cases; complete remission occurred in 11 patients with percentage of 55% and failure of remission occurred in 9 patients with percentage of 45%. No cases developed partial remission in SG cases. In MGB cases; 15 developed diabetic remission with percentage of 75% (11 (55%) patients developed complete remission, 4 (20%) patients developed partial remission). Failure of remission occurs in 5 patients in MGB cases with percentage of 25%.Conclusion: Based on our results, LSG and LMGB are efficient operations for reducing weight in morbidly obese patients and also in diabetic control in T2DM. LMGB might be superior to LSG in %EWL and T2DM remission after 1.5 year follow-up.

1796. Inappropriate Aztreonam Usage Identified as an Opportunity to Reduce Pharmaceutical Expenditures

BackgroundTargeting “low-hanging fruit” is a pillar of antimicrobial stewardship (AMS). Β-lactam allergies (BLA) frequently restrict clinical decision-making and lead to utilization of alternative, less preferred antimicrobials making them an ideal AMS target. Prior studies have demonstrated that BLA are grossly over reported by patients. This study aimed to calculate the excess pharmaceutical expenditures incurred by utilization of aztreonam in patients who had previously (or subsequently) tolerated a β lactam (BL).MethodsRetrospective chart review was performed on inpatients >18 years old at our institution who received at least one dose of aztreonam during the 2017 calendar year. Data collected included: BLA, both prior and subsequent BL classes tolerated, number of doses and days of aztreonam administered. Patients were excluded from the analysis if they did not have a documented BLA or if they received aztreonam as targeted/de-escalation therapy. Cost of aztreonam therapy was then compared with the cost of alterative BL agents based on prior and subsequently tolerated classes of BLs. Comparator agents included: pipericillin/tazobactam (penicillin), cefepime (cephalosporin) and meropenem (carbapenem). Wholesale acquisition costs were used for each agent and comparator regimens were based on our health system-wide dosing guidelines adjusted for renal function.ResultsOne hundered thirty-two patients met inclusion criteria. Of those patients, 88/132 (66.7%) had demonstrated tolerance of a BL agent. Specifically 69/132 (52.3%) previously and 19/132 (14.4%) subsequently tolerated a β-lactam. Across the study, $40,768.84 was spent on aztreonam for patients with prior/subsequent BL tolerance. Cost for alternative therapy was estimated at $13,143.25 total; with an estimated cost difference of $27,625.59. Estimated cost difference for prior tolerance was $21,987.87 and subsequent tolerance $5,637.72.ConclusionAztreonam is an uncommon but costly antimicrobial. This study demonstrated that reduction in aztreonam utilization based on prior tolerance of β-lactam agents could lead to a meaningful reduction in pharmaceutical expenditures and serve as low-hanging fruit for an antimicrobial stewardship program.Disclosures All authors: No reported disclosures.

Trajectory of Excess Medical Expenditures 10 Years Before and After Diabetes Diagnosis Among U.S. Adults Aged 25-64 Years, 2001-2013.

We assessed the excess medical expenditures for adults newly diagnosed with diabetes, for up to 10 years before and after diabetes diagnosis. Using the 2001-2013 MarketScan data, we identified people with newly diagnosed diabetes among adults aged 25-64 years (diabetes cohort) and matched them with people who did not have diagnosed diabetes (control cohort) using 1:1 propensity score matching. We followed these two cohorts up to ±10 years from the index date, with annual matched cohort sizes ranging from 3,922 to 39,726 individuals. We estimated the yearly and cumulative excess medical expenditures of the diabetes cohorts before and after the diagnosis of diabetes. The per capita annual total excess medical expenditure for the diabetes cohort was higher for the entire 10 years prior to their index date, ranging between $1,043 in year -10 and $4,492 in year -1. Excess expenditure spiked in year 1 ($8,109), declined in year 2, and then increased steadily, ranging from $4,261 to $6,162 in years 2-10. The cumulative excess expenditure for the diabetes cohort during the entire 20 years of follow-up was $69,177 ($18,732 before and $50,445 after diagnosis). People diagnosed with diabetes had higher medical expenditures compared with their counterparts, not only after diagnosis but also up to 10 years prior to diagnosis. Managing risk factors for type 2 diabetes and cardiovascular disease before diagnosis, and for diabetes-related complications after diagnosis, could alleviate medical expenditure in people with diabetes.

