Implementation Of New Procedures Research Articles

The PD-ROBOSCORE: A difficulty score for robotic pancreatoduodenectomy

BackgroundDifficulty scoring systems are important for the safe, stepwise implementation of new procedures. We designed a retrospective observational study for building a difficulty score for robotic pancreatoduodenectomy. MethodsThe difficulty score (PD-ROBOSCORE) aims at predicting severe postoperative complications after robotic pancreatoduodenectomy. The PD-ROBOSCORE was developed in a training cohort of 198 robotic pancreatoduodenectomies and was validated in an international multicenter cohort of 686 robotic pancreatoduodenectomies. Finally, all centers tested the model during the early learning curve (n = 300). Growing difficulty levels (low, intermediate, high) were defined using cut-off values set at the 33rd and 66th percentile (NCT04662346). ResultsFactors included in the final multivariate model were a body mass index of ≥25 kg/m2 for males and ≥30 kg/m2 for females (odds ratio:2.39; P < .0001), borderline resectable tumor (odd ratio:1.98; P < .0001), uncinate process tumor (odds ratio:1.69; P < .0001), pancreatic duct size <4 mm (odds ratio:1.59; P < .0001), American Society of Anesthesiologists class ≥3 (odds ratio:1.59; P < .0001), and hepatic artery originating from the superior mesenteric artery (odds ratio:1.43; P < .0001). In the training cohort, the absolute score value (odds ratio = 1.13; P = .0089) and difficulty groups (odds ratio = 2.35; P = .041) predicted severe postoperative complications. In the multicenter validation cohort, the absolute score value predicted severe postoperative complications (odds ratio = 1.16, P < .001), whereas the difficulty groups did not (odds ratio = 1.94, P = .082). In the learning curve cohort, both absolute score value (odds ratio:1.078, P = .04) and difficulty groups (odds ratio: 2.25, P = .017) predicted severe postoperative complications. Across all cohorts, a PD-ROBOSCORE of ≥12.51 doubled the risk of severe postoperative complications. The PD-ROBOSCORE score also predicted operative time, estimated blood loss, and vein resection. The PD-ROBOSCORE predicted postoperative pancreatic fistula, delayed gastric emptying, postpancreatectomy hemorrhage, and postoperative mortality in the learning curve cohort. ConclusionThe PD-ROBOSCORE predicts severe postoperative complications after robotic pancreatoduodenectomy. The score is readily available via www.pancreascalculator.com

Handling of Allogeneic HPC Grafts in European Transplant Centers during the COVID-19 Pandemic - a Survey from the Infectious Diseases and Cellular Therapy & Immunobiology Working Parties of the EBMT

Background: For more than two years, the COVID-19 pandemic has had detrimental impact on medical practices. Because of its intrinsic complexity, the delivery of allogeneic hematopoietic cell transplantation (HCT) in this context represents an enormous challenge. Transplant centers have adapted promptly and developed strategies to enable safe HCT, by introducing significant changes in their procedures, e.g. through changes in donor types and an unprecedented use of cryopreservation for allogeneic hematopoietic progenitor cell (HPC) grafts. Methods: To explore how centers modified their strategies in terms of donor selection and implementation of new procedures (e.g. SARS-CoV-2 test strategy, cryopreservation), a 14-item survey was developed by the Infectious Disease (IDWP) & Cellular Therapy & Immunobiology (CTIWP) working parties of the European Society for Blood and Marrow Transplantation (EBMT). The survey was sent to 509 EBMT-affiliated allogeneic HCT in Q2, 2011 and re-opened between January 31st and March 18th, 2022 to also cover changes during to the infection period with the Omicron variant. Results: One hundred thirty-five of 509 (27%) centers from 31countries responded. Seventy-four percent of centers introduced COVID-19 mitigation measures for their donors (e.g. physical and social distancing) to minimize the risk of infection. Thirty-four percent of centers changed their donor search strategy, and favored recruitment of related haploidentical donors over unrelated donors (URD). In addition, 33% and 50% of centers searched for a backup donor in the related and URD settings, respectively. Only 10 (7.4 %) of centers resorted to cord blood (CB) as an alternative source to URD. Of these, four centers where pediatric centers and three, pediatric and adult transplant centers. Before COVID-19, only ten of 135 centers (7.4%) were routinely cryopreserving HPC products, whereas this percentage increased to 90% (122/135) during the pandemic. In details, 84/122 (69%) of centers cryopreserved both related and URD grafts, 34 (28%) only URD and 4 (3%) related grafts only. One hundred twenty centers responded during the re-opening of the survey to cover the situation during the Omicron wave. Of those, 78% were still considering graft cryopreservation, whereas 18/26 (70%) of centers not using cryopreservation during the Omicron wave used it before that period. In the majority of centers, changes in policies were introduced based on EBMT recommendations (88/117; 75%) and/or national guidelines (73/117; 62%). Bone marrow (BM) grafts were avoided by 52 (39%) centers (possibly because of the notorious low recovery percentage of cryopreserved BM progenitor cells). In the study period, a total of 4,443 related and 4,586 URD transplants have been reported. Of these transplants, 62% (n=2,748) related and 71% (n=3,254) of URD grafts have been cryopreserved pre-emptively and infused in the vast majority of cases. Sixty-four (2.3 %) related and hundred-eight (3.3 %) URD cryopreserved products have not been infused during the observation period. Release criteria for cryopreserved products in terms of COVID-19 were based on a negative SARS-CoV-2 test (not further specified) in 58/121 (48%), interview of the donor (medical history) in 4/121 (3%), and both in 38/121 (31%) of centers. Eighty-eight centers reported on their test strategy for related donors (multiple answers possible). A SARS-CoV-2 test was performed during check-up in 43% (38/88), before HPC mobilization in 63% (55/88) and before HPC collection in 41% (36/88) centers. Test strategies for URD were not covered by the survey. Conclusions: These data are limited by the low number of respondents, but show a historical increase in cryopreservation of allogeneic HPC grafts during the first three waves of the SARS-CoV-2 pandemic, more in URD than in related donor grafts. The use of BM decreased, and CB grafts were not used as an alternative at most centers. A significant proportion of cryopreserved products (2.8%) were not infused. The reason for this is under investigation. The clinical impact of allogeneic cryopreserved HPCs has to be further analyzed in a larger cohort of patients.

Comparison of hospital service performances under COVID-19 pandemics for pilot regions with low vaccination rates

It is essential to measure the quality and performance of health centers and propose policies in order for health services to continue without interruption during the pandemic period and for the continuous and proper implementation of new procedures in hospitals with COVID-19.The measurement of service quality and performance in hospitals should be provided not only for the smooth flow of health services that are vital for individuals but also for the elimination of hesitations in the treatment and vaccination processes related to COVID-19. Previously, models have been proposed by introducing some criteria to measure and evaluate hospital service performance in some extraordinary conditions, but such a study has not yet been put forward under pandemic conditions. Starting from this point, we aim to fill the gap in the literature by conducting a measurement study for hospitals in the pilot region, where COVID-19 cases are common but vaccination is observed at low rates. For this aim, the evaluation criteria are gathered under basic dimensions as in SERVPERF (Service Performance), which is a widely used tool for measuring service quality and a fuzzy multi-criteria decision analysis is proposed to measure the service performance of state hospitals for a pilot region. In the proposed methodology, the integrated methods consisting of CRITIC-TOPSIS have been extended with fermatean fuzzy sets. Expert opinions are taken via questionaries to determine hospital service performances. Based on the results obtained from the hospitals in the pilot region, the policies and strategies to be adopted by the hospitals serving under pandemic conditions worldwide to increase the service quality have been put forward. Additionally, the sensitivity of the parameters in the problem is measured, and then the validity of the obtained results is also validated. According to the results, assurance is determined as the most important main service performance factor during the pandemic period. So, the managers should develop strategies to address people's concerns about vaccines and increase people's trust in hospitals.