The relationship between catastrophic health expenditure and health-related quality of life

ObjectivesThe objective of our study was to investigate the relationship between catastrophic health expenditure (CHE) and health-related quality of life (HRQoL) in general population.MethodsWe used Korean Health Panel Survey data from 2011 to 2013, which included data from 8850 baseline participants of 19 years of age or older. We defined CHE as total annual out-of-pocket health payment that was 40% greater than the household’s capacity to pay. HRQoL was measured using the EuroQol-visual analogue scale (EQ-VAS). We used generalized estimating equations to perform a longitudinal regression analysis.ResultsA total of 4.5% of the participants (n = 398) experienced CHE. Those with CHE tended to have a lower EQ-VAS index score compared with those without CHE (β: − 1.34, p = 0.013). A subgroup analysis revealed that individuals experiencing CHE had significant decreases as the number of chronic diseases increased (three or more, β: − 1.85, p = 0.014).ConclusionsCatastrophic health expenditure influences HRQoL, which was more pronounced in patient with chronic disease. The efforts should focus on people who suffer from excessive health expenditures and chronic diseases.

Neuropeptide receptors as potential pharmacological targets for obesity.

Obesity is a chronic multifactorial disease, characterized by an excessive accumulation of adipose tissue. It is usually the result of excessive food intake and/or low energy expenditure. Obesity can be triggered by lifestyle, nutritional, genetic, environmental, hormonal and psychological factors. Several strategies are used to treat obesity, including dietary reeducation, with balanced food intake, increased physical exercise, in order to promote energy expenditure and to overcome the insufficiency in weight reduction by other strategies, and administration of drugs. However, these medications are associated to undesirable side effects, resulting in a high withdrawal rate. Several studies have been focused on the development of compounds that act in the hypothalamic region where the center of the regulation of hunger and satiety is located. Some of them target the activity of endogenous peptides, such as ghrelin pancreatic polypeptide, peptide YY and neuropeptide Y, as well as their receptors. This review addresses the importance of understanding the neuropeptide/peptide hormones and their receptors for the development of novel anti-obesity compounds that may aid in weight reduction as a promising alternative for the treatment of obesity.

Effect of Regional Climatic Factors on Reducing Noise Level from Power Equipment

The effect of regional climatic factors exerted on noise reduction from power equipment is considered based on data processing results for 210 cities over the territory of Russia. The value of the required noise reduction determines the capital and operating costs of silencers, shields, and other facilities designed to reduce the noise produced by power equipment. At the same time, the regional climatic factors exert a different effect on the required noise reduction from power equipment: they can be neglected at low frequencies on the one hand, while this influence can be crucial at high frequencies on the other hand. It is shown that the influence of climatic factors in different regions significantly differs at the same octave band frequency, and this difference can amount to several dozen decibels. With increasing octave band frequency, this difference increases. For example, at a octave band frequency amounting to 8 kHz, the greatest change ranges from 60–100 dB/km for the European part of Russia to 160 dB/km for northeastern Siberia. It is shown that an incorrect determination of the sound attenuation coefficient α in the atmosphere can lead, on the one hand, to an excess expenditure of energy resources at higher real α values, and, on the other hand, to the absence of any expected effect after the implementation of environmental measures at lower real α values. Thus, in developing measures for the attenuation of power equipment noise, it is necessary to take into account the effect of regional climatic factors, especially at high frequencies.

Impact of Publicly Financed Health Insurance Scheme (Rashtriya Swasthya Bima Yojana) from Equity and Efficiency Perspectives

Executive Summary Catastrophic health expenses result in impoverishment of a large number of people every year in India. This often forces the resource-poor households to forego treatment due to lack of affordability. Providing quality health care to all at an affordable cost is a policy commitment for India as it is a signatory of the Alma Ata Declaration. The Government of India is working towards providing universal health coverage through its National Health Policy. As part of universalization of health care, the government had launched a publicly financed health insurance scheme, Rashtriya Swasthya Bima Yojana (RSBY), to provide affordable and quality health services. The present study dealt with understanding the impact of the scheme for improving health care-seeking and reducing burden of health expenditure among resource-poor families through a matched controlled cross-sectional study. The study tried to assess whether RSBY had improved care-seeking and reduced incidences of catastrophic health expenditure (CHE) and health expenditure-induced poverty among the insured population and also tried to explore whether the benefits were equitable. It was conducted in purposively selected two blocks of Ranchi district in Jharkhand with 1,643 households below poverty line (BPL). Both enrolled and non-enrolled households were selected randomly for the study after matching with some key matching criteria. It was found that RSBY neither increased in-facility treatment (hospitalization) nor reduced the likelihood of CHE among the enrolled households. More importantly, it significantly increased the incidence of health expenditure-induced poverty among the households who were above the poverty line before incurring any health expenditure. From equity perspective, care-seeking was much lower among the economically weaker households compared to the better-off households. Similarly, incidences of CHE and health expenditure-induced poverty were also found to be higher among the weaker sections. The study shows that RSBY did not achieve its objective of improving care-seeking and providing financial security to the enrolled households, and more importantly to the economically weaker sections of the society. Other studies have also found that one of the factors for high out-of-pocket expenditure in health is a weak public health delivery system which forces people to seek care from private providers. Hence, it is important for the policymakers to critically evaluate whether such insurance models will actually ensure better financial security for the households from excessive health expenditure and whether strengthening the existing public health delivery system would be a better option.