A colonoscopy quality improvement intervention in an endoscopy unit

Many studies identified colonoscopy quality indicators in order to improve performance and safety. We conducted a colonoscopy improvement study. Our study was designed according to a Plan-Do-Study-Act cycle: first recording of our quality indicators and identification of shortcomings, second identification of improvement targets and implementation of new procedures, third second recording of quality indicators, fourth validation of procedures and identification of new goals. Quality indicators derived from European and French guidelines were recorded before and after our improvement actions. We were mainly interested in the quality indicators of the colonic preparation, the description of the diagnosed lesions and on the examination reports. The data of 134 patients prospectively included in January–February 2017 were compared to 133 patients included in May–June 2019, after implementation of improvement procedures, in the digestive endoscopy unit of the university hospital of Dijon, France. Our intervention, and in particular the implementation of new standardized forms, improved preparation quality: Boston Bowel Preparation Scale scores increased significantly from 7.8 to 8.2. Cecal intubation rate increased by 6%, and more adenomas were diagnosed and removed (+3.3%). Adenoma detection rate increased significantly from 26 to 42%. The completion of withdrawal time measure improved from 6.7 to 100%. Our study led to the rapid implementation of corrective actions and improved quality in our unit and in our personal practice. This quality improvement strategy could be easily implemented in every digestive endoscopy unit.

How Do Academic Otolaryngologists Decide to Implement New Procedures Into Practice?

To identify barriers and facilitators to adoption of a new surgical procedure via an implementation science framework to characterize associated socioemotional, clinical, and decision-making processes. Qualitative study with a semistructured interview approach. Large tertiary care referral center. Academic otolaryngologists with at least 2 years of practice were identified and interviewed. Transcripts were thematically coded and separated into steps in the clinical pathway. Synthesis of major themes characterized facilitators and barriers to uptake of a new surgical technique. Of 22 otolaryngologists, 19 were interviewed (85% male). They had a median 18 years of practice (interquartile range, 7.8-26.3), and 65% were subspecialty trained. In the decision to implement a new procedure, improving patient outcomes and addressing unmet clinical needs facilitated adoption, whereas costs and adopting profit-driven technologies without improved outcomes were barriers. In patient consults, establishing trust facilitated implementation of new techniques; barriers included participants' hesitation to communicate about the unknowns of a new procedure. Intraoperatively, little change to existing workflow or improved efficiency facilitated adoption, while a substantial learning curve for the new procedure was a barrier. Achieving favorable outcomes and patient satisfaction sustained implementation of new procedures. Too few referrals or indications for the new procedure hindered implementation. Our study demonstrates that innovation in otolaryngology is often an individual iterative process that providers pursue to improve patients' outcomes. Although models for the oversight of surgical innovation emphasize the need for evidence, obtaining sufficient numbers of providers and patients to generate evidence remains a challenge in specialty surgical practice.

Assessment of functioning and disability in patients with low back pain – the low back pain assessment tool. Part 2: field-testing

Purpose To evaluate comprehensiveness and acceptability of the patient-reported outcome instrument (PRO-LBP) and the clinician-reported outcome instrument (ClinRO-LBP) included in the low back pain (LBP) assessment tool. Second, to assess degree of implementation after three months. Methods Feasibility-testing, training of health professionals, field-testing, and a feedback meeting was undertaken. Field-testing provided data to evaluate comprehensiveness, acceptability, and degree of implementation. Results Feasibility-testing and training of health professionals revealed that the LBP assessment tool was usable and ready for field-testing. In total, 152 patients participated in the field-testing of whom 95% considered the PRO-LBP comprehensive and 59% found it acceptable. Health professionals found the ClinRO-LBP comprehensive and acceptable. The feedback meeting revealed that the LBP assessment tool broadened the health professionals’ approach to functioning and facilitated a consultation based on the patient perspective. The degree of implementation reached 79%. Conclusions The PRO-LBP and the ClinRO-LBP covered key concepts of LBP and were found acceptable by patients and health professionals. Despite the reduced degree of implementation after three months the LBP assessment tool allowed the health professionals to apply a biopsychosocial and patient-centred approach. Future research should investigate whether the LBP assessment can enhance patient-centred care. Implications for rehabilitation The low back pain (LBP) assessment tool is the first evidence-based tangible tool to cover biopsychosocial aspects related to LBP as defined by the International Classification of Functioning, Disability and Health (ICF). The LBP assessment tool allowed health professionals to apply a biopsychosocial and patients-centred approach and has the potential to be used in rehabilitation planning. Awareness to continuous facilitation and training of health professionals is important to facilitate and maintain implementation of new procedures into routine clinical practice.

A non-linear business process management maturity framework to apprehend future challenges

In a context where enterprises and organizations aim to optimise their behaviour, obtain certifications and labels, and benefit from the smart use of information systems and technology, two considerations drive this research: (1) the weak maturity level of worldwide Business Process Management (BPM), which exposes the need to reconcile academic theories with industrial contexts, and (2) the need for upcoming software functionalities that prioritize removing the barriers frequently encountered by industrialists when trying to implement the method. To reach such goals, this research work has developed a conceptual framework to represent the BPM implementation state. It is built along three axes: the BPM Cycle (Design, Enact, Maintain), the Field (Culture, Business, IT) and the Abstraction Level (Data, Jobs, Behaviour). An organization’s overall BPM maturity can thus be evaluated by positioning its capabilities along the framework’s axes. It is also suggested that the framework be used to track the implementation of new procedures in an organisation. The framework is presented and detailed before being applied to a complete case study.

The 5th WFNS Spine Committee Biennial Conference in conjunction with The 22nd Annual Scientific Meeting of Indonesian Neurosurgical Society (INS), The 12th Asian Epilepsy Surgery Congress (AESC) and, The 2nd International Fujita Bantane Interim Meeting

Dear Friends,It is our great pleasure to invite you to The 5th WFNS Spine Committee Biennial Conference of WFNS which will be held at Bali, Indonesia between October 25th - 27th, 2018. WFNS scientific committees try to contribute to the education and progress of sub disciplines of neurosurgery. Spine surgery is getting a high interest and Spine Committee Symposia every two years are the largest activity of the committee. I am happy to invite you to Bali, Indonesia to endorse activities in this part of the world. This meeting will be in conjunction with the Annual Meeting of Indonesian Neurological Society, Asian Epilepsy Surgery Congress. On October 25, a one-day cadaver dissection course will be held in Surabaya. The meeting aims to reach a large number of audience, thus contribute to the spine education in this area more effectively. There will be “intense”, and full of excellent lectures from prominent experts, results of implementation of new procedures, case discussions, debate sessions, video demonstrations, and workshops from industry. The location of our congress is Bali island, one of the most beautiful and exotic place of the world. We really hope that it will endow us with many precious and long-lasting memories to cherish. We look forward to seeing you in Bali in October 2018.Co-chairman of the WFNS Spine Committee.

Prevalence, source and severity of work-related injuries among "foreign" construction workers in a large Malaysian organisation: a cross-sectional study.