Establishment of a quantitative in vivo method for estimating adipose tissue volumes and the effects of dietary soy sauce oil on adipogenesis in medaka, Oryzias latipes.

Adipose tissue, which is conserved in higher eukaryotes, plays central roles in controlling the body’s energy balance, including excess energy storage and energy expenditure during starvation. In adipogenesis, intranuclear receptor, peroxisome proliferator–activated receptor gamma (PPARγ) is a key molecule, and PPARγ agonists can promote adipogenesis. Many studies on the in vitro screening of PPARγ agonists with compounds derived from various materials have been reported; however, in vivo assays for quick examination of these feeding effects have not been established. In this study, we developed a technique using a lipophilic fluorescent reagent, Nile red to quantitatively estimate the adipose tissue volumes by using Japanese rice fish, medaka (Oryzias latipes) and studied effects of dietary soy sauce oil (SSO), which is a discarded by-product from Japanese traditional food and is known to have PPARγ-agonistic activity, on adipogenesis. We found that SSO feeding increased the adipose tissue volumes, and the expression levels of adipogenesis-related genes increased in these medaka larvae. These results suggest that SSO feeding increases the adipose tissue volumes through adipogenesis promotion by PPARγ-agonistic activity in medaka, and medaka is a powerful model for studying adipogenesis. Furthermore, our study also demonstrates the availability of SSO as a dietary additive for farmed fish.

Subventions in income generation of local budgets in Ukraine

The article considers the national practice of generating local budget revenues through subventions. It is stressed that within intergovernmental relations they provide an opportunity to allocate a fixed amount of funds from a higher-level budget to a lower-level budget in order to balance the latter, when there is an excess of expenditure over revenue. It is pointed out that the growth of their percentage results in reduced motivation of local authorities to increase their financial base, inertia of regional elite and dependency. It is also noted that within intergovernmental relations subventions play a key role in government support for social initiatives of local bodies and capital investments. They act as social transfers which provide approximately the same level of public goods and services across regions. An increase in the percentage of subventions within intergovernmental transfers positively affects the social environment of the regions. It is reasoned that the implementation of a new version of the Budget Code of Ukraine has made it possible to systematically use government support through intergovernmental transfers. In particular, local budgets would receive educational and medical subventions for carrying out investment projects. It is obvious that social support for local development is essential and undisputable, even though it diverts significant funds from the implementation of economic programmes and measures. A particular attention is paid to subventions for the implementation of investment projects which are seen as intergovernmental transfers that stimulate sustainable development of the territories. However, differences in geographical location, climate conditions, demographics and other factors impede its full availability to depressed regions. The relative weight of these subventions has been rather low and ultimately deteriorating to their successful functioning.

Roosting habitat selection of Hume's Pheasant (Syrmaticus humiae) in a fragmented forest patch, northwestern Guangxi, southwestern China

Knowledge of roosting site preference has shown a great importance for the conservation of Galliformes. The selection of good roosting habitats may prevent an excessive energy expenditure and reduce the risk of predation. The night roosts selected by two male and two female Hume's Pheasants (Syrmaticus humiae) were studied using radio transmitters in the Jinzhongshan National Nature Reserve, Guangxi, southern China. Thirty-five night roost sites were detected between February and August 2012. Hume's Pheasant roosted in family groups, predominantly in Tung oil tree (Vernicia fordii). The roosting site characteristics of Hume's Pheasant, including the distance to the habitat edge and road, shrub coverage, and height of roost branches between the breeding and non-breeding period showed statistically significant differences (P < 0.05). The factors discriminating roosting habitat selection in the breeding season from that in non-breeding season were: slope position, distance to habitat edge, distance to road, height of roost branch, and height of the lowest branch. Our results suggested that the selection of night roosts is determined by predator avoidance, and energy saving strategies aimed at reducing flight activity and increasing feeding opportunities. Furthermore, roost microclimate seemed to also influence the selection of night roosts.