: Malaysian construction sector is regarded as critical in the field of health because of the high rates of accidents and fatalities. This research aimed to determine the prevalence, sources and severity of injuries and its association with commitment to safety among foreign construction workers. A cross-sectional study was conducted among 323 foreign construction workers from six construction projects of a large organization in Malaysia, using a simple random sampling method. Data was collected using a structured questionnaire to assess work-related injuries and safety commitment. The collected data was analysed by SPSS 22.0 using descriptive statistics and χ2 test. The prevalence of work-related injuries in a one year period was 22.6%, where most of the injuries were of moderate severity (39.7%) and falls from heights represented the main source (31.5%). The majority of the foreign construction workers had perceived between moderate and high safety commitment, which was significantly associated with work-related injuries. The results also showed a significant association of work-related injuries with the company’s interest in Safety and Health, Safety and Health training, and safety equipment. Thus, the implementation of new procedures and providing relevant trainings and safety equipment; will lead to a decrease in injury rates in construction sites.

Development of a New Integrated Care Organizational Model for Patients with Complex Needs in The Basque Country

Development of a New Integrated Care Organizational Model for Patients with Complex Needs in The Basque Country

Standardising fast-track surgical nursing care in Denmark.

Considerable variations in procedures, hospital stay and rates of recovery have been recorded within specific surgical procedures at Danish hospitals. The aim of this paper is to report on a national initiative in Denmark to improve the quality of surgical care by implementation of clinical guidelines based on the principles of fast-track surgery-i.e. patient information, surgical stress reduction, effective analgesia, early mobilisation and rapid return to normal eating. Fast-track surgery was introduced systematically in Denmark by the establishment of the Unit of Perioperative Nursing (UPN) in 2004. The unit was responsible for guideline construction and implementation using the 'workshop practice method': establishing a website, creating a knowledge centre, coordinating implementation agents, and arranging national workshops and conferences. The UPN has promoted implementation of fast-track regimes in all surgical departments in Denmark. We recommend the workshop-practice method for implementation of new procedures in other areas of patient care.

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Background and aims: Surveillance program of invasive prosthesis is central for continuous quality assessment of pediatric intensive care unit and monitoring occurence of health care associated infections. Aims: Daily assessment of all invasive prosthesis and related complications in patients admitted in our unit. Methods: Evaluate over a 6 years period use of invasive prosthesis (ETT, central venous catheter, urinary catheter) and evaluate incidence of prosthesis-related morbidity. Results: Between 2006 and 2011, 3431 patients were admitted in our unit. Contemporary to the introduction of non invasive ventilator strategy, number of patients requiring invasive ventilation drops from 55.7% in 2006 to 40.2% in 2011. Frequency of extubation failure drops from 14.9% to 8.9%, as well as incidence of ventilator associated pneumonia from 9.8 to 9/1000 days of ventilation. Although number of patients requiring a central venous catheter was stable, incidence of catheter related blood infection drops from 5 to 1.3/1000 days whereas echo-guided internal jugular vein puncture increase from 48.5% to 74.5% in 2011. Urinary catheter related infection drops from 8 to 1.5/1000 days of bladder catheterism. Conclusions: Prospective surveillance program of invasive prosthesis allows the development of accurate indicators necessary for continuing quality assessment of pediatric intensive care unit, benchmarking, and monitoring the implementation of new procedures.

Environmental impact assessment of a WtE plant after structural upgrade measures

The study focuses on analysing the evolution of environmental impacts caused by a medium–large Italian WtE plant before and after revamping and maintenance operations, with the aim of providing an evaluation of how much these structural upgrade measures may affect the total environmental performance.LCA methodology was applied for the modelling and comparison of six WtE scenarios, each describing the main structural upgrades carried out in the plant over the years 1996–2011. The comparison was conducted by adopting 1ton of MSW as the functional unit, and the net contribution from energy recovery to power generation was distinguished by defining consistent national grid electricity mixes for every year considered. The Ecoindicator99 2.09 impact assessment method was used to evaluate the contribution to midpoint and endpoint categories (e.g. carcinogens, respiratory inorganics and organics, climate change, damage to human health). Lastly, the “Pedigree quality matrix” was applied to verify the reliability and robustness of the model created.As expected, the results showed better environmental scores after both the implementation of new procedures and the integration of operations. However, while a net reduction of air emissions seems to be achievable through dedicated flue gas treatment technologies, outcomes underscored potentials for improving the management of bottom ash through the adoption of alternative options aimed to use that solid residue mainly as filler, and to decrease risks from its current disposal in landfill. If the same effort that is put into flue gas treatment were devoted to energy recovery, the targets for the WtE plant could be easily met, achieving a higher sustainability. This aspect is even more complex: national policies for implementing greener and renewable energy sources would result in a lower impact of the national energy mix and, hence, in a lower net avoided burden from energy recovery.The study confirmed the expected improvements, indicating quantitatively the lower environmental impact resulting from structural upgrade operations in a WtE plant. Furthermore, the work highlights the importance of considering the evolution of the national energy mix in LCA studies, especially during the present years of transition from fossil fuels to renewable sources.

Homograft banking in Singapore: two years of cardiovascular tissue banking in Southeast Asia.

Established in 2008, the National Cardiovascular Homograft Bank (NCHB) has been instrumental in creating an available supply of cardiovascular tissues for implantation in Singapore. This article introduces its collaboration with Singapore General Hospital Skin Bank Unit. The procedure of homograft recovery, processing, cryopreservation and quality assurance are presented. Since its establishment, the NCHB has followed the guidelines set by the Ministry of Health Singapore and the American Association of Tissue Banks. A total of 57 homografts had been recovered and 40 homografts were determined to be suitable for clinical use. The most significant reasons for non-clinical use are positive microbiological culture or unsuitable graft condition. Crucial findings prompted reviews and implementation of new procedures to improve the safety of homograft recipients. These include (1) a change in antibiotic decontamination regime from penicillin and streptomycin to amikacin and vancomycin after a review and (2) mandating histopathogical examination since the discovery of cardiac sarcoidosis in a previously undiagnosed donor. Further, the NCHB also routinely performs dengue virus screening, for donors suspected of dengue infection. Cultural factors which affect the donation rate are also briefly explored. By 2010, 31 homografts had been implanted into recipients with congenital or acquired heart valve conditions. More than half of these recipients were children. Post-operative outcomes had been encouraging, with no report of adverse events attributed to implanted homografts.

Factors involved in clinician adoption and nonadoption of evidence‐based interventions in mental health.

With the development of empirically supported psychological treatments and the growing mandate for evidence-based practice, the dissemination and implementation of interventions with proven efficacy has assumed a growing sense of urgency. One barrier to the implementation of new procedures involves

1120 Evidence Based Practice or Rather Knowledge Based Practice - How to Get there

Background and aims: Neonatal Intensive Care Units (NICU) are highly specialized wards that require specially trained and highly qualified nurses focused on ensuring the best possible outcome for their patients. The areas of neonatology and neonatal nursing are constantly developing, therefore it is imperative that nurses keep up to date with research and development of best practice guidelines. Methods and Results: The need for knowledge based practice comes both from clinical practice and hospital administration. Clinical practice generates a need for new knowledge and clinical development. Increased clinical competency and academic development is also advantageous from the point of view of unit administration, and thus the Oslo University Hospital administration requires all wards to implement evidence based practice. These different needs are met with a well organised competency development program, and to ensure knowledge based practice in the NICU, the organisation plays a crucial part. NICU, Oslo University Hospital provides three professional and clinical development study days per 18 week roster including teaching, medical simulation, staff certification of medical technical equipment and implementation of new procedures. To ensure professional develpment, the NICU provide Professional Development Nurses, Clinical Tutors and a Medical Technical Nurse. These key elements facilitates integration of knowledge based practice into the daily lives and routines of NICU nurses. Conclusions: Today's clinical practice requires optimal quality of care and effective use of resources. Knowledge based practice focuses on patient safety and building knowledge in the individual nurse and in the nursing staff.