CT Scan Imaging in Diagnosing Acute Uncomplicated Pancreatitis: Usefulness versus Cost

Introduction: Guidelines indicate that routine use of imaging is unwarranted in patients with acute uncomplicated pancreatitis (AUP) that present with abdominal pain and increased serum amylase or lipase activity without systemic signs of severe disease. The objective of this study is to assess the overutilization and associated cost of computed tomography (CT) imaging in patients with acute uncomplicated pancreatitis that meet two of the three diagnostic criteria. Methods: In this Institutional Review Board-approved retrospective single-center study, we identified all adult patients with acute pancreatitis (AP) from January 2012 through October 2017. Patients were initially identified via ICD-9 code for acute pancreatitis (577.0) and ICD-10 codes for different etiological AP (K85.9 unspecified, K85.0 idiopathic, K85.1 biliary, K85.2 alcohol-induced, K85.3 drug-induced, and K85.8 other). Diagnosis was confirmed by chart review using established non-imaging diagnostic criteria (presence of typical abdominal pain and elevated lipase or amylase greater than 3 times upper limit of normal) prior to any imaging ordered. Ranson criteria and BISAP scores on presentation were calculated and only those that met scores less than or equal to 2 for both were included, suggesting AUP. The utilization and cost of imaging in these patients were recorded. Results: Between January 2012 and October 2017, 1305 patients were admitted with AP, and 405 patients (31%) met our inclusion criteria for AUP (201 males, 204 females; mean age 49, range 18-98). Of those, 210 patients (51.85%) underwent computed tomography. One patient (0.47%) had evidence of complication (pancreatic necrosis). The average cost of CT scan imaging was $4,510 with a total cost of $947,056 spent on overutilized CT imaging. Median length of hospitalization among those that received CT imaging and those did not were the same at 3 days. Conclusion: In patients with acute pancreatitis, diagnosed clinically and biochemically, computed tomography rarely demonstrates pancreatitis related complications when Ranson and BISAP scores are less or equal to 2. Reducing the overuse of diagnostic CT imaging in AUP will limit excess healthcare expenditure and decrease radiation exposure to patients, especially in younger individuals with risk to suffer from potential delayed deleterious effects. Efforts should be made for evidence based practice that discourages overutilization and increased awareness in radiation risk through the Image Wisely campaign by ACR/RSNA.

Obedience or escape: Examining the contingency influences of corruption on firm exports

This article examines the relationship between corruption and export in emerging economies. Considering the institution-based view (IBV) and the specificities of emerging markets, we propose a U-shaped relationship between firm corruption and exports. A moderate level of corruption may dampen firms' inclination to export, but excessive expenditures on corruption will drive firms to resort to an export strategy as a way to escape institutional constraints and inefficiencies in their home markets. We further examine the moderating roles of political instability, regulatory burden, and threats of competition from the informal sector in the relationship between corruption and export. Based on a multi-country sample of firms from emerging economies, our empirical results confirm a U-shaped relationship between firms' corruption and exports and show that in a business environment with high levels of political instability, regulatory burden or threats of competition from the informal sector, the relationship between corruption and exportation is strengthened to varying degrees.

Efficacy of Corrective Surgery for Gait and Energy Expenditure in Patients with Scoliosis: A Literature Review.

The aim of this literature review was to evaluate selected original papers that measured gait parameters and energy expenditure in idiopathic scoliosis (IS) treated with surgical intervention. IS is a progressive growth disease that affects spinal anatomy, mobility, and left–right trunk symmetry. Consequently, IS can modify human gait. Spinal fusions remain the primary approach to correcting scoliosis deformities, thereby halting progression. Using the population intervention comparison outcome measure framework and selected keywords, 15 studies that met the inclusion criteria were selected. Alteration of spatial and temporal variables in patients with IS was contradictory among the selected studies. Ankle and foot kinematics did not change after surgery; however, pelvic and hip frontal motions increased and pelvic rotation decreased following surgery. Patients with IS continued to show excessive energy expenditure following surgery in the absence of a physical rehabilitation protocol. Spinal surgery may be considered for gait improvement and IS treatment. There were inadequate data regarding the effect of corrective surgery on the kinetics, energy expenditure, and muscle activity parameters.

Quantifying the physical intensity of construction workers, a mechanical energy approach

Construction workers typically undertake highly demanding physical tasks involving various types of stresses from awkward postures, using excessive force, highly repetitive actions, and excessive energy expenditure, which increases the likelihood of unsafe actions, productivity loss, and human errors. Biomechanical models have been developed to estimate joint loadings, which can help avoid strenuous physical exertion, potentially enhancing construction workforce productivity, safety, and well-being. However, the models used are mainly in 2D, or to predict static strength ignored their velocity and acceleration or using marker-based method for dynamic motion data collection. To address this issue, this paper proposes a novel framework for investigating the mechanical energy expenditure (MEE) of workers using a 3D biomechanical model based on computer vision-based techniques. Human 3D Pose Estimation algorithm based on 2D videos is applied to approximate the coordinates of human joints for working postures, and smart insoles are used to collect foot pressures and plantar accelerations, as input data for the biomechanical analyses. The results show a detailed MEE rate for the whole body, at which joints the maximum and minimum values were obtained to avoid excessive physical exertion. The proposed method can approximate the total daily MEE of construction tasks by summing the assumed cost of individual tasks (such as walking, lifting, and stooping), providing suggestions for the design of a daily workload that workers can sustain without developing cumulative fatigue.