Corps des foetus mort-nés

A february-2008 rule about << children born lifeless >> stressed that << every fetus born lifeless >> could be registered at the General Register Office. This rule, which was followed in 2009 by the implementation of new procedures to deal with dead fetuses, highlighted that this topic is more and more becoming an important public issue. The rights for parents to choose has now been recognized, bringing about new questions for health professionals. Another point is which symbolism is to be given to dead fetuses to alleviate couples' suffering, without being too ideological, i.e. seeing fetuses as persons. This change also makes professionals reconsider public health system priorities, and this at a very particular time. Indeed, as parent mourning has now been made easier through registration at the General Register Office, there has not been any rule yet linking national epidemiological registration and fetal death in France. double dagger.

Successful implementation of evidence‐based routines in Ukrainian maternities

To describe the process of change and assess compliance and effect on maternal and infant outcome when the WHO package Effective Perinatal Care (EPC) was implemented at maternities in Ukraine. Intervention study comparing outcomes before and during 2.5 years after training. Three maternities in Donetsk, Lutsk and Lviv 2003-2006. Baseline data were collected for 652, 742 and 302 deliveries and 420, 381 and 135 infants, respectively, in Donetsk, Lutsk and Lviv. Follow-up data included 4,561, 9,865 and 7,227 deliveries and 3,829, 8,658 and 6,401 infants. Staff training on evidence-based guideline. Interventions during labor, maternal outcomes and hypothermia in the infants. EPC procedures were successfully implemented and adherence to the protocols was excellent. For most variables, the change occurred during the first three months but was well sustained. The use of partogram increased fourfold in Donetsk and from 0% to 60% in Lviv. Induction and augmentation of labor decreased to less than 1% and less than 5%, respectively. Cesarean section rate dropped significantly in two of the maternities. The proportion of hypothermic infants decreased from 60% (Donetsk), 85% (Lutsk) and 77% (Lviv) to 1% in all three maternities during the first three months and was stable throughout the study period. Admission to Neonatal Intensive Care Unit decreased significantly in two of the maternities and there was no effect on early neonatal mortality. The process of education and change was well anchored in the organization, and implementation of new procedures was quick and successful.

Operational change as a profitable cleaner production tool for a brewery

The development and implementation of new procedures and operational changes in the production processes constitutes a powerful tool for the practical application of Cleaner Production in industries. In this work an operational change (new procedure) was developed for the elaboration of a type of beer which uses sugar as malt adjunct. The change consists in processing separately the three main components of the beer wort: malt extract, sugar and water, and use them properly in a different sequence than that used up to date in the traditional process. The new procedure was successfully assayed on industrial scale in Tínima brewery, located in Camagüey, Cuba, obtaining a good quality beer, technological and economical advantages with benefits for the environment, registering significant savings in energy (49%), sugar (4%), water (7%) and caustic soda (3%) consumption; and diminishing the surplus hot water (74%), waste generation (11%) and greenhouse gases emission (21%). Beer production capacity is increased also almost three times. With the application of the new technology to the Cuban beer type of 8 °P, it was achieved a total saving of US$ 481.83/1000 hL of beer produced.

Seasonal Adjustment of Monetary Aggregates: Implementation of New Procedures

The analysis of seasonality in economics and the development of new seasonal adjustment procedures have been following new directions in the last twenty years. We study this question through the work performed at the Banque de France (Monetary Statistic and Studies Directorate) to compile new seasonally adjusted (SA) data. A brief discussion of the academic literature show the necessity to complement the existing software with empirical rules fixed by the practitioner in order to make all the methodological choices clear, thus avoiding any ambiguity. In the implementation of the new production process, we focus on the revision policy of some keys parameters of the whole process in order to minimize the subsequent revisions in the publication of SA data. We illustrate this new methodology with SA series relating to monetary aggregates, including loans to enterprises and to households, and provide a detailed analysis of the consistency between flows and outstanding amount SA figures, an issue particularly relevant for monetary an financial data